[{"_1":2,"_118":-5,"_119":-5},"loaderData",{"_3":4},"routes/package",{"_5":6,"_112":113,"_116":117},"package",{"_7":8,"_9":10,"_11":12,"_13":14,"_15":16,"_17":18,"_19":20,"_21":22,"_24":25,"_26":27,"_110":111},"name","medical-docs","author","Bill Ressl","description","A package to assist in medical Documentation","title","Medical Documentation","version","0.1.2","archive_url","https://github.com/espanso/hub/releases/latest/download/medical-docs-0.1.2.zip","archive_sha256_url","https://github.com/espanso/hub/releases/latest/download/medical-docs-0.1.2-sha256.txt","tags",[23],"medical","id","medical-docs-0.1.2","files",{"_28":29,"_30":31,"_32":33,"_34":35,"_36":37,"_38":39,"_40":41,"_42":43,"_44":45,"_46":47,"_48":49,"_50":51,"_52":53,"_54":55,"_56":57,"_58":59,"_60":61,"_62":63,"_64":65,"_66":67,"_68":69,"_70":71,"_72":73,"_74":75,"_76":77,"_78":79,"_80":81,"_82":83,"_84":85,"_86":87,"_88":89,"_90":91,"_92":93,"_94":95,"_96":97,"_98":99,"_100":101,"_102":103,"_104":105,"_106":107,"_108":109},"nosebleed.yml","matches:\n - trigger: \":nosebleed\"\n word: true\n replace: |\n Subjective: \n {{cc}} nose bleed from RIGHT side for past DURATION\n {{sp}} recurrent bleeds about every INTERVAL\n lasting about DURATION\n {{sp}} no identified triggers\n (trauma, nasal surgery, nasal picking, foreign body,\n upper respiratory tract infection, allergic rhinitis)\n\n Red Flags:\n {{sp}} no chest pain\n {{sp}} no shortness of breath\n {{sp}} no dizziness\n\n {{sp}} no bleeding disorder\n {{sp}} no high blood pressure\n {{sp}} no liver cirrhosis\n {{sp}} no coronary artery disease\n {{sp}} no use of intranasal corticosteroid\n {{sp}} no use of anti-platelet drugs such as\n aspirin, clopidigrel, or ticagrelor\n {{sp}} no use of anti-coagulants such as heparin, warfarin,\n rivaroxaban, apixaban, edoxaban, or dabigatran\n\n Objective: \n {{op}} generally well appearance\n {{op}} no bruising (ecchymosis)\n {{op}} no rash suggestive of platelet dysfunction (petechiae)\n {{op}} no abnormal blood vessel growth (telangiectasia)\n {{op}} no active bleeding\n {{op}} no evidence of recent bleeding in nose (at Kiesselbachs plexus)\n {{op}} no blood in the mouth or throat (oropharynx)\n\n cotton soaked in lidocaine 2% with epi applied\n followed by cautery using silver nitrate\n\n Assessment:\n {{ap}} anterior nasal bleeding with no red flags\n\n Plan:\n {{pp}} lean forward and clamp nose if active bleeding\n {{pp}} seek medical attention if bleeding doesn't stop in 10 minutes\n {{pp}} stop intranasal corticosteroid spray\n {{pp}} direct nasal spray away from septum\n {{pp}} sleep in a humidified environment\n {{pp}} apply topical antibiotic (bactroban) in nostril using cotton swab\n {{pp}} follow-up if symptoms worsening or other concerns\n","ophtho.yml","matches:\n - trigger: \"PERRLA\"\n word: true\n replace: |\n pupils equal, round, reactive to light and accomodation (PERRLA)\n\n - trigger: \"EOM\"\n word: true\n replace: |\n extraocular movements (EOM)\n\n\n - trigger: \":opsredflag\"\n word: true\n replace: |\n Red Flags:\n {{sp}} no severe pain\n {{sp}} no marked pain or decreased vision with the use of contact lenses\n {{sp}} no pain deep in eye\n {{sp}} no inability to tolerate light (photophobia)\n {{sp}} no visual loss\n {{sp}} no colored halos around lights\n {{sp}} no trauma or foreign body\n {{sp}} no chemical injury\n {{sp}} no recent eye surgery\n\n - trigger: \":oporedflag\"\n word: true\n replace: |\n Red Flags:\n {{op}} no decreased visual acuity\n {{op}} no pupil irregularity\n {{op}} no sluggish pupillary reaction to light\n {{op}} no corneal opacification\n {{op}} no pooling of blood inside the anterior chamber of the eye (hyphema)\n {{op}} no pooling of pus inside the anterior chamber of the eye (hypyon)\n {{op}} no elevated intraocular pressure\n\n - trigger: \":redeye\"\n word: true\n replace: |\n Subjective:\n {{cc}} red eye for the past DURATION\n {{sp}} redness in RIGHT LEFT BOTH eye(s)\n {{sp}} no thick purulent discharge\n {{sp}} no watery discharge\n {{sp}} no eyes stuck shut on waking in morning\n {{sp}} no sandy feeling/irritation\n {{sp}} no itching\n\n {{sp}} no contact lens use\n {{sp}} no sensation of a foreign body in the eye\n {{sp}} no severe headache\n {{sp}} no nausea\n\n {{sredflags}}\n\n Objective:\n {{op}} conjunctival injection in RIGHT LEFT BOTH eye(s)\n {{op}} no discharge\n {{op}} pupils equal round, reactive to light and accomodation (PERRLA)\n {{op}} normal eye movements (extraocular movements (EOM))\n {{op}} no repetitive, uncontrolled movements (nystagmus)\n {{op}} no significant pain with eye movement\n {{op}} no double vision (diplopia)\n {{op}} no visualized foreign body\n {{op}} no photophobia.\n {{op}} normal cornea and anterior chamber\n\n {{oredflags}}\n\n Assessment:\n {{ap}} Viral Conjunctivitis\n {{ap}} Bacterial Conjunctivitis\n {{ap}} Allergic Conjunctivitis\n No alarm symptoms/signs (red flags) present\n\n Plan:\n {{pp}} use topical antibiotics as prescribed\n may reduce the dose from 4 times daily to twice daily,\n if there is improvement in symptoms after a few days.\n A decrease in discharge, redness, and irritation should occur in 1-2 days\n {{pp}} use antihistamines with mast cell-stabilizing properties (Pataday)\n {{pp}} use over-the-counter eye lubricant drops 1-2 drops every 1-6 hours as needed\n\n {{pp}} use warm or cool compresses\n {{pp}} avoid eye rubbing\n {{pp}} stop use of contact lenses during symptoms\n {{pp}} avoid sharing tissues, towels, cosmetics, linens, or eating utensils\n\n {{pp}} seek reassessment if current symptoms persist, worsen, or new symptoms develop.\n {{pp}} immediately seek reassessment if red flags (as described above)\n\n vars:\n - name: sredflags\n type: match\n params:\n trigger: \":opsredflag\"\n\n - name: oredflags\n type: match\n params:\n trigger: \":oporedflag\"\n\n","flu.yml","matches:\n - trigger: \":fluvac\"\n word: true\n replace: |\n Subjective: \n {{cc}} annual flu vaccine\n {{sp}} no previous flu vaccine injections\n {{sp}} no previous reaction to previous flu vaccines\n {{sp}} no allergy to eggs, latex, or neomycin.\n {{sp}} no recent sickness\n Discussed benefits and possible adverse reactions\n\n Objective:\n Vaccine administered by intramuscular injection\n into left deltoid using aseptic technique with\n 25 gauge 1 inch needle\n Injection was well tolerated\n Lot and expiry date noted on chart\n\n Assessment:\n {{ap}} need for regular influenza vaccine\n\n Plan: \n {{pp}} wait 15 minutes in the waiting room to ensure\n no immediate serious reaction\n {{pp}} refer to handout for possible side-effects\n {{pp}} contact clinic if concerns, especially for\n possible infection (increasing redness, pain,\n swelling, or pus after 3 days)\n","fatigue.yml","matches:\n - trigger: \":fatigue\"\n word: true\n replace: |\n {{menses}}\n\n You have had no frequent nose bleeds.\n You have had no blood in your urine.\n You have had no blood in your stool, or any black/tarry stool (melena).\n\n You have a varied diet, which includes red meats.\n You are not currently taking any iron supplementation.\n\n You have had no blurry vision.\n You have had no frequent headaches.\n You have had no frequent urination.\n You have no family history of diabetes.\n\n Considering possible signs of low thyroid:\n {{hitsh}}\n You have no family history of thyroid disease.\n\n {{noother}}\n\n Given your previous history of low iron, your current fatigue is also\n likely due to low iron. However we should complete testing to be sure\n and also confirm there are not other causes contributing.\n\n Also, note that factors contributing to fatigue may include psychological stress,\n anxiety, low mood, inadequate time for relaxation, poor diet, or too much alcohol.\n A healthy lifestyle is important, including stress reduction, and setting aside\n time for adequate relaxation and sleep. As well, even though you are already tired,\n gradually increasing physical exercise often helps.\n\n {{finish}}\n\n vars:\n - name: menses\n type: match\n params:\n trigger: \":menses\"\n - name: hitsh\n type: match\n params:\n trigger: \":hitsh\"\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n\n","_manifest.yml","author: Bill Ressl\ndescription: A package to assist in medical Documentation\nname: medical-docs\ntitle: Medical Documentation\nversion: 0.1.2\nhomepage: \"https://github.com/wressl/medical-docs\"\ntags: [\"medical\"]","urti.yml","matches:\n - trigger: \":urti\"\n word: true\n replace: |\n Subjective:\n {{cc}} cold/flu like symptoms for XX days\n {{sp}} no sore throat\n {{sp}} no cough\n {{sp}} no fever\n {{sp}} no congestion\n {{sp}} no ear pain\n {{sp}} no headache\n {{sp}} no sinus pain\n {{sp}} no dental pain\n {{sp}} no nausea/emesis\n {{sp}} no diarrhea\n {{sp}} no sick contacts\n {{sp}} no recent travel\n {{sp}} no flu shot this year\n\n Objective:\n {{op}} normal ear drums (tympanic membranes) bilaterally\n {{op}} normal appearing throat (oropharynx) (no redness, no swelling, no exudates)\n {{op}} no swollen neck lymph nodes (anterior cervical lympadenopathy)\n {{op}} clear chest (no wheezes, no crackles)\n {{op}} no increased work of breathing\n\n Assessment:\n {{ap}} Viral Upper Respiratory Infection\n However, there are features suggestive of a bacterial throat infection.\n\n Plan:\n {{pp}} continue supportive management with fluids and rest\n {{pp}} use tylenol/advil for comfort\n {{pp}} use nasal saline rinses twice daily and nasal steroid spray before bed\n {{pp}} await results of throat swab and take antibiotics only if positive\n {{pp}} seek reassessment if increasing symptoms after 7 days\n {{pp}} call 911 or go to ED if difficulty breathing develops\n\n\n","imaging.yml","matches:\n - trigger: \"xr\"\n replace: \"x-ray\"\n propagate_case: true\n word: true\n\n - trigger: \"cxr\"\n replace: \"chest X-ray\"\n propagate_case: true\n word: true\n\n - trigger: \"u/s\"\n replace: \"ultrasound\"\n propagate_case: true\n word: true\n\n - trigger: \"mammo\"\n replace: \"mammogram\"\n propagate_case: true\n word: true\n\n - trigger: \"bmd\"\n replace: \"bone mineral density\"\n propagate_case: true\n word: true\n\n - trigger: \"fit test\"\n replace: \"FIT test (colon cancer screen)\"\n word: true\n","injection.yml","matches:\n - trigger: \":injcort\"\n word: true\n replace: |\n Subjective: \n {{cc}} cortisone injection of LOCATION\n\n Risks and possible complications including\n lack of benefit or only very short term relief,\n bleeding, and infection\n Specifically discussed possible increased\n pain in the first three days after injection\n (\"steroid flare\")\n\n Consent obtained.\n\n Objective:\n Area located and marked.\n Sterilized with chlorhexidine multiple times.\n Injection with 25 gauge 1.5 inch sterile needle\n Medication injected:\n Kenalog 40mg/ml (Lot: Expiry: ) x 1 ml\n and Lidocaine 2% with no epinephrine x 3 ml\n\n Injection well tolerated\n Injection site covered with bandaid\n No immediate complication.\n\n Assessment:\n {{ap}} subacromial bursitis\n {{ap}} osteoarthritis of the left knee\n\n Plan:\n {{pp}} follow-up immediately if concerns for infection\n (increased redness, pain, swelling, warmth after 3 days)\n\n","prep.yml","matches:\n # HIRI-MSM risk assessment tool\n - trigger: \":preprisk\"\n word: true\n replace: |\n How old are you today? <18 years 0\n 18-28 years 8\n 29-40 years 5\n 41-48 years 2\n >= 49 years 0\n\n How many men have you had sex with in the past 6 months? >10 7\n 6-10 4\n 0-5 0\n\n How many of your male sex partners were HIV positive? >1 8\n 1 4\n 0 0\n\n In the last 6 months, how many times did you have >=1 10\n receptive anal sex (you were the bottom) with a man 0 0\n without a condom?\n\n In the last 6 months, how many times did you have >=5 6\n insertive anal sex (you were the top) with a man 0-4 0\n who was HIV positive?\n\n In the last 6 months, have you used methamphetamines Yes 5\n such as crystal or speed? No 0\n\n In the last 6 months, have you used poppers (amyl nitrate)? Yes 3\n No 0\n\n Risk score of >=11 warrants PrEP\n\n\n","derm.yml","matches:\n - trigger: \":hairloss\"\n word: true\n replace: |\n Subjective:\n {{cc}} hair loss at [location] for the past DURATION\n\n Objective:\n {{op}} smooth localized area of complete hair loss at [location]\n {{op}} negative hair pull test.\n {{op}} no inflammation or scarring.\n\n Assessment:\n {{ap}} Alopecia Areata.\n\n Plan:\n A referral has been sent to dermatology\n\n - trigger: \":rxkeflex\"\n word: true\n replace: |\n You are advised to take the medication as prescribed:\n Cephalexin (Keflex) 500mg one tablet every 6 hours for up to 7 days\n If you are completely better in 3 days, you can stop after 5 days.\n\n If there is no improvement after 48 hours, please arrange for\n reassessment in person.\n\n - trigger: \":skininfection\"\n word: true\n replace: |\n Subjective:\n {{cc}} possible skin infection for DURATION\n The location is\n Symptoms started after\n {{sp}} no fever (temperature measured at home XXC)\n {{sp}} no nausea or emesis\n {{sp}} no diarrhea\n {{sp}} no pain\n {{sp}} no purulence\n {{sp}} no swelling\n {{sp}} no redness\n {{sp}} no heat\n {{sp}} no treatment to date\n {{sp}} no progression over the past 48 hours\n {{sp}} no proximal prosthetic joint or vascular graft\n {{sp}} no previous skin infections\n {{sp}} no diabetes\n {{sp}} no immunocompromised state\n {{sp}} no risks for MRSA (eg previous MRSA, recent hospitalization,\n long-term care facility, hemodialysis, HIV infection,\n lack of response to treatment without MRSA coverage)\n {{sp}} no allergies to antibiotics\n\n Objective: \n {{op}} temperature of XXC\n {{op}} blood pressure of XXX/YY and heart rate of XXX\n The affected area is located at XXXX\n and extends XXXXXXX\n {{op}} no purulence\n {{op}} no ulceration\n {{op}} no abscess\n {{op}} no erythema\n {{op}} no warmth\n {{op}} no tenderness\n {{op}} no swelling\n {{op}} no induration\n {{op}} no clear demarcation of infection\n {{op}} no raised erythema\n\n Assessment:\n {{ap}} Non-purulent cellulitis\n {{ap}} Erysipelas\n {{ap}} Skin abscess\n {{ap}} Inflammed intradermal cyst\n {{ap}} Paronychia\n with NO systemic features requiring hospitalization or parenteral\n antibiotics, and NO indication for MRSA coverage.\n\n Plan:\n Wound culture has been sent to guide antibiotic therapy,\n if not improving with initial treatment.\n {{pp}} start oral antibiotics today as prescribed\n {{pp}} book for incision and drainage of abscess\n {{pp}} proceed to ER for parenteral antibiotics and possible admission\n {{pp}} keep affected area elevated\n {{pp}} seek reassessment if no improvement after 72h,\n worsening despite 48h antibiotics, or new systemic symptoms (fever, nausea)\n {{pp}} go to ER if rapid progression of redness, severe nausea or high fever\n\n - trigger: \":eczemamgt\"\n word: true\n replace: |\n Eczema Care Instructions:\n 1. Bathing\n a. Not about frequency but duration. Must be between 5-15 minutes.\n b. Warm – lukewarm/moderate warm\n c. Do not wipe dry – Pat dry only. Leave some moisture on skin\n\n 2. Do not use soap – use hypoallergenic baby wash once a week only (e.g. Cetaphil, Cerave, Avene, Aveeno)\n\n 3. If needs medicated cream (Steroid (Betamethasone, Hydrocortisone, Mometasone etc.) or Tacrolimus base Cream(Protopic/Elidel) ) – apply as first layer.\n a. Steroid must be used consecutively daily, then stop when controlled\n (do not use intermittently).\n b. Maximum daily use is 2 weeks\n c. After 2 weeks use of steroids must have 1-2 weeks of break\n then can resume using this again.\n d. Tacrolimus based meds can be used indefinitely until complete control.\n e. Minimize direct sun exposure when on medicated creams.\n\n 4. Apply moisturizing creams (Cerave Cream, Vaseline Creamy, Avene Cream) – avoid lotions (has alcohol usually which dries the skin more)\n\n 5. Add extra layer of Petroleum Jelly (Vaseline). Must be used at flare up and may be used in maintenance phase well.\n\n 6. Maintenance – once Eczema is controlled NEVER STOP using moisturizer (e.g. Cerave) that works best for you.\n\n 7. RELAPSE IS VERY HIGH IF YOU STOP MAINTENANCE!\n\n 8. Improve moisture with use of humidifier, increase fluids, healthy diet (more fruits and veggies).\n\n\n - trigger: \":shingles\"\n word: true\n replace: |\n Subjective:\n {{cc}} rash concerning for possible shingles for the past DURATION\n The rash location is LOCATION\n {{sp}} no pain\n {{sp}} no blisters\n {{sp}} no previous similar rash\n {{sp}} no previous diagnosed shingles\n {{sp}} no previous shingles vaccine (Shingrix or Zostavax)\n {{sp}} no previous chicken pox\n\n Objective:\n {{op}} unilateral (on one side of body) multiple vesicles on erythematous base at LOCATION\n\n Assessment:\n {{ap}} Shingles (Herpes Zoster)\n\n Plan:\n {{pp}} take valacyclovir for 7 days (1g three times daily)\n {{pp}} take acetaminophen (Tylenol) as needed for pain\n {{pp}} follow-up if not responding to treatment or other concerns\n\n - trigger: \":rxmastitis\"\n word: true\n replace: |\n Compound prescription: Mupirocin ointment 2% (15g)\n + Betamethasone ointment 0.1% (15g)\n + Miconazole powder to 2%\n Apply to to affected areas twice daily\n Wrap with saran wrap for maximum absorption if possible\n\n - trigger: \":nailfungus\"\n word: true\n replace: |\n Your main concern today is possible toe nail fungus.\n Your LEFT RIGHT toenail has been discolored and thicker for the past XX\n You have no other nail involvement or previous nail fungus infections.\n You have no pain or itch or bleeding.\n You have had no previous trauma to the nails involved.\n\n You have tried some over the counter treatments with limited improvement.\n You have not had any previous prescription treatments.\n\n You have previous bloodwork showing normal liver enzyme levels.\n\n {{noother}}\n\n Your nail appears thickened with a yellowish discoloration.\n\n Given your history and nail appearance it is very likely there is a nail\n fungus present.\n\n Nail fungus can be uncomfortable and certainly affects appearance\n but if left untreated we do not expect it to lead to any serious\n health issue.\n Some patients may decide not to treat, given their other priorities.\n Treatment of nail fungus can be topical or oral.\n For infections involving only a few nails and less than half of each nail\n a topical treatment can be effective but must be continued until the nail\n grows out fully. For toenails this is generally about 48 weeks.\n Oral treatment is considered the most effective treatment, especially if\n there are many nails involved or over half of the nail area is involved.\n Oral treatment is also shorter: 6 weeks for fingernails\n and 12 weeks for toenails\n Oral treatment is also generally lower cost than topical treatment.\n The potential drawback of oral treatment is that it does expose\n your entire body to a medication that may rarely cause side effects.\n In particular, there is some concern of potential effects on the liver\n so may not be recommended in individuals with prior liver disease.\n\n In your case, you have no previous medical issues and no excessive\n alcohol intake, so we believe you are at low risk for these side effects.\n\n After discussing the above, your preference is for oral treatment.\n After discussing the above, your preference is for topical treatment.\n\n To confirm the diagnosis, you are recommended to submit nail clipping for\n fungal culture. You will be contacted to arrange this test.\n Preliminary results are usually available with 3 days, but final results\n for this test take up to 6 weeks.\n\n You are advised to complete a baseline check of your liver enzymes\n (ALT and AST). You will be contacted to arrange this blood work.\n\n You are advised to take the prescribed medication,\n Terbinafine (Lamisil) 250mg once daily for 12 weeks as prescribed.\n Efinaconazole (Jublia) applied once daily for 48 weeks as prescribed.\n\n {{finish}}\n\n If you feel unwell and feel you may be having side-effects of the\n medication, stop the medication immediately and seek reassessment\n by a physician.\n In particular you should monitor for persistent nausea, anorexia\n (low appetite), fatigue, vomiting, right upper abdominal pain,\n jaundice (yellowish tinge to whites of eyes or skin), dark urine,\n or pale stools.\n vars:\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n\n - trigger: \":canker\"\n word: true\n replace: |\n Your main concern today is white spots in your mouth.\n These are located\n and have been present for\n They are not painful.\n They have not been bleeding.\n They may have been triggered by\n You cannot think of anything they may have been triggered by.\n You do not have a habit of biting your lip and cannot remember biting your lip.\n You do not have braces, mouthguards or dental appliances.\n You have never had anything similar in the past.\n You have no other rashes or spots anywhere else on your skin or eyes.\n You do not have any known sensitivity to gluten, or other gastrointestinal issues.\n\n {{noother}}\n\n The photo you attached shows some irregularly shaped white spots on the inside\n (mucosal) surface of your upper lip. It is a little difficult to see due to\n the focus but it appears there is some small amount of ulceration.\n These spots are most likely aphthous ulcers.\n This is a benign condition usually triggered by stress or trauma (biting),\n or possibly acidic foods and usually heals on its own in 7-14 days.\n However we can use treatments to help minimize the symptoms and help healing.\n\n\n You are advised to avoid any trauma inside the mouth,\n avoid biting cheeks or lips, and avoid foods that exacerbate the symptoms\n (typically very acidic or spicey foods).\n\n You are advised to use the prescribed topical medications to help reduce symptoms:\n lidocaine viscous 2% 15 ml swish and spit (do not swallow) no more than every 3 hours\n before meals to relieve discomfort. (150ml dispense with one refill)\n\n Oracort (triamcinolone 0.1%) paste applied to the lesions after meals to improve healing.\n Do not eat or drink for at least 30 minutes afterward. (7.5g dispense with no refills)\n\n {{finish}}\n vars:\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n\n\n - trigger: \":stye\"\n word: true\n replace: |\n Your main concern today is redness and swelling in your RIGHT TOP eyelid\n This developed about XXXX days ago\n\n You have had no foreign object enter your eye.\n You have had no affect on your vision.\n You have had no discharge or drainage.\n The eyeball itself does not appear red.\n Moving your eye is not painful\n The eyelid is not painful at rest but is tender when pressed.\n\n You do not wear contact lenses.\n You have had no previous similar symptoms.