pediatric acute headache
[text memo="#"] year old [select value="female|male"] [select value="with no history of headaches|with history of migraines|with history of headaches"] here for [select value="constant|intermittent"], [select value="stable|worsening|improving"], [text memo="description (ie sharp)"], [text memo="location"] headache since [text memo="onset"]. Headache reached maximum intensity [select value="suddenly|over time"] [select value="Pt reports that this is different than typical headaches|Pt reports that this is the same as other headaches| "] Headache [select value="does not|does|sometimes"] wake pt from sleep. [select value="Denies|Endorses"] trouble walking. [select value="Denies|Endorses"] recent trauma. Headache [select value="is not |is"] worse with cough/defecating/physical activity. [select value="Denies|Endorses"] neck pain. [select value="Denies|Endorses"] back pain. Guardian [select value="denies|endorses"] personality changes. [text memo="(notes)" size="35"] [checklist value="nausea|vomiting|sensitivity to light|sensitivity to sound|watery or droopy eye|vision changes|cough|congestion|runny nose|fever|dizziness|fainting|muscle weakness"] Has tried [checkbox value="acetaminophen |ibuprofen|nothing"][text] Made worse by [textarea default="foods:\nsmells: \nbright lights, noise, lack of sleep, menses (in females), strenuous activity"] Alleviated by [textarea default="dark, quiet room, cool compress, sleep"] Unchanged by [textarea memo=""] MEDs: [text memo="meds" size="50"] [checklist value="oral contraceptives|glucocorticoids|SSRI/SNRIs|growth hormone|tetracyclines|vitamin A derivatives"] ALLERGIES: [text memo="allergies" size="50"] PMH: [checklist value="sickle cell disease|immune deficiency|cancer or history of cancer |bleeding disorder|heart disease|head trauma|neurofibromatosis|tuberous sclerosis|hydrocephalus or shunt"] FamHx: [checklist name="variable_1" value="migraine|headaches|seizure disorders|neurologic disorders"]
Result - Copy and paste this output:
Sandbox Metrics: Structured Data Index 0.62, 29 form elements, 46 boilerplate words, 8 text boxes, 3 text areas, 1 checkboxes, 4 check lists, 13 drop downs, 59 total clicks
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