4 Year WCC

Patient is a [text] YO [select value= "Select|M|F"] that presents to clinic for annual well child check. 
Parental concerns: [textarea default= "recent illness, behavior problems, development"]. 
Motor Milestones:
[checklist value="Catch a ball|serve themself food|Holds pencil between finger and thumb|Unbutton some buttons"]
Social/Language Milestone:
[checklist value="Notices other kids and wants to play|Comforts others|Imaginative play|Uses sentences with 4 or more words|Can talk about something they did today|Knows 2+ colors"]
Sleep/Naps: sleeps [text] hours at night and naps [text]
Potty Training readiness:
[checklist value="showing intrest|completely potty trained|dry naps|indicates need to use bathroom"][text]
Food: 
[textarea]
Child care:
[checkbox value="daycare|stays at home|both daycare and home"] [text]
Home: 
[textarea default= "Who lives at home: Siblings: Parents occupation:"]
Activities: [textarea name="variable_1" default="Hobbies: Physical Activity: Reading:"]
Screen Time:[text default="sample text"]
Dentist: [checkbox value="Sees dentist on a regular basis|Going to establish|No dental visits"] [comment memo="Consider fluoride tx"] [text]
Safety:[checklist name="variable_1" value="Wears Helmet|Cleaning supples stored safely|Supervised outside play|in properly sized carseat|Swimming lessons|Tobacco exposure"][text]
[textarea default="Meds: Allergies: PMH: PSH: FH:"]
[comment memo="PE: **Red reflex"]
[comment memo="Immunizations:    5th    dose    DTaP.    4th    dose    IPV.    2nd    dose    MMR/Varicella"]
Patient is a YO that presents to clinic for annual well child check.
Parental concerns:
.
Motor Milestones:

Social/Language Milestone:

Sleep/Naps: sleeps hours at night and naps
Potty Training readiness:

Food:

Child care:

Home:

Activities:

Screen Time:
Dentist: Consider fluoride tx
Safety:

PE: **Red reflex
Immunizations: 5th dose DTaP. 4th dose IPV. 2nd dose MMR/Varicella

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.35, 23 form elements, 40 boilerplate words, 8 text boxes, 5 text areas, 2 checkboxes, 4 check lists, 1 drop downs, 3 comments, 40 total clicks
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