Minor Skin Procedures Note

[comment memo="physical exam" memo_size="small" memo_color="blue"][checkbox name="examskinabn2" value="SKIN EXAM-
"][conditional field="examskinabn2" condition="(examskinabn2).is('SKIN EXAM-
')"][checkbox memo="*" memo_size="small" name="Lesion1" value=" -#1
"][/conditional][conditional field="Lesion1" condition="(Lesion1).is(' -#1
')"] -Location: [select name="skinexamlocation1" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|Breast(s)|Abdomen|Buttocks|Inguinal|Male Genital Region|Female Genital Region|Arm|Elbow|Forearm|Wrist|Hand|Finger|Hip|Thigh|Knee|Leg|Ankle|Foot|Toe"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Shoulder')||(skinexamlocation1).is('Elbow')||(skinexamlocation1).is('Wrist')||(skinexamlocation1).is('Hip')||(skinexamlocation1).is('Knee')||(skinexamlocation1).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Arm')||(skinexamlocation1).is('Forearm')||(skinexamlocation1).is('Thigh')||(skinexamlocation1).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Breast(s)')"]- [select value="right|left"], [checkbox value="inferior intertriginous area|medial intertriginous area|periareolar area"], clock position [text size="5"][checkbox value="n/a"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Female Genital Region')"]- [select value="right|left|midline"] [select value="labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Hand')||(skinexamlocation1).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Foot')||(skinexamlocation1).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation1" condition="(skinexamlocation1).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="Lesion1" condition="(Lesion1).is(' -#1
')"]
-Description: [checkbox name="skinexamlesion1" value="macule|papule|patch|plaque|palpable lump|visible wound|visible lump (concerning for infection)"]
-Size/diameter: [text size="5"] [select value="cm|mm"]
[/conditional][conditional field="skinexamlesion1" condition="(skinexamlesion1).is('macule')||(skinexamlesion1).is('papule')||(skinexamlesion1).is('patch')||(skinexamlesion1).is('plaque')"] -Characteristics: [checkbox value="rough|smooth|firm|soft|mobile|fixed|pedunculated"]
-Color: [select value="uniform color|non-uniform color"], [select value="erthythematous|flesh-color|brown|black|blue|multicolored"] [text size="20"]
-Borders: [select value="well-circumscribed|ill-defined"]
[/conditional][conditional field="skinexamlesion1" condition="(skinexamlesion1).is('visible lump (concerning for infection)')"] -Characteristics - [checkbox name="abscessPEchar" value="erythema|edema|induration|fluctuance|tenderness to palpation|drainage"][/conditional][conditional field="abscessPEchar" condition="(abscessPEchar).is('drainage')"] - [checkbox value="purulent|serous|sanguinous/bloody"][/conditional][conditional field="skinexamlesion1" condition="(skinexamlesion1).is('visible lump (concerning for infection)')"]
[/conditional][conditional field="skinexamlesion1" condition="(skinexamlesion1).is('visible wound')"] -Tissue layers damaged/affected - [checkbox value="epidermis|dermis|subcutaneous layer|muscle/tendon|periosteum/bone"]
-Hemostatic - [select value="|Yes|NO"]
-Wound approximation - [select value="|good|marginal|POOR"]
-Debris/foreign body present - [text default="no" size="20"]
[/conditional][conditional field="Lesion1" condition="(Lesion1).is(' -#1
')"] -Other details: [text default="none" size="80"]
[/conditional][conditional field="examskinabn2" condition="(examskinabn2).is('SKIN EXAM-
')"][checkbox memo="*" memo_size="small" name="Lesion2" value=" -#2
"][/conditional][conditional field="Lesion2" condition="(Lesion2).is(' -#2
')"] -Location: [select name="skinexamlocation2" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|Breast(s)|Abdomen|Buttocks|Inguinal|Male Genital Region|Female Genital Region|Arm|Elbow|Forearm|Wrist|Hand|Finger|Hip|Thigh|Knee|Leg|Ankle|Foot|Toe"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Shoulder')||(skinexamlocation2).is('Elbow')||(skinexamlocation2).is('Wrist')||(skinexamlocation2).is('Hip')||(skinexamlocation2).is('Knee')||(skinexamlocation2).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Arm')||(skinexamlocation2).is('Forearm')||(skinexamlocation2).is('Thigh')||(skinexamlocation2).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Breast(s)')"]- [select value="right|left"], [checkbox value="inferior intertriginous area|medial intertriginous area|periareolar area"], clock position [text size="5"][checkbox value="n/a"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Female Genital Region')"]- [select value="right|left|midline"] [select value="labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Hand')||(skinexamlocation2).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Foot')||(skinexamlocation2).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation2" condition="(skinexamlocation2).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="Lesion2" condition="(Lesion2).is(' -#2
')"]
-Description: [checkbox name="skinexamlesion2" value="macule|papule|patch|plaque|palpable lump|visible wound|visible lump (concerning for infection)"]
