ROS: Neurological

NEUROLOGICAL: [checkbox name="variable_114" value="Deferred"]
Sensory loss? [checkbox name="variable_115" value="Yes|No"]
Parestesia? [checkbox name="variable_116" value="Yes|No"]
Sudden onset loss of motor function? [checkbox name="variable_117" value="Yes|No"]
     If yes, where? [checkbox name="variable_118" value="Arm|Leg|Face|Right|Left"]
     If yes, timing of onset? [text name="variable_17" default=""]
Dysarthria? [checkbox name="variable_119" value="Yes|No"]
Facial plegia? [checkbox name="variable_120" value="Yes|No"]
Epileptiform activity? [checkbox name="variable_121" value="Yes|No"]
Headache? [checkbox name="variable_122" value="Yes|No"]
     If yes, describe the location: [checkbox name="variable_123" value="Frontal|Parietal|Occipital|Temporal|Global|Left|Right"]
     If yes describe the severity: [checkbox name="variable_124" value="Mild |Moderate|Severe|Very Severe"]
Confusion? [checkbox name="variable_125" value="Yes|No"]
Deliriousness? [checkbox name="variable_126" value="Yes|No"]
Altered level of alertness? [checkbox name="variable_127" value="Yes|No"]
Altered level of awareness? [checkbox name="variable_128" value="Yes|No"]
Tremulousness? [checkbox name="variable_129" value="Yes|No"]
Fasciculations? [checkbox name="variable_130" value="Yes|No"]
Vertigo? [checkbox name="variable_131" value="Yes|No"]
Ataxia? [checkbox name="variable_132" value="Yes|No"]
Desequilibrium? [checkbox name="variable_133" value="Yes|No"]
Falls? [checkbox name="variable_134" value="Yes|No"]
Loss of muscle bulk? [checkbox name="variable_135" value="Yes|No"]
Tone: [checkbox name="variable_136" value="Normal|Increased|Decreased"]
NEUROLOGICAL:
Sensory loss?
Parestesia?
Sudden onset loss of motor function?
If yes, where?
If yes, timing of onset?
Dysarthria?
Facial plegia?
Epileptiform activity?
Headache?
If yes, describe the location:
If yes describe the severity:
Confusion?
Deliriousness?
Altered level of alertness?
Altered level of awareness?
Tremulousness?
Fasciculations?
Vertigo?
Ataxia?
Desequilibrium?
Falls?
Loss of muscle bulk?
Tone:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.96, 24 form elements, 55 boilerplate words, 1 text boxes, 23 checkboxes, 57 total clicks
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