medical-docs 0.1.2 | Espanso Hub

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Medical Documentation

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medical-docs

By Bill Ressl

A package to assist in medical Documentation

medical

Paste this command in a terminal to install the package

espanso install medical-docs

Description

Source

Provides text expansion and templates to assist medical documentation. The author is a practising family physician so the original package is targeted to family physicians, but should be general enough to help anyone interested in medical documentation.

For more information, visit: https://github.com/wressl/medical-docs

package.yml

nosebleed.yml

ophtho.yml

flu.yml

fatigue.yml

urti.yml

imaging.yml

injection.yml

prep.yml

derm.yml

covid.yml

insomnia.yml

resp.yml

msk_ankle.yml

headache.yml

driver.yml

digexam.yml

gyne.yml

sti.yml

cardio.yml

intro.yml

excision.yml

msk.yml

msk_back.yml

nephro.yml

heme.yml

urology.yml

common.yml

strep.yml

psych.yml

neuro.yml

uti.yml

rx.yml

thyroid.yml

gi.yml

ptfacing.yml

# medical-docs package

matches:
  - trigger: ":nosebleed"
    word: true
    replace: |
      Subjective: 
        {{cc}} nose bleed from RIGHT side for past DURATION
        {{sp}} recurrent bleeds about every INTERVAL
        lasting about DURATION
        {{sp}} no identified triggers
                 (trauma, nasal surgery, nasal picking, foreign body,
                  upper respiratory tract infection, allergic rhinitis)

        Red Flags:
        {{sp}} no chest pain
        {{sp}} no shortness of breath
        {{sp}} no dizziness

        {{sp}} no bleeding disorder
        {{sp}} no high blood pressure
        {{sp}} no liver cirrhosis
        {{sp}} no coronary artery disease
        {{sp}} no use of intranasal corticosteroid
        {{sp}} no use of anti-platelet drugs such as
              aspirin, clopidigrel, or ticagrelor
        {{sp}} no use of anti-coagulants such as heparin, warfarin,
               rivaroxaban, apixaban, edoxaban, or dabigatran

      Objective: 
        {{op}} generally well appearance
        {{op}} no bruising (ecchymosis)
        {{op}} no rash suggestive of platelet dysfunction (petechiae)
        {{op}} no abnormal blood vessel growth (telangiectasia)
        {{op}} no active bleeding
        {{op}} no evidence of recent bleeding in nose (at Kiesselbachs plexus)
        {{op}} no blood in the mouth or throat (oropharynx)

        cotton soaked in lidocaine 2% with epi applied
        followed by cautery using silver nitrate

      Assessment:
        {{ap}} anterior nasal bleeding with no red flags

      Plan:
        {{pp}} lean forward and clamp nose if active bleeding
        {{pp}} seek medical attention if bleeding doesn't stop in 10 minutes
        {{pp}} stop intranasal corticosteroid spray
        {{pp}} direct nasal spray away from septum
        {{pp}} sleep in a humidified environment
        {{pp}} apply topical antibiotic (bactroban) in nostril using cotton swab
        {{pp}} follow-up if symptoms worsening or other concerns

matches:
  - trigger: "PERRLA"
    word: true
    replace: |
      pupils equal, round, reactive to light and accomodation (PERRLA)

  - trigger: "EOM"
    word: true
    replace: |
      extraocular movements (EOM)


  - trigger: ":opsredflag"
    word: true
    replace: |
      Red Flags:
        {{sp}} no severe pain
        {{sp}} no marked pain or decreased vision with the use of contact lenses
        {{sp}} no pain deep in eye
        {{sp}} no inability to tolerate light (photophobia)
        {{sp}} no visual loss
        {{sp}} no colored halos around lights
        {{sp}} no trauma or foreign body
        {{sp}} no chemical injury
        {{sp}} no recent eye surgery

  - trigger: ":oporedflag"
    word: true
    replace: |
      Red Flags:
        {{op}} no decreased visual acuity
        {{op}} no pupil irregularity
        {{op}} no sluggish pupillary reaction to light
        {{op}} no corneal opacification
        {{op}} no pooling of blood inside the anterior chamber of the eye (hyphema)
        {{op}} no pooling of pus inside the anterior chamber of the eye (hypyon)
        {{op}} no elevated intraocular pressure

  - trigger: ":redeye"
    word: true
    replace: |
      Subjective:
        {{cc}} red eye for the past DURATION
        {{sp}} redness in RIGHT LEFT BOTH eye(s)
        {{sp}} no thick purulent discharge
        {{sp}} no watery discharge
        {{sp}} no eyes stuck shut on waking in morning
        {{sp}} no sandy feeling/irritation
        {{sp}} no itching

        {{sp}} no contact lens use
        {{sp}} no sensation of a foreign body in the eye
        {{sp}} no severe headache
        {{sp}} no nausea

        {{sredflags}}

      Objective:
        {{op}} conjunctival injection in RIGHT LEFT BOTH eye(s)
        {{op}} no discharge
        {{op}} pupils equal round, reactive to light and accomodation (PERRLA)
        {{op}} normal eye movements (extraocular movements (EOM))
        {{op}} no repetitive, uncontrolled movements (nystagmus)
        {{op}} no significant pain with eye movement
        {{op}} no double vision (diplopia)
        {{op}} no visualized foreign body
        {{op}} no photophobia.
        {{op}} normal cornea and anterior chamber

        {{oredflags}}

      Assessment:
        {{ap}} Viral Conjunctivitis
        {{ap}} Bacterial Conjunctivitis
        {{ap}} Allergic Conjunctivitis
        No alarm symptoms/signs (red flags) present

      Plan:
        {{pp}} use topical antibiotics as prescribed
        may reduce the dose from 4 times daily to twice daily,
        if there is improvement in symptoms after a few days.
        A decrease in discharge, redness, and irritation should occur in 1-2 days
        {{pp}} use  antihistamines with mast cell-stabilizing properties (Pataday)
        {{pp}} use over-the-counter eye lubricant drops 1-2 drops every 1-6 hours as needed

        {{pp}} use warm or cool compresses
        {{pp}} avoid eye rubbing
        {{pp}} stop use of contact lenses during symptoms
        {{pp}} avoid sharing tissues, towels, cosmetics, linens, or eating utensils

        {{pp}} seek reassessment if current symptoms persist, worsen, or new symptoms develop.
        {{pp}} immediately seek reassessment if red flags (as described above)

    vars:
      - name: sredflags
        type: match
        params:
          trigger: ":opsredflag"

      - name: oredflags

matches:
  - trigger: ":fluvac"
    word: true
    replace: |
      Subjective: 
        {{cc}} annual flu vaccine
        {{sp}} no previous flu vaccine injections
        {{sp}} no previous reaction to previous flu vaccines
        {{sp}} no allergy to eggs, latex, or neomycin.
        {{sp}} no recent sickness
        Discussed benefits and possible adverse reactions

      Objective:
        Vaccine administered by intramuscular injection
        into left deltoid using aseptic technique with
        25 gauge 1 inch needle
        Injection was well tolerated
        Lot and expiry date noted on chart

      Assessment:
        {{ap}} need for regular influenza vaccine

      Plan: 
        {{pp}} wait 15 minutes in the waiting room to ensure
        no immediate serious reaction
        {{pp}} refer to handout for possible side-effects
        {{pp}} contact clinic if concerns, especially for
        possible infection (increasing redness, pain,
        swelling, or pus after 3 days)

matches:
  - trigger: ":fatigue"
    word: true
    replace: |
       {{menses}}

       You have had no frequent nose bleeds.
       You have had no blood in your urine.
       You have had no blood in your stool, or any black/tarry stool (melena).

       You have a varied diet, which includes red meats.
       You are not currently taking any iron supplementation.

       You have had no blurry vision.
       You have had no frequent headaches.
       You have had no frequent urination.
       You have no family history of diabetes.

       Considering possible signs of low thyroid:
       {{hitsh}}
       You have no family history of thyroid disease.

       {{noother}}

       Given your previous history of low iron, your current fatigue is also
       likely due to low iron.  However we should complete testing to be sure
       and also confirm there are not other causes contributing.

       Also, note that factors contributing to fatigue may include psychological stress,
       anxiety, low mood, inadequate time for relaxation, poor diet, or too much alcohol.
       A healthy lifestyle is important, including stress reduction, and setting aside
       time for adequate relaxation and sleep. As well, even though you are already tired,
       gradually increasing physical exercise often helps.

       {{finish}}

    vars:
      - name: menses
        type: match
        params:
          trigger: ":menses"
      - name: hitsh
        type: match
        params:
          trigger: ":hitsh"
      - name: noother
        type: match
        params:
          trigger: ":noother"
      - name: finish
        type: match
        params:
          trigger: ":finish"

matches:
  - trigger: ":urti"
    word: true
    replace: |
      Subjective:
        {{cc}} cold/flu like symptoms for XX days
        {{sp}} no sore throat
        {{sp}} no cough
        {{sp}} no fever
        {{sp}} no congestion
        {{sp}} no ear pain
        {{sp}} no headache
        {{sp}} no sinus pain
        {{sp}} no dental pain
        {{sp}} no nausea/emesis
        {{sp}} no diarrhea
        {{sp}} no sick contacts
        {{sp}} no recent travel
        {{sp}} no flu shot this year

      Objective:
        {{op}} normal ear drums (tympanic membranes) bilaterally
        {{op}} normal appearing throat (oropharynx) (no redness, no swelling, no exudates)
        {{op}} no swollen neck lymph nodes (anterior cervical lympadenopathy)
        {{op}} clear chest (no wheezes, no crackles)
        {{op}} no increased work of breathing

      Assessment:
        {{ap}} Viral Upper Respiratory Infection
           However, there are features suggestive of a bacterial throat infection.

