Pain 2

C/o [select value="10|9|8|7|6|5|4|3|2|1|0|Severe|Moderate|Mild"] out of 10 
Pain orientation
[checkbox value="right|left|anterior|distal|inner|lower|mid|outer|posterior|proximal|upper|other"] [select value="abdomen|ankle|arm|back|breast|buttocks|chest|coccyx|ear|elbow|epigastric|extremity|eye|face|flank|foot|generalized|groin|hand|head|hip|incision|jaw|knee|leg|mediastinum|mouth|neck|nose|perlvis|perineum|penis|pretibia|rib cage|rectum|sacrum|sclera|shoulder|scrotum|sternum|tibia|throat|teeth|umbilicus|uterine|vagina|wrist"] pain
[checkbox value="Radiating to_|Non radiating"]
[select value="acute pain|chronic pain|surgical pain|neuropathic pain|phantom pain|referred pain"]
[select value="Gradual|Sudden|Progressing"] onset
Exacerbated by [select value="Movement|Reposition|Bending"]
Alleviated by [select value="Meds|Rest"]
Pain interventions [checkbox value="Meds|Massage|Music|Prayers|Walking|Distraction"]