Knee Subjective

Knee Pain
Chief Complaint: [checkbox name="variable_1" value="Left Knee problem|Right Knee problem|Bilateral knee problem"]
Pain began on: [text name="variable_1" default=" "]
Circumstances of onset were: [checkbox name="variable_2" value="Gradual|Sudden"]
Type of Inury: [checkbox name="variable_3" value="No specific injury|Contact injury|Noncontact injury|Pivot injury w/pop|Pivot injury without pop|Overuse|Arthritis"][text name="variable_2" default=" "]
Prior surgery: [checkbox name="variable_4" value="Yes|No"][text name="variable_3" default=""]

Location of knee discomfort: [checkbox name="variable_5" value="front|back|inside|outside|all around|in the calf|in the thigh"]
Current level of knee pain (0-10): [text name="variable_4" default=" "]
The pain is: [checkbox name="variable_6" value="Getting better|Getting worse|Unchanged"]
Quality of Knee pain: [checkbox name="variable_7" value="Constant|Intermittent|Sharp|Dull|Throbbing"]
Radiating knee pain: [checkbox name="variable_8" value="None|Hip|Thigh|Calf|Foot|Quadriceps|Hamstring"]

Patient currently experiencing the following with knee(s): [checkbox name="variable_9" value="Swelling|Stiffness|Pain with rest|Popping|Night pain|Locking|Grinding|Giving way|Catching|Buckling"]

Previous treatments for knee pain: [checkbox name="variable_10" value="Synvisc/Hyalgan/Supartz injection|Rest|OTC meds|Prescription meds|PT|Ice|Heat|Exercises|Mobile Aide|Cortisone injection|Bracing"]
The following treatments were helpful: [checkbox name="variable_11" value="Synvisc/Hyalgan/Supartz injection|Rest|OTC meds|Prescription meds|PT|Ice|Heat|Exercises|Mobile Aide|Cortisone injection|Bracing"] [text name="variable_5" default=" "]
Knee Pain
Chief Complaint:
Pain began on:
Circumstances of onset were:
Type of Inury:
Prior surgery:

Location of knee discomfort:
Current level of knee pain (0-10):
The pain is:
Quality of Knee pain:
Radiating knee pain:

Patient currently experiencing the following with knee(s):

Previous treatments for knee pain:
The following treatments were helpful:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.69, 16 form elements, 54 boilerplate words, 5 text boxes, 11 checkboxes, 73 total clicks
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