Lower Back Pain Exam Elements

[comment memo_color="blue" memo="The formatting may be a little weird, but it's the output that matters."]
Strength.........Left/5.....Right/5.....Comment
Hip Flex.........[select name="variable_1" value="5|4|3|2|1|0"]..........[select name="variable_2" value="5|4|3|2|1|0"]...........[text name="variable_3"]
Knee Ext.........[select name="variable_4" value="5|4|3|2|1|0"]..........[select name="variable_5" value="5|4|3|2|1|0"]...........[text name="variable_6"]
Tib Ant..........[select name="variable_7" value="5|4|3|2|1|0"]..........[select name="variable_8" value="5|4|3|2|1|0"]...........[text name="variable_9"]
EHL..............[select name="variable_10" value="5|4|3|2|1|0"]..........[select name="variable_11" value="5|4|3|2|1|0"]...........[text name="variable_12"]
Gastroc/Soleus...[select name="variable_13" value="5|4|3|2|1|0"]..........[select name="variable_14" value="5|4|3|2|1|0"]...........[text name="variable_15"]
Sensation........Left.......Right.......Comment
L2...............[select name="variable_16" value="intact|dmnshd|absent"].....[select name="variable_17" value="intact|dmnshd|absent"]......[text name="variable_18"]
L3...............[select name="variable_19" value="intact|dmnshd|absent"].....[select name="variable_20" value="intact|dmnshd|absent"]......[text name="variable_21"]
L4...............[select name="variable_22" value="intact|dmnshd|absent"].....[select name="variable_23" value="intact|dmnshd|absent"]......[text name="variable_24"]
L5...............[select name="variable_25" value="intact|dmnshd|absent"].....[select name="variable_26" value="intact|dmnshd|absent"]......[text name="variable_27"]
S1...............[select name="variable_28" value="intact|dmnshd|absent"].....[select name="variable_29" value="intact|dmnshd|absent"]......[text name="variable_30"]
Test.............Left.......Right.......Comment
Patel. Reflex....[select name="variable_31" value="2+|4+|3+|2+|1+|0."].........[select name="variable_32" value="2+|4+|3+|2+|1+|0."]..........[text name="variable_33"]
Achil. Reflex....[select name="variable_34" value="2+|4+|3+|2+|1+|0."].........[select name="variable_35" value="2+|4+|3+|2+|1+|0."]..........[text name="variable_36"]
Clonus...........[select name="variable_37" value="negative|positive"]...[select name="variable_38" value="negative|positive"]....[text name="variable_39"]
SLR..............[select name="variable_40" value="negative|positive"]...[select name="variable_41" value="negative|positive"]....[text name="variable_42"]
The formatting may be a little weird, but it's the output that matters.
Strength.........Left/5.....Right/5.....Comment
Hip Flex..............................
Knee Ext..............................
Tib Ant...............................
EHL...................................
Gastroc/Soleus........................
Sensation........Left.......Right.......Comment
L2..........................
L3..........................
L4..........................
L5..........................
S1..........................
Test.............Left.......Right.......Comment
Patel. Reflex.......................
Achil. Reflex.......................
Clonus..................
SLR.....................

Result - Copy and paste this output:

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