Per caregivers, the patient has been experiencing the following dementia-related symptoms:
[checkbox name="gerdelusions" value="persecutory delusions|delusional beliefs that others are stealing|delusional beliefs that others are planning to harm in some way"]
[textarea name="descrDel" default=""][checkbox name="gerhallucinations" value="visual hallucinations|auditory hallucinations"]
[textarea name="descrHall" default=""] [checkbox name="geragitation" value="agitated behaviors|resistance to help from others|uncooperative with care|uncooperative with medications|resistance to redirection|episodes of verbal aggression|episodes of physical aggression|threatening behaviors|combativeness"]
[textarea name="descrag" default=""] [checkbox name="gerdisinhibition" value="disinhibited behaviors|impulsivity|overly familiar conversation|sexually inappropriate behaviors|making sexually inappropriate comments|making rude comments|making offensive comments|inappropriately disrobing|urinating in public|appearing in public partially undressed"]
[textarea name="descrgerdisinh" default=""][checkbox name="germood" value="depressed mood|sad mood|low mood|dysphoric mood|episodes of distinctly elevated mood|episodes of euphoria|appears excessively happy at times|apathy|seems indifferent to things previously cared about|decreased interest in usual activities|decreased interest in the activities and plans of others"]
[textarea name="descrgermood" default=""] [checkbox name="geranx" value="increased anxiety|becomes upset when separated from caregiver|signs of nervousness such as:|shortness of breath|sighing|being unable to relax|muscle tension|tense facial expressions"]
[textarea name="descrgeranx" default=""] [checkbox name="gerirritability" value="irritability|mood lability|difficulty coping with delays|impatience|difficulty waiting for planned activities"] 
[textarea name="descrgerirritability" default=""][checkbox name="germotordist" value="engages in repetitive behaviors|psychomotor agitation|pacing around the house|folding items repetitively"]
[textarea name="descrgermotordist" default=""][checkbox name="gersleepdist" value="irregular sleep pattern|rising too early in morning|excessive napping|days and nights mixed up"]
[textarea name="descrgersleepdisturn" default=""] [checkbox name="gerappdist" value="decreased appetite|increased appetite|hyper oral|increased cravings of sugary foods|change in favorite foods|dislike of previously favorite foods|c/o that food doesn't taste good|weight loss|weight gain"]
[textarea name="descrgerappdist" default=""]
Per caregivers, the patient has been experiencing the following dementia-related symptoms:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.5, 20 form elements, 11 boilerplate words, 10 text areas, 10 checkboxes, 75 total clicks
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