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"]
Sleep/Naps: sleeps [text] hours at night and naps [text]. Patient sleeps [textarea default= "location, put to sleep with bottle?Pacifier?"]
Food: 
[textarea default= "Frequency of meals, Picky Eater"]
Dental:
[checkbox value= "Scheduled dentist appointment|Looking to schedule|Brush teeth daily|Fluoride given today"]
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]
[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:
Sleep/Naps: sleeps hours at night and naps . Patient sleeps

Food:

Dental:

Child care:

Home:

Safety:

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 0.38, 18 form elements, 37 boilerplate words, 5 text boxes, 5 text areas, 2 checkboxes, 3 check lists, 1 drop downs, 2 comments, 30 total clicks
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