PRE-OP DIAGNOSIS: [select value="|Ingrowing Nail - L60.0|Tinea unguium - B35.1"]
POST-OP DIAGNOSIS: [select value="|Ingrowing Nail - L60.0|Tinea unguium - B35.1"]
PROCEDURE: [select value="|Complete Toenail Removal without matrix ablation - 11730|Partial Toenail Removal without matrix ablation - 11730|Complete Toenail Removal WITH matrix ablation - 11750"] of [select value="Right|Left"] [select value="1st/Great|2nd|3rd|4th|5th"] Toenail
ANESTHESIA: Lidocaine [select value="1%|2%"] [select value="Without|With"] Epinephrine
[checkbox name="supervision" value="Supervising Physician:"][conditional field="supervision" condition="(supervision).is('Supervising Physician:')"] Dr. [text size="20"]
-Patient desires toe nail removal and is medically indicated
-Discussed risks of procedure which include: [checkbox value="bleeding|pain|infection|scarring|recurrence of condition|failure to remove affected nail|need for repeat procedure"].
-Discussed alternatives to procedure which include: [checkbox value="proper trimming of nails|inserting cotton under nail edges|other-"] [text size="50"]
-Verified that all patient's questions were answered. No guarantees were given or implied.
-Consent form was signed as hardcopy to be scanned into patient's record.
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record.
-Toe was cleansed with [select value="Betadine/Iodine|Chlorhexidine"] per manufacturer and infection control recommendations.
-Performed digital block of the [select value="Right|Left"] [select value="1st/Great|2nd|3rd|4th|5th"] toe using [text size="5"]ml of anesthetic agent listed above.
[checkbox value="-Toe tourniquet was placed for hemostasis.
"]-Elevated [select value="affected portion of|complete"] nail plate from matrix and freed from adjacent cuticle and periungual skin.
[checkbox value="-Cut elevated/freed portion of nail plate and removed.
"][checkbox value="-Removed complete nail plate.
"][checkbox value="-Electrocautery was used to ablate the nail-forming matrix beneath the area where the nail plate was removed.
"][checkbox name="Phenol" value="-Phenol was used"][conditional field="Phenol" condition="(Phenol).is('-Phenol was used')"] to ablate the nail-forming matrix beneath the area where the nail plate was removed. Phenol applied with cotton swab to matrix for 30 seconds, and repeated 3 times. Matrix then was thoroughly cleansed with isopropyl Alcohol 70%.
[/conditional]-EBL [select value="less than 1ml|"][text size="30"].
-Toe was then gently irrigated with saline irrigation
-Bacitracin and Telfa gauze was applied.
-Regular gauze was placed and bandage secured with [select value="Coban dressing|Sock dressing"].
-Instructed the patient to follow up for fever, erythema, swelling, pain, or foul-smelling purulent discharge from the wound.
[checkbox name="PtDisp" value="PATIENT DISPOSITION"][conditional field="PtDisp" condition="(PtDisp).is('PATIENT DISPOSITION')"]
-Patient tolerated overall procedure(s) well
-No immediate complications noted
-Patient left in stable condition with appropriate counseling as described above.[/conditional][checkbox memo="select for additional free text" name="endfreetext" value=""][conditional field="endfreetext" condition="(endfreetext).is('')"]-[textarea memo="additional text"][/conditional]
Result - Copy and paste this output: