BOP- General Sick call
[text name="variable_1" default="AGE"] year old AIC seen in [text name="variable_2" default="LOCATION VISIT"] for [text name="variable_3" default="Complaint"]: 1. [text name="variable_3" default="Complaint"]: - Onset:[text name="variable_4" default="sample text"][select name="variable_6" value="days|weeks|months"] - Location of Sx: [textarea name="variable_5" default=""] - Duration: [text name="variable_7" default=""] - Characteristic: [textarea name="variable_8" default=""] - Associated Sx: [textarea name="variable_9" default=""] - Aggravting factors: [text name="variable_10" default=""] - Relieving factors: [text name="variable_11" default=""] - Severity/pain: [textarea name="variable_12" default=""] otc/non-rx remedies tried: [text name="variable_13" default="sample text"]
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Sandbox Metrics: Structured Data Index 0.07, 14 form elements, 32 boilerplate words, 9 text boxes, 4 text areas, 1 drop downs, 14 total clicks
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