Preplacement (NNN)

New Hire: [text name="newhire" default=""]
DOH: [date name="doh" default=""]
Work Group: NNN
Immunizations:
MMR: not required [text name="mmr" default=""]
Varicella: not required [text name="varicella" default=""]
HepB: not required [text name="hepb" default=""]

TdaP: [select name="TdaP" value="received|given today|"]
FLU:[select name="flu" value="received|given today|"]
COVID: [select name="COVID" value="x3|x2, instructed booster deadline was 3/31/22, needs booster ASAP in order to receive badge|"]

TB: [select name="TB" value="drawn @ lab today|received within last 90 days|tested positive in past - has documentation of +tb test, neg chest xray and drs. note stated counseling provided|"]
[text name="tb" default=""]

Allergies: [select name="allergies" value="none|yes"]
[text name="allergies" default=""]
Med Hx: [select name="MedHx" value="none|yes"]
[text name="MedHx" default=""]
Accommodations: [select name="Accommodations" value="none|yes"]
[text name="accommodations" default=""]



OHS Clearance: [select name="OHS_clearance" value="pending|cleared"]
Needs:
[text name="needs" default=""]
New Hire:
DOH:
Work Group: NNN
Immunizations:
MMR: not required
Varicella: not required
HepB: not required

TdaP:
FLU:
COVID:

TB:


Allergies:

Med Hx:

Accommodations:




OHS Clearance:
Needs:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.5, 18 form elements, 27 boilerplate words, 9 text boxes, 1 dates, 8 drop downs, 18 total clicks
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