Dispatch

HCESA [checkbox name="variable_1" value="Company 10|Company  3|Company 13|Company 5|Company 1|Company 11|Company 42|Company 9|Company 8"] alerted to [select name="variable_2" value="residence|intersection|facility|other"] at [text name="variable_3" default="sample text"] WV, for [select name="variable_4" value="fall|bleed|OB|cardiac|general illness|seizures|unresponsive|pain|blood pressure|suicide|MVA|stand by|brush fire|other"]. [select name="level" value="BLS|ALS"] [select name="unit" value="101|102|105|106|107|108|109"] responded priority from [select name="station" value="Romney station|Capon Bridge station|Springfield station|the area of"]. [textarea name="extra" default="sample text"]

Chief Compliant:[select name="cc" value="fall|bleed|cardiac|MVA|seizures|OB|allergy|breathing difficulty"]

Hx:[textarea name="Hx" default="sample text"]