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"]
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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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