Itemized Problem List

Health Problems
[text name="a_number" size=3 default="#"] [text name="a_name" size=20 default="problem"]
[textarea name="a_history" default="history"]
[textarea name="a_diagnostics" default="diagnostic evaluation"]
[textarea name="a_past_treatments" default="past treatment"]
[textarea name="a_current_treatment" default="current treatment"]
[textarea name="a_future_plan" default="future plan"]
[checkbox name="b_show" memo="another" value=""][conditional field="b_show" condition="(b_show).is('')"]
[text name="b_number" size=3 default="#"] [text name="b_name" size=20 default="problem"]
[textarea name="b_history" default="history"]
[textarea name="b_diagnostics" default="diagnostic evaluation"]
[textarea name="b_past_treatments" default="past treatment"]
[textarea name="b_current_treatment" default="current treatment"]
[textarea name="b_future_plan" default="future plan"]
[/conditional]
[checkbox name="c_show" memo="another" value=""][conditional field="c_show" condition="(c_show).is('')"]
[text name="c_number" size=3 default="#"] [text name="c_name" size=20 default="problem"]
[textarea name="c_history" default="history"]
[textarea name="c_diagnostics" default="diagnostic evaluation"]
[textarea name="c_past_treatments" default="past treatment"]
[textarea name="c_current_treatment" default="current treatment"]
[textarea name="c_future_plan" default="future plan"]
[/conditional]
[checkbox name="d_show" memo="another" value=""][conditional field="d_show" condition="(d_show).is('')"]
[text name="d_number" size=3 default="#"] [text name="d_name" size=20 default="problem"]
[textarea name="d_history" default="history"]
[textarea name="d_diagnostics" default="diagnostic evaluation"]
[textarea name="d_past_treatments" default="past treatment"]
[textarea name="d_current_treatment" default="current treatment"]
[textarea name="d_future_plan" default="future plan"]
[/conditional]
[checkbox name="e_show" memo="another" value=""][conditional field="e_show" condition="(e_show).is('')"]
[text name="e_number" size=3 default="#"] [text name="e_name" size=20 default="problem"]
[textarea name="e_history" default="history"]
[textarea name="e_diagnostics" default="diagnostic evaluation"]
[textarea name="e_past_treatments" default="past treatment"]
[textarea name="e_current_treatment" default="current treatment"]
[textarea name="e_future_plan" default="future plan"]
[/conditional]
[checkbox name="f_show" memo="another" value=""][conditional field="f_show" condition="(f_show).is('')"]
[text name="f_number" size=3 default="#"] [text name="f_name" size=20 default="problem"]
[textarea name="f_history" default="history"]
[textarea name="f_diagnostics" default="diagnostic evaluation"]
[textarea name="f_past_treatments" default="past treatment"]
[textarea name="f_current_treatment" default="current treatment"]
[textarea name="f_future_plan" default="future plan"]
[/conditional]
[checkbox name="g_show" memo="another" value=""][conditional field="g_show" condition="(g_show).is('')"]
[text name="g_number" size=3 default="#"] [text name="g_name" size=20 default="problem"]
[textarea name="g_history" default="history"]
[textarea name="g_diagnostics" default="diagnostic evaluation"]
[textarea name="g_past_treatments" default="past treatment"]
[textarea name="g_current_treatment" default="current treatment"]
[textarea name="g_future_plan" default="future plan"]
[/conditional]
[checkbox name="h_show" memo="another" value=""][conditional field="h_show" condition="(h_show).is('')"]
[text name="h_number" size=3 default="#"] [text name="h_name" size=20 default="problem"]
[textarea name="h_history" default="history"]
[textarea name="h_diagnostics" default="diagnostic evaluation"]
[textarea name="h_past_treatments" default="past treatment"]
[textarea name="h_current_treatment" default="current treatment"]
[textarea name="h_future_plan" default="future plan"]
[/conditional]
[checkbox name="i_show" memo="another" value=""][conditional field="i_show" condition="(i_show).is('')"]
[text name="i_number" size=3 default="#"] [text name="i_name" size=20 default="problem"]
[textarea name="i_history" default="history"]
[textarea name="i_diagnostics" default="diagnostic evaluation"]
[textarea name="i_past_treatments" default="past treatment"]
