AP/Chart Review
AP/Chart Review [date name="variable_1" default="05/28/2022"] [textarea name="variable_1" default="notes:"] ___________________________________________________________ Immunizations: MMR: [checkbox name="variable_1" value="vaccine x 2|hx of pos titer|not required|not provided|other"] Varicella: [checkbox name="variable_2" value="vaccine x 2|hx of pos titer|not required|not provided|other"] Hep B: [checkbox name="variable_3" value="vaccine x 3|hx of pos titer|not required|not provided|other"] Tdap: [checkbox name="variable_4" value="UTD|last immunization >10 years|not provided|other"] Flu: [checkbox name="variable_5" value="UTD|not provided|not required with start date after 4/30|other"] COVID: [checkbox name="variable_6" value="Moderna x 2|Pfizer x 2|J&J x 1|not provided|plus booster|other"] TB: [checkbox name="variable_7" value="Neg IGRA w/i 90 doh|not provided|hx of pos TST or IGRA|Neg CXR provided|not required|TST x 2, most current w/i 90 doh|other"] ___________________________________________________________ Respiratory Baseline Questionnaire: [checkbox name="variable_10" value="clear|not clear|not required|not provided|other"] [text name="variable_1" default="comments"] ___________________________________________________________ Recommended: [textarea name="variable_11" default=" "] Needs: [textarea name="variable_18" default=" "]
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Sandbox Metrics: Structured Data Index 0.69, 13 form elements, 17 boilerplate words, 1 text boxes, 3 text areas, 1 dates, 8 checkboxes, 46 total clicks
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