18 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= "Interval History:"]. 

Motor Milestones: 
[checklist value= "Walk without support|Tries to use utensils|Scribbles"][text]

Social/Language Milestone: 
[checklist value= "Follows one step directions|Helps dress themself|Points to something of interest|Says three or more words|Copies you doing chores"]

[textarea default= "Sleep"]
[textarea default= "Food"]

Child care:
[checkbox value= "Daycare|Home|Both daycare and home"]
Home: 
[textarea default= "Who lives at home: Siblings: Parents occupation:"]

Safety: 
[checklist value= "Cleaning supplies and medications stored in a safe place|Outlet  covers|Baby gates on stairs|Rear facing car seat if not at height/weight limit"][text]

Dental:
[checkbox value= "Scheduled dentist appointment|Looking to schedule|Brush teeth daily|Fluoride given today"]

[textarea default="Meds: Allergies: PMH: PSH: FH:"]
[comment memo="Parental Education: Reading to child daily and avoiding use of screens. Dentist?"]
[comment memo="4th    dose    DTaP/HepA"]



Patient is a Month Old that presents to clinic for a well child check.
Parental concerns:
.

Motor Milestones:


Social/Language Milestone:





Child care:

Home:


Safety:


Dental:



Parental Education: Reading to child daily and avoiding use of screens. Dentist?
4th dose DTaP/HepA



Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.43, 16 form elements, 26 boilerplate words, 3 text boxes, 5 text areas, 2 checkboxes, 3 check lists, 1 drop downs, 2 comments, 28 total clicks
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