Date		Note	{$ped_assessment.assessment_note}

---

Complain & Present History
Cyanotic	choose {foreach $allCyanotic as $data} {$data.name} {/foreach} Delete	Chest infection	choose {foreach $allChestInfection as $data} {$data.name} {/foreach} Delete
Exercise tolerance	choose {foreach $allExerciseTolerance as $data} {$data.name} {/foreach} Delete	Chest pain	choose {foreach $allChestPain as $data} {$data.name} {/foreach} Delete
Palpitations	choose {foreach $allPalpitations as $data} {$data.name} {/foreach} Delete	Hospitalization	choose {foreach $allHospitalization as $data} {$data.name} {/foreach} Delete
Edema	choose {foreach $allEdema as $data} {$data.name} {/foreach} Delete	Others	choose {foreach $allPedCompOthers as $data} {$data.name} {/foreach} Delete

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Pregnancy History and Prenatal Testing

Genetic syndromes
Maternal illness
Family history	Congenital cardiac diseases sudden death
Others

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Past History

Medical
Surgical
Co-morbidities
Allergies	choose {foreach $allAllergies as $data} {$data.name} {/foreach} Add Delete
Previous investigations

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General Examination

General condition		Mental status
Built		Decubitus
Facies		Complexion
Pulsation		Lymph nodes
Upper limb		Lower limb
ECG		CXR

Cardiac Auscultation:S1		S2		Murmurs
Chest Auscultation

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Cardiac Examination
Chest Examination
ECG		CXR

---

{assign var=itr value=1} {foreach $allMedData as $data } {capture assign=itr}{$itr+1}{/capture} {/foreach}

Drug	Dosage frequency	Route	Duration	Delete
Choose Drug {foreach $drugs as $drug} {$drug['drugname']} {/foreach} Choose Drug	choose dose {foreach $allDrugDoses as $dos} {$dos['drugdos']} {/foreach} choose dose

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Provisional Diagnosis
Plan

---

{assign var=itr value=1} {foreach $allCarePlanData as $data } {capture assign=itr}{$itr+1}{/capture} {/foreach}

Date	Needs	Intervention	Outcome	Timeframe	Delete