2 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= "Interval History:"]. 
Motor Milestones:
[checklist name="Motor" value="Kicks a ball|runs|Eats with a utensil|Walk up a few steps without help"]
Social/Language Milestone:
[checklist value="Notices when someone is upset|Sentences with 2 words together|Knows 2 body parts"]
Sleep/Naps: sleeps [text] hours at night and naps [text]
Potty Training readiness:
[checklist value="showing intrest|knows wet and dry|dry naps|indicates need to use bathroom"][text]
Miscellaneous:
[checkbox value= "still uses bottle|still uses pacifier|sucks thumb"]
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 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 value="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="Labs: Iron"]
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:

Miscellaneous:

Food:

Child care:

Home:

Activities:

Screen Time:
Dentist: Consider fluoride tx
Safety:

PE: **Red reflex
Labs: Iron

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.38, 24 form elements, 41 boilerplate words, 8 text boxes, 5 text areas, 3 checkboxes, 4 check lists, 1 drop downs, 3 comments, 39 total clicks
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