Further History Past Medical HistoryNewline Past Medical History Past Medical HistoryNo significant past medical historyCancerAsthmaCOPDHypertensionHeart failureAtrial fibrillationCoronary Artery DiseaseCerebrovascular diseasePeripheral vascular diseaseDiabetesChronic kidney diseaseChronic liver diseaseChronic neurological diseaseImmunosuppressionHIV/AIDSTuberculosisRheumatological diseaseThyroid diseaseOther medical historyCABGValve replacementSplenectomyOrgan transplantJoint replacementOther surgical historyNo significant past medical historyNewline New_Line CancerNewline New_Line AsthmaNewline New_Line COPDNewline New_Line HypertensionNewline New_Line Heart failureNewline New_Line Atrial fibrillationNewline New_Line Coronary Artery DiseaseNewline New_Line Cerebrovascular diseaseNewline New_Line Peripheral vascular diseaseNewline New_Line DiabetesNewline New_Line Chronic kidney diseaseNewline New_Line Chronic liver diseaseNewline New_Line Chronic neurological conditionNewline New_Line ImmunosuppressionNewline New_Line_Dash HIV/AIDSNewline New_Line TuberculosisNewline New_Line Rheumatological diseaseNewline New_Line Thyroid diseaseNewline New_Line Other medical history - Other medical history:Newline New_Line CABGNewline New_Line Heart valve replacementNewline New_Line SplenectomyNewline New_Line Organ transplantNewline New_Line Joint replacementNewline New_Line Surgical history - Surgical history:Newline New_Line_Dash Negative Past Medical HistoryNo CancerNo AsthmaNo COPDNo HypertensionNo Heart failureNo Atrial fibrillationNo Coronary Artery DiseaseNo Cerebrovascular diseaseNo Peripheral vascular diseaseNo DiabetesNo Chronic kidney diseaseNo Chronic liver diseaseNo Chronic neurological diseaseNo TuberculosisNo ImmunosuppressionNo HIV/AIDSNo TuberculosisNo Rheumatological diseaseNo Thyroid diseaseNo other medical historyNo CABGNo Valve replacementNo SplenectomyNo Organ transplantNo Joint replacementNo significant surgical history Family HistoryNewline Family History Family HistoryNo significant family historyCancerAsthmaCOPDHypertensionHeart failureCoronary Artery DiseaseCerebrovascular diseasePeripheral vascular diseaseThrombotic diseaseDiabetesChronic kidney diseaseChronic neurological diseaseRheumatological diseaseThyroid diseaseOther family historyNo significant family historyNewline New_Line CancerNewline New_Line AsthmaNewline New_Line COPDNewline New_Line HypertensionNewline New_Line Heart failureNewline New_Line Coronary Artery DiseaseNewline New_Line Cerebrovascular diseaseNewline New_Line Peripheral vascular diseaseNewline New_Line Thrombotic diseaseNewline New_Line DiabetesNewline New_Line Chronic kidney diseaseNewline New_Line Chronic neurological conditionNewline New_Line Rheumatological diseaseNewline New_Line Thyroid diseaseNewline New_Line Other family history - Other family history: Medication History and AllergiesNewline Medication History and Allergies Medication History and AllergiesMedication history and allergies as documented in clinical notesMedications listNo prescribed or OTC medicationCompliant with medicationNon-compliant with medicationNo known medication allergyMedication allergyFood allergyMedication history and allergies as documented in clinical notesNewline New_Line Medications list: - Medications list: Newline New_Line No prescribed or OTC medicationNewline New_Line Compliant with medicationNewline New_Line Non-compliant with medicationNewline New_Line No known medication allergyNewline New_Line Medication allergyNewline New_Line Food allergy Recreational drugsNewline Recreational drugs Recreational drugsNever smokedEx-smokerSmokerNo alcoholAlcohol useNo recreational drugsRecreational drug useDrug dependenceNon-smoker - No alcohol - No recreational drugsNever smokedEx-smokerSmokerDocument number of pack-years and any adviceNo alcoholAlcohol usedocument amount in units and any adviceNo recreational drugsRecreational drug useDocument details - what? how much? how often? administration route?Drug dependenceDocument details - what? how much? how often? administration route? Social historyNewline Social history Social HistorySingleLong-term relationshipMarriedDivorcedWidowedLives aloneLives withEmployed Full-TimeEmployed Part-TimeSelf-employedNot employed but looking for workNot employed and not looking for workHomemakerRetiredStudentSingleLong-term relationshipMarriedDivorcedWidowedLives aloneLives withEmployed Full-TimeEmployed Part-TimeSelf-employedNot employed but looking for workNot employed and not looking for workHomemakerRetiredStudentNewline New_Line {PMHx:2:value} {text:6:value} {newline:89:value} {text:7:value} {newline:90:value} {text:8:value} {newline:91:value} {text:9:value} {newline:92:value} {text:10:value} {newline:93:value} {text:11:value} {newline:94:value} {text:12:value} {newline:95:value} {text:13:value} {newline:96:value} {text:14:value} {newline:97:value} {text:15:value} {newline:98:value} {text:16:value} {newline:99:value} {text:17:value} {newline:100:value} {text:18:value} {newline:101:value} {text:19:value} {newline:102:value} {text:20:value} {newline:103:value} {text:21:value} {newline:104:value} {text:22:value} {newline:105:value} {text:23:value} {newline:106:value} {text:24:value} {newline:107:value} {text:25:value} {newline:108:value} {text:26:value} {newline:109:value} {text:27:value} {newline:110:value} {text:28:value} {newline:111:value} {text:29:value} {newline:112:value} {text:30:value} {newline:113:value} {text:31:value} {newline:114:value} {Multiselect:32:value} {FHx:137:value} {text:35:value} {newline:115:value} {text:36:value} {newline:116:value} {text:37:value} {newline:117:value} {text:38:value} {newline:118:value} {text:39:value} {newline:119:value} {text:40:value} {newline:120:value} {text:41:value} {newline:121:value} {text:42:value} {newline:122:value} {text:43:value} {newline:123:value} {text:44:value} {newline:124:value} {text:45:value} {newline:125:value} {text:46:value} {newline:126:value} {text:47:value} {newline:127:value} {text:48:value} {newline:128:value} {text:49:value} {newline:129:value} {text:50:value} {DHx:138:value} {text:53:value} {newline:130:value} {text:54:value} {text:57:value} {newline:130:value} {text:55:value} {text:56:value} {text:58:value} {text:59:value} {text:60:value} {RHx:139:value} {text:63:value} {text:64:value} {text:65:value} {text:66:value} {text:67:value} {text:68:value} {text:69:value} {text:70:value} {text:71:value} {SHx:140:value} {text:74:value} {text:75:value} {text:76:value} {text:77:value} {text:78:value} {text:79:value} {text:80:value} {text:81:value} {text:82:value} {text:83:value} {text:84:value} {text:85:value} {text:86:value} {text:87:value} {text:88:value} Copy Text to clipboard