-Size/diameter: [text size="5"] [select value="cm|mm"]
[/conditional][conditional field="skinexamlesion2" condition="(skinexamlesion2).is('macule')||(skinexamlesion2).is('papule')||(skinexamlesion2).is('patch')||(skinexamlesion2).is('plaque')"] -Characteristics: [checkbox value="rough|smooth|firm|soft|mobile|fixed|pedunculated"]
-Color: [select value="uniform color|non-uniform color"], [select value="erthythematous|flesh-color|brown|black|blue|multicolored"] [text size="20"]
-Borders: [select value="well-circumscribed|ill-defined"]
[/conditional][conditional field="skinexamlesion2" condition="(skinexamlesion2).is('visible lump (concerning for infection)')"] -Characteristics - [checkbox name="abscessPEchar2" value="erythema|edema|induration|fluctuance|tenderness to palpation|drainage"][/conditional][conditional field="abscessPEchar2" condition="(abscessPEchar2).is('drainage')"] - [checkbox value="purulent|serous|sanguinous/bloody"][/conditional][conditional field="skinexamlesion2" condition="(skinexamlesion2).is('visible lump (concerning for infection)')"]
[/conditional][conditional field="skinexamlesion2" condition="(skinexamlesion2).is('visible wound')"] -Tissue layers damaged/affected - [checkbox value="epidermis|dermis|subcutaneous layer|muscle/tendon|periosteum/bone"]
-Hemostatic - [select value="|Yes|NO"]
-Wound approximation - [select value="|good|marginal|POOR"]
-Debris/foreign body present - [text default="no" size="20"]
[/conditional][conditional field="Lesion2" condition="(Lesion2).is(' -#2
')"] -Other details: [text default="none" size="80"]
[/conditional][conditional field="examskinabn2" condition="(examskinabn2).is('SKIN EXAM-
')"][checkbox memo="*" memo_size="small" name="Lesion3" value=" -#3
"][/conditional][conditional field="Lesion3" condition="(Lesion3).is(' -#3
')"] -Location: [select name="skinexamlocation3" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|Breast(s)|Abdomen|Buttocks|Inguinal|Male Genital Region|Female Genital Region|Arm|Elbow|Forearm|Wrist|Hand|Finger|Hip|Thigh|Knee|Leg|Ankle|Foot|Toe"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Shoulder')||(skinexamlocation3).is('Elbow')||(skinexamlocation3).is('Wrist')||(skinexamlocation3).is('Hip')||(skinexamlocation3).is('Knee')||(skinexamlocation3).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Arm')||(skinexamlocation3).is('Forearm')||(skinexamlocation3).is('Thigh')||(skinexamlocation3).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Breast(s)')"]- [select value="right|left"], [checkbox value="inferior intertriginous area|medial intertriginous area|periareolar area"], clock position [text size="5"][checkbox value="n/a"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Female Genital Region')"]- [select value="right|left|midline"] [select value="labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Hand')||(skinexamlocation3).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Foot')||(skinexamlocation3).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation3" condition="(skinexamlocation3).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="Lesion3" condition="(Lesion3).is(' -#3
')"]
-Description: [checkbox name="skinexamlesion3" value="macule|papule|patch|plaque|palpable lump|visible wound|visible lump (concerning for infection)"]
-Size/diameter: [text size="5"] [select value="cm|mm"]
[/conditional][conditional field="skinexamlesion3" condition="(skinexamlesion3).is('macule')||(skinexamlesion3).is('papule')||(skinexamlesion3).is('patch')||(skinexamlesion3).is('plaque')"] -Characteristics: [checkbox value="rough|smooth|firm|soft|mobile|fixed|pedunculated"]
-Color: [select value="uniform color|non-uniform color"], [select value="erthythematous|flesh-color|brown|black|blue|multicolored"] [text size="20"]
-Borders: [select value="well-circumscribed|ill-defined"]
[/conditional][conditional field="skinexamlesion3" condition="(skinexamlesion3).is('visible lump (concerning for infection)')"] -Characteristics - [checkbox name="abscessPEchar3" value="erythema|edema|induration|fluctuance|tenderness to palpation|drainage"][/conditional][conditional field="abscessPEchar3" condition="(abscessPEchar3).is('drainage')"] - [checkbox value="purulent|serous|sanguinous/bloody"][/conditional][conditional field="skinexamlesion3" condition="(skinexamlesion3).is('visible lump (concerning for infection)')"]
[/conditional][conditional field="skinexamlesion3" condition="(skinexamlesion3).is('visible wound')"] -Tissue layers damaged/affected - [checkbox value="epidermis|dermis|subcutaneous layer|muscle/tendon|periosteum/bone"]
-Hemostatic - [select value="|Yes|NO"]
-Wound approximation - [select value="|good|marginal|POOR"]
-Debris/foreign body present - [text default="no" size="20"]
[/conditional][conditional field="Lesion3" condition="(Lesion3).is(' -#3
')"] -Other details: [text default="none" size="80"]
[/conditional][comment memo="procedure note" memo_size="small" memo_color="blue"][checkbox name="SkinProcSup" value="Supervising Physician:"][conditional field="SkinProcSup" condition="(SkinProcSup).is('Supervising Physician:')"] Dr. [text size="20"]

[/conditional][checkbox name="minorproctypeExcision" value="EXCISION OF BENIGN LESION PROCEDURE NOTE"][conditional field="minorproctypeExcision" condition="(minorproctypeExcision).is('EXCISION OF BENIGN LESION PROCEDURE NOTE')"][comment memo="includes full thickness removal of skin lesions, EICs, Lipomas" memo_size="small" memo_color="blue"]

PRE-OP DIAGNOSIS: [select value="Localized Lump/Mass- R22.9|Nevus, non-neoplastic- I78.1|"][text size="50"]
FINDINGS: [select value="|none|lipoma|epidermal inclusion cyst"] [text memo="opt text" memo_size="small" size="50"]
POST-OP DIAGNOSIS: [select value="Localized Lump/Mass- R22.9|Nevus, non-neoplastic- I78.1|Lipoma- D17.9|Epidermal Inclusion Cyst- L72.0|"][text size="50"]
PROCEDURE: EXCISION OF BENIGN LESION [comment memo="location" memo_size="small"][select name="excleslocation" value="trunk/arm/leg=0|scalp/neck/hands/feet/genitalia=20|face/ear/eyelid/nose/lips/mucous membrane=40"] [comment memo="size" memo_size="small"][select name="exclesionsize" value="0.5cm or less=0|0.6-1cm=1|1.1-2cm=2|2.1-3cm=3|3.1-4cm=4|greater than 4cm=6"][checkbox memo="select for intermediate closure" memo_size="small" name="intermclos" value=""][/conditional][conditional field="intermclos" condition="(intermclos).is('')"]; INTERMEDIATE CLOSURE/REPAIR OF INCISION [comment memo="location" memo_size="small"][select name="intermcloslocation" value="scalp/axilla/trunk/extremities=30|neck/hands/feet/external genitalia=40|face/ears/eyelids/nose/lips/mucous membranes"] [comment memo="incision length" memo_size="small"][select name="intermcloslength" value="2.5cm or less=1|2.6-7.5cm=2|7.6-12.5cm=4"][/conditional][conditional field="minorproctypeExcision" condition="(minorproctypeExcision).is('EXCISION OF BENIGN LESION PROCEDURE NOTE')"]
-CPT Code: [calc value="score=11400+(excleslocation)+(exclesionsize)" memo="calc'd value"][/conditional][conditional field="intermclos" condition="(intermclos).is('')"]; [calc value="score=12000+(intermcloslocation)+(intermcloslength)" memo="calc'd value"][/conditional][conditional field="minorproctypeExcision" condition="(minorproctypeExcision).is('EXCISION OF BENIGN LESION PROCEDURE NOTE')"]
ANESTHESIA AGENT(S): [checkbox value="Lidocaine 1% with epinephrine|Lidocaine 1% without epinephrine|Lidocaine 2% with epinephrine|Lidocaine 2% without epinephrine|Marcaine 0.5%|Bicarbonate buffering solution"]
-Total amt used: [text size="5"] ml

