PMH

[checkbox name="PMH" value="Immunizations current: |record unavailable |Dental care current: |trauma /injuries|Hospitalizations|surgeries|Hearing problems|Vision problems|Asthma                               |Pneumonia|Anemia\t(lead, etc.)                 |hepatitis|Bladder/kidney infections            |Cancer||Immune suppression Muscle/bone disease |substance use (alcohol, drug, tobacco Use) physical/sexual/emotional abuse ||Developmental delays/learning disorder||psychiatric disorder other/Explanation:|ADHD       |depression  "]

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Sandbox Metrics: Structured Data Index 1, 1 form elements, 1 checkboxes, 23 total clicks
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