COVID NOTE

SUBJECTIVE: CHEIF COMPLAINT 
[text name="variable_1" default="sample text"]

Onset:[text name="Onset"]
[text name="variable_1" default="sample text"]Y/O
[checklist name="male" value="male|female"]


Symptoms:
[checkbox name="Symptoms" value="Subjective fever|Chills|Congestion|Rhinorrhea|Sore Throat|Myalgias|Dry cough|Productive cough|Headache|Nausea|Vomiting|Diarrhea |Fatigue|SOB"]

Therapies tried:
[checkbox name="Therapies" value="Antipyretics|Cough meds|Nothing"] 

Pertinent hx:[text name="Pertinenthistory"]
High Risk Conditions:[text name="Highriskconditions" default="None"]


Symptoms are [select name="variable_4" value="IMPROVING|WORSENING|STAYING THE SAME"] since onset

STREP SCREENING: Is sore throat the main complaint without concurrent cold-like symptoms (nose/eyes/etc)? [select name="Centor" value="no|YES"][comment memo="Choose 'yes' to bring up Centor Criteria"][conditional field="Centor" condition="(Centor).is('YES')"]
Denies: [checkbox name="variable_18" value="dyspnea on exertion|subjective fever|productive cough|myagl"]
Modified Centor Score
[select name="Q1Fever" value="No (0 points)=0|YES (1 point)=1"] <-- History of fever or measured temperature > 100.4 degrees F
[select name="Q2Cough" value="Cough is present (0 points)=0|COUGH IS ABSENT (1 point)=1"] <-- Presence of coughing
[select name="Q3Nodes" value="No (0 points)=0|YES (1 point)=1"] <-- Tender anterior cervical nodes
[select name="Q4Tonsil" value="No (0 points)=0|YES (1 point)=1"] <-- Tonsillar swelling or exudates
[select name="Q5Age" value="< 15 years (1 point)=1|15 to 45 years (0 points)=0|> 45 years (-1 point)=-1"] <-- Age
Score --> [calc value="score=(Q1Fever)+(Q2Cough)+(Q3Nodes)+(Q4Tonsil)+(Q5Age)" memo="score"][/conditional]
COVID-19 QUESTIONS: Documented fever: [select name="variable_1" value="NO|YES"]
Close contact with person with confirmed or suspected COVID-19: [select name="variable_2" value="NO|YES"]
Travel to high risk COVID-19 areas per current local guidance: [select name="variable_3" value="NO|YES"]

OBJECTIVE: PHYSICAL EXAM
[checkbox name="examchaperone" memo="Chaperone" value=""][conditional field="examchaperone" condition="(examchaperone).is('')"]-Chaperone - [text size="60"]