[textarea name="i_current_treatment" default="current treatment"]
[textarea name="i_future_plan" default="future plan"]
[/conditional]
[checkbox name="j_show" memo="another" value=""][conditional field="j_show" condition="(j_show).is('')"]
[text name="j_number" size=3 default="#"] [text name="j_name" size=20 default="problem"]
[textarea name="j_history" default="history"]
[textarea name="j_diagnostics" default="diagnostic evaluation"]
[textarea name="j_past_treatments" default="past treatment"]
[textarea name="j_current_treatment" default="current treatment"]
[textarea name="j_future_plan" default="future plan"]
[/conditional]
[checkbox name="k_show" memo="another" value=""][conditional field="k_show" condition="(k_show).is('')"]
[text name="k_number" size=3 default="#"] [text name="k_name" size=20 default="problem"]
[textarea name="k_history" default="history"]
[textarea name="k_diagnostics" default="diagnostic evaluation"]
[textarea name="k_past_treatments" default="past treatment"]
[textarea name="k_current_treatment" default="current treatment"]
[textarea name="k_future_plan" default="future plan"]
[/conditional]
[checkbox name="l_show" memo="another" value=""][conditional field="l_show" condition="(l_show).is('')"]
[text name="l_number" size=3 default="#"] [text name="l_name" size=20 default="problem"]
[textarea name="l_history" default="history"]
[textarea name="l_diagnostics" default="diagnostic evaluation"]
[textarea name="l_past_treatments" default="past treatment"]
[textarea name="l_current_treatment" default="current treatment"]
[textarea name="l_future_plan" default="future plan"]
[/conditional]
[checkbox name="m_show" memo="another" value=""][conditional field="m_show" condition="(m_show).is('')"]
[text name="m_number" size=3 default="#"] [text name="m_name" size=20 default="problem"]
[textarea name="m_history" default="history"]
[textarea name="m_diagnostics" default="diagnostic evaluation"]
[textarea name="m_past_treatments" default="past treatment"]
[textarea name="m_current_treatment" default="current treatment"]
[textarea name="m_future_plan" default="future plan"]
[/conditional]
[checkbox name="n_show" memo="another" value=""][conditional field="n_show" condition="(n_show).is('')"]
[text name="n_number" size=3 default="#"] [text name="n_name" size=20 default="problem"]
[textarea name="n_history" default="history"]
[textarea name="n_diagnostics" default="diagnostic evaluation"]
[textarea name="n_past_treatments" default="past treatment"]
[textarea name="n_current_treatment" default="current treatment"]
[textarea name="n_future_plan" default="future plan"]
[/conditional]
[checkbox name="o_show" memo="another" value=""][conditional field="o_show" condition="(o_show).is('')"]
[text name="o_number" size=3 default="#"] [text name="o_name" size=20 default="problem"]
[textarea name="o_history" default="history"]
[textarea name="o_diagnostics" default="diagnostic evaluation"]
[textarea name="o_past_treatments" default="past treatment"]
[textarea name="o_current_treatment" default="current treatment"]
[textarea name="o_future_plan" default="future plan"]
[/conditional]
[checkbox name="p_show" memo="another" value=""][conditional field="p_show" condition="(p_show).is('')"]
[text name="p_number" size=3 default="#"] [text name="p_name" size=20 default="problem"]
[textarea name="p_history" default="history"]
[textarea name="p_diagnostics" default="diagnostic evaluation"]
[textarea name="p_past_treatments" default="past treatment"]
[textarea name="p_current_treatment" default="current treatment"]
[textarea name="p_future_plan" default="future plan"]
[/conditional]
[checkbox name="q_show" memo="another" value=""][conditional field="q_show" condition="(q_show).is('')"]
[text name="q_number" size=3 default="#"] [text name="q_name" size=20 default="problem"]
[textarea name="q_history" default="history"]
[textarea name="q_diagnostics" default="diagnostic evaluation"]
[textarea name="q_past_treatments" default="past treatment"]
[textarea name="q_current_treatment" default="current treatment"]
[textarea name="q_future_plan" default="future plan"]
[/conditional]
[checkbox name="r_show" memo="another" value=""][conditional field="r_show" condition="(r_show).is('')"]
[text name="r_number" size=3 default="#"] [text name="r_name" size=20 default="problem"]
