Our patient presented for a(n) [select name="variable_1" value="initial visit|follow up|MRI review"] following a motor vehicle accident which occurred on [date name="variable_1" default="06/16/2020"]. Patient was the restrained [select name="variable_2" value="driver|front passenger|rear passenger"] of the vehicle. Patient reports that the air bags [select name="variable_3" value="did|did not"] deploy. Patient denies loss consciousness in the accident. The patient was initially seen at [select name="variable_4" value="the ER| the urgent care|our office"], where [select name="variable_5" value="x-rays|MRI|CT"] were taken. Our patient was [select name="variable_6" value="treated and released the same day|treated and was admitted"]. Patient denies any lightheadedness, change in vision, change in hearing, loss of urine or bowel control, or neurological deficits. [select name="variable_7" value="Patient denies any prior MVA or previous injuries and maintains that he was symptom-free prior to this accident.|Patient reports a previous MVA with injuries to the or previous injuries and maintains that he was symptom-free prior to this accident."] INITIAL COMPLAINTS: As a result of the accident, the patient complains of [textarea name="variable_8" default="sample text"]. The [textarea name="variable_1" default="sample text"] pain is rated as a [select name="variable_9" value="1/10|2/10|3/10|4/10|5/10|6/10|7/10|8/10|9/10|10/10"]. The pain is described as a [textarea name="variable_10" default="sample text"]. The pain is aggravated by [textarea name="variable_11" default="sample text"]. The pain is alleviated by [text name="variable_12" default="sample text"].
There are 14 form elements.
Result - Copy and paste this output:
Sandbox Metrics: Structured Data Index 0.64, 14 form elements, 100 boilerplate words, 1 text boxes, 4 text areas, 1 dates, 8 drop downs, 14 total clicks
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