Labs Report Template

LAB WORK:
[checkbox value="Unremarkable"]
[checkbox value="Glucose:"] [textarea memo="65-110" rows="1"]
[checkbox value="BUN:"] [textarea memo="5-20 mg/mL" rows="1"]
[checkbox value="Creatinine:"] [textarea memo="0.3-1.5 mg/dL" rows="1"]
[checkbox value="Prealbumin:"] [textarea memo="16 - 40 mg/dL" rows="1"]
[checkbox value="BUN/Creat Ratio:"] [textarea memo="6-3-" rows="1"]
[checkbox value="Sodium"] [textarea memo="135 - 148" rows="1"]
[checkbox value="Potassium :"] [textarea memo="3.5 - 5.3" rows="1"]
[checkbox value="Chloride :"] [textarea memo="98-109" rows="1"]
[checkbox value="CO2 :"] [textarea memo="23-35" rows="1"]
[checkbox value="Calcium :"] [textarea memo="8.5-10.5" rows="1"]
[checkbox value="Total Protein :"] [textarea memo="6.0 - 8.5" rows="1"]
[checkbox value="Albumin:"] [textarea memo="3.5 - 5.5" rows="1"]
[checkbox value="AST (SGOT):"] [textarea memo="7 - 45" rows="1"]
[checkbox value="ALT (SGPT):"] [textarea memo="5 - 40" rows="1"]
[checkbox value="Alk Phos:"] [textarea memo="37 - 147" rows="1"]
[checkbox value="Total Bilirubin"] [textarea memo="0.1 - 1.5" rows="1"]
[checkbox value="GFR (Afr-Amer)"] [textarea memo="> OR = 60" rows="1"]
[checkbox value="GFR (Non African American)"] [textarea memo="> OR = 60" rows="1"]
[text name="variable_1" default="sample text"]
LAB WORK:

65-110
5-20 mg/mL
0.3-1.5 mg/dL
16 - 40 mg/dL
6-3-
135 - 148
3.5 - 5.3
98-109
23-35
8.5-10.5
6.0 - 8.5
3.5 - 5.5
7 - 45
5 - 40
37 - 147
0.1 - 1.5
> OR = 60
> OR = 60

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.5, 38 form elements, 2 boilerplate words, 1 text boxes, 18 text areas, 19 checkboxes, 38 total clicks
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