{% for currentItem in QuestionnaireResponse.item.where((linkId = 'questionnaire')) %}{% if currentItem.linkId = 'questionnaire' %}{% for currentItem in currentItem.item.where((linkId = 'section47163071') or (linkId = 'section2763158') or (linkId = 'section4572141') or (linkId = 'i_nmedications_n') or (linkId = 'allergies') or (linkId = 'i_npast_medical_histo') or (linkId = 'section68506771') or (linkId = 'i_nsocial_history_n')) %}{% if currentItem.linkId = 'section47163071' %}Patient Information
{% for currentItem in currentItem.item.where((linkId = 'item29578021' and answer.exists()) or (linkId = 'item67890802' and answer.exists())) %}{% if currentItem.linkId = 'item29578021' %}{% if currentItem.answer.exists() %}Height (cm): {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item67890802' %}{% if currentItem.answer.exists() %}Weight (kg): {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}
{% endif %}{% if currentItem.linkId = 'section2763158' %}Referral Information
{% for currentItem in currentItem.item.where((linkId = 'item48807357' and answer.exists()) or (linkId = 'section42000384') or (linkId = 'section41623208') or (linkId = 'section87236956')) %}{% if currentItem.linkId = 'item48807357' %}{% if currentItem.answer.exists() %}Reason for Referral: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section42000384' %}Pregnancy History
{% for currentItem in currentItem.item.where((linkId = 'item67762889' and answer.exists()) or (linkId = 'item91252875' and answer.exists()) or (linkId = 'item47328769' and answer.exists()) or (linkId = 'item36834119' and answer.exists()) or (linkId = 'item29828101' and answer.exists())) %}{% if currentItem.linkId = 'item67762889' %}{% if currentItem.answer.exists() %}Total number of pregnancies: {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item91252875' %}{% if currentItem.answer.exists() %}Number of vaginal deliveries: {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item47328769' %}{% if currentItem.answer.exists() %}Number of C-sections: {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item36834119' %}{% if currentItem.answer.exists() %}Number of miscarriages/pregnancy losses/ectopic pregnancies: {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item29828101' %}{% if currentItem.answer.exists() %}Number of abortions/pregnancy terminations: {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section41623208' %}Menstrual History
{% for currentItem in currentItem.item.where((linkId = 'item68062550' and answer.exists()) or (linkId = 'item35661442' and answer.exists()) or (linkId = 'item34464904' and answer.exists()) or (linkId = 'item12983596' and answer.exists()) or (linkId = 'item93188178' and answer.exists()) or (linkId = 'item9542494' and answer.exists())) %}{% if currentItem.linkId = 'item68062550' %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{{ answer.value.ofType(date) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item35661442' %}{% if currentItem.answer.exists() %}Number of days between periods: {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item34464904' %}{% if currentItem.answer.exists() %}Number of days period lasts: {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item12983596' %}{% if currentItem.answer.exists() %}Are patient's periods painful: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item93188178' %}{% if currentItem.answer.exists() %}Are patient's periods heavy: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item9542494' %}{% if currentItem.answer.exists() %}Number of pads/tampons used on the heaviest day of period: {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section87236956' %}Gynecologic History
{% for currentItem in currentItem.item.where((linkId = 'section90671878') or (linkId = 'item127317' and answer.exists()) or (linkId = 'item54300787' and answer.exists()) or (linkId = 'item96682694' and answer.exists()) or (linkId = 'item86913170' and answer.exists())) %}{% if currentItem.linkId = 'section90671878' %}{% for currentItem in currentItem.item.where((linkId = 'item27527635' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section95740632')) %}{% if currentItem.linkId = 'item27527635' %}None{% endif %}{% if currentItem.linkId = 'section95740632' %}{% for currentItem in currentItem.item.where((linkId = 'item97846576' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item76524094' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item62031353' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item78555427' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item86136829' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item50977523' and answer.exists())) %}{% if currentItem.linkId = 'item97846576' %}Abnormal pap tests{% endif %}{% if currentItem.linkId = 'item76524094' %}Fibroids{% endif %}{% if currentItem.linkId = 'item62031353' %}Endometriosis{% endif %}{% if currentItem.linkId = 'item78555427' %}Ovarian cysts{% endif %}{% if currentItem.linkId = 'item86136829' %}Sexually transmitted infection(s){% endif %}{% if currentItem.linkId = 'item50977523' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{% if answer.value.code = 'Gonorrhea' %}Gonorrhea{% endif %}{% if answer.value.code = 'Chlamydia' %}Chlamydia{% endif %}{% if answer.value.code = 'Herpes' %}Herpes{% endif %}{% if answer.value.code = 'Genital warts' %}Genital warts{% endif %}{% if answer.value.code = 'Syphilis' %}Syphilis{% endif %}{% if answer.value.code = 'Other' %}Other{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endcapture %}{{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item127317' %}{% if currentItem.answer.exists() %}Date of last pap test: {% for answer in currentItem.answer %}{{ answer.value.ofType(date) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item54300787' %}{% if currentItem.answer.exists() %}Patient is sexually active: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item96682694' %}{% if currentItem.answer.exists() %}With: {% for answer in currentItem.answer %}{% if answer.value.code = 'Men' %}Men{% endif %}{% if answer.value.code = 'Women' %}Women{% endif %}{% if answer.value.code = 'Both' %}Both{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item86913170' %}{% if currentItem.answer.exists() %}Form of birth control used: {% for answer in currentItem.answer %}{% if answer.value.code = 'Birth Control pill / patch / ring' %}Birth Control pill / patch / ring{% endif %}{% if answer.value.code = 'Condoms' %}Condoms{% endif %}{% if answer.value.code = 'IUD (hormone)' %}IUD (hormone){% endif %}{% if answer.value.code = 'IUD (copper)' %}IUD (copper){% endif %}{% if answer.value.code = 'Pull-out/withdrawal' %}Pull-out/withdrawal{% endif %}{% if answer.value.code = 'Calendar / Natural Family Planning' %}Calendar / Natural Family Planning{% endif %}{% if answer.value.code = 'Partner had vasectomy' %}Partner had vasectomy{% endif %}{% if answer.value.code = 'Permanent tubal sugery' %}Permanent tubal sugery{% endif %}{% if answer.value.code = 'Subdermal implant' %}Subdermal implant{% endif %}{% if answer.value.code = 'None' %}None{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}
{% endif %}{% if currentItem.linkId = 'section4572141' %}Medical History
{% for currentItem in currentItem.item.where((linkId = 'prob' and answer.exists()) or (linkId = 'section61677093')) %}{% if currentItem.linkId = 'prob' %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section61677093' %}{% for currentItem in currentItem.item.where((linkId = 'item16667176' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item18948376' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item35434575' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item69273958' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item47066864' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item75358255' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item41631847' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item18292760' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item66877002' and answer.exists()) or (linkId = 'item77134898' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item880791' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item72238932' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item37884318' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item41904126' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item51470870' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item78475900' and answer.exists())) %}{% if currentItem.linkId = 'item16667176' %}High blood pressure{% endif %}{% if currentItem.linkId = 'item18948376' %}Diabetes{% endif %}{% if currentItem.linkId = 'item35434575' %}Blood clots in lungs/legs{% endif %}{% if currentItem.linkId = 'item69273958' %}Migraine headaches{% endif %}{% if currentItem.linkId = 'item47066864' %}Liver disease/hepatitis{% endif %}{% if currentItem.linkId = 'item75358255' %}Osteoporosis{% endif %}{% if currentItem.linkId = 'item41631847' %}Infertility{% endif %}{% if currentItem.linkId = 'item18292760' %}Cancer{% endif %}{% if currentItem.linkId = 'item66877002' %}{% if currentItem.answer.exists() %}Type(s): {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item77134898' %}Thyroid problems{% endif %}{% if currentItem.linkId = 'item880791' %}Asthma{% endif %}{% if currentItem.linkId = 'item72238932' %}Anxiety/ Depression{% endif %}{% if currentItem.linkId = 'item37884318' %}Incontinence (urine/stool){% endif %}{% if currentItem.linkId = 'item41904126' %}Constipation{% endif %}{% if currentItem.linkId = 'item51470870' %}Frequent bladder infections{% endif %}{% if currentItem.linkId = 'item78475900' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Other: {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'i_nmedications_n' %}Medications
