Procedure Note
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[checkbox memo="Skin Exam" name="skinexam" value=""][conditional field="skinexam" condition="(skinexam).is('')"]SKIN EXAM
[checkbox memo="1st Lesion" name="Lesion1" value=""][/conditional][conditional field="Lesion1" condition="(Lesion1).is('')"]Lesion#1
-Location: [select name="skinexamlocation1" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|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('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('')"]
-Description:
--Character/Texture: [checkbox name="skinexamlesion1" value="macule|papule|patch|plaque|rough|smooth|firm|soft|mobile|fixed|pedunculated|palpable subdermal lump|palpable subcutaneous lump"]
--Size: [text size="5"] cm[/conditional][conditional field="skinexamlesion1" condition="(skinexamlesion1).is('macule')||(skinexamlesion1).is('papule')||(skinexamlesion1).is('patch')||(skinexamlesion1).is('plaque')||(skinexamlesion1).is('rough')||(skinexamlesion1).is('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="Lesion1" condition="(Lesion1).is('')"]
[checkbox value="--Other features:"] [text size="40"]
[/conditional][conditional field="skinexam" condition="(skinexam).is('')"][checkbox memo="2nd Lesion" name="Lesion2" value=""][/conditional][conditional field="Lesion2" condition="(Lesion2).is('')"]
Lesion#2
-Location: [select name="skinexamlocation2" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|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('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('')"]
-Description:
--Character/Texture: [checkbox name="skinexamlesion2" value="macule|papule|patch|plaque|rough|smooth|firm|soft|mobile|fixed|pedunculated|palpable subdermal lump|palpable subcutaneous lump"]
--Size: [text size="5"] cm[/conditional][conditional field="skinexamlesion2" condition="(skinexamlesion2).is('macule')||(skinexamlesion2).is('papule')||(skinexamlesion2).is('patch')||(skinexamlesion2).is('plaque')||(skinexamlesion2).is('rough')||(skinexamlesion2).is('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="Lesion2" condition="(Lesion2).is('')"]
[checkbox value="--Other features:"] [text size="40"]
[/conditional][conditional field="skinexam" condition="(skinexam).is('')"][checkbox memo="3rd Lesion" name="Lesion3" value=""][/conditional][conditional field="Lesion3" condition="(Lesion3).is('')"]
Lesion#3
-Location: [select name="skinexamlocation3" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|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('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('')"]
-Description:
--Character/Texture: [checkbox name="skinexamlesion3" value="macule|papule|patch|plaque|rough|smooth|firm|soft|mobile|fixed|pedunculated|palpable subdermal lump|palpable subcutaneous lump"]
--Size: [text size="5"] cm[/conditional][conditional field="skinexamlesion3" condition="(skinexamlesion3).is('macule')||(skinexamlesion3).is('papule')||(skinexamlesion3).is('patch')||(skinexamlesion3).is('plaque')||(skinexamlesion3).is('rough')||(skinexamlesion3).is('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="Lesion3" condition="(Lesion3).is('')"]
[checkbox value="--Other features:"] [text size="40"]
[/conditional][conditional field="skinexam" condition="(skinexam).is('')"][checkbox memo="4th Lesion" name="Lesion4" value=""][/conditional][conditional field="Lesion4" condition="(Lesion4).is('')"]
Lesion#4
-Location: [select name="skinexamlocation4" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|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="skinexamlocation4" condition="(skinexamlocation4).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Shoulder')||(skinexamlocation4).is('Elbow')||(skinexamlocation4).is('Wrist')||(skinexamlocation4).is('Hip')||(skinexamlocation4).is('Knee')||(skinexamlocation4).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Arm')||(skinexamlocation4).is('Forearm')||(skinexamlocation4).is('Thigh')||(skinexamlocation4).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).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="skinexamlocation4" condition="(skinexamlocation4).is('Hand')||(skinexamlocation4).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Foot')||(skinexamlocation4).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation4" condition="(skinexamlocation4).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="Lesion4" condition="(Lesion4).is('')"]
-Description:
--Character/Texture: [checkbox name="skinexamlesion4" value="macule|papule|patch|plaque|rough|smooth|firm|soft|mobile|fixed|pedunculated|palpable subdermal lump|palpable subcutaneous lump"]
