{** * Review of systems form * * @package OpenEMR * @link http://www.open-emr.org * @author Brady Miller * @copyright Copyright (c) 2017-2019 Brady Miller * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3 *} {xl t='Review Of Systems'|text} {headerTemplate}

{xlt t="Review Of Systems"}

{xlt t="Constitutional"}
{html_radios name="weight_change" id="weight_change" options=$form->get_options() selected=$form->get_weight_change() separator=""}
{html_radios name="anorexia" id="anorexia" options=$form->get_options() selected=$form->get_anorexia() separator=""}
{html_radios name="night_sweats" id="night_sweats" options=$form->get_options() selected=$form->get_night_sweats() separator=""}
{html_radios name="heat_or_cold" name="heat_or_cold" options=$form->get_options() selected=$form->get_heat_or_cold() separator=""}
{html_radios name="weakness" id="weakness" options=$form->get_options() selected=$form->get_weakness() separator=""}
{html_radios name="fever" name="fever" options=$form->get_options() selected=$form->get_fever() separator=""}
{html_radios name="insomnia" name="insomnia" options=$form->get_options() selected=$form->get_insomnia() separator=""}
{html_radios name="intolerance" id="intolerance" options=$form->get_options() selected=$form->get_intolerance() separator=""}
{html_radios name="fatigue" id="fatigue" options=$form->get_options() selected=$form->get_fatigue() separator=""}
{html_radios name="chills" id="chills" options=$form->get_options() selected=$form->get_chills() separator=""}
{html_radios name="irritability" id="irritability" options=$form->get_options() selected=$form->get_irritability() separator=""}
{xlt t="Eyes"}
{html_radios name="change_in_vision" id="change_in_vision" options=$form->get_options() selected=$form->get_weight_change() separator=""}
{html_radios name="irritation" id="irritation" options=$form->get_options() selected=$form->get_irritation() separator=""}
{html_radios name="double_vision" id="double_vision" options=$form->get_options() selected=$form->get_double_vision() separator=""}
{html_radios name="glaucoma_history" id="glaucoma_history" options=$form->get_options() selected=$form->get_glaucoma_history() separator=""}
{html_radios name="redness" id="redness" options=$form->get_options() selected=$form->get_redness() separator=""}
{html_radios name="blind_spots" id="blind_spots" options=$form->get_options() selected=$form->get_blind_spots() separator=""}
{html_radios name="eye_pain" id="eye_pain" options=$form->get_options() selected=$form->get_eye_pain() separator=""}
{html_radios name="excessive_tearing" id="excessive_tearing" options=$form->get_options() selected=$form->get_excessive_tearing() separator=""}
{html_radios name="photophobia" id="photophobia" options=$form->get_options() selected=$form->get_photophobia() separator=""}
{xlt t="Ears"}, {xlt t="Nose"}, {xlt t="Mouth"}, {xlt t="Throat"}
{html_radios name="hearing_loss" id="hearing_loss" options=$form->get_options() selected=$form->get_hearing_loss() separator=""}
{html_radios name="vertigo" id="vertigo" options=$form->get_options() selected=$form->get_vertigo() separator=""}
{html_radios name="sore_throat" id="sore_throat" options=$form->get_options() selected=$form->get_sore_throat() separator=""}
{html_radios name="nosebleed" options=$form->get_options() selected=$form->get_nosebleed() separator=""}
{html_radios name="discharge" id="discharge" options=$form->get_options() selected=$form->get_discharge() separator=""}
{html_radios name="tinnitus" id="tinnitus" options=$form->get_options() selected=$form->get_tinnitus() separator=""}
{html_radios name="sinus_problems" id="sinus_problems" options=$form->get_options() selected=$form->get_sinus_problems() separator=""}
{html_radios name="snoring" id="snoring" options=$form->get_options() selected=$form->get_snoring() separator=""}
{html_radios name="pain" id="pain" options=$form->get_options() selected=$form->get_pain() separator=""}
{html_radios name="frequent_colds" id="frequent_colds" options=$form->get_options() selected=$form->get_frequent_colds() separator=""}
{html_radios name="post_nasal_drip" id="post_nasal_drip" options=$form->get_options() selected=$form->get_post_nasal_drip() separator=""}
{html_radios name="apnea" id="apnea" options=$form->get_options() selected=$form->get_apnea() separator=""}
{xlt t="Breast"}
