[text default="Assault"]
Onset [text] prior to evaluation
Onset while: [text]
Episode location: [text]
Episode description: [text].
Weapons involved: [text]

Associated Injuries:
[text]

ROS
[select value="no|YES"] <-- seizure
[select value="no|YES"] <-- extremity weakness
[select value="no|YES"] <-- headache
[select value="no|YES"] <-- sensory changes (vision, hearing)
[select value="no|YES"] <-- shortness or breath
[select value="no|YES"] <-- chest pain
[select value="no|YES"] <-- nausea/vomiting
[select value="no|YES"] <-- incontinence of urine or stool
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference: contributed by Dr. Scott Moses, creator/author of the Family Practice Notebook [link url="//www.fpnotebook.com" memo="(link)"][/conditional]