[comment memo="type of consent (choose one)" memo_color="blue"][checkbox memo="verbal" memo_size="small" name="skinexcisconsenttypeverbal" value=""][checkbox memo="written" memo_size="small" name="skinexcisconsenttypewritten" value=""]INDICATIONS/COUNSELING:
-Discussed reason and medical indication(s) for procedure which include(s): [checkbox value="frequent pain/discomfort with wear of usual clothing/attire/work-gear|frequent traumatization to lesion(s)"]
[checkbox value="-Discussed and patient demonstrated understanding of: 
 -limitations and risks of procedure
 -risk/likelihood of pain during/after procedure
 -risk/likelihood of bleeding during/after procedure
 -risk/likelihood of infection during/after procedure
 -complications from anesthesia/analgesia during/after procedure
 -possibility of incomplete removal of lesion
 -possibility of repeat procedure needed"]
-Discussed alternatives to procedure which include: allowing trial period to see of lesion self-resolves or becomes less painful.
-Patient acknowledged understanding of the above items and desired to proceed.
[/conditional][conditional field="skinexcisconsenttypeverbal" condition="(skinexcisconsenttypeverbal).is('')"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="austere medical conditions|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="skinexcisconsenttypewritten" condition="(skinexcisconsenttypewritten).is('')"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][conditional field="minorproctypeExcision" condition="(minorproctypeExcision).is('EXCISION OF BENIGN LESION PROCEDURE NOTE')"][comment memo="only select what's applicable" memo_size="small"]
[checkbox value=" -Patient was identified using full name and DOB.
 -Patient was evaluated and medical record reviewed including history and lab/imaging findings if applicable.
 -Procedure and site/side matches the consent form.
 -Patient was involved in the site/side marking.
"][checkbox name="timeoutskinexc" value=" -For final timeout, physician paused or verbally confirmed with procedure team of:
  -correct patient, correct procedure, and correct site/side. 
  -The patient has been positioned correctly for the procedure. 
  -All necessary equipment are available.
"][checkbox value=" -Instrument sterility verified.
"]
PROCEDURE:
-The area surrounding the [select value="|skin|subcutaneous"] lesion was prepared and draped in usual fashion using [select value="|Betadine/Iodine|Chlorhexidine"] per manufacturer and infection control recommendations.
-The skin overlying the indentified lesion infiltrated with above anesthetic agent.
[checkbox value="-Incisional area overlying skin was planned and marked with skin marker
"]-A [text size="5"] cm [/conditional][conditional field="skinexctooltype|minorproctypeExcision" condition="((skinexctooltype).is('#15 blade scalpel')||(skinexctooltype).is('#11 blade scalpel'))&&(minorproctypeExcision).is('EXCISION OF BENIGN LESION PROCEDURE NOTE')"][select value="linear|elliptical"][/conditional][conditional field="minorproctypeExcision" condition="(minorproctypeExcision).is('EXCISION OF BENIGN LESION PROCEDURE NOTE')"] excision was made over the identified lesion using [select name="skinexctooltype" value="#15 blade scalpel|#11 blade scalpel|2mm punch tool|3mm punch tool|4mm punch tool|5mm punch tool"].
-Dissection of surrounding/overlying tissue was performed to isolate, expose, and remove lesion utilizing: [checkbox value="tissue scissors in blunt fashion|#15 blade scalpel under careful direct visualization|#11 blade scalpel under careful direct visualization|sharp curved surgical dissecting clamp"].
[checkbox value="-Excised lesion was collected and sent to pathology for analysis.
"][/conditional][conditional field="intermclos" condition="(intermclos).is('')"]-Intermediate closure was required to best reapproximate and prepare the wound for final closure. This was performed subcutaneously [select value="in running fashion|with single horizontal suture"] using [select value="3-0|4-0"] [select value="Vicryl|Monocryl|PDS"] suture material. 
[/conditional][conditional field="minorproctypeExcision" condition="(minorproctypeExcision).is('EXCISION OF BENIGN LESION PROCEDURE NOTE')"]-Final closure was performed with [text size="3"] simple interrupted sutures using [select value="3-0|4-0|5-0|6-0"] [select value="Ethilon/nylon|Prolene/polypropylene|silk"] suture material.
[select value="-EBL was less than 1ml and good hemostasis noted.|-Minor electrocautery required to achieve good hemostasis.|"] [text memo="optional text for EBL" memo_size="small" size="50"]
-Antibiotic ointment and a bandage were applied.

PATIENT DISPOSITION
-Patient tolerated overall procedure well.
-No immediate complications noted.
-Discussed with patient return precautions to include: fever, erythema, swelling, pain, or purulent discharge from the wound. 
-Post-procedure care of surgical wound discussed.
-Patient instructed to return for suture removal in [text size="5"] days.
-Patient left in stable condition. [textarea memo="optional additional text" memo_size="small"][/conditional][checkbox name="minorproctypeShave" value="SHAVE REMOVAL OF BENIGN SKIN LESION PROCEDURE NOTE"][conditional field="minorproctypeShave" condition="(minorproctypeShave).is('SHAVE REMOVAL OF BENIGN SKIN LESION PROCEDURE NOTE')"]

PRE-OP DIAGNOSIS: [select value="|Localized Lump/Mass- R22.9|Nevus, non-neoplastic- I78.1|Seborrheic keratosis- L82.1|Cutaneous horn- L85.8"][text size="50"]
FINDINGS: [select value="none|"][text memo="opt text" memo_size="small" size="50"]
POST-OP DIAGNOSIS: [select value="|Localized Lump/Mass- R22.9|Nevus, non-neoplastic- I78.1|Seborrheic keratosis- L82.1|Cutaneous horn- L85.8"][text size="50"]
PROCEDURE: SHAVE REMOVAL OF BENIGN SKIN LESION [comment memo="location" memo_size="small"][select name="shaveremovleslocation" value="trunk/arm/leg=0|scalp/neck/hands/feet/genitalia=5|face/ear/eyelid/nose/lips/mucous membrane=10"] [comment memo="size" memo_size="small"][select name="shaveremovlesionsize" value="0.5cm or less=0|0.6-1cm=1|1.1-2cm=2|over 2cm=3"]
-CPT Code: [calc value="score=11300+(shaveremovleslocation)+(shaveremovlesionsize)" memo="calc'd value"]
ANESTHESIA AGENT(S): [checkbox value="Lidocaine 1% with epinephrine|Lidocaine 1% without epinephrine|Lidocaine 2% with epinephrine|Lidocaine 2% without epinephrine|Marcaine 0.5%|Bicarbonate buffering solution"]
-Total amt used: [text size="5"] ml

