Conditional Field Example

CONDITIONAL EXAMPLE: [checkbox name="Radiology" value="caries|calculus|missing tooth"]
[conditional field="Radiology" condition="(Radiology).is('caries')"] caries # [textarea name="#"][/conditional]


Chief complaint: [text name="CC" default="" size="65"]

BP [text name="BP" default="" size="35"]; Weight  [text name="Wt" default="" size="35"] lbs; RR  [text name="RR" default="" size="35"]

Premed: 
Medical History: RMH;
  Medication change: [text default="--" size="35"]
  Hospitalization: [text default="--" size="35"]
  Surgery: [text default="--" size="35"]
  Change in medical diagnosis: [text default="--" size="35"]
  Change in ROS: [text default="--" size="35"]
  Visit to ER: [text default="--" size="35"]
  
Medical risk assessment: 
  ASA: [checkbox name="ASA" value="1|2|3"]
  Medical consultation need: [checkbox name="Medical_consult_need" value="Mandatory: Patient CANNOT proceed wihout a medical consult|Limited: Patient may proceed with limited care pending medical consultation|No medical consultation required"]
  
  Medical consonsultation status: [checkbox name="Medical_consult_status" value="sent|recieved"]
  
  Final medical risk assessment: [checkbox name="Medical_consult_review" value="No precautions, proceed with treatment|Precautions necessary - see medical management plan|Anticaog meds discontinued, advised to contact physician ASAP to resume use|Epi restriction|Premed required"] 
  

Social history: 
  Alcohol use: [checkbox name="Alcohol_use" value="never drank ROH|Drink ROH presently|Stopped drinking|recovered from dependency|----|Beer|Liquor|----|less than daily|2 or less each day|more than 2 each day"]
 
 Tobacco use: [checkbox name="Tobacco_use" value="non-smoker|use tobacco presently|stopped using tobacco|----|Cigars|Cigarettes|Chew tobacco|Marijuana|----|<1pk/day|1 pk/day|>1 pk/day|----|at least daily|at least weekly|monthly or less"] 
  
Dental history:
  Reason for past dental care: [checkbox name="Past_Dental_care" value="Mostly regular dental visits|Mostly ER visits"]
  
  Oral hygiene: [checkbox name="Oral_Hygiene" value="Brush teeth once daily|Brush teeth more than once daily|does not brush teeth daily|Floss daily|FLoss occasionally|Never floss"]
  
  Missing teeth: [checkbox name="Missing_teeth" value="Yes|No|Some|All"]
  Prosthesis: [checkbox name="Prosthesis" value="FU|FL|PU|PL"]
  
  Oral function: [checkbox name="Oral_function" value="Difficulty chewing food|Pain/limited jaw opening/closing|Jaw locks open or closed|Loss/diminished taste or smell"] 
  
  Habits: [checkbox name="Habits" value="Biting/sucking the lip or cheek|Tongue thrusting/finger sucking|Clenching or grinding teeth"]
  
  Types of past dental therapy: [checkbox name="Past_Dental_Therapy" value="No h/o caries|Caries/restoration during last year|Caries/restoration >1 yr ago|Extractions|Tooth bleaching|Cosmetic dentistry|Orthodontics|RCT|Dentures|Crowns|Bridges|Implants|Sealants"]
  Chronic oral/facial pain: [checkbox name="Chronic_oral_pain" value="Yes|No|Jaw|TMJ|Burning tongue/mouth"]
  Oral lesions: [checkbox name="Oral_lesions" value="Yes|No|mouth|lips|past|current|recurrent"]
  Other:  [text name="Dental_History_Other" default=""  size="65"]
  
Head and Neck 
OCS: 
EOE: 
  Skin: [text default="--" size="35"];   Eyes: [text default="--" size="35"];   Cranial nerves: [text default="--" size="35"];   Lymph nodes: [text default="--" size="35"];  Carotid: [text default="--" size="35"];   Veins: [text default="--" size="35"];   Salivary glands: [text default="--" size="35"];   Jaws: [text default="--" size="35"];   Thyroid: [text default="--" size="35"];   Other: [text default="--" size="35"]
  
