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Medic/Nurse/Scribe History – Soldier Acute/Followup Visits
Oct 15, 2019
•
Mark Morgan
categories:
Subjective/History
Vital signs:
*
HR
; SpO2
;
Temp
deg F;
BP
/
mmHg;
RR
breaths/min;
HT
in
cm
;
WT
lbs
kg
*
cc/reason for visit:
*
HPI:
yo
M
F
here for-
Template List
Symptoms
generic #1
-Symptoms:
.
-Symptoms started
hour(s)
day(s)
week(s)
month(s)
year(s)
ago.
-Patient reports these symptoms are located
.
-Patient reports these symptoms are
getting worse
getting better
the same
since onset.
-Rates it as
/10 in severity.
-Describes the character/quality as
sharp
dull
burning
tingling
N/A
.
Other comments on character/quality
-Above symptom(s)
do not travel/radiate
travel/radiate to
.
-Associated sx:
Denies any associated symptoms
.
-Related activities or events that occured at or right before symptoms started:
.
-Therapies attempted:
.
-Symptoms are improved with
.
-Symptoms are worsened by
.
-Patient
denies
admits to
history of similar symptoms previously.
-Additional comments-
none
speech input
Symptoms
generic #2
-Symptoms:
.
-Symptoms started
hour(s)
day(s)
week(s)
month(s)
year(s)
ago.
-Patient reports these symptoms are located
.
-Patient reports these symptoms are
getting worse
getting better
the same
since onset.
-Rates it as
/10 in severity.
-Describes the character/quality as
sharp
dull
burning
tingling
N/A
.
Other comments on character/quality
-Above symptom(s)
do not travel/radiate
travel/radiate to
.
-Associated sx:
Denies any associated symptoms
.
-Related activities or events that occured at or right before symptoms started:
.
-Therapies attempted:
.
-Symptoms are improved with
.
-Symptoms are worsened by
.
-Patient
denies
admits to
history of similar symptoms previously.
-Additional comments-
none
speech input
Upper Respiratory Sx
URI
-Symptoms:
runny nose
stuffy nose
itchy eyes
watery eyes
ear pain
sinus pain in cheeks and/or forehead
sore throat
pain with swallowing
difficulty swallowing
hoarseness
productive cough
dry cough
fever
chills
body aches
-Duration:
day(s)
week(s)
-Pain severity:
/10
-Is sore throat the main complaint without concurrent cold-like symptoms (nose/eyes/etc)?
no
YES
Choose 'yes' to bring up Centor Criteria
Modified Centor Score
No (0 points)
YES (1 point)
<-- History of fever or measured temperature > 100.4 degrees F
Cough is present (0 points)
COUGH IS ABSENT (1 point)
<-- Presence of coughing
No (0 points)
YES (1 point)
<-- Tender anterior cervical nodes
No (0 points)
YES (1 point)
<-- Tonsillar swelling or exudates
< 15 years (1 point)
15 to 45 years (0 points)
> 45 years (-1 point)
<-- Age
Score -->
score
score=(Q1Fever)+(Q2Cough)+(Q3Nodes)+(Q4Tonsil)+(Q5Age)
modifying factors
-Therapies tried that have improved symptoms:
-Therapies tried that have NOT improved symptoms:
-Additional comments-
none
speech input
-Review of Systems:
Fever
Chills
Body aches
Chest pain
Nausea
Vomiting
Diarrhea
Respiratory Sx
cough/chest symptoms
-Symptoms-
cough
mild chest pain
chest tightness
shortness of breath
other-
-Duration:
day(s)
hour(s)
week(s)
month(s)
-
Denies cough
Non-productive cough
Productive cough
- sputum color is
-Symptoms started when/while
inciting event
-Remedies/medicines attempted:
-Effect of attempted remedies/medicines:
-Since onset, sx have
gotten better
gotten worse
stayed about the same
-Patient describes severity is
minimal
moderate
severe
-Patient feels cough at nighttime
not significantly affecting sleep
preventing adequate sleep
-Patient reports
no known
known
sick contacts at home, school, or work.
-Additional comments-
none
speech input
-Hx of these conditions:
-
no
YES
<-recent cold
-
no
YES
<-allergic rhinitis
-
no
YES
<-non-allergic rhinitis
-
no
YES
<-frequent sinus infection
-
no
YES
<-asthma
-
no
YES
<-frequent pneumonia
-
no
YES
<-frequent bronchitis
-
no
YES
<-GERD
-
no
YES
<-head/neck/throat/thyroid/lung cancer
-
no
YES
<-tuberculosis or positive tuberculin skin test
-
no
YES
<-Diabetes Mellitus
-
no
YES
<-Previous use of tobacco products or vaping {textarea memo="if tobacco hx include heaviest daily/weekly use and #years" memo_size="small"]
-Review of systems:
-
no
YES
<-chest pain with coughing
-
no
YES
<-coughing up blood
-
no
YES
<-fever/chills
-
no
YES
<-body aches
-
no
YES
<-hoarseness
-
no
YES
<-sore throat
-
no
YES
<-runny/stuffy nose
-
no
YES
<-ear pain
-
no
YES
<-sinus pain
-
no
YES
<-itchy/watery eyes
-
no
YES
<-pain with swallowing
-
no
YES
<-feeling of lump in throat (globus sensation)
Travel: recent travel in past 6 months to foreign country and regular close contact with local people where tuberculosis is endemic-
no
YES
Immunization status:
vaccines UTD (incl pertussis/PCV if indicated)
PERTUSSIS VACCINATION STATUS UNKNOWN
UNVACCINATED TO PERTUSSIS
PNEUMOCOCCAL VACCINE INDICATED BY NOT RECEIVED
Gastrointestinal Sx
N/V/D/pain
-Symptoms-
decreased appetite
bloating sensation
pain with defecation
constipation
diarrhea
abdominal pain
nausea/vomiting
other-
-Sx started
day(s)
hour(s)
week(s)
month(s)
ago
-Sx started when/while
-Last BM was
day(s)
hour(s)
week(s)
ago and consistency was
soft
slightly firm
very hard
loose
like water
, and color was described as
.
-#BMs in past 24hrs:
-Last meal eaten was
hour(s)
day(s)
ago
-Therapies/medications attempted-
-Sx improved by
-Sx worsened by
-Since onset, sx have
gotten better
gotten worse
stayed about the same
-Pain Location:
-Pain Radiation:
-Pain Severity currently:
/10
-Pain Severity at worst:
/10
-Pain Timing:
constant
comes and goes
Duration of pain if episodic:
-Pain described as:
both sharp and dull
sharp/knifelike
dull/pressure
other-
N/V specific questions
-
no
YES
<-- nausea
-
no
YES
<-- vomiting
if yes, indicate color
Exposures
-
no
YES
<-- Recent intake of questionable/new food
-
no
YES
<-- Recent antibiotics
-
no
YES
<-- Recent travel
-Additional comments-
none
speech input
-Review of Systems:
-
no
YES
<-- Chest pain or chest/belly pain with breathing
-
no
YES
<-- Black or bloody stool
-
no
YES
<-- Fever
-
no
YES
<-- Dysuria
-
no
YES
<-- Urinary frequency
-
no
YES
<-- Urinary urgency
-
no
YES
<-- Hematuria
-Hx of these conditions:
-
no
YES
<-- Gall Bladder or liver disease
-
no
YES
<-- GERD
-
no
YES
<-- Peptic ulcer(s)
-
no
YES
<-- Pancreatitis
-
no
YES
<-- Kidney stones
-
no
YES
<-- Urinary tract infections
-
no
YES
<-- Diverticulitis
-
no
YES
<-- Inflammatory Bowel Disease
-
no
YES
<-- Pelvic Infection
-
no
YES
<-- Vascular disease
-Hx of these surgeries:
-
no
YES
<-- Appendectomy
-
no
YES
<-- Cholecystectomy
-Currently using:
pertinent meds/substances
-
no
YES
<-- Daily or near-daily use of NSAIDs
-
no
YES
<-- Daily or near-daily alcohol use
-
no
YES
<-- Daily or near-daily use of Opioids
-
no
YES
<-- aortic aneurysm history or risk (age over 60, tobacco history)
MSK Sx
#1
-Symptoms:
pain
popping
grinding
joint weakness
other-
-Onset:
days
weeks
months
years
-Location:
-Pain started while/after:
no specific inciting event
-Pain Radiation:
none
-Timing:
constant
comes and goes
-->
Portion(s) of day when it occurs mostly:
-Type/quality of pain:
sharp/knifelike
dull/pressure
both sharp and dull
-Action/activity that bothers most:
-Other aggravating actions/activities:
-Progression of pain:
getting better
getting worse
staying the same
-Severity of pain:
/10
-Previously seen for this:
no
YES
-Number of visits:
.
