Assessment & Plan Elements
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Team member presents today [select name="wwo" value="with|without|"] a doctor's note. [select name="heshe" value="He|She|"] is requesting accommodations for [text name="whatfor" size="40"].
In the office today:
[checkbox name="IO" value="Cigna information was provided and TM was instructed to call|Release of information was signed|the reasonable accommodation request form was completed by the TM|the medical inquiry form was given to be completed by their PCP|work status form initiated|work status form completed and sent to WTL, LMA, HRBP & EE|RA log updated|TM added to RA log|***"].
Follow up date scheduled with HS: [text name="date" size="20"].
Follow up date scheduled with PCP: [text name="datefu" size="20"]
Team member presents today a doctor's note. is requesting accommodations for .
In the office today:
.
Follow up date scheduled with HS: .
Follow up date scheduled with PCP:

Result - Copy and paste this output:

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