Visit Note

Patient's response to visit this date was [select name="variable_1" value="excellent|good|fair|poor"]. Interventions focused upon [checklist name="variable_1" value="HEP progression|strengthening|endurance training|gait mechanics|gait capacity|standing balance|transfer mechanics|safety awareness|postural positioning|core stabilization|pain management"].Therapist offered skilled instruction and cues which included [textarea name="variable_2" default="specific instruction/cues given"]. Progression [select name="variable_3" value="observed|hindered"] this date as supported by [textarea name="variable_4" default="examples of progression/roadblocks"]. Continued therapy services are medically necessary in order to [textarea name="variable_5" default="medical necessity"]; plan to include [textarea name="variable_6" default="future interventions"] for achievement of goals. 
Patient's response to visit this date was . Interventions focused upon .Therapist offered skilled instruction and cues which included
. Progression this date as supported by
. Continued therapy services are medically necessary in order to
; plan to include
for achievement of goals.

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Sandbox Metrics: Structured Data Index 0.43, 7 form elements, 40 boilerplate words, 4 text areas, 1 check lists, 2 drop downs, 17 total clicks
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