Death

Date of Death:  [date name="variable_1" default="today"]
Time of Death:  [text name="variable_2" default="11:59 AM"]
Provider Pronouncing Death:  [text name="variable_3"]
Cause of Death:  
[textarea name="variable_4" default="Cardiopulmonary arrest."]
Examination Findings:  
[textarea fillable="true" name="variable_5" default="Absence of pulse, respiration, pupil response.  "]
[textarea fillable="true" name="variable_6" default="Family ***present/not present/informed***.  ***Attending physician notified.***  ***Pastoral care notified.***  ***Social work notified.***"]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"]
References:
[link url="https://www.uab.edu/medicine/palliativecare/training/resources/beacon" memo="#1"] University of Alabama at Birmingham - BEACON Project[/conditional]
Date of Death:
Time of Death:
Provider Pronouncing Death:
Cause of Death:

Examination Findings:
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Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.29, 9 form elements, 14 boilerplate words, 2 text boxes, 3 text areas, 1 dates, 1 checkboxes, 1 links, 1 conditionals, 7 total clicks
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