IOE:
  Lips:  [text default="--" size="35"];   B mucosa:  [text default="--" size="35"];   Labial mucosa:  [text default="--" size="35"];   Gingiva:  [text default="--" size="35"];   Tongue:  [text default="--" size="35"];   Soft palate:  [text default="--" size="35"];   Hard palate:  [text default="--" size="35"];   Floor of mouth:  [text default="--" size="35"];   Pharynx:  [text default="--" size="35"];   Other:   [text default="--" size="35"]
  
Musculoskeletal TMJ:
  Limited mand. ROM(<35mm): [text default="--" size="35"]
  TMJ sounds (abnormal): [text default="--" size="35"]
  Masticatory muscle palp pain: [text default="--" size="35"]
  Cervical muscle pain: [text default="--" size="35"]
  TMJ palp pain: [text default="--" size="35"]
  Other:  [text default="--" size="35"]
  
Clinical Findings:
  Edema
  Leukoplakia
  Tumor
  Erosion
  Nodule
  Ulcer
  Erythroplakia
  Pigmented lesion
  Salivary hypofunction
  Gingival enlargement
  Salivary gland swelling
  Other:

Occlusion/Notes:
  Angle class:
    Overbite:
    Overjet:
    Open bite:
  Wear: 
  Crowding:
  Crossbite:
    Midline deviation:
  Occlusal trauma:
    tooth mobility:
    migration:
    damage/wear: 
  
Endo Exam: 
#[text default="" size="15"] - [checkbox name="Pulp_test1" value="large restoration|decay into pulp|palp(+)|perc(+)|cold(+)|NR to thermal stim"]
#[text default="--" size="15"]- [checkbox name="Pulp_test2" value="large restoration|decay into pulp|palp(+)|perc(+)|cold(+)|NR to thermal stim"]
#[text default="--" size="15"]- [checkbox name="Pulp_test3" value="large restoration|decay into pulp|palp(+)|perc(+)|cold(+)|NR to thermal stim"]

Perio Exam: 

Radiology: 
  Caries: [text default="--" size="35"]; Calculus:[text default="--" size="35"];   Horizontal bone loss:[text default="--" size="35"];   Vertical bone loss:[text default="--" size="35"];   Widened PDL space:[text default="--" size="35"];   Radiolucency-periapical:[text default="--" size="35"];   Radiolucency-other:[text default="--" size="35"];   Opacification-periapical: [text default="--" size="35"];   Opacification-other: [text default="--" size="35"];  Sclerotic bone: [text default="--" size="35"]
  Torus [text default="--" size="35"];   Root resorption: [text default="--" size="35"];   Foreign body: [text default="--" size="35"];   Missing teeth: [text default="--" size="35"];   Supernumerary teeth: [text default="--" size="35"];   Hypercementosis: [text default="--" size="35"];   Fractured root: [text default="--" size="35"];   Residual root: [text default="--" size="35"];   Root canal therapy: [text default="--" size="35"];   Impaction: [text default="--" size="35"];   Abnormal maxillary sinus: [text default="--" size="35"];   TMJ abnormality: [text default="--" size="35"];   Other: [text default="--" size="35"]
    
    Radiographic Narrative Report: [text default="--" size="65"]
    

Assessment:  
  Caries: [text default="#" size="35"]
  Perio: 
  Endo:
  Esthetic concerns:
  Problematic occlusion:
  Limited oral function:
  Other:
  
  Oral Medicine/Path:
    Mucosa:
    Musculoskeletal/Neural:
    Salivary gland:
    Other:
    
Treatment Plan:
  Prevention/Health promote:
  Caries:
  Perio:
    Non-surgical tx:
    Surgical tx:
    Recall sched:
  Endo:
    RCT #
    Re-RCT #
    Apico #
  Restorative:
    Fillings: 
    Crowns:
    Bridges:
  Prosthodontic:
    Parital denture:
    Full denture:
  Oral Surgery:
    3rd molar ext:
    Ext:
    Implants:
  Orthodontic:
  Oral Medicine
    Mucosal lesion:
    TMD/pain:
  Other:



[checkbox name="plan_perio" value="Periodontal"] [conditional field="plan_perio" condition="(plan_perio).is('Periodontal')"] SRP [checkbox name="SRP_area" value="UR|UL|LR|LL"] with [checkbox name="Recall_sched" value="3 month recall|4 month recall|6 month recall"]need to come in for routine cleanings or else [/conditional]