-Specialties seen:
primary care
physical therapy
orthopedist
chiropractor
acupuncturist
pain management specialist
-Modalities attempted:
none
home remedies
stretches
rest
ice
heat
elevation
medications
physical therapy
injections
surgery
other-
-Effect of these modalities:
helped pain
worsened pain
made no difference
mixed -see additional comments
-Other associated symptoms:
-
n/a
no
YES
<-if knee involved, any locking up of joint when attempting movement
-
n/a
no
YES
<-if knee involved, any buckling or giving-out of joint with use
-
n/a
no
YES
<-if joint involved, any swelling
-
n/a
no
YES
<-if joint involved, any stiffness
-
no
YES
<-any fevers or chills
-
no
YES
<-any recent tick exposure within the past year
-Additional comments-
none
speech input
MSK Sx
#2
-Symptoms:
pain
popping
grinding
joint weakness
other-
-Onset:
days
weeks
months
years
-Location:
-Pain started while/after:
no specific inciting event
-Pain Radiation:
none
constant
comes and goes
-->
Portion(s) of day when it occurs mostly:
-Type/quality of pain:
sharp/knifelike
dull/pressure
both sharp and dull
-Action/activity that bothers most:
-Other aggravating actions/activities:
-Progression of pain:
getting better
getting worse
staying the same
-Severity of pain:
/10
-Previously seen for this:
no
YES
-Number of visits:
.
-Specialties seen:
primary care
physical therapy
orthopedist
chiropractor
acupuncturist
pain management specialist
-Modalities attempted:
none
home remedies
stretches
rest
ice
heat
elevation
medications
physical therapy
injections
surgery
other-
-Effect of these modalities:
helped pain
worsened pain
made no difference
mixed -see additional comments
-Other associated symptoms:
-
n/a
no
YES
<-if knee involved, any locking up of joint when attempting movement
-
n/a
no
YES
<-if knee involved, any buckling or giving-out of joint with use
-
n/a
no
YES
<-if joint involved, any swelling
-
n/a
no
YES
<-if joint involved, any stiffness
-
no
YES
<-any fevers or chills
-
no
YES
<-any recent tick exposure within the past year
-Additional comments-
none
speech input
Male GU Sx
urinary/penile/STD concerns
-Symptoms:
other/not listed
penile discharge
(color/consistency -
),
penis tenderness
scrotal pain
penis rash/lesion
pain with urinating
urinary frequency
urinary urgency
blood in urine
blood in semen
difficulty urinating
(last urinated
minute(s)
hour(s)
day(s)
ago, amount was
a drop
scant/small
average amt
large amt
)
-Onset-
hour(s)
day(s)
week(s)
month(s)
year(s)
ago.
-Symptoms first noticed during/after-
no reported inciting event
-Symptoms are located-
n/a
-Symptoms character/quality:
N/A
both sharp and dull
sharp/knifelike
dull/pressure
burning
tingling
other-
-Symptom radiation-
none
travel/radiate to
-Symptom timing-
constant
intermittent/comes and goes
-Sx episodes last
second(s)
minute(s)
hour(s)
day(s)
week(s)
month(s)
-Sx progression:
the same
getting worse
getting better
since onset
pain scale if applicable
-Pain rated as
/10 in severity currently, at its worst
/10
-Symptoms are worsened by-
nothing
-Therapies attempted-
none
-Effect of these therapies:
helped
worsened
made no difference
mixed -see additional comments
-Patient
denies
admits to
history of similar symptoms previously
-Sexually active?
no
Yes
-Number of sexual partners in past year *
*
-Additional comments-
none
speech input
Associated Sx/Review of Systems:
fever/chills
decreased appetite
nausea
vomiting
diarrhea
constipation
black or bloody stool
Pertinent History
STD
-
include which type, how long ago, and how many prior episodes
speech input
Epididymitis
Prostatitis
BPH
Prostate Cancer
Kidney stones
Urinary tract infections
Diverticulitis
Pertinent Past Surgeries:
Appendectomy
Prostatectomy
Female GU Sx
itching/pain/discharge/STD concerns
-G
#pregnancies
P
#deliveries
-Symptoms:
other/not listed
unusual vaginal bleeding
unusual vaginal discharge
vaginal itching/irritation
vaginal pain
-Onset-
hour(s)
day(s)
week(s)
month(s)
year(s)
ago.
-Symptoms first noticed during/after:
no reported inciting event
-Symptoms are located:
n/a
-Symptom progression:
gotten better
gotten worse
stayed about the same
-Bowel movements/stools consistency usually
soft
slightly firm
very hard
loose
like water
, and frequency is
stool(s) every
days.
-Therapies attempted:
none
-Effect of these therapies:
helped
worsened
made no difference
mixed -see explanation
-Color/consistency of vaginal discharge (if present):
n/a
white
cottage cheese like
yellow/green vaginal discharge
frothy
malodorous
bloody
-Uses cleansing products inside the vagina (other than water)-
no
YES
-Symptom radiation-
none
travel/radiate to
-Severity currently:
/10
-Severity at worst:
/10
-Timing:
constant
comes and goes
-Duration of pain if episodic:
-Described as:
both sharp and dull
sharp/knifelike
dull/pressure
burning
other-
-Worse with intercourse:
no
YES
-Sexually active:
Yes
no
-Additional comments-
none
speech input
-Review of Systems:
dysuria
urinary frequency
hematuria
decreased appetite
nausea
vomiting
back/flank pain
pelvic pain
black or bloody stool
fever
-Hx of these conditions:
STD/STI
Ectopic Pregnancy
Endometriosis
Ovarian Cyst
Kidney Stones
Urinary Tract Infections
Diverticulitis
Diabetes Mellitus
Candida Vaginitis recent/recurrent
Bacterial Vaginosis recent/recurrent
Trichomonas vaginitis
Atrophic Vaginitis
PID
recent new sexual partner
multiple sexual partners in the past year
-Past Surgeries:
Appendectomy
Ceserean Section
Hysterectomy
Tubal ligation
Other abdominal/pelvic surgeries
speech input
explanation of other abd/pelv surgeries
Urinary Sx
UTI sx
-Symptoms:
other/not listed
dysuria
frequency
urgency
incontinence
hematuria
cloudy urine
fever
chills
vaginal discharge
flank pain
-Onset-
hour(s)
day(s)
week(s)
month(s)
year(s)
ago.
-Symptoms first noticed during/after-
no reported inciting event
-Symptoms are worsened by-
nothing
-Therapies attempted:
none
-Effect of these therapies:
helped
worsened
made no difference
mixed- see comments
-Symptom progression:
gotten better
gotten worse
stayed about the same
-Previous episodes:
denies
admits
to a UTI in the past.
-Additional comments-
none
speech input
Review of systems:
symptoms >7 days duration
shaking chills
flank pain
temp >101F
nausea
vomiting
abdominal pain
change in vaginal/penile discharge or odor
painful with intercourse
Pertinent medical history:
Headache Sx
headaches/migraines
-Symptoms:
other/not listed
headache
-Onset-
hour(s)
day(s)
week(s)
month(s)
year(s)
ago.
-Symptoms first noticed during/after:
no reported inciting event
-Symptom location-
-Symptom radiation-
none
-Pain severity- currently
/10; at worst
/10
-Characterized as-
sharp
dull
throbbing
pounding
-Symptom progression:
getting better
GETTING WORSE
the same
-Therapies/medications tried-
none
-Pain improved with
nothing
.
-Pain worsened by
nothing
.
