House Calls visit

Follow up visit:[date name="variable_1" default="09/30/2019"]
Type of visit: [select name="variable_1" value="choice A|choice B|choice C"]

ROS:
General: 
Cards
Respiratory
GI
GU
Neuro
Musc
Int
Psych

PE:
Vitals:
General: 
Cards
Respiratory
GI
GU
Neuro
Musc
Int
Psych
Follow up visit:
Type of visit:

ROS:
General:
Cards
Respiratory
GI
GU
Neuro
Musc
Int
Psych

PE:
Vitals:
General:
Cards
Respiratory
GI
GU
Neuro
Musc
Int
Psych

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 1, 2 form elements, 27 boilerplate words, 1 dates, 1 drop downs, 2 total clicks
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