URI

[comment memo="HPI"]
Patient is an active duty [comment memo="age"][text name= default=""] year old [select name= value="male|female"] presenting with a [comment memo="duration"][text name= default=""] history of [checkbox name= value="dyspnea|sore throat|non-productive cough|productive cough|nasal congestion|rhinorrhea|subjective fever|fatigue|headache|abdominal pain|diarrhea|ear pain| facial pain"]. Patient denies [checkbox name= value="dyspnea|sore throat|non-productive cough|productive cough|nasal congestion|rhinorrhea|subjective fever|fatigue|headache|abdominal pain|diarrhea|ear pain| facial pain"]. Patient reports [select name= value="no sick contacts|sick contacts"]. Patient has tried [checkbox value="nothing|acteminophen|ibuprofen|OTC cough medications|DayQuil"] for symptoms. [comment memo="additional notes"][textarea default=""]
HPI
Patient is an active duty age year old presenting with a duration history of . Patient denies . Patient reports . Patient has tried for symptoms. additional notes

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.63, 12 form elements, 21 boilerplate words, 2 text boxes, 1 text areas, 3 checkboxes, 2 drop downs, 4 comments, 36 total clicks
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