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

Associated Pain (0=none, 10=severe)
Location: [text]
Radiation: [text]
Severity now (0-10): [text]
Severity at worst (0-10): [text]
Duration: [text]
Characterized as: [text].

The pain is relieved with [text]
[select value="no|YES"] <-- exertional pain
[select value="no|YES"] <-- pleuritic pain

Associated Symptoms:
[select value="no|YES"] <-- nausea/vomiting
[select value="no|YES"] <-- diaphoresis
[select value="no|YES"] <-- shortness of breath

Pertinent PMH
[select value="no|YES"] <-- Coronary Disease
[select value="no|YES"] <-- Cerebrovascular disease
[select value="no|YES"] <-- Diabetes Mellitus
[select value="no|YES"] <-- Peptic Ulcer or GERD
[select value="no|YES"] <-- Chest injury or overuse

Pertinent Medications:
[select value="no|YES"] <-- Aspirin was taken today
[select value="no|YES"] <-- Nitroglycerin

Pitfalls:
[select value="no|YES"] <-- unilateral leg swelling
[select value="no|YES"] <-- recent prolonged travel, recent trauma, hypercoagulable state, hormonal therapy

Cardiovascular risks are reviewed as follows:
Family history of Premature CAD or CVA (age less than 55): [text]
Tobacco use: [text]
Hyperlipidemia: [text]
Hypertension: [text]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference: contributed by Dr. Scott Moses, creator/author of the [link url="http://www.fpnotebook.com" memo="FP Notebook Site"] Family Practice Notebook[/conditional]