{html_radios name="breast_mass" id="breast_mass" options=$form->get_options() selected=$form->get_breast_mass() separator=""}
{html_radios name="abnormal_mammogram" id="abnormal_mammogram" options=$form->get_options() selected=$form->get_abnormal_mammogram() separator=""}
{html_radios name="breast_discharge" id="breast_discharge" options=$form->get_options() selected=$form->get_breast_discharge() separator=""}
{html_radios name="biopsy" id="biopsy" options=$form->get_options() selected=$form->get_biopsy() separator=""}
{xlt t="Respiratory"}
{html_radios name="cough" id="cough" options=$form->get_options() selected=$form->get_cough() separator=""}
{html_radios name="wheezing" id="wheezing" options=$form->get_options() selected=$form->get_wheezing() separator=""}
{html_radios name="copd" id="copd" options=$form->get_options() selected=$form->get_copd() separator=""}
{html_radios name="sputum" id="sputum" options=$form->get_options() selected=$form->get_sputum() separator=""}
{html_radios name="hemoptsyis" id="hemoptsyis" options=$form->get_options() selected=$form->get_hemoptsyis() separator=""}
{html_radios name="shortness_of_breath" id="shortness_of_breath" options=$form->get_options() selected=$form->get_shortness_of_breath() separator=""}
{html_radios name="asthma" id="asthma" options=$form->get_options() selected=$form->get_asthma() separator=""}
{xlt t="Cardiovascular"}
{html_radios name="chest_pain" id="chest_pain" options=$form->get_options() selected=$form->get_chest_pain() separator=""}
{html_radios name="pnd" id="pnd" options=$form->get_options() selected=$form->get_pnd() separator=""}
{html_radios name="peripheal" id="peripheal" options=$form->get_options() selected=$form->get_peripheal() separator=""}
{html_radios name="history_murmur" id="history_murmur" options=$form->get_options() selected=$form->get_history_murmur() separator=""}
{html_radios name="palpitation" id="palpitation" options=$form->get_options() selected=$form->get_palpitation() separator=""}
{html_radios name="doe" id="doe" options=$form->get_options() selected=$form->get_doe() separator=""}
{html_radios name="edema" id="edema" options=$form->get_options() selected=$form->get_edema() separator=""}
{html_radios name="arrythmia" id="arrythmia" options=$form->get_options() selected=$form->get_arrythmia() separator=""}
{html_radios name="syncope" id="syncope" options=$form->get_options() selected=$form->get_syncope() separator=""}
{html_radios name="orthopnea" id="orthopnea" options=$form->get_options() selected=$form->get_orthopnea() separator=""}
{html_radios name="legpain_cramping" id="legpain_cramping" options=$form->get_options() selected=$form->get_legpain_cramping() separator=""}
{html_radios name="heart_problem" id="heart_problem" options=$form->get_options() selected=$form->get_heart_problem() separator=""}
{xlt t="Gastrointestinal"}
{html_radios name="dysphagia" id="dysphagia" options=$form->get_options() selected=$form->get_dysphagia() separator=""}
{html_radios name="belching" id="belching" options=$form->get_options() selected=$form->get_belching() separator=""}
{html_radios name="vomiting" id="vomiting" options=$form->get_options() selected=$form->get_vomiting() separator=""}
{html_radios name="food_intolerance" id="food_intolerance" options=$form->get_options() selected=$form->get_food_intolerance() separator=""}
{html_radios name="hematochezia" id="hematochezia" options=$form->get_options() selected=$form->get_hematochezia() separator=""}
{html_radios name="constipation" id="constipation" options=$form->get_options() selected=$form->get_constipation() separator=""}
{html_radios name="heartburn" id="heartburn" options=$form->get_options() selected=$form->get_heartburn() separator=""}
{html_radios name="flatulence" id="flatulence" options=$form->get_options() selected=$form->get_flatulence() separator=""}
{html_radios name="hematemesis" id="hematemesis" options=$form->get_options() selected=$form->get_hematemesis() separator=""}
{html_radios name="hepatitis" id="hepatitis" options=$form->get_options() selected=$form->get_hepatitis() separator=""}
{html_radios name="changed_bowel" id="changed_bowel" options=$form->get_options() selected=$form->get_changed_bowel() separator=""}
{html_radios name="bloating" id="bloating" options=$form->get_options() selected=$form->get_bloating() separator=""}