[checkbox name="plan_filling" value="Filling"] [conditional field="plan_filling" condition="(plan_filling).is('Filling')"] #[text name="Tooth_text1" default=""] Advised tooth may need RCT, crown, if symptoms develop. Alternative options discussed including do nothing and re-eval.  Explain differences between comp vs ceramics.  Discussed all risks and complications including use of local anes, poss of pain, swelling, and poss loss of tooth.  All Q's answered. [/conditional]

[checkbox name="plan_Crown" value="Crown/Buildup"] [conditional field="plan_Crown" condition="(plan_Crown).is('Crown/Buildup')"] #[text name="Tooth_text2" default=""] Crn, buildup.  Advised tooth may need endo treatment if becomes symptomatic.  Alt options discussed including do nothing and specialist eval prior to treatment.  Discussed all risks and complications including use of local anes, poss of pain, swelling, and poss loss of tooth.  All Q's answered.   [/conditional]
[textarea name="treatmentPlan" default=""]  All Q's answered.  

Follow-up: [textarea name="followUp" default=""]





CONDITIONAL EXAMPLE:



Chief complaint:

BP ; Weight lbs; RR

Premed:
Medical History: RMH;
Medication change:
Hospitalization:
Surgery:
Change in medical diagnosis:
Change in ROS:
Visit to ER:

Medical risk assessment:
ASA:
Medical consultation need:

Medical consonsultation status:

Final medical risk assessment:


Social history:
Alcohol use:

Tobacco use:

Dental history:
Reason for past dental care:

Oral hygiene:

Missing teeth:
Prosthesis:

Oral function:

Habits:

Types of past dental therapy:
Chronic oral/facial pain:
Oral lesions:
Other:

Head and Neck
OCS:
EOE:
Skin: ; Eyes: ; Cranial nerves: ; Lymph nodes: ; Carotid: ; Veins: ; Salivary glands: ; Jaws: ; Thyroid: ; Other:

IOE:
Lips: ; B mucosa: ; Labial mucosa: ; Gingiva: ; Tongue: ; Soft palate: ; Hard palate: ; Floor of mouth: ; Pharynx: ; Other:

Musculoskeletal TMJ:
Limited mand. ROM(<35mm):
TMJ sounds (abnormal):
Masticatory muscle palp pain:
Cervical muscle pain:
TMJ palp pain:
Other:

Clinical Findings:
Edema
Leukoplakia
Tumor
Erosion
Nodule
Ulcer
Erythroplakia
Pigmented lesion
Salivary hypofunction
Gingival enlargement
Salivary gland swelling
Other:

Occlusion/Notes:
Angle class:
Overbite:
Overjet:
Open bite:
Wear:
Crowding:
Crossbite:
Midline deviation:
Occlusal trauma:
tooth mobility:
migration:
damage/wear:

Endo Exam:
# -
#-
#-

Perio Exam:

Radiology:
Caries: ; Calculus:; Horizontal bone loss:; Vertical bone loss:; Widened PDL space:; Radiolucency-periapical:; Radiolucency-other:; Opacification-periapical: ; Opacification-other: ; Sclerotic bone:
Torus ; Root resorption: ; Foreign body: ; Missing teeth: ; Supernumerary teeth: ; Hypercementosis: ; Fractured root: ; Residual root: ; Root canal therapy: ; Impaction: ; Abnormal maxillary sinus: ; TMJ abnormality: ; Other:

Radiographic Narrative Report:


Assessment:
Caries:
Perio:
Endo:
Esthetic concerns:
Problematic occlusion:
Limited oral function:
Other:

Oral Medicine/Path:
Mucosa:
Musculoskeletal/Neural:
Salivary gland:
Other:

Treatment Plan:
Prevention/Health promote:
Caries:
Perio:
Non-surgical tx:
Surgical tx:
Recall sched:
Endo:
RCT #
Re-RCT #
Apico #
Restorative:
Fillings:
Crowns:
Bridges:
Prosthodontic:
Parital denture:
Full denture:
Oral Surgery:
3rd molar ext:
Ext:
Implants:
Orthodontic:
Oral Medicine
Mucosal lesion:
TMD/pain:
Other:








All Q's answered.

Follow-up:






Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.26, 98 form elements, 286 boilerplate words, 67 text boxes, 3 text areas, 24 checkboxes, 4 conditionals, 189 total clicks
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