INTERNAL STEPDOWN

INTERNAL STEPDOWN. 

[text name="variable_1" default=" Patient Name "]

Email: [text name="variable_2" default="sample text"]

Date of discharge: [text name="variable_3" default="sample text"]

Requested outpatient Site: South Elgin  [text name="variable_4" default="Insert Level of care "]

Special Instructions: [checkbox name="variable_1" value="Yes|No"] [text name="variable_7" default=""]

INTERNAL STEPDOWN.



Email:

Date of discharge:

Requested outpatient Site: South Elgin

Special Instructions:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.17, 6 form elements, 13 boilerplate words, 5 text boxes, 1 checkboxes, 7 total clicks
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