Subjective/History Elements
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[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"]
Use with MSK HPI Questionnaire
yo with MSK concern:
-Onset:
-Location:
-Inciting event:
-Pain Radiation:
-Timing:
-Type/quality of pain:
-Action/activity that bothers most:
-Other aggravating actions/activities:
-Progression of pain:
-Severity of pain: /10
-Previously seen for this:
-Modalities attempted:
-Effect of these modalities:
-Other associated symptoms:
-- <-if knee involved, any locking up of joint when attempting movement
-- <-if knee involved, any buckling or giving-out of joint with use
-- <-if joint involved, any swelling
-- <-if joint involved, any stiffness
-- <-any fevers or chills
-- <-any recent tick exposure within the past year
provide additional comments and concerns here

For use in CRDAMC FM Clinic
Result - Copy and paste this output: