Infeksion prova
[text size="3"]yo [select name="Sex" value="M|F"] presenting with: [comment memo="Initial questions"] -Sx include: [checkbox name="URTI" value="fever|cough|nose secretions|ear pain|lack of appetite|sore throat|pain with swallowing|other-"][conditional field="URTI" condition="(URTI).is('other-')"] [text size="50"][/conditional] [checkbox name="variable_2" value="for the past 1 day.|for the past 2 days.|for the past 3 days."] [text name="variable_3" default=""]. [conditional field="URTI" condition="(URTI).is('fever')"][comment memo="Fever related questions"] The fever has been as high as [text name="variable_4" default=" "] [checkbox name="variable_5" value="38C|38.5C|39C|39.5C |40C "] and has been treated with [text name="variable_7" default=""][checkbox name="variable_6" value="Ibuprofen|Paracetamol"][text name="variable_27" default=" "] , [checkbox name="variable_8" value="with good results.| without result."][/conditional] [conditional field="URTI" condition="(URTI).is('cough')"][comment memo="cough specific questions"]-Cough is [select name="prod" value="non-productive|productive"][conditional field="prod" condition="(prod).is('productive')"] -Cough started when/while [text memo="inciting event" size="80"] -Remedies/medicines attempted: [text size="80"] -Effect of attempted remedies/medicines: [text size="80"] -Since onset, sx have [select value="gotten better|gotten worse|stayed about the same"] -Patient describes severity is [select value="minimal|moderate|severe"] -Patient feels cough at nighttime [select value="not significantly affecting sleep|preventing adequate sleep"] -Patient reports [select value="no known|known"] sick contacts at home, school, or work. [text size="40"] -Other associated symptoms: --[select value="no|YES"] <-chest pain with coughing --[select value="no|YES"] <-coughing up blood --[select value="no|YES"] <-fever/chills --[select value="no|YES"] <-body aches --[select value="no|YES"] <-hoarseness --[select value="no|YES"] <-sore throat --[select value="no|YES"] <-runny/stuffy nose --[select value="no|YES"] <-ear pain --[select value="no|YES"] <-sinus pain --[select value="no|YES"] <-itchy/watery eyes --[select value="no|YES"] <-pain with swallowing --[select value="no|YES"] <-feeling of lump in throat (globus sensation) -Hx of these conditions: --[select value="no|YES"] <-recent cold --[select value="no|YES"] <-allergic rhinitis --[select value="no|YES"] <-non-allergic rhinitis --[select value="no|YES"] <-frequent sinus infection --[select value="no|YES"] <-asthma --[select value="no|YES"] <-frequent pneumonia --[select value="no|YES"] <-frequent bronchitis --[select value="no|YES"] <-GERD --[select value="no|YES"] <-head/neck/throat/thyroid/lung cancer --[select value="no|YES"] <-tuberculosis or positive tuberculin skin test --[select value="no|YES"] <-Diabetes Mellitus [/conditional] Appetite is [checkbox name="variable_18" value="normal.|decreased.|lower than normal."] Pt is [checkbox name="variable_9" value="active.|tired.|irritated."] No [checkbox name= value="sore throat| cough|nasal congestion|rhinorrhea| fever|fatigue|headache|abdominal pain|diarrhea|ear pain| facial pain|SOB |dyspnea|headache"]. The patient has [checkbox name="variable_10" value="been exposed to ill contacts.|not been exposed to ill contacts."] [checkbox name="variable_11" value="Attends day care."] [checkbox memo="Me shume" name="B" value=""][conditional field="B" condition="(B).is('')"][textarea]Allergies Medications FH MH/SH SocHx[/textarea][/conditional] Subjective General: The patient is alert and in [checkbox name="variable_12" value="no distress|mild distress|moderate distress"] [text name="variable_25" default=""]. Skin: [checkbox name="variable_14" value="wnl|Good turgor|no rash|no unusual bruising"][text name="variable_26" default=""]. Eyes: [checkbox name="variable_13" value="wnl|Conjunctiva clear|sclera non-icteric|PERRL"] [text name="variable_13" default=""]. Ears: [checkbox name="variable_15" value="wnl|No tenderness|EACs clear|TMs translucent & mobile, ossicles nl appearance|hearing intact"] [text name="variable_16" default=""]. Nose [checkbox name="variable_17" value="wnl| No external lesions| no nasal discharge| Mucosa non-inflamed| septum and turbinates normal"][text name="variable_17" default=""]. Mouth: [checkbox name="variable_19" value="wnl|Mucous membranes moist| no mucosal lesions"][text name="variable_19" default=""]. Pharynx: [checkbox name="variable_20" value="wnl|Mucosa non-inflamed| no tonsillar hypertrophy or exudate"] [text name="variable_20" default=""]. Neck: [checkbox name="variable_21" value="wnl|Supple.| Without adenopathy.| Thyroid non-enlarged and non-tender"] [text name="variable_21" default=""]. Heart: [checkbox name="variable_22" value="wnl|S1+S2+0| Regular Rate and Rhythm.| no murmur or gallop"] [text name="variable_22" default=""]. Lungs: [checkbox name="variable_23" value="wnl|Clear to auscultation| Normal vesicular breath sounds bilaterally.| No wheezes,rales or rubs"] [text name="variable_23" default=""]. Abdomen: [checkbox name="variable_24" value="wnl|Bowel sounds normal| no tenderness| no organomegaly"] [text name="variable_24" default=""]. Assessment [checkbox name="variable_28" value="Fever|Fever unspecified|Viral URI"] Plan [checkbox name="variable_30" value="Explained findings to the parent|Explained findings to the pt"] Use[text name="variable_32" default=" ml"] [checkbox name="variable_31" value="of Ibuprofen 100mg/5ml|Ibuprofen|every 8 hours"] and [text name="variable_34" default=" ml"] [checkbox name="variable_33" value="Paracetamol 120mg/5ml|Paracetamol| every 6 hours| use both interchangeably every 4 hours"]. [checkbox name="variable_38" value="Advised to come back if fever lasts more than 3 full days |Advised to bring child back if symptoms change or parents are worried| Recheck if not improved in five days or sooner if worsening. "]. [checkbox name="variable_35" value="Pt|Parents"] verbalized understanding and agreement
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Sandbox Metrics: Structured Data Index 0.7, 89 form elements, 39 boilerplate words, 23 text boxes, 1 text areas, 28 checkboxes, 29 drop downs, 3 comments, 5 conditionals, 157 total clicks
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