\n You have had no treatment so far.\n\n {{noother}}\n\n Your eyelid appears somewhat red.\n There is a larger bulge near the lid margin and\n a whitehead of purulence visible.\n\n Your symptoms are consistent with a hordeolum or stye.\n These can almost always be treated successfully without antibiotics.\n\n You are advised to apply warm compresses several times a day:\n Use a clean washcloth and wet with warm water, placing over the stye.\n Once the cloth cools, reheat it and repeat for a total of 15 minutes,\n repeating this process at least 4 times daily.\n\n You are advised to avoid squeezing or popping the stye, and also avoid using\n contact lens or any cosmetic products around the eye until your symptoms are\n completely gone.\n\n {{findfp}}\n {{covidremind}}\n\n Please book for follow-up if:\n Your symptoms do not resolve within 2 weeks of using warm compresses\n Your vision is affected.\n Your stye is getting very big or bleeding.\n The redness spreads from your eyelid into your eye\n or into other parts of your face\n vars:\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: findfp\n type: match\n params:\n trigger: \":findfp\"\n - name: covidremind\n type: match\n params:\n trigger: \":covidremind\"\n\n\n\n\n\n","LICENSE"," GNU GENERAL PUBLIC LICENSE\n Version 3, 29 June 2007\n\n Copyright (C) 2007 Free Software Foundation, Inc. \n Everyone is permitted to copy and distribute verbatim copies\n of this license document, but changing it is not allowed.\n\n Preamble\n\n The GNU General Public License is a free, copyleft license for\nsoftware and other kinds of works.\n\n The licenses for most software and other practical works are designed\nto take away your freedom to share and change the works. By contrast,\nthe GNU General Public License is intended to guarantee your freedom to\nshare and change all versions of a program--to make sure it remains free\nsoftware for all its users. We, the Free Software Foundation, use the\nGNU General Public License for most of our software; it applies also to\nany other work released this way by its authors. You can apply it to\nyour programs, too.\n\n When we speak of free software, we are referring to freedom, not\nprice. Our General Public Licenses are designed to make sure that you\nhave the freedom to distribute copies of free software (and charge for\nthem if you wish), that you receive source code or can get it if you\nwant it, that you can change the software or use pieces of it in new\nfree programs, and that you know you can do these things.\n\n To protect your rights, we need to prevent others from denying you\nthese rights or asking you to surrender the rights. Therefore, you have\ncertain responsibilities if you distribute copies of the software, or if\nyou modify it: responsibilities to respect the freedom of others.\n\n For example, if you distribute copies of such a program, whether\ngratis or for a fee, you must pass on to the recipients the same\nfreedoms that you received. You must make sure that they, too, receive\nor can get the source code. And you must show them these terms so they\nknow their rights.\n\n Developers that use the GNU GPL protect your rights with two steps:\n(1) assert copyright on the software, and (2) offer you this License\ngiving you legal permission to copy, distribute and/or modify it.\n\n For the developers' and authors' protection, the GPL clearly explains\nthat there is no warranty for this free software. For both users' and\nauthors' sake, the GPL requires that modified versions be marked as\nchanged, so that their problems will not be attributed erroneously to\nauthors of previous versions.\n\n Some devices are designed to deny users access to install or run\nmodified versions of the software inside them, although the manufacturer\ncan do so. This is fundamentally incompatible with the aim of\nprotecting users' freedom to change the software. The systematic\npattern of such abuse occurs in the area of products for individuals to\nuse, which is precisely where it is most unacceptable. Therefore, we\nhave designed this version of the GPL to prohibit the practice for those\nproducts. If such problems arise substantially in other domains, we\nstand ready to extend this provision to those domains in future versions\nof the GPL, as needed to protect the freedom of users.\n\n Finally, every program is threatened constantly by software patents.\nStates should not allow patents to restrict development and use of\nsoftware on general-purpose computers, but in those that do, we wish to\navoid the special danger that patents applied to a free program could\nmake it effectively proprietary. To prevent this, the GPL assures that\npatents cannot be used to render the program non-free.\n\n The precise terms and conditions for copying, distribution and\nmodification follow.\n\n TERMS AND CONDITIONS\n\n 0. Definitions.\n\n \"This License\" refers to version 3 of the GNU General Public License.\n\n \"Copyright\" also means copyright-like laws that apply to other kinds of\nworks, such as semiconductor masks.\n\n \"The Program\" refers to any copyrightable work licensed under this\nLicense. Each licensee is addressed as \"you\". \"Licensees\" and\n\"recipients\" may be individuals or organizations.\n\n To \"modify\" a work means to copy from or adapt all or part of the work\nin a fashion requiring copyright permission, other than the making of an\nexact copy. The resulting work is called a \"modified version\" of the\nearlier work or a work \"based on\" the earlier work.\n\n A \"covered work\" means either the unmodified Program or a work based\non the Program.\n\n To \"propagate\" a work means to do anything with it that, without\npermission, would make you directly or secondarily liable for\ninfringement under applicable copyright law, except executing it on a\ncomputer or modifying a private copy. Propagation includes copying,\ndistribution (with or without modification), making available to the\npublic, and in some countries other activities as well.\n\n To \"convey\" a work means any kind of propagation that enables other\nparties to make or receive copies. Mere interaction with a user through\na computer network, with no transfer of a copy, is not conveying.\n\n An interactive user interface displays \"Appropriate Legal Notices\"\nto the extent that it includes a convenient and prominently visible\nfeature that (1) displays an appropriate copyright notice, and (2)\ntells the user that there is no warranty for the work (except to the\nextent that warranties are provided), that licensees may convey the\nwork under this License, and how to view a copy of this License. If\nthe interface presents a list of user commands or options, such as a\nmenu, a prominent item in the list meets this criterion.\n\n 1. Source Code.\n\n The \"source code\" for a work means the preferred form of the work\nfor making modifications to it. \"Object code\" means any non-source\nform of a work.\n\n A \"Standard Interface\" means an interface that either is an official\nstandard defined by a recognized standards body, or, in the case of\ninterfaces specified for a particular programming language, one that\nis widely used among developers working in that language.\n\n The \"System Libraries\" of an executable work include anything, other\nthan the work as a whole, that (a) is included in the normal form of\npackaging a Major Component, but which is not part of that Major\nComponent, and (b) serves only to enable use of the work with that\nMajor Component, or to implement a Standard Interface for which an\nimplementation is available to the public in source code form. A\n\"Major Component\", in this context, means a major essential component\n(kernel, window system, and so on) of the specific operating system\n(if any) on which the executable work runs, or a compiler used to\nproduce the work, or an object code interpreter used to run it.\n\n The \"Corresponding Source\" for a work in object code form means all\nthe source code needed to generate, install, and (for an executable\nwork) run the object code and to modify the work, including scripts to\ncontrol those activities. However, it does not include the work's\nSystem Libraries, or general-purpose tools or generally available free\nprograms which are used unmodified in performing those activities but\nwhich are not part of the work. For example, Corresponding Source\nincludes interface definition files associated with source files for\nthe work, and the source code for shared libraries and dynamically\nlinked subprograms that the work is specifically designed to require,\nsuch as by intimate data communication or control flow between those\nsubprograms and other parts of the work.\n\n The Corresponding Source need not include anything that users\ncan regenerate automatically from other parts of the Corresponding\nSource.\n\n The Corresponding Source for a work in source code form is that\nsame work.\n\n 2. Basic Permissions.\n\n All rights granted under this License are granted for the term of\ncopyright on the Program, and are irrevocable provided the stated\nconditions are met. This License explicitly affirms your unlimited\npermission to run the unmodified Program. The output from running a\ncovered work is covered by this License only if the output, given its\ncontent, constitutes a covered work. This License acknowledges your\nrights of fair use or other equivalent, as provided by copyright law.\n\n You may make, run and propagate covered works that you do not\nconvey, without conditions so long as your license otherwise remains\nin force. You may convey covered works to others for the sole purpose\nof having them make modifications exclusively for you, or provide you\nwith facilities for running those works, provided that you comply with\nthe terms of this License in conveying all material for which you do\nnot control copyright. Those thus making or running the covered works\nfor you must do so exclusively on your behalf, under your direction\nand control, on terms that prohibit them from making any copies of\nyour copyrighted material outside their relationship with you.\n\n Conveying under any other circumstances is permitted solely under\nthe conditions stated below. Sublicensing is not allowed; section 10\nmakes it unnecessary.\n\n 3. Protecting Users' Legal Rights From Anti-Circumvention Law.\n\n No covered work shall be deemed part of an effective technological\nmeasure under any applicable law fulfilling obligations under article\n11 of the WIPO copyright treaty adopted on 20 December 1996, or\nsimilar laws prohibiting or restricting circumvention of such\nmeasures.\n\n When you convey a covered work, you waive any legal power to forbid\ncircumvention of technological measures to the extent such circumvention\nis effected by exercising rights under this License with respect to\nthe covered work, and you disclaim any intention to limit operation or\nmodification of the work as a means of enforcing, against the work's\nusers, your or third parties' legal rights to forbid circumvention of\ntechnological measures.\n\n 4. Conveying Verbatim Copies.\n\n You may convey verbatim copies of the Program's source code as you\nreceive it, in any medium, provided that you conspicuously and\nappropriately publish on each copy an appropriate copyright notice;\nkeep intact all notices stating that this License and any\nnon-permissive terms added in accord with section 7 apply to the code;\nkeep intact all notices of the absence of any warranty; and give all\nrecipients a copy of this License along with the Program.\n\n You may charge any price or no price for each copy that you convey,\nand you may offer support or warranty protection for a fee.\n\n 5. Conveying Modified Source Versions.\n\n You may convey a work based on the Program, or the modifications to\nproduce it from the Program, in the form of source code under the\nterms of section 4, provided that you also meet all of these conditions:\n\n a) The work must carry prominent notices stating that you modified\n it, and giving a relevant date.\n\n b) The work must carry prominent notices stating that it is\n released under this License and any conditions added under section\n 7. This requirement modifies the requirement in section 4 to\n \"keep intact all notices\".\n\n c) You must license the entire work, as a whole, under this\n License to anyone who comes into possession of a copy. This\n License will therefore apply, along with any applicable section 7\n additional terms, to the whole of the work, and all its parts,\n regardless of how they are packaged. This License gives no\n permission to license the work in any other way, but it does not\n invalidate such permission if you have separately received it.\n\n d) If the work has interactive user interfaces, each must display\n Appropriate Legal Notices; however, if the Program has interactive\n interfaces that do not display Appropriate Legal Notices, your\n work need not make them do so.\n\n A compilation of a covered work with other separate and independent\nworks, which are not by their nature extensions of the covered work,\nand which are not combined with it such as to form a larger program,\nin or on a volume of a storage or distribution medium, is called an\n\"aggregate\" if the compilation and its resulting copyright are not\nused to limit the access or legal rights of the compilation's users\nbeyond what the individual works permit. Inclusion of a covered work\nin an aggregate does not cause this License to apply to the other\nparts of the aggregate.\n\n 6. Conveying Non-Source Forms.\n\n You may convey a covered work in object code form under the terms\nof sections 4 and 5, provided that you also convey the\nmachine-readable Corresponding Source under the terms of this License,\nin one of these ways:\n\n a) Convey the object code in, or embodied in, a physical product\n (including a physical distribution medium), accompanied by the\n Corresponding Source fixed on a durable physical medium\n customarily used for software interchange.\n\n b) Convey the object code in, or embodied in, a physical product\n (including a physical distribution medium), accompanied by a\n written offer, valid for at least three years and valid for as\n long as you offer spare parts or customer support for that product\n model, to give anyone who possesses the object code either (1) a\n copy of the Corresponding Source for all the software in the\n product that is covered by this License, on a durable physical\n medium customarily used for software interchange, for a price no\n more than your reasonable cost of physically performing this\n conveying of source, or (2) access to copy the\n Corresponding Source from a network server at no charge.\n\n c) Convey individual copies of the object code with a copy of the\n written offer to provide the Corresponding Source. This\n alternative is allowed only occasionally and noncommercially, and\n only if you received the object code with such an offer, in accord\n with subsection 6b.\n\n d) Convey the object code by offering access from a designated\n place (gratis or for a charge), and offer equivalent access to the\n Corresponding Source in the same way through the same place at no\n further charge. You need not require recipients to copy the\n Corresponding Source along with the object code. If the place to\n copy the object code is a network server, the Corresponding Source\n may be on a different server (operated by you or a third party)\n that supports equivalent copying facilities, provided you maintain\n clear directions next to the object code saying where to find the\n Corresponding Source. Regardless of what server hosts the\n Corresponding Source, you remain obligated to ensure that it is\n available for as long as needed to satisfy these requirements.\n\n e) Convey the object code using peer-to-peer transmission, provided\n you inform other peers where the object code and Corresponding\n Source of the work are being offered to the general public at no\n charge under subsection 6d.\n\n A separable portion of the object code, whose source code is excluded\nfrom the Corresponding Source as a System Library, need not be\nincluded in conveying the object code work.\n\n A \"User Product\" is either (1) a \"consumer product\", which means any\ntangible personal property which is normally used for personal, family,\nor household purposes, or (2) anything designed or sold for incorporation\ninto a dwelling. In determining whether a product is a consumer product,\ndoubtful cases shall be resolved in favor of coverage. For a particular\nproduct received by a particular user, \"normally used\" refers to a\ntypical or common use of that class of product, regardless of the status\nof the particular user or of the way in which the particular user\nactually uses, or expects or is expected to use, the product. A product\nis a consumer product regardless of whether the product has substantial\ncommercial, industrial or non-consumer uses, unless such uses represent\nthe only significant mode of use of the product.\n\n \"Installation Information\" for a User Product means any methods,\nprocedures, authorization keys, or other information required to install\nand execute modified versions of a covered work in that User Product from\na modified version of its Corresponding Source. The information must\nsuffice to ensure that the continued functioning of the modified object\ncode is in no case prevented or interfered with solely because\nmodification has been made.\n\n If you convey an object code work under this section in, or with, or\nspecifically for use in, a User Product, and the conveying occurs as\npart of a transaction in which the right of possession and use of the\nUser Product is transferred to the recipient in perpetuity or for a\nfixed term (regardless of how the transaction is characterized), the\nCorresponding Source conveyed under this section must be accompanied\nby the Installation Information. But this requirement does not apply\nif neither you nor any third party retains the ability to install\nmodified object code on the User Product (for example, the work has\nbeen installed in ROM).\n\n The requirement to provide Installation Information does not include a\nrequirement to continue to provide support service, warranty, or updates\nfor a work that has been modified or installed by the recipient, or for\nthe User Product in which it has been modified or installed. Access to a\nnetwork may be denied when the modification itself materially and\nadversely affects the operation of the network or violates the rules and\nprotocols for communication across the network.\n\n Corresponding Source conveyed, and Installation Information provided,\nin accord with this section must be in a format that is publicly\ndocumented (and with an implementation available to the public in\nsource code form), and must require no special password or key for\nunpacking, reading or copying.\n\n 7. Additional Terms.\n\n \"Additional permissions\" are terms that supplement the terms of this\nLicense by making exceptions from one or more of its conditions.\nAdditional permissions that are applicable to the entire Program shall\nbe treated as though they were included in this License, to the extent\nthat they are valid under applicable law. If additional permissions\napply only to part of the Program, that part may be used separately\nunder those permissions, but the entire Program remains governed by\nthis License without regard to the additional permissions.\n\n When you convey a copy of a covered work, you may at your option\nremove any additional permissions from that copy, or from any part of\nit. (Additional permissions may be written to require their own\nremoval in certain cases when you modify the work.) You may place\nadditional permissions on material, added by you to a covered work,\nfor which you have or can give appropriate copyright permission.\n\n Notwithstanding any other provision of this License, for material you\nadd to a covered work, you may (if authorized by the copyright holders of\nthat material) supplement the terms of this License with terms:\n\n a) Disclaiming warranty or limiting liability differently from the\n terms of sections 15 and 16 of this License; or\n\n b) Requiring preservation of specified reasonable legal notices or\n author attributions in that material or in the Appropriate Legal\n Notices displayed by works containing it; or\n\n c) Prohibiting misrepresentation of the origin of that material, or\n requiring that modified versions of such material be marked in\n reasonable ways as different from the original version; or\n\n d) Limiting the use for publicity purposes of names of licensors or\n authors of the material; or\n\n e) Declining to grant rights under trademark law for use of some\n trade names, trademarks, or service marks; or\n\n f) Requiring indemnification of licensors and authors of that\n material by anyone who conveys the material (or modified versions of\n it) with contractual assumptions of liability to the recipient, for\n any liability that these contractual assumptions directly impose on\n those licensors and authors.\n\n All other non-permissive additional terms are considered \"further\nrestrictions\" within the meaning of section 10. If the Program as you\nreceived it, or any part of it, contains a notice stating that it is\ngoverned by this License along with a term that is a further\nrestriction, you may remove that term. If a license document contains\na further restriction but permits relicensing or conveying under this\nLicense, you may add to a covered work material governed by the terms\nof that license document, provided that the further restriction does\nnot survive such relicensing or conveying.\n\n If you add terms to a covered work in accord with this section, you\nmust place, in the relevant source files, a statement of the\nadditional terms that apply to those files, or a notice indicating\nwhere to find the applicable terms.\n\n Additional terms, permissive or non-permissive, may be stated in the\nform of a separately written license, or stated as exceptions;\nthe above requirements apply either way.\n\n 8. Termination.\n\n You may not propagate or modify a covered work except as expressly\nprovided under this License. Any attempt otherwise to propagate or\nmodify it is void, and will automatically terminate your rights under\nthis License (including any patent licenses granted under the third\nparagraph of section 11).