{% for currentItem in currentItem.item.where((linkId = 'rx' and answer.exists())) %}{% if currentItem.linkId = 'rx' %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'allergies' %}Allergies
{% for currentItem in currentItem.item.where((linkId = 'allg' and answer.exists())) %}{% if currentItem.linkId = 'allg' %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'i_npast_medical_histo' %}Past Medical History
{% for currentItem in currentItem.item.where((linkId = 'pmhx' and answer.exists())) %}{% if currentItem.linkId = 'pmhx' %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section68506771' %}Family History
{% for currentItem in currentItem.item.where((linkId = 'fhx' and answer.exists()) or (linkId = 'section48519309')) %}{% if currentItem.linkId = 'fhx' %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section48519309' %}{% for currentItem in currentItem.item.where((linkId = 'item65894204' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item82516489' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item30885585' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item4088333' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item37784990' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item53504294' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item4801402' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item75842905' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item29254997' and answer.exists())) %}{% if currentItem.linkId = 'item65894204' %}High blood pressure{% endif %}{% if currentItem.linkId = 'item82516489' %}Heart Disease/Stroke{% endif %}{% if currentItem.linkId = 'item30885585' %}Diabetes{% endif %}{% if currentItem.linkId = 'item4088333' %}Bad reaction to anesthetic{% endif %}{% if currentItem.linkId = 'item37784990' %}Breast Cancer{% endif %}{% if currentItem.linkId = 'item53504294' %}Uterine Cancer{% endif %}{% if currentItem.linkId = 'item4801402' %}Ovarian Cancer{% endif %}{% if currentItem.linkId = 'item75842905' %}Colon/Bowel Cancer{% endif %}{% if currentItem.linkId = 'item29254997' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Other Cancer(s): {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'i_nsocial_history_n' %}Social History
{% for currentItem in currentItem.item.where((linkId = 'soc' and answer.exists()) or (linkId = 'section64573544')) %}{% if currentItem.linkId = 'soc' %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section64573544' %}{% for currentItem in currentItem.item.where((linkId = 'item57834583' and answer.exists()) or (linkId = 'item10529961' and answer.exists()) or (linkId = 'item44127211' and answer.exists()) or (linkId = 'item41506070' and answer.exists()) or (linkId = 'item151992' and answer.exists()) or (linkId = 'item94627251' and answer.exists()) or (linkId = 'item93764222' and answer.exists()) or (linkId = 'item74607677' and answer.exists()) or (linkId = 'item33664919' and answer.exists()) or (linkId = 'item45718527' and answer.exists())) %}{% if currentItem.linkId = 'item57834583' %}{% if currentItem.answer.exists() %}Smoker: {% for answer in currentItem.answer %}{% if answer.value.code = 'No' %}No{% endif %}{% if answer.value.code = 'Yes' %}Yes{% endif %}{% if answer.value.code = 'Ex-Smoker' %}Ex-Smoker{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item10529961' %}{% if currentItem.answer.exists() %}Number of years: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item44127211' %}{% if currentItem.answer.exists() %}Number of cigarettes per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item41506070' %}{% if currentItem.answer.exists() %}Quit date: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item151992' %}{% if currentItem.answer.exists() %}Consumes alcohol: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item94627251' %}{% if currentItem.answer.exists() %}Number of drinks per week on average: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item93764222' %}{% if currentItem.answer.exists() %}Uses recreational and/or street drugs: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item74607677' %}{% if currentItem.answer.exists() %}Specify: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item33664919' %}{% if currentItem.answer.exists() %}Consumes caffeine: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item45718527' %}{% if currentItem.answer.exists() %}Number of cups of coffee/tea/cola per day: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}