1 Month WCC

Patient is a [text] Month Old [select value= "Select|M|F"] that presents to clinic for a well child check. 
Parental concerns: [textarea default= "
post Partum Depression"]. 
Motor Milestones: [checklist value= "head flops back|hands in fists moving in front of mouth/face|Tummy time"][text]
Social/Language Milestone: [checklist value= "eyes wander|turns to sounds"]
Sleep/Naps: sleeps [text] hours at night and naps [text]. Patient sleeps [textarea default= "location"]
Food: 
[textarea default= "frequency of feeds, how much if bottle fed, time spent eating, Vitamin D drops for breast fed infants, 400 IUs daily, Iron supplement for pre-me 1mg/kg"]
Child care:
[textarea default= "When are you going back to work, child care?"]
Home: 
[textarea default= "Who lives at home: Siblings: Parents occupation:"]
Safety: [checklist value= "Put to sleep on back|No blankets, pillows or toys in crib|Firm mattress|Rear facing car seat|Never left unattended on raised surfaces"]
[textarea default="Meds: Allergies: PMH: PSH: FH:"]
[comment memo="PE: **Red reflex"]

Patient is a Month Old that presents to clinic for a well child check.
Parental concerns:
.
Motor Milestones:
Social/Language Milestone:
Sleep/Naps: sleeps hours at night and naps . Patient sleeps

Food:

Child care:

Home:

Safety:

PE: **Red reflex

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.29, 15 form elements, 36 boilerplate words, 4 text boxes, 6 text areas, 3 check lists, 1 drop downs, 1 comments, 21 total clicks
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