\n\n However, if you cease all violation of this License, then your\nlicense from a particular copyright holder is reinstated (a)\nprovisionally, unless and until the copyright holder explicitly and\nfinally terminates your license, and (b) permanently, if the copyright\nholder fails to notify you of the violation by some reasonable means\nprior to 60 days after the cessation.\n\n Moreover, your license from a particular copyright holder is\nreinstated permanently if the copyright holder notifies you of the\nviolation by some reasonable means, this is the first time you have\nreceived notice of violation of this License (for any work) from that\ncopyright holder, and you cure the violation prior to 30 days after\nyour receipt of the notice.\n\n Termination of your rights under this section does not terminate the\nlicenses of parties who have received copies or rights from you under\nthis License. If your rights have been terminated and not permanently\nreinstated, you do not qualify to receive new licenses for the same\nmaterial under section 10.\n\n 9. Acceptance Not Required for Having Copies.\n\n You are not required to accept this License in order to receive or\nrun a copy of the Program. Ancillary propagation of a covered work\noccurring solely as a consequence of using peer-to-peer transmission\nto receive a copy likewise does not require acceptance. However,\nnothing other than this License grants you permission to propagate or\nmodify any covered work. These actions infringe copyright if you do\nnot accept this License. Therefore, by modifying or propagating a\ncovered work, you indicate your acceptance of this License to do so.\n\n 10. Automatic Licensing of Downstream Recipients.\n\n Each time you convey a covered work, the recipient automatically\nreceives a license from the original licensors, to run, modify and\npropagate that work, subject to this License. You are not responsible\nfor enforcing compliance by third parties with this License.\n\n An \"entity transaction\" is a transaction transferring control of an\norganization, or substantially all assets of one, or subdividing an\norganization, or merging organizations. If propagation of a covered\nwork results from an entity transaction, each party to that\ntransaction who receives a copy of the work also receives whatever\nlicenses to the work the party's predecessor in interest had or could\ngive under the previous paragraph, plus a right to possession of the\nCorresponding Source of the work from the predecessor in interest, if\nthe predecessor has it or can get it with reasonable efforts.\n\n You may not impose any further restrictions on the exercise of the\nrights granted or affirmed under this License. For example, you may\nnot impose a license fee, royalty, or other charge for exercise of\nrights granted under this License, and you may not initiate litigation\n(including a cross-claim or counterclaim in a lawsuit) alleging that\nany patent claim is infringed by making, using, selling, offering for\nsale, or importing the Program or any portion of it.\n\n 11. Patents.\n\n A \"contributor\" is a copyright holder who authorizes use under this\nLicense of the Program or a work on which the Program is based. The\nwork thus licensed is called the contributor's \"contributor version\".\n\n A contributor's \"essential patent claims\" are all patent claims\nowned or controlled by the contributor, whether already acquired or\nhereafter acquired, that would be infringed by some manner, permitted\nby this License, of making, using, or selling its contributor version,\nbut do not include claims that would be infringed only as a\nconsequence of further modification of the contributor version. For\npurposes of this definition, \"control\" includes the right to grant\npatent sublicenses in a manner consistent with the requirements of\nthis License.\n\n Each contributor grants you a non-exclusive, worldwide, royalty-free\npatent license under the contributor's essential patent claims, to\nmake, use, sell, offer for sale, import and otherwise run, modify and\npropagate the contents of its contributor version.\n\n In the following three paragraphs, a \"patent license\" is any express\nagreement or commitment, however denominated, not to enforce a patent\n(such as an express permission to practice a patent or covenant not to\nsue for patent infringement). To \"grant\" such a patent license to a\nparty means to make such an agreement or commitment not to enforce a\npatent against the party.\n\n If you convey a covered work, knowingly relying on a patent license,\nand the Corresponding Source of the work is not available for anyone\nto copy, free of charge and under the terms of this License, through a\npublicly available network server or other readily accessible means,\nthen you must either (1) cause the Corresponding Source to be so\navailable, or (2) arrange to deprive yourself of the benefit of the\npatent license for this particular work, or (3) arrange, in a manner\nconsistent with the requirements of this License, to extend the patent\nlicense to downstream recipients. \"Knowingly relying\" means you have\nactual knowledge that, but for the patent license, your conveying the\ncovered work in a country, or your recipient's use of the covered work\nin a country, would infringe one or more identifiable patents in that\ncountry that you have reason to believe are valid.\n\n If, pursuant to or in connection with a single transaction or\narrangement, you convey, or propagate by procuring conveyance of, a\ncovered work, and grant a patent license to some of the parties\nreceiving the covered work authorizing them to use, propagate, modify\nor convey a specific copy of the covered work, then the patent license\nyou grant is automatically extended to all recipients of the covered\nwork and works based on it.\n\n A patent license is \"discriminatory\" if it does not include within\nthe scope of its coverage, prohibits the exercise of, or is\nconditioned on the non-exercise of one or more of the rights that are\nspecifically granted under this License. You may not convey a covered\nwork if you are a party to an arrangement with a third party that is\nin the business of distributing software, under which you make payment\nto the third party based on the extent of your activity of conveying\nthe work, and under which the third party grants, to any of the\nparties who would receive the covered work from you, a discriminatory\npatent license (a) in connection with copies of the covered work\nconveyed by you (or copies made from those copies), or (b) primarily\nfor and in connection with specific products or compilations that\ncontain the covered work, unless you entered into that arrangement,\nor that patent license was granted, prior to 28 March 2007.\n\n Nothing in this License shall be construed as excluding or limiting\nany implied license or other defenses to infringement that may\notherwise be available to you under applicable patent law.\n\n 12. No Surrender of Others' Freedom.\n\n If conditions are imposed on you (whether by court order, agreement or\notherwise) that contradict the conditions of this License, they do not\nexcuse you from the conditions of this License. If you cannot convey a\ncovered work so as to satisfy simultaneously your obligations under this\nLicense and any other pertinent obligations, then as a consequence you may\nnot convey it at all. For example, if you agree to terms that obligate you\nto collect a royalty for further conveying from those to whom you convey\nthe Program, the only way you could satisfy both those terms and this\nLicense would be to refrain entirely from conveying the Program.\n\n 13. Use with the GNU Affero General Public License.\n\n Notwithstanding any other provision of this License, you have\npermission to link or combine any covered work with a work licensed\nunder version 3 of the GNU Affero General Public License into a single\ncombined work, and to convey the resulting work. The terms of this\nLicense will continue to apply to the part which is the covered work,\nbut the special requirements of the GNU Affero General Public License,\nsection 13, concerning interaction through a network will apply to the\ncombination as such.\n\n 14. Revised Versions of this License.\n\n The Free Software Foundation may publish revised and/or new versions of\nthe GNU General Public License from time to time. Such new versions will\nbe similar in spirit to the present version, but may differ in detail to\naddress new problems or concerns.\n\n Each version is given a distinguishing version number. If the\nProgram specifies that a certain numbered version of the GNU General\nPublic License \"or any later version\" applies to it, you have the\noption of following the terms and conditions either of that numbered\nversion or of any later version published by the Free Software\nFoundation. If the Program does not specify a version number of the\nGNU General Public License, you may choose any version ever published\nby the Free Software Foundation.\n\n If the Program specifies that a proxy can decide which future\nversions of the GNU General Public License can be used, that proxy's\npublic statement of acceptance of a version permanently authorizes you\nto choose that version for the Program.\n\n Later license versions may give you additional or different\npermissions. However, no additional obligations are imposed on any\nauthor or copyright holder as a result of your choosing to follow a\nlater version.\n\n 15. Disclaimer of Warranty.\n\n THERE IS NO WARRANTY FOR THE PROGRAM, TO THE EXTENT PERMITTED BY\nAPPLICABLE LAW. EXCEPT WHEN OTHERWISE STATED IN WRITING THE COPYRIGHT\nHOLDERS AND/OR OTHER PARTIES PROVIDE THE PROGRAM \"AS IS\" WITHOUT WARRANTY\nOF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO,\nTHE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR\nPURPOSE. THE ENTIRE RISK AS TO THE QUALITY AND PERFORMANCE OF THE PROGRAM\nIS WITH YOU. SHOULD THE PROGRAM PROVE DEFECTIVE, YOU ASSUME THE COST OF\nALL NECESSARY SERVICING, REPAIR OR CORRECTION.\n\n 16. Limitation of Liability.\n\n IN NO EVENT UNLESS REQUIRED BY APPLICABLE LAW OR AGREED TO IN WRITING\nWILL ANY COPYRIGHT HOLDER, OR ANY OTHER PARTY WHO MODIFIES AND/OR CONVEYS\nTHE PROGRAM AS PERMITTED ABOVE, BE LIABLE TO YOU FOR DAMAGES, INCLUDING ANY\nGENERAL, SPECIAL, INCIDENTAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE\nUSE OR INABILITY TO USE THE PROGRAM (INCLUDING BUT NOT LIMITED TO LOSS OF\nDATA OR DATA BEING RENDERED INACCURATE OR LOSSES SUSTAINED BY YOU OR THIRD\nPARTIES OR A FAILURE OF THE PROGRAM TO OPERATE WITH ANY OTHER PROGRAMS),\nEVEN IF SUCH HOLDER OR OTHER PARTY HAS BEEN ADVISED OF THE POSSIBILITY OF\nSUCH DAMAGES.\n\n 17. Interpretation of Sections 15 and 16.\n\n If the disclaimer of warranty and limitation of liability provided\nabove cannot be given local legal effect according to their terms,\nreviewing courts shall apply local law that most closely approximates\nan absolute waiver of all civil liability in connection with the\nProgram, unless a warranty or assumption of liability accompanies a\ncopy of the Program in return for a fee.\n\n END OF TERMS AND CONDITIONS\n\n How to Apply These Terms to Your New Programs\n\n If you develop a new program, and you want it to be of the greatest\npossible use to the public, the best way to achieve this is to make it\nfree software which everyone can redistribute and change under these terms.\n\n To do so, attach the following notices to the program. It is safest\nto attach them to the start of each source file to most effectively\nstate the exclusion of warranty; and each file should have at least\nthe \"copyright\" line and a pointer to where the full notice is found.\n\n \n Copyright (C) \n\n This program is free software: you can redistribute it and/or modify\n it under the terms of the GNU General Public License as published by\n the Free Software Foundation, either version 3 of the License, or\n (at your option) any later version.\n\n This program is distributed in the hope that it will be useful,\n but WITHOUT ANY WARRANTY; without even the implied warranty of\n MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the\n GNU General Public License for more details.\n\n You should have received a copy of the GNU General Public License\n along with this program. If not, see .\n\nAlso add information on how to contact you by electronic and paper mail.\n\n If the program does terminal interaction, make it output a short\nnotice like this when it starts in an interactive mode:\n\n Copyright (C) \n This program comes with ABSOLUTELY NO WARRANTY; for details type `show w'.\n This is free software, and you are welcome to redistribute it\n under certain conditions; type `show c' for details.\n\nThe hypothetical commands `show w' and `show c' should show the appropriate\nparts of the General Public License. Of course, your program's commands\nmight be different; for a GUI interface, you would use an \"about box\".\n\n You should also get your employer (if you work as a programmer) or school,\nif any, to sign a \"copyright disclaimer\" for the program, if necessary.\nFor more information on this, and how to apply and follow the GNU GPL, see\n.\n\n The GNU General Public License does not permit incorporating your program\ninto proprietary programs. If your program is a subroutine library, you\nmay consider it more useful to permit linking proprietary applications with\nthe library. If this is what you want to do, use the GNU Lesser General\nPublic License instead of this License. But first, please read\n.","covid.yml","matches:\n - trigger: \"cv\"\n replace: \"COVID-19\"\n word: true\n\n - trigger: \":covidphone\"\n replace: |\n COVID PHONE COMMUNICATION\n\n Start Time: {{mytime}}\n\n Reason for call: In lieu of office visit due to COVID-19 concerns\n\n Notes:\n {{sp}} no travel\n {{sp}} no contact with recent travellers or suspected COVID-19 cases.\n {{sp}} no symptoms of COVID (cough, fever, shortness of breath, runny nose, or sore throat)\n that is not related to a pre-existing illness or health condition\n\n Recommended to continue social distancing.\n\n End Time:\n vars:\n - name: mytime\n type: match\n params:\n trigger: \":time\"\n\n# This COVID risk assessement and monitoring is based on the\n# COVID-19 Positive Primary Care Pathway\n# Posted on www.specialistlink.ca\n - trigger: \":covidrisk\"\n replace: |\n COVID PHONE RISK ASSESSMENT\n\n Start Time: {{mytime}}\n\n Reason for call: Risk stratification for presumed or confirmed COVID case\n\n Safety Net Check:\n {{sp}} no social isolation\n {{sp}} no lack of caregiver support\n {{sp}} no inability to maintain hydration\n {{sp}} no food/financial insecurity\n {{sp}} no homecare\n {{sp}} no challenges with health literacy or concerns with ability to self-manage\n\n High Risk Features:\n {{sp}} no recent discharge from tertiary care (hospital, complex care hub)\n {{sp}} no lack of safety net\n {{sp}} no age >70\n {{sp}} no age >60 with medical comorbitities\n {{sp}} no symptom deterioration\n\n Average Risk Features:\n {{sp}} no age <18\n {{sp}} no pregnancy\n {{sp}} no absence of symptoms (but swab positive)\n\n If above all negative, considered Lower Risk\n\n Overall Risk Assessment:\n High Risk - requires daily monitoring for 14 days\n Average Risk - requires monitoring every 2 days for 7 days\n Lower Risk - consider self monitoring only - handout provided\n\n End Time:\n vars:\n - name: mytime\n type: match\n params:\n trigger: \":time\"\n\n - trigger: \":covidredflags\"\n replace: |\n {{sp}} no severe shortness of breath at rest\n {{sp}} no difficulty breathing\n {{sp}} no pain or pressure in chest\n {{sp}} no cold, clammy or pale molted skin\n {{sp}} no new confusion\n {{sp}} no blue lips or face\n {{sp}} no becoming difficult to rouse\n {{sp}} no coughing up blood\n {{sp}} no reduced urine output\n {{sp}} no return of cough after period of improvement (may signal development of COVID pneumonia)\n {{sp}} no return of fever after afebrile period (may signal development of COVID pneumonia)\n {{sp}} no low oxygen saturation (<92% if prev healthly, <90% if underlying lung condition)\n {{sp}} no increased O2 requirements on home O2\n\n - trigger: \":covidmonitor\"\n replace: |\n COVID PHONE MONITORING\n\n Start Time: {{mytime}}\n\n Reason for call: Monitoring for presumed or confirmed COVID case\n\n Previous Risk Stratification: High Average Lower\n\n {{sp}} overall been feeling worse unchanged better\n\n If not worse, breathing assessment questionnaire was completed:\n How is your breathing?\n Is it worse today than yesterday?\n What does your breathing prevent you from doing?\n\n Overall worse or breathing questions positive, so red flags were checked:\n\n {{sp}} red flags, and need urgent or emergent referral\n {{sp}} no red flags, but since symptoms are worsening, now considered High Risk\n Overall not worse and breathing questions negative, so will continue to monitor\n High Risk - every 24h for total of 14 days\n Average Risk - every 48h for total of 7 days\n Lower Risk - consider self monitoring, using self-monitoring checklist\n\n Must isolate for a minimum of 10 days from symptom onset\n or when symptoms are gone, whichever is longer.\n\n End Time:\n vars:\n - name: mytime\n type: match\n params:\n trigger: \":time\"\n\n - trigger: \":covidtest\"\n word: true\n replace: |\n You are recommended to arrange COVID-19 testing through the online assessment tool:\n {{covidwebsite}}\n\n - trigger: \":covidremind\"\n word: true\n replace: |\n We are reminding all patients to do your part in reducing the spread of COVID-19\n by keeping a safe distance, washing hands often, and staying home if unwell.\n\n\n","insomnia.yml","matches:\n # sleep hygiene\n - trigger: \":sleephy\"\n word: true\n replace: |\n {{pp}} remove the TV and computer from the bedroom.\n {{pp}} avoid a bedroom that is too hot or too cold.\n {{pp}} maintain a quiet, dark, safe, and comfortable sleep environment. Minimize noise and light\n {{pp}} use the bed and bedroom only for sleep and sex.\n {{pp}} avoid caffeine after lunch and alcohol within 6 hours of bedtime\n {{pp}} avoid nicotine close to bedtime or during the night\n {{pp}} engage in moderate physical activity but avoid heavy exercise within 3 hours of bedtime\n {{pp}} avoid consuming excessive liquids or a heavy evening meal before bedtime\n {{pp}} use an alarm clock to get up at the same time every day\n {{pp}} go to bed only when sleepy, even if later than prescribed sleep schedule.\n {{pp}} get out of bed if not able to sleep within 20 minutes - go to another room and relax. Return to bed only when sleepy.\n {{pp}} avoid watching/checking the clock\n {{pp}} avoid excessive napping during the day - a brief nap (15-30 minutes) during the mid-afternoon can be refreshing and is okay.\n\n # difficulty sleeping\n - trigger: \":insomnia\"\n word: true\n replace: |\n Subjective: \n {{cc}} difficulty sleeping for DURATION\n {{sp}} no difficulty falling asleep\n {{sp}} no difficulty staying asleep\n {{sp}} no impact on function throughout the day\n {{sp}} no concerns regarding driving or operating heavy machinery\n {{sp}} no prior treatments to help sleep\n {{sp}} no identified trigger (such as stress, travel, shift work, depression, anxiety, pain)\n {{sp}} no nighttime cough\n {{sp}} no difficulty breathing\n {{sp}} no waking to urinate\n {{sp}} no noise in bedroom (such as partner snoring)\n {{sp}} no sleep disturbance due to children or pets\n {{sp}} no uncomfortable temperature in bedroom\n {{sp}} no lights in bedroom\n {{sp}} no screens in bedroom\n {{sp}} no nicotine late in day\n {{sp}} no caffeine late in day\n {{sp}} no alcohol late in day\n {{sp}} last meal of the day at XX pm\n {{sp}} consistent time to bed XX pm (even on weekends)\n {{sp}} consistent time to wake XX am (even on weekends)\n {{sp}} total time in bed of XX hours\n {{sp}} total sleep time of XX hours\n\n Assessment:\n {{ap}} Primary insomnia\n {{ap}} Secondary insomnia due to XXXX\n\n Plan:\n {{pp}} start a sleep diary\n {{pp}} refer to mysleepwell.ca for strategies to improve sleep\n {{pp}} consider reading Say Good Night to Insomnia for strategies to improve sleep\n {{pp}} follow recommendations for sleep hygiene:\n {{sleephy}}\n A referral has been made for obstructive sleep apnea.\n {{pp}} consider short term intermittent use of pharmacologic sleeping aid\n {{pp}} follow-up in 4 weeks\n\n vars:\n - name: sleephy\n type: match\n params:\n trigger: \":sleephy\"\n","resp.yml","matches:\n - trigger: \"sob\"\n replace: \"shortness of breath\"\n propagate_case: true\n word: true\n\n - trigger: \"soboe\"\n replace: \"shortness of breath on exertion\"\n propagate_case: true\n word: true\n\n - trigger: \":asthma\"\n word: true\n replace: |\n Asthma is a disease that causes inflammation in the airways, narrowing the space\n available for air to flow.\n Ventolin is a bronchodilator, which helps to relax the muscles and open the airwarys temporarily\n but does not address the underlying inflammation.\n You should benefit from the addition of regular daily medications such as inhaled corticosteroids\n to help suppress the underlying inflammation, and montelukast (Singulair) which is particularly\n helpful for allergy induced asthma.\n Combination puffers such as Symbicort have both a corticosteroid to help with the inflammation and\n a bronchodilator to open th airways that is both rapid onset (close to ventolin)\n and longer acting (compared to ventolin), so can be used effectively as a rescue inhaler as well.\n\n A prescription has been provided to extend your use of:\n Ventolin HFA 100mcg 1-2 puffs every 4 hours as needed\n\n In addition, prescriptions for the following medications have been provided to try to better\n control your asthma symptoms:\n Symbicort 200 1 puff twice daily, and as needed up to a total of 8 puffs daily\n Montelukast (Singulair) 10mg once daily\n\n You may not need to take these medications the entire year, but regular daily consistent use during\n the allergy season should help to control your symptoms.\n\n You are recommended to follow-up with your regular family physician within 30 days to review how\n well these new medications are working and whether you wish to continue them or any dose adjustment\n is necessary.\n","msk_ankle.yml","matches:\n - trigger: \":ankle\"\n replace: |\n Subjective:\n {{cc}} right left ankle pain for the past DURATION\n It started after MECHANISM\n {{sp}} been able walk after the injury\n {{sp}} no inability to bear weight immediately after the injury or right now (4 steps) (1)\n {{sp}} ongoing pain in [location]\n {{sp}} no significant ongoing pain in the midfoot (2)\n {{sp}} no previous ankle sprains\n\n Objective:\n {{op}} no visible deformity\n {{op}} no bruising\n {{op}} no swelling\n {{op}} no decreased range of motion\n {{op}} no loss of feeling\n {{op}} no loss of circulation\n\n {{op}} no significant tenderness at posterior edge or tip of the lateral malleous (3)\n {{op}} no significant tenderness at posterior edge or tip of the medial malleous (4)\n\n {{op}} no significant tenderness at the navicular bone (5)\n {{op}} no significant tenderness at the base of the 5th metatarsal (6)\n\n {{op}} no other significant tenderness\n {{op}} no pain with passive gentle inversion\n {{op}} no pain with passive gentle eversion\n {{op}} a negative squeeze test\n {{op}} a negative external rotation stress test\n {{op}} a negative anterior drawer test\n {{op}} a negative talar tilt test\n {{op}} a negative Thompson test\n\n\n Assessment:\n {{ap}} a Right Left Lateral Medial ankle sprain\n Based on the Ottawa Ankle Rules\n malleolar pain with (1),(3) or (4)], we need to rule out an ankle fracture.\n Based on the Ottawa Foot Rules\n midfoot pain with (1),(5), or (6)] we need to rule out a foot fracture.\n\n Plan:\n {{pp}} complete an xray of the ankle and foot\n {{pp}} rest the ankle\n {{pp}} use ice, compression, and keep the ankle elevated\n {{pp}} use NSAIDs (such as ibuprofen) for pain management\n {{pp}} follow up with physiotherapy to assist in recovery\n","headache.yml","matches:\n - trigger: \":headachefu\"\n word: true\n replace: |\n {{pp}} immediately seek medical attention if:\n Your headache comes on suddenly, quickly becomes severe,\n or could be described as \"the worst headache of your life\"\n Your headache is severe and you also have a fever or stiff neck\n You have a seizure, personality changes or confusion, or you pass out\n Your headache began right after you exercised or had a minor injury\n You have weakness, numbness, or trouble seeing\n\n - trigger: \":headacheredflag\"\n word: true\n replace: |\n {{sp}} no thunderclap onset\n {{sp}} no fever\n {{sp}} no rash\n {{sp}} no neck stiffness\n {{sp}} no focal weakness\n {{sp}} no numbness\n {{sp}} no speech difficulties\n {{sp}} no imbalance\n {{sp}} no eye pain\n {{sp}} no night sweats\n {{sp}} no unintentional weight loss\n\n - trigger: \":headache\"\n word: true\n replace: |\n Subjective:\n {{cc}} headache for the past DURATION\n\n Red Flags:\n {{redflags}}\n\n {{pain}}\n\n {{sp}} no aura (neurological symptoms before headache starts)\n {{sp}} no previous head injury\n {{sp}} no previous medical history (eg high blood pressure, diabetes, insomnia)\n {{sp}} no analgesia overuse (>14 days/month for plain acetaminophen or NSAID,\n >9 days/month for triptans, opioids, or combinations)\n {{sp}} no excess alcohol consumption\n\n Objective:\n {{op}} normal blood pressure\n {{op}} no fever\n {{op}} no scalp tenderness\n {{op}} no neck tenderness\n {{op}} no sinus tenderness\n {{op}} no temporomandibular joint (TMJ) clicking or tenderness\n {{op}} normal painless range of motion of the neck\n\n {{neuroexam}}\n\n Assessment:\n {{ap}} Cervicogenic Headache\n {{ap}} Migraine Headache without Aura\n There are NO red flags\n\n Plan:\n {{pp}} start a headache diary\n {{pp}} decrease caffeine\n {{pp}} increase regular exercise\n {{pp}} maintain regular sleep and regular meals\n {{pp}} use over the counter medication for mild attacks:\n Tylenol 1 g PRN, Advil 400 mg PRN, or Naproxen 550 mg PRN\n {{pp}} use prescription medication for severe attacks: Zolmitriptan\n {{pp}} avoid overuse of medication: (>14 days/month for\n acetaminophen or ibuprofen, >9 days/month for triptans)\n {{pp}} start daily migraine prophylaxis medication: Propranolol\n {{pp}} trial saline nasal rinse with distilled water\n and intra-nasal corticosteroid spray\n {{pp}} follow-up in 2 weeks to review effectiveness of treatment\n\n {{followup}}\n\n vars:\n - name: redflags\n type: match\n params:\n trigger: \":headacheredflag\"\n - name: followup\n type: match\n params:\n trigger: \":headachefu\"\n - name: neuroexam\n type: match\n params:\n trigger: \":neuroexam\"\n - name: pain\n type: match\n params:\n trigger: \":pain\"\n","driver.yml","matches:\n - trigger: \":driver\"\n word: true\n replace: |\n Subjective:\n {{cc}} Medical Examination for Driver's License\n Class of driver license required:\n Class 1 : Professional license to drive any vehicle\n Class 2 : Professional license for buses\n Class 3 : Vehicles with 3 axles plus - trucks\n Class 4 : Professional license for taxi, ambulance, small bus\n Class 5 : Standard driver’s license for cars, light trucks, motorhomes\n Class 6 : Motorcycles and mopeds\n\n {{sp}} no concerns with driving\n {{sp}} no difficulty with vision\n {{sp}} no difficulty with hearing the TV, telephone, or understanding speech in crowded room.\n {{sp}} no difficulty moving neck, shoulders, elbows, wrists, or ankles\n {{sp}} no history of ischemic heart disease (angina, heart attack)\n {{sp}} no history of diabetes mellitus\n {{sp}} no history of low blood sugar (hypoglycemia)\n {{sp}} no history of ministroke or blacking out.\n {{sp}} no history of seizures in the past year.\n {{sp}} no traffic violations, accidents, or close calls within the past year\n\n Objective:\n {{op}} normal range of motion of neck, shoulders, elbows, wrists, fingers, and ankles.\n {{op}} normal strength (5/5) throughout including hand grip strength\n {{op}} no abdominal pulsations\n {{op}} normal heart sounds (S1/S2)\n {{op}} no extra heart sounds (EHS)\n {{op}} no heart murmurs\n {{op}} good air entry to both lungs (GAEB)\n {{op}} no abnormal lung sounds (adventitia)\n\n Assessment:\n {{ap}} no concerns regarding medical fitness to drive\n\n Plan:\n Form filled and given\n {{pp}} follow-up as needed\n","digexam.yml","matches:\n - trigger: \":depain\"\n word: true\n replace: |\n {{op}} no distressed appearance\n {{op}} normal level of alertness\n {{op}} normal ability to mobilize\n {{op}} normal ability to mobilize to toilet\n\n - trigger: \":demental\"\n word: true\n replace: |\n {{op}} normal eye contact\n {{op}} normal behavior\n {{op}} normal expression of emotion (affect)\n {{op}} normal appearance and grooming\n {{op}} normal appearance of surroundings\n {{op}} normal interactions with others \n\n - trigger: \":depeds\"\n word: true\n replace: |\n {{op}} normal alertness\n {{op}} normal level of play\n {{op}} normal level of interest in surroundings\n {{op}} no apparent discomfort looking at lights\n {{op}} normal breathing rate\n {{op}} no increased work of breathing\n {{op}} normal skin color\n {{op}} no trouble looking up (no neck stiffness)\n\n - trigger: \":deresp\"\n word: true\n replace: |\n {{op}} normal ability to speak in full sentences\n {{op}} normal rate of breathing\n {{op}} normal rhythm of breathing\n {{op}} normal color\n {{op}} no increased work of breathing\n (no accessory muscle use, no tracheal tug,\n no subcostal/intercostal retractions)\n\n - trigger: \":deabdo\"\n word: true\n replace: |\n {{op}} normal ability to jump up and down\n {{op}} no apparent pain with cough or sneeze\n {{op}} normal ability to press own abdomen\n","gyne.yml","matches:\n - trigger: \":ocp\"\n word: true\n replace: |\n Subjective:\n {{cc}} Prescription for Oral Contraceptive Medication\n\n {{sp}} no current contraception\n\n {{sp}} no liver disease\n {{sp}} no migraines\n {{sp}} no previous cancer diagnosis\n {{sp}} no breast abnormalities\n {{sp}} no clotting disorders\n {{sp}} no tobacco use\n\n {{sp}} had last menstrual period on DATE\n {{sp}} regular menstruation\n {{sp}} no increased risk for sexually transmitted infection (STI)\n {{sp}} had last STI screen DURATION prior\n {{sp}} no need for pregnancy test at this time\n\n Objective:\n {{op}} current blood pressure of SBP/DBP\n\n Assessment:\n {{ap}} need for ongoing contraceptive medication\n with no contraindications\n\n Plan:\n {{pp}} continue with previously prescribed oral contraceptive medication\n Prescription provided for XXX\n\n {{pp}} reference the following links for more information:\n https://www.sexandu.ca/\n https://www.plannedparenthood.org/learn/birth-control\n\n {{pp}} reference the following links in case of missed doses:\n https://www.sexandu.ca/sos/\n https://www.plannedparenthood.org/online-tools/missed-birth-control-pill\n\n {{pp}} follow-up if further concerns or questions\n\n\n - trigger: \":ffertility\"\n word: true\n replace: |\n Subjective:\n {{cc}} failure to conceive after DURATION\n\n Menstrual History:\n {{sp}} menstruation starting at age XX\n {{sp}} irregular menstrual periods ranging from XX to YY days\n {{sp}} regular menstrual periods every XX days\n {{sp}} menstrual bleeding lasting XX days\n\n Pregnancy History:\n {{sp}} no previous pregnancies\n {{sp}} no previous pregnancies with current partner\n\n {{sp}} vaginal intercourse every second day\n around the time of ovulation\n {{sp}} verified time of ovulation with ovulation kits\n\n {{sp}} no lactation\n {{sp}} no nipple discharge\n {{sp}} symptoms of PCOS (abnormal hair growth, deep voice,\n acne, irregular menstruation)\n {{sp}} symptoms of endometriosis (severe menstrual cramps,\n pain with intercourse, excessive or irregular bleeding)\n {{sp}} no hypothyroidism symptoms:\n {{hitsh}}\n\n {{sp}} no history of pelvic inflammatory disease (PID)\n {{sp}} no history of polycystic ovarian syndrome (PCOS)\n {{sp}} no history of pelvic surgery\n {{sp}} no history of pelvic radiation\n {{sp}} no history of dilitation and curretage (D&C)\n\n {{sp}} no previous investigations or treatments\n\n Assessment:\n {{ap}} primary female infertility\n\n Plan:\n {{pp}} complete investigations including:\n CBC, TSH, Prolactin, FSH, LH, Progesterone, Testosterone, DHEA\n {{pp}} follow-up when results are available\n Referral sent to fertility clinic for further assessment\n vars:\n - name: hitsh\n type: match\n params:\n trigger: \":hitsh\"\n\n - trigger: \":menses\"\n word: true\n replace: |\n Your last menstrual period was on XXXX XX, XXX days ago\n Typically it will come regularly every XXXX days.\n Your menstrual cycle has been irregular since XXXXX\n It will last XXX days.\n The heaviest days are days XXXX - XXXX\n On those days, you typically would use XXXX pads/tampons in a day.\n There is no bleeding between menstrual periods.\n There is no bleeding after intercourse.\n There is significant cramping at the beginning of your period.\n There is no significant pain with your periods.\n\n - trigger: \":aub\"\n word: true\n replace: |\n Your main concern today is irregular menstrual bleeding.\n\n {{menses}}\n\n Your weight has been stable.\n You have no increased stress.\n You have no recent illness.\n You have not been increasing your amount of exercise.\n You have not had any trauma to your pelvic area.\n\n Your current method of contraception is\n You do not believe you could be pregnant because\n Your last vaginal intercourse was ago\n Your last PAP (cervical cancer screen) was\n and it was normal.\n\n Your last STI (sexually transmitted infection) screen was\n and it was negative.\n You have no lower abdominal pain, fever, or abnormal vaginal discharge.\n\n You have no changes in bladder or bowel function.\n You have no milky discharge from the breasts (galactorrhea)\n You have no heat or cold intolerance.\n You have no abnormal hair growth (hirsutism).\n You have no hot flashes.\n\n You are very certain your bleeding is only coming from the vagina.\n\n You have never been diagnosed with any conditions of the\n uterus such as fibroids or polyps.\n You have never had pelvic surgery, such as a C-section.\n You have no other issues with bleeding such as excessive bleeding\n with dental work or frequent nose bleeds.\n\n You are not aware of any family members with irregular periods\n or early menopause (before age 40).\n You are not aware of any family members with cancer in the\n pelvis such as uterine cancer or cervical cancer.\n You are not aware of any family history of bleeding disorders,\n thyroid disease, or celiac disease.\n\n {{noother}}\n\n You are experiencing irregular menstruation possibly due to\n\n You are advised to complete testing to clarify possible causes\n including blood work (Beta HCG, CBC, Ferritin, TSH, Prolactin,\n Testosterone, 17-hydroxyprogesterone, FSH, LH, Estradiol, INR, PTT)\n and a pelvic ultrasound.\n\n {{finish}}\n\n vars:\n - name: menses\n type: match\n params:\n trigger: \":menses\"\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n\n","sti.yml","matches:\n - trigger: \":sti\"\n word: true\n replace: |\n Subjective:\n {{cc}} possible sexually transmitted infection (STI)\n\n Symptoms:\n {{sp}} no pain with urination\n {{sp}} no sores, rashes, or growths\n {{sp}} no unusual discharge from penis, vagina, or anus\n {{sp}} no testicular pain\n {{sp}} no pelvic pain\n {{sp}} no pain during sex\n\n {{sp}} current strategies to avoid STIs including XXXXX\n {{sp}} current strategies to avoid pregnancy including XXXXX\n {{sp}} sexual contact including oral, anal, and vaginal\n\n\n High Risk Factors:\n {{sp}} no known STI contact\n {{sp}} a known STI contact, with last contact XXXX days/weeks ago\n {{sp}} no sexual activity under 25 years of age\n {{sp}} no new sexual partner\n {{sp}} not more than one sexual partner in the past year\n {{sp}} no anonymous sexual partnering\n {{sp}} no MSM (Men who have Sex with Men) contact\n {{sp}} no contact with sex workers or their clients\n {{sp}} no homelessness or street involvementf\n {{sp}} no previous sexual assault or abuse\n {{sp}} no use of non-barrier contraception\n {{sp}} no use of injection drugs\n {{sp}} no use of other substances\n {{sp}} no history of STI\n\n Screening History:\n {{sp}} most recent STI screen XXXX months/years ago\n {{sp}} most recent PAP smear XXXX months/years ago\n {{sp}} most recent menstrual period: \n\n\n Objective:\n {{op}} no weight loss\n {{op}} no fever\n {{op}} no enlarged lymph nodes\n {{op}} normal appearance of mouth and throat\n {{op}} normal appearance of external genitalia\n {{op}} no scrotal tenderness\n {{op}} normal vaginal exam with illuminated speculum\n {{op}} normal bimanual exam with no uterine or adnexal tenderness\n\n Assessment:\n {{ap}} routine STI screening request\n {{ap}} Chlamydia\n {{ap}} Gonorrhea\n\n Plan:\n {{pp}} complete STI testing\n {{pp}} treat with Azithromycin 1g and Cefixime 800mg for presumed exposure to Chlamydia and Gonorrhea\n {{pp}} practice safe sexual practice with consistent use of barrier protection (condoms)\n {{pp}} undergo regular STI screening, at least yearly, but more frequent if higher risk\n\n - trigger: \":hsv\"\n word: true\n replace: |\n Based on your symptoms, you are very likely having the rash in response to\n initial infection with a herpes simplex virus. Unfortunately, although the\n rash will heal, this virus generally never completely clears from the body\n and will very likely cause repeated outbreaks of a blistering rash.\n However, the first episode is the worst, and medications can also help\n reduce the severity and duration of future outbreaks.\n\n There is no blood test available to test for an active\n herpes simplex infection (HSV). To obtain a definite diagnosis\n you would need to visit a clinic in person and have a swab of the rash.\n\n To reduce the duration of the current outbreak, you are advised to use the '\n prescribed medication valacyclovir (Valtrex) 2 capsules (1g) twice daily\n for 10 days. If the rash is not completely healed, please extend the\n treatment for another 10 days.\n\n Note that if you have recurrence of this rash, you should take the same\n medication valacyclovir (Valtrex) 1 capsule (500mg) twice daily for 3 days\n starting when you first notice a tingle or blister forming.\n\n To reduce discomfort, you are advised to use the prescribed topical\n lidocaine 2% gel applied up to four times daily.\n\n {{apprx}}\n vars:\n - name: apprx\n type: match\n params:\n trigger: \":apprx\"\n\n - trigger: \":stitest\"\n word: true\n replace: |\n You are advised to complete a full STI (sexually transmitted infection)\n screening test including tests for Chlamydia, Gonorrhea, Syphilis, HIV,\n Hepatitis B and Hepatitis C.\n You will be contacted to arrange testing.\n\n Note that there can be a brief window after exposure to an STI where\n you test negative although you actually have the disease.\n If a partner has a confirmed STI but you initially test negative it\n is advised to retest 12 weeks after your last contact to confirm.\n\n Generally it is recommended to have STI screening at least every year,\n but if you have more than one partner or may be at higher risk, you should\n be tested at least every 6 months, and also after you have a new partner.\n\n {{results}}\n vars:\n - name: results\n type: match\n params:\n trigger: \":results\"\n\n","cardio.yml","matches:\n - trigger: \":cp\"\n replace: \"chest pain\"\n propagate_case: true\n word: true\n\n - trigger: \":chestpain\"\n word: true\n replace: |\n Subjective:\n {{cc}} chest pain for the past DURATION\n {{pain}}\n {{sp}} no exertional component\n {{sp}} no worsening with deep breaths\n {{sp}} no shortness of breath\n {{sp}} no nausea\n {{sp}} no sweating\n {{sp}} no previous similar episodes\n\n\n Objective:\n {{op}} blood pressure of\n {{op}} heart rate of\n {{op}} no distress\n {{op}} no increased work of breathing\n {{op}} normal heart sounds (S1/S2) with no murmurs or extra heart sounds\n {{op}} normal regular heart rhythm\n {{op}} good air entry to both lungs, with no abnormal sounds (adventitia)\n {{op}} no chest wall tenderness\n {{op}} no skin rash\n {{op}} no swelling (edema) in lower legs\n {{op}} no tenderness or redness in lower legs\n (no suspicion of a blod clot (Deep Vein Thrombosis))\n\n Assessment:\n {{ap}} Non-cardiac Chest Pain, not related to heart or lungs,\n most likely originating in chest wall\n\n Plan:\n {{pp}} use analgesia (such as ibuprofen or tylenol) for pain relief\n {{pp}} use medication to control acid reflux (GERD)\n as prescribed\n {{pp}} follow-up in 2 weeks if pain not improving\n {{pp}} seek emergency medical care if unremitting pain or shortness of breath\n\n vars:\n - name: pain\n type: match\n params:\n trigger: \":pain\"\n\n # Causes of tachy or brady arrythmias (6Hs and 5Ts)\n - trigger: \":arcause\"\n word: true\n replace: |\n Hypoxia\n Hypothermia\n Hypovolemia\n Hypoglycemia\n Hydrogen ion (acidosis)\n Hypo/Hyperkalemia\n\n Trauma (increase intracranial pressure, hypovolemia)\n Thrombosis (pulmonary or coronary)\n Tamponade (cardiac)\n Tension pneumothorax\n Toxins\n\n - trigger: \":wellsdvt\"\n word: true\n replace: |\n Wells Score for Deep Vein Thrombosis (DVT):\n Active malignancy (past 6 months) 1\n Immobilization at least 3 days OR\n surgery in past 12 weeks 1\n Immobilization of lower extremity 1\n Localized tenderness of deep venous system 1\n Entire leg swollen 1\n Calf swelling >=3 cm larger than other side 1\n Pitting edema confined to symptomatic side 1\n Collateral superficial veins 1\n Previously documented DVT 1\n Alternatives diagnosis at least as likely -2\n\n Score >=3 indicates high probability of DVT\n\n - trigger: \":wellspe\"\n word: true\n replace: |\n Wells Score for Pulmonary Embolism (PE):\n Clinical signs and symptoms of DVT 3\n Alternatives less likely than PE 3\n Heart rate >100 1.5\n Previous PE or DVT (confirmed) 1.5\n Immobilization at least 3 days OR\n surgery in past 4 weeks 1.5\n Hemoptysis (coughing blood) 1\n Active malignancy (past 6 months) 1\n\n Score <=4 do d-dimer and if negative stop\n Score >=5 do CTPA or V/Q scan\n\n - trigger: \":perc\"\n word: true\n replace: |\n PERC Criteria to Rule Out Pulmonary Embolism (PE):\n If the probability of PE is less than 15% and\n all the following are true, no further tests required\n\n {{sp}} age <50\n {{sp}} pulse <100 bpm\n {{sp}} oxygen saturation >=95%\n {{sp}} no coughing up blood (hemoptysis)\n {{sp}} no estrogen use (oral contraceptive or hormone replacement)\n {{sp}} no surgery or trauma needing general anesthesia in past 4 weeks\n {{sp}} no previous blood clots (venous thromboembolism)\n {{sp}} no leg swelling on only one side\n","intro.yml","matches:\n - trigger: \":intro\"\n replace: |\n Introduction visit (Meet & Greet):\n\n Self introduction and general clinic information and policies\n (clinic hours, walk-in appointments, after hours care, uninsured services) discussed.\n\n Discussed any issues with previous family physician relationship.\n\n Agreement on care relationship, expectations and boundaries discussed.\n Patient's questions answered.\n\n Recorded medical, medication, allergies, family, social histories.\n\n Plan:\n Patient signed request for previous medical records and faxed to previous provider\n Laboratory/Imaging requisition provided as needed\n Patient to book Periodic health Exam\n Counselled and advised when to follow-up.\n\n","README.md","Provides text expansion and templates to assist medical documentation.\nThe author is a practising family physician so the original package is targeted to family physicians, but should be general enough to help\nanyone interested in medical documentation.\n\nFor more information, visit: [https://github.com/wressl/medical-docs](https://github.com/wressl/medical-docs)","excision.yml","matches:\n - trigger: \":excision\"\n word: true\n replace: |\n Subjective:\n {{cc}} excision of skin growth on LOCATION\n {{sp}} noticed for the past DURATION\n {{sp}} no growth\n {{sp}} no color change\n {{sp}} no bleeding\n {{sp}} no pain\n {{sp}} no itch\n\n {{sp}} no specific concerns\n {{sp}} specific concerns including:\n\n {{sp}} no personal history of skin cancer\n {{sp}} no family history of skin cancer\n\n Risks and possible complications were discussed\n including bleeding, infection, scarring, regrowth\n Alternatives were discussed including no intervention\n Expected benefits include removal of a worrisome\n growth and diagnosis to guide further treatment\n Consent obtained\n\n Objective: \n Sterilization with alcohol 3 times\n followed by local infiltration with lidocaine with epinephrine \n Area then sterilized with chlorhexidine 3 times\n and sterile draping applied\n Excision performed with sterile surgical blade\n Bleeding controlled\n Incision sutured with sterile surgical suture/s\n (Nylon 3-0 x 5)\n Area cleansed and dressed\n Excised tissue sent to pathology\n\n Assessment:\n {{ap}} atypical melanocytic nevus\n {{ap}} irritated seborrheic keratosis\n {{ap}} irritated skin tag\n\n Plan:\n {{pp}} await diagnostic results from pathology\n {{pp}} keep covered and dry for next 24 hours\n {{pp}} apply polysporin to keep moist\n {{pp}} keep covered with bandage, replacing daily\n or sooner if soaked with blood\n {{pp}} return to clinic if suture removal in 7 days\n {{pp}} return to clinic sooner if concern for infection\n such as increasing pain, redness, warmth, swelling, or pus\n\n","msk.yml","matches:\n - trigger: \":rice\"\n word: true\n replace: |\n You are advised to obtain a splint to support your XXXXX and allow rest.