Subjective/History Elements
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[text size="3"] yo [select value="female|male"] complains of [checkbox value="dysuria|frequency|urgency|incontinence|hematuria|cloudy urine|fever|chills|vaginal discharge|flank pain"] starting [text size="3"] day(s) ago.

Patient [select value="has not|has"] had a UTI in the past.

Review of systems:
[select value="no|YES"]<-symptoms >7 days duration
[select value="no|YES"]<-shaking chills
[select value="no|YES"]<-flank pain
[select value="no|YES"]<-temp >101F
[select value="no|YES"]<-nausea
[select value="no|YES"]<-vomiting
[select value="no|YES"]<-abdominal pain
[select value="no|YES"]<-change in vaginal discharge or odor
[select value="no|YES|n/a"]<-painful intercourse

Risk factors present:
[select value="no|YES"]<-pyelonephritis within the last 3 months
[select value="no|YES"]<-diabetes
[select value="no|YES"]<-pregnancy
[select value="no|YES"]<-immunosuppression
[select value="no|YES"]<-kidney stones
[select value="no|YES"]<-kidney failure
[select value="no|YES"]<-catheterization within the last 2 weeks
[select value="no|YES"]<-hospitalization or nursing home residency within the last 2 weeks
[select value="no|YES"]<-4 or more UTIs within the last 12 months
[select value="no|YES"]<-antibiotic for a UTI in the last 4 weeks

[comment memo="For use in CRDAMC FM clinic"]
yo complains of starting day(s) ago.

Patient had a UTI in the past.

Review of systems:
<-symptoms >7 days duration
<-shaking chills
<-flank pain
<-temp >101F
<-nausea
<-vomiting
<-abdominal pain
<-change in vaginal discharge or odor
<-painful intercourse

Risk factors present:
<-pyelonephritis within the last 3 months
<-diabetes
<-pregnancy
<-immunosuppression
<-kidney stones
<-kidney failure
<-catheterization within the last 2 weeks
<-hospitalization or nursing home residency within the last 2 weeks
<-4 or more UTIs within the last 12 months
<-antibiotic for a UTI in the last 4 weeks

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