Varicella History

[checkbox memo="Short Version" name="short" value=""][conditional field="short" condition="(short).is('')"][textarea default="History provided by ***mother/father/grandparent***
The patient comes in with *** days of vesicular rash.  The rash is described as initially occurring as small water blisters with surrounding erythema. There ***has/has not*** been a known exposure to varicella virus.
The patient ***has/has no*** accompanying pruritus, ***has/has no*** accompanying fever, ***has had/has not had*** a cough and ***has had/has not had*** ocular symptoms."][/conditional][checkbox memo="Long Version" name="long" value=""][conditional field="long" condition="(long).is('')"]
Patient accompanied with [select name+"Q1" value="Mother|Father|Grandparent|Guardian|None"]
[text memo="how many"] days of vesicular rash
[select name="Q2" value="Yes|No"] <-- Typical varicella rash (The rash is described as initially occurring as small water blisters with surrounding erythema.) [text]
[select name="Q3" value="Yes|No"] <-- Pruritis [text]
[select name="Q4" value="Yes|No"] <-- Fever [text]
[select name="Q5" value="Yes|No"] <-- Cough [text]
[select name="Q6" value="Yes|No"] <-- Ocular symptoms [text]
[textarea cols=80 rows=5 default="" memo="other details"][/conditional]
Short Version Long Version

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Sandbox Metrics: Structured Data Index 0.67, 8 form elements, 71 boilerplate words, 1 text boxes, 1 text areas, 2 checkboxes, 2 drop downs, 2 conditionals, 6 total clicks
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