Kaybee Follow up

Patient presents for follow-up appointment [select name="variable_1" value="through telehealth.|in office."]During the last visit on [date name="variable_1" default="05/11/2021"], [textarea name="variable_1" default=""]. Client reported that [select name="variable_2" value="he|she"]has [select name="variable_3" value=" been compliant|not compliant"] with medication regimen [textarea name="variable_4" default=""]. With regards to benefits [select name="variable_5" value="he|she"][textarea name="variable_3" default=""] and stated that [text name="variable_2" default=""]. In terms of sleep,[text name="variable_3" default=""] and appetite has been [text name="variable_4" default=""]
Patient presents for follow-up appointment During the last visit on ,
. Client reported that has with medication regimen
. With regards to benefits
and stated that . In terms of sleep, and appetite has been

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.45, 11 form elements, 32 boilerplate words, 3 text boxes, 3 text areas, 1 dates, 4 drop downs, 11 total clicks
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