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[text size="3"]yo [select name="Sex" value="M|F"] with gastrointestinal symptoms:
[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="GI" condition="(GI).is('other-')"]
[text size="50"][/conditional]

[conditional field="URTI" condition="(URTI).is('fever')"][comment memo="Fever related questions"] 
[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=""].
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=" ml"][checkbox name="variable_6" value="Ibuprofen,|Paracetamol"][text name="variable_27" default="  ml"] , [checkbox name="variable_8" value="with good results.| without result."]
[text size="50"]
[/conditional]

History of present illness
Chief complaint
I have a cough that is really bothering me.
Cough productive of sputum
Not usually. But in the past few days, yes, I have been coughing up some gunk.
Color of sputum
It is greenish.
Volume of sputum 
I would say about 1 teaspoon per day.
Blood in sputum
No.
Onset
3–4 months ago.
Constant/intermittent
It comes and goes.
Precipitating events
The first time I had it was at one of my gymnastics classes. Nothing special was really going on with me at the time though.
Progression
It had been the same until about 4 days ago, but then it suddenly got a lot worse.
Previous episodes
No.
Frequency
On and off, until 4 days ago. Now I have it several times a day.
Alleviating factors
Nothing really.
Aggravating factors
When exercising I will suddenly have a big cough attack and have to stop. It is so annoying.
Associated symptoms
Sometimes when I have the cough attacks, I also feel like I cannot catch my breath, which is scary.
Review of systems specific to recurrent cough
Recent travel 
No.
Headache 
No.
Nausea/vomiting
No.
Fever/chills
Hmm, I felt a bit hot in the evening the past 2 days.
Night sweats 
No.
Fatigue
No.
Racing of the heart
None.
Chest pain
For the past 4 days, my cough has been painful.
Urinary problems
None.
Bowel problems
None.
Sleep problems 
For the past month, this cough has woken me up several times during the night, so my sleep has not been as good as it normally is.
Appetite
Normal.
Weight changes 
No.
Recent infections
Well, I have a cold, if that is what you mean.
Symptoms of upper respiratory infection 
I have had a runny nose for the past 5 days.
Exposure to tuberculosis
No.
Exposure to fumes/dust 
No.
Exposure to animals/pets 
No.
Past medical history, family history, social history
Past medical history
I have eczema. 
Allergies
I think I am allergic to horses. My eczema has always gotten worse when I have gone riding.
Medications
I use a couple of different moisturizing creams for my eczema, and when it gets really bad I have to use a hydrocortisone cream.
Hospitalizations
Never, thank God!
Ill contacts
No.
Past surgical history
No.
Family history
My mom also has eczema.
Work
I am going to college to become a graphic designer.
Home
I live in a dorm.
Alcohol
Sometimes I drink a beer at parties, but I do not drink regularly.
Recreational drugs
I smoke marijuana sometimes or try one of the pills I get offered at the parties I go to. But I do not take something everyday or anything like that.
Tobacco
I do not smoke cigarettes, only marijuana once in a while.
Exercise
I have done gymnastics since I was little, and I am on the college gymnastics team, but now I have trouble getting through practice because of these awful cough attacks.
Focused physical examination
Washed hands
Used respectful draping
Head, eyes, ears, nose, and throat examination
Inspection of the oropharynx
Neck examination
Palpation of the lymph nodes of the head and neck
Cardiovascular examination
Auscultation of the heart
Chest examination
Inspection of the chest
Palpation of the chest
Percussion of the lung fields
Auscultation of the lungs
Examination for fremitus
Extremities
Inspection of the hands