--Size: [text size="5"] cm[/conditional][conditional field="skinexamlesion4" condition="(skinexamlesion4).is('macule')||(skinexamlesion4).is('papule')||(skinexamlesion4).is('patch')||(skinexamlesion4).is('plaque')||(skinexamlesion4).is('rough')||(skinexamlesion4).is('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="Lesion4" condition="(Lesion4).is('')"]
[checkbox value="--Other features:"] [text size="40"]
[/conditional][conditional field="skinexam" condition="(skinexam).is('')"][checkbox memo="5th Lesion" name="Lesion5" value=""][/conditional][conditional field="Lesion5" condition="(Lesion5).is('')"]
Lesion#5
-Location: [select name="skinexamlocation5" value="|Scalp|Face|Neck|Shoulder|Chest/Trunk|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="skinexamlocation5" condition="(skinexamlocation5).is('Scalp')"]- [select value="right|left|midline"] [select value="occipital|parietal|temporal|frontal|preauricular|postauricular"] area[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Face')"]- [select value="right|left|midline"] [select value="preauricular|mandibular angle|cheek|nose|periorbital|perioral|chin|submandibular|submental"] area[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Neck')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Shoulder')||(skinexamlocation5).is('Elbow')||(skinexamlocation5).is('Wrist')||(skinexamlocation5).is('Hip')||(skinexamlocation5).is('Knee')||(skinexamlocation5).is('Ankle')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Arm')||(skinexamlocation5).is('Forearm')||(skinexamlocation5).is('Thigh')||(skinexamlocation5).is('Leg')"]- [select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Chest/Trunk')"]- [select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Abdomen')"]- [select value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Buttocks')"]- [select value="right|left|midline"] [select value="|medial|lateral"] [select value="perianal|gluteal cleft|cheek|gluteal fold"][/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Inguinal')"]- [select value="right|left"][/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Male Genital Region')"]- [select value="right|left|midline"] [select value="penile glans|penile shaft|base of penis|scrotum|periscrotal area"][/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).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="skinexamlocation5" condition="(skinexamlocation5).is('Hand')||(skinexamlocation5).is('Finger')"]- [select value="right|left"], [checkbox value="palmar/volar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Finger')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MCP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Foot')||(skinexamlocation5).is('Toe')"]- [select value="right|left"], [checkbox value="plantar|dorsal|medial|lateral"] aspect[/conditional][conditional field="skinexamlocation5" condition="(skinexamlocation5).is('Toe')"], [select value="1st|2nd|3rd|4th|5th"] digit, [select value="MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"][/conditional][conditional field="Lesion5" condition="(Lesion5).is('')"]
-Description:
--Character/Texture: [checkbox name="skinexamlesion5" value="macule|papule|patch|plaque|rough|smooth|firm|soft|mobile|fixed|pedunculated|palpable subdermal lump|palpable subcutaneous lump"]
--Size: [text size="5"] cm[/conditional][conditional field="skinexamlesion5" condition="(skinexamlesion5).is('macule')||(skinexamlesion5).is('papule')||(skinexamlesion5).is('patch')||(skinexamlesion5).is('plaque')||(skinexamlesion5).is('rough')||(skinexamlesion5).is('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="Lesion5" condition="(Lesion5).is('')"]
[checkbox value="--Other features:"] [text size="40"]
[/conditional]
[select memo="Select Minor Procedure Type" memo_size="small" name="minorproctype" value="|EXCISION OF BENIGN LESION|SHAVE REMOVAL OF BENIGN SKIN LESION|CRYOTHERAPY|SKIN BIOPSY"]
[conditional field="minorproctype" condition="(minorproctype).is('EXCISION OF BENIGN LESION')"][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="minorproctype" condition="(minorproctype).is('EXCISION OF BENIGN LESION')"]
-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="minorproctype" condition="(minorproctype).is('EXCISION OF BENIGN LESION')"]
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
[checkbox name="ExcisSup" value="Supervising Physician:"][/conditional][conditional field="ExcisSup" condition="(ExcisSup).is('Supervising Physician:')"] Dr. [text size="20"]
[/conditional][conditional field="minorproctype" condition="(minorproctype).is('EXCISION OF BENIGN LESION')"]
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)"]
-Discussed and patient demonstrated understanding of: [checkbox value="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.
