[text memo="age"] old [select value="male|female"] brought in by [text] due to concerns regarding [textarea default=""] This began [date name="variable_1" default="11/06/2021"] and has been [select value="worsening|improving|about the same"] since then Pt has been eating [text memo="#"] oz of [select value="formula|breastmilk"] every [text memo=""] hours. Pt has been urinating [select value="normally|less than normal|"]. Last wet diaper [text memo="when"] [textarea name="variable_1" default=""] [checklist value="congestion|vomiting|spitting up|diarrhea|bloody stool|cough|fever|rash|poor feeding|gastric distention|sweating with feeds|constipation "] RELEVANT HISTORY [select value="Denies|Reports"] birth trauma [select value="denies|reports"] vitamin K administration at birth, [select value="denies|reports"] administration of honey/Zarbees. BIRTH HX: Born at [text memo="#"] weeks via [select value="NSVD|CS|"]. [select value="normal|late/limited|no|unknown|"] prenatal care [text default="maternal complications" size="50"] [text default="infant complications" size="50"] EXAM: WNWD in NAD; NC/AT. Anterior fontanelle open and flat. Ear canals clear. TMs gray; no bulging PERRL. Conjunctiva clear. No discharge from nares. Oropharynx reveals no inflammation, swelling, exudate or lesion. Lips and gums appear normal. No cervical or supraclavicular lymphadenopathy. RRR no MRG Lungs CTA bilaterally; normal effort Soft, nondistended, nontender abdomen without hernia or mass. No TTP. Normal external genitals; no rash; no anal fissure // no paraphimosis Normal digits and extremities; no hair tourniquet No jaundice or rash
There are 21 form elements.
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Sandbox Metrics: Structured Data Index 0.52, 21 form elements, 133 boilerplate words, 8 text boxes, 2 text areas, 1 dates, 1 check lists, 9 drop downs, 32 total clicks
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