{html_radios name="nausea" id="nausea" options=$form->get_options() selected=$form->get_nausea() separator=""}
{html_radios name="gastro_pain" id="gastro_pain" options=$form->get_options() selected=$form->get_gastro_pain() separator=""}
{html_radios name="jaundice" id="jaundice" options=$form->get_options() selected=$form->get_jaundice() separator=""}
{html_radios name="diarrhea" id="diarrhea" options=$form->get_options() selected=$form->get_diarrhea() separator=""}
{xlt t="Genitourinary"} {xlt t="General"}
{html_radios name="polyuria" id="polyuria" options=$form->get_options() selected=$form->get_polyuria() separator=""}
{html_radios name="hematuria" id="hematuria" options=$form->get_options() selected=$form->get_hematuria() separator=""}
{html_radios name="incontinence" id="incontinence" options=$form->get_options() selected=$form->get_incontinence() separator=""}
{html_radios name="polydypsia" id="polydypsia" options=$form->get_options() selected=$form->get_polydypsia() separator=""}
{html_radios name="frequency" id="frequency" options=$form->get_options() selected=$form->get_frequency() separator=""}
{html_radios name="renal_stones" id="renal_stones" options=$form->get_options() selected=$form->get_renal_stones() separator=""}
{html_radios name="dysuria" id="dysuria" options=$form->get_options() selected=$form->get_dysuria() separator=""}
{html_radios name="urgency" id="urgency" options=$form->get_options() selected=$form->get_urgency() separator=""}
{html_radios name="utis" id="utis" options=$form->get_options() selected=$form->get_utis() separator=""}
{xlt t="Genitourinary"} {xlt t="Male"}
{html_radios name="hesitancy" id="hesitancy" options=$form->get_options() selected=$form->get_hesitancy() separator=""}
{html_radios name="nocturia" id="nocturia" options=$form->get_options() selected=$form->get_nocturia() separator=""}
{html_radios name="dribbling" id="dribbling" options=$form->get_options() selected=$form->get_dribbling() separator=""}
{html_radios name="erections" id="erections" options=$form->get_options() selected=$form->get_erections() separator=""}
{html_radios name="stream" id="stream" options=$form->get_options() selected=$form->get_stream() separator=""}
{html_radios name="ejaculations" id="ejaculations" options=$form->get_options() selected=$form->get_ejaculations() separator=""}
{xlt t="Genitourinary"} {xlt t="Female"}
{html_radios name="g" id="g" options=$form->get_options() selected=$form->get_g() separator=""}
{html_radios name="lc" id="lc" options=$form->get_options() selected=$form->get_lc() separator=""}
{html_radios name="lmp" id="lmp" options=$form->get_options() selected=$form->get_lmp() separator=""}
{html_radios name="f_symptoms" id="f_symptoms" options=$form->get_options() selected=$form->get_f_symptoms() separator=""}
{html_radios name="p" id="p" options=$form->get_options() selected=$form->get_p() separator=""}
{html_radios name="mearche" id="mearche" options=$form->get_options() selected=$form->get_mearche() separator=""}
{html_radios name="f_frequency" id="f_frequency" options=$form->get_options() selected=$form->get_f_frequency() separator=""}
{html_radios name="abnormal_hair_growth" id="abnormal_hair_growth" options=$form->get_options() selected=$form->get_abnormal_hair_growth() separator=""}
{html_radios name="ap" id="ap" options=$form->get_options() selected=$form->get_ap() separator=""}
{html_radios name="menopause" id="menopause" options=$form->get_options() selected=$form->get_menopause() separator=""}
{html_radios name="f_flow" id="f_flow" options=$form->get_options() selected=$form->get_f_flow() separator=""}
{html_radios name="f_hirsutism" id="f_hirsutism" options=$form->get_options() selected=$form->get_f_hirsutism() separator=""}
{xlt t="Musculoskeletal"}
{html_radios name="joint_pain" id="joint_pain" options=$form->get_options() selected=$form->get_joint_pain() separator=""}
{html_radios name="m_warm" id="m_warm" options=$form->get_options() selected=$form->get_m_warm() separator=""}
{html_radios name="m_aches" id="m_aches" options=$form->get_options() selected=$form->get_m_aches() separator=""}
{html_radios name="swelling" id="swelling" options=$form->get_options() selected=$form->get_swelling() separator=""}
{html_radios name="m_stiffness" id="m_stiffness" options=$form->get_options() selected=$form->get_m_stiffness() separator=""}
