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Number of fluids hanging: [select name="Q2" value="0|1|2|3|4|5|6"]
[conditional field="Q2" condition="(Q2).isGreaterOrEqual(1)"]
-------------------------Fluid 1-----------------------------------
Fluid Name [select name="var1_fluid" value="0.9% Normal Saline|Heparin|Blood (packed red cells)|vancomyacin|levoquin|nitroglycerin"]
Bolus [text name="var1_bolus_amt" size="4] ml at a rate of [text name="var1_bolus_rate" size="4] ml/hr
Rate [text name="var1_rate" size="4"] ml/hr
Method [select name="var1_method" value="pump|gravity / drip "]
Concentration [text name="var1_concentration" size="6"] [select name="var1_units" value="mg|units"] in [select name="var1_amt" value="50|100|150|200|250|500|1000"] ml
[calc value="var1_score1=(var1_concentration)/(var1_amt)"] [var name="var1_units"] per ml
[calc value="var1_score2=(var1_score1)*(var1_rate)"] [var name="var1_units"] per hour

[select name="var1_location" value="Antecubital Vein|Hand Vein|Jugular Vein|Wrist Vein|Forearm Vein|Foot Vein|Central Line|Pic Line|"] [select name="var1_side" value="|Left|Right"]

[checkbox name="var1_notes" value="Site Inspected for redness and infiltration. None Noted.|Titrate to effect|Was started prior to transport.|Finished in route, Terminated and flushed with normal saline."]
[/conditional]
[conditional field="Q2" condition="(Q2).isGreaterOrEqual(2)"]
-------------------------Fluid 2-----------------------------------
Fluid Name [select name="var2_fluid" value="0.9% Normal Saline|Heparin|Blood (packed red cells)|vancomyacin|levoquin|nitroglycerin "]
Bolus [text name="var2_bolus_amt" size="4] ml at a rate of [text name="var2_bolus_rate" size="4] ml/hr
Rate [text name="var2_rate" size="4"] ml/hr
Method [select name="var2_method" value="pump|gravity / drip "]
Concentration [text name="var2_concentration" size="6"] [select name="var2_units" value="mg|units"] in [select name="var2_amt" value="50|100|150|200|250|500|1000"] ml
[calc value="var2_score1=(var2_concentration)/(var2_amt)"] [var name="var2_units"] per ml
[calc value="var2_score2=(var2_score1)*(var2_rate)"] [var name="var2_units"] per hour

[select name="var2_location" value="Antecubital Vein|Hand Vein|Jugular Vein|Wrist Vein|Forearm Vein|Foot Vein|Central Line|Pic Line|"] [select name="var2_side" value="|Left|Right"]

[checkbox name="var2_notes" value="Site Inspected for redness and infiltration. None Noted.|Titrate to effect|Was started prior to transport.|Finished in route, Terminated and flushed with normal saline."]
[/conditional]
[conditional field="Q2" condition="(Q2).isGreaterOrEqual(3)"]
-------------------------Fluid 3-----------------------------------
Fluid Name [select name="var3_fluid" value="0.9% Normal Saline|Heparin|Blood (packed red cells)|vancomyacin|levoquin|nitroglycerin "]
Bolus [text name="var3_bolus_amt" size="4] ml at a rate of [text name="var3_bolus_rate" size="4] ml/hr
Rate [text name="var3_rate" size="4"] ml/hr
Method [select name="var3_method" value="pump|gravity / drip "]
Concentration [text name="var3_concentration" size="6"] [select name="var3_units" value="mg|units"] in [select name="var3_amt" value="50|100|150|200|250|500|1000"] ml
[calc value="var3_score1=(var3_concentration)/(var3_amt)"] [var name="var3_units"] per ml
[calc value="var3_score2=(var3_score1)*(var3_rate)"] [var name="var3_units"] per hour

[select name="var3_location" value="Antecubital Vein|Hand Vein|Jugular Vein|Wrist Vein|Forearm Vein|Foot Vein|Central Line|Pic Line|"] [select name="var3_side" value="|Left|Right"]

