ROS: Cardiovascular

CARDIOVASCULAR: [checkbox name="variable_74" value="Deferred"]
Chest discomfort? [checkbox name="variable_75" value="Yes|No"]
     If yes, describe the location: [checkbox name="variable_76" value="Front|Back|Left|Right"]
     If yes describe character: [checkbox name="variable_77" value="Squeezing|Pressure|Tightness|Tearing/Ripping|Pleuritic|Positional"]
     If yes, describe the severity: [checkbox name="variable_78" value="Mild|Moderate|Severe|Very severe"]
     If yes, describe radiation: [checkbox name="variable_79" value="Back|Chest|Shoulder|Left arm|Right arm|Left jaw|Right jaw"]
Palpitations? [checkbox name="variable_80" value="Yes|No"]
Syncope? [checkbox name="variable_81" value="Yes|No"]
Near-syncope
Paroxysmal nocturnal dyspnea? [checkbox name="variable_82" value="Yes|No"]
Artifical valves? [checkbox name="variable_83" value="Yes|No"]
Pacemaker? [checkbox name="variable_84" value="Yes|No"]
Defibrillator? [checkbox name="variable_85" value="Yes|No"]
CARDIOVASCULAR:
Chest discomfort?
If yes, describe the location:
If yes describe character:
If yes, describe the severity:
If yes, describe radiation:
Palpitations?
Syncope?
Near-syncope
Paroxysmal nocturnal dyspnea?
Artifical valves?
Pacemaker?
Defibrillator?

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 1, 12 form elements, 31 boilerplate words, 12 checkboxes, 36 total clicks
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