CCTT annual physical

CCTT annual physical
Role: [text name="variable_1" default=""]
Agility testing completed- meets standard (see scanned documents).
________________________________________________
Medications: [text name="variable_2" default=""]
Allergies: [text name="variable_3" default=""]
PMH: [textarea name="variable_4" default=""]
[checkbox name="variable_5" value="Denies all risk factors and s/s of hypertrophic cardiomyopathy."]
[checkbox name="variable_20" value="Denies hx of or s/s of sleep apnea."]
[checkbox name="variable_19" value="Denies additional hospitalizations, chronic diseases, and need for accommodations."]
________________________________________________
EXAM
Vision - L: [text name="variable_6" default=""], R: [text name="variable_7" default=""]
BP: [text name="variable_8" default=""]
HR: [text name="variable_9" default=""]
Height: [text name="variable_10" default=""]
Weight: [text name="variable_11" default=""]
BMI: [text name="variable_12" default=""]
Neck circumference: [text name="variable_13" default=""]
________________________________________________
Neuro: [textarea name="variable_14" default=" A&Ox3, clear speech, appropriately groomed"]
MSK: [textarea name="variable_15" default=" Good muscle tone throughout, ambulating steadily, non-antalgic gait"]
Lungs: [textarea name="variable_16" default=" CTAB"]
Heart: [textarea name="variable_17" default=" S1, S2 noted. Absent S3, S4, murmurs"]
[checkbox name="variable_18" value="FIT test not performed today, EE to be fitted by department|FIT testing completed|FIT test failed, educated on PAPR usage|Passed with Prestige Regular|Provided qualitative fit testing using bitrex or saccharin in compliance with NFPA 1500, NFPA 1404, ANSI Z88.5, ANSI Z88.21992, OSHA CRF 1910.134, and CCR Title 8 Sec. 5144. Annual respirator training provided on why the respirator is necessary and how improper fit, use or maintenance can compromise its protective effect; limitations and capabilities of the respirator; effective use in emergency situations; how to inspect, put on and remove, use and check the seals; maintenance and storage; and recognition of medical signs and symptoms that may limit or prevent effective use"]
________________________________________________
CCTT employee meets all standards for clearance.
Clearance form sent to managers by front desk.
CCTT annual physical
Role:
Agility testing completed- meets standard (see scanned documents).
________________________________________________
Medications:
Allergies:
PMH:




________________________________________________
EXAM
Vision - L: , R:
BP:
HR:
Height:
Weight:
BMI:
Neck circumference:
________________________________________________
Neuro:

MSK:

Lungs:

Heart:


________________________________________________
CCTT employee meets all standards for clearance.
Clearance form sent to managers by front desk.

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.2, 20 form elements, 46 boilerplate words, 11 text boxes, 5 text areas, 4 checkboxes, 24 total clicks
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