      Plan:
         {{pp}} continue supportive management with fluids and rest
         {{pp}} use tylenol/advil for comfort
         {{pp}} use nasal saline rinses twice daily and nasal steroid spray before bed
         {{pp}} await results of throat swab and take antibiotics only if positive
         {{pp}} seek reassessment if increasing symptoms after 7 days
         {{pp}} call 911 or go to ED if difficulty breathing develops

matches:
  - trigger: "xr"
    replace: "x-ray"
    propagate_case: true
    word: true

  - trigger: "cxr"
    replace: "chest X-ray"
    propagate_case: true
    word: true

  - trigger: "u/s"
    replace: "ultrasound"
    propagate_case: true
    word: true

  - trigger: "mammo"
    replace: "mammogram"
    propagate_case: true
    word: true

  - trigger: "bmd"
    replace: "bone mineral density"
    propagate_case: true
    word: true

  - trigger: "fit test"
    replace: "FIT test (colon cancer screen)"
    word: true

matches:
  - trigger: ":injcort"
    word: true
    replace: |
      Subjective: 
        {{cc}} cortisone injection of LOCATION

        Risks and possible complications including
        lack of benefit or only very short term relief,
        bleeding, and infection
        Specifically discussed possible increased
        pain in the first three days after injection
        ("steroid flare")

        Consent obtained.

      Objective:
        Area located and marked.
        Sterilized with chlorhexidine multiple times.
        Injection with 25 gauge 1.5 inch sterile needle
        Medication injected:
          Kenalog 40mg/ml (Lot:  Expiry: ) x 1 ml
          and Lidocaine 2% with no epinephrine x 3 ml

        Injection well tolerated
        Injection site covered with bandaid
        No immediate complication.

      Assessment:
        {{ap}} subacromial bursitis
        {{ap}} osteoarthritis of the left knee

      Plan:
        {{pp}} follow-up immediately if concerns for infection
         (increased redness, pain, swelling, warmth after 3 days)

matches:
  # HIRI-MSM risk assessment tool
  - trigger: ":preprisk"
    word: true
    replace: |
      How old are you today?                                      <18 years   0
                                                                18-28 years   8
                                                                29-40 years   5
                                                                41-48 years   2
                                                                >= 49 years   0

      How many men have you had sex with in the past 6 months?     >10        7
                                                                  6-10        4
                                                                   0-5        0

      How many of your male sex partners were HIV positive?        >1         8
                                                                    1         4
                                                                    0         0

      In the last 6 months, how many times did you have           >=1        10
      receptive anal sex (you were the bottom) with a man           0         0
      without a condom?

      In the last 6 months, how many times did you have           >=5         6
      insertive anal sex (you were the top) with a man            0-4         0
      who was HIV positive?

      In the last 6 months, have you used methamphetamines        Yes         5
      such as crystal or speed?                                    No         0

      In the last 6 months, have you used poppers (amyl nitrate)? Yes         3
                                                                   No         0

      Risk score of >=11 warrants PrEP

matches:
  - trigger: ":hairloss"
    word: true
    replace: |
     Subjective:
      {{cc}} hair loss at [location] for the past DURATION

     Objective:
      {{op}} smooth localized area of complete hair loss at [location]
      {{op}} negative hair pull test.
      {{op}} no inflammation or scarring.

     Assessment:
      {{ap}} Alopecia Areata.

     Plan:
      A referral has been sent to dermatology

  - trigger: ":rxkeflex"
    word: true
    replace: |
       You are advised to take the medication as prescribed:
       Cephalexin (Keflex) 500mg one tablet every 6 hours for up to 7 days
       If you are completely better in 3 days, you can stop after 5 days.

       If there is no improvement after 48 hours, please arrange for
       reassessment in person.

  - trigger: ":skininfection"
    word: true
    replace: |
      Subjective:
        {{cc}} possible skin infection for DURATION
        The location is
        Symptoms started after
        {{sp}} no fever (temperature measured at home XXC)
        {{sp}} no nausea or emesis
        {{sp}} no diarrhea
        {{sp}} no pain
        {{sp}} no purulence
        {{sp}} no swelling
        {{sp}} no redness
        {{sp}} no heat
        {{sp}} no treatment to date
        {{sp}} no progression over the past 48 hours
        {{sp}} no proximal prosthetic joint or vascular graft
        {{sp}} no previous skin infections
        {{sp}} no diabetes
        {{sp}} no immunocompromised state
        {{sp}} no risks for MRSA (eg previous MRSA, recent hospitalization,
               long-term care facility, hemodialysis, HIV infection,
               lack of response to treatment without MRSA coverage)
        {{sp}} no allergies to antibiotics

      Objective: 
        {{op}} temperature of XXC
        {{op}} blood pressure of XXX/YY and heart rate of XXX
        The affected area is located at XXXX
        and extends XXXXXXX
        {{op}} no purulence
        {{op}} no ulceration
        {{op}} no abscess
        {{op}} no erythema
        {{op}} no warmth
        {{op}} no tenderness
        {{op}} no swelling
        {{op}} no induration
        {{op}} no clear demarcation of infection
        {{op}} no raised erythema

      Assessment:
        {{ap}} Non-purulent cellulitis
        {{ap}} Erysipelas
        {{ap}} Skin abscess
        {{ap}} Inflammed intradermal cyst
        {{ap}} Paronychia
        with NO systemic features requiring hospitalization or parenteral
        antibiotics, and NO indication for MRSA coverage.

      Plan:
        Wound culture has been sent to guide antibiotic therapy,
        if not improving with initial treatment.
        {{pp}} start oral antibiotics today as prescribed
        {{pp}} book for incision and drainage of abscess
        {{pp}} proceed to ER for parenteral antibiotics and possible admission
        {{pp}} keep affected area elevated
        {{pp}} seek reassessment if no improvement after 72h,
               worsening despite 48h antibiotics, or new systemic symptoms (fever, nausea)
        {{pp}} go to ER if rapid progression of redness, severe nausea or high fever

  - trigger: ":eczemamgt"
    word: true
    replace: |
      Eczema Care Instructions:
      1. Bathing
        a. Not about frequency but duration. Must be between 5-15 minutes.
        b. Warm – lukewarm/moderate warm
        c. Do not wipe dry – Pat dry only. Leave some moisture on skin

      2. Do not use soap – use hypoallergenic baby wash once a week only (e.g. Cetaphil, Cerave, Avene, Aveeno)

matches:
  - trigger: "cv"
    replace: "COVID-19"
    word: true

  - trigger: ":covidphone"
    replace: |
      COVID PHONE COMMUNICATION

      Start Time: {{mytime}}

      Reason for call:  In lieu of office visit due to COVID-19 concerns

      Notes:
      {{sp}} no travel
      {{sp}} no contact with recent travellers or suspected COVID-19 cases.
      {{sp}} no symptoms of COVID (cough, fever, shortness of breath, runny nose, or sore throat)
      that is not related to a pre-existing illness or health condition

      Recommended to continue social distancing.

      End Time:
    vars:
    - name: mytime
      type: match
      params:
        trigger: ":time"

# This COVID risk assessement and monitoring is based on the
# COVID-19 Positive Primary Care Pathway
# Posted on www.specialistlink.ca
  - trigger: ":covidrisk"
    replace: |
      COVID PHONE RISK ASSESSMENT

      Start Time: {{mytime}}

      Reason for call:  Risk stratification for presumed or confirmed COVID case

      Safety Net Check:
        {{sp}} no social isolation
        {{sp}} no lack of caregiver support
        {{sp}} no inability to maintain hydration
        {{sp}} no food/financial insecurity
        {{sp}} no homecare
        {{sp}} no challenges with health literacy or concerns with ability to self-manage

      High Risk Features:
        {{sp}} no recent discharge from tertiary care (hospital, complex care hub)
        {{sp}} no lack of safety net
        {{sp}} no age >70
        {{sp}} no age >60 with medical comorbitities
        {{sp}} no symptom deterioration

      Average Risk Features:
        {{sp}} no age <18
        {{sp}} no pregnancy
        {{sp}} no absence of symptoms (but swab positive)

      If above all negative, considered Lower Risk

      Overall Risk Assessment:
         High Risk - requires daily monitoring for 14 days
         Average Risk - requires monitoring every 2 days for 7 days
         Lower Risk - consider self monitoring only - handout provided

      End Time:
    vars:
    - name: mytime
      type: match
      params:
        trigger: ":time"

  - trigger: ":covidredflags"
    replace: |
      {{sp}} no severe shortness of breath at rest
      {{sp}} no difficulty breathing
      {{sp}} no pain or pressure in chest
      {{sp}} no cold, clammy or pale molted skin
      {{sp}} no new confusion
      {{sp}} no blue lips or face
      {{sp}} no becoming difficult to rouse
      {{sp}} no coughing up blood
      {{sp}} no reduced urine output
      {{sp}} no return of cough after period of improvement (may signal development of COVID pneumonia)
      {{sp}} no return of fever after afebrile period (may signal development of COVID pneumonia)
      {{sp}} no low oxygen saturation (<92% if prev healthly, <90% if underlying lung condition)
      {{sp}} no increased O2 requirements on home O2

  - trigger: ":covidmonitor"
    replace: |
     COVID PHONE MONITORING

      Start Time: {{mytime}}

      Reason for call:  Monitoring for presumed or confirmed COVID case

      Previous Risk Stratification:  High  Average  Lower

      {{sp}} overall been feeling  worse  unchanged  better

matches:
  # sleep hygiene
  - trigger: ":sleephy"
    word: true
    replace:  |
      {{pp}} remove the TV and computer from the bedroom.
      {{pp}} avoid a bedroom that is too hot or too cold.
      {{pp}} maintain a quiet, dark, safe, and comfortable sleep environment. Minimize noise and light
      {{pp}} use the bed and bedroom only for sleep and sex.
      {{pp}} avoid caffeine after lunch and alcohol within 6 hours of bedtime
      {{pp}} avoid nicotine close to bedtime or during the night
      {{pp}} engage in moderate physical activity but avoid heavy exercise within 3 hours of bedtime
      {{pp}} avoid consuming excessive liquids or a heavy evening meal before bedtime
      {{pp}} use an alarm clock to get up at the same time every day
      {{pp}} go to bed only when sleepy, even if later than prescribed sleep schedule.
      {{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.
      {{pp}} avoid watching/checking the clock
      {{pp}} avoid excessive napping during the day - a brief nap (15-30 minutes) during the mid-afternoon can be refreshing and is okay.

  # difficulty sleeping
  - trigger: ":insomnia"
    word: true
    replace:  |
      Subjective: 
       {{cc}} difficulty sleeping for DURATION
       {{sp}} no difficulty falling asleep
       {{sp}} no difficulty staying asleep
       {{sp}} no impact on function throughout the day
       {{sp}} no concerns regarding driving or operating heavy machinery
       {{sp}} no prior treatments to help sleep
       {{sp}} no identified trigger (such as stress, travel, shift work, depression, anxiety, pain)
       {{sp}} no nighttime cough
       {{sp}} no difficulty breathing
       {{sp}} no waking to urinate
       {{sp}} no noise in bedroom (such as partner snoring)
       {{sp}} no sleep disturbance due to children or pets
       {{sp}} no uncomfortable temperature in bedroom
       {{sp}} no lights in bedroom
       {{sp}} no screens in bedroom
       {{sp}} no nicotine late in day
       {{sp}} no caffeine late in day
       {{sp}} no alcohol late in day
       {{sp}} last meal of the day at XX pm
       {{sp}} consistent time to bed XX pm (even on weekends)
       {{sp}} consistent time to wake XX am (even on weekends)
       {{sp}} total time in bed of XX hours
       {{sp}} total sleep time of XX hours

      Assessment:
       {{ap}}  Primary insomnia
       {{ap}}  Secondary insomnia due to XXXX

      Plan:
        {{pp}} start a sleep diary
        {{pp}} refer to mysleepwell.ca for strategies to improve sleep
        {{pp}} consider reading Say Good Night to Insomnia for strategies to improve sleep
        {{pp}} follow recommendations for sleep hygiene:
        {{sleephy}}
        A referral has been made for obstructive sleep apnea.
        {{pp}} consider short term intermittent use of pharmacologic sleeping aid
        {{pp}} follow-up in 4 weeks

    vars:
      - name: sleephy
        type: match
        params:
          trigger: ":sleephy"

matches:
    - trigger: "sob"
      replace: "shortness of breath"
      propagate_case: true
      word: true

    - trigger: "soboe"
      replace: "shortness of breath on exertion"
      propagate_case: true
      word: true

    - trigger: ":asthma"
      word: true
      replace: |
         Asthma is a disease that causes inflammation in the airways, narrowing the space
         available for air to flow.
         Ventolin is a bronchodilator, which helps to relax the muscles and open the airwarys temporarily
         but does not address the underlying inflammation.
         You should benefit from the addition of regular daily medications such as inhaled corticosteroids
         to help suppress the underlying inflammation, and montelukast (Singulair) which is particularly
         helpful for allergy induced asthma.
         Combination puffers such as Symbicort have both a corticosteroid to help with the inflammation and
         a bronchodilator to open th airways that is both rapid onset (close to ventolin)
         and longer acting (compared to ventolin), so can be used effectively as a rescue inhaler as well.

         A prescription has been provided to extend your use of:
         Ventolin HFA 100mcg 1-2 puffs every 4 hours as needed

         In addition, prescriptions for the following medications have been provided to try to better
         control your asthma symptoms:
         Symbicort 200 1 puff twice daily, and as needed up to a total of 8 puffs daily
         Montelukast (Singulair) 10mg once daily

         You may not need to take these medications the entire year, but regular daily consistent use during
         the allergy season should help to control your symptoms.

         You are recommended to follow-up with your regular family physician within 30 days to review how
         well these new medications are working and whether you wish to continue them or any dose adjustment
         is necessary.

matches:
  - trigger: ":ankle"
    replace:  |
      Subjective:
        {{cc}} right left ankle pain for the past DURATION
        It started after MECHANISM
        {{sp}} been able walk after the injury
        {{sp}} no inability to bear weight immediately after the injury or right now (4 steps) (1)
        {{sp}} ongoing pain in [location]
        {{sp}} no significant ongoing pain in the midfoot (2)
        {{sp}} no previous ankle sprains

      Objective:
        {{op}} no visible deformity
        {{op}} no bruising
        {{op}} no swelling
        {{op}} no decreased range of motion
        {{op}} no loss of feeling
        {{op}} no loss of circulation

        {{op}} no significant tenderness at posterior edge or tip of the lateral malleous (3)
        {{op}} no significant tenderness at posterior edge or tip of the medial malleous  (4)

        {{op}} no significant tenderness at the navicular bone (5)
        {{op}} no significant tenderness at the base of the 5th metatarsal (6)

        {{op}} no other significant tenderness
        {{op}} no pain with passive gentle inversion
        {{op}} no pain with passive gentle eversion
        {{op}} a negative squeeze test
        {{op}} a negative external rotation stress test
        {{op}} a negative anterior drawer test
        {{op}} a negative talar tilt test
        {{op}} a negative Thompson test


      Assessment:
        {{ap}} a Right Left Lateral Medial ankle sprain
        Based on the Ottawa Ankle Rules
           malleolar pain with (1),(3) or (4)], we need to rule out an ankle fracture.
        Based on the Ottawa Foot Rules
           midfoot pain with (1),(5), or (6)] we need to rule out a foot fracture.

      Plan:
        {{pp}} complete an xray of the ankle and foot
        {{pp}} rest the ankle
        {{pp}} use ice, compression, and keep the ankle elevated
        {{pp}} use NSAIDs (such as ibuprofen) for pain management
        {{pp}} follow up with physiotherapy to assist in recovery

matches:
  - trigger: ":headachefu"
    word: true
    replace:  |
     {{pp}} immediately seek medical attention if:
       Your headache comes on suddenly, quickly becomes severe,
            or could be described as "the worst headache of your life"
       Your headache is severe and you also have a fever or stiff neck
       You have a seizure, personality changes or confusion, or you pass out
       Your headache began right after you exercised or had a minor injury
       You have weakness, numbness, or trouble seeing

  - trigger: ":headacheredflag"
    word: true
    replace:  |
     {{sp}} no thunderclap onset
       {{sp}} no fever
       {{sp}} no rash
       {{sp}} no neck stiffness
       {{sp}} no focal weakness
       {{sp}} no numbness
       {{sp}} no speech difficulties
       {{sp}} no imbalance
       {{sp}} no eye pain
       {{sp}} no night sweats
       {{sp}} no unintentional weight loss

  - trigger: ":headache"
    word: true
    replace:  |
      Subjective:
        {{cc}} headache for the past DURATION

        Red Flags:
        {{redflags}}

        {{pain}}

        {{sp}} no aura (neurological symptoms before headache starts)
        {{sp}} no previous head injury
        {{sp}} no previous medical history (eg high blood pressure, diabetes, insomnia)
        {{sp}} no analgesia overuse (>14 days/month for plain acetaminophen or NSAID,
               >9 days/month for triptans, opioids, or combinations)
        {{sp}} no excess alcohol consumption

      Objective:
        {{op}} normal blood pressure
        {{op}} no fever
        {{op}} no scalp tenderness
        {{op}} no neck tenderness
        {{op}} no sinus tenderness
        {{op}} no temporomandibular joint (TMJ) clicking or tenderness
        {{op}} normal painless range of motion of the neck

        {{neuroexam}}

      Assessment:
        {{ap}} Cervicogenic Headache
        {{ap}} Migraine Headache without Aura
        There are NO red flags

      Plan:
        {{pp}} start a headache diary
        {{pp}} decrease caffeine
        {{pp}} increase regular exercise
        {{pp}} maintain regular sleep and regular meals
        {{pp}} use over the counter medication for mild attacks:
          Tylenol 1 g PRN,  Advil 400 mg PRN, or Naproxen 550 mg PRN
        {{pp}} use prescription medication for severe attacks:  Zolmitriptan
        {{pp}} avoid overuse of medication: (>14 days/month for
               acetaminophen or ibuprofen, >9 days/month for triptans)
        {{pp}} start daily migraine prophylaxis medication: Propranolol
        {{pp}} trial saline nasal rinse with distilled water
               and intra-nasal corticosteroid spray
        {{pp}} follow-up in 2 weeks to review effectiveness of treatment

        {{followup}}

    vars:
      - name: redflags
        type: match
        params:
          trigger: ":headacheredflag"
      - name: followup
        type: match
        params:
          trigger: ":headachefu"
      - name: neuroexam
        type: match
        params:
          trigger: ":neuroexam"
      - name: pain
        type: match
        params:
          trigger: ":pain"

matches:
  - trigger: ":driver"
    word: true
    replace: |
      Subjective:
        {{cc}} Medical Examination for Driver's License
        Class of driver license required:
          Class 1 : Professional license to drive any vehicle
          Class 2 : Professional license for buses
          Class 3 : Vehicles with 3 axles plus - trucks
          Class 4 : Professional license for taxi, ambulance, small bus
          Class 5 : Standard driver’s license for cars, light trucks, motorhomes
          Class 6 : Motorcycles and mopeds

        {{sp}} no concerns with driving
        {{sp}} no difficulty with vision
        {{sp}} no difficulty with hearing the TV, telephone, or understanding speech in crowded room.
        {{sp}} no difficulty moving neck, shoulders, elbows, wrists, or ankles
        {{sp}} no history of ischemic heart disease (angina, heart attack)
        {{sp}} no history of diabetes mellitus
        {{sp}} no history of low blood sugar (hypoglycemia)
        {{sp}} no history of  ministroke or blacking out.
        {{sp}} no history of seizures in the past year.
        {{sp}} no traffic violations, accidents, or close calls within the past year

      Objective:
        {{op}} normal range of motion of neck, shoulders, elbows, wrists, fingers, and ankles.
        {{op}} normal strength (5/5) throughout including hand grip strength
        {{op}} no abdominal pulsations
        {{op}} normal heart sounds (S1/S2)
        {{op}} no extra heart sounds (EHS)
        {{op}} no heart murmurs
        {{op}} good air entry to both lungs (GAEB)
        {{op}} no abnormal lung sounds (adventitia)

      Assessment:
        {{ap}} no concerns regarding medical fitness to drive

      Plan:
        Form filled and given
        {{pp}} follow-up as needed

matches:
  - trigger: ":depain"
    word: true
    replace: |
      {{op}} no distressed appearance
      {{op}} normal level of alertness
      {{op}} normal ability to mobilize
      {{op}} normal ability to mobilize to toilet

  - trigger: ":demental"
    word: true
    replace: |
      {{op}} normal eye contact
      {{op}} normal behavior
      {{op}} normal expression of emotion (affect)
      {{op}} normal appearance and grooming
      {{op}} normal appearance of surroundings
      {{op}} normal interactions with others 

  - trigger: ":depeds"
    word: true
    replace: |
      {{op}} normal alertness
      {{op}} normal level of play
      {{op}} normal level of interest in surroundings
      {{op}} no apparent discomfort looking at lights
      {{op}} normal breathing rate
      {{op}} no increased work of breathing
      {{op}} normal skin color
      {{op}} no trouble looking up (no neck stiffness)

  - trigger: ":deresp"
    word: true
    replace: |
      {{op}} normal ability to speak in full sentences
      {{op}} normal rate of breathing
      {{op}} normal rhythm of breathing
      {{op}} normal color
      {{op}} no increased work of breathing
             (no accessory muscle use, no tracheal tug,
             no subcostal/intercostal retractions)

  - trigger: ":deabdo"
    word: true
    replace: |
      {{op}} normal ability to jump up and down
      {{op}} no apparent pain with cough or sneeze
      {{op}} normal ability to press own abdomen

matches:
  - trigger: ":ocp"
    word: true
    replace: |
      Subjective:
        {{cc}} Prescription for Oral Contraceptive Medication

        {{sp}} no current contraception

        {{sp}} no liver disease
        {{sp}} no migraines
        {{sp}} no previous cancer diagnosis
        {{sp}} no breast abnormalities
        {{sp}} no clotting disorders
        {{sp}} no tobacco use

        {{sp}} had last menstrual period on DATE
        {{sp}} regular menstruation
        {{sp}} no increased risk for sexually transmitted infection (STI)
        {{sp}} had last STI screen DURATION prior
        {{sp}} no need for pregnancy test at this time

      Objective:
        {{op}} current blood pressure of SBP/DBP

      Assessment:
        {{ap}} need for ongoing contraceptive medication
        with no contraindications

      Plan:
        {{pp}} continue with previously prescribed oral contraceptive medication
        Prescription provided for XXX

        {{pp}} reference the following links for more information:
        https://www.sexandu.ca/
        https://www.plannedparenthood.org/learn/birth-control

        {{pp}} reference the following links in case of missed doses:
        https://www.sexandu.ca/sos/
        https://www.plannedparenthood.org/online-tools/missed-birth-control-pill

        {{pp}} follow-up if further concerns or questions


  - trigger: ":ffertility"
    word: true
    replace: |
      Subjective:
        {{cc}} failure to conceive after DURATION

        Menstrual History:
          {{sp}} menstruation starting at age XX
          {{sp}} irregular menstrual periods ranging from XX to YY days
          {{sp}} regular menstrual periods every XX days
          {{sp}} menstrual bleeding lasting XX days

        Pregnancy History:
          {{sp}} no previous pregnancies
          {{sp}} no previous pregnancies with current partner

        {{sp}} vaginal intercourse every second day
        around the time of ovulation
        {{sp}} verified time of ovulation with ovulation kits

        {{sp}} no lactation
        {{sp}} no nipple discharge
        {{sp}} symptoms of PCOS (abnormal hair growth, deep voice,
               acne, irregular menstruation)
        {{sp}} symptoms of endometriosis (severe menstrual cramps,
               pain with intercourse, excessive or irregular bleeding)
        {{sp}} no hypothyroidism symptoms:
          {{hitsh}}

        {{sp}} no history of pelvic inflammatory disease (PID)
        {{sp}} no history of polycystic ovarian syndrome (PCOS)
        {{sp}} no history of pelvic surgery
        {{sp}} no history of pelvic radiation
        {{sp}} no history of dilitation and curretage (D&C)

        {{sp}} no previous investigations or treatments

      Assessment:
        {{ap}} primary female infertility

      Plan:
        {{pp}} complete investigations including:
          CBC, TSH, Prolactin, FSH, LH, Progesterone, Testosterone, DHEA
        {{pp}} follow-up when results are available
        Referral sent to fertility clinic for further assessment
    vars:
      - name: hitsh
        type: match
        params:
          trigger: ":hitsh"

  - trigger: ":menses"
    word: true
    replace: |
       Your last menstrual period was on XXXX XX,  XXX days ago
       Typically it will come regularly every XXXX days.

matches:
  - trigger: ":sti"
    word: true
    replace:  |
      Subjective:
        {{cc}} possible sexually transmitted infection (STI)

        Symptoms:
        {{sp}} no pain with urination
        {{sp}} no sores, rashes, or growths
        {{sp}} no unusual discharge from penis, vagina, or anus
        {{sp}} no testicular pain
        {{sp}} no pelvic pain
        {{sp}} no pain during sex

        {{sp}} current strategies to avoid STIs including XXXXX
        {{sp}} current strategies to avoid pregnancy including XXXXX
        {{sp}} sexual contact including oral, anal, and vaginal


        High Risk Factors:
        {{sp}} no known STI contact
        {{sp}} a known STI contact, with last contact XXXX days/weeks ago
        {{sp}} no sexual activity under 25 years of age
        {{sp}} no new sexual partner
        {{sp}} not more than one sexual partner in the past year
        {{sp}} no anonymous sexual partnering
        {{sp}} no MSM (Men who have Sex with Men) contact
        {{sp}} no contact with sex workers or their clients
        {{sp}} no homelessness or street involvementf
        {{sp}} no previous sexual assault or abuse
        {{sp}} no use of non-barrier contraception
        {{sp}} no use of injection drugs
        {{sp}} no use of other substances
        {{sp}} no history of STI

        Screening History:
        {{sp}} most recent STI screen XXXX months/years ago
        {{sp}} most recent PAP smear XXXX months/years ago
        {{sp}} most recent menstrual period: 


      Objective:
        {{op}} no weight loss
        {{op}} no fever
        {{op}} no enlarged lymph nodes
        {{op}} normal appearance of mouth and throat
        {{op}} normal appearance of external genitalia
        {{op}} no scrotal tenderness
        {{op}} normal vaginal exam with illuminated speculum
        {{op}} normal bimanual exam with no uterine or adnexal tenderness

      Assessment:
        {{ap}} routine STI screening request
        {{ap}} Chlamydia
        {{ap}} Gonorrhea

      Plan:
        {{pp}} complete STI testing
        {{pp}} treat with Azithromycin 1g and Cefixime 800mg for presumed exposure to Chlamydia and Gonorrhea
        {{pp}} practice safe sexual practice with consistent use of barrier protection (condoms)
        {{pp}} undergo regular STI screening, at least yearly, but more frequent if higher risk

  - trigger: ":hsv"
    word: true
    replace: |
       Based on your symptoms, you are very likely having the rash in response to
       initial infection with a herpes simplex virus. Unfortunately, although the
       rash will heal, this virus generally never completely clears from the body
       and will very likely cause repeated outbreaks of a blistering rash.
       However, the first episode is the worst, and medications can also help
       reduce the severity and duration of future outbreaks.

       There is no blood test available to test for an active
       herpes simplex infection (HSV).  To obtain a definite diagnosis
       you would need to visit a clinic in person and have a swab of the rash.

       To reduce the duration of the current outbreak, you are advised to use the '
       prescribed medication valacyclovir (Valtrex) 2 capsules (1g) twice daily
       for 10 days. If the rash is not completely healed, please extend the
       treatment for another 10 days.

       Note that if you have recurrence of this rash, you should take the same
       medication valacyclovir (Valtrex) 1 capsule (500mg) twice daily for 3 days
       starting when you first notice a tingle or blister forming.

       To reduce discomfort, you are advised to use the prescribed topical
       lidocaine 2% gel applied up to four times daily.

       {{apprx}}
    vars:
      - name: apprx
        type: match
        params:
          trigger: ":apprx"

  - trigger: ":stitest"
    word: true
    replace: |
       You are advised to complete a full STI (sexually transmitted infection)

matches:
  - trigger: ":cp"
    replace: "chest pain"
    propagate_case: true
    word: true

  - trigger: ":chestpain"
    word: true
    replace: |
      Subjective:
        {{cc}} chest pain for the past DURATION
        {{pain}}
        {{sp}} no exertional component
        {{sp}} no worsening with deep breaths
        {{sp}} no shortness of breath
        {{sp}} no nausea
        {{sp}} no sweating
        {{sp}} no previous similar episodes


      Objective:
        {{op}} blood pressure of
        {{op}} heart rate of
        {{op}} no distress
        {{op}} no increased work of breathing
        {{op}} normal heart sounds (S1/S2) with no murmurs or extra heart sounds
        {{op}} normal regular heart rhythm
        {{op}} good air entry to both lungs, with no abnormal sounds (adventitia)
        {{op}} no chest wall tenderness
        {{op}} no skin rash
        {{op}} no swelling (edema) in lower legs
        {{op}} no tenderness or redness in lower legs
               (no suspicion of a blod clot (Deep Vein Thrombosis))

      Assessment:
        {{ap}} Non-cardiac Chest Pain, not related to heart or lungs,
               most likely originating in chest wall

      Plan:
        {{pp}} use analgesia (such as ibuprofen or tylenol) for pain relief
        {{pp}} use medication to control acid reflux (GERD)
               as prescribed
        {{pp}} follow-up in 2 weeks if pain not improving
        {{pp}} seek emergency medical care if unremitting pain or shortness of breath

    vars:
      - name: pain
        type: match
        params:
          trigger: ":pain"

  # Causes of tachy or brady arrythmias (6Hs and 5Ts)
  - trigger: ":arcause"
    word: true
    replace: |
      Hypoxia
      Hypothermia
      Hypovolemia
      Hypoglycemia
      Hydrogen ion (acidosis)
      Hypo/Hyperkalemia

      Trauma (increase intracranial pressure, hypovolemia)
      Thrombosis (pulmonary or coronary)
      Tamponade (cardiac)
      Tension pneumothorax
      Toxins

  - trigger: ":wellsdvt"
    word: true
    replace: |
      Wells Score for Deep Vein Thrombosis (DVT):
        Active malignancy (past 6 months)            1
        Immobilization at least 3 days OR
        surgery in past 12 weeks                     1
        Immobilization of lower extremity            1
        Localized tenderness of deep venous system   1
        Entire leg swollen                           1
        Calf swelling >=3 cm larger than other side  1
        Pitting edema confined to symptomatic side   1
        Collateral superficial veins                 1
        Previously documented DVT                    1
        Alternatives diagnosis at least as likely   -2

      Score >=3 indicates high probability of DVT

  - trigger: ":wellspe"
    word: true
    replace: |
      Wells Score for Pulmonary Embolism (PE):
        Clinical signs and symptoms of DVT      3
        Alternatives less likely than PE        3
        Heart rate >100                         1.5
        Previous PE or DVT (confirmed)          1.5
        Immobilization at least 3 days OR
        surgery in past 4 weeks                 1.5
        Hemoptysis (coughing blood)             1
        Active malignancy (past 6 months)       1

      Score <=4 do d-dimer and if negative stop

matches:
  - trigger: ":intro"
    replace: |
      Introduction visit (Meet & Greet):

      Self introduction and general clinic information and policies
      (clinic hours, walk-in appointments, after hours care, uninsured services) discussed.

      Discussed any issues with previous family physician relationship.

      Agreement on care relationship, expectations and boundaries discussed.
      Patient's questions answered.

      Recorded medical, medication, allergies, family, social histories.

      Plan:
        Patient signed request for previous medical records and faxed to previous provider
        Laboratory/Imaging requisition provided as needed
        Patient to book Periodic health Exam
        Counselled and advised when to follow-up.

matches:
  - trigger: ":excision"
    word: true
    replace: |
      Subjective:
        {{cc}} excision of skin growth on LOCATION
        {{sp}} noticed for the past DURATION
        {{sp}} no growth
        {{sp}} no color change
        {{sp}} no bleeding
        {{sp}} no pain
        {{sp}} no itch

        {{sp}} no specific concerns
        {{sp}} specific concerns including:

        {{sp}} no personal history of skin cancer
        {{sp}} no family history of skin cancer

        Risks and possible complications were discussed
           including bleeding, infection, scarring, regrowth
        Alternatives were discussed including no intervention
        Expected benefits include removal of a worrisome
        growth and diagnosis to guide further treatment
        Consent obtained

      Objective: 
        Sterilization with alcohol 3 times
        followed by local infiltration with lidocaine with epinephrine 
        Area then sterilized with chlorhexidine 3 times
        and sterile draping applied
        Excision performed with sterile surgical blade
        Bleeding controlled
        Incision sutured with sterile surgical suture/s
           (Nylon 3-0 x 5)
        Area cleansed and dressed
        Excised tissue sent to pathology

      Assessment:
        {{ap}} atypical melanocytic nevus
        {{ap}} irritated seborrheic keratosis
        {{ap}} irritated skin tag

      Plan:
        {{pp}} await diagnostic results from pathology
        {{pp}} keep covered and dry for next 24 hours
        {{pp}} apply polysporin to keep moist
        {{pp}} keep covered with bandage, replacing daily
               or sooner if soaked with blood
        {{pp}} return to clinic if suture removal in 7 days
        {{pp}} return to clinic sooner if concern for infection
           such as increasing pain, redness, warmth, swelling, or pus

matches:
  - trigger: ":rice"
    word: true
    replace: |
       You are advised to obtain a splint to support your XXXXX and allow rest.
       You are advised to apply ice packs to the affected area for 20-30 minutes
       every 3-4 hours for 2-3 days until the pain goes away.
       You are advised to use elevate the affected area to reduce swelling.
       You are advised to use topical anti-inflammatory medication as prescribed
       (Diclofenac 10% Gel applied as needed 4 times daily) for pain relief
       You are advised to take anti-inflammatory medication as prescribed
       (Naproxen 250mg 1-2 tabs as needed every 24 hours) for pain relief
       You are advised to use over the counter anti-inflammatory medication
       such as ibuprofen or naproxen for pain relief

  - trigger: ":xray"
    word: true
    replace: |
       You are advised to obtain an xray of your XXXXX.  You will be contacted
       to arrange the details. Once your tests are completed and results are available,
       you will hear from us.

       If you have not received notification of your results from us
       WITHIN 2 DAYS of completing your tests, please contact us:
         Email: {{myemail}}
         Phone: {{myphone}}

  - trigger: ":physio"
    word: true
    replace: |
       You are advised to refer to the following handout materials detailing
       stretches and exercises to guide your recovery:
       https://www.primarycaresportsmedicine.com/wp-content/uploads/2016/12/WRIST-WRIST-SPRAIN.pdf

       https://www.primarycaresportsmedicine.com/wp-content/uploads/2016/12/WRIST-WRIST-TENDONITIS.pdf

       https://www.primarycaresportsmedicine.com/wp-content/uploads/2016/12/WRIST-DE-QUERVAINS-TENOSYNOVITIS.pdf

       http://www.primarycaresportsmedicine.com/wp-content/uploads/2016/12/BACK-LOW-BACK-PAIN.pdf

       If feasible, you are advised to consult a physiotherapist to help
       guide your rehabilitation and reduce the chance of repeat injury.
       A referral for physiotherapy will be sent to you to help with an
       insurance claim if necessary.

  - trigger: ":wrist"
    word: true
    replace: |
       Your main concern today is RIGHT LEFT wrist pain which started about
       This is not a work related condition.
       You have no previous injuries to your wrist.

       {{pain}}

       {{noother}}

       Your wrist is not swollen.
       Your wrist is not bruised.       
       Your wrist has full range of motion.

       Your wrist has reduced range of motion.
       Extension is limited by about 10 degrees compared to the opposite side.
       Flexion is limited by about 10 degrees compared to the opposite side.
       Radial deviation is limited by about 10 degrees compared to the opposite side.
       Ulnar deviation is limited by about 10 degrees compared to the opposite side.

       There is no pain with resisted extension
       There is no pain with resisted flexion

       Your history and symptoms are most consistent with a RIGHT LEFT wrist sprain.
       Your history and symptoms are most consistent with a RIGHT LEFT wrist tendonitis.
       Your history and symptoms are most consistent with a RIGHT LEFT De Quervain's Tenosynovitis.
       Given the history, there is also concern for a possible fracture of the wrist bones.

       {{xray}}

       {{rice}}

       {{physio}}

       {{finish}}
    vars:
      - name: pain
        type: match
        params:
          trigger: ":pain"
      - name: noother
        type: match
        params:
          trigger: ":noother"
      - name: xray
        type: match
        params:
          trigger: ":xray"
      - name: rice
        type: match
        params:
          trigger: ":rice"
      - name: physio
        type: match

matches:
  - trigger: ":back"
    replace:  |
      Subjective:
        {{cc}} Upper Mid Low back pain for the past [duration]

        Red flags:
        {{sp}} no urinary or bowel incontinence or urinary retention
        {{sp}} no new weakness in legs
        {{sp}} no saddle anesthesia (numbness or tingling around genitalss, buttocks or inner thighs)
        {{sp}} no unintentional wt loss
        {{sp}} no worse pain with lying flat
        {{sp}} no waking in the night with back pain
        {{sp}} no feeling tired all the time
        {{sp}} no drenching night sweats
        {{sp}} no fever
        {{sp}} no feeling of being extremely unwell
        {{sp}} no abdo pain radiating into the back

        {{pain}}

        {{sp}} no urinary symptoms such as pain with urination, increased urinary frequency or urgency, blood in urine
        {{sp}} no history of kidney stones
        {{sp}} no testicular pain
        {{sp}} no pain radiating to the groin
        {{sp}} no history of MVA or high impact collision
        {{sp}} no history of straining such as heavy lifting

      Objective:
        {{op}} significant distress due to back pain.
        {{op}} no paraspinal muscle tenderness
        {{op}} no warmth or redness on the back
        {{op}} normal range of motion of the back
        {{op}} normal range of motion in hips
        {{op}} normal strength in lower limbs
        {{op}} normal deep tendon reflexes
        {{op}} normal (negative) Babinski on both sides
        {{op}} normal gait (including toe and heel walking)
        {{op}} normal (negative) straight leg in both legs
        {{op}} normal (negative) FABER's test in both legs

      Assessment:
        {{ap}} Mechanical Lower Back Pain

      Plan:
        {{pp}} use Tylenol, Short term NSAID, topical diclofenac, short term Cyclobenzaprine before bed
        {{pp}} use heating pad or ice to help with symptoms
        {{pp}} stay active and learn exercises that help strengthen and stretch your back.
        {{pp}} learn to lift using your legs instead of your back.
        {{pp}} avoid sitting or standing in the same position for too long.
        {{pp}} monitor for development of red flags as described above
        {{pp}} seek medical attention if the pain persists over 6 weeks, worsens, or new symptoms develop.

    vars:
      - name: pain
        type: match
        params:
          trigger: ":pain"

matches:
  - trigger: ":ksprevent"
    word: true
    replace:  |
      Strategies to Prevent Kidney Stones

      Diet
      Increase fluid intake (2.5-3L/day to make >2L urine per day)
      Increase citric acid containing fruits or beverages such as lemon juice/orange juice
      Cut salt intake (<2300mg sodium/day)
      Minimize phosphoric acid containing soda (colas)
      Limit animal protein to <=2 meals per day, less than 6-8 ounces
      Limit high oxalate foods such as spinach and rhubarb

      Exercise:
      Moderate exercise and weight reduction.

      Supplements:
      Vitamin B6 to help metabolize oxalate
      Fish oil supplement (potential benefit)
      Limit vitamin C to < 1000mg/day

matches:
  - trigger: ":delayedejac"
    replace:  |
     Subjective:
       {{cc}} delayed ejaculation for the past DURATION
       {{sp}} no difficulty with ejaculation with masturbation
       {{sp}} no difficulty with ejaculation with partner
       {{sp}} no history of anxiety
       {{sp}} no seratonin enhancing drugs
         Examples: 
           SSRI, SNRI, Bupropion, TCAs, MAOIs
           Anti-psychotics,
           triptans, Carbamazepine, Valproic acid, Lithium
           Opioids,
           Metoclopramide, Ondansetron
           Cyclobenzaprine, Dextromethorphan
           LSD, ecstasy, cocaine, amphetamines       

     Assessment:
       {{ap}} Primary Delayed Ejaculation (likely at least partly secondary to serotonergic medication]
       Primary delayed ejaculation is difficult to treat unless directly related to a medication.
       If a medication cause is suspected, strategies include:
       1) Switching SSRI to vilazodone (Viibryd) or low dose vortioxetine (Trintellix)
       2) Switching SSRI to SNRI - duloxetine (cymbalta) or levomilnacipran (Fetzima) likely best
       3) Adding mirtazapine (Remeron) or bupropion (Wellbutrin) to an SSRI

       If not medication related, it is usually related to anxiety, and overcontrolling or obsessive personality traits.
       Intensive counselling may be helpful.

       Most men are able to find specific stimuli when alone that help them reach their particularly high ejaculation threshold.
       Having their partner mimic these techniques may allow them to ejaculate with their partner. 

       Finally, a stimulant  (eg Dexedrine 5-10mg) 1 hour before sexual activity may help. 
       If this approach is effective, one should consider screening for ADHD.

     Plan:
       {{pp}} self refer to counselling
       {{pp}} trial a medication switch to vilazodone (Viibryd) vortioxetine (Trintellix)  duloxetine (Cymbalta) levominacipran (Fetzima)]
       {{pp}} trial adding mirtazapine (Remeron) bupropion (Wellbutrin)
       {{pp}} trial dexedrine 5mg, taken one hour before sexual activity
       {{pp}} follow-up within 1 month regarding effectiveness of treatment, sooner if concerns


  - trigger: ":lowtest"
    word: true
    replace:  |
      Subjective:
        {{cc}} possible low testosterone

        Sexual Symptoms:
        {{sp}} no decreased libido
        {{sp}} no erectile dysfunction
        {{sp}} no decreased frequency of morning erections
        {{sp}} no decreased performance

        Somatic Symptoms:
        {{sp}} no increased visceral body fat/obesity,
        {{sp}} no decreased lean muscle mass,
        {{sp}} no decreased strength,
        {{sp}} no fatigue/loss of energy,
        {{sp}} no decreased physical activity/ vitality,
        {{sp}} no low bone mineral density,
        {{sp}} no anemia,
        {{sp}} no flushes,
        {{sp}} no loss of facial, axillary and pubic hair/slow beard growth
        {{sp}} no decline in general feeling of well-being

        Psychological Symptoms:
        {{sp}} no depression/depressed mood,
        {{sp}} no mood changes,
        {{sp}} no irritability,
        {{sp}} no inability to concentrate
        {{sp}} no insomnia/sleep disturbances

      Objective: 
        {{op}} no gonadal atrophy,
        {{op}} no decrease in pubic and facial hair, 
        {{op}} no decrease in muscle mass, 
        {{op}} no increase in visceral fat

      Assessment:
        {{ap}} Testosterone Deficiency Syndrome

      Plan:
        {{pp}} complete testing for testosterone level (recommended 7 - 11am or within 3 hours of waking if shift work)
        and related levels to confirm diagnosis and allow monitoring during treatment
        (FSH, LH, Prolactin, SHBG, Albumin (cFT or cBAT), TSH, Ferritin (or % iron saturation), CBC, PSA)

  # This is a general discussion of testosterone deficiency syndrome for reference
  # This information is not necessarily up to date or compliant with any guidelines 
  - trigger: ":lowtestinfo"
    word: true
    replace:  |
        Testing:
        Testosterone 7am-11am or within 3 h of rising for shift workers
        If borderline, use bioavailable testosterone - user pay or calculate with testosterone, SHBG, albumin
        www.issam.ch/freetesto.htm
        Bioavailable testosterone normal range (4.0 - 16.0)
        If normal, do not replace as may suppress natural production and pt feels worse!

matches:
  - trigger: "S:"
    replace: "Subjective:"
    word: true
  - trigger: "O:"
    replace: "Objective:"
    word: true
  - trigger: "A:"
    replace: "Assessment:"
    word: true
  - trigger: "P:"
    replace: "Plan:"
    word: true

  - trigger: ":SOAP"
    word: true
    replace: |
      Subjective:
      Objective:
      Assessment:
      Plan:

      Start Time: {{mytime}}
      End Time:
    vars:
      - name: mytime
        type: date
        params:
          format: "%H:%M"

  - trigger: ":FIFE"
    word: true
    replace: |
      Feelings: What are concerned most about? Specific fears or worries?
      Ideas: What do you think might be going on?
      Function: How has this affected you day to day? What have you given up?
      Expectations: What do expect or hope I can do for you today?

  - trigger: "Rt"
    replace: "right"
    word: true

  - trigger: "Lt"
    replace: "left"
    word: true

  - trigger: "sec"
    replace: "seconds"
    word: true

  - trigger: "min"
    replace: "minutes"
    word: true

  - trigger: "hr"
    replace: "hours"
    word: true

  - trigger: "wk"
    replace: "weeks"
    word: true

  - trigger: "mo"
    replace: "months"
    word: true

  - trigger: "yr"
    replace: "years"
    word: true

  - trigger: ":myn"
    replace: "{{myname}}"
    word: true

  - trigger: ":mycl"
    replace: "{{cname}}"
    word: true

  - trigger: ":myem"
    replace: "{{myemail}}"
    word: true

  - trigger: ":myph"
    replace: "{{myphone}}"
    word: true

  - trigger: "labreq"
    replace: "Laboratory Requistion"
    word: true

  - trigger: "prn"
    replace: "as needed"
    word: true

  - trigger: "rx"
    replace: "prescription"
    word: true

  - trigger: "rxhld"
    replace: "Please do not fill until requested by patient"

matches:
  - trigger: ":strep"
    word: true
    replace: |
     Subjective:
        {{cc}} sore throat for XX days
        {{sp}} no cough
        {{sp}} no previous strep
        {{sp}} no known strep contact
        Strep throat is most common in ages less than 15, and least common over 45.

     Objective:
        {{op}} temperature today of
        {{op}} no tender swollen lymph nodes in the neck (anterior cervical lymphadenopathy)
        {{op}} no tonsillar swelling
        {{op}} no tonsillar white spots (exudates)

     Assessment:
        {{ap}} Acute Streptococcal Pharyngitis (Strep Throat)
        {{ap}} Acute Viral Pharyngitis
        Approximately 80% of sore throats are viral in origin and do not improve
        with antibiotics, since antibiotics do not kill viruses

     Plan:
        A throat swab was sent to check for a bacterial infection (strep throat)
        {{pp}}wait until infection is confirmed before taking prescribed antibiotics
        {{pp}}start taking prescribed antibiotics immediately
        {{pp}}continue supportive management (hydrate with gatorade and salty soups,
              tylenol and/or advil for pain, salt gargles for throat, and rest)
        {{pp}}seek reassessment if worsening symptoms in 48 hours despite treatment
        {{pp}}call 911 or go to ED if trouble breathing

  - trigger: ":strepphone"
    word: true
    replace: |
      PHONE COMMUNICATION

      Reason for call: Strep swab positive

      Notes:
        Informed strep swab positive and should start prescription given last visit.
        Patient understands and agreeable.  Grateful for call.
        Will contact clinic if further concerns, not improving despite treatment.

  - trigger: ":strepscore"
    word: true
    replace: |
      {{sp}} fever  (temperature >38C)            (1 point)
      {{sp}} tonsillar exudates (white spots)     (1 point)
      {{sp}} no cough                             (1 point)
      {{sp}} swollen glands in neck               (1 point)
             (anterior cervical lymphadenopathy)
      {{sp}} age of 3-14 years                    (1 point)
      {{sp}} age of 15-44 years                   (0 point)
      {{sp}} age of over 44 years                 (-1 point)

      Interpretation:
        -1, 0, 1 points - risk of strep infection <10%
            no antibiotic or throat culture necessary
        2 or 3 points - risk of strep 15% - 32%
            throat culture and antibiotics if culture is positive
        4 or 5 points - risk of strep 56%
            consider strep testing and/or culture

matches:
  - trigger: ":mse"
    word: true
    replace: |
      Mental Status Exam:
        {{op}} casual dress, normal grooming and hygiene
        {{op}} calm and cooperative
        {{op}} no unusual movements or psychomotor changes
        {{op}} normal rate, tone, and volume of speech without pressure
        {{op}} normal range of emotional expression (affect)
        {{op}} normal stated mood (euthymic)
        {{op}} goal directed and logical thought processes
        {{op}} thought content free of delusions and fixations
        {{op}} no suicidal or homocidal thoughts
        {{op}} no hallucinations during interview
        {{op}} orientation to time, place, and person intact
        {{op}} normal memory and attention
        {{op}} good insight and judgement

  - trigger: ":psylink"
    word: true
    replace: |
      {{pp}} refer to the following links:

      https://psychhealthandsafety.org/asw
      https://cmha.bc.ca/
      https://moodgym.com.au/
      https://www.anxietycanada.com/
      https://bouncebackbc.ca/
      https://www.keltyskey.com/

  # some links specific to counselling resources in British Columbia
  - trigger: ":psylinkbc"
    word: true
    replace: |
      {{pp}} see the links below to arrange a counselling group or therapist.
      Normally one-on-one therapy is private pay and a physician referral is not required.
      Vancouver Coastal Health offers free group therapy and this requires a physician referral.

      https://counsellingbc.com/
      https://www.psychologists.bc.ca/find_psychologist
      https://divisionsbc.ca/sites/default/files/inline-files/NEW_2019%20-%2003%20-%20CBT%20BROCHURE%20FOR%20PATIENTS%20%28HOME%20PRINTER%29.pdf

  - trigger: ":psymed"
    word: true
    replace: |
      Medications can sometimes be helpful for anxiety and depression.
      To be effective, they must be taken once daily, every day.
      They usually take several weeks to start having a significant effect.
      They are usually continued for at least 9 to 12 months.
      Some more common side effects include nausea, headache, sleep disturbance,
      sexual dysfunction, sweating and dry mouth.
      When first starting, they may cause a temporary increase in anxiety,
      and rarely an increase in suicidal thinking.
      If suicidal thoughts are increasing, it is important to seek help immediately.

  - trigger: ":risksuicide"
    word: true
    replace: |
      {{sp}} no male sex
      {{sp}} no age over 60 or under 18
      {{sp}} no depression
      {{sp}} no previous attempts
      {{sp}} no alcohol abuse
      {{sp}} no loss of rational thinking
      {{sp}} no suicide in the family
      {{sp}} no organized plan
      {{sp}} no lack of social supports
      {{sp}} no serious illness or intractable pain

  - trigger: ":sxgad"
    word: true
    replace: |
      {{sp}} no feeling of mind going blank
      {{sp}} no increased fatigue
      {{sp}} no sleep disturbance
      {{sp}} no feeling of being very excited or nervous
      {{sp}} no increased irritability
      {{sp}} no increased muscle tension

  - trigger: ":sxpanic"
    word: true
    replace: |
      {{sp}} no sweating
      {{sp}} no trembling
      {{sp}} no unsteadiness
      {{sp}} no derealization
      {{sp}} no excessive heart rate
      {{sp}} no nausea
      {{sp}} no tingling
      {{sp}} no shortness of breath
      Symptoms usually peak within 10 minutes.


  - trigger: ":sxmdd"
    word: true
    replace: |
      {{sp}} no depressed mood
      {{sp}} no sleep disturbance
      {{sp}} no reduced interest and pleasure in doing things

matches:
  - trigger: ":cthead"
    word: true
    replace:  |
      Canadian Head CT Rule
        (not for age <16, anticoag or bleeding disorder, pregnancy)
      CT if any present:
        Basal Skull Fracture
        Emesis twice or more
        Age of 65 or over
        GCS score <15 at 2 hours after injury
        Suspected open or depressed skull fracture
        Signs of basal skull fracture
           (hemotympanum, 'racoon' eyes, CSR otorrhea/rhinorrhea, Battle's sign)
        Amnesia before impact of 30 minutes or more
        Dangerous mechanism (pedestrian, ejected from vehicle, fall from elevation >=3 feet or 5 stairs)

  - trigger: ":gcs"
    word: true
    replace:  |
      Glasgow Coma Scale
      Eyes:
        4: Open spontaneously
        3: Open to speech
        2: Open to pain
        1: No response
      Verbal:
        5: Alert and oriented
        4: Disoriented
        3: Inappropriate words
        2: Unintelligible (moans)
        1: No response
      Motor:
        6: Follows commands
        5: Localizes to pain
        4: Withdraws from pain
        3: Decorticate
           (stiff with bent arms, clenched fists, and legs held out straight)
        2: Decerebrate
           (arms and legs held straight out, toes pointed downward, and the head and neck arched backward)
        1: No response

  - trigger: ":neuroexam"
    word: true
    replace:  |
      {{op}} normal level of conciousness
        {{op}} normal exam of head, eyes, ears, nose and throat
        {{op}} normal cranial nerve exam
        {{op}} normal strength in upper and lower limbs
        {{op}} normal deep tendon reflexes in upper and lower limbs
        {{op}} normal cerebellar exam (including finger to nose, and alternating movements)
        {{op}} normal gait, including heel to toe
        {{op}} normal ability to retain balance with eyes closed (negative Rhomberg)

  - trigger: ":neuroredflag"
    word: true
    replace:  |
      {{sp}} no difficulty speaking (dysarthria)
        {{sp}} no double vision (diplopia)
        {{sp}} no difficulty swallowing (dysphagia)
        {{sp}} no difficulty with precise movements like finger to nose (dysmetria)
        {{sp}} no inability to perform rapid alternating movements (dysdiadochokinesia)


  - trigger: ":vertigo"
    word: true
    replace:  |
      Subjective:
        {{cc}} dizziness for the past DURATION
        {{sp}} a feeling like the room is spinning
        The sensation is intermittent, lasting for XX seconds
        {{sp}} no identified triggers - no recent sickness or cold and no trauma.
        It is associated with nausea
        {{sp}} no other symptoms.

        Red Flags:
        {{neuroredflag}}

      Objective:
        {{neuroexam}}
        {{op}} symptoms provoked by laying down quickly with head turned to one side (Dix hallpike)
               Worse when turning to RIGHT, including dizziness, nausea, involuntary eye movements (nystagmus)

      Assessment:
        {{ap}} Benign Paroxysmal Peripheral Vertigo (BPPV)

      Plan:
        {{pp}} review the educational materials provided
        {{pp}} attempt self-treatment according to hand out provided
        {{pp}} consider physiotherapy if ineffective.
        {{pp}} maintain adequate hydration.
        {{pp}} use provided prescription (betahistine) to help with symptoms as needed

    vars:
      - name: neuroexam
        type: match
        params:
          trigger: ":neuroexam"
      - name: neuroredflag
        type: match

matches:
  - trigger: ":uti"
    word: true
    replace: |
     Subjective:
       {{cc}} possible urinary tract infection for the past XX days
       {{sp}} no dysuria
       {{sp}} no frequency
       {{sp}} no urgency,
       {{sp}} no hematuria
       {{sp}} no fever
       {{sp}} no chills
       {{sp}} no nausea and vomiting
       {{sp}} no flank pain
       {{sp}} no abdominal pain

       {{sp}} no vaginal discharge
       {{sp}} no vaginal bleeding
       {{sp}} no bowel changes

       {{sp}} no urinary tract infections (uti) in the past 6 month (and none in the past year)
              (recurrent uti defined as ≥2 infections in six months or ≥3 infections in one year)
       {{sp}} no antibiotic use within 4 weeks
       {{sp}} no immunocompromised state
       {{sp}} no allergies to antibiotics
       {{sp}} no pregnancy

     Objective:
       {{op}} no suprapubic tenderness (overlying bladder)
       {{op}} no costavertebral angle tenderness (overlying kidneys)
       {{op}} no leukocytes (white blood cells) on urine dip
       {{op}} no nitrites (byproduct of bacterial infection) on urine dip

     Assessment:
       {{ap}} Uncomplicated Urinary Tract Infection

     Plan:
       {{pp}} increase fluids
       {{pp}} start prescribed antibiotic: Macrobid Ciprofloxacin Septra  Monurol Cephalexin
       A urine culture has been sent to guide treatment in case symptoms do not improve

       {{pp}} monitor for symptoms of kidney infection (pyelonephritis) including fever, nausea, and back pain
       {{pp}} seek reassessment if current symptoms worsen, persist, or new symptoms develop.

  - trigger: ":uti2"
    word: true
    replace: |
       {{cc}} possible urinary tract infection for the past XX days
       {{sp}} no dysuria
       {{sp}} no frequency
       {{sp}} no urgency,
       {{sp}} no hematuria
       {{sp}} no fever
       {{sp}} no chills
       {{sp}} no nausea and vomiting
       {{sp}} no flank pain
       {{sp}} no abdominal pain

       {{sp}} no vaginal discharge
       {{sp}} no vaginal bleeding
       {{sp}} no bowel changes

       {{sp}} no urinary tract infections (uti) in the past 6 month (and none in the past year)
              (recurrent uti defined as ≥2 infections in six months or ≥3 infections in one year)
       {{sp}} no antibiotic use within 4 weeks
       {{sp}} no immunocompromised state
       {{sp}} no allergies to antibiotics
       {{sp}} no pregnancy

       {{op}} no suprapubic tenderness (overlying bladder)

       Based on your symptoms it is very likely you have a urinary tract infection and
       treatment can be started now.
       However, it would also be useful to submit a sample of urine for culture to confirm the infection
       and help guide treatment if the initial treatment is not working.
       On discussion, you have responded well to previous treatments for urinary tract infection and
       do not want to pursue this additional testing at this time.

       You are recommended to submit a sample of urine for culture to confirm the diagnosis and
       guide treatment in case symptoms do not improve.  You will be contacted to arrange this testing.

       {{pp}} start the prescribed antibiotic: Macrobid (nitrofurantoin) 100mg twice daily for 7 days
       {{pp}} increase fluids and consider cranberry pills as these can help clear the infection faster.

       {{finish}}

       {{pp}} monitor for symptoms of kidney infection (pyelonephritis) including fever, nausea, and back pain
       and seek reassessment urgently if these symptoms develop. 

    vars:
      - name: finish
        type: match
        params:
          trigger: ":finish"

matches:
  - trigger: ":rxpre"
    word: true
    replace: |
      To Whom This May Concern,

      This is to confirm that that above patient was assessed and
      due to a medical condition will benefit from:

  - trigger: ":rxpost"
    word: true
    replace: |
      Should you have any questions or clarifications
      please don't hesitate to contact me.

  - trigger: ":rxcompression"
    word: true
    replace: |
      {{rxpre}}
      Compression stockings for both lower extremities

      Pressure gradient: 30-40 mmHg
      Diagnosis: Varicose veins
      Usage: Activities of Daily Living (ADLs) and all the time for work
      Duration: 1 year

      {{rxpost}}

    vars:
      - name: rxpre
        type: match
        params:
          trigger: ":rxpre"
      - name: rxpost
        type: match
        params:
          trigger: ":rxpost"

  - trigger: ":rxorthotic"
    word: true
    replace: |
      {{rxpre}}
      Custom made orthotics for both feet

      Diagnosis: Plantar fasciitis, Pes Planus
      Usage: Activities of Daily Living (ADLs) and all the time for work
      Duration: 1 year

      {{rxpost}}

    vars:
      - name: rxpre
        type: match
        params:
          trigger: ":rxpre"
      - name: rxpost
        type: match
        params:
          trigger: ":rxpost"

  - trigger: ":rxphysio"
    word: true
    replace: |
      {{rxpre}}
      Physiotherapy

      Diagnosis: Mechanical Lower Back Pain

      Details:
      Please assess and treat lower back pain

      {{rxpost}}

    vars:
      - name: rxpre
        type: match
        params:
          trigger: ":rxpre"
      - name: rxpost
        type: match
        params:
          trigger: ":rxpost"

  - trigger: ":rxmassage"
    word: true
    replace: |
      {{rxpre}}
      Massage Therapy

      Diagnosis: Mechanical Lower Back Pain

      Details:
      Please assess and treat lower back pain

      {{rxpost}}

    vars:
      - name: rxpre
        type: match
        params:

matches:
  - triggers: [":hyperthyroid", ":lotsh"]
    word: true
    replace: |
     {{sp}} no palpitations, rapid heart rate (tachycardia) or atrial fibrillation
     {{sp}} no widened pulse pressure (>100mmHg between systolic and diastolic pressures)
     {{sp}} no nervousness and tremor
     {{sp}} no heat intolerance
     {{sp}} no weight loss
     {{sp}} no muscular weakness
     {{sp}} no goiter

  - triggers: [":hyperthyroid", ":hitsh"]
    word: true
    replace: |
     {{sp}} no weight gain
     {{sp}} no lethargy
     {{sp}} no cold intolerance
     {{sp}} no menstrual irregularities
     {{sp}} no depression
     {{sp}} no constipation
     {{sp}} no dry skin

matches:
    - trigger: "ruq"
      replace: "right upper abdomen"
      propagate_case: true
      word: true

    - trigger: "rlq"
      replace: "right lower abdomen"
      propagate_case: true
      word: true

    - trigger: "llq"
      replace: "left lower abdomen"
      propagate_case: true
      word: true

    - trigger: "luq"
      replace: "left upper abdomen"
      propagate_case: true
      word: true

    - trigger: ":giredflag"
      word: true
      replace: |
        Gastrointestinal Red Flags:
          {{sp}} no family history of colon cancer
          {{sp}} no family history of inflammatory bowel disease
          {{sp}} no blood in stool, or black, tarry stools (melena)
          {{sp}} no blood or "coffee grounds" in vomit
          {{sp}} no difficulty swallowing (dysphagia)
          {{sp}} no nocturnal symptoms
          {{sp}} no progressive symptoms
          {{sp}} no onset after age 50
          {{sp}} no anemia
          {{sp}} no weight loss

          Any of the above features requires a referral to gastroenterology

    - trigger: ":ibs"
      word: true
      replace: |
        Subjective:
          {{cc}} recurrent abdominal pain for the past DURATION
          {{sp}} no change in frequency of stool
          {{sp}} no change in form of stool
          {{sp}} no relief of pain by defecation

          {{redflags}}

          {{sp}} no bloating
          {{sp}} no flatulence
          {{sp}} no nausea
          {{sp}} no burping
          {{sp}} no early satiety
          {{sp}} no gastroesophageal reflux
          {{sp}} no dyspepsia

          {{sp}} no dysuria
          {{sp}} no frequent/urgent urination
          {{sp}} no widespread musculoskeletal pain
          {{sp}} no dysmenorrhea
          {{sp}} no dyspareunia
          {{sp}} no fatigue
          {{sp}} no anxiety
          {{sp}} no depression

          Medications that may be worsening symptoms:
          no laxatives/antacids
          no PPI (proton pump inhibitors)
          no ASA/NSAIDs
          no iron/calcium/magnesium supplements
          no calcium channel blockers
          no antidepressants
          no opioids
          no diuretics,
          no herbal products

        Objective:
          {{op}} no abdominal masses
          {{op}} no abdominal tenderness
          {{op}} no abdominal guarding (tensing with pain)
          {{op}} normal bowel sounds

        Assessment:
          {{ap}} Irritable Bowel Syndrome (IBS), diarrhea predominant, constipation predominant, mixed

          ROME IV Criteria for Irritable Bowel Syndrome (IBS):
            1. Recurrent abdo pain >=3 months >=1 day per week
            2. Associated with change in frequency and/or form of stool
            3. AND pain relieved by defecation.

          However, additional testing is required to ensure other possible causes are not missed.

        Plan:
          {{pp}} complete further investigations according to the Laboratory Requistion provided
            CBC, ferritin, celiac screen

            Diarrhea predominant:
              CRP, albumin, electrolytes
              Stool: C.diff, O&P, leuks, pH, fat globules, elastase

matches:
  - trigger: "ya"
    replace: "You are at home in"
    word: true

  - trigger: "yaa"
    word: true
    replace: |
       You are at home in XXXX accompanied by your mother (XXX).

  - trigger: "yar"
    word: true
    replace: "You are advised to"

  - trigger: "ym"
    replace: "Your main concern today is"
    word: true

  - trigger: "yfut"
    replace: "Your main concern today is to follow-up on test results"
    word: true

  - trigger: "yh"
    replace: "You have had"
    word: true

  - trigger: "yn"
    replace: "You have had no"
    word: true

  - trigger: "yrx"
    replace: "You are requesting a prescription for"
    word: true

  - trigger: "yw"
    replace: "You appear well, with no apparent distress"
    word: true

  - trigger: "trx"
    replace: "Please take medication(s) prescribed as directed"
    word: true

  - trigger: "ymhx"
    replace: "Your medical history significantly includes"
    word: true

  - trigger: "yfhx"
    replace: "Your family history significantly includes"
    word: true

  - trigger: "ymed"
    replace: "Your current medications include"
    word: true

  - trigger: "ynhx"
    replace: "You have no previous significant medical history, no prescription medications and no relevant family history"
    word: true

  - trigger: "ymnd"
    replace: "You were accompanied by your mom and dad."
    word: true

  - trigger: "vutd"
    replace: "vaccinations are up to date"
    word: true

  - trigger: "cpl"
    replace: "Please copy the following link into your browser:"
    word: true

  - trigger: ":results"
    word: true
    replace: |
      Once your tests are completed and results are available,
      you will hear from us.
      For some tests, this will be within 2-3 DAYS of completing the tests,
      but for other tests it will be longer.  Some blood tests take up to
      7 WORKING DAYS and MRIs can take up to 10 WORKING DAYS.

      You will be contacted regardless of whether or not the results
      require follow up. Please wait to be contacted about the results
      before booking a follow up appointment.

      If you have not received notification of your results from us
      WITHIN 5 DAYS of completing your tests, please contact us:
        Email: {{myemail}}
        Phone: {{myphone}}

      If there is a significant change in your symptoms, or decline
      in your health while waiting for the results, please do not wait
      for the results before being reassessed. Please seek out medical care
      as soon as possible if there is a significant worsening of your condition.

  - trigger: ":findfp"
    word: true
    replace: |
             You are recommended to find a regular family physician. This website should be helpful:
             {{findfpwebsite}}

  - trigger: ":refer"

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