SUMSearch: adult preventive care

Demographics:

Age:

Gender: Male Female

Ethnicity: Black Other

Habits:

Tobacco: Yes No

Past medical history:

Diabetes Type II: Yes No

Hypertension: Yes No

Coronary artery disease: Yes No

Other artery disease : Yes No
     (definition: aortic, peripheral, symptomatic carotid)

Chronic kidney disease: Yes No

Cirrhosis: Yes No

Family medical history:

Premature coronary artery disease: Yes No

Colorectal cancer: Yes No
     (definition: "First-degree relatives who developed colorectal cancer at a younger age, or with multiple affected first-degree relatives")

Examination (optional):

Height: (Inches Centimeters)

Weight: (Pounds Kilograms)

Blood pressure: /

Labs (optional for calculation of Framingham score, eGFR, etc):

Serum creatinine (needed for eGFR):

HDL:

Cholesterol Select type Total LDL

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