Altered Level of Consciousness History

Patient with altered level of consciousness

Onset [text] prior to evaluation
Onset while: [text]

Key Symptoms
[select value="no|YES"] <-- Confusion
[select value="no|YES"] <-- Agitation
[select value="no|YES"] <-- Difficult to awaken
[select value="no|YES"] <-- Complete Loss of Consciousness (lasted [text])
[select value="no|YES"] <-- Seizure
[select value="no|YES"] <-- Extremity weakness [text]
[select value="no|YES"] <-- Change in sensation [text]
[select value="no|YES"] <-- Headache
[select value="no|YES"] <-- Dizziness/Ataxia
[select value="no|YES"] <-- Falls [text]

Exposures
[select value="no|YES"] <-- Low blood sugar [text]
[select value="no|YES"] <-- Excessive alcohol
[select value="no|YES"] <-- Drug abuse

Pertinent ROS
[select value="no|YES"] <-- fever
[select value="no|YES"] <-- dizziness
[select value="no|YES"] <-- chest pain
[select value="no|YES"] <-- shortness of breath
[select value="no|YES"] <-- cough
[select value="no|YES"] <-- nausea/vomiting
[select value="no|YES"] <-- abdominal pain
[select value="no|YES"] <-- dysuria
[select value="no|YES"] <-- urinary frequency

Pertinent PMH:
[select value="no|YES"] <-- Dementia [text]
[select value="no|YES"] <-- Decreased mobility/ambulation [text]
[select value="no|YES"] <-- Diabetes Mellitus
[select value="no|YES"] <-- Cerebrovascular Accident
[select value="no|YES"] <-- Coronary Artery Disease
[select value="no|YES"] <-- COPD
[select value="no|YES"] <-- Cirrhosis
[select value="no|YES"] <-- Chronic renal failure
[select value="no|YES"] <-- Head Trauma
[select value="no|YES"] <-- Serious CNS risks (e.g. active cancer, immunosuppression, HIV)
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference: contributed by Dr. Scott Moses, creator/author of the Family Practice Notebook [link url="http://www.fpnotebook.com" memo="website"][/conditional]