Shoulder Subjective

Shoulder Pain
Chief Complaint: [checkbox name="variable_1" value="Left Shoulder problem|Right Shoulder problem|Bilateral Shoulder 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|Injury w/pop|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 Shoulder discomfort: [checkbox name="variable_5" value="front|back|top|inside the joint|all around"]
Current level of Shoulder pain (0-10): [text name="variable_4" default=""]
The pain is: [checkbox name="variable_6" value="Getting better|Getting worse|Unchanged"]
Quality of Shoulder pain: [checkbox name="variable_7" value="Constant|Intermittent|Sharp|Dull|Throbbing"]
Radiating Shoulder pain: [checkbox name="variable_8" value="None|Neck|Upper back|Down the arm"]

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

Previous treatments for Shoulder pain: [checkbox name="variable_10" value="Rest|OTC meds|Prescription meds|PT|Ice|Heat|Exercises|Mobile Aide|Cortisone injection|Bracing"].[text name="variable_6" default=""]
The following treatments were helpful: [checkbox name="variable_11" value="Rest|OTC meds|Prescription meds|PT|Ice|Heat|Exercises|Mobile Aide|Cortisone injection|Bracing"].[text name="variable_5" default=""]
Shoulder Pain
Chief Complaint:
Pain began on:
Circumstances of onset were:
Type of Inury:
Prior surgery:

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

Patient currently experiencing the following with Shoulder (s):

Previous treatments for Shoulder pain: .
The following treatments were helpful: .

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.65, 17 form elements, 54 boilerplate words, 6 text boxes, 11 checkboxes, 66 total clicks
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