Flu

[checkbox name="variable_1" value="DOB confirmed"].
[checkbox name="variable_2" value="VIS form given to patient prior to administration"].
[checkbox name="variable_3" value="Consent form signed and scanned into patient's chart"].
[checkbox name="variable_4" value="Patient afebrile"].
risks and benefits discussed.
0.5 mL vaxine given in [select name="variable_5" value="right|left"] Deltoid. Patient tolerated procedure well.
~BW
.
.
.
.
risks and benefits discussed.
0.5 mL vaxine given in Deltoid. Patient tolerated procedure well.
~BW

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 1, 5 form elements, 14 boilerplate words, 4 checkboxes, 1 drop downs, 5 total clicks
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