MRI Checklist

MRI Checklist
[checklist name="variable_1" value="Weight over 300 lbs|Contrast allergy|Claustrophobic|Requires sedation|Hypertension|Renal insufficiency|Dialysis|Transplanted kidney|Diabetes mellitus|Cardiovascular disease|Body piercings|Metal appliance in the body|Other metal in the body|Cataract implants|Orbital injury with metal|Pacemaker|Aneurysm clip or coil|Stent|Bio- or neurostimulator|Electronic device|Infusion pump|Cochlear (inner ear) implant|Other"][conditional field="variable_1" condition="(variable_1).is('Weight over 300 lbs')||(variable_1).is('Contrast allergy')||(variable_1).is('Claustrophobic')||(variable_1).is('Requires sedation')||(variable_1).is('Hypertension')||(variable_1).is('Renal insufficiency')||(variable_1).is('Dialysis')||(variable_1).is('Transplanted kidney')||(variable_1).is('Diabetes mellitus')||(variable_1).is('Cardiovascular disease')||(variable_1).is('Body piercings')||(variable_1).is('Metal appliance in the body')||(variable_1).is('Other metal in the body')||(variable_1).is('Cataract implants')||(variable_1).is('Orbital injury with metal')||(variable_1).is('Pacemaker')||(variable_1).is('Aneurysm clip or coil')||(variable_1).is('Stent')||(variable_1).is('Bio- or neurostimulator')||(variable_1).is('Electronic device')||(variable_1).is('Infusion pump')||(variable_1).is('Cochlear (inner ear) implant')||(variable_1).is('Other')"]
Comments:  [text name="variable_1" memo_color="orange" memo="details"][/conditional]
MRI Checklist

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Sandbox Metrics: Structured Data Index 0.5, 3 form elements, 2 boilerplate words, 1 text boxes, 1 check lists, 1 conditionals, 24 total clicks
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