[/conditional][checkbox name="vitals" memo="Vitals" value=""][conditional field="vitals" condition="(vitals).is('')"]-Vitals - [select name="vitals1" value="reviewed, no remarkable abnormalities|significant for"][text size="50"]
[/conditional][checkbox name="briefexam" memo="Brief Visual Exam" value=""][conditional field="briefexam" condition="(briefexam).is('')"]-General - [text default="well developed, well nourished, no apparent distress" size="80"]
-HEENT - [text default="normocephalic, atraumatic, nares patent, mucous membranes moist" size="80"]
-Neck - [text default="Supple" size="80"]
-Abd - [text default="non-distended" size="80"]
-Ext - [text default="no cyanosis" size="80"]
-Neuro - [text default="appropriate balance, normal gait" size="80"]
-Psych - [text default="appropriate mood/affect" size="80"]
[/conditional][checkbox name="gendetailexam" memo="*" memo_size="small" value="-General - "][conditional field="gendetailexam" condition="(gendetailexam).is('-General - ')"][checkbox name="examgen" value="well developed|well nourished|A&Ox4|NAD"];[comment memo="abnormals" memo_size="small" memo_color="orange" value=""][checkbox value="MILDLY ILL|SLEEPY|APPEARS CONFUSED|APPEARS LETHARGIC|CACHECTIC APPEARANCE|APPEARS OLDER THAN STATED AGE"][textarea memo="General free text" memo_size="small" rows="2"]
[/conditional][checkbox name="heentdetailexam" memo="*" memo_size="small" value="-HEENT - "][conditional field="heentdetailexam" condition="(heentdetailexam).is('-HEENT - ')"][checkbox name="examheent" value="normocephalic|atraumatic|conjunctiva clear|sclerae aninteric|TMs with clearly visible landmarks|nares patent b/l|turbinates nonedematous/nonerythematous b/l|mucous membranes moist|throat nonerythematous/noninjected|good dentition"];[comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox value="R CONJUNCTIVAL ERYTHEMA|L CONJUNCTIVAL ERYTHEMA|R TM OPAQUENESS & LOSS OF LANDMARKS|R TM VIEW OBSCURRED BY CERUMEN|L TM OPAQUENESS & LOSS OF LANDMARKS|L TM VIEW OBSCURRED BY CERUMEN|NASAL SEPTUM DEVIATION|R TURBINATE EDEMA|R TURBINATE ERYTHEMA|L TURBINATE EDEMA|L TURBINATE ERYTHEMA|NASAL DISCHARGE|PHARYNGEAL ERYTHEMA/INJECTION|PHARYNGEAL COBBLESTONING|TONSILS INJECTED/EDEMATOUS|TONSILS WITH EXUDATE|GLOSSAL HYPERTROPHY|UVULAR DEVIATION"] [textarea memo="HEENT free text" memo_size="small" rows="2"]
[/conditional][checkbox name="neckdetailexam" memo="*" memo_size="small" value="-Neck - "][conditional field="neckdetailexam" condition="(neckdetailexam).is('-Neck - ')"][checkbox name="examneck" value="soft/supple|no JVD|no thyromegaly|no tender/enlarged lymph nodes"]; [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox value="R ANTERIOR CHAIN LYMPHADENOPATHY|R POSTERIOR CHAIN LYMPHADENOPATHY|L ANTERIOR CHAIN LYMPHADENOPATHY|L POSTERIOR CHAIN LYMPHADENOPATHY|JUGULAR VENOUS DISTENSION|GOITER"] [textarea memo="Neck free text" memo_size="small" rows="2"]
[/conditional][checkbox name="chestdetailexam" memo="*" memo_size="small" value="-Chest - "][conditional field="chestdetailexam" condition="(chestdetailexam).is('-Chest - ')"][checkbox name="examchest" value="normal rise and fall B/L|no accessory muscle use"]; [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox value="INTERCOSTAL RETRACTIONS|SUPRACOSTAL RETRACTIONS|INFRACOSTAL RETRACTIONS|PECTUS EXCAVATUM|PECTUS CARINATUM"] [textarea memo="Chest free text" memo_size="small" rows="2"]
[/conditional][checkbox name="heartdetailexam" memo="*" memo_size="small" value="-Heart - "][conditional field="heartdetailexam" condition="(heartdetailexam).is('-Heart - ')"][checkbox value="RRR|normal S1/S2|No M/R/G|No S3/S4 auscultated|no friction rub"]; [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox name="examheartabn1" value="MURMUR AUSCULTATED"][/conditional][conditional field="examheartabn1" condition="(examheartabn1).is('MURMUR AUSCULTATED')"] - GRADE [text size="3"]/6 [select value="SYSTOLIC EJECTION|SYSTOLIC|DIASTOLIC|HOLOSYSTOLIC"] HEARD BEST AT [select value="R|L"] [select value="UPPER STERNAL BORDER|LOWER STERNAL BORDER|APEX"]
