Home Health Intake Report

The patient is a [text name="variable_1" default="-year-old"] [select name="variable_1" value="male|female"] open to home health for the following services:      [checkbox name="variable_1" value="medication teaching|wound care|home safety|knee pilot|hip pilot"].

Pertinent Medical History includes: 
[checkbox name="variable_1" value="Diabetes|Heart Failure|HTN|Recent Joint Surgery"]
The patient is a open to home health for the following services: .

Pertinent Medical History includes:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.75, 4 form elements, 16 boilerplate words, 1 text boxes, 2 checkboxes, 1 drop downs, 11 total clicks
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