Surgery Presentation Template

Patient Name:[text name="variable_1" default=""]
Room #: [text name="variable_2" default=""]
One Liner: This is a [text name="variable_3" default=""] y.o. [select name="variable_4" value="male|female"] that is post operative day [text name="variable_5" default=""] after a [text name="variable_6" default=""]. 
Subjective: Pt reports [textarea name="variable_7" default=""].  Pain is [select name="variable_8" value="well controlled|not well controlled"] on [text name="variable_9" default=""].  Pt [select name="variable_10" value="has had|has not had"] a [select name="variable_11" value="BM|passage of flatus|BM & passage of flatus"].  They [select name="variable_12" value="have been able to|have not been able to"] ambulate.  
Medications: [textarea name="variable_17" default=""]
Vitals: [select name="variable_13" value="Grossly Normal|Abnormal"]
BP: [text name="variable_44" default=""] mmHg; HR: [text name="variable_45" default=""] beats/min; RR: [text name="variable_46" default=""] breaths/min; Temp: [text name="variable_47" default=""]C; SaO2: [text name="variable_48" default=""]% [text name="variable_49" default="O2 Requirement"]
I&Os:[text name="variable_14" default=""]
    General: [checkbox name="variable_50" value="No Apparent Distress|Well Appearing|Alert|Interactive"] [text name="variable_51" default=""]
    HEENT: [checkbox name="variable_52" value="Normocephalic/Atraumatic|PERRl|EOMI|Good Conjugate Gaze|Nares Patent|MMM"] [text name="variable_53" default=""]
    Neck: [checkbox name="variable_54" value="Supple|No LAD|Normal ROM"] [text name="variable_55" default=""]
    Respiratory: [checkbox name="variable_56" value="Normal Respiratory Effort|No Wheezing|No Ronchi|No Rales|CTAB"] [text name="variable_57" default=""]
    Cardiovascular: [checkbox name="variable_58" value="RRR|S1/S2 Heart Sounds|No m/r/g"] [text name="variable_59" default=""]
    Abdominal: [checkbox name="variable_60" value="Soft|Non-distended|Non-tender|Normal Bowel Sounds|No palpable Masses"] [text name="variable_61" default=""]
    Extremities: [checkbox name="variable_62" value="Normal Tone|Normal ROM|Strength Intact|Sensation Intact|Capillary Refill <2sec"] [text name="variable_63" default=""]
    Neurological: [checkbox name="variable_64" value="A&OX3|Cranial Nerves 2-12 Intact|Reflex Symmetric|Sensation Normal|Gait Normal"] [text name="variable_66" default=""]
    Skin: [checkbox name="variable_67" value="Intact|No Rashes|No Lesions|No Erythema"] [text name="variable_68" default=""]
    Labs:
    Hgb: [text name="variable_69" default=""]
    Hct: [text name="variable_70" default=""]
    WBC: [text name="variable_71" default=""]
    Plt: [text name="variable_72" default=""]
    PT: [text name="variable_73" default=""]
    PTT: [text name="variable_74" default=""]
    INR: [text name="variable_75" default=""]
    Na: [text name="variable_76" default=""]
    K: [text name="variable_77" default=""]
    Cl: [text name="variable_78" default=""]
    HCO3: [text name="variable_79" default=""]
    BUN: [text name="variable_80" default=""]
    Cr: [text name="variable_81" default=""]
    Glucose: [text name="variable_82" default=""]
    Ca: [text name="variable_83" default=""]
    Mg: [text name="variable_84" default=""]
    PO4: [text name="variable_85" default=""]
    Bili: [text name="variable_86" default=""]
    AST: [text name="variable_87" default=""]
    ALT: [text name="variable_88" default=""]
    ALKP: [text name="variable_89" default=""]
    Other Labs:[textarea name="variable_90" default=""]
    Imaging: [textarea name="variable_91" default=""]
Assessment/Plan: [textarea name="variable_92" default=""]