{html_radios name="fms" id="fms" options=$form->get_options() selected=$form->get_fms() separator=""}
{html_radios name="m_redness" id="m_redness" options=$form->get_options() selected=$form->get_m_redness() separator=""}
{html_radios name="muscle" id="muscle" options=$form->get_options() selected=$form->get_muscle() separator=""}
{html_radios name="arthritis" id="arthritis" options=$form->get_options() selected=$form->get_arthritis() separator=""}
{xlt t="Neurologic"}
{html_radios name="loc" id="loc" options=$form->get_options() selected=$form->get_loc() separator=""}
{html_radios name="tia" id="tia" options=$form->get_options() selected=$form->get_tia() separator=""}
{html_radios name="paralysis" id="paralysis" options=$form->get_options() selected=$form->get_paralysis() separator=""}
{html_radios name="dementia" id="dementia" options=$form->get_options() selected=$form->get_dementia() separator=""}
{html_radios name="seizures" id="seizures" options=$form->get_options() selected=$form->get_seizures() separator=""}
{html_radios name="n_numbness" id="n_numbness" options=$form->get_options() selected=$form->get_n_numbness() separator=""}
{html_radios name="intellectual_decline" id="intellectual_decline" options=$form->get_options() selected=$form->get_intellectual_decline() separator=""}
{html_radios name="n_headache" id="n_headache" options=$form->get_options() selected=$form->get_n_headache() separator=""}
{html_radios name="stroke" id="stroke" options=$form->get_options() selected=$form->get_stroke() separator=""}
{html_radios name="n_weakness" id="n_weakness" options=$form->get_options() selected=$form->get_n_weakness() separator=""}
{html_radios name="memory_problems" id="memory_problems" options=$form->get_options() selected=$form->get_memory_problems() separator=""}
{xlt t="Skin"}
{html_radios name="s_cancer" id="s_cancer" options=$form->get_options() selected=$form->get_s_cancer() separator=""}
{html_radios name="s_other" id="s_other" options=$form->get_options() selected=$form->get_s_other() separator=""}
{html_radios name="psoriasis" id="psoriasis" options=$form->get_options() selected=$form->get_psoriasis() separator=""}
{html_radios name="s_disease" id="s_disease" options=$form->get_options() selected=$form->get_s_disease() separator=""}
{html_radios name="s_acne" id="s_acne" options=$form->get_options() selected=$form->get_s_acne() separator=""}
{xlt t="Psychiatric"}
{html_radios name="p_diagnosis" id="p_diagnosis" options=$form->get_options() selected=$form->get_p_diagnosis() separator=""}
{html_radios name="anxiety" id="anxiety" options=$form->get_options() selected=$form->get_anxiety() separator=""}
{html_radios name="p_medication" id="p_medication" options=$form->get_options() selected=$form->get_p_medication() separator=""}
{html_radios name="social_difficulties" id="social_difficulties" options=$form->get_options() selected=$form->get_social_difficulties() separator=""}
{html_radios name="depression" id="depression" options=$form->get_options() selected=$form->get_depression() separator=""}
{xlt t="Endocrine"}
{html_radios name="thyroid_problems" id="thyroid_problems" options=$form->get_options() selected=$form->get_thyroid_problems() separator=""}
{html_radios name="diabetes" id="diabetes" options=$form->get_options() selected=$form->get_diabetes() separator=""}
{html_radios name="abnormal_blood" id="abnormal_blood" options=$form->get_options() selected=$form->get_abnormal_blood() separator=""}
{xlt t="Hematologic"}/{xlt t="Allergic"}/{xlt t="Immunologic"}
{html_radios name="anemia" id="anemia" options=$form->get_options() selected=$form->get_anemia() separator=""}
{html_radios name="allergies" id="allergies" options=$form->get_options() selected=$form->get_allergies() separator=""}
{html_radios name="hai_status" id="hai_status" options=$form->get_options() selected=$form->get_hai_status() separator=""}
{html_radios name="fh_blood_problems" id="fh_blood_problems" options=$form->get_options() selected=$form->get_fh_blood_problems() separator=""}
{html_radios name="frequent_illness" id="frequent_illness" options=$form->get_options() selected=$form->get_frequent_illness() separator=""}
{html_radios name="bleeding_problems" id="bleeding_problems" options=$form->get_options() selected=$form->get_bleeding_problems() separator=""}
{html_radios name="hiv" id="hiv" options=$form->get_options() selected=$form->get_hiv() separator=""}