\n You are advised to apply ice packs to the affected area for 20-30 minutes\n every 3-4 hours for 2-3 days until the pain goes away.\n You are advised to use elevate the affected area to reduce swelling.\n You are advised to use topical anti-inflammatory medication as prescribed\n (Diclofenac 10% Gel applied as needed 4 times daily) for pain relief\n You are advised to take anti-inflammatory medication as prescribed\n (Naproxen 250mg 1-2 tabs as needed every 24 hours) for pain relief\n You are advised to use over the counter anti-inflammatory medication\n such as ibuprofen or naproxen for pain relief\n\n - trigger: \":xray\"\n word: true\n replace: |\n You are advised to obtain an xray of your XXXXX. You will be contacted\n to arrange the details. Once your tests are completed and results are available,\n you will hear from us.\n\n If you have not received notification of your results from us\n WITHIN 2 DAYS of completing your tests, please contact us:\n Email: {{myemail}}\n Phone: {{myphone}}\n\n - trigger: \":physio\"\n word: true\n replace: |\n You are advised to refer to the following handout materials detailing\n stretches and exercises to guide your recovery:\n https://www.primarycaresportsmedicine.com/wp-content/uploads/2016/12/WRIST-WRIST-SPRAIN.pdf\n\n https://www.primarycaresportsmedicine.com/wp-content/uploads/2016/12/WRIST-WRIST-TENDONITIS.pdf\n\n https://www.primarycaresportsmedicine.com/wp-content/uploads/2016/12/WRIST-DE-QUERVAINS-TENOSYNOVITIS.pdf\n\n http://www.primarycaresportsmedicine.com/wp-content/uploads/2016/12/BACK-LOW-BACK-PAIN.pdf\n\n If feasible, you are advised to consult a physiotherapist to help\n guide your rehabilitation and reduce the chance of repeat injury.\n A referral for physiotherapy will be sent to you to help with an\n insurance claim if necessary.\n\n - trigger: \":wrist\"\n word: true\n replace: |\n Your main concern today is RIGHT LEFT wrist pain which started about\n This is not a work related condition.\n You have no previous injuries to your wrist.\n\n {{pain}}\n\n {{noother}}\n\n Your wrist is not swollen.\n Your wrist is not bruised. \n Your wrist has full range of motion.\n\n Your wrist has reduced range of motion.\n Extension is limited by about 10 degrees compared to the opposite side.\n Flexion is limited by about 10 degrees compared to the opposite side.\n Radial deviation is limited by about 10 degrees compared to the opposite side.\n Ulnar deviation is limited by about 10 degrees compared to the opposite side.\n\n There is no pain with resisted extension\n There is no pain with resisted flexion\n\n Your history and symptoms are most consistent with a RIGHT LEFT wrist sprain.\n Your history and symptoms are most consistent with a RIGHT LEFT wrist tendonitis.\n Your history and symptoms are most consistent with a RIGHT LEFT De Quervain's Tenosynovitis.\n Given the history, there is also concern for a possible fracture of the wrist bones.\n\n {{xray}}\n\n {{rice}}\n\n {{physio}}\n\n {{finish}}\n vars:\n - name: pain\n type: match\n params:\n trigger: \":pain\"\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: xray\n type: match\n params:\n trigger: \":xray\"\n - name: rice\n type: match\n params:\n trigger: \":rice\"\n - name: physio\n type: match\n params:\n trigger: \":physio\"\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n\n - trigger: \":hernia\"\n word: true\n replace: |\n Your main concern today is a hernia which is becoming more painful\n You first noticed a bulge around the navel (umbilicus) about XX ago\n It has gradually worsened and has become more painful in the past XX\n Your pain is XX/10 at rest and becomes XX/10 when you bend down.\n The bulge is tender to touch.\n There is no color change or bowel changes.\n\n Your height is XX cm and weight is XX kg\n for a body mass index (BMI) of XX\n\n On exam, you have a reducible bulge around your umbilicus\n approximately XX cm in diameter with\n no colour change or overlying skin changes.\n\n You have a symptomatic umbilical hernia, that is now\n signicantly impacting your function.\n\n {{refer}}\n\n In particular, if you have intense pain or the hernia changes color\n and your bowel movements stop, please\n call 911 or proceed immediately to the nearest Emergency Department.\n vars:\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: refer\n type: match\n params:\n trigger: \":refer\"\n\n - trigger: \":gout\"\n word: true\n replace: |\n Your main concern today is a possible gout attack in LOCATION\n\n You have had pain and swelling since \n There is also redness\n It is difficult to walk because of the pain.\n It started after\n So far you have tried treatments with\n\n You have had gout for DURATION\n The attacks or flares occur about XXX times per year\n You have identified triggers including\n These attacks usually affect your LEFT RIGHT GREAT TOE ANKLE\n\n Usually your attacks are treated successfully with\n\n This feels like your previous attacks.\n\n {{noother}}\n\n Your LEFT RIGHT GREAT TOE ANKLE appears swollen, with increased redness\n and is tender to the touch.\n\n Based on your history and examination, this is very likely a gout flare.\n\n You are advised to use the prescribed medication,\n Indomethacin 50mg as needed up to three times daily for pain relief\n\n You are also advised to use the prescribed medication\n Colchine 0.6mg twice daily until the symptoms completely resolve,\n usually about two weeks.\n\n It can sometimes be difficult to determine the trigger for gout and\n attacks may continue despite your best efforts to avoid triggers.\n If you are having more than three gout attacks per year, you may want to consider\n a daily medication, such as allopurinol, to prevent gout flares.\n Please speak with the doctor if you would like to discuss further.\n\n {{finish}}\n\n If your symptoms are not improving within 3 days or you have other concerns, please\n book for follow-up. \n\n vars:\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n\n\n","msk_back.yml","matches:\n - trigger: \":back\"\n replace: |\n Subjective:\n {{cc}} Upper Mid Low back pain for the past [duration]\n\n Red flags:\n {{sp}} no urinary or bowel incontinence or urinary retention\n {{sp}} no new weakness in legs\n {{sp}} no saddle anesthesia (numbness or tingling around genitalss, buttocks or inner thighs)\n {{sp}} no unintentional wt loss\n {{sp}} no worse pain with lying flat\n {{sp}} no waking in the night with back pain\n {{sp}} no feeling tired all the time\n {{sp}} no drenching night sweats\n {{sp}} no fever\n {{sp}} no feeling of being extremely unwell\n {{sp}} no abdo pain radiating into the back\n\n {{pain}}\n\n {{sp}} no urinary symptoms such as pain with urination, increased urinary frequency or urgency, blood in urine\n {{sp}} no history of kidney stones\n {{sp}} no testicular pain\n {{sp}} no pain radiating to the groin\n {{sp}} no history of MVA or high impact collision\n {{sp}} no history of straining such as heavy lifting\n\n Objective:\n {{op}} significant distress due to back pain.\n {{op}} no paraspinal muscle tenderness\n {{op}} no warmth or redness on the back\n {{op}} normal range of motion of the back\n {{op}} normal range of motion in hips\n {{op}} normal strength in lower limbs\n {{op}} normal deep tendon reflexes\n {{op}} normal (negative) Babinski on both sides\n {{op}} normal gait (including toe and heel walking)\n {{op}} normal (negative) straight leg in both legs\n {{op}} normal (negative) FABER's test in both legs\n\n Assessment:\n {{ap}} Mechanical Lower Back Pain\n\n Plan:\n {{pp}} use Tylenol, Short term NSAID, topical diclofenac, short term Cyclobenzaprine before bed\n {{pp}} use heating pad or ice to help with symptoms\n {{pp}} stay active and learn exercises that help strengthen and stretch your back.\n {{pp}} learn to lift using your legs instead of your back.\n {{pp}} avoid sitting or standing in the same position for too long.\n {{pp}} monitor for development of red flags as described above\n {{pp}} seek medical attention if the pain persists over 6 weeks, worsens, or new symptoms develop.\n\n vars:\n - name: pain\n type: match\n params:\n trigger: \":pain\"\n","nephro.yml","matches:\n - trigger: \":ksprevent\"\n word: true\n replace: |\n Strategies to Prevent Kidney Stones\n\n Diet\n Increase fluid intake (2.5-3L/day to make >2L urine per day)\n Increase citric acid containing fruits or beverages such as lemon juice/orange juice\n Cut salt intake (<2300mg sodium/day)\n Minimize phosphoric acid containing soda (colas)\n Limit animal protein to <=2 meals per day, less than 6-8 ounces\n Limit high oxalate foods such as spinach and rhubarb\n\n Exercise:\n Moderate exercise and weight reduction.\n\n Supplements:\n Vitamin B6 to help metabolize oxalate\n Fish oil supplement (potential benefit)\n Limit vitamin C to < 1000mg/day\n\n","heme.yml","matches:\n - trigger: \":ironho\"\n word: true\n replace: |\n {{pp}} refer to the following links on dietary iron:\n https://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-iron-and-your-health.pdf\n https://www.healthlinkbc.ca/sites/hlbcprox-prod.health.gov.bc.ca/files/documents/healthfiles/hfile68d.pdf\n","urology.yml","matches:\n - trigger: \":delayedejac\"\n replace: |\n Subjective:\n {{cc}} delayed ejaculation for the past DURATION\n {{sp}} no difficulty with ejaculation with masturbation\n {{sp}} no difficulty with ejaculation with partner\n {{sp}} no history of anxiety\n {{sp}} no seratonin enhancing drugs\n Examples: \n SSRI, SNRI, Bupropion, TCAs, MAOIs\n Anti-psychotics,\n triptans, Carbamazepine, Valproic acid, Lithium\n Opioids,\n Metoclopramide, Ondansetron\n Cyclobenzaprine, Dextromethorphan\n LSD, ecstasy, cocaine, amphetamines \n\n Assessment:\n {{ap}} Primary Delayed Ejaculation (likely at least partly secondary to serotonergic medication]\n Primary delayed ejaculation is difficult to treat unless directly related to a medication.\n If a medication cause is suspected, strategies include:\n 1) Switching SSRI to vilazodone (Viibryd) or low dose vortioxetine (Trintellix)\n 2) Switching SSRI to SNRI - duloxetine (cymbalta) or levomilnacipran (Fetzima) likely best\n 3) Adding mirtazapine (Remeron) or bupropion (Wellbutrin) to an SSRI\n\n If not medication related, it is usually related to anxiety, and overcontrolling or obsessive personality traits.\n Intensive counselling may be helpful.\n\n Most men are able to find specific stimuli when alone that help them reach their particularly high ejaculation threshold.\n Having their partner mimic these techniques may allow them to ejaculate with their partner. \n\n Finally, a stimulant (eg Dexedrine 5-10mg) 1 hour before sexual activity may help. \n If this approach is effective, one should consider screening for ADHD.\n\n Plan:\n {{pp}} self refer to counselling\n {{pp}} trial a medication switch to vilazodone (Viibryd) vortioxetine (Trintellix) duloxetine (Cymbalta) levominacipran (Fetzima)]\n {{pp}} trial adding mirtazapine (Remeron) bupropion (Wellbutrin)\n {{pp}} trial dexedrine 5mg, taken one hour before sexual activity\n {{pp}} follow-up within 1 month regarding effectiveness of treatment, sooner if concerns\n\n\n - trigger: \":lowtest\"\n word: true\n replace: |\n Subjective:\n {{cc}} possible low testosterone\n\n Sexual Symptoms:\n {{sp}} no decreased libido\n {{sp}} no erectile dysfunction\n {{sp}} no decreased frequency of morning erections\n {{sp}} no decreased performance\n\n Somatic Symptoms:\n {{sp}} no increased visceral body fat/obesity,\n {{sp}} no decreased lean muscle mass,\n {{sp}} no decreased strength,\n {{sp}} no fatigue/loss of energy,\n {{sp}} no decreased physical activity/ vitality,\n {{sp}} no low bone mineral density,\n {{sp}} no anemia,\n {{sp}} no flushes,\n {{sp}} no loss of facial, axillary and pubic hair/slow beard growth\n {{sp}} no decline in general feeling of well-being\n\n Psychological Symptoms:\n {{sp}} no depression/depressed mood,\n {{sp}} no mood changes,\n {{sp}} no irritability,\n {{sp}} no inability to concentrate\n {{sp}} no insomnia/sleep disturbances\n\n Objective: \n {{op}} no gonadal atrophy,\n {{op}} no decrease in pubic and facial hair, \n {{op}} no decrease in muscle mass, \n {{op}} no increase in visceral fat\n\n Assessment:\n {{ap}} Testosterone Deficiency Syndrome\n\n Plan:\n {{pp}} complete testing for testosterone level (recommended 7 - 11am or within 3 hours of waking if shift work)\n and related levels to confirm diagnosis and allow monitoring during treatment\n (FSH, LH, Prolactin, SHBG, Albumin (cFT or cBAT), TSH, Ferritin (or % iron saturation), CBC, PSA)\n\n # This is a general discussion of testosterone deficiency syndrome for reference\n # This information is not necessarily up to date or compliant with any guidelines \n - trigger: \":lowtestinfo\"\n word: true\n replace: |\n Testing:\n Testosterone 7am-11am or within 3 h of rising for shift workers\n If borderline, use bioavailable testosterone - user pay or calculate with testosterone, SHBG, albumin\n www.issam.ch/freetesto.htm\n Bioavailable testosterone normal range (4.0 - 16.0)\n If normal, do not replace as may suppress natural production and pt feels worse!\n\n Additional testing FSH, LH, Prolactin, SHBG, Albumin (cFT or cBAT), TSH, Ferritin (or % iron\n saturation), CBC, PSA\n\n FSH, LH low indicates secondary hypogonadism\n\n Secondary hypogonadism causes:\n Kallmann syndrome - associated with color blindness, anosmia\n Pituitary disorders - pituitary tumor, or treatment for tumor\n Inflammatory disease - sarcoidosis, histiocytosis, tuberculosis\n HIV/AIDS\n Medications - opiates, hormones, glucocorticoids, ketoconazole\n Substances - etoh, heroin\n Obesity\n Normal aging\n Concurrent illness - severe OSA, liver disease, hemochromatosis, severe illness, surgery, emotional stress\n\n Treatment:\n Lifestyle: aerobic exercise and resistance training, healthy diet, sleep, stress mgt\n Huge overlap of pre-diabetes/diabetes/metbolic syndrome, erectile dysfunction, low testosterone\n Treatment should improve sexual function, reduce need for PDE-5 inhibitors\n\n TRT:\n Contraindications: Metastatic Prostate CA, Hx of Breast Ca\n Side effects:\n Fertility: TRT suppresses sperm counts but fully reversible. Either withdraw or use clomid\n CV risk: no convincing evidence of increased risk, but conflicting studies. Some suggest protection for pts with low T to start.\n Prostate CA: Does not cause but could enhance growth if already present\n\n Delatestryl: 1ml (200mg) q2week 0.5ml (100mg) q1week\n Testosterone Cypionate: 2ml (200mg) q2week 1ml (100mg) q1week\n Oral has poor absorption: Andriol 80mg bid with fatty meals, fist oil supplement, olive oil\n Topical: Androgel/Testim starting 5g/day, Axiron 3-6g/day (axillary application),\n Androderm patch 5g/qhs)\n Intranasal: Natesto (testosterone nasal gel 4.5%) 1 actuation (5.5mg) per nostril or 2 actuations total bid (22mg/day) to start\n\n Monitoring\n Prior to treatment: Baseline DRE, 6 mo, 12mo, then annual\n Bloodwork (CBC, LFTs, Creatinine, BG/A1C, Lipids, PSA) prior to, 3,6,12mo, then annual\n\n If PSA rising to greater than age cutoff or >0.75/year, stop testosterone,\n recheck PSA and if still elevated, refer to urology (Rapid Access PSA Clinic in Calgary)\n\n Test level for Oral/transdermal - ideally 2 hours after dose (relative peak)\n Injectable - day prior or day of injection (trough)\n Goal of mid range (normal is 10-29) without s/e, improved general wellbeing, and sexual health\n\n Organ system Benefits Harms\n Erectile function/libido Improvement None\n Depression/mood/fatigue Improvement Aggressive behaviour\n Erythropoiesis Increase in hematocrit Increased risk of polycythemia,\n embolism\n Skeletal muscle Increase in fat-free mass None\n Bone metabolism Prevention of osteoporosis None\n Cardiovascular system Improvement in congestive Increased risk of thromboembolic\n heart failure, cardiovascular events\n exercise capacity\n\n Prostate\n Benign prostatic hyperplasia None beyond manifestations Marginal increase in volume and\n of testosterone deficiency prostate-specific antigen level\n syndrome\n Cancer (metastatic or high risk of recurrence) Absolute contraindication\n Recurrence and rapid progression\n\n\n Cancer (localized and treated) None beyond manifestations Potential exacerbation of subclinical\n of testosterone deficiency syndrome\n residual cancer\n\n Testicle None beyond manifestations Atrophy or impairment of \n of testosterone deficiency syndrome spermatogenesis\n\n Also see: CMAJ Guidelines 2015\n\n - trigger: \":cialis\"\n word: true\n replace: |\n You are advised to trial the prescribed Cialis (Tadalafil) starting with 10mg (1/2 tablet)\n as needed at least 30 minutes before sexual activity. This medication is expected to\n improve function for up to 36 hours after a single dose.\n If 10 mg works well, you may try reducing the dose to 5 mg (1/4 tablet) to reduce cost\n and any possible side-effects.\n If 10 mg provides only a partial response, you can increase to 20 mg (full tablet).\n If 20 mg is not effective, please follow-up for further discussion of alternative treatments.\n Do not exceed 20mg.\n\n If you find it more convenient to take daily, rather than as needed,\n the recommended daily dose is 2.5mg (1/8 tablet) up to 5 mg (1/4 tablet).\n A pill splitter may help to cut to 1/8 tablet, and usually we prescribe the 20mg\n tablets since they are the most cost effective, but there are smaller\n dose tablets (2.5mg, 5mg, 10mg) available if needed.\n\n Since this is your first time using this medication, you are recommended to only pick-up\n a minimum amount (4 tablets) to start to ensure it is working well before obtaining more,\n although your prescription is for more tablets so you can continue if it is working well.\n\n Please follow-up with your regular family physician to ensure you have appropriate monitoring\n of vascular risk factors, to determine if you may be a candidate for hormonal supplementation,\n and to help with smoking cessation. \n","common.yml","matches:\n - trigger: \"S:\"\n replace: \"Subjective:\"\n word: true\n - trigger: \"O:\"\n replace: \"Objective:\"\n word: true\n - trigger: \"A:\"\n replace: \"Assessment:\"\n word: true\n - trigger: \"P:\"\n replace: \"Plan:\"\n word: true\n\n - trigger: \":SOAP\"\n word: true\n replace: |\n Subjective:\n Objective:\n Assessment:\n Plan:\n\n Start Time: {{mytime}}\n End Time:\n vars:\n - name: mytime\n type: date\n params:\n format: \"%H:%M\"\n\n - trigger: \":FIFE\"\n word: true\n replace: |\n Feelings: What are concerned most about? Specific fears or worries?\n Ideas: What do you think might be going on?\n Function: How has this affected you day to day? What have you given up?\n Expectations: What do expect or hope I can do for you today?\n\n - trigger: \"Rt\"\n replace: \"right\"\n word: true\n\n - trigger: \"Lt\"\n replace: \"left\"\n word: true\n\n - trigger: \"sec\"\n replace: \"seconds\"\n word: true\n\n - trigger: \"min\"\n replace: \"minutes\"\n word: true\n\n - trigger: \"hr\"\n replace: \"hours\"\n word: true\n\n - trigger: \"wk\"\n replace: \"weeks\"\n word: true\n\n - trigger: \"mo\"\n replace: \"months\"\n word: true\n\n - trigger: \"yr\"\n replace: \"years\"\n word: true\n\n - trigger: \":myn\"\n replace: \"{{myname}}\"\n word: true\n\n - trigger: \":mycl\"\n replace: \"{{cname}}\"\n word: true\n\n - trigger: \":myem\"\n replace: \"{{myemail}}\"\n word: true\n\n - trigger: \":myph\"\n replace: \"{{myphone}}\"\n word: true\n\n - trigger: \"labreq\"\n replace: \"Laboratory Requistion\"\n word: true\n\n - trigger: \"prn\"\n replace: \"as needed\"\n word: true\n\n - trigger: \"rx\"\n replace: \"prescription\"\n word: true\n\n - trigger: \"rxhld\"\n replace: \"Please do not fill until requested by patient\"\n word: true\n\n - trigger: \"pf\"\n replace: \"puffs\"\n word: true\n\n - trigger: \":od\"\n replace: \"once daily\"\n word: true\n\n - trigger: \":bid\"\n replace: \"twice daily\"\n word: true\n\n - trigger: \":tid\"\n replace: \"three times daily\"\n word: true\n\n - trigger: \":qid\"\n replace: \"four times daily\"\n word: true\n\n - trigger: \":qhs\"\n replace: \"at bed-time\"\n word: true\n\n - trigger: \"bp\"\n replace: \"blood pressure\"\n word: true\n\n - trigger: \":temp\"\n replace: \"temperature\"\n word: true\n\n - trigger: \"appt\"\n replace: \"appointment\"\n word: true\n\n - trigger: \"f/u\"\n replace: \"follow-up\"\n word: true\n propagate_case: true\n\n - trigger: \"wic\"\n replace: \"walk-in clinic\"\n word: true\n\n - trigger: \"fp\"\n replace: \"Family Physician\"\n word: true\n\n - trigger: \":fufp\"\n replace: \"{{pp}} follow-up with your regular Family Physician.\"\n word: true\n\n - trigger: \"amit\"\n replace: \"Amitriptyline (Elavil)\"\n word: true\n\n - trigger: \"nort\"\n replace: \"Nortriptyline (Avantyl)\"\n word: true\n\n - trigger: \"valt\"\n replace: \"Valacyclovir (Valtrex)\"\n word: true\n\n - trigger: \"vrx\"\n replace: \"2-4 puffs four times daily as needed\"\n word: true\n\n - trigger: \"ocp\"\n replace: \"oral contraceptive pill\"\n word: true\n\n - trigger: \"bcp\"\n replace: \"birth control pill\"\n word: true\n\n - trigger: \"lmp\"\n replace: \"last menstrual period (LMP)\"\n word: true\n\n - trigger: \"otc\"\n replace: \"over-the-counter\"\n word: true\n\n - trigger: \"ds\"\n replace: \"drug-store\"\n word: true\n\n - trigger: \"pn\"\n replace: \"BC PharmaNet\"\n word: true\n\n - trigger: \"nc\"\n replace: \"Alberta Netcare\"\n word: true\n\n - trigger: \"oeph\"\n replace: \"On examination of the photo provided, \"\n word: true\n\n - trigger: \":fuwr\"\n replace: \"{{pp}} follow-up when results are available\"\n word: true\n\n - trigger: \":life\"\n word: true\n replace: |\n {{pp}} set a regular time to bed and to wake even on days off\n {{pp}} set regular meal times, eating a variety of non-processed foods\n {{pp}} get regular physical exercise, aiming for at least 30 minutes per day, 5 days per week\n {{pp}} reduce or eliminate use of substances, including alcohol\n Guidelines suggest a maximum 2 drinks/day and 10 drinks/week for women and 3 drinks/day and 15 drinks/week for men.\n {{pp}} keep up with your hobbies\n {{pp}} invest time in friendships and social contacts\n {{pp}} maintain your connection to spirituality and personal values\n\n - trigger: \":snet\"\n word: true\n replace: |\n {{pp}} book for follow-up if worsening or new symptoms\n\n - trigger: \":snet2\"\n word: true\n replace: |\n If there is a significant change in your symptoms, or decline\n in your health while waiting for the results, please do not wait\n for the results before being reassessed. Please seek out medical care\n as soon as possible if there is a significant worsening of your condition.\n\n - trigger: \":finish\"\n word: true\n replace: |\n {{results}}\n {{rxget}}\n {{findfp}}\n {{covidremind}}\n {{snet}}\n vars:\n - name: results\n type: match\n params:\n trigger: \":results\"\n - name: rxget\n type: match\n params:\n trigger: \":rxget\"\n - name: findfp\n type: match\n params:\n trigger: \":findfp\"\n - name: covidremind\n type: match\n params:\n trigger: \":covidremind\"\n - name: snet\n type: match\n params:\n trigger: \":snet\"\n\n # Dates\n - trigger: \":date\"\n replace: \"{{mydate}}\"\n vars:\n - name: mydate\n type: date\n params:\n format: \"%m/%d/%Y\"\n\n - trigger: \":time\"\n replace: \"{{mytime}}\"\n vars:\n - name: mytime\n type: date\n params:\n format: \"%H:%M\"\n\n - trigger: \":phone\"\n word: true\n replace: |\n PHONE COMMUNICATION\n Reason for call: \n Notes:\n\n\n - trigger: \"lmom\"\n replace: \"{{mytime}} Phoned but no answer. Left voice mail to call clinic when available.\"\n word: true\n vars:\n - name: mytime\n type: date\n params:\n format: \"%H:%M\"\n\n - trigger: \":pain\"\n replace: |\n The pain is located in \n and it radiates to \n The pain is associated with nausea vomitting sweating shortness of breath\n It has been present for \n and started when\n The symptoms are getting better staying the same getting worse\n It is constant intermittent\n The pain is better in the morning evening the same throughout the day\n It usually occurs about X times a day\n When it comes, each episode lasts for \n The character of the pain is \n The intensity is X out of 10 pain (where 10 is the worst pain imaginable)\n The pain gets worse when \n The pain gets better when \n Treatments tried so far include\n\n - trigger: \":PQRST\"\n word: true\n replace: |\n Provokes, palliates - What causes the pain?\n What makes it better or worse?\n Quality - What exactly is it like? (stinging, dull, sharp, burning, crushing)\n Radiation - Is the pain focal or does it spread anywhere?\n Severity - How severe is it? (scale 1 - 10)\n How much does it affect your life?\n TIming - Is it there all the time or does it come and go?\n When does it start and how long does it last?\n When was the last pain medication?\n\n - trigger: \":OLDCARTS\"\n word: true\n replace: |\n Onset:\n Location:\n Duration:\n Characteristic:\n Aggravating Factors:\n Relieving Factors:\n Therapies Tried:\n Severity:\n\n - trigger: \":SOCRATES\"\n word: true\n replace: |\n Site:\n Onset:\n Character:\n Radiates:\n Associated Symptoms:\n Time/duration:\n Exacerbating/relieving factors:\n Severity:\n\n\n - trigger: \":refill\"\n word: true\n replace: |\n Subjective:\n {{cc}} needing to refill previously prescribed medication: MEDNAME\n which is being prescribed for INDICATION\n for approximately the past DURATION\n\n {{sp}} no concerns with how well it is working (efficacy)\n {{sp}} no concerns with side-effects\n Plan:\n Prescription provided to extend use of MEDNAME\n {{pp}} continue to use medication as prescribed\n {{pp}} follow-up with regular Family Physician \n\n - trigger: \":sicknote\"\n word: true\n replace: |\n To whom this may concern,\n\n The above patient was seen and was assessed in my clinic.\n The patient is advised to be off work school on:\n\n {{mydate}}\n\n Should you have any clarifications please don't hesitate to contact me.\n\n Thank you very much.\n\n vars:\n - name: mydate\n type: date\n params:\n format: \"%B %d, %Y\"\n\n - trigger: \":noother\"\n word: true\n replace: |\n You have no known allergies.\n You have no other medical issues.\n You are not taking any medications (prescription or over the counter).\n You are a non-smoker.\n You do not drink alcohol.\n You do not use any other substances such as cannabis.\n\n - trigger: \":refills\"\n word: true\n replace: |\n Your main concern today is needing to refill previously prescribed medications:\n 1) MEDNAME DOSE FREQUENCY\n which is being prescribed for INDICATION\n for approximately the past DURATION\n\n 2) MEDNAME DOSE FREQUENCY\n which is being prescribed for INDICATION\n for approximately the past DURATION\n\n 3) MEDNAME DOSE FREQUENCY\n which is being prescribed for INDICATION\n for approximately the past DURATION\n\n {{noother}}\n\n You appear well, with no apparent distress\n You have no concerns with how well these medications are working (efficacy)\n You have no concerns with side-effects\n\n Prescriptions have been provided to extend your use of:\n MEDNAMES\n\n You are recommended to continue to use these medications as prescribed\n\n You are recommended to follow-up with your regular family physician\n\n {{finish}}\n vars:\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n\n\n\n\n\n","package.yml","# medical-docs package","strep.yml","matches:\n - trigger: \":strep\"\n word: true\n replace: |\n Subjective:\n {{cc}} sore throat for XX days\n {{sp}} no cough\n {{sp}} no previous strep\n {{sp}} no known strep contact\n Strep throat is most common in ages less than 15, and least common over 45.\n\n Objective:\n {{op}} temperature today of\n {{op}} no tender swollen lymph nodes in the neck (anterior cervical lymphadenopathy)\n {{op}} no tonsillar swelling\n {{op}} no tonsillar white spots (exudates)\n\n Assessment:\n {{ap}} Acute Streptococcal Pharyngitis (Strep Throat)\n {{ap}} Acute Viral Pharyngitis\n Approximately 80% of sore throats are viral in origin and do not improve\n with antibiotics, since antibiotics do not kill viruses\n\n Plan:\n A throat swab was sent to check for a bacterial infection (strep throat)\n {{pp}}wait until infection is confirmed before taking prescribed antibiotics\n {{pp}}start taking prescribed antibiotics immediately\n {{pp}}continue supportive management (hydrate with gatorade and salty soups,\n tylenol and/or advil for pain, salt gargles for throat, and rest)\n {{pp}}seek reassessment if worsening symptoms in 48 hours despite treatment\n {{pp}}call 911 or go to ED if trouble breathing\n\n - trigger: \":strepphone\"\n word: true\n replace: |\n PHONE COMMUNICATION\n\n Reason for call: Strep swab positive\n\n Notes:\n Informed strep swab positive and should start prescription given last visit.\n Patient understands and agreeable. Grateful for call.\n Will contact clinic if further concerns, not improving despite treatment.\n\n - trigger: \":strepscore\"\n word: true\n replace: |\n {{sp}} fever (temperature >38C) (1 point)\n {{sp}} tonsillar exudates (white spots) (1 point)\n {{sp}} no cough (1 point)\n {{sp}} swollen glands in neck (1 point)\n (anterior cervical lymphadenopathy)\n {{sp}} age of 3-14 years (1 point)\n {{sp}} age of 15-44 years (0 point)\n {{sp}} age of over 44 years (-1 point)\n\n Interpretation:\n -1, 0, 1 points - risk of strep infection <10%\n no antibiotic or throat culture necessary\n 2 or 3 points - risk of strep 15% - 32%\n throat culture and antibiotics if culture is positive\n 4 or 5 points - risk of strep 56%\n consider strep testing and/or culture\n\n","psych.yml","matches:\n - trigger: \":mse\"\n word: true\n replace: |\n Mental Status Exam:\n {{op}} casual dress, normal grooming and hygiene\n {{op}} calm and cooperative\n {{op}} no unusual movements or psychomotor changes\n {{op}} normal rate, tone, and volume of speech without pressure\n {{op}} normal range of emotional expression (affect)\n {{op}} normal stated mood (euthymic)\n {{op}} goal directed and logical thought processes\n {{op}} thought content free of delusions and fixations\n {{op}} no suicidal or homocidal thoughts\n {{op}} no hallucinations during interview\n {{op}} orientation to time, place, and person intact\n {{op}} normal memory and attention\n {{op}} good insight and judgement\n\n - trigger: \":psylink\"\n word: true\n replace: |\n {{pp}} refer to the following links:\n\n https://psychhealthandsafety.org/asw\n https://cmha.bc.ca/\n https://moodgym.com.au/\n https://www.anxietycanada.com/\n https://bouncebackbc.ca/\n https://www.keltyskey.com/\n\n # some links specific to counselling resources in British Columbia\n - trigger: \":psylinkbc\"\n word: true\n replace: |\n {{pp}} see the links below to arrange a counselling group or therapist.\n Normally one-on-one therapy is private pay and a physician referral is not required.\n Vancouver Coastal Health offers free group therapy and this requires a physician referral.\n\n https://counsellingbc.com/\n https://www.psychologists.bc.ca/find_psychologist\n https://divisionsbc.ca/sites/default/files/inline-files/NEW_2019%20-%2003%20-%20CBT%20BROCHURE%20FOR%20PATIENTS%20%28HOME%20PRINTER%29.pdf\n\n - trigger: \":psymed\"\n word: true\n replace: |\n Medications can sometimes be helpful for anxiety and depression.\n To be effective, they must be taken once daily, every day.\n They usually take several weeks to start having a significant effect.\n They are usually continued for at least 9 to 12 months.\n Some more common side effects include nausea, headache, sleep disturbance,\n sexual dysfunction, sweating and dry mouth.\n When first starting, they may cause a temporary increase in anxiety,\n and rarely an increase in suicidal thinking.\n If suicidal thoughts are increasing, it is important to seek help immediately.\n\n - trigger: \":risksuicide\"\n word: true\n replace: |\n {{sp}} no male sex\n {{sp}} no age over 60 or under 18\n {{sp}} no depression\n {{sp}} no previous attempts\n {{sp}} no alcohol abuse\n {{sp}} no loss of rational thinking\n {{sp}} no suicide in the family\n {{sp}} no organized plan\n {{sp}} no lack of social supports\n {{sp}} no serious illness or intractable pain\n\n - trigger: \":sxgad\"\n word: true\n replace: |\n {{sp}} no feeling of mind going blank\n {{sp}} no increased fatigue\n {{sp}} no sleep disturbance\n {{sp}} no feeling of being very excited or nervous\n {{sp}} no increased irritability\n {{sp}} no increased muscle tension\n\n - trigger: \":sxpanic\"\n word: true\n replace: |\n {{sp}} no sweating\n {{sp}} no trembling\n {{sp}} no unsteadiness\n {{sp}} no derealization\n {{sp}} no excessive heart rate\n {{sp}} no nausea\n {{sp}} no tingling\n {{sp}} no shortness of breath\n Symptoms usually peak within 10 minutes.\n\n\n - trigger: \":sxmdd\"\n word: true\n replace: |\n {{sp}} no depressed mood\n {{sp}} no sleep disturbance\n {{sp}} no reduced interest and pleasure in doing things\n {{sp}} no guilt and self blame\n {{sp}} no loss of energy and fatigue\n {{sp}} no concentration problems\n {{sp}} no appetite change\n {{sp}} no moving and speaking very slowly, or moving much more than usual\n {{sp}} no suicidal thoughts\n\n - trigger: \":sxmania\"\n word: true\n replace: |\n {{sp}} no increased distractibility\n {{sp}} no increased impulsivity\n {{sp}} no grandiosity\n {{sp}} no flight of ideas\n {{sp}} no increase in goal directed activities\n {{sp}} no decreased need for sleep\n {{sp}} no increase in talkativeness\n\n - trigger: \":sessri\"\n word: true\n replace: |\n Common side-effects of selective seratonin reuptake inhibitor (SSRI)\n anti-depressant medications include nausea, anxiety, insomnia,\n agitation, tremor, headache and sexual dysfunction\n\n - trigger: \":phq9\"\n word: true\n replace: |\n Patient Health Questionnaire (PHQ-9)\n\n Over the last 2 weeks, how often have you been bothered by any of the\n following problems?\n 0 = Not at all\n 1 = Several days\n 2 = More than half the days\n 3 = Nearly every day\n\n 1. Little interest or pleasure in doing things 0 1 2 3\n\n 2. Feeling down, depressed, or hopeless 0 1 2 3\n\n 3. Trouble falling or staying asleep, or sleeping too much 0 1 2 3\n\n 4. Feeling tired or having little energy 0 1 2 3\n\n 5. Poor appetite or overeating 0 1 2 3\n\n 6. Feeling bad about yourself – or that you are a failure or have let\n yourself or your family down 0 1 2 3\n\n 7. Trouble concentrating on things, such as reading the newspaper or\n watching television 0 1 2 3\n\n 8. Moving or speaking so slowly that other people could have noticed?\n Or the opposite – being so fidgety or restless that you have been\n moving around a lot more than usual 0 1 2 3\n\n 9. Thoughts that you would be better off dead or of hurting yourself in\n some way 0 1 2 3\n\n - trigger: \":gad7\"\n word: true\n replace: |\n Generalized Anxiety Disorder 7-item (GAD-7) scale\n\n Over the last 2 weeks, how often have you been bothered by any of the\n following problems?\n 0 = Not at all\n 1 = Several days\n 2 = More than half the days\n 3 = Nearly every day\n\n\n 1. Feeling nervous, anxious, or on edge 0 1 2 3\n\n 2. Not being able to stop or control worrying 0 1 2 3\n\n 3. Worrying too much about different things 0 1 2 3\n\n 4. Trouble relaxing 0 1 2 3\n\n 5. Being so restless that it's hard to sit still 0 1 2 3\n\n 6. Becoming easily annoyed or irritable 0 1 2 3\n\n 7. Feeling afraid as if something awful might happen 0 1 2 3\n\n If you checked off any problems, how difficult have these made it for you to do your work, take\n care of things at home, or get along with other people?\n Not difficult at all __________\n Somewhat difficult _________\n Very difficult _____________\n Extremely difficult _________\n\n - trigger: \":cage\"\n word: true\n replace: |\n Have you ever felt you needed to cut down your drinking?\n Are you annoyed by people criticizing your drinking\n Do you feel guilty about your drinking\n Do you every need a drink in the morning to steady your nerves?\n\n Score >=2 indicates further investigation needed\n\n - trigger: \":sxetohwd\"\n word: true\n replace: |\n Symptoms of Alcohol Withdrawal\n Stage 1:\n {{sp}} no tremor\n {{sp}} no sweating\n {{sp}} no anorexia\n {{sp}} no diarrhea\n {{sp}} no agitation\n Stage 2:\n {{sp}} no hallucinations\n Stage 3:\n {{sp}} no seizures\n Stage 4: (Delirium Tremens)\n {{sp}} no severe confusion, disorientation\n {{sp}} no abnormally fast heart rate (tachycardia)\n {{sp}} no high blood pressure (hypertension)\n {{sp}} no fever\n\n - trigger: \":depression\"\n word: true\n replace: |\n You are at home in XXXXX\n Your main concern today is discussion of antidepressant medication prescription.\n You have had what you believe are depression symptoms for\n These started after\n\n You have had no previous mental health diagnoses.\n You have had no history of manic symptoms, such as grandiose thinking\n (feeling like your able to do something clearly impossible),\n very impulsive and reckless behavior, or not needing sleep for days at a time.\n\n You have no family history of mental health issues.\n You have had no previous antidepressant prescriptions.\n\n {{noother}}\n\n We completed the following questionairre today to check for depression symptoms.\n\n {{phq9}}\n\n Your total score is XX/27, consistent with mild-moderate depression.\n\n From my observations today, your Mental Status Exam is as follows:\n You have casual dress, normal grooming and hygiene\n You are calm and cooperative\n You have no unusual movements or psychomotor changes\n You have normal rate, tone, and volume of speech without pressure\n You have normal range of emotional expression (affect)\n You have normal stated mood (euthymic)\n You have goal directed and logical thought processes\n You have thought content free of delusions and fixations\n You have no suicidal or homocidal thoughts\n You have no apparent hallucinations during interview\n You are orientated to time, place, and person intact\n You have normal memory and attention\n You have good insight and judgement\n\n\n Your symptoms are consistent with mild to moderate depression.\n Antidepressant medication can be a part of a comprehensive treatment plan,\n and you would like to trial a medication today. \n\n You are advised to complete some basic blood tests to check for physical\n issues such as anemia that may be contributing to your symptoms. \n\n You are recommended to start the medication prescribed\n ( ) once daily. You are recommended to take it in the morning\n but if it is making you sleepy, you can switch to taking it in the evening.\n You should follow-up in 2 weeks to assess your tolerance to the medication\n and any early effects but the full effect of the medication can take\n 6-8 weeks.\n\n Realizing that the most effective treatment for depression is multi-faceted\n you are encouraged to also work on other dimensions of treatment as follows:\n\n Biological\n You are recommended to have regular times for sleeping and waking\n You are recommended to have regular meal times\n You are recommended to have regular exercise (at least 30 minutes daily)\n You are recommended to reduce and, if possible, avoid substances\n such as alcohol or cannabis\n\n Psychological\n You are recommended to pursue talk therapy to build psychologic skills\n to help you lead a rich, full, and meaningful life\n You can make use of services to help find mental health resources:\n Alberta Wide Mental Health Help Line: 1-877-303-2642\n\n You are also recommended to consider self-help resources such as:\n https://www.anxietycanada.com/\n https://thehappinesstrap.com/free-resources/\n https://mysleepwell.ca/ (specific resources to improve sleep)\n\n Social\n You are encouraged to take opportunities to engage and socialize\n with friends and family.\n Maintaining social connection is an integral part of mental health.\n\n Spiritual\n Many people draw strength and resilience from their spirituality.\n For some this is organized religion, but for others it may be more\n keeping in touch with their personal values.\n Remembering what is truly important and meaningful and letting this\n be your guide to inspiring change can be enormously powerful.\n\n {{finish}}\n\n If you become suicidal and fear for your own safety, or are otherwise\n in crisis, please call 911\n or the Alberta Wide Mental Health Help Line: 1-877-303-2642\n vars:\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: phq9\n type: match\n params:\n trigger: \":phq9\"\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n","neuro.yml","matches:\n - trigger: \":cthead\"\n word: true\n replace: |\n Canadian Head CT Rule\n (not for age <16, anticoag or bleeding disorder, pregnancy)\n CT if any present:\n Basal Skull Fracture\n Emesis twice or more\n Age of 65 or over\n GCS score <15 at 2 hours after injury\n Suspected open or depressed skull fracture\n Signs of basal skull fracture\n (hemotympanum, 'racoon' eyes, CSR otorrhea/rhinorrhea, Battle's sign)\n Amnesia before impact of 30 minutes or more\n Dangerous mechanism (pedestrian, ejected from vehicle, fall from elevation >=3 feet or 5 stairs)\n\n - trigger: \":gcs\"\n word: true\n replace: |\n Glasgow Coma Scale\n Eyes:\n 4: Open spontaneously\n 3: Open to speech\n 2: Open to pain\n 1: No response\n Verbal:\n 5: Alert and oriented\n 4: Disoriented\n 3: Inappropriate words\n 2: Unintelligible (moans)\n 1: No response\n Motor:\n 6: Follows commands\n 5: Localizes to pain\n 4: Withdraws from pain\n 3: Decorticate\n (stiff with bent arms, clenched fists, and legs held out straight)\n 2: Decerebrate\n (arms and legs held straight out, toes pointed downward, and the head and neck arched backward)\n 1: No response\n\n - trigger: \":neuroexam\"\n word: true\n replace: |\n {{op}} normal level of conciousness\n {{op}} normal exam of head, eyes, ears, nose and throat\n {{op}} normal cranial nerve exam\n {{op}} normal strength in upper and lower limbs\n {{op}} normal deep tendon reflexes in upper and lower limbs\n {{op}} normal cerebellar exam (including finger to nose, and alternating movements)\n {{op}} normal gait, including heel to toe\n {{op}} normal ability to retain balance with eyes closed (negative Rhomberg)\n\n - trigger: \":neuroredflag\"\n word: true\n replace: |\n {{sp}} no difficulty speaking (dysarthria)\n {{sp}} no double vision (diplopia)\n {{sp}} no difficulty swallowing (dysphagia)\n {{sp}} no difficulty with precise movements like finger to nose (dysmetria)\n {{sp}} no inability to perform rapid alternating movements (dysdiadochokinesia)\n\n\n - trigger: \":vertigo\"\n word: true\n replace: |\n Subjective:\n {{cc}} dizziness for the past DURATION\n {{sp}} a feeling like the room is spinning\n The sensation is intermittent, lasting for XX seconds\n {{sp}} no identified triggers - no recent sickness or cold and no trauma.\n It is associated with nausea\n {{sp}} no other symptoms.\n\n Red Flags:\n {{neuroredflag}}\n\n Objective:\n {{neuroexam}}\n {{op}} symptoms provoked by laying down quickly with head turned to one side (Dix hallpike)\n Worse when turning to RIGHT, including dizziness, nausea, involuntary eye movements (nystagmus)\n\n Assessment:\n {{ap}} Benign Paroxysmal Peripheral Vertigo (BPPV)\n\n Plan:\n {{pp}} review the educational materials provided\n {{pp}} attempt self-treatment according to hand out provided\n {{pp}} consider physiotherapy if ineffective.\n {{pp}} maintain adequate hydration.\n {{pp}} use provided prescription (betahistine) to help with symptoms as needed\n\n vars:\n - name: neuroexam\n type: match\n params:\n trigger: \":neuroexam\"\n - name: neuroredflag\n type: match\n params:\n trigger: \":neuroredflag\"\n\n - trigger: \":tremor\"\n word: true\n replace: |\n Subjective:\n {{cc}} tremor in LEFT HAND for DURATION\n {{sp}} no tremor at rest\n {{sp}} no difficulty with activities of daily living\n {{sp}} no progressively worsening symptoms\n {{sp}} no improvement with drinking alcohol\n {{sp}} no previous treatment\n {{sp}} no family history of tremor\n\n Objective:\n Psychogenic Tremor:\n With rapid alternating movements of the contralateral limb, the tremor is\n BETTER WORSE UNCHANGED with fist open/close\n BETTER WORSE UNCHANGED with forearm pronation/supination\n BETTER WORSE UNCHANGED with foot tap on the floor\n\n Note: Typically parkinson disease resting tremor becomes more obvious\n psychogenic tremor disappears, or takes on rhythm of voluntary limb (entrainment).\n\n Action Tremor:\n The tremor is:\n BETTER WORSE UNCHANGED when drawing a spiral inside another spiral,\n BETTER WORSE UNCHANGED when joining 2 points between closely spaced straight lines\n BETTER WORSE UNCHANGED when pouring water from one glass to another\n\n Postural Tremor:\n The tremor is:\n BETTER WORSE UNCHANGED when arms are outstretched for 10-15s, with a loose sheet of paper on the hand(s)\n\n Kinetic Tremor\n The tremor is:\n BETTER WORSE UNCHANGED with nose-finger-nose movement\n BETTER WORSE UNCHANGED with knee-heel-shin movement\n\n Intention Tremor\n The tremor is NOT present during target-directed movements.\n Tremor amplitude is INCREASED DECREASED UNCHANGED as the hand approaches the target.\n\n Simple Kinetic Tremor\n The tremor is NOT present during all non-targeted movements\n such as repeated flexion-extension of the elbow or pronation-supination\n of the forearm.\n There is NO increase in amplitude in the terminal phase.\n\n Task Specific Tremor\n The tremor APPEARS WORSENS IMPROVES IS UNCHANGED with writing.\n The tremor APPEARS WORSENS IMPROVES IS UNCHANGED with playing a musical instrument\n The tremor APPEARS WORSENS IMPROVES IS UNCHANGED with holding a note.\n\n Isometric Tremor\n The tremor does NOT appear as a result of contraction of muscles\n against a rigid stationary object. \n\n Assessment:\n There is a rhythmic, involuntary oscillation of the LEFT RIGHT UPPER LOWER limb,\n predominantly involving the WRIST AND DISTAL PORTION OF THEN FINGERS, NOT present at rest,\n INCREASED DECREASED UNCHANGED during activities, SLOW MODERATE FAST in frequency, \n MILD MODERATE SEVERE in amplitude, INCREASED DECREASED UNCHANGED by distracting movements\n of other limbs and having NO entrainment.\n\n In summary, this appears to be a RESTING ACTION tremor.\n The tremor characteristics are most consistent with a POSTURAL KINETIC PSYCHOGENIC tremor.\n The kinetic tremor appears to be a SIMPLE KINETIC INTENTION TASK SPECIFIC ISOMETRIC tremor.\n\n {{ap}} Benign Essential Tremor\n\n Plan:\n {{pp}} start a trial of propranolol \n {{pp}} avoid using alcohol to treat\n {{pp}} follow-up within one month to review effectiveness of treatment\n\n - trigger: \":tremorinfo\"\n word: true\n replace: |\n DDx:\n Tremor: rhythmic, involuntary oscillations of a body part\n Resting tremor: present in body part not voluntarily activated, completely\n supported against gravity (supported on armrest of chair)\n Action tremor: seen during voluntary activity of muscles.\n Postural tremor: with voluntary maintenance of antigravity position\n Kinetic tremor: present during voluntary movements\n Simple kinetic tremor: present during all voluntary movements\n that are not targeted\n Intention tremor: present during target-directed movements\n Worse as target is approached.\n Task-specific tremor: exacerbated by specific activity\n Isometric: with muscle contraction against rigid stationary object.\n\n Myoclonus: nonrhythmic, rapid, jerky, shocklike\n Steriotypy: repeated and continuous complex motor acts\n Epilepsia partialis continua: can be rhythmic, but movements\n do NOT change with alteration in position or activity.\n Clonus: rhythmic oscillations around a joint in response to\n sudden passive contraction.\n Increases in amplitude and force with passive stretching of muscles\n Dystonia: sustained muscular contractions frequently causing\n twisting and abnormal posturing of a body part\n Tic: brief, nonrhythmic, rapid movements, usually orofacial, can be suppressed\n voluntarily with rebound increase afterward.\n Chorea: Non-rhythmic, nonstereotyped,semipurposive,relatively slow movements\n that flow from one part of the body to another.\n\n - trigger: \":bellsp\"\n word: true\n replace: |\n Your main concern today is a weakness on one side of your face\n that developed over the past\n\n You have had no difficulty in closing your eye on the affected side.\n You have had no reduction in your normal ability to taste\n You have had no reduction in tears\n You have had no increased sensitivity to sound.\n You have had no pain in your ear.\n You have had no rash.\n You have had no other pain.\n You have had no trauma to your face, head, or neck.\n You have had no previous similar symptoms.\n\n {{noother}}\n\n You have an obvious asymmetry between the two sides of your face\n particularly when you are trying to move.\n Your eye appears to close completely, but not tightly.\n You have very little motion in your forehead on the affected side.\n There are no visible rashes. \n\n Your history and examination is consistent with Bell's Palsy, which is\n an acute impairment of the facial nerve of uncertain cause.\n Treatments are most effective if started within 72 hours of symptom onset.\n However, this condition can take several weeks and even months to fully recover.\n\n The primary treatment is an oral corticosteroid (prednisone) to reduce the\n inflammation responsible for the nerve impairment.\n However, it is thought a viral cause may be present in some cases so\n for severe cases, where there is very little movement and you are unable\n to fully close the eye, it is recommended to also take an antiviral medication.\n\n You are advised to take the prescribed medications:\n Prednisone 60mg once daily for 7 days and\n Valacyclovir (Valtrex) 1000mg three times day for 7 days\n\n You are advised to also apply a liquid or gel artificial tears to your eye\n every hour while awake and use an ointment form at night.\n You should also wear a patch over the eye at night to further protect the eye.\n Please speak to your pharmacist to obtain these items as they do not\n require a prescription.\n\n {{finish}}\n\n You are advised to follow-up with an in-person assessment within 3 weeks,\n unless you have completely recovered before then.\n\n Please seek reassessment sooner if your symptoms are worsening with\n treatment or you have other concerns. \n vars:\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n\n\n","uti.yml","matches:\n - trigger: \":uti\"\n word: true\n replace: |\n Subjective:\n {{cc}} possible urinary tract infection for the past XX days\n {{sp}} no dysuria\n {{sp}} no frequency\n {{sp}} no urgency,\n {{sp}} no hematuria\n {{sp}} no fever\n {{sp}} no chills\n {{sp}} no nausea and vomiting\n {{sp}} no flank pain\n {{sp}} no abdominal pain\n\n {{sp}} no vaginal discharge\n {{sp}} no vaginal bleeding\n {{sp}} no bowel changes\n\n {{sp}} no urinary tract infections (uti) in the past 6 month (and none in the past year)\n (recurrent uti defined as ≥2 infections in six months or ≥3 infections in one year)\n {{sp}} no antibiotic use within 4 weeks\n {{sp}} no immunocompromised state\n {{sp}} no allergies to antibiotics\n {{sp}} no pregnancy\n\n Objective:\n {{op}} no suprapubic tenderness (overlying bladder)\n {{op}} no costavertebral angle tenderness (overlying kidneys)\n {{op}} no leukocytes (white blood cells) on urine dip\n {{op}} no nitrites (byproduct of bacterial infection) on urine dip\n\n Assessment:\n {{ap}} Uncomplicated Urinary Tract Infection\n\n Plan:\n {{pp}} increase fluids\n {{pp}} start prescribed antibiotic: Macrobid Ciprofloxacin Septra Monurol Cephalexin\n A urine culture has been sent to guide treatment in case symptoms do not improve\n\n {{pp}} monitor for symptoms of kidney infection (pyelonephritis) including fever, nausea, and back pain\n {{pp}} seek reassessment if current symptoms worsen, persist, or new symptoms develop.\n\n - trigger: \":uti2\"\n word: true\n replace: |\n {{cc}} possible urinary tract infection for the past XX days\n {{sp}} no dysuria\n {{sp}} no frequency\n {{sp}} no urgency,\n {{sp}} no hematuria\n {{sp}} no fever\n {{sp}} no chills\n {{sp}} no nausea and vomiting\n {{sp}} no flank pain\n {{sp}} no abdominal pain\n\n {{sp}} no vaginal discharge\n {{sp}} no vaginal bleeding\n {{sp}} no bowel changes\n\n {{sp}} no urinary tract infections (uti) in the past 6 month (and none in the past year)\n (recurrent uti defined as ≥2 infections in six months or ≥3 infections in one year)\n {{sp}} no antibiotic use within 4 weeks\n {{sp}} no immunocompromised state\n {{sp}} no allergies to antibiotics\n {{sp}} no pregnancy\n\n {{op}} no suprapubic tenderness (overlying bladder)\n\n Based on your symptoms it is very likely you have a urinary tract infection and\n treatment can be started now.\n However, it would also be useful to submit a sample of urine for culture to confirm the infection\n and help guide treatment if the initial treatment is not working.\n On discussion, you have responded well to previous treatments for urinary tract infection and\n do not want to pursue this additional testing at this time.\n\n You are recommended to submit a sample of urine for culture to confirm the diagnosis and\n guide treatment in case symptoms do not improve. You will be contacted to arrange this testing.\n\n {{pp}} start the prescribed antibiotic: Macrobid (nitrofurantoin) 100mg twice daily for 7 days\n {{pp}} increase fluids and consider cranberry pills as these can help clear the infection faster.\n\n {{finish}}\n\n {{pp}} monitor for symptoms of kidney infection (pyelonephritis) including fever, nausea, and back pain\n and seek reassessment urgently if these symptoms develop. \n\n vars:\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n\n","rx.yml","matches:\n - trigger: \":rxpre\"\n word: true\n replace: |\n To Whom This May Concern,\n\n This is to confirm that that above patient was assessed and\n due to a medical condition will benefit from:\n\n - trigger: \":rxpost\"\n word: true\n replace: |\n Should you have any questions or clarifications\n please don't hesitate to contact me.\n\n - trigger: \":rxcompression\"\n word: true\n replace: |\n {{rxpre}}\n Compression stockings for both lower extremities\n\n Pressure gradient: 30-40 mmHg\n Diagnosis: Varicose veins\n Usage: Activities of Daily Living (ADLs) and all the time for work\n Duration: 1 year\n\n {{rxpost}}\n\n vars:\n - name: rxpre\n type: match\n params:\n trigger: \":rxpre\"\n - name: rxpost\n type: match\n params:\n trigger: \":rxpost\"\n\n - trigger: \":rxorthotic\"\n word: true\n replace: |\n {{rxpre}}\n Custom made orthotics for both feet\n\n Diagnosis: Plantar fasciitis, Pes Planus\n Usage: Activities of Daily Living (ADLs) and all the time for work\n Duration: 1 year\n\n {{rxpost}}\n\n vars:\n - name: rxpre\n type: match\n params:\n trigger: \":rxpre\"\n - name: rxpost\n type: match\n params:\n trigger: \":rxpost\"\n\n - trigger: \":rxphysio\"\n word: true\n replace: |\n {{rxpre}}\n Physiotherapy\n\n Diagnosis: Mechanical Lower Back Pain\n\n Details:\n Please assess and treat lower back pain\n\n {{rxpost}}\n\n vars:\n - name: rxpre\n type: match\n params:\n trigger: \":rxpre\"\n - name: rxpost\n type: match\n params:\n trigger: \":rxpost\"\n\n - trigger: \":rxmassage\"\n word: true\n replace: |\n {{rxpre}}\n Massage Therapy\n\n Diagnosis: Mechanical Lower Back Pain\n\n Details:\n Please assess and treat lower back pain\n\n {{rxpost}}\n\n vars:\n - name: rxpre\n type: match\n params:\n trigger: \":rxpre\"\n - name: rxpost\n type: match\n params:\n trigger: \":rxpost\"\n\n - trigger: \":rxchiro\"\n word: true\n replace: |\n {{rxpre}}\n Chiropractor Treatment\n\n Diagnosis: Mechanical Lower Back Pain\n\n Details:\n Please assess and treat lower back pain\n\n {{rxpost}}\n\n vars:\n - name: rxpre\n type: match\n params:\n trigger: \":rxpre\"\n - name: rxpost\n type: match\n params:\n trigger: \":rxpost\"\n\n","thyroid.yml","matches:\n - triggers: [\":hyperthyroid\", \":lotsh\"]\n word: true\n replace: |\n {{sp}} no palpitations, rapid heart rate (tachycardia) or atrial fibrillation\n {{sp}} no widened pulse pressure (>100mmHg between systolic and diastolic pressures)\n {{sp}} no nervousness and tremor\n {{sp}} no heat intolerance\n {{sp}} no weight loss\n {{sp}} no muscular weakness\n {{sp}} no goiter\n\n - triggers: [\":hyperthyroid\", \":hitsh\"]\n word: true\n replace: |\n {{sp}} no weight gain\n {{sp}} no lethargy\n {{sp}} no cold intolerance\n {{sp}} no menstrual irregularities\n {{sp}} no depression\n {{sp}} no constipation\n {{sp}} no dry skin\n\n\n\n","gi.yml","matches:\n - trigger: \"ruq\"\n replace: \"right upper abdomen\"\n propagate_case: true\n word: true\n\n - trigger: \"rlq\"\n replace: \"right lower abdomen\"\n propagate_case: true\n word: true\n\n - trigger: \"llq\"\n replace: \"left lower abdomen\"\n propagate_case: true\n word: true\n\n - trigger: \"luq\"\n replace: \"left upper abdomen\"\n propagate_case: true\n word: true\n\n - trigger: \":giredflag\"\n word: true\n replace: |\n Gastrointestinal Red Flags:\n {{sp}} no family history of colon cancer\n {{sp}} no family history of inflammatory bowel disease\n {{sp}} no blood in stool, or black, tarry stools (melena)\n {{sp}} no blood or \"coffee grounds\" in vomit\n {{sp}} no difficulty swallowing (dysphagia)\n {{sp}} no nocturnal symptoms\n {{sp}} no progressive symptoms\n {{sp}} no onset after age 50\n {{sp}} no anemia\n {{sp}} no weight loss\n\n Any of the above features requires a referral to gastroenterology\n\n - trigger: \":ibs\"\n word: true\n replace: |\n Subjective:\n {{cc}} recurrent abdominal pain for the past DURATION\n {{sp}} no change in frequency of stool\n {{sp}} no change in form of stool\n {{sp}} no relief of pain by defecation\n\n {{redflags}}\n\n {{sp}} no bloating\n {{sp}} no flatulence\n {{sp}} no nausea\n {{sp}} no burping\n {{sp}} no early satiety\n {{sp}} no gastroesophageal reflux\n {{sp}} no dyspepsia\n\n {{sp}} no dysuria\n {{sp}} no frequent/urgent urination\n {{sp}} no widespread musculoskeletal pain\n {{sp}} no dysmenorrhea\n {{sp}} no dyspareunia\n {{sp}} no fatigue\n {{sp}} no anxiety\n {{sp}} no depression\n\n Medications that may be worsening symptoms:\n no laxatives/antacids\n no PPI (proton pump inhibitors)\n no ASA/NSAIDs\n no iron/calcium/magnesium supplements\n no calcium channel blockers\n no antidepressants\n no opioids\n no diuretics,\n no herbal products\n\n Objective:\n {{op}} no abdominal masses\n {{op}} no abdominal tenderness\n {{op}} no abdominal guarding (tensing with pain)\n {{op}} normal bowel sounds\n\n Assessment:\n {{ap}} Irritable Bowel Syndrome (IBS), diarrhea predominant, constipation predominant, mixed\n\n ROME IV Criteria for Irritable Bowel Syndrome (IBS):\n 1. Recurrent abdo pain >=3 months >=1 day per week\n 2. Associated with change in frequency and/or form of stool\n 3. AND pain relieved by defecation.\n\n However, additional testing is required to ensure other possible causes are not missed.\n\n Plan:\n {{pp}} complete further investigations according to the Laboratory Requistion provided\n CBC, ferritin, celiac screen\n\n Diarrhea predominant:\n CRP, albumin, electrolytes\n Stool: C.diff, O&P, leuks, pH, fat globules, elastase\n\n Constipation predominant:\n TSH, electrolytes, ionized calcium\n\n Mixed: no additional investigations\n\n {{fu}}\n {{snet}}\n\n vars:\n - name: redflags\n type: match\n params:\n trigger: \":giredflag\"\n\n - name: fu\n type: match\n params:\n trigger: \":fuwr\"\n\n - name: snet\n type: match\n params:\n trigger: \":snet\"\n\n - trigger: \":ibsmgt\"\n word: true\n replace: |\n General management of IBS:\n {{pp}} reduce stress\n {{pp}} engage in regular exercise\n {{pp}} treat sleep issues\n {{pp}} treat psychological issues\n {{pp}} stop offending medications\n {{pp}} trial probiotics\n\n Diarrhea predominant:\n {{pp}} trial a FODMAPs diet\n {{pp}} consider loperamide\n {{pp}} consider Amitriptyline (Elavil) or Nortriptyline (Avantyl)\n {{pp}} consider a bile acid sequestrants\n {{pp}} consider Rifaximin\n\n Constipation predominant:\n {{pp}} increase daily fluid intake\n {{pp}} use a PEG-based laxative\n {{pp}} consider Linaclotide\n {{pp}} consider Prucalopride\n\n Mixed:\n {{pp}} trial a FODMAPs diet\n {{pp}} consider loperamide as needed\n {{pp}} consider PEG-based laxative as needed\n\n - trigger: \":ppistop\"\n word: true\n replace: |\n To reduce heartburn, you are advised to avoid, or at least reduce, things that\n trigger your symptoms. Commonly these include smoking, alcohol, coffee,\n chocolate, foods that are acidic, fatty or spicey, and non-steroidal\n anti-inflammatories such as ibuprofen, naproxen, or aspirin.\n Eating smaller meals and eating at least 3 hours before bed,\n as well as weight loss and looser clothing are also helpful.\n Elevating the head of bed slightly is another useful strategy.\n\n Some individuals can reduce or even stop using their proton pump inhibitor\n (PPI) medication (in your case XXXXXX) for acid reflux (heartburn).\n The following document outlines strategies for stopping if you would be\n interested in reducing your medication:\n https://www.rxfiles.ca/rxfiles/uploads/documents/Deprescribing-PPI-Patient-Tool.pdf\n As noted, there may be certain benefits in stopping these medications.\n However, if they are the only treatment that controls your symptoms,\n then you should continue.\n\n - trigger: \":abdopain\"\n word: true\n replace: |\n Your main concern today is stomach pains for the past DURATION\n {{pain}}\n\n You have had no vomiting.\n You have had no changes to your bowel movements.\n You have had no blood in your stool\n You have had no black,tarry stools (melena)\n\n You have no family history of inflammatory bowel disease such as\n Crohn's or Ulcerative Colitis.\n\n {{deabdo}}\n {{noother}}\n\n Your symptoms are consistent with dyspepsia (upset stomach) and\n may be due to underlying excess acid production or low level stomach\n inflammation (gastritis).\n Other, less likely possibilities include liver inflammation,\n early gallbladder disease or peptic ulcer disease.\n\n You are advised to complete blood tests and an abdominal ultrasound to check for\n possible internal organ disease including liver, gallbladder, or pancreas.\n You are advised to start the prescribed medication Pantoprazole 40mg\n once daily 30 minutes before your morning meal.\n\n {{finish}}\n\n vars:\n - name: pain\n type: match\n params:\n trigger: \":pain\"\n - name: finish\n type: match\n params:\n trigger: \":finish\"\n - name: noother\n type: match\n params:\n trigger: \":noother\"\n - name: deabdo\n type: match\n params:\n trigger: \":deabdo\"\n\n\n\n\n\n\n\n\n","ptfacing.yml","matches:\n - trigger: \"ya\"\n replace: \"You are at home in\"\n word: true\n\n - trigger: \"yaa\"\n word: true\n replace: |\n You are at home in XXXX accompanied by your mother (XXX).\n\n - trigger: \"yar\"\n word: true\n replace: \"You are advised to\"\n\n - trigger: \"ym\"\n replace: \"Your main concern today is\"\n word: true\n\n - trigger: \"yfut\"\n replace: \"Your main concern today is to follow-up on test results\"\n word: true\n\n - trigger: \"yh\"\n replace: \"You have had\"\n word: true\n\n - trigger: \"yn\"\n replace: \"You have had no\"\n word: true\n\n - trigger: \"yrx\"\n replace: \"You are requesting a prescription for\"\n word: true\n\n - trigger: \"yw\"\n replace: \"You appear well, with no apparent distress\"\n word: true\n\n - trigger: \"trx\"\n replace: \"Please take medication(s) prescribed as directed\"\n word: true\n\n - trigger: \"ymhx\"\n replace: \"Your medical history significantly includes\"\n word: true\n\n - trigger: \"yfhx\"\n replace: \"Your family history significantly includes\"\n word: true\n\n - trigger: \"ymed\"\n replace: \"Your current medications include\"\n word: true\n\n - trigger: \"ynhx\"\n replace: \"You have no previous significant medical history, no prescription medications and no relevant family history\"\n word: true\n\n - trigger: \"ymnd\"\n replace: \"You were accompanied by your mom and dad.\"\n word: true\n\n - trigger: \"vutd\"\n replace: \"vaccinations are up to date\"\n word: true\n\n - trigger: \"cpl\"\n replace: \"Please copy the following link into your browser:\"\n word: true\n\n - trigger: \":results\"\n word: true\n replace: |\n Once your tests are completed and results are available,\n you will hear from us.\n For some tests, this will be within 2-3 DAYS of completing the tests,\n but for other tests it will be longer. Some blood tests take up to\n 7 WORKING DAYS and MRIs can take up to 10 WORKING DAYS.\n\n You will be contacted regardless of whether or not the results\n require follow up. Please wait to be contacted about the results\n before booking a follow up appointment.\n\n If you have not received notification of your results from us\n WITHIN 5 DAYS of completing your tests, please contact us:\n Email: {{myemail}}\n Phone: {{myphone}}\n\n If there is a significant change in your symptoms, or decline\n in your health while waiting for the results, please do not wait\n for the results before being reassessed. Please seek out medical care\n as soon as possible if there is a significant worsening of your condition.\n\n - trigger: \":findfp\"\n word: true\n replace: |\n You are recommended to find a regular family physician. This website should be helpful:\n {{findfpwebsite}}\n\n - trigger: \":refer\"\n word: true\n replace: |\n A referral to SPECIALITY has been sent today.\n You should hear back within two weeks regarding the status of your\n referral and possible wait time.\n\n If you have not heard an update within 2 weeks, please contact us:\n Email: {{myemail}}\n Phone: {{myphone}}\n\n {{findfp}}\n {{covidremind}}\n\n If there is a significant change in your symptoms, or decline\n in your health while waiting for the results, please do not wait\n before being reassessed. Please seek out medical care as\n soon as possible if there is a significant worsening of your condition.\n vars:\n - name: findfp\n type: match\n params:\n trigger: \":findfp\"\n - name: covidremind\n type: match\n params:\n trigger: \":covidremind\"\n\n - trigger: \":noshow\"\n word: true\n replace: |\n Unfortunately we were not able to complete today's consult\n because I was unable to contact you.\n I attempted to contact you for video conference through the app\n and waited over 60 seconds twice.\n I then attempted to contact you by cell phone but\n you did not answer.\n I then once again attempted to contact you for video conference\n through the app and waited over 60 seconds.\n\n If you have not already addressed your concern in another way,\n please rebook your appointment.\n\n\n\n\n","ruby/health.rb","require 'clipboard'\nrequire 'date'\n\nclass HealthStatus\n # make a look-up of health conditions to a standard form\n @@HealthCond = Hash.new\n @@HealthCond = {\n \"htn\" => \"blood pressure\",\n \"diabetes type 2\" => \"diabetes\",\n \"ckd\" => \"low kidney function\",\n \"gerd\" => \"acid reflux\",\n \"bph\" => \"enlarged prostate\",\n \"atrial fib\" => \"afib\"\n }\n # lists of meds for common health conditions\n @@CondMeds = Hash.new\n @@CondMeds = {\n \"acid reflux\" => [\"omeprazole\", \"pantoprazole\"],\n \"afib\" => [\"apixaban\", \"carvedilol\", \"coumadin\",\n \"metoprolol\", \"propafenone\"],\n \"blood pressure\" => [\"amlodipine\", \"bisoprolol\",\n \"carvedilol\", \"hydrochlorothiazide\",\n \"irbesartan\", \"metoprolol\", \"olmesartan\",\n \"telmisartan\",\"valsartan\", \"verapamil\"],\n \"diabetes\" => [\"empagliflozin\", \"metformin\"],\n \"enlarged prostate\" => [\"finasteride\", \"tamsulosin\"],\n \"high cholesterol\" => [\"atorvastatin\", \"evolocumab\", \"fluvastatin\",\n \"icosapent ethyl\", \"lovastatin\", \"pravastatin\",\n \"rosuvastatin\", \"simvastatin\"],\n }\n\n # make a look-up from generic to brand drug names\n @@MedGeneric = Hash.new\n @@MedGeneric = {\n \"apixaban\" => \"eliquis\",\n \"atorvastatin\" => \"lipitor\",\n \"coumadin\" => \"warfarin\",\n \"empagliflozin\" => \"jardiance\",\n \"evolocumab\" => \"repatha\",\n \"fluvastatin\" => \"lescol\",\n \"icosapent ethyl\" => \"vascepa\",\n \"lovastatin\" => \"mevacor\",\n \"pantoprazole\" => \"pantoloc\",\n \"pravastatin\" => \"pravachol\",\n \"rosuvastatin\" => \"crestor\",\n \"salbutamol\" => \"ventolin\",\n \"simvastatin\" => \"zocor\",\n \"tamsulosin\" => \"flomax\"\n }\n # make a reverse look-up from brand to generic drug names\n @@MedBrand = Hash.new\n @@MedGeneric.each do |key, value|\n @@MedBrand[value] = key\n end\n\n # initialize report\n def initialize(my_input)\n @LabValues = Hash.new\n @Meds = Hash.new\n @Conditions = Hash.new\n @Allergies = Array.new\n @FamilyHx = Array.new\n @Lifestyle = Hash.new\n @Prevent = Hash.new\n @actionplan = Array.new\n @outtext = \"\"\n @outbuffer = 0\n @outbuffer_text = \"\"\n @labname = \"\"\n @hmn_topics = \"\"\n @hmn_recommended = 0\n parse_status(my_input);\n end\n\n # parse line of medication\n def med_parse(name, line)\n # all lower case\n name = name.downcase\n line = line.downcase\n # remove brand prefix\n if name =~ /\\w+-(\\w+)/\n name = $1\n end\n # switch to generic name if this is a brand name\n if @@MedBrand.key?(name)\n name = @@MedBrand[name]\n end\n\n # find the medication route\n route = \"oral\"\n if line =~ /\\blotion\\b|\\bcream\\b|\\bgel\\b|\\bointment\\b/\n route = \"topical\"\n end\n if line =~ /\\binhaler\\b/\n route = \"inhaled\"\n end\n if line =~ /\\[im:|\\bvial\\b/\n route = \"injected\"\n end\n\n # add to the list of meds\n # note that we do not have an indication yet\n indication = \"\"\n @Meds[name] = [route, indication];\n puts \"Found med: #{name} (#{route})\"\n end\n\n # parse line of active medication\n def med_act_parse(line)\n return unless line =~ /^\\w\\w\\w \\d\\d, \\d\\d\\d\\d\\s+([\\w-]+)/\n med_parse($1, line)\n end\n\n # parse line of external medication\n def med_ext_parse(line)\n return unless line =~ /^Unknown\\s+([\\w-]+)/\n med_parse($1, line)\n end\n\n def med_indication_attach(med, indication)\n if @Meds.key?(med)\n if @Meds[med][1] == \"\"\n @Meds[med][1] = indication\n else\n @Meds[med][1] += \", #{indication}\"\n end\n end\n end\n\n # try to match existing conditions to medications\n def med_indication_find()\n # go through all conditions\n @Conditions.each do |key, value|\n # if list of meds available for this condition\n if @@CondMeds.key?(key)\n @@CondMeds[key].each { |med| med_indication_attach(med,key) }\n end\n end\n\n # look for any medications without an indication\n # and attach our best guess\n @Meds.each do |key, value|\n indication = value[1]\n if indication == \"\"\n # go through all known conditions and attach\n # any matching indication with a question mark\n @@CondMeds.each do |ckey, cvalue|\n cvalue.each { |med|\n if med == key\n med_indication_attach(key,\"?#{ckey}\")\n @Conditions[ckey] = \"Presumed from medication list\"\n end\n }\n end\n end\n end\n end\n\n # Add single med to output stream \n def med_single_dump(name)\n route = @Meds[name][0];\n indication = @Meds[name][1];\n if indication != \"\"\n indication = \"for #{indication}\"\n end\n # do not print oral as a route\n if route == \"oral\"\n route = \"\"\n end\n brand = \"\"\n if @@MedGeneric.key?(name)\n brand = @@MedGeneric[name]\n # enclose brand name in parantheses\n brand = \"(#{brand})\"\n end\n\n fout = sprintf(\"%s %s %s %s\", name.ljust(20), route.ljust(10),\n brand.ljust(15), indication)\n out_add(fout);\n end\n\n # Add med list to output stream\n def med_dump()\n oralmeds = Array.new\n inhaledmeds = Array.new\n topicalmeds = Array.new\n injectedmeds = Array.new\n\n # separate into routes\n @Meds.each do |key, value|\n if value[0] == \"oral\"\n oralmeds.push(key)\n elsif value[0] == \"inhaled\"\n inhaledmeds.push(key)\n elsif value[0] == \"topical\"\n topicalmeds.push(key)\n elsif value[0] == \"injected\"\n injectedmeds.push(key)\n end\n end\n # sort into alphabetical order within routes\n oralmeds.sort!\n inhaledmeds.sort!\n topicalmeds.sort!\n injectedmeds.sort!\n\n # if more than 5 oral meds, potential polypharmacy\n if oralmeds.length > 5\n num = oralmeds.length\n action_add(\"Consider reducing number of medications. Currently #{num} oral medications\")\n end\n\n out_add_section(\"Medications\")\n\n # now add a line for every med\n oralmeds.each { |name| med_single_dump name }\n injectedmeds.each { |name| med_single_dump name }\n inhaledmeds.each { |name| med_single_dump name }\n topicalmeds.each { |name| med_single_dump name }\n end\n\n def mhx_dump()\n out_add_section(\"Medical History\")\n\n @Conditions.keys.sort.each do |key|\n fout = sprintf(\"%s %s\", key.ljust(20), @Conditions[key])\n out_add(fout)\n end\n end\n\n def mhx_parse(line)\n return unless line =~ /^([^-]+)-(.+)$/\n name = $1.strip.downcase\n # map to a standard name if available\n if @@HealthCond.key?(name)\n nname = @@HealthCond[name]\n puts \"Mapped #{name} to #{nname}\"\n name = nname\n end\n # @Conditions[name] = $2.strip\n # most details seem to be irrelevant here\n # for a patient facing report\n # will just remove for now\n @Conditions[name] = \" \"\n puts \"Found history: #{name} (#{$2})\"\n end\n\n def allergy_dump()\n out_add_section(\"Allergies\")\n @Allergies.each { |x| out_add(x) }\n end\n\n def allergy_parse(line)\n return unless line =~ /^\\w\\w\\w \\d\\d, \\d\\d\\d\\d\\s+(.+)\\z/\n @Allergies << $1\n end\n\n def lifestyle_dump()\n out_add_section(\"Lifestyle\")\n\n @Lifestyle.each do |key, value|\n fout = sprintf(\"%s %s\", key.ljust(20), value[1])\n out_add(fout)\n date = value[0]\n due_date = date >> 12\n if @date > due_date\n action_add(\"Yearly update for #{key} overdue. Last #{date}\")\n end\n end\n end\n\n def lifestyle_parse(line)\n return unless line =~ /^(\\w\\w\\w \\d\\d, \\d\\d\\d\\d)\\s+(\\w+)\\s+-\\s+(.+)\\z/\n date = Date.parse $1\n @Lifestyle[$2] = [date, $3]\n end\n\n def famhx_dump()\n out_add_section(\"Family History\")\n\n @FamilyHx.each { |x| out_add(x) }\n end\n\n def famhx_parse(line)\n @FamilyHx << line\n end\n\n def prevent_parse(line)\n return unless line =~ /^(\\w\\w\\w \\d\\d, \\d\\d\\d\\d)\\s+(\\w+.*)\\z/\n date = Date.parse $1\n remainder = $2\n\n puts \"Remainder is (#{remainder})\"\n # keep track of repeat interval in months\n # 0 means no repeat\n months = 0\n if remainder =~ /repeat in (\\d+)\\s+(\\w+)/\n puts \"Matched (#{$1}) and (#{$2})\"\n months = $1.to_i\n if $2 =~ /year/\n months *= 12\n end\n end\n puts \"Months is #{months}\"\n if remainder =~ /Fibroscan/\n item = \"Fatty Liver Scan\"\n months = 36 unless months > 0\n end\n if remainder =~ /Influenza/\n item = \"Flu Vaccine\"\n months = 12 unless months > 0\n end\n if remainder =~ /Colonoscopy/\n item = \"Colonoscopy\"\n months = 120 unless months > 0\n end\n if remainder =~ /FIT/\n item = \"Colon Cancer Screen (FIT)\"\n months = 24 unless months > 0\n end\n if remainder =~ /Mammo/\n item = \"Breast Cancer Screen (Mammogram)\"\n months = 24 unless months > 0\n end\n if remainder =~ /PAP/\n item = \"Cervical Cancer Screen (PAP)\"\n months = 36 unless months > 0\n end\n @Prevent[item] = [date, months]\n end\n\n # lab values are kept in hash of arrays\n # each item of the array is an array:\n # [value, date]\n def lab_add(name, value, date)\n puts \"Adding Lab: #{name} #{value} #{date}\"\n if !@LabValues.key?(name)\n @LabValues[name] = Array.new\n end\n @LabValues[name] << [value, date]\n end\n\n # labs are added in reverse chronically order\n # so index 0 is the most recent\n # index 1 is the second most recent and so on\n # if the index doesn't exist, will return \"\"\n def lab_get(name, index)\n retval = \"\"\n if @LabValues.key?(name)\n if !@LabValues[name][index].nil?\n retval = @LabValues[name][index][0]\n end\n end\n return retval\n end\n\n def lab_date_get(name, index)\n retval = \"\"\n if @LabValues.key?(name)\n if !@LabValues[name][index].nil?\n retval = @LabValues[name][index][1]\n end\n end\n return retval\n end\n\n # generate a table of most recent lab values\n # with a maximum number of columns specified\n def lab_table(names, columns)\n cur_index = Array.new\n dates = Array.new\n table = Hash.new\n cur_col = 0\n empty = 0\n\n # start at the most recent entry for all\n names.each_with_index { |val, index| cur_index[index] = 0 }\n\n # keep collecting values until the columns\n # filled or no more data\n while ((cur_col < columns) && (empty == 0))\n\n # find the next most recent date out of all\n # note that if an entry doesn't exist it\n # will return \"\"\n cur_index.each_with_index {|val, index|\n dates[index] = lab_date_get(names[index], val)}\n\n latest = \"\"\n dates.each_with_index {|val, index|\n if latest == \"\"\n latest = val\n latest_index = index\n elsif val != \"\"\n if val > latest\n latest = val\n latest_index = index\n end\n end\n }\n # if latest date is still empty, must mean\n # no data left.\n if latest == \"\"\n empty = 1\n else\n # otherwise add a column for the next date\n table[latest] = Array.new\n # find all the values available for this date\n # for the next column in the table\n dates.each_with_index {|val, index|\n labval = \"\"\n if (val == latest)\n labval = lab_get(names[index],cur_index[index])\n cur_index[index] += 1\n end\n table[latest][index] = labval\n }\n cur_col += 1\n end\n end\n\n # print out the table\n # blank line before the table\n out_add(\"\")\n \n # print out the dates\n row = \"\"\n table.keys.sort.each do |key|\n date = key.strftime('%b %Y')\n row = sprintf(\"%-20s%-10s\",row,date)\n end\n out_add(row)\n\n # then print the values for each lab\n names.each_with_index { |val, index|\n row = val\n table.keys.sort.each do |key|\n value = table[key]\n row = sprintf(\"%-20s%-10s\",row,value[index])\n end\n out_add(row)\n }\n end\n\n def lab_dump\n @LabValues.each do |key, value|\n puts \"Key is #{key}\"\n @LabValues[key].each { |x| puts x }\n end\n end\n\n # parse lab values section\n def lab_parse(line)\n # lab names appear on a separate line followed by a colon\n if line =~ /^([-\\w\\s]+):/\n @labname = $1\n end\n if line =~ /^([\\.\\d]+).*\\s(\\w\\w\\w \\d\\d, \\d\\d\\d\\d)\\z/\n value = $1\n date = Date.parse $2\n if @labname == \"\"\n puts \"Got lab value #{value} and date #{date} but no lab name\"\n else\n lab_add(@labname, value, date)\n end\n end\n end\n\n def parse_status(my_input)\n section = \"\"\n my_input.each_line do |line|\n line = line.strip\n case line\n when /^Active Medications:/\n section = \"Meds\"\n next\n when /^External Medications:/\n section = \"EMeds\"\n next\n when /^Surgical\\/Medical History:/\n section = \"MHx\"\n next\n when /^Known Allergies:/\n section = \"Allergies\"\n next\n when /^Lifestyle Notes:/\n section = \"Lifestyle\"\n next\n when /^Family History:/\n section = \"FamHx\"\n next\n when /^Accuro to Accuro Summary Entries:/\n section = \"Ignore\"\n next\n when /^Preventative Screening:/\n section = \"Prevent\"\n next\n when /^Screening:/\n section = \"Ignore\"\n next\n when /^Laboratory Values:/\n section = \"Labs\"\n next\n end\n\n case section\n when \"Meds\"\n med_act_parse(line)\n next\n when \"EMeds\"\n med_ext_parse(line)\n next\n when \"MHx\"\n mhx_parse(line)\n next\n when \"Allergies\"\n allergy_parse(line)\n next\n when \"Lifestyle\"\n lifestyle_parse(line)\n next\n when \"FamHx\"\n famhx_parse(line)\n next\n when \"Ignore\"\n next\n when \"Prevent\"\n prevent_parse(line)\n next\n when \"Labs\"\n lab_parse(line)\n next\n else\n if line =~ /^Health Status Update/\n @date = line[/\\bDate:\\s+(\\w\\w\\w \\d\\d, \\d\\d\\d\\d)/, 1]\n @date = Date.parse @date\n puts \"Date is #{@date}\"\n elsif line =~ /^Age:/\n @age = line[/\\b(\\d+)\\z/, 1]\n puts \"Age is #{@age}\"\n elsif line =~ /^Sex at Birth:/\n @sex = line[/\\b(\\w+)\\z/, 1]\n puts \"Sex is #{@sex}\"\n end\n end\n end\n # try to find indications for the medications\n med_indication_find\n end\n\n def out_buffer(buffer)\n @outbuffer = buffer\n end\n \n def out_buffer_flush()\n @outtext << \"#{@outbuffer_text}\\n\"\n end\n\n def out_add(line)\n if line.length > 75\n line = \"#{line[0...71]}...\"\n end\n\n # save output to a side buffer to add later\n if (@outbuffer == 1)\n @outbuffer_text << \"#{line}\\n\"\n else\n @outtext << \"#{line}\\n\"\n end\n end\n\n def out_add_line()\n out_add(\"----------------------------------------------------------------------\")\n end\n\n def out_add_section(title)\n out_add(\"\")\n out_add(title)\n out_add_line()\n end\n\n # add to the action plan\n def action_add(line)\n @actionplan << \"#{line}\"\n end\n\n # keep track of recommendations to consult\n # health management nurse\n # which is an allied health professional who can help\n # with lifestyle, weight loss, and diabetes management including foot exams\n def hmn_book(topic)\n puts \"booking hmn for #{topic}\"\n if @hmn_topics == \"\"\n @hmn_topics = topic\n else\n @hmn_topics = \"#{@hmn_topics}, #{topic}\"\n end\n @hmn_recommended = 1\n end\n\n # add hmn recommendations to actions\n def hmn_dump\n if (@hmn_recommended == 1)\n action_add(\"Book with Health Management Nurse to discuss #{@hmn_topics}\")\n action_add(\"call 1-855-79-CFPCN (23726) or 587-774-9736 or online at cfpcn.ca\")\n end\n end\n\n # dump the action plan\n def action_dump()\n out_add_section(\"Action Plan\")\n hmn_dump\n\n @actionplan.each { |line| out_add(line) }\n end\n\n\n def lab_compare_prev(name, desc, targ_above, targ_below)\n too_high = 0\n too_low = 0\n\n # check for current value\n cur_val = lab_get(name,0)\n if cur_val != \"\"\n prev_val = lab_get(name,1)\n if prev_val != \"\"\n cur_val = cur_val.to_f\n prev_val = prev_val.to_f\n if cur_val > prev_val\n diff = (cur_val - prev_val).round(1)\n out_add(\"Current #{desc} has increased by #{diff} from previous.\")\n elsif cur_val < prev_val\n diff = (prev_val - cur_val).round(1)\n out_add(\"Current #{desc} has decreased by #{diff} from previous.\")\n else\n out_add(\"Current #{desc} is the same as previous.\")\n end\n end\n\n # if target range\n if (targ_above != \"\") && (targ_below != \"\")\n targ_above = targ_above.to_f\n targ_below = targ_below.to_f\n\n # check if too high\n if cur_val > targ_below\n out_add(\"**Current #{desc} (#{cur_val}) is TOO HIGH (target is #{targ_above} - #{targ_below})\")\n too_high = 1\n elsif cur_val < targ_above\n out_add(\"**Current #{desc} (#{cur_val}) is TOO LOW (target is #{targ_above} - #{targ_below})\")\n too_low = 1\n else\n out_add(\"Current #{desc} (#{cur_val}) is in range (target is #{targ_above} - #{targ_below})\")\n end\n # if target of equal or above a certain number\n elsif (targ_above != \"\")\n targ_above = targ_above.to_f\n if cur_val >= targ_above\n out_add(\"Current #{desc} (#{cur_val}) is within target (#{targ_above} or above)\")\n else\n out_add(\"**Current #{desc} (#{cur_val}) is BELOW target (#{targ_above} or above)\")\n too_low = 1\n end\n # if target of below or equal a certain number\n elsif (targ_below != \"\")\n targ_below = targ_below.to_f\n if cur_val <= targ_below\n out_add(\"Current #{desc} (#{cur_val}) is within target (#{targ_below} or below)\")\n too_low = 1\n else\n out_add(\"**Current #{desc} (#{cur_val}) is ABOVE target (#{targ_below} or below)\")\n too_high = 1\n end\n end\n end\n end\n\n # return formatted conversion of kg to lb\n def kg_to_lb kg\n lbs = (kg.to_f / 0.45459237).round(0)\n return \"#{lbs} lbs\"\n end\n\n # return formatted conversion of cm to ft in\n def cm_to_ft cm\n inches = cm.to_f * 0.39370079\n feet = (inches/12).floor\n inches = (inches - feet*12).round\n return \"#{feet}ft #{inches}in\"\n end\n\n # BMI calculation\n def bmi_calc(kg, cm)\n return (kg.to_f / (cm.to_f / 100)**2).round(1)\n end\n # Calculate a weight (kg) for a given height and BMI\n def bmi_reverse_calc(cm, bmi)\n return (bmi * (cm.to_f / 100)**2).round(1)\n end\n\n # Height, Weight, and BMI section\n def bmi_dump()\n cur_ht_cm = lab_get(\"Height\",0)\n cur_wt_kg = lab_get(\"Weight\",0)\n cur_date = lab_date_get(\"Weight\",0)\n cur_date = cur_date.strftime('%b %Y')\n\n cur_ht_ft = cm_to_ft(cur_ht_cm)\n cur_wt_lbs = kg_to_lb(cur_wt_kg)\n cur_bmi = bmi_calc(cur_wt_kg, cur_ht_cm)\n\n prev_ht_cm = lab_get(\"Height\",1)\n prev_wt_kg = lab_get(\"Weight\",1)\n prev_date = lab_date_get(\"Weight\",1)\n prev_date = prev_date.strftime('%b %Y')\n\n prev_bmi = bmi_calc(prev_wt_kg, prev_ht_cm)\n\n diff_ht = cur_ht_cm.to_i - prev_ht_cm.to_i\n diff_wt = cur_wt_kg.to_i - prev_wt_kg.to_i\n diff_bmi = cur_bmi.to_i - prev_bmi.to_i\n\n ht_dir = \"you gained\"\n if diff_ht < 0\n ht_dir = \"you lost\"\n diff_ht = diff_ht.abs\n end\n diff_ht = \"#{ht_dir} #{diff_ht} cm\"\n\n wt_dir = \"you gained\"\n if diff_wt < 0\n wt_dir = \"you lost\"\n diff_wt = diff_wt.abs\n end\n diff_wt_lbs = kg_to_lb(diff_wt)\n diff_wt = \"#{wt_dir} #{diff_wt} kg (#{diff_wt_lbs})\"\n\n cur_ht = \"#{cur_ht_cm} cm (#{cur_ht_ft})\"\n cur_wt = \"#{cur_wt_kg} kg (#{cur_wt_lbs})\"\n\n if cur_bmi < 18.5\n bmi_class = \"Underweight (below 18.5)\"\n elsif cur_bmi < 25\n bmi_class = \"Normal (18.5-24.9)\"\n elsif cur_bmi < 30\n bmi_class = \"Overweight (25-29.9)\"\n else\n bmi_class = \"Obese (30 or above)\"\n end\n if cur_bmi > 25\n hmn_book(\"weight loss\")\n action_add(\"Consider weight management (current BMI #{cur_bmi})\")\n end\n\n # calculate BMI cutoff weights\n wt_min_kg = bmi_reverse_calc(cur_ht_cm, 18.5)\n wt_max_kg = bmi_reverse_calc(cur_ht_cm, 24.9)\n wt_obese_kg = bmi_reverse_calc(cur_ht_cm, 29.9)\n wt_min_lbs = kg_to_lb(wt_min_kg)\n wt_max_lbs = kg_to_lb(wt_max_kg)\n wt_obese_lbs = kg_to_lb(wt_obese_kg)\n wt_range = \"#{wt_min_kg} kg - #{wt_max_kg} kg (#{wt_min_lbs} - #{wt_max_lbs})\"\n wt_obese = \"#{wt_obese_kg} kg (#{wt_obese_lbs})\"\n\n out_add_section(\"Body Mass Index (BMI) Analysis\")\n\n out_add(\"Latest #{cur_date} Height: #{cur_ht} Weight: #{cur_wt}\")\n out_add(\"Compared to #{prev_date} #{diff_ht} and #{diff_wt}\")\n out_add(\"Current BMI at #{cur_bmi} is classified as #{bmi_class}\")\n out_add(\"\")\n out_add(\"Your normal BMI weight range is #{wt_range}\")\n out_add(\"Your obese BMI weight range is over #{wt_obese}\")\n\n lab_table([\"Height\", \"Weight\"],5)\n end\n\n # diabetes dump\n def diabetes_dump\n a1c = \"Hemoglobin A1C\"\n fbg = \"Fasting Glucose\"\n\n if @Conditions.key?(\"diabetes\")\n out_add_section(\"Diabetes Analysis\")\n # known diabetes\n # analyze results considering current A1C target\n # default to 7.0\n targetA1C = 7.0\n desc = @Conditions[\"diabetes\"]\n if desc =~ /[T|t]arget\\s+([\\d.]+)/\n targetA1C = $1\n end\n\n # check for current A1C date\n currentDate = lab_date_get(a1c,0)\n if (currentDate != \"\")\n # check if current A1C is more than 3 months in the past\n if ((currentDate >> 3) < @date)\n out_add(\"Average Sugar (A1C) is more than 3 months old and should be retested\")\n action_add(\"Retest A1C (last more than 3 months ago)\")\n end\n end\n lab_compare_prev(a1c, \"Average Sugar\", \"\", targetA1C)\n\n currentA1C = lab_get(a1c,0)\n if (currentA1C != \"\")\n currentA1C = currentA1C.to_f\n if currentA1C > targetA1C\n hmn_book(\"diabetic control\")\n action_add(\"Discuss improving diabetic control (A1C is #{currentA1C}) vs modifying target (#{targetA1C})\")\n end\n end\n else\n # if diabetes is not noted as a current health issue\n # analyze the data for risk of diabetes\n out_add_section(\"Diabetes Risk Analysis\")\n\n prediabetes = 0\n diabetes = 0\n a1c_msg = \"Average sugar is unavailable\"\n fbg_msg = \"Fasting sugar is unavailable\"\n currentA1C = lab_get(a1c,0)\n if (currentA1C != \"\")\n if (currentA1C < 6.0)\n a1c_msg = \"Average sugar is normal (under 6.0)\"\n elsif (currentA1C < 6.4)\n a1c_msg = \"Average sugar is prediabetic (6.0 - 6.4)\"\n prediabetic = 1;\n else\n a1c_msg = \"Average sugar is diabetic (6.5 and above)\"\n diabetic = 1;\n end\n end\n currentFBG = lab_get(fpg,0)\n if (currentFBG != \"\")\n if (currentFGB < 6.0)\n fbg_msg = \"Fasting sugar is normal (under 6.0)\"\n elsif (currentA1C < 6.4)\n fbg_msg = \"Fasting sugar is prediabetic (6.0 - 6.9)\"\n prediabetic = 1;\n else\n fbg_msg = \"Fasting sugar is diabetic (7.0 and above)\"\n diabetic = 1;\n end\n end\n out_add(\"#{a1c_msg} #{fbg_msg}\")\n if (diabetic == 1)\n action_add(\"Discuss diagnosis of diabetes\")\n hmn_book(\"new diabetes\")\n elsif (prediabetic == 1)\n action_add(\"Discuss lifestyle improvements to avoid progression to diabetes\")\n hmn_book(\"pre-diabetes\")\n end\n end\n #construct a table of relevant diabetes values\n lab_table([a1c, fbg], 5);\n\n end\n\n\n\n # cholesterol dump\n def cholesterol_dump\n ldl = \"LDL\"\n hdl = \"HDL\"\n total = \"Total Cholesterol\"\n nonhdl = \"Non-HDL Cholesterol\"\n\n out_add_section(\"Cholesterol Analysis\")\n\n\n ldl_targ = 3.4\n hdl_targ = 1.4\n\n if @Conditions.key?(\"high cholesterol\")\n ldl_targ = 2.0\n end\n\n lab_compare_prev(ldl, \"LDL (Bad Cholesterol)\", \"\", ldl_targ)\n lab_compare_prev(hdl, \"HDL (Good Cholesterol)\", hdl_targ, \"\")\n\n lab_table([total,hdl,ldl,nonhdl],5)\n end\n\n\n def bloodpressure_dump()\n out_add_section(\"Blood Pressure Analysis\")\n\n lab_table([\"SBP\", \"DBP\"],5)\n end\n\n def kidney_dump()\n out_add_section(\"Kidney Function Analysis\")\n\n lab_table([\"eGFR\", \"ACR\", \"Urine RBC\"],5)\n end\n\n def liver_dump()\n out_add_section(\"Liver Function Analysis\")\n\n lab_table([\"ALT\", \"AST\", \"ALP\", \"GGT\"],5)\n end\n\n # prostate screening dump\n def prostate_dump\n out_add_section(\"Prostate Analysis\")\n\n psa = \"PSA\"\n\n # get psa target based on age\n psa_targ = 3.0\n\n # get previous psa value\n # set limit for maximum rise based on time between\n # last two measurements\n\n # adjust target based on maximum rise\n\n lab_compare_prev(psa, \"Prostate Antigen\", \"\", psa_targ)\n\n lab_table([psa],5)\n\n end\n\n # generate the output report\n # at this point all the data has been read\n # we can now analyze, summarize, and make recommendations\n def report_dump()\n curdate = @date.strftime('%b %d, %Y')\n out_add_section(\"Health Status Update and Plan #{curdate}\")\n\n # process everything but save it for later\n # since we want the action plan to appear first\n\n # turn on buffering\n out_buffer(1)\n out_add_section(\"Demographics\")\n out_add(\"Age: #{@age}\")\n out_add(\"Sex at Birth: #{@sex}\")\n allergy_dump\n mhx_dump\n med_dump\n lifestyle_dump\n famhx_dump\n bmi_dump\n\n diabetes_dump\n cholesterol_dump\n bloodpressure_dump\n kidney_dump\n liver_dump\n prostate_dump\n\n # turn off buffering\n out_buffer(0)\n\n action_dump\n out_buffer_flush()\n return @outtext\n end\nend\n\nstatus = HealthStatus.new(Clipboard.paste)\nreport = status.report_dump\n\nClipboard.copy(report)\n","ruby/Gemfile","source \"https://rubygems.org\"\ngem 'clipboard'\ngem \"ffi\", :platforms => [:mswin, :mingw] #required by Clipboard on Windows\n\n","repositoryHome","https://github.com/wressl/medical-docs","versions",[16,114,115],"0.1.1","0.1.0","isLatest",true,"actionData","errors"]