MSK HPI
[comment memo="Use with MSK HPI Questionnaire"] [text size="3"]yo [select value="M|F"] with MSK concern: -Onset: [text size="3"] [select value="days|weeks|months|years"] -Location: [text size="40"] -Inciting event: [select value="none|pain started when"] [text size="80"] -Pain Radiation: [text size="50"] -Timing: [select name="Timing" value="constant|comes and goes"][conditional field="Timing" condition="(Timing).is('comes and goes')"] --Portion of day when it occurs mostly: [text size="40"][/conditional] -Type/quality of pain: [select value="|sharp/knifelike|dull/pressure|both sharp and dull"] [text size="40"] -Action/activity that bothers most: [text size="50"] -Other aggravating actions/activities: [text size="80"] -Progression of pain: [select value="getting better|getting worse|staying the same"] -Severity of pain: [select value="1|2|3|4|5|6|7|8|9|10"]/10 -Previously seen for this: [select name="PV" value="no|YES"][conditional field="PV" condition="(PV).is('YES')"] --Number of visits: [text size="4"]. --Specialties seen: [checkbox value="primary care|physical therapy|orthopedist|chiropractor|acupuncturist|pain management specialist"] [text size="30"][/conditional] -Modalities attempted: [checkbox value="none|home remedies|stretches|rest|ice|heat|elevation|medications|physical therapy|injections|surgery"] -Effect of these modalities: [select value="helped pain|worsened pain|made no difference|mixed -see explanation"] -Other associated symptoms: --[select value="n/a|no|YES"] <-if knee involved, any locking up of joint when attempting movement --[select value="n/a|no|YES"] <-if knee involved, any buckling or giving-out of joint with use --[select value="n/a|no|YES"] <-if joint involved, any swelling --[select value="n/a|no|YES"] <-if joint involved, any stiffness --[select value="no|YES"] <-any fevers or chills --[select value="no|YES"] <-any recent tick exposure within the past year [textarea memo="provide additional comments and concerns here"] [comment memo="For use in CRDAMC FM Clinic"]
Result - Copy and paste this output:
Sandbox Metrics: Structured Data Index 0.59, 33 form elements, 99 boilerplate words, 11 text boxes, 1 text areas, 2 checkboxes, 15 drop downs, 2 comments, 2 conditionals, 44 total clicks
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