Cervical Cancer Screening Tool

Cervical Cancer Screening Tool
[select name="Qpurpose" value="Screening Recommendation|Pap and HPV Test Interpretation"] <-- Purpose
[select name="Qage" value="Less than 21=5000|21 to 24=4000|25 to 29=3000|30 to 34=2000|35 to 65=1000|Greater than 65=0"] <-- Age
[remark]Screening[/remark][conditional field="Qpurpose|Qage" condition="(Qpurpose).is('Screening Recommendation')&&(Qage).is('Greater than 65=0')"]
Risk Assessment:
[select name="Qrisk1" value="No=0|Yes=10"] <-- History of abnormal screening
[select name="Qrisk2" value="No=0|Yes=10"] <-- Unknown screening history
[select name="Qrisk3" value="No=0|Yes=10"] <-- Previous HPV-related disease
[select name="Qrisk4" value="No=0|Yes=10"] <-- New partners
[select name="Qrisk5" value="No=0|Yes=10"] <-- Current smoker or history of smoking
[select name="Qrisk6" value="No=0|Yes=10"] <-- Immunocompromised
[select name="Qrisk7" value="No=0|Yes=10"] <-- In utero diethylstilbestrol exposure

Prior Screening:
[select name="Qprior1" value="Yes=0|No=100"] <-- Two negative consecutive co-tests OR Three negative Pap tests within the past 10 years
[select name="Qprior2" value="Yes=0|No=100"] <-- Most recent test within the previous five years

Recommendation --> [calc memo="suggestion" value="score=(Qage)+(Qrisk1)+(Qrisk2)+(Qrisk3)+(Qrisk4)+(Qrisk5)+(Qrisk6)+(Qrisk7)+(Qprior1)+(Qprior2);score>4999?'Begin screening with Pap Test at age 21':score>2999?'Pap Test every 3 years is recommended':score>999?'Co-testing with Pap Test and HPV Testing every 5 years is recommended':score>200?'Inadequate prior screening with risk factors - Continued screening is recommended':score>199?'Inadequate prior screening with no risk factors - Continued screening is recommended':score>100?'Inadequate prior screening with risk factors - Continued screening is recommended':score>99?'Inadequate prior screening with no risk factors - Continued screening is recommended':score>0?'Adequate prior screening with risk factors - Continued screening is recommended':'Adequate prior screening with no risk factors - Consider discontinuation of screening'"][/conditional][conditional field="Qpurpose|Qage" condition="(Qpurpose).is('Screening Recommendation')&&(Qage).isNot('Greater than 65=0')"]

Recommendation --> [calc memo="suggestion" value="score2=(Qage);score2>4999?'Begin screening with Pap Test at age 21':score2>2999?'Pap Test every 3 years is recommended':score2>999?'Co-testing with Pap Test and HPV Testing every 5 years is recommended':score2>200?'Inadequate prior screening with risk factors - Continued screening is recommended':score2>199?'Inadequate prior screening with no risk factors - Continued screening is recommended':score2>100?'Inadequate prior screening with risk factors - Continued screening is recommended':score2>99?'Inadequate prior screening with no risk factors - Continued screening is recommended':score2>0?'Adequate prior screening with risk factors - Continued screening is recommended':'Adequate prior screening with no risk factors - Consider discontinuation of screening'"][/conditional][conditional field="Qpurpose" condition="(Qpurpose).is('Pap and HPV Test Interpretation')"][remark]

Pap interpretation[/remark]
[select name="Qpapfinding" value="Unsatisfactory Cytology|Cytology negative, EC/TZ absent or insufficient|Cytology negative|Atypical Squamous Cells of Undetermined Significance - ASC-US|Low-grade Squamous Intraepithelial Lesion - LSIL|Atypical Squamous Cells - cannot exclude High-grade SIL - ASC-H|High-grade Squamous Intraepithelial Lesions - HSIL|Atypical Glandular Cells - AGC"] <-- Cytology Result[/conditional][remark]

Unsatisfactory Cytology
[/remark][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Unsatisfactory Cytology')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))"]
Recommendation --> Repeat cytology after 2-4 months - OR - Colposcopy may be performed if HPV positive.  See [link memo="Unsatisfactory cytology age 30 and over" url="//soapnote.org/women/unsatisfactory-cytology-30-plus/"][/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Unsatisfactory Cytology')&&((Qage).is('21 to 24=4000')||(Qage).is('25 to 29=3000'))"]
Recommendation --> Repeat cytology after 2-4 months.  See [link memo="Unsatisfactory cytology age 21 to 29" url="//soapnote.org/women/unsatisfactory-cytology-21-to-29/"][/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Unsatisfactory Cytology')&&(Qage).is('Less than 21=5000')"]
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening.   You may consider repeating cytology at age 21 or in 12 months, whichever comes later.[/conditional][remark]

Cytology negative, EC/TZ absent
[/remark][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative, EC/TZ absent or insufficient')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))"]
Recommendation --> Further action is based on the HPV result.  See [link memo="EC/TZ absent age 30 and over" url="//soapnote.org/women/ectz-absent-30-plus/"][/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative, EC/TZ absent or insufficient')&&((Qage).is('21 to 24=4000')||(Qage).is('25 to 29=3000'))"]
Recommendation --> Continue routine screening with Pap Smear (cytology only) every 3 years.  [/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative, EC/TZ absent or insufficient')&&(Qage).is('Less than 21=5000')"]
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening.   You may consider repeating cytology at age 21 or in 12 months, whichever comes later.[/conditional][remark]

Cytology negative
[/remark][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative')&&(Qage).is('Greater than 65=0')"]
[select name="Qhpv65up" value="Unknown|Negative|Positive"] <-- What is the HPV result?  [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qhpv65up" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative')&&(Qage).is('Greater than 65=0')&&((Qhpv65up).is('Negative')||(Qhpv65up).is('Unknown'))"]
Recommendation --> Continue routine screening with Pap smear (cytology only) every 3 years or Co-Testing (cytology and HPV testing) every 5 years.  Consider discontinuing screening if patient has had adequate prior screening and is not high risk.[/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qhpv65up" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative')&&(Qage).is('Greater than 65=0')&&(Qhpv65up).is('Positive')"]
Recommendation --> Repeat cotesting at 1 year -OR- HPV DNA typing now is acceptable.  See [link memo="HPV positive age 30 and over" url="//soapnote.org/women/negative-cytology-positive-hpv-30-plus/"][/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000'))"]
[select name="Qhpv3065" value="Unknown|Negative|Positive"] <-- What is the HPV result?  [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qhpv3065" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000'))&&((Qhpv3065).is('Negative')||(Qhpv3065).is('Unknown'))"]
Recommendation --> Continue routine screening with Pap smear (cytology only) every 3 years or Co-Testing (cytology and HPV testing) every 5 years.  [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qhpv3065" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000'))&&(Qhpv3065).is('Positive')"]
Recommendation --> Repeat cotesting at 1 year -OR- HPV DNA typing now is acceptable.  See [link memo="HPV positive age 30 and over" url="//soapnote.org/women/negative-cytology-positive-hpv-30-plus/"][/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative')&&((Qage).is('21 to 24=4000')||(Qage).is('25 to 29=3000'))"]
Recommendation --> Screen every 3 years with cytology.  [/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Cytology negative')&&(Qage).is('Less than 21=5000')"]
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening.  You may consider repeating cytology at age 21 or in 12 months, whichever comes later. [/conditional][remark]

ASC-US
[/remark][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&(Qage).is('Less than 21=5000')"]
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&(Qage).is('21 to 24=4000')"]
Recommendation --> Either Reflex HPV Testing (acceptable) or Repeat Cytology at 12 months (preferred) may be performed.
[select name="Qascus2124" value="Reflex HPV Testing|Repeat Cytology"] <-- Which follow-up study is chosen?[/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qascus2124" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&(Qage).is('21 to 24=4000')&&(Qascus2124).is('Reflex HPV Testing')"]
[select name="Qascus2124hpv" value="Negative|Positive"] <-- What is the reflex HPV result?[/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qascus2124|Qascus2124hpv" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&(Qage).is('21 to 24=4000')&&(Qascus2124).is('Reflex HPV Testing')&&(Qascus2124hpv).is('Positive')"]
Recommendation --> Repeat Cytology at 12 months.  See [link memo="Women age 21-24 with ASC-US" url="//soapnote.org/women/ascus-repeat-cytology-21-to-24/"][/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qascus2124|Qascus2124hpv" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&(Qage).is('21 to 24=4000')&&(Qascus2124).is('Reflex HPV Testing')&&(Qascus2124hpv).is('Negative')"]
Recommendation --> Resume routine screening. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qascus2124" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&(Qage).is('21 to 24=4000')&&(Qascus2124).is('Repeat Cytology')"]
Recommendation --> Repeat Cytology at 12 months.  See [link memo="Women age 21-24 with ASC-US" url="//soapnote.org/women/ascus-repeat-cytology-21-to-24/"][/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&((Qage).is('25 to 29=3000')||(Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))"]
Recommendation --> Either Repeat Cytology at 12 months (acceptable) or HPV Testing (preferred) may be performed.
[select name="Qascus25up" value="Repeat Cytology|HPV Testing"] <-- Which follow-up study is chosen?[/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qascus25up" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&((Qage).is('25 to 29=3000')||(Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qascus25up).is('Repeat Cytology')"]
[select name="Qascusrepeatcytology" value="Negative|ASC-US, LSIL, ASC-H, AGC, or HSIL"] <-- What is the follow up cytology result at 12 months? [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qascus25up|Qascusrepeatcytology" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&((Qage).is('25 to 29=3000')||(Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qascus25up).is('Repeat Cytology')&&(Qascusrepeatcytology).is('Negative')"]
Recommendation --> Resume routine screening. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qascus25up|Qascusrepeatcytology" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&((Qage).is('25 to 29=3000')||(Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qascus25up).is('Repeat Cytology')&&(Qascusrepeatcytology).is('ASC-US, LSIL, ASC-H, AGC, or HSIL')"]
Recommendation --> Colposcopy. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qascus25up" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&((Qage).is('25 to 29=3000')||(Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qascus25up).is('HPV Testing')"]
[select name="Qascushpv" value="Negative|Positive"] <-- What is the HPV testing result? [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qascus25up|Qascushpv" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&((Qage).is('25 to 29=3000')||(Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qascus25up).is('HPV Testing')&&(Qascushpv).is('Negative')"] 
Recommendation --> Resume routine screening. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qascus25up|Qascushpv" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells of Undetermined Significance - ASC-US')&&((Qage).is('25 to 29=3000')||(Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qascus25up).is('HPV Testing')&&(Qascushpv).is('Positive')"]
Recommendation --> Colposcopy. [/conditional][remark]

Pregnant question
[/remark][conditional field="Qpurpose|Qpapfinding" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&((Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')||(Qpapfinding).is('Atypical Squamous Cells - cannot exclude High-grade SIL - ASC-H')||(Qpapfinding).is('High-grade Squamous Intraepithelial Lesions - HSIL'))"]
[select name="Qpregnant" value="No|Yes"] <-- Currently pregnant?[/conditional][remark]

LSIL
[/remark][conditional field="Qpurpose|Qpapfinding|Qpregnant" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&(Qpregnant).is('Yes')&&(Qage).isNot('Less than 21=5000')"]
Recommendation --> Either Colposocopy now (preferred) or Colposcopy deferred until at least 6 weeks postpartum (acceptable) may be performed. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))"]
[select name="Qhpvlsil" value="Unknown|Negative|Positive"] <-- What is the HPV result?  [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant|Qhpvlsil" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&((Qhpvlsil).is('Unknown')||(Qhpvlsil).is('Positive'))"]
Recommendation --> Colposcopy. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant|Qhpvlsil" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qhpvlsil).is('Negative')"]
Recommendation --> Either Co-Testing at 1 year (preferred) or Colposocopy (acceptable) may be performed.
[select name="Qlsil30up" value="Co-Testing at 1 year|Colposcopy"] <-- Which follow-up study is chosen?[/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant|Qhpvlsil|Qlsil30up" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qhpvlsil).is('Negative')&&(Qlsil30up).is('Colposcopy')"]
Recommendation --> Manage colposcopy per current ASCCP guidelines. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant|Qhpvlsil|Qlsil30up" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qhpvlsil).is('Negative')&&(Qlsil30up).is('Co-Testing at 1 year')"]
[select name="Qlsilcotest" value="Cytology Negative and HPV Negative|HPV Positive or Cytology Abnormal - ASC-US, LSIL, ASC-H, AGC, HSIL"] <-- Co-Test Result[/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant|Qhpvlsil|Qlsil30up|Qlsilcotest" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qhpvlsil).is('Negative')&&(Qlsil30up).is('Co-Testing at 1 year')&&(Qlsilcotest).is('Cytology Negative and HPV Negative')"]
Recommendation --> Repeat Co-Testing at 3 years. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant|Qhpvlsil|Qlsil30up|Qlsilcotest" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&((Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qhpvlsil).is('Negative')&&(Qlsil30up).is('Co-Testing at 1 year')&&(Qlsilcotest).is('HPV Positive or Cytology Abnormal - ASC-US, LSIL, ASC-H, AGC, HSIL')"]
Recommendation --> Colposcopy. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&(Qage).is('25 to 29=3000')"]
Recommendation --> Colposcopy. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&(Qage).is('21 to 24=4000')"]
Recommendation --> Repeat Cytology at 12 months is recommended.  See [link memo="Women age 21-24 with ASC-US" url="//soapnote.org/women/ascus-repeat-cytology-21-to-24/"][/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Low-grade Squamous Intraepithelial Lesion - LSIL')&&(Qage).is('Less than 21=5000')"]
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening.  [/conditional][remark]

