ROS: Gastrointestinal

GASTROINTESTINAL: [checkbox name="variable_86" value="Deferred"]
Abdominal pain? [checkbox name="variable_1" value="Yes|No"]
     If yes, describe character: [checkbox name="variable_87" value="Cramping|Stabbing|Dull|Colicky"]
     If yes, describe the severity: [checkbox name="variable_88" value="Mild|Moderate|Severe|Very severe"]
     If yes, describe the timing:[checkbox name="variable_89" value="Intermittent|Constant"]
     If yes, describe the location:[checkbox name="variable_90" value="Upper|Lower|Right|Left"]
     If yes, describe radiation:[checkbox name="variable_91" value="Back|Flank|Right|Left"]
Nausea? [checkbox name="variable_92" value="Yes|No"]
Vomiting? [checkbox name="variable_93" value="Yes|No"]
     If yes, is there hematemesis? [checkbox name="variable_94" value="Yes|No"]
     Coffee ground? [checkbox name="variable_95" value="Yes|No"]
     Hemorrhagic? [checkbox name="variable_96" value="Yes|No"]
     Bilious? [checkbox name="variable_97" value="Yes|No"]
     Feculent? [checkbox name="variable_98" value="Yes|No"]
Pyrosis/GERD? [checkbox name="variable_99" value="Yes|No"]
Diarrhea? [checkbox name="variable_100" value="Yes|No"]
     If yes, describe the consistency: [checkbox name="variable_101" value="Soft|Liquid|Mushy"]
     If yes, describe the frequency:
[text name="variable_16" default="_ bowel movements per day"]
Alternating diarrhea and constipation? [checkbox name="variable_102" value="Yes|No"]
Melena? [checkbox name="variable_103" value="Yes|No"]
Hematochezia? [checkbox name="variable_104" value="Yes|No"]
     If yes: [checkbox name="variable_105" value="Large volume|Small volume"]
Dysphagia? [checkbox name="variable_106" value="Yes|No"]
Odynophagia? [checkbox name="variable_107" value="Yes|No"]
Thrush? [checkbox name="variable_108" value="Yes|No"]
Aspiration? [checkbox name="variable_109" value="Yes|No"]
Ascites? [checkbox name="variable_110" value="Yes|No"]
Jaundice? [checkbox name="variable_111" value="Yes|No"]
Icterus? [checkbox name="variable_112" value="Yes|No"]
Petechiae? [checkbox name="variable_113" value="Yes|No"]
GASTROINTESTINAL:
Abdominal pain?
If yes, describe character:
If yes, describe the severity:
If yes, describe the timing:
If yes, describe the location:
If yes, describe radiation:
Nausea?
Vomiting?
If yes, is there hematemesis?
Coffee ground?
Hemorrhagic?
Bilious?
Feculent?
Pyrosis/GERD?
Diarrhea?
If yes, describe the consistency:
If yes, describe the frequency:

Alternating diarrhea and constipation?
Melena?
Hematochezia?
If yes:
Dysphagia?
Odynophagia?
Thrush?
Aspiration?
Ascites?
Jaundice?
Icterus?
Petechiae?

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.97, 30 form elements, 67 boilerplate words, 1 text boxes, 29 checkboxes, 67 total clicks
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