[/conditional][conditional field="heartdetailexam" condition="(heartdetailexam).is('-Heart - ')"] [textarea memo="Heart free text" memo_size="small" rows="2"]
[/conditional][checkbox name="lungsdetailexam" memo="*" memo_size="small" value="-Lungs - "][conditional field="lungsdetailexam" condition="(lungsdetailexam).is('-Lungs - ')"][checkbox value="CTAB|BSE b/l|no wheezes|no crackles|no rhonchi"]; [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox name="examlungsabn1" value="WHEEZING-"][/conditional][conditional field="examlungsabn1" condition="(examlungsabn1).is('WHEEZING-')"] [checkbox value="EXPIRATORY|INSPIRATORY|B/L LUNGS|R LUNG|L LUNG|DIFFUSE|LOWER FIELD(S)|UPPER FIELD(S)"];[/conditional][conditional field="lungsdetailexam" condition="(lungsdetailexam).is('-Lungs - ')"][checkbox name="examlungsabn2" value="RHONCHI-"][/conditional][conditional field="examlungsabn2" condition="(examlungsabn2).is('RHONCHI-')"] [checkbox value="EXPIRATORY|INSPIRATORY|B/L LUNGS|R LUNG|L LUNG|DIFFUSE|LOWER FIELD(S)|UPPER FIELD(S)"];[/conditional][conditional field="lungsdetailexam" condition="(lungsdetailexam).is('-Lungs - ')"][checkbox name="examlungsabn3" value="BREATH SOUNDS DIMINISHED-"][/conditional][conditional field="examlungsabn3" condition="(examlungsabn3).is('BREATH SOUNDS DIMINISHED-')"] [checkbox value="B/L LUNGS|R LUNG|L LUNG|DIFFUSE|LOWER FIELD(S)|UPPER FIELD(S)"];[/conditional][conditional field="lungsdetailexam" condition="(lungsdetailexam).is('-Lungs - ')"] [textarea memo="free text" memo_size="small" rows="2"]
[/conditional][checkbox name="ABDdetailexam" memo="*" memo_size="small" value="-Abdomen - "][conditional field="ABDdetailexam" condition="(ABDdetailexam).is('-Abdomen - ')"][checkbox value="soft|nontender|nondistended|no voluntary/involuntary guarding|no rigidity|no rebound|bowel sounds present in all 4 quadrants"]; [comment memo="abnormals" memo_color="orange" memo_size="small"]
[checkbox name="examABDabn1" value="TTP-"][/conditional][conditional field="examABDabn1" condition="(examABDabn1).is('TTP-')"] [checkbox value="MILD|MODERATE|EXQUISITE|OUT OF PROPORTION TO EXAM|RUQ|EPIGASTRIC AREA|LUQ|RLQ|LLQ|PERIUMBILICAL|SUPRAPUBIC"];[/conditional][conditional field="ABDdetailexam" condition="(ABDdetailexam).is('-Abdomen - ')"][checkbox name="examABDabn2" value="BOWEL SOUNDS-"][/conditional][conditional field="examABDabn2" condition="(examABDabn2).is('BOWEL SOUNDS-')"] [checkbox value="HYPOACTIVE|HYPERACTIVE|RUQ|LUQ|RLQ|LLQ|DIFFUSELY"];[/conditional][conditional field="ABDdetailexam" condition="(ABDdetailexam).is('-Abdomen - ')"][checkbox name="examABDabn3" value="PALPABLE MASS-"][/conditional][conditional field="examABDabn3" condition="(examABDabn3).is('PALPABLE MASS-')"] APPROXIMATE SIZE - [text size="5"] CM, [checkbox value="RUQ|LUQ|RLQ|LLQ|MIDLINE|PERIUMBILICAL|PULSATILE"];[/conditional][conditional field="ABDdetailexam" condition="(ABDdetailexam).is('-Abdomen - ')"][checkbox value="VISIBLE SCAR(S)"] [textarea memo="Abdomen free text" memo_size="small" rows="2"]
[/conditional][checkbox name="GUdetailexam" memo="*" memo_size="small" value="-GU - "][conditional field="GUdetailexam" condition="(GUdetailexam).is('-GU - ')"][checkbox name="GUdetailexamfemale" memo="female" memo_size="small" memo_color="red" value=""][/conditional][conditional field="GUdetailexamfemale" condition="(GUdetailexamfemale).is('')"][checkbox name="examGUF" value="normal appearance of external genitalia|normal appearance of vagina|normal appearance of vaginal mucosa|no vaginal discharge|no cervical discharge|no CMT|no uterine tenderness|no adnexal tenderness|IUD string visualized|no tender inguinal lymphadenopathy b/l"]; [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox name="examGUabnF1" value="VAGINAL DISCHARGE-"][/conditional][conditional field="examGUabnF1" condition="(examGUabnF1).is('VAGINAL DISCHARGE-')"] [text default="color/consistency-" size="80"];[/conditional][conditional field="GUdetailexamfemale" condition="(GUdetailexamfemale).is('')"][checkbox name="examGUabnF2" value="VAGINAL MUCOSA-"][/conditional][conditional field="examGUabnF2" condition="(examGUabnF2).is('VAGINAL MUCOSA-')"] [text size="80"];[/conditional][conditional field="GUdetailexamfemale" condition="(GUdetailexamfemale).is('')"][checkbox name="examGUabnF3" value="VAGINAL TENDERNESS|CERVICAL MOTION TENDERNESS|CERVICAL DISCHARGE-"][/conditional][conditional field="examGUabnF3" condition="(examGUabnF3).is('CERVICAL DISCHARGE-')"] [text default="color/consistency-" size="80"];[/conditional][conditional field="GUdetailexamfemale" condition="(GUdetailexamfemale).is('')"][checkbox name="examGUabnF4" value="ADNEXAL TENDERNESS|ADNEXAL MASS-"][/conditional][conditional field="examGUabnF4" condition="(examGUabnF4).is('ADNEXAL MASS-')"] [text default="location-" size="80"];[/conditional][conditional field="GUdetailexam" condition="(GUdetailexam).is('-GU - ')"][checkbox name="GUdetailexamMale" memo="male" memo_size="small" memo_color="blue" value=""][/conditional][conditional field="GUdetailexamMale" condition="(GUdetailexamMale).is('')"][checkbox value="penis normal appearance|penis normal palpatory texture|no penile discharge|scrotum normal appearance b/l|no scrotal ecchymosis/edema/erythema|scrotum freely mobile b/l|testes descended b/l|no palpatory testicular mass b/l|cremasteric reflex intact b/l|no palpable epididymal mass b/l|no palpable inguinal hernia on exam b/l|no tender inguinal lymphadenopathy b/l"][comment memo="for skin masses use 'Skin' section" memo_size="small"]; [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox name="examGUabnM1" value="PENILE DISCHARGE-"][/conditional][conditional field="examGUabnM1" condition="(examGUabnM1).is('PENILE DISCHARGE-')"] [text default="color/consistency-" size="80"];[/conditional][conditional field="GUdetailexamMale" condition="(GUdetailexamMale).is('')"][checkbox name="examGUabnM2" value="URETHRAL MEATUS-"][/conditional][conditional field="examGUabnM2" condition="(examGUabnM2).is('URETHRAL MEATUS-')"] [text size="80"];[conditional field="GUdetailexamMale" condition="(GUdetailexamMale).is('')"][checkbox name="examGUabnM3" value="PENIS TENDERNESS TO PALPATION|SCROTAL TENDERNESS TO PALPATION-"][/conditional][conditional field="examGUabnM3" condition="(examGUabnM3).is('SCROTAL TENDERNESS TO PALPATION-')"] [text default="location/severity-" size="80"];[/conditional][conditional field="GUdetailexamMale" condition="(GUdetailexamMale).is('')"][checkbox name="examGUabnM4" value="PALPABLE SCROTAL MASS-"][/conditional][conditional field="examGUabnM4" condition="(examGUabnM4).is('PALPABLE SCROTAL MASS-')"] palpable mass located [select value="R|L|B/L"] [text size="80" memo="location/size/texture" memo_size="small"];[/conditional][conditional field="GUdetailexamMale" condition="(GUdetailexamMale).is('')"][checkbox name="examGUabnM4" value="INGUINAL HERNIA EXAM-"][/conditional][conditional field="examGUabnM4" condition="(examGUabnM4).is('INGUINAL HERNIA EXAM-')"] palpable inguinal mass with valsalva on [select value="R side|L side|both sides"]
[/conditional][conditional field="GUdetailexam" condition="(GUdetailexam).is('-GU - ')"] [textarea memo="GU free text" memo_size="small" rows="2"]
[/conditional][checkbox name="skindetailexam" memo="*" memo_size="small" value="-Skin - "][conditional field="skindetailexam" condition="(skindetailexam).is('-Skin - ')"][checkbox name="examskin" value="warm|dry|intact|no edema|no erythema|no ecchymosis"]; [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox name="examskinabn1" value="JAUNDICE|ACROCYANOSIS|DIFFUSE/NON-FOCAL LESION(S)-"][/conditional][conditional field="examskinabn1" condition="(examskinabn1).is('DIFFUSE/NON-FOCAL LESION(S)-')"] LOCATION(S)- [checkbox value="FACE|FOREHEAD|ANTERIOR NECK|POSTERIOR NECK|ANTERIOR TRUNK|POSTERIOR TRUNK|R SHOULDER|L SHOULDER|R ARM|L ARM|R ELBOW|L ELBOW|R FOREARM|L FOREARM|R WRIST|L WRIST|R HAND DORSUM|L HAND DORSUM|R PALM|L PALM|R INGUINAL AREA|L INGUINAL AREA|R HIP|L HIP|R THIGH|L THIGH|R KNEE|L KNEE|R LEG|L LEG|R ANKLE|L ANKLE|R FOOT DORSUM|L FOOT DORSUM|R FOOT SOLE|L FOOT SOLE"]. DESCRIPTION- [checkbox name="examskinabn11" value="MACULAR|PAPULAR|LACEY APPEARANCE|PATCHY|SCATTERED|CLUSTERED|ROUGH TEXTURE|ERYTHEMATOUS|ECCHYMOSIS|SKIN/FLESH COLORED|HYPERPIGMENTED|HYPOPIGMENTED|NON-BLANCHING|SCALY|EXCORIATION|ULCERATION"], [textarea memo="add'l description" memo_color="orange" memo_size="small" rows="2"]