[comment memo="type of consent (choose one)" memo_color="blue"][checkbox memo="verbal" memo_size="small" name="skinshaveconsenttypeverbal" value=""][checkbox memo="written" memo_size="small" name="skinshaveconsenttypewritten" value=""]INDICATIONS/COUNSELING:
-Discussed reason and medical indication(s) for procedure which include(s): [checkbox value="frequent pain/discomfort with wear of usual clothing/attire/work-gear|frequent traumatization to lesion(s)"]
[checkbox value="-Discussed and patient demonstrated understanding of:
 -limitations and risks of procedure
 -risk/likelihood of pain during/after procedure
 -risk/likelihood of bleeding during/after procedure
 -risk/likelihood of infection during/after procedure
 -complications from anesthesia/analgesia during/after procedure
 -possibility of incomplete removal of lesion
 -possibility of repeat procedure needed"]
-Discussed alternatives to procedure which include: allowing trial period to see of lesion self-resolves or becomes less painful.
-Patient acknowledged understanding of the above items and desired to proceed.
[/conditional][conditional field="skinshaveconsenttypeverbal" condition="(skinshaveconsenttypeverbal).is('')"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="austere medical conditions|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="skinshaveconsenttypewritten" condition="(skinshaveconsenttypewritten).is('')"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][conditional field="minorproctypeShave" condition="(minorproctypeShave).is('SHAVE REMOVAL OF BENIGN SKIN LESION PROCEDURE NOTE')"][comment memo="only select what's applicable" memo_size="small"]
[checkbox value=" -Patient was identified using full name and DOB.
 -Patient was evaluated and medical record reviewed including history and lab/imaging findings if applicable.
 -Procedure and site/side matches the consent form.
 -Patient was involved in the site/side marking.
"][checkbox name="timeoutskinshave" value=" -For final timeout, physician paused or verbally confirmed with procedure team of:
  -correct patient, correct procedure, and correct site/side. 
  -The patient has been positioned correctly for the procedure. 
  -All necessary equipment are available.
"][checkbox value=" -Instrument sterility verified.
"]
PROCEDURE:
-The area surrounding the skin lesion was prepared and draped in usual fashion using [select value="|Betadine/Iodine|Chlorhexidine"] per manufacturer and infection control recommendations.
[checkbox value="-Incisional area overlying skin was planned and marked with skin marker
"]-The skin overlying the indentified lesion infiltrated with above anesthetic agent.
-A [text size="5"] cm length [select value="tangential slice|saucerization"] was made through the indentified lesion using a flexible tissue razor.
[checkbox value="-Excised lesion was collected and sent to pathology for analysis.
"]-For hemostasis after shave removal of lesion, applied [checkbox value="direct pressure|Drysol/Aluminum Chloride solution|silver nitrate|monsel's solution|minor electrocautery"].
[select value="-EBL was less than 1ml and good hemostasis noted.|"] [text memo="opt text for other EBL" memo_size="small" size="50"]
-Antibiotic ointment and a bandage were applied.

PATIENT DISPOSITION
-Patient tolerated overall procedure well.
-No immediate complications noted.
-Discussed with patient return precautions to include: fever, erythema, swelling, pain, or purulent discharge from the wound. 
-Post-procedure care of surgical wound discussed.
-Patient left in stable condition. [textarea memo="optional additional text" memo_size="small']

[/conditional][checkbox name="minorproctypeCryo" value="CRYOTHERAPY PROCEDURE NOTE"][conditional field="minorproctypeCryo" condition="(minorproctypeCryo).is('CRYOTHERAPY PROCEDURE NOTE')"] - [select memo="method" name="cryomethod" value="|COTTON-TIP APPLICATOR|LIQUID NITROGEN SPRAY|CRYOPROBE/PEN"]

