Subjective/History Elements
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The patient is a [text default="AGE"] year-old [select name="variable_sex" value="male|female"] who presents to the [text default="Medicine"] Clinic complaining of [text default="CHIEF COMPLAINT"] that began [text default="ONSET"] while [text default="CONTEXT"]. Symptoms have been [text default="TIMING"] since onset and [select name="variable_sex1" value="he|she"] rates them as [text default="SEVERITY"] in severity. Patient reports the symptoms are located [text default="LOCATION"] and describes the quality as [text default="QUALITY"]. Per patient, [select name="variable_sex1" value="he|she"] has had associated [text default="POSITIVE SYMPTOMS"] but denies any [text default="NEGATIVE SYMPTOMS"]. Symptoms are improved with [text default="MODIFYING FACTOR"] and exacerbated by [text default="MODIFYING FACTOR"]. Patient [select name="variable_reports" value="reports|denies"] history of similar symptoms. Pertinent medical history includes [text default="PERTINENT PAST MEDICAL HISTORY"]. Patient adds [text default="OTHER DETAILS"].

***** PREVENTIVE MEDICINE *****
DM is [select name="variable_dm" value="appropriately controlled|poorly controlled."]
- Glucose value today: [text name="variable_BS_today" default="ENTER ACCUCHECK"] mg/dL
- Prescribed medication regimen: [text name="variable_bsmeds" default="DM Meds"]
- Most recent: A1C [text name="variable_last_a1c" default="LAST A1C"]%
- Last eye exam: [date name="variable_eye" default="11/02/2018"]
- Last foot exam: [date name="variable_foot" default="11/02/2018"]

HTN is [select name="variable_htn" value="appropriately controlled|poorly controlled."]
- Current 10 year ASCVD risk: [select name="variable_2" value="recommend high intensity statin therapy|recommend moderate intensity statin therapy|recommend low-intensity statin therapy|no indication for statin therapy at this time"]
- Goal blood pressure is 140/90 mmHG
- Prescribed medication regimen: [text name="variable_htnmeds" default="BP meds"]

Immunization Hx:
- Pneumococcal vaccine given - [select name="variable_pna" value="Yes|No"]
- Influenza given this season - [select name="variable_inf" value="Yes|No"]
- Hep B - for unvaccinated adults 19-59 given - [select name="variable_hBV" value="Yes|No"]

Screening Procedures:
[text name="variable_1" default="xx/xx/xxxx"] Colonoscopy:
[text name="variable_2" default="xx/xx/xxxx"] Mammogram:
[text name="variable_3" default="xx/xx/xxxx"] Pap-smear:
[text name="variable_4" default="xx/xx/xxxx"] DEXA scan:
The patient is a year-old who presents to the Clinic complaining of that began while . Symptoms have been since onset and rates them as in severity. Patient reports the symptoms are located and describes the quality as . Per patient, has had associated but denies any . Symptoms are improved with and exacerbated by . Patient history of similar symptoms. Pertinent medical history includes . Patient adds .

***** PREVENTIVE MEDICINE *****
DM is
- Glucose value today: mg/dL
- Prescribed medication regimen:
- Most recent: A1C %
- Last eye exam:
- Last foot exam:

HTN is
- Current 10 year ASCVD risk:
- Goal blood pressure is 140/90 mmHG
- Prescribed medication regimen:

Immunization Hx:
- Pneumococcal vaccine given -
- Influenza given this season -
- Hep B - for unvaccinated adults 19-59 given -

Screening Procedures:
Colonoscopy:
Mammogram:
Pap-smear:
DEXA scan:
Result - Copy and paste this output: