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"]
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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