Allergic Rhinitis/Conjunctivits

[date name="variable_1" default="05/08/2020"]


[select value="less than 1 day|1 day|2 days|3 days|4 days|5 days|6 days|7 days|more than 1 week|more than 1 month"] <-- duration
[select value="no|YES"] <-- nasal congestion
[select value="no|YES"] <-- nasal discharge
[select value="no|YES"] <-- sneezing
[select value="no|YES"] <-- watery eyes
[select value="no|YES"] <-- cough
[select value="no|YES"] <-- headache
[select value="no|YES"] <-- fever
[select value="no|YES"] <-- past history of similar symptoms

Prior treatment
[select value="no|YES"] <-- over the counter antihistamines
[select value="no|YES"] <-- loratidine
[select value="no|YES"] <-- fexofenadine
[select value="no|YES"] <-- cetirizine
[select value="no|YES"] <-- intranasal steroids

Past History
[select value="no|YES"] <-- asthma
[select value="no|YES"] <-- eczema

[select name="Q1" value="Allergic Rhinitis|Bronchitis|Conjunctivitis|Dizziness|Gastroenteritis|Migraine/Headache|Otitis|Pharyngitis|Shortness of Breath|Stye|Urinary Tract Infection"][conditional field="Q1" condition="(Q1).is('Allergic Rhinitis')"]
[text size=112 default="General Appearance: alert, NAD."]
[text size=112 default="Nose: normal, mucosa without edema or inflammation. No clear or purulent nasal discharge."]
[text size=112 default="Ears: without pain to external ears, without pain inside ears"]
[text size=112 default="Eyes: normal conjunctiva, lids, PERRL"]
[text size=112 default="Throat: normal, without erythema, tonsillar inflammation or exudate. No posterior pharyngeal drainage"]
[text size=112 default="Lungs: No wheezes or crackles heard in video consult"]
[text size=112 default="Heart: no chest pain"]
[textarea cols=80 rows=1 default="Assessment:  Allergic rhinitis"]
Plan: [checkbox value="Fexofenadine 60 mg twice a day|Fexofenadine 180 mg 1 tab daily|Loratidine 10 mg daily|Cetirizine 10 mg 1 tab daily|Over the counter antihistamines|Nasacort 2 sprays each nostril daily|Flonase 2 sprays each nostril daily|Beconase 2 sprays each nostril twice daily|Rhinocort 2 sprays each nostril twice daily|Epinastine instill 1 drop into each eye twice daily"]


<-- duration
<-- nasal congestion
<-- nasal discharge
<-- sneezing
<-- watery eyes
<-- cough
<-- headache
<-- fever
<-- past history of similar symptoms

Prior treatment
<-- over the counter antihistamines
<-- loratidine
<-- fexofenadine
<-- cetirizine
<-- intranasal steroids

Past History
<-- asthma
<-- eczema


Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.68, 29 form elements, 65 boilerplate words, 7 text boxes, 2 text areas, 1 dates, 1 checkboxes, 17 drop downs, 1 conditionals, 37 total clicks
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