BREASTS:
[text name="variable_1" size=80 default="No chest deformity, asymmetry. Normal contours. No nodules, masses, tenderness, or axillary adenopathy. No nipple discharge."][comment memo="Enter abnormal details below..."]
[select name="variable_2" value="|Left side:|Right side:"] [checkbox name="variable_3" value="dimpling|mastectomy|fibrocystic changes|breast tenderness|muscle tenderness|dominant mass|nipple discharge|axillary adenopathy"] [text name="variable_4"]
[select name="variable_5" value="|Left side:|Right side:"] [checkbox name="variable_6" value="dimpling|mastectomy|fibrocystic changes|breast tenderness|muscle tenderness|dominant mass|nipple discharge|axillary adenopathy"] [text name="variable_7"]