Pain 2

C/o [select value="10|9|8|7|6|5|4|3|2|1|0|Resident unable to tell|Severe|Moderate|Mild"] out of 10 [select value="Generalized|Headache|Body|Arm|Back|Leg|Chest"] pain
[checkbox value="Radiating to_|Non radiating"]
[select value="Acute|Chronic"]
[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"]
C/o out of 10 pain

Exacerbated by
Alleviated by
Pain interventions

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 1, 8 form elements, 12 boilerplate words, 2 checkboxes, 6 drop downs, 14 total clicks
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