@if(request()->has('from_consultation_flow'))
General Health Information
This information will help your healthcare provider understand your health needs and provide appropriate care. Please be as detailed as possible.
Important: All fields in this form are required. If a question doesn't apply to you, please enter "N/A" or "Not applicable" rather than leaving it blank.
Your Health Profile
@if($hasMedicalConditions)
Medical Conditions Added
@else
+ Add Medical Condition
@endif
@if($hasMedicationOrders)
Medication Orders Added
@else
+ Request Medication
@endif
@php
$medicalConditions = Auth::user()->medicalConditions()->get();
@endphp
@if($medicalConditions && $medicalConditions->count() > 0)
Your Medical Conditions
Condition
Diagnosed
Type
Actions
@foreach($medicalConditions as $condition)
{{$condition->condition_id ? $condition->condition->name : $condition->condition_name }}
{{ $condition->formatDate('diagnosed_at') }}
@if($condition->is_chronic)
Chronic
@endif
@if($condition->had_condition_before)
Recurring
@endif
Edit
@endforeach
+ Add Another Medical Condition
@endif
@if($medicationOrders && $medicationOrders->count() > 0)
Your Medication Orders
Medication
Requested Dosage / Frequency
Quantity
Status
Actions
@foreach($medicationOrders as $order)
@foreach($order->items as $item)
@if($item->medication)
{{ $item->medication->name }}
@else
{{ $item->custom_medication_name }}
Custom medication
@endif
{{ $item->requested_dosage ?? 'Not specified' }}
{{ $item->requested_quantity ?? 'Not specified' }}
{{ ucfirst($item->status) }}
Edit
@endforeach
@endforeach
@endif
{{-- @if($hasMedicalConditions)
Medical Conditions
Please answer these questions about your medical conditions.
View or edit your conditions
@endif --}}
@php
$cardioVascular = collect([
'Cardiovascular', 'Heart Conditions', 'Blood Pressure', 'Anticoagulation', 'Cholesterol Management',
'Cardiovascular Drugs', 'Angiotensin-Converting Enzyme (ACE) Inhibitors', 'ACE Inhibitors',
'Angiotensin II Receptor Blockers (ARBs)', 'Beta Blockers', 'Calcium Channel Blockers',
'HMG-CoA Reductase Inhibitors (Statins)', 'Nitrates', 'Vasodilators',
'Direct Oral Anticoagulants', 'Loop Diuretics', 'Thiazide Diuretics',
'Potassium-Sparing Diuretics', 'ACE Inhibitor/Thiazide Diuretic Combinations',
'Alpha/Beta Blockers', 'Alpha-2 Adrenergic Agonists'
]);
$hasCardio = $categories->intersect($cardioVascular)->isNotEmpty();
@endphp
@if($hasCardio)
Cardiovascular Assessment
@endif
@php
$neurological = collect([
'Neurological', 'Seizures', 'RLS', 'Anticonvulsants',
'Centrally Acting Muscle Relaxants', 'Direct-Acting Skeletal Muscle Relaxants',
'Muscle Relaxants', 'Dopamine Agonists'
]);
$hasNeurological = $categories->intersect($neurological)->isNotEmpty();
@endphp
@if($hasNeurological)
@endif
@php
$gastrointestinal = collect([
'Gastrointestinal', 'Proton Pump Inhibitors', 'Prokinetic Agents',
'Guanylate Cyclase-C Agonists'
]);
$hasGI = $categories->intersect($gastrointestinal)->isNotEmpty();
@endphp
@if($hasGI)
Gastrointestinal Assessment
@endif
@php
$endocrine = collect([
'Endocrine/Hormonal', 'Antidiabetic Drugs', 'Biguanides',
'Thyroid Hormones', 'Estrogens', '5-Alpha Reductase Inhibitors',
'Antiandrogens'
]);
$hasEndocrine = $categories->intersect($endocrine)->isNotEmpty();
@endphp
@if($hasEndocrine)
@endif
@php
$pc = collect(['Preventive Care', 'Osteoporosis Prevention']);
$hasPreventiveCare = $categories->intersect($pc)->isNotEmpty();
@endphp
@if($hasPreventiveCare)
Preventive Care Assessment
@endif
@php
$infection = collect([
'Prophylaxis', 'Bacterial', 'Fungal', 'Viral', 'Antibiotics',
'Cephalosporin Antibiotics', 'Fluoroquinolone Antibiotics',
'Glycopeptide Antibiotics', 'Macrolide Antibiotics',
'Nitroimidazole Antibiotics', 'Oxazolidinone Antibiotics',
'Penicillin Antibiotics', 'Rifamycin Antibiotics',
'Sulfonamide Antibiotics', 'Tetracycline Antibiotics',
'Topical Antibiotics', 'Urinary Tract Antibiotics',
'Antifungals', 'Azole Antifungals', 'Antivirals',
'Antiviral Agents', 'Nucleoside Analogues',
'Nucleotide Reverse Transcriptase Inhibitors'
]);
$hasInfection = $categories->intersect($infection)->isNotEmpty();
@endphp
@if($hasInfection)
Infection Prevention Assessment
@endif
@php
$dermatological = collect([
'Skin/Dermatological', 'Dermatological Drugs', 'Retinoids',
'Corticosteroids'
]);
$hasDermatological = $categories->intersect($dermatological)->isNotEmpty();
@endphp
@if($hasDermatological)
Dermatological Assessment
@endif
@php
$immunology = collect([
'Immunology & Allergies', 'Antihistamines',
'Leukotriene Receptor Antagonists'
]);
$hasImmunology = $categories->intersect($immunology)->isNotEmpty();
@endphp
@if($hasImmunology)
@endif
@php
$mentalHealth = collect([
'Mental Health', 'Anxiety Disorders', 'Depression', 'Antidepressants',
'Selective Serotonin Reuptake Inhibitors (SSRIs)', 'Tetracyclic Antidepressants',
'Anxiolytics', 'Atypical Antipsychotics', 'Norepinephrine Reuptake Inhibitors'
]);
$hasMentalHealth = $categories->intersect($mentalHealth)->isNotEmpty();
@endphp
@if($hasMentalHealth)
@endif
@php
$pain = collect([
'Pain & Inflammation', 'Migraine', 'Musculoskeletal', 'Analgesics',
'Anti-Inflammatory Drugs', 'Barbiturate-Analgesic Combinations',
'Phosphodiesterase Type 5 Inhibitors'
]);
$hasPain = $categories->intersect($pain)->isNotEmpty();
@endphp
@if($hasPain)
@endif
@php
$respiratory = collect([
'Respiratory', 'Nasal Conditions', 'Adrenergic Agonists',
'Long-Acting Beta Agonists', 'Short-Acting Beta-2 Agonists',
'Long-Acting Beta Agonists/Corticosteroids', 'Anticholinergics'
]);
$hasRespiratory = $categories->intersect($respiratory)->isNotEmpty();
@endphp
@if($hasRespiratory)
@endif
@php
$prevention = collect([
'Surgical Prophylaxis', 'UTI Prevention', 'Stroke Prevention',
'Preventive Care', 'Osteoporosis Prevention', 'Bisphosphonates'
]);
$hasPrevention = $categories->intersect($prevention)->isNotEmpty();
@endphp
@if($hasPrevention)
@endif
@php
$weightManagement = collect(['Weight Management']);
$hasWeightManagement = $categories->intersect($weightManagement)->isNotEmpty();
@endphp
@if($hasWeightManagement)
Weight Management Assessment
@endif
@if($hasMedicationOrders)
Medication Information
Please answer these questions about your medications.
View your medication orders
Medication Effectiveness
Side Effects
Medication Management
@endif
Current Medications
Please list all medications you are currently taking, including prescription, over-the-counter, and supplements.
Select Type
Prescription
Over-the-Counter
Supplement/Vitamin
Herbal/Natural
Remove
Add Medication
Allergies and Sensitivities
Please list any allergies or sensitivities you have to medications, foods, or other substances.
Select Type
Medication
Food
Environmental
Other
Select Severity
Mild
Moderate
Severe
Life-threatening
Remove
Add Allergy
Treatment Goals and Preferences
Please share your treatment goals and preferences to help us provide personalized care.
Select Preference
Conservative (minimal intervention)
Balanced approach
Aggressive (maximum intervention)
Select Preference
Minimize medication use
Open to medication as needed
Prefer natural alternatives when possible
Additional Information
Submit Health Information