[text size="3"] yo [select value="female|male"] complains of [checkbox value="dysuria|frequency|urgency|dysuria|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.
Pertinent symptoms present: [checkbox value="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: [checkbox value="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"]
[comment memo="For use in CRDAMC FM clinic"]
Result - Copy and paste this output: