5 Year WCC

Patient is a [text] YO [select value= "Select|M|F"] presents to clinic for annual well child check. 
Parental concerns: [textarea default= "recent illness, behavior problems, development"]. 
Motor Milestones: [checklist value= "Hops on one foot|Buttons some buttons|Can dress themself"]
Social/Language Milestones: [checklist value= "Takes turns when playing a game|Can repeat a story they heard|Can count to 10|Recognizes some letters"]
School/Academics:[textarea default= "In ** grade and attends ** School. Activities:"]
Home: [textarea default= "who lives at home: siblings: Parents occupation"]
Food: [textarea]
Activities: [textarea default="Hobbies: Physical Activity: "]
Screen Time:[textarea]
Dentist: [checkbox value="Sees dentist on a regular basis|Going to establish|No dental visits"] [comment memo="Consider fluoride tx"]
Safety:[checklist name="variable_1" value="Wears Helmet|Cleaning supples stored safely|Supervised outside play|Knows address|Knows phone number|Tobacco exposure|Swimming lessons"][text]
[textarea default="Meds: Allergies: PMH: PSH: FH:"]
[comment memo="PE: **Red reflex"]
[comment memo= "Time spent reading"]