ASC-H
[/remark][conditional field="Qpurpose|Qpapfinding|Qpregnant|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells - cannot exclude High-grade SIL - ASC-H')&&(Qpregnant).is('Yes')&&(Qage).isNot('Less than 21=5000')"]
Recommendation --> Colposcopy. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells - cannot exclude High-grade SIL - ASC-H')&&((Qage).is('25 to 29=3000')||(Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))"]
Recommendation --> Colposcopy. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells - cannot exclude High-grade SIL - ASC-H')&&(Qage).is('21 to 24=4000')"]
Recommendation --> Colposcopy. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Squamous Cells - cannot exclude High-grade SIL - ASC-H')&&(Qage).is('Less than 21=5000')"]
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening.  [/conditional][remark]

HSIL
[/remark][conditional field="Qpurpose|Qpapfinding|Qpregnant|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('High-grade Squamous Intraepithelial Lesions - HSIL')&&(Qpregnant).is('Yes')&&(Qage).isNot('Less than 21=5000')"]
Recommendation --> Colposcopy. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('High-grade Squamous Intraepithelial Lesions - HSIL')&&((Qage).is('25 to 29=3000')||(Qage).is('30 to 34=2000')||(Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))"]
Recommendation --> Either Immediate Loop Electrosurgical Excision or Colposcopy with Endocervical Assessment may be performed. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qpregnant" condition="(Qpregnant).is('No')&&(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('High-grade Squamous Intraepithelial Lesions - HSIL')&&(Qage).is('21 to 24=4000')"]
Recommendation --> Colposcopy. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('High-grade Squamous Intraepithelial Lesions - HSIL')&&(Qage).is('Less than 21=5000')"]
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening. [/conditional][remark]

AGC
[/remark][conditional field="Qpurpose|Qpapfinding" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Glandular Cells - AGC')"]
[select name="Qagcsubcat" value="Endocervical|Endometrial|Not Otherwise Specified - NOS|Favor Neoplasia|Adenocarcinoma In Situ - AIS|Adenocarcinoma"] <-- What is the subcategory? [/conditional][conditional field="Qpurpose|Qpapfinding|Qagcsubcat|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Glandular Cells - AGC')&&(Qagcsubcat).is('Endometrial')&&(Qage).isNot('Less than 21=5000')"]
Recommendation --> Endometrial and endocervical sampling. [/conditional][conditional field="Qpurpose|Qpapfinding|Qagcsubcat|Qage" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Glandular Cells - AGC')&&(Qage).isNot('Less than 21=5000')&&((Qagcsubcat).is('Endocervical')||(Qagsubcat).is('Not Otherwise Specified - NOS')||(Qagsubcat).is('Favor Neoplasia')||(Qagsubcat).is('Adenocarcinoma in Situ - AIS')||(Qagsubcat).is('Adenocarcinoma'))"]
[select name="Qagcbleeding" value="No|Yes"] <-- Is there an irregular bleeding pattern, unexplained vaginal bleeding, conditions suggesting chronic anovulation, or other risks for endometrial neoplasia?[/conditional][conditional field="Qpurpose|Qpapfinding|Qagcbleeding|Qagcsubcat" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Glandular Cells - AGC')&&(Qagcbleeding).is('Yes')&&(Qagcsubcat).isNot('Endometrial')"]
Recommendation --> Colposcopy with endocervical sampling and endometrial sampling. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qagcbleeding|Qagcsubcat" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Glandular Cells - AGC')&&((Qage).is('35 to 65=1000')||(Qage).is('Greater than 65=0'))&&(Qagcbleeding).is('No')&&(Qagcsubcat).isNot('Endometrial')"]
Recommendation --> Colposcopy with endocervical sampling and endometrial sampling. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qagcbleeding|Qagcsubcat" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Glandular Cells - AGC')&&((Qage).is('21 to 24=4000')||(Qage).is('25 to 29=3000')||(Qage).is('30 to 34=2000'))&&(Qagcbleeding).is('No')&&(Qagcsubcat).isNot('Endometrial')"]
Recommendation --> Colposcopy with endocervical sampling. [/conditional][conditional field="Qpurpose|Qpapfinding|Qage|Qagcbleeding|Qagcsubcat" condition="(Qpurpose).is('Pap and HPV Test Interpretation')&&(Qpapfinding).is('Atypical Glandular Cells - AGC')&&(Qage).is('Less than 21=5000')"]
Recommendation --> This falls outside of existing guidelines - the patient is below the recommended age range for cervical cancer screening. [/conditional][remark]

[checkbox memo="References (Hide/Show)" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"][link memo="Saslow D et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis. 2012 Jul;16(3):175-204." url="https://www.ncbi.nlm.nih.gov/pubmed/22418039"][/conditional]