PRE-OP DIAGNOSIS: [select name="cryodx" value="|Viral Wart- B07.9|Actinic Keratosis- L57.0|Molloscum Contagiosum- B08.1|Cutaneous horn- L85.8|Seborrheic keratosis- L82.1|Cherry angioma- D18.01|Pyogenic granuloma- L98.0|Dermatofibroma- D23.9|Hypertrophic scar- L91.0"][text size="50"]
FINDINGS: [text default="none" size="50"]
POST-OP DIAGNOSIS: [select value="|Viral Wart- B07.9|Actinic Keratosis- L57.0|Molloscum Contagiosum- B08.1|Cutaneous horn- L85.8|Seborrheic keratosis- L82.1|Cherry angioma- D18.01|Pyogenic granuloma- L98.0|Dermatofibroma- D23.9|Hypertrophic scar- L91.0"][text size="50"]
PROCEDURE: [/conditional][conditional field="cryodx" condition="(cryodx).is('Actinic Keratosis- L57.0')"]CRYOTHERAPY DESTRUCTION OF PREMALIGNANT LESION(S) x [text name="cryopremaliglesioncount" size="3"]
-CPT Code: [calc value="score1=(cryopremaliglesioncount);score1>14?'17004':score1>13?'17000 ; 17003 x 13 units of service':score1>12?'17000 ; 17003 x 12 units of service':score1>11?'17000 ; 17003 x 11 units of service':score1>10?'17000 ; 17003 x 10 units of service':score1>9?'17000 ; 17003 x 9 units of service':score1>8?'17000 ; 17003 x 8 units of service':score1>7?'17000 ; 17003 x 7 units of service':score1>6?'17000 ; 17003 x 6 units of service':score1>5?'17000 ; 17003 x 5 units of service':score1>4?'17000 ; 17003 x 4 units of service':score1>3?'17000 ; 17003 x 3 units of service':score1>2?'17000 ; 17003 x 2 units of service':score1>1?'17000 ; 17003': score1>0?'17000':''" memo="calc’d code"][/conditional][conditional field="cryodx" condition="(cryodx).isNot('Actinic Keratosis- L57.0')&&(cryodx).isNot('')"]CRYOTHERAPY DESTRUCTION OF LESION x [text name="cryolesioncount" size="3"]
-CPT Code: [calc value="score2=(cryolesioncount);score2>14?'17111':score2>0?'17110':''" memo="calc’d code"][/conditional][conditional field="minorproctypeCryo" condition="(minorproctypeCryo).is('CRYOTHERAPY PROCEDURE NOTE')"]
ANESTHESIA AGENT(S): [checkbox name="cryoanes" value="None|Lidocaine 1% with epinephrine|Lidocaine 1% without epinephrine|Lidocaine 2% with epinephrine|Lidocaine 2% without epinephrine|Marcaine 0.5%|Bicarbonate buffering solution"][/conditional][conditional field="cryoanes" condition="(cryoanes).is('Lidocaine 1% with epinephrine')||(cryoanes).is('Lidocaine 1% without epinephrine')||(cryoanes).is('Lidocaine 2% with epinephrine')||(cryoanes).is('Lidocaine 2% without epinephrine')"]
-Total amt used: [text size="5"] ml[/conditional][conditional field="minorproctypeCryo" condition="(minorproctypeCryo).is('CRYOTHERAPY PROCEDURE NOTE')"]

[comment memo="type of consent (choose one)" memo_color="blue"][checkbox memo="verbal" memo_size="small" name="skincryoconsenttypeverbal" value=""][checkbox memo="written" memo_size="small" name="skincryoconsenttypewritten" value=""]INDICATIONS/COUNSELING:
-Discussed reason and medical indication(s) for procedure which include(s): [checkbox value="frequent pain/discomfort with wear of usual clothing/attire/work-gear|frequent traumatization to lesion(s)|destruction of premalignant lesion(s)"]
[checkbox value="-Discussed and patient demonstrated understanding of:
 -limitations and risks of procedure
 -risk/likelihood of pain during/after procedure
 -risk/likelihood of bleeding during/after procedure
 -risk/likelihood of infection during/after procedure
 -complications from anesthesia/analgesia during/after procedure
 -post-procedural pain and possible blistering that can occur
 -possibility of incomplete resolution of lesion
 -possibility of repeat procedure needed"]
-Discussed alternatives to procedure which include: [checkbox value="allowing trial period to see of lesion self-resolves or becomes less painful|topical salicylic acid and other wart treatment"].
-Patient acknowledged understanding of the above items and desired to proceed.
[/conditional][conditional field="skincryoconsenttypeverbal" condition="(skincryoconsenttypeverbal).is('')"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="austere medical conditions|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="skincryoconsenttypewritten" condition="(skincryoconsenttypewritten).is('')"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][conditional field="minorproctypeCryo" condition="(minorproctypeCryo).is('CRYOTHERAPY PROCEDURE NOTE')"][comment memo="only select what's applicable" memo_size="small"]
[checkbox value=" -Patient was identified using full name and DOB.
 -Patient was evaluated and medical record reviewed including history and lab/imaging findings if applicable.
 -Procedure and site/side matches the consent form.
 -Patient was involved in the site/side marking.
"][checkbox name="timeoutskincryo" value=" -For final timeout, physician paused or verbally confirmed with procedure team of:
  -correct patient, correct procedure, and correct site/side. 
  -The patient has been positioned correctly for the procedure. 
  -All necessary equipment are available.
"][checkbox value=" -Instrument sterility verified.
"]
PROCEDURE:
-The Lesion was treated with light cryotherapy using cryocautery.
[/conditional][conditional field="cryomethod" condition="(cryomethod).is('LIQUID NITROGEN SPRAY')"]-The nozzle of the spray gun was positioned 1.0 to 1.5 cm above the skin surface and aimed at the center of the target lesion.  
-Liquid Nitrogen[/conditional][conditional field="cryomethod" condition="(cryomethod).is('COTTON-TIP APPLICATOR')"]-Frozen Cotton-tip applicator[/conditional][conditional field="cryomethod" condition="(cryomethod).is('CRYOPROBE/PEN')"]-[select value="Cryoprobe|Cryopen"][/conditional][conditional field="minorproctypeCryo" condition="(minorproctypeCryo).is('CRYOTHERAPY PROCEDURE NOTE')"] was applied until an ice field encompassed the lesion and the desired margin of [text size="5"] mm. 
-[text size="5"] cycle(s) of freeze-thaw-freeze technique was performed with complete thawing of 2-3 minutes in-between. 

PATIENT DISPOSITION:
-Patient tolerated overall procedure well.
-No immediate complications noted.
-Discussed with patient return precautions to include: fever, erythema, swelling, pain, or purulent discharge from the wound. 
-Post-procedure care of treated lesion(s) discussed.
-Discussed prognosis of lesion(s) current state: [select value="today's treatment likely curative an no followup required|lesion(s) will likely need repeat treatment and followup scheduled"].
-Patient left in stable condition. [textarea memo="optional additional text" memo_size="small"][/conditional][checkbox name="minorproctypeSkinBx" value="SKIN BIOPSY PROCEDURE NOTE"][conditional field="minorproctypeSkinBx" condition="(minorproctypeSkinBx).is('SKIN BIOPSY PROCEDURE NOTE')"][comment memo="for punch/shave/excisional techniques, use ONLY if primary purpose is obtaining sample for biopsy, use different applicable skin procedure type if complete removal is the goal" memo_size="small" memo_color="blue"]

PRE-OP DIAGNOSIS: [select value="Localized Lump/Mass- R22.9|Atypical Nevus- D48.5|"][text size="50"]
FINDINGS: [select value="none|"][text size="50"]
POST-OP DIAGNOSIS: [select value="Localized Lump/Mass- R22.9|Atypical Nevus- D48.5|"][text size="50"]
PROCEDURE: SKIN BIOPSY - [select memo="choose bx method" memo_size="small" name="biopsytype" value="|PUNCH|SHAVE|EXCISIONAL"] x [text name="biopsylesioncount" size="3"] lesions
-CPT Code: 11100[/conditional][conditional field="biopsylesioncount" condition="(biopsylesioncount).isGreater('1')"] ; 11101 x [calc  value="score=(biopsylesioncount)-1" memo="calc'd value"] units of service[/conditional][conditional field="minorproctypeSkinBx" condition="(minorproctypeSkinBx).is('SKIN BIOPSY PROCEDURE NOTE')"]
ANESTHESIA AGENT(S): [checkbox value="Lidocaine 1% with epinephrine|Lidocaine 1% without epinephrine|Lidocaine 2% with epinephrine|Lidocaine 2% without epinephrine|Marcaine 0.5%|Bicarbonate buffering solution"]
-Total amt used: [text size="5"] ml