-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-Performed official timeout which was recorded and hardcopy to be scanned into patient's medical record.

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 length [select value="linear|elliptical"] excision using [select value="#15|#11"] blade scalpel was made over the indentified lesion.
-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="minorproctype" condition="(minorproctype).is('EXCISION OF BENIGN LESION')"]-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][conditional field="minorproctype" condition="(minorproctype).is('SHAVE REMOVAL OF BENIGN SKIN LESION')"]
PRE-OP DIAGNOSIS: [select value="|Localized Lump/Mass- R22.9|Nevus, non-neoplastic- I78.1|Seborrheic keratosis- ICD10|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- ICD10|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
[checkbox name="ShaveRemovSup" value="Supervising Physician:"][/conditional][conditional field="ShaveRemovSup" condition="(ShaveRemovSup).is('Supervising Physician:')"] Dr. [text size="20"]
[/conditional][conditional field="minorproctype" condition="(minorproctype).is('SHAVE REMOVAL OF BENIGN SKIN LESION')"]
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)"]
-Discussed and patient demonstrated understanding of: [checkbox value="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.
-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-Performed official timeout which was recorded and hardcopy to be scanned into patient's medical record.

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][conditional field="minorproctype" condition="(minorproctype).is('CRYOTHERAPY')"] - [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="minorproctype" condition="(minorproctype).is('CRYOTHERAPY')"]
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="minorproctype" condition="(minorproctype).is('CRYOTHERAPY')"]
[checkbox name="CryoSup" value="Supervising Physician:"][/conditional][conditional field="CryoSup" condition="(CryoSup).is('Supervising Physician:')"] Dr. [text size="20"]
[/conditional][conditional field="minorproctype" condition="(minorproctype).is('CRYOTHERAPY')"]
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)"]
-Discussed and patient demonstrated understanding of: [checkbox value="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.
-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-Performed official timeout which was recorded and hardcopy to be scanned into patient's medical record.

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="minorproctype" condition="(minorproctype).is('CRYOTHERAPY')"] 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][conditional field="minorproctype" condition="(minorproctype).is('SKIN BIOPSY')"][comment memo="use for punch/shave/excisional techniques" 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="minorproctype" condition="(minorproctype).is('SKIN BIOPSY')"]
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
[checkbox name="SkinBxSup" value="Supervising Physician:"][/conditional][conditional field="SkinBxSup" condition="(SkinBxSup).is('Supervising Physician:')"] Dr. [text size="20"]
[/conditional][conditional field="minorproctype" condition="(minorproctype).is('SKIN BIOPSY')"]
INDICATIONS/COUNSELING:
-Discussed reason and medical indication(s) for procedure which include(s): [checkbox value="determine malignant potential|better diagnose skin condition/disease"]
-Discussed and patient demonstrated understanding of: [checkbox value="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.
-Confirmed that consent form appropriately signed and hardcopy to be scanned into patient's medical record.
-Performed official timeout which was recorded and hardcopy to be scanned into patient's medical record.

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="minorproctype" condition="(minorproctype).is('SKIN BIOPSY')"]-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="minorproctype" condition="(minorproctype).is('SKIN BIOPSY')"][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="minorproctype" condition="(minorproctype).is('SKIN BIOPSY')"]-Patient left in stable condition. [textarea memo="optional additional text" memo_size="small"][/conditional]
Skin Exam
Select Minor Procedure Type
Result - Copy and paste this output: