medical-docs 0.1.0 | 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 --version 0.1.0

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

urti.yml

imaging.yml

derm.yml

covid.yml

insomnia.yml

resp.yml

msk_ankle.yml

headache.yml

sti.yml

cardio.yml

intro.yml

msk_back.yml

urology.yml

common.yml

strep.yml

neuro.yml

uti.yml

thyroid.yml

gi.yml

ptfacing.yml

# medical-docs package

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

  - 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.

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: ":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: ":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

matches:
  - 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"

  - trigger: ":covidsig"
    replace: |
      Please remember to practise social distancing.


      # 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: ":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: ":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

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: ":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: ":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

  # Dates
  - trigger: ":date"
    replace: "{{mydate}}"
    vars:
      - name: mydate
        type: date
        params:
          format: "%m/%d/%Y"

  - trigger: ":time"
    replace: "{{mytime}}"
    vars:
      - name: mytime
        type: date
        params:
          format: "%H:%M"

  - trigger: ":phone"
    word: true
    replace:  |
      PHONE COMMUNICATION
      Reason for call: 
      Notes:


  - trigger: "lmom"
    replace: "{{mytime}} Phoned but no answer. Left voice mail to call clinic when available."
    word: true
    vars:
      - name: mytime

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)

     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}}
        {{pp}}start taking prescribed antibiotics immediately
        {{pp}}
        {{pp}}continue supportive management (tylenol,advil,rest,and fluids)
        {{pp}}seek reassessment if worsening symptoms in 48 hours despite treatment
        {{pp}}call 911 or go to ED if trouble breathing

matches:
  - trigger: ":neuroexam"
    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"
    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
        params:
          trigger: ":neuroredflag"

  - trigger: ":tremor"
    word: true
    replace:  |
      Subjective:
        {{cc}} tremor in LEFT HAND for DURATION
        {{sp}} no tremor at rest
        {{sp}} no difficulty with activities of daily living
        {{sp}} no progressively worsening symptoms
        {{sp}} no improvement with drinking alcohol
        {{sp}} no previous treatment
        {{sp}} no family history of tremor

      Objective:
        Psychogenic Tremor:
        With rapid alternating movements of the contralateral limb, the tremor is
        BETTER WORSE UNCHANGED with fist open/close
        BETTER WORSE UNCHANGED with forearm pronation/supination
        BETTER WORSE UNCHANGED with foot tap on the floor

        Note: Typically parkinson disease resting tremor becomes more obvious
         psychogenic tremor disappears, or takes on rhythm of voluntary limb (entrainment).

        Action Tremor:
        The tremor is:
        BETTER WORSE UNCHANGED when drawing a spiral inside another spiral,
        BETTER WORSE UNCHANGED when joining 2 points between closely spaced straight lines
        BETTER WORSE UNCHANGED when pouring water from one glass to another

        Postural Tremor:
        The tremor is:
        BETTER WORSE UNCHANGED when arms are outstretched for 10-15s, with a loose sheet of paper on the hand(s)

        Kinetic Tremor
        The tremor is:
        BETTER WORSE UNCHANGED with nose-finger-nose movement
        BETTER WORSE UNCHANGED with knee-heel-shin movement

        Intention Tremor
        The tremor is NOT present during target-directed movements.
        Tremor amplitude is INCREASED DECREASED UNCHANGED as the hand approaches the target.

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.

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

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