Exercise Therapy Progress Note

Name[text name="variable_1" default="sample text"]DOB[text name="variable_1" default="sample text"][date name="variable_1" default="01/20/2020"]
HT[text name="variable_1" default="sample text"]WT[text name="variable_1" default="sample text"]BMI[text name="variable_1" default="sample text"]
BP[text name="variable_1" default="sample text"]Pulse[text name="variable_1" default="sample text"]
Patient Goals
[textarea name="variable_1" default="sample text"]
Subjective
[textarea name="variable_1" default="sample text"]
Objective
[textarea name="variable_1" default="sample text"]
Assessment
[textarea name="variable_1" default="sample text"]
Plan
Extensive counseling regarding diet, exercise, behavioral modifications and lifestyle changes.
Food / exercise journal
Supplements:  MVI / B12 / CA / Iron / Vit D
Nutritional Evaluation
Fitness Evaluation	
Exercise Therapy				
Other:[text name="variable_1" default="sample text"]

Potential for achieving goals:
[select name="variable_1" value="Excellent|Good|Fair"]
NameDOB
HTWTBMI
BPPulse
Patient Goals

Subjective

Objective

Assessment

Plan
Extensive counseling regarding diet, exercise, behavioral modifications and lifestyle changes.
Food / exercise journal
Supplements: MVI / B12 / CA / Iron / Vit D
Nutritional Evaluation
Fitness Evaluation
Exercise Therapy
Other:

Potential for achieving goals:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.14, 14 form elements, 40 boilerplate words, 8 text boxes, 4 text areas, 1 dates, 1 drop downs, 14 total clicks
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