[comment memo="type of consent (choose one)" memo_color="blue"][checkbox memo="verbal" memo_size="small" name="skinbxconsenttypeverbal" value=""][checkbox memo="written" memo_size="small" name="skinbxconsenttypewritten" value=""]INDICATIONS/COUNSELING:
-Discussed reason and medical indication(s) for procedure which include(s): [checkbox value="determine malignant potential|better diagnose skin condition/disease"]
[checkbox value="-Discussed and patient demonstrated understanding of: 
 -limitations and risks of procedure
 -risk/likelihood of pain during/after procedure
 -risk/likelihood of bleeding during/after procedure
 -risk/likelihood of infection during/after procedure
 -complications from anesthesia/analgesia during/after procedure
 -possibility of incomplete removal of lesion
 -possibility of repeat procedure needed"]
-Discussed alternatives to procedure which include: [checkbox value="serial monitoring|empiric treatment"]. [text size="50"]
-Patient acknowledged understanding of the above items and desired to proceed.
[/conditional][conditional field="skinbxconsenttypeverbal" condition="(skinbxconsenttypeverbal).is('')"]-Patient consent and timeout were performed verbally in lieu of written consent due to: [checkbox value="austere medical conditions|high patient volume and unavailability of support staff to assist|unavailability of accessible/printed forms"]
-Patient made aware of above conditions preventing written consent and agreed to proceed.
-A time out was performed prior to the procedure ensuring:
[/conditional][conditional field="skinbxconsenttypewritten" condition="(skinbxconsenttypewritten).is('')"]-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
[/conditional][conditional field="minorproctypeSkinBx" condition="(minorproctypeSkinBx).is('SKIN BIOPSY PROCEDURE NOTE')"][comment memo="only select what's applicable" memo_size="small"]
[checkbox value=" -Patient was identified using full name and DOB.
 -Patient was evaluated and medical record reviewed including history and lab/imaging findings if applicable.
 -Procedure and site/side matches the consent form.
 -Patient was involved in the site/side marking.
"][checkbox name="timeoutskinbx" value=" -For final timeout, physician paused or verbally confirmed with procedure team of:
  -correct patient, correct procedure, and correct site/side. 
  -The patient has been positioned correctly for the procedure. 
  -All necessary equipment are available.
"][checkbox value=" -Instrument sterility verified.
"]
PROCEDURE:
-The area overlying the lesion targeted for biopsy was prepared and draped in usual fashion using [select value="|Betadine/Iodine|Chlorhexidine"] per manufacturer and infection control recommendations.
-The skin overlying the indentified lesion infiltrated with above anesthetic agent.
[checkbox value="-Biopsy area of skin lesion was planned and marked with skin marker.
"][/conditional][conditional field="biopsytype" condition="(biopsytype).is('PUNCH')"]-A [text size="3"] mm punch biopsy tool was used to circumferentially excise [select value="desired portion of lesion|complete lesion"].
-Using forceps to elevate the excised tissue, tissue scissors used to sharply dissect excised tissue sample from underlying subcutaneous tissue.
[/conditional][conditional field="biopsytype" condition="(biopsytype).is('SHAVE')"]-[select value="Forceps|Stick-end of cotton-tip applicator"] was used to secure the lesion and provide counter-traction while a thin razor was used to obtain [select value="superficial/tangential|saucerized"] sample of lesion.
[/conditional][conditional field="biopsytype" condition="(biopsytype).is('EXCISIONAL')"]-A [text size="5"] cm elliptical incision was made with [select value="#15|#11b"] blade scalpel around the lesion/mass with [text size="5"] cm margins.
-Forceps were used to elevate lesion while utilizing the following to aide in excising sample from underlying tissue: [checkbox value="tissue scissors in blunt fashion|#15 blade scalpel under careful direct visualization|#11 blade scalpel under careful direct visualization|sharp curved surgical dissecting clamp"].
[/conditional][conditional field="minorproctypeSkinBx" condition="(minorproctypeSkinBx).is('SKIN BIOPSY PROCEDURE NOTE')"]-The specimen was placed in placed in specimen jar and sent for analysis.  
-Closure was [select name="biopsyclos" value="|not performed |performed with "][/conditional][conditional field="biopsyclos" condition="(biopsyclos).is('not performed ')"]and left to heal by secondary intent.
[/conditional][conditional field="biopsyclos" condition="(biopsyclos).is('performed with ')"][text size="3"] simple interrupted sutures using [select value="3-0|4-0|5-0|6-0"] [select value="Ethilon/nylon|Prolene/polypropylene|silk"] suture material.
[/conditional][conditional field="biopsylesioncount" condition="(biopsylesioncount).isGreater('1')"]-These steps were repeated for the rest of the lesions.
[/conditional][conditional field="minorproctypeSkinBx" condition="(minorproctypeSkinBx).is('SKIN BIOPSY PROCEDURE NOTE')"][select value="-EBL was less than 1ml and good hemostasis noted.|-Minor electrocautery required to achieve good hemostasis.|"] [text memo="optional text for EBL" memo_size="small" size="50"]
-Antibiotic ointment and a bandage were applied.

PATIENT DISPOSITION
-Patient tolerated overall procedure well.
-No immediate complications noted.
-Discussed with patient return precautions to include: fever, erythema, swelling, pain, or purulent discharge from the wound. 
-Post-procedure care of biopsy site discussed.
[/conditional][conditional field="biopsyclos" condition="(biopsyclos).is('performed with ')"]
-Patient instructed to return for suture removal in [text size="5"] days.
[/conditional][conditional field="minorproctypeSkinBx" condition="(minorproctypeSkinBx).is('SKIN BIOPSY PROCEDURE NOTE')"]-Patient left in stable condition. [textarea memo="optional additional text" memo_size="small"][/conditional]