[checkbox name="var3_notes" value="Site Inspected for redness and infiltration. None Noted.|Titrate to effect|Was started prior to transport.|Finished in route, Terminated and flushed with normal saline."]
[/conditional]
[conditional field="Q2" condition="(Q2).isGreaterOrEqual(4)"]
-------------------------Fluid 4-----------------------------------
Fluid Name [select name="var4_fluid" value="0.9% Normal Saline|Heparin|Blood (packed red cells)|vancomyacin|levoquin|nitroglycerin "]
Bolus [text name="var4_bolus_amt" size="4] ml at a rate of [text name="var4_bolus_rate" size="4] ml/hr
Rate [text name="var4_rate" size="4"] ml/hr
Method [select name="var4_method" value="pump|gravity / drip "]
Concentration [text name="var4_concentration" size="6"] [select name="var4_units" value="mg|units"] in [select name="var4_amt" value="50|100|150|200|250|500|1000"] ml
[calc value="var4_score1=(var4_concentration)/(var4_amt)"] [var name="var4_units"] per ml
[calc value="var4_score2=(var4_score1)*(var4_rate)"] [var name="var4_units"] per hour

[select name="var4_location" value="Antecubital Vein|Hand Vein|Jugular Vein|Wrist Vein|Forearm Vein|Foot Vein|Central Line|Pic Line|"] [select name="var4_side" value="|Left|Right"]

[checkbox name="var4_notes" value="Site Inspected for redness and infiltration. None Noted.|Titrate to effect|Was started prior to transport.|Finished in route, Terminated and flushed with normal saline."]
[/conditional]
[conditional field="Q2" condition="(Q2).isGreaterOrEqual(5)"]
-------------------------Fluid 5-----------------------------------
Fluid Name [select name="var5_fluid" value="0.9% Normal Saline|Heparin|Blood (packed red cells)|vancomyacin|levoquin|nitroglycerin "]
Bolus [text name="var5_bolus_amt" size="4] ml at a rate of [text name="var5_bolus_rate" size="4] ml/hr
Rate [text name="var5_rate" size="4"] ml/hr
Method [select name="var5_method" value="pump|gravity / drip "]
Concentration [text name="var5_concentration" size="6"] [select name="var5_units" value="mg|units"] in [select name="var5_amt" value="50|100|150|200|250|500|1000"] ml
[calc value="var5_score1=(var5_concentration)/(var5_amt)"] [var name="var5_units"] per ml
[calc value="var5_score2=(var5_score1)*(var5_rate)"] [var name="var5_units"] per hour

[select name="var5_location" value="Antecubital Vein|Hand Vein|Jugular Vein|Wrist Vein|Forearm Vein|Foot Vein|Central Line|Pic Line|"] [select name="var5_side" value="|Left|Right"]

[checkbox name="var5_notes" value="Site Inspected for redness and infiltration. None Noted.|Titrate to effect|Was started prior to transport.|Finished in route, Terminated and flushed with normal saline."]
[/conditional]
[conditional field="Q2" condition="(Q2).isGreaterOrEqual(6)"]
-------------------------Fluid 6-----------------------------------
Fluid Name [select name="var6_fluid" value="0.9% Normal Saline|Heparin|Blood (packed red cells)|vancomyacin|levoquin|nitroglycerin"]
Bolus [text name="var6_bolus_amt" size="4] ml at a rate of [text name="var6_bolus_rate" size="4] ml/hr
Rate [text name="var6_rate" size="4"] ml/hr
Method [select name="var6_method" value="pump|gravity / drip "]
Concentration [text name="var6_concentration" size="6"] [select name="var6_units" value="mg|units"] in [select name="var6_amt" value="50|100|150|200|250|500|1000"] ml
[calc value="var6_score1=(var6_concentration)/(var6_amt)"] [var name="var6_units"] per ml
[calc value="var6_score2=(var6_score1)*(var6_rate)"] [var name="var6_units"] per hour

[select name="var6_location" value="Antecubital Vein|Hand Vein|Jugular Vein|Wrist Vein|Forearm Vein|Foot Vein|Central Line|Pic Line|"] [select name="var6_side" value="|Left|Right"]

[checkbox name="var6_notes" value="Site Inspected for redness and infiltration. None Noted.|Titrate to effect|Was started prior to transport.|Finished in route, Terminated and flushed with normal saline."]
[/conditional]
Number of fluids hanging:





Result - Copy and paste this output: