Chronic Condition SOAP
[remark memo="Replace word NUMBER with numeral in field names chrNUMBER, controlNUMBER, symptomsNUMBER, currenttxNUMBER, prevtxNUMBER, ptxNUMBER1, ptxNUMBER2, ptxNUMBER3, medtxNUMBER, MedSideEffectsNUMBER, dxreqNUMBER, SatisfiedNUMBER, OtherSpecsNUMBER, and OtherDetailsNUMBER "] [checkbox memo="#NUMBER" memo_size="small" name="chrNUMBER" value="-Chronic Condition-"][conditional field="chrNUMBER" condition="(chrNUMBER).is('-Chronic Condition-')"][comment memo="-------------BEGIN CONDITION NUMBER-------------"][comment memo_size="small" memo_color="blue" memo="select one ▼▼"][frontload soapnote="sample/drgfms-include-condition-dropdown/"][textarea memo="◀︎◀︎ and/or freetext" memo_size="small" memo_color="blue" rows="2" cols="50"] -Patient reports that the condition is [select name="controlNUMBER" value="well controlled|not well controlled|stable|unchanged from last visit|improved from last visit|worse than at last visit"] -Currently, [select name="symptomsNUMBER" value="the patient notes there are no symptoms.|symptoms are present including"][/conditional][conditional field="symptomsNUMBER" condition="(symptomsNUMBER).is('symptoms are present including')"] [checkbox value="pain|fatigue|shortness of breath|palpitations|nausea|vomiting|abdominal pain|urinary symptoms"][text default="."] [/conditional][conditional field="chrNUMBER" condition="(chrNUMBER).is('-Chronic Condition-')"][checkbox name="currenttxNUMBER" memo="current treatment" value=""][/conditional][conditional field="currenttxNUMBER" condition="(currenttxNUMBER).is('')"] -Current treatments include [select name="medtxNUMBER" value="no medications.|medications including "][/conditional][conditional field="medtxNUMBER" condition="(medtxNUMBER).is('medications including ')"][textarea]. [select name="MedSideEffectsNUMBER" value="The patient denies side effects|The patient complains of side effects including "][/conditional][conditional field="MedSideEffectsNUMBER" condition="(MedSideEffectsNUMBER).is('The patient complains of side effects including ')"][checkbox value="constipation|skin rash|diarrhea|diaphoresis|dizziness|drowsiness|dry mouth|headache|insomnia|nausea|suicidal thoughts|palpitations|anxiety|depression|malaise"][textarea cols="50" rows="2" memo_size="small" memo_color="blue" memo="◀︎◀︎ include more here."][comment memo_size="small" memo_color="blue" memo=" Add a space/comma/period in front, as appropriate, if any above are selected"].[/conditional][conditional field="currenttxNUMBER" condition="(currenttxNUMBER).is('')"] [select name="othertxNUMBER" value="No other treatments are noted.|Additional treatments include "][/conditional][conditional field="othertxNUMBER" condition="(othertxNUMBER).is('Additional treatments include ')"][textarea cols="50" rows="2"]. [/conditional][conditional field="chrNUMBER" condition="(chrNUMBER).is('-Chronic Condition-')"][checkbox name="prevtxNUMBER" memo="previous treatments" value=""][/conditional][conditional field="prevtxNUMBER" condition="(prevtxNUMBER).is('')"] -Previous treatments include [checkbox name="ptxNUMBER1" value=" -#1 - "][/conditional][conditional field="ptxNUMBER1" condition="(ptxNUMBER1).is(' -#1 - ')"][text size="60"], reason discontinued - [checkbox value="intolerable side effects|no improvement"][textarea memo="other reason" memo_size="small" memo_color="blue"] [/conditional][conditional field="prevtxNUMBER" condition="(prevtxNUMBER).is('')"][checkbox name="ptxNUMBER2" value=" -#2 - "][/conditional][conditional field="ptxNUMBER2" condition="(ptxNUMBER2).is(' -#2 - ')"][text size="60"], reason discontinued - [checkbox value="intolerable side effects|no improvement"][textarea memo="other reason" memo_size="small" memo_color="blue"] [/conditional][conditional field="prevtxNUMBER" condition="(prevtxNUMBER).is('')"][checkbox name="ptxNUMBER3" value=" -#3 - "][/conditional][conditional field="ptxNUMBER3" condition="(ptxNUMBER3).is(' -#3 - ')"][text size="60"], reason discontinued - [checkbox value="intolerable side effects|no improvement"][textarea memo="other reason" memo_size="small" memo_color="blue"] [/conditional][conditional field="chrNUMBER" condition="(chrNUMBER).is('-Chronic Condition-')"][checkbox memo="patient requests/needs diagnostic or lab tests" name="dxreqNUMBER" value=""][/conditional][conditional field="dxreqNUMBER" condition="(dxreqNUMBER).is('')"] -Patient [select value="needs|is due for|requests"] diagnostic testing including [comment memo_size="small" memo_color="blue" memo="select any number from below ▼▼"][checkbox value="CBC|CMP|Fasting Lipids|A1c|gout/uric acid labs|Thyroid labs|TSH|Free T4|Vitamin B12|Vitamin D|lupus labs|rheumatoid arthritis labs|lyme disease labs|RMSF labs|COVID-19 antibodies|COVID-19 nasopharyngeal swab|STI testing|X-ray|CT|MRI|Ultrasound"][textarea cols="50" rows="2" memo_size="small" memo_color="blue" memo="◀︎◀︎ include more here."][comment memo_size="small" memo_color="blue" memo=" Add a space/comma/period in front, as appropriate, if any above are selected"]. [/conditional][conditional field="chrNUMBER" condition="(chrNUMBER).is('-Chronic Condition-')"][checkbox memo="Other specialists comanage the condition" name="OtherSpecsNUMBER" value=""][/conditional][conditional field="OtherSpecsNUMBER" condition="(OtherSpecsNUMBER).is('')"] -Other specialists comanaging - [textarea rows="2" cols="50"][/conditional][conditional field="chrNUMBER" condition="(chrNUMBER).is('-Chronic Condition-')"][checkbox memo="Other details" name="OtherDetailsNUMBER" value=""][/conditional][conditional field="OtherDetailsNUMBER" condition="(OtherDetailsNUMBER).is('')"] [textarea default=""][/conditional][conditional field="chrNUMBER" condition="(chrNUMBER).is('-Chronic Condition-')"][checkbox memo="Patient satisfied with treatment" name="PtSatisfied" value=""][/conditional][conditional field="PtSatisfied" condition="(PtSatisfied).is('')"] -Pt [select name="SatisfiedNUMBER" value="|is|is not"] satisfied with current management[/conditional][conditional field="SatisfiedNUMBER" condition="(SatisfiedNUMBER).is('is not')"]; [text memo="details" size=60].[/conditional][conditional field="SatisfiedNUMBER" condition="(SatisfiedNUMBER).is('is')"].[/conditional][conditional field="chrNUMBER" condition="(chrNUMBER).is('-Chronic Condition-')"] [comment memo="--------------END CONDITION NUMBER--------------"][/conditional]
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Sandbox Metrics: Structured Data Index 0.62, 73 form elements, 5 text boxes, 10 text areas, 16 checkboxes, 8 drop downs, 6 comments, 1 remarks, 26 conditionals, 1 frontloads, 83 total clicks
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