Subjective/History Elements
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[comment memo="Male genitourinary symptoms HPI"]
[text size="4"] yo M presents with the following GU sx: [checkbox name="maleGUsxdischarge" value="penile discharge"][conditional field="maleGUsxdischarge" condition="(maleGUsxdischarge).is('penile discharge')"](color/consistency - [text size="60"]), [/conditional][checkbox value="penis tenderness|scrotal pain|penis rash/lesion|pain with urinating|urinary frequency|urinary urgency|blood in urine|blood in semen"][checkbox name="maleGUsxdifficulturine" value="difficulty urinating"][conditional field="maleGUsxdifficulturine" condition="(maleGUsxdifficulturine).is('difficulty urinating')"] (last urinated [text size="5"][select value="minute(s)|hour(s)|day(s)"] ago, amount was [select value="a drop|scant/small|average amt|large amt"])[/conditional][checkbox name="maleGUsxfreetext" memo="other sx" memo_size="small" value=""][conditional field="maleGUsxfreetext" condition="(maleGUsxfreetext).is('')"] [textarea rows="2"]
[/conditional]-Symptoms started [text size="3"] [select value="hour(s)|day(s)|week(s)|month(s)|year(s)"] ago.
-Sx first noticed while: [text size="80"]
-Sx are located [text size="50"]
-Sx character/quality is: [checkbox name="maleGUsxchar" value="N/A"][conditional field="maleGUsxchar" condition="(maleGUsxchar).isNot('N/A')"][checkbox value="both sharp and dull|sharp/knifelike|dull/pressure|burning|tingling"][checkbox name="maleGUsxcharfreetext" memo="freetext for character/quality" memo_size="small" value=""][/conditional][conditional field="maleGUsxcharfreetext" condition="(maleGUsxcharfreetext).is('')"][text size="80"][/conditional]
-Sx [select name="maleGUsxradiate" value="do not travel/radiate|travel/radiate to "][conditional field="maleGUsxradiate" condition="(maleGUsxradiate).is('travel/radiate to ')"][text size="80"][/conditional]
-Sx timing is [select name="maleGUsxtiming" value= "constant|intermittent/comes and goes"][conditional field="maleGUsxtiming" condition="(maleGUsxtiming).is('intermittent/comes and goes')"]
-Sx episodes last [text size="5"][select value="second(s)|minute(s)|hour(s)|day(s)|week(s)|month(s)"][/conditional]
-Sx are [select value="the same|getting worse|getting better"] since onset
[checkbox name="maleGUsxpainscale" memo="pain scale if applicable" memo_size="small" value=""][conditional field="maleGUsxpainscale" condition="(maleGUsxpainscale).is('')"]-Pain rated as [text size="4"]/10 in severity currently, at its worst [text size="4"]/10
[/conditional]
-Symptoms are improved with [checkbox name="maleGUsxmodifierimprove" value="nothing"][conditional field="maleGUsxmodifierimprove" condition="(maleGUsxmodifierimprove).is('nothing')"] - therapies attempted include [text size ="80"][/conditional][conditional field="maleGUsxmodifierimprove" condition="(maleGUsxmodifierimprove).isNot('nothing')"][text size ="80"][/conditional]
-Symptoms are worsened by [text size="80"].
-Patient [select value="denies|admits to"] history of similar symptoms previously
-Sexually active? [select name="maleGUsxSex" value="no|Yes"][conditional field="maleGUsxSex" condition="(maleGUsxSex).is('Yes')"]
-Number of sexual partners in past year *[text size="3"]*[/conditional]

Associated Sx/Review of Systems:
[select value="no|YES"] <-- fever/chills
[select value="no|YES"] <-- decreased appetite
[select value="no|YES"] <-- nausea
[select value="no|YES"] <-- vomiting
[select value="no|YES"] <-- diarrhea
[select value="no|YES"] <-- constipation
[select value="no|YES"] <-- black or bloody stool

Pertinent PMH
[select name="maleGUrosSTD" value="no|YES"] <-- STD[conditional field="maleGUrosSTD" condition="(maleGUrosSTD).is('YES')"] - [comment memo="include which type, how long ago, and how many prior episodes" memo_size="small" memo_color="orange"][textarea rows="2"][/conditional]
[select value="no|YES"] <-- Epididymitis
[select value="no|YES"] <-- Prostatitis
[select value="no|YES"] <-- BPH
[select value="no|YES"] <-- Prostate Cancer
[select value="no|YES"] <-- Kidney stones
[select value="no|YES"] <-- Urinary tract infections
[select value="no|YES"] <-- Diverticulitis

Pertinent Past Surgeries:
[select value="no|YES"] <-- Appendectomy
[select value="no|YES"] <-- Prostatectomy
[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][comment memo="For use in CRDAMC FM Clinic"]
Male genitourinary symptoms HPI
yo M presents with the following GU sx: other sx-Symptoms started ago.
-Sx first noticed while:
-Sx are located
-Sx character/quality is:
-Sx
-Sx timing is
-Sx are since onset
pain scale if applicable
-Symptoms are improved with
-Symptoms are worsened by .
-Patient history of similar symptoms previously
-Sexually active?

Associated Sx/Review of Systems:
<-- fever/chills
<-- decreased appetite
<-- nausea
<-- vomiting
<-- diarrhea
<-- constipation
<-- black or bloody stool

Pertinent PMH
<-- STD
<-- Epididymitis
<-- Prostatitis
<-- BPH
<-- Prostate Cancer
<-- Kidney stones
<-- Urinary tract infections
<-- Diverticulitis

Pertinent Past Surgeries:
<-- Appendectomy
<-- Prostatectomy
display/hide referencesFor use in CRDAMC FM Clinic
Result - Copy and paste this output: