Trauma MVC

[text name="variable_1" default="Age"] years old [select name="sex" value="male|female|"]
[select name="" value="belted|unbeleted|"]  [select name="frontvsrear" value="front|rear||"] [select name="passengerordriver" value="passenger|driver||"]
in [text name="variable_2" default="type of accident"]
airbags [select name="depolyed/not deployed" value="were depolyed |were not deployed"]    and pt belives they [select name="variable_1" value="did|did not|"] hit them