SCREENING CALCULATOR
1. Chief complaint/presenting concern(s) or problem(s):[textarea name="variable_1"] 2. Referral source:[text name="variable_9"] 3. Historical Diagnoses: [checklist name="historical" value="ADHD|Bipolar|Schizophrenia|Dememtia|Traumatic Brain Injury|Autism"] 4. Any Psychiatric Medication? [select name="variable_3" value=" |yes= Physician|no = Non-physician"] [textarea name="variable_1"] 5. Insurance Type: [select name="variable_21" value="Medicare=96127|Medicaid=H0002|Commercial=96127"] *[calc value="Code = (variable_21)"]* *[calc value="Level of Care = (variable_3)"]*
Result - Copy and paste this output:
Sandbox Metrics: Structured Data Index 0.5, 8 form elements, 17 boilerplate words, 1 text boxes, 2 text areas, 1 check lists, 2 drop downs, 2 calculations, 11 total clicks
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