* 1. Your USUHS email address

* 2. Hospital Site

* 3. Rotation:

* 4. My patient was a

* 5. Patient age

* 6. Level of involvement

* 7. The patient had the following DIAGNOSES, either as a main problem or an item addressed/listed on their problem list. Skip each one that is not applicable, otherwise click on the number of diagnoses (up to 6) in each CORE DIAGNOSIS GROUP. For example. If your patient had vomiting click on the "1" next to abdominal. If the patient also happened to have a history of GERD and he needed his appendix out too, then you would click on "3" next to abdominal to get proper credit.

  1 2 3 4 5 6
Abdominal: Appendicitis, bowel obstruction or ileus, constipation, diarrhea, diverticulosis or diverticulitis, gallstone disease or cholecystitis, inflammatory bowel disease, irritable bowel syndrome IBS, nausea and or vomiting, pancreatitis, ulcer disease peptic, gastric, acid reflux
Anemia:, B12 deficiency or pernicious anemia, iron deficiency, transfusion of blood products, anemia
Cancers: prostate cancer, prostate cancer, lung cancer, colon or rectal cancer, breast cancer
Congestive Heart Failure: cardiomyopathy or CHF
COPD, asthma, asthma reactive airways disease RAD, COPD obstructive lung disease emphysema
Coronary Artery Disease: Angina diagnostic evaluation, known CAD ASHD or history of CABG, acute myocardial infarction (MI), history of MI
Diabetes Mellitus: diabetes mellitus or hyperglycemia, diabetic foot ulcer
Health Maintenance: health maintenance, colonoscopy screening, contraception, abnormal pap smear or cervical dysplasia, ordered screening mammogram, prostate cancer screening, breast cancer screening, lung cancer screening
Hyperlipidemia: hyperlipidemia, hyperlipidemia HLP
Hypertension: hypertension HTN, hypertension urgency or emergency
Infection: fever, abcess, pneumonia, hepatitis A B or C, salpingitis or PID, URI, cellulitis skin infection, chlamydia STD, fever workup, fungal infection, gonorrhea, herpes simplex zoster or shingles, HIV positive or AIDS, influenza, Leishmania, malaria, meningitis, MRSA infection or positive, mycobacterial infection including TB, opportunistic infection, rickettsial infection, sepsis, viral infection, osteomyelitis, bacteremia
Musculoskeletal: carpal tunnel syndrome, chronic pain or pain management, DJD osteoarthritis, fibromyalgia, gout or crystal arthropathy, joint pain other, low back pain or herniated disc HNP, myalgia, plantar fasciitis, PMR or temporal arteritis, polymyositis or dermatomyositis, psoriatic arthritis, rheumatoid arthritis, spinal stenosis, tendonitis or bursitis, neuropathy or radiculopathy
Renal Disease: chronic kidney injury, acute kidney injury, end stage renal disease dialysis, glomerulonephritis, proteinuria nephrotic syndrome
Thromboembolic Disease:, thromboembolic disease, pulmonary embolism, deep venous thrombosis DVT, DVT prophylaxis

* 8. The patient had the following PROBLEMS (check ALL that apply):

* 9. What is one thing you LEARNED by seeing this patient?

* 10. What is one thing you NEED TO READ ABOUT after seeing this patient?