Motor Vehicle Accident History
Motor Vehicle Accident This was a [text] velocity impact. The vehicle impact was at the [text]. [select value="no|YES"] <-- Air bags deployed Before the accident, the patient was seated [text] in relation to the vehicle. Vehicle Restraints (e.g. seat belt): [text]. Extrication at the scene: [text] [select value="no|YES"] <-- inside the vehicle after the accident. [select value="no|YES"] <-- able to ambulate after the accident [select value="no|YES"] <-- conscious during the accident [select value="no|YES"] <-- remembers the impact [select value="no|YES"] <-- remembers after the accident Injury [text] prior to evaluation Onset while: [text] Episode location: [text] Episode description: [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
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Sandbox Metrics: Structured Data Index 0.33, 3 form elements, 169 boilerplate words, 2 text boxes, 1 drop downs, 3 total clicks
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