-#Episodes per
month
week
-
n/a
-Additional comments-
none
speech input
Review of Symptoms:
worse with bright lights
worse with loud noises
nausea/vomiting
preceding aura before the headache (e.g. vision change, smell, other symptom prodrome)
blurred vision
fever
sinus pressure or nasal drainage
arm/leg weakness
speech input
explanation of positives
Pertinent PMH:
Migraine Headache
Frequent Sinusitis
Glaucoma
Head Trauma
Serious CNS risks (e.g. active cancer, immunosuppression, HIV)
Exposures (e.g. Tick bites, carbon monoxide)
Family history of cerebral aneurysm or stroke
Sleep Concerns
insomnias/parasomnias
-Symptoms:
other/not listed
difficulty getting to sleep
difficulty staying asleep
legs/arms restless feeling
not feeling rested when waking up for the day
excessive sleepiness during the day
-Duration:
day(s)
week(s)
month(s)
year(s)
-Specific life event that during/afterwards the symptoms started:
none/denies
speech input
-Symptom progression:
gotten better
gotten worse
no change
-Therapies attempted:
speech input
other/not listed
Sleep hygiene, stimulus and temporal control
Lie down to sleep only when feeling sleepy
Avoid wakeful activities at bedtime (watching television, talking on the phone, eating)
Leave the bed if unable to fall asleep within 20 minutes and return when sleepy
Maintaining consistent bed/wake times (including weekends/days-off)
Avoiding daytime naps
Exercise regularly (not within 4 hours of bedtime, outside of unit PT)
Avoiding large meals and limit fluid intake in the evenings
Limiting caffeine, tobacco, and alcohol use
Using the bedroom for only sleep/sex
Avoiding distracting stimuli at bedtime like loud noises, bright lights when not being used therapeutically, and extreme temperature variations
Ear-plugs used to limit noise
Sleep restriction
Limiting time in bed to the number of hours actually spent sleeping (not less than 5 hours, sleep time gradually increases as sleep efficiency improves)
Paradoxical intention
Focuses on remaining awake in calm environment to address the anxiety a/w the pressure to fall asleep
Relaxation training
Autogenic training (imagining a calm environment with comforting body perceptions such as warmth and heaviness of the limbs)
Imagery training (focus on pleasant images)
Repetitive focus (focus on a word, sound, prayer, phrase, or muscle activity)
Hypnosis
Meditation
Yoga
Abdominal breathing
Progressive muscle relaxation (from the feet up to the facial muscles)
Paced respirations (Take a deep breath and hold for five seconds, repeat several times; focus on the sound of the breath)
-Effect of attempted therapies:
helped
worsened
no difference
mixed- see comments
-Additional comments-
none
speech input
-Pertinent PMHx review:
Generalized Anxiety D/O
Major Depressive D/O
Adjustment D/O
Bipolar D/O
PTSD
TBI
ADHD
Sleep paralysis
Restless Legs Syndrome
Sleep Apnea
GERD
Asthma/COPD/CHF
MSK chronic issues that cause pain at night
-Review of systems/behaviors/environment:
choking/gasping in sleep
loud snoring
sleep walking
injured self/others when asleep
frequent disturbing nightmares
frequent changes in timing of work shifts
difficulty 'shutting down' mind when it is time for sleep
regularly watch TV/movies and/or play video games less than 1 hr before bedtime
last meal less than 2 hr before bedtime
presence of roommate
presence of bedmate
Contraception Questions/Concerns
birth control questions/renewal/management visits
G
#pregnancies
P
#deliveries
with LMP of
DD MMM
here to discuss contraception.
-For contraception, currently using:
none
Condoms
Withdrawal method
Calendar method (timing intercourse around ovulation)
Birth control pills
Birth control patch (OrthoEvra)
Vaginal ring (NuvaRing)
Injection (DepoProvera)
Diaphragm
Nexplanon
Mirena IUD
Copper IUD
Other-
-She is currently interested in:
Birth control pills
Birth control patch (OrthoEvra)
Vaginal ring (NuvaRing)
Injection (DepoProvera)
Diaphragm
Nexplanon
Mirena IUD
Copper IUD
Other-
-She has previously used:
Condoms
Withdrawal method
Calendar method (timing intercourse around ovulation)
Birth control pills
Birth control patch (OrthoEvra)
Vaginal ring (NuvaRing)
Injection (DepoProvera)
Diaphragm
Nexplanon
Mirena IUD
Copper IUD
Other-
-Problems with prior contraception methods?
No problems
The following problems-
-Patient identified reasons for seeking/using contraception:
prevent pregnancy
irregular menses
acne
severe menstrual pain
heavy menstrual bleeding
other-
-How soon patient desires to attempt to conceive:
never
year(s)
month(s)
-Age of menarche
age first started menstruating
?
