TEST
DISPATCHED TO ABOVE ADDRESS FOR REPORTED:[textarea name="dispatch" default=" "] RESPONSE: [checkbox name="RESPONSE" value="EMERGENT;LIGHTS/SIRENS.|NONEMERGENT;NO LIGHTS/SIRENS.|ARRIVED WITHOUT INCIDENT."] DISPATCH PRIORITY: [checkbox name="Alpha" value="3|2|1"] =================================================================================== ************** * COVID - 19 * ************** Close contact with person with confirmed or suspected COVID-19: [select name="variable_2" value="NO|YES"] Travel to high risk COVID-19 areas per current local guidance: [select name="variable_3" value="NO|YES"] SYMPTOMS: [textarea name="variable_1" default="NONE"] Symptoms are [select name="variable_1"name="variable_2"name="variable_3"name="variable_3"name=variable_4"name=variable_5"name=variable_5"name=variable_6"name="variable_7"name=variable_8" value="IMPROVING|WORSENING|STAYING THE SAME"] since onset. =================================================================================== *** SUBJECTIVE *** =================================================================================== =================================================================================== Arrived to find [text name="variable_1" default="sample text"][text name="variable_1" default=" "] Age [text name="variable_1" default=" "] Gender [checkbox name="Gender" value="Male|Female|Refused to Answer"] Patient complained of: [textarea name="The Patient complained of" default="sample text"] Patient DENIED:[textarea name="The Patient denied the following:" default="sample text"] Patient's Medical History: [textarea name="The Patient's Medical History is" default="sample text"] Patient's Allergies: [textarea name="The Patient's Allergies are" default="sample text"] Patient's Medications: [textarea name="The Patient's Medications are" default="sample text"] =================================================================================== Onset: [text name="Onset:" default="sample text"] Location: [text name="Location:" default="sample text"] Duration:[text name="Duration:" default="sample text"] Characterization:[text name="Characterization:" default="sample text"] Alleviating and Aggravating Factors:[text name="Alleviating and Aggravating Factors default="sample text"] Radiation:[text name="Radiation" default="sample text"] Time:[text name="Time" default="sample text"] Severity:[text name="Severity" default="sample text"] =================================================================================== Admits or Denies Headache[select name="variable_1" value="NO|YES"] Dizziness[select name="variable_1" value="NO|YES"] Blurred Vision[select name="variable_1" value="NO|YES"] Nausea[select name="variable_1" value="NO|YES"] Vomiting[select name="variable_1" value="NO|YES"] Diarrhea[select name="variable_1" value="NO|YES"] Chest Pain[select name="variable_1" value="NO|YES"] Difficulty Breathing[select name="variable_1" value="NO|YES"] Abdominal Pain[select name="variable_1" value="NO|YES"] Pelvic Pain[select name="variable_1" value="NO|YES"] Leg Pain[select name="variable_1" value="NO|YES"] Arm Pain[select name="variable_1" value="NO|YES"] Back Pain[select name="variable_1" value="NO|YES"] Neck Pain[select name="variable_1" value="NO|YES"] LOC[select name="variable_1" value="NO|YES"] Alcoholic Beverages[select name="variable_1" value="NO|YES"] Recreational Drugs[select name="variable_1" value="NO|YES"] Pregnancy[select name="variable_1" value="NO|YES"] Foreign Travel[select name="variable_1" value="NO|YES"] Recent Illness[select name="variable_1" value="NO|YES"] Recent Trauma[select name="variable_1" value="NO|YES"] Recent Surgery[select name="variable_1" value="NO|YES"] =================================================================================== == Objective == =================================================================================== ABC'S Airway: [checkbox name="variable_1" value="Patent|Compromised|Obstructed"] Breathing: ---Regularity [checkbox name="variable_1" value="Regular|Irregular|Agonal|Apneic"] ---Rate [checkbox name="variable_1" value="Normal|Fast|Slow"] ---Depth [checkbox name="variable_1" value="Normal|Shallow|Deep"] ---Effort [checkbox name="variable_1" value="Without Effort|With Effort"] Circulation: Skin: [checkbox name="variable_1" value="Pink|Pale|Cyanotic|Jaundice|Lividity|Mottled"] Hospital Destination: [text name="Hospital Destination" default=" "] Reason For Hospital Destinaton: [text name="Reason For Hospital Destination" default=" "]
Result - Copy and paste this output:
Sandbox Metrics: Structured Data Index 0.63, 54 form elements, 120 boilerplate words, 13 text boxes, 7 text areas, 9 checkboxes, 25 drop downs, 75 total clicks
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