General & Administrative
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[comment memo_color="mediumpurple" memo="Demographics and Vitals Part"]
[date name="variable_1"] <-- date of birth
[checkbox name="variable_2" memo="show service time" value=" "][conditional field="variable_2" condition="(variable_2).is(' ')"][text name="variable_3" default="00:00" size=11] [/conditional][date name="variable_4" default="today"] <-- service date
[select name="variable_5" value="Female|Male"] <-- gender
[select name="variable_6" value="African American|White|Other"] <-- race
[checkbox name="variable_7" memo="show weight date" value=" "][conditional field="variable_7" condition="(variable_7).is(' ')"][date name="variable_8" default="today"] [/conditional][text name="variable_9"] <-- weight (kg)
[checkbox name="variable_10" memo="show height date" value=" "][conditional field="variable_10" condition="(variable_10).is(' ')"] [date name="variable_11" default="today"] [/conditional][text name="variable_12"] <-- height (cm)
[text name="variable_13"] <-- temperature (°C)
[text name="variable_14"] <-- seated systolic blood pressure (mmHg)
[text name="variable_15"] <-- seated diastolic blood pressure (mmHg)
[text name="variable_16"] <-- seated heart rate
[checkbox name="variable_17" memo="show orthostatic vitals" value=" "][conditional field="variable_17" condition="(variable_17).is(' ')"][text name="variable_18"] <-- supine systolic blood pressure (mmHg)
[text name="variable_19"] <-- supine blood pressure (mmHg)
[text name="variable_20"] <-- supine heart rate
[text name="variable_21"] <-- standing systolic blood pressure (mmHg)
[text name="variable_22"] <-- standing diastolic blood pressure (mmHg)
[text name="variable_23"] <-- standing heart rate[/conditional]
[text name="variable_24"] <-- respiratory rate
[text name="variable_25"] <-- oxygen saturation (%)
[select name="variable_26" value="room air|1 L NC|2 L NC|3 L NC|4 L NC|5 L NC|6 L NC"] <-- supplemental oxygen
Demographics and Vitals Part
<-- date of birth
show service time <-- service date
<-- gender
<-- race
show weight date <-- weight (kg)
show height date <-- height (cm)
<-- temperature (°C)
<-- seated systolic blood pressure (mmHg)
<-- seated diastolic blood pressure (mmHg)
<-- seated heart rate
show orthostatic vitals
<-- respiratory rate
<-- oxygen saturation (%)
<-- supplemental oxygen

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