Bedside Ultrasound Reports 2 of 2 (DRAFT)

Performed by: [text size="40"]
Interpreted by: [text size="40"]
[checkbox memo="Supervising Physician" name="ussup" value="" memo_color="lightgreen"][conditional field="ussup" condition="(ussup).is('')"]Supervised by: [text size="20"][/conditional]
Chaperoned by: [conditional field="procchapdecl" condition="(procchapdecl).isNot('declined')"][text size="40"][/conditional][checkbox name="procchapdecl" value="Patient declined"]

Consent: [select name="abdmiscconsent_1" value="Verbal|Written|Not obtained"]
Exam Performed:[select name="abdminconsent_2" value="Complete|Limited"]

[checkbox name="variable_8" value="Fluid Status Scan" value="Fluid Status Ultrasound Report"][checkbox name="variable_9" value="Lung Scan" value="Lung Ultrasound Report"][checkbox name="variable_10" value="Non-OB Pelvic Scan" value="Non-OB Pelvic Ultrasound Report"][checkbox name="variable_11" value="Ocular Scan" value="Ocular Ultrasound Report"][checkbox name="variable_12" value="Renal Scan" value="Renal Ultrasound Report"][checkbox name="variable_13" value="RUQ Scan" value="Right Upper Quadrant Ultrasound Report"][checkbox name="variable_14" value="RUSH Scan" value="RUSH Ultrasound Report"][checkbox name="variable_15" value="Testicular Scan" value="Testicular Ultrasound Report"]

[checkbox memo="*" memo_size="small" memo_color="blue" name="endfreetext" value="Additional comments:"][conditional field="endfreetext" condition="(endfreetext).is('Additional comments:')"] [textarea default="none"][/conditional]
Performed by:
Interpreted by:
Supervising Physician
Chaperoned by:

Exam Performed:


Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.72, 21 form elements, 9 boilerplate words, 4 text boxes, 1 text areas, 11 checkboxes, 2 drop downs, 3 conditionals, 18 total clicks
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