Review of Systems
[text name="General"] [checkbox name="Reports:" value="Fever|Chills|Changes in appetite/activity|Unintended weight loss|Unintended weight gain"] [checkbox name="Denies:" value="Fever|Chills|Changes in appetite/activity|Unintended weight loss|Unintended weight gain"]
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Sandbox Metrics: Structured Data Index 0.67, 3 form elements, 1 text boxes, 2 checkboxes, 11 total clicks
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