[/conditional][conditional field="skindetailexam" condition="(skindetailexam).is('-Skin - ')"][checkbox name="examskinabn2" value="FOCAL/ISOLATED LESION(S)-"]
[/conditional][conditional field="examskinabn2" condition="(examskinabn2).is('FOCAL/ISOLATED LESION(S)-')"][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('')"]---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="examskinabn2" condition="(examskinabn2).is('FOCAL/ISOLATED LESION(S)-')"][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('')"]---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="examskinabn2" condition="(examskinabn2).is('FOCAL/ISOLATED LESION(S)-')"][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('')"]---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="examskinabn2" condition="(examskinabn2).is('FOCAL/ISOLATED LESION(S)-')"][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="examskinabn2" condition="(examskinabn2).is('FOCAL/ISOLATED LESION(S)-')"][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('')"]---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][conditional field="skindetailexam" condition="(skindetailexam).is('-Skin - ')"] [textarea memo="Skin freetext" memo_size="small" rows="2"]
[/conditional][checkbox name="EXTdetailexam" memo="*" memo_size="small" value="-EXT - "][conditional field="EXTdetailexam" condition="(EXTdetailexam).is('-EXT - ')"][checkbox value="no gross deformities noted|no cyanosis|no clubbing|peripheral pulses 2/4 x4"]; [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox name="examEXTabn1" value="CLUBBING-"][/conditional][conditional field="examEXTabn1" condition="(examEXTabn1).is('CLUBBING-')"] [checkbox value="DIGITS UPPER EXTREMITY|GROSS DEFORMITY"] [text size="80"];[/conditional][conditional field="EXTdetailexam" condition="(EXTdetailexam).is('-EXT - ')"] [textarea memo="Extremities freetext" memo_size="small" rows="2"]
[/conditional][checkbox name="NEUROdetailexam" memo="*" memo_size="small" value="-Neuro - "][conditional field="NEUROdetailexam" condition="(NEUROdetailexam).is('-Neuro - ')"][checkbox value="mentating well|moves all extremities equally well|CN 2-12 grossly intact b/l|normal sensorium all 4 extremities|no gross motor deficits|Romberg negative|cerebellar testing normal|DTRs 2/4 x4|gait testing without abnormalities"]; [comment memo="abnormals" memo_color="orange" memo_size="small"][checkbox name="examNEUROabn1" value="SENSORY DEFICIT(S)- "][/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn11" value="Scalp "][/conditional][conditional field="examNEUROabn11" condition="(examNEUROabn11).is('Scalp ')"][checkbox value="R occipital|R parietal|R temporal|R frontal|R preauricular|R postauricular|L occipital|L parietal|L temporal|L frontal|L preauricular|L postauricular"] area(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn12" value="Face "][/conditional][conditional field="examNEUROabn12" condition="(examNEUROabn12).is('Face ')"][checkbox value="R preauricular|R mandibular angle|R cheek|R nasal bridge|R periorbital|R perioral|chin|submental|R submandibular|L preauricular|L mandibular angle|L cheek|L nasal bridge|L periorbital|L perioral|L submandibular"] area(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn13" value="Neck "][/conditional][conditional field="examNEUROabn13" condition="(examNEUROabn13).is('Neck ')"][select value="right|left"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior|middle"] aspect(s) [textarea rows="2" memo="description if needed" memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn14" value="Shoulder "][/conditional][conditional field="examNEUROabn14" condition="(examNEUROabn14).is('Shoulder ')"][checkbox value="right|left|anterior|posterior|medial|lateral"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn15" value="Chest/Trunk "][/conditional][conditional field="examNEUROabn15" condition="(examNEUROabn15).is('Chest/Trunk ')"][select value="right|left|midline"], [checkbox value="anterior|posterior|medial|lateral"], [select value="superior|inferior"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn16" value="Abdomen "][/conditional][conditional field="examNEUROabn16" condition="(examNEUROabn16).is('Abdomen ')"][checkbox value="periumbilical|epigastrium|RUQ|LUQ|RLQ|LLQ"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn17" value="Buttocks "][/conditional][conditional field="examNEUROabn17" condition="(examNEUROabn17).is('Buttocks ')"][checkbox value="right|left|midline|medial|lateral|perianal|gluteal cleft|cheek|gluteal fold|saddle"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn18" value="Inguinal "][/conditional][conditional field="examNEUROabn18" condition="(examNEUROabn18).is('Inguinal ')"][checkbox value="right|left|superior|inferior|medial|lateral"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn19" value="Male Genital "][/conditional][conditional field="examNEUROabn19" condition="(examNEUROabn19).is('Male Genital ')"][checkbox value="right|left|midline|b/l|penile glans|penile shaft|base of penis|scrotum|periscrotal"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn111" value="Female Genital "][/conditional][conditional field="examNEUROabn111" condition="(examNEUROabn111).is('Female Genital ')"][checkbox value="right|left|midline|labia majora|labia minora|perilabial area|periclitoral area|mons pubis|perineum"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn112" value="Arm "][/conditional][conditional field="examNEUROabn112" condition="(examNEUROabn112).is('Arm ')"][checkbox value="right|left|anterior|posterior|medial|lateral|superior|inferior|middle"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn113" value="Elbow "][/conditional][conditional field="examNEUROabn113" condition="(examNEUROabn113).is('Elbow ')"][checkbox value="right|left|anterior|posterior|medial|lateral|antecubital|olecranon|epicondylar"] aspect(s) [textarea rows="2" memo="description if needed" memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn114" value="Forearm "][/conditional][conditional field="examNEUROabn114" condition="(examNEUROabn114).is('Forearm ')"][checkbox value="right|left|anterior|posterior|medial|lateral|distal|proximal"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn115" value="Wrist "][/conditional][conditional field="examNEUROabn115" condition="(examNEUROabn115).is('Wrist ')"][checkbox value="right|left|anterior|posterior|volar|dorsal|medial|lateral"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn116" value="Hand/Finger(s) "][/conditional][conditional field="examNEUROabn116" condition="(examNEUROabn116).is('Hand/Finger(s) ')"][checkbox value="right|left|palmar/volar hand|dorsal hand|medial|lateral|thenar|hypothenar|1st digit|2nd digit|3rd digit|4th digit|5th digit|MCP|proximal phalanx|middle phalanx|distal phalanx|periungual|dorsal|volar|medial|lateral"]aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn117" value="Hip "][/conditional][conditional field="examNEUROabn117" condition="(examNEUROabn117).is('Hip ')"][checkbox value="right|left|anterior|posterior|medial|lateral"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn118" value="Thigh "][/conditional][conditional field="examNEUROabn118" condition="(examNEUROabn118).is('Thigh ')"][checkbox value="right|left|anterior|posterior|medial|lateral|superior|inferior|middle"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn119" value="Knee "][/conditional][conditional field="examNEUROabn119" condition="(examNEUROabn119).is('Knee ')"][checkbox value="right|left|anterior|posterior|medial|lateral"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn120" value="Leg "][/conditional][conditional field="examNEUROabn120" condition="(examNEUROabn120).is('Leg ')"][checkbox value="right|left|anterior|posterior|medial|lateral|superior|inferior|middle"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn121" value="Ankle "][/conditional][conditional field="examNEUROabn121" condition="(examNEUROabn121).is('Ankle ')"][checkbox value="right|left|anterior|posterior|medial|lateral"] aspect(s) [textarea rows="2" memo="description if needed"memo_size="small"]; [/conditional][conditional field="examNEUROabn1" condition="(examNEUROabn1).is('SENSORY DEFICIT(S)- ')"][checkbox name="examNEUROabn122" value="Foot/Toe(s) "][/conditional][conditional field="examNEUROabn122" condition="(examNEUROabn122).is('Foot/Toe(s) ')"][checkbox value="right|left|plantar|dorsal|medial|lateral|distal|proximal|1st digit|2nd digit|3rd digit|4th digit|5th digit|MTP|proximal phalanx|middle phalanx|distal phalanx|periungual area"] aspect(s) [textarea rows="2" memo="description of deficit" memo_size="small" memo_color="orange"]; [/conditional][conditional field="NEUROdetailexam" condition="(NEUROdetailexam).is('-Neuro - ')"][checkbox name="examNEUROabn2" value="MOTOR DEFICIT(S)- "][/conditional][conditional field="examNEUROabn2" condition="(examNEUROabn2).is('MOTOR DEFICIT(S)- ')"][checkbox name="examNEUROabn21" value="R UPPER EXTREMITY- "][/conditional][conditional field="examNEUROabn21" condition="(examNEUROabn21).is('R UPPER EXTREMITY')"]STRENGTH [text size="5"]/5; [/conditional][conditional field="examNEUROabn2" condition="(examNEUROabn2).is('MOTOR DEFICIT(S)- ')"][checkbox name="examNEUROabn22" value="L UPPER EXTREMITY- "][/conditional][conditional field="examNEUROabn22" condition="(examNEUROabn22).is('L UPPER EXTREMITY')"]STRENGTH [text size="5"]/5; [/conditional][conditional field="examNEUROabn2" condition="(examNEUROabn2).is('MOTOR DEFICIT(S)- ')"][checkbox name="examNEUROabn23" value="R LOWER EXTREMITY- "][/conditional][conditional field="examNEUROabn23" condition="(examNEUROabn23).is('R LOWER EXTREMITY- ')"]STRENGTH [text size="5"]/5; [/conditional][conditional field="examNEUROabn2" condition="(examNEUROabn2).is('MOTOR DEFICIT(S)- ')"]--[checkbox name="examNEUROabn24" value="L LOWER EXTREMITY- "][/conditional][conditional field="examNEUROabn24" condition="(examNEUROabn24).is('L LOWER EXTREMITY- ')"]STRENGTH [text size="5"]/5; [/conditional][conditional field="examNEUROabn2" condition="(examNEUROabn2).is('MOTOR DEFICIT(S)- ')"][text memo="motor deficit freetext" memo_size="small" size="80"]; [/conditional][conditional field="NEUROdetailexam" condition="(NEUROdetailexam).is('-Neuro - ')"][checkbox name="examNEUROabn3" value="ABNORMAL REFLEXES- "][/conditional][conditional field="examNEUROabn3" condition="(examNEUROabn3).is('ABNORMAL REFLEXES- ')"][checkbox value="BICEPS|TRICEPS|BRACIORADIALIS|PATELLAR|ACHILLES"] [text memo="abn reflexes freetext" memo_size="small" size="80"]; [/conditional][conditional field="NEUROdetailexam" condition="(NEUROdetailexam).is('-Neuro - ')"][checkbox name="examNEUROabn4" value="CEREBELLAR DEFICITS- "][/conditional][conditional field="examNEUROabn4" condition="(examNEUROabn4).is('CEREBELLAR DEFICITS- ')"][checkbox value="POSITIVE ROMBERG|PRONATOR DRIFT|IMPAIRED FINGER-TO-NOSE|IMPAIRED HAND PRONATE/SUPINATE|IMPARIED HEEL-TO-SHIN"] [text memo="cerebellar deficits freetext" memo_size="small" size="80"]; [/conditional][conditional field="NEUROdetailexam" condition="(NEUROdetailexam).is('-Neuro - ')"][checkbox name="examNEUROabn5" value="GAIT- "][/conditional][conditional field="examNEUROabn5" condition="(examNEUROabn5).is('GAIT- ')"][checkbox value="HEMIPLEGIC|DIPLEGIC|NEUROPATHIC|CHOREIFORM|ATAXIC|PARKINSONIAN"] [text memo="abn gait freetext" memo_size="small" size="80"]; [/conditional][conditional field="NEUROdetailexam" condition="(NEUROdetailexam).is('-Neuro - ')"] [textarea memo="Neuro Freetext" memo_size="small" rows="2"][/conditional]
Testing Ordered:
[checkbox name="Testing" value="Rapid flu|Rapid Strep|COVID State lab|COVID Quest|None"]
ASSESMENT: 
[checkbox name="variable_1" value="URI|Close exposure to COVID-19|Cough|Close exposure to COVID-19||Coronovirus infection, unspecified|Fatigue|Nasal Congestion|Close exposure to COVID-19|viral pneumonia|"]
[textarea name="variable_1" default="sample text"]

