IV Access

IV Access:
IV Site: [select name="variable_1" value="Left AC|Left Bicep|Left Hand|Left Forearm|Right AC|Right Bicep|Right Hand|Right Forearm|Left Radial|Right Radial"]
Catheter Size: [select name="size" value="14g|16g|18g|20g|22g|24g"]
Number of Attempts:[text name="variable_1" default="1"]
Successful?: [select name="success" value="Yes|No"]
IV Access:
IV Site:
Catheter Size:
Number of Attempts:
Successful?:

Result - Copy and paste this output:

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