<PATFIRSTNAME> presented for <Visit.combo> of <Type.combo>.

Symptoms: [<symptoms 1.checkbox>|<symptoms 2.checkbox>|<symptoms 3.checkbox>|<symptoms 4.checkbox>|<symptoms 5.checkbox>]

Current Meds: [<current meds 1.checkbox>|<current meds 2.checkbox>|<current meds 3.checkbox>|<current meds 4.checkbox>|<current meds 5.checkbox>|<current meds 6.checkbox>|<current meds 7.checkbox>]

Home blood glucose monitoring is <glucose monitoring 1.checkbox<current meds 2.checkbox<current meds 3.checkbox>.

Pertinent Medical History: <Pertinent Medical History.textarea

hypoglycemiano.checkbox<hypoglycemia yes.checkbox

diabetes education no.checkbox<diabetes education yes.checkbox

<PATFIRSTNAME> [<occ-Daycare-Nursery School.checkbox>|<occ-Employed.checkbox>|<occ-On Disability.checkbox>|<occ-Retired.checkbox>|<occ-Semi-Retired.checkbox>|<occ-Student.checkbox>|<occ-Unemployed.checkbox>][<occupation.textfield>|], [<smoke-1 pack.checkbox>|<smoke-half pack.checkbox>|<smoke-half-1 pack.checkbox>|<smoke-Non-Smoker.checkbox>|<smoke-Quit smoking.checkbox>|<smoke-Secondhand Smoke.checkbox>], and [<etoh 1-5.checkbox>|<etoh 10-15.checkbox>|<etoh 15.checkbox>|<etoh 5-10.checkbox>|<etoh previous abuse.checkbox>].

<PATFIRSTNAME> suffers with [<social stressor 1.checkbox>|<social stressor 2.checkbox>|<social stressor 3.checkbox>|<social stressor 4.checkbox>|<social stressor 5.checkbox>].

Immunization Status: [<immunizations 1.checkbox>|<immunizations 2.checkbox>|<immunizations 3.checkbox>]

Examination:

Vital Signs: Notes and Reviewed

CV Exam: [<cv exam 1.checkbox>|<cv exam 2.checkbox>|<cv exam 3.checkbox>]

Neuropathy Exam: [<neuropathy exam 1.checkbox>|<neurophathy exam text 2.textfield>]

Foot Exam: <foot exam text.textfield

Labs: Noted and Reviewed

Examination.textarea

Assessment:

Glycemic Control A1c: <assessment 1.combo>

Blood Pressure: <assessment 2.combo>

Lipids: <assessment 3.combo>

BMI: <assessment 4.combo>

Proteinurea: <assessment 5.combo>

Waist Circumference: <assessment 6.combo>

Target Organ Damage

Cardiovascular: <target organ damage 1.checkbox<target organ damage 2.checkbox>

PAD: <target organ damage 3.checkbox<target organ damage 4.checkbox>

Eye: <target organ damage 5.checkbox<target organ damage 6.checkbox>

Renal: <target organ damage 7.checkbox<target organ damage 8.checkbox>

Neuropathy: <target organ damage 9.checkbox<target organ damage 10.checkbox>

Psychiatric Issues: <psychiatric no.checkbox<psychiatric yes.checkbox

Plan:

Pharmecology: <plan 1.checkbox<plan 2.checkbox>

Bloodwork: [<plan 3.checkbox>|<plan 4.checkbox>|<plan 5.checkbox>|<plan 6.checkbox>|<plan 7.checkbox>|<plan 8.checkbox>|<plan 9.checkbox>|<plan 10.checkbox>|<plan 11.checkbox>]

Referral To: [<referral 1.checkbox>|<referral 2.checkbox>|<referral 3.checkbox>|<referral 4.checkbox>|<referral 5.checkbox>|<referral 6.checkbox>|<referral 7.checkbox>|<referral 8.checkbox>]

Immunizations Up to Date: <plan_immunizations 1.combo> [<plan_immunizations 2.checkbox>|<plan_immunizations 3.checkbox>|<plan_immunizations 4.checkbox>]

Follow-up: <plan_fu 1.combo<plan_fu 2.combo>