N/A
-Sexually active?
no
Yes
-Number of sexual partners in past year *
*
-Age of first intercourse?
N/A
-Pertinent PMHx:
relative contraindications for contraception
Heart disease
Blood clots
High blood pressure
gallbladder problems
Diabetes
Chest pain
Liver problems
Close relative with blood clots in legs/lungs
hx of breast cancer
hx of severe HAs/migraines
smokes/chews/vapes
explanation of positives
-Recent pregnancy in the past month?
No
Yes
-Unprotected sex (without a condom or other birth control) since last period?
No
YES
-Approximate date of unprotected sex -
-Prior Pap?
No
Yes
- Month/year-
; Results-
-Additional comments-
none
speech input
Well Woman Visit
G
#pregnancies
P
#deliveries
with LMP of
DD MMM
.
-Last Pap-
n/a
years ago.
-Results of last Pap:
normal
n/a
other-
-Hx of abnormal Pap test:
no
YES
-Menarche at age
-Age of menopause:
not yet reached
started withing past 1/2yrs
-Frequency of menstrual cycles- every
days?
-Menstrual cycle regularity-
regular
irregular
-Duration of menses-
days
-Amount of bleeding on heaviest days-
pads/tampons per day
-Between cycle bleeding-
no
YES
-Unusual vaginal discharge-
no
YES
-Sexually active-
no
Yes
-Number of sexual partners in past year *
*
-Current method(s) of birth control?
None
Condoms
Withdrawal method
Calendar method (timing intercourse around ovulation)
Birth control pills
Birth control patch (OrthoEvra)
Vaginal ring (NuvaRing)
Injection (DepoProvera)
Diaphragm
Nexplanon
Mirena IUD
Copper IUD
Tubal Ligation
Hysterectomy
Post-menopausal
Other-
-History of STD?-
no
YES
-Problematic hot flashes-
no
YES
-Currently on hormone replacement-
no
YES
-Smoking-
no
YES
-Hx of breast problems-
no
YES
-Last mammogram-
n/a
date-
-Reports being abused-
no
YES
-Feels safe at home?
yes
NO
-Additional comments-
none
speech input
-Family history:
Breast cancer
Ovarian cancer
Heart disease
Osteoporosis
Diabetes
Other cancers
Colon cancer
Uterine cancer
-Pain during your usual period:
/10
-Pain during sex:
/10
-PMS (premenstrual tension syndrome):
/10
Additional Questions for Female Soldiers/Patients (don't use with WWE or contraception templates)
Additional female-specific questions
-Currently pregnant-
no
unsure
YES
-Current contraception method:
Condoms
Withdrawal method
Calendar method (timing intercourse around ovulation)
Birth control pills
Birth control patch (OrthoEvra)
Vaginal ring (NuvaRing)
Injection (DepoProvera)
Diaphragm
Nexplanon
Mirena
Other-
-LMP:
stop here if below items documented/updated elsewhere
Social Hx:
*
-EtOH -
none/denies any
drinks/week
-
Tobacco
Vape
Chew
-
none/denies any
pack(s)/day
can(s)/wk
recharge(s)/pod(s)/wk
speech input
freetext
Medication Allergies:
*
NKDA
Medications:
*
none
including prescription, OTC, herbals, etc
speech input
PMHx:
*
none
all current conditions that affect soldier's physical and mental health
speech input
PSHx:
*
none
list all previous surgeries including year of surgery
speech input
Military Unit:
1-12 Cav
2-7 Cav
215th BSB
6-9 Cav
3-8 Cav
2-82 FA
3 BEB
.
HHC
A Co
B Co
C Co
G FSC
Contact Info
*
-Phone/voice:
cell
WhatsApp
-
-Email:
none given
use only if documenting exam done/confirmed by provider
PHYSICAL EXAM
*
-HEENT -
-Neck -
-Abd -
-Ext -
-Neuro -
-Psych -
-MSK -
Immunizations/IV/IM/PO meds/respiratory therapy/IV hydration
PWF1 - questionnaires
PWF2a - non-MSK PE
PWF2b - MSK PE
PWF3a - Acute/MSK A/P
Links to Procedure Templates
I&D & Laceration Repair
Toenail Removal
Minor Skin Procedures
Female Procedures
OMT/Auricular Acupuncture
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