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Appointment visit
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Chief Complaint(s)
• • •
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Other Chief Complaint
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Cough
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Cough Duration
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Cough Quality
|
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Other Respiratory Symptoms
• • •
|
Cough Comments
|
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Nasal Congestion
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Nasal Congestion Comments
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Nasal Congestion Duration
|
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Fever
|
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Fever Duration
|
TMax
|
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Ocular Symptoms
|
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Ocular Symptoms Duration
|
Ocular Symptoms
• • •
|
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|
Ocular Symptoms Comments
|
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Rash
|
|
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Rash Itchy?
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Rash Location
• • •
|
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|
|
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Abdominal Pain
|
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Abdominal Pain Quality
|
Abdominal Pain Location
• • •
|
|
Radiation?
|
|
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Association with food
|
Radiates To
|
|
Abdominal Pain Comments
|
Stools
• • •
|
|
|
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Vomiting
|
|
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Vomiting Quality
• • •
|
Number of Episodes
|
|
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Vomiting Comments
|
|
Diarrhea
|
|
|
Diarrhea Quality
• • •
|
Number of Episodes
|
|
|
Diarrhea Comments
|
|
Appetite
|
|
|
|
|
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Other Symptoms
|
|
|
|
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ROS negative
|
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Assessment
• • •
|
|
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Supportive Care
• • •
|
|
|
Antibiotic
• • •
|
Antibiotic Concentration
|
|
Antibiotic Dose
|
|
|
|
|
|
Ear
|
|