[textarea name="r_history" default="history"]
[textarea name="r_diagnostics" default="diagnostic evaluation"]
[textarea name="r_past_treatments" default="past treatment"]
[textarea name="r_current_treatment" default="current treatment"]
[textarea name="r_future_plan" default="future plan"]
[/conditional]
[checkbox name="s_show" memo="another" value=""][conditional field="s_show" condition="(s_show).is('')"]
[text name="s_number" size=3 default="#"] [text name="s_name" size=20 default="problem"]
[textarea name="s_history" default="history"]
[textarea name="s_diagnostics" default="diagnostic evaluation"]
[textarea name="s_past_treatments" default="past treatment"]
[textarea name="s_current_treatment" default="current treatment"]
[textarea name="s_future_plan" default="future plan"]
[/conditional]
[checkbox name="t_show" memo="another" value=""][conditional field="t_show" condition="(t_show).is('')"]
[text name="t_number" size=3 default="#"] [text name="t_name" size=20 default="problem"]
[textarea name="t_history" default="history"]
[textarea name="t_diagnostics" default="diagnostic evaluation"]
[textarea name="t_past_treatments" default="past treatment"]
[textarea name="t_current_treatment" default="current treatment"]
[textarea name="t_future_plan" default="future plan"]
[/conditional]
[checkbox name="s_show" memo="another" value=""][conditional field="s_show" condition="(s_show).is('')"]
[text name="u_number" size=3 default="#"] [text name="u_name" size=20 default="problem"]
[textarea name="u_history" default="history"]
[textarea name="u_diagnostics" default="diagnostic evaluation"]
[textarea name="u_past_treatments" default="past treatment"]
[textarea name="u_current_treatment" default="current treatment"]
[textarea name="u_future_plan" default="future plan"]
[/conditional]
[checkbox name="v_show" memo="another" value=""][conditional field="v_show" condition="(v_show).is('')"]
[text name="v_number" size=3 default="#"] [text name="v_name" size=20 default="problem"]
[textarea name="v_history" default="history"]
[textarea name="v_diagnostics" default="diagnostic evaluation"]
[textarea name="v_past_treatments" default="past treatment"]
[textarea name="v_current_treatment" default="current treatment"]
[textarea name="v_future_plan" default="future plan"]
[/conditional]
[checkbox name="w_show" memo="another" value=""][conditional field="w_show" condition="(w_show).is('')"]
[text name="w_number" size=3 default="#"] [text name="w_name" size=20 default="problem"]
[textarea name="w_history" default="history"]
[textarea name="w_diagnostics" default="diagnostic evaluation"]
[textarea name="w_past_treatments" default="past treatment"]
[textarea name="w_current_treatment" default="current treatment"]
[textarea name="w_future_plan" default="future plan"]
[/conditional]
[checkbox name="x_show" memo="another" value=""][conditional field="x_show" condition="(x_show).is('')"]
[text name="x_number" size=3 default="#"] [text name="x_name" size=20 default="problem"]
[textarea name="x_history" default="history"]
[textarea name="x_diagnostics" default="diagnostic evaluation"]
[textarea name="x_past_treatments" default="past treatment"]
[textarea name="x_current_treatment" default="current treatment"]
[textarea name="x_future_plan" default="future plan"]
[/conditional]
[checkbox name="y_show" memo="another" value=""][conditional field="y_show" condition="(y_show).is('')"]
[text name="y_number" size=3 default="#"] [text name="y_name" size=20 default="problem"]
[textarea name="y_history" default="history"]
[textarea name="y_diagnostics" default="diagnostic evaluation"]
[textarea name="y_past_treatments" default="past treatment"]
[textarea name="y_current_treatment" default="current treatment"]
[textarea name="y_future_plan" default="future plan"]
[/conditional]
[checkbox name="z_show" memo="another" value=""][conditional field="z_show" condition="(z_show).is('')"]
[text name="z_number" size=3 default="#"] [text name="z_name" size=20 default="problem"]
[textarea name="z_history" default="history"]
[textarea name="z_diagnostics" default="diagnostic evaluation"]
[textarea name="z_past_treatments" default="past treatment"]
[textarea name="z_current_treatment" default="current treatment"]
[textarea name="z_future_plan" default="future plan"]
[/conditional]