PLAN
Prescribe:
[checklist name="variable_1" value="Hydroxychloroquine Sulfate|Decadron|Z-pac|Tamiflu|ZyrTEC-D|Tessalon Perles|"]
Quarantine: [checkbox name="Quarantineintiated" value="Yes |No"]
Quarantine Orders:
[checkbox name="Quarantine" value="Mask on out of cell|Use appropriate PPE for assessment|BID symptom monitoring, Pulse oximeter readings, and temperature|Notify provider if SP02 less than 94%, fever greater than 100.4, respiratory distress, or change in mentation"]

Isolation: [checkbox name="Isolationintiated" value="Yes |No"]
Isolation Orders:
[checkbox name="Isolation" value="Single cell and mask on out of cell|Use appropriate PPE for assessment and transport|BID symptom monitoring with lung assessment, Pulse oximeter readings, respiratory rate, and temperature|Encourage hydration and provide supportive medications on MAR|Notify provider if SP02 less than 94%, respiratory distress, or change in mentation"]

End date of Quarantine/Isolation:
[date name="variable_1" default="04/04/2020"]
SUBJECTIVE: CHEIF COMPLAINT


Onset:
Y/O



Symptoms:


Therapies tried:


Pertinent hx:
High Risk Conditions:


Symptoms are since onset

STREP SCREENING: Is sore throat the main complaint without concurrent cold-like symptoms (nose/eyes/etc)? Choose 'yes' to bring up Centor Criteria
COVID-19 QUESTIONS: Documented fever:
Close contact with person with confirmed or suspected COVID-19:
Travel to high risk COVID-19 areas per current local guidance:

OBJECTIVE: PHYSICAL EXAM
Chaperone Vitals Brief Visual Exam * * * * * * * * * * *
Testing Ordered:

ASSESMENT:



PLAN
Prescribe:

Quarantine:
Quarantine Orders:


Isolation:
Isolation Orders:


End date of Quarantine/Isolation:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.81, 652 form elements, 75 boilerplate words, 48 text boxes, 34 text areas, 1 dates, 169 checkboxes, 2 check lists, 170 drop downs, 14 comments, 1 calculations, 213 conditionals, 1001 total clicks
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