How to Use This Template
- Select the patient's gender first — this unlocks gender-specific symptom and examination sections.
- Complete history, sexual history, examination, and plan fields.
- Tick applicable options — additional questions appear where further detail is needed.
- Use Generate to create the clerking note, then copy when ready.
- Complete referral details and generate an AI referral letter when referral is needed.
1. Patient Details
♀ Female — Gynaecological History
2. Presenting Complaint
♂ Male — Specific Symptoms
Urethral Discharge
Other Male Symptoms
♀ Female — Specific Symptoms
Vaginal Discharge
Other Female Symptoms
General / Systemic Symptoms
3. Sexual History
This information is confidential and used solely for clinical assessment and partner notification.
Type of Sexual Contact
Additional Sexual History
4. STI History & Vaccination
Previous STIs
5. Red Flags
Red flag selected. Assess urgency — consider immediate management, urgent referral, or safeguarding action based on clinical condition and local protocol.
6. Examination
General Appearance
Inguinal Lymph Nodes
⚠ Abnormal findings
Perianal / Rectal
⚠ Abnormal findings
Abdominal Exam
⚠ Abnormal findings
♂ Male — Genital Examination
Penile Examination
⚠ Abnormal findings
Scrotal / Testicular Exam
⚠ Abnormal findings
♀ Female — Genital Examination
Vulval / External Exam
⚠ Abnormal findings
Speculum Examination
⚠ Abnormal findings
Bimanual Examination
⚠ Abnormal findings
7. Impression & Plan
Clinical Pattern Suggestions
Suggestions are based on selected history and examination findings and do not replace clinical assessment or investigation results.
Select relevant findings above to view possible clinical patterns.
Impression
Investigations Plan
Tick "Plan investigations" to expand all investigation options, then select those required.
Microbiology
Blood Tests
Plan Checklist
Generate Referral Letter with AI
Generates a referral letter via the server-side AI endpoint (
generate_letter.php), using the clerking summary above. Requires this page to be hosted on the same server as that endpoint.AI usage today: 0 / 500
Click "Generate Referral Letter with AI" to auto-fill this section.