RPS checkbox

[checkbox value="Constitutional: No fevers, changes in weight, fatigue, night sweats|
Head: No headache, sinus congestion or pain|
Ears: No ear pain, discharge, hearing loss, tinnitus, vertigo|
Eyes No changes in vision, eye pain, diplopia, photophobia|
Nose: No nasal discharge, coryza, sneezing, epistaxis|
Throat: No cough, sore throat, dysphagia, odynophagia|
Skin: No diagnosed skin conditions, new lesions, rashes, discoloration, dryness, hair changes|
Heme: No easy bruising, easy bleeding|
CV: No chest pain, palpitations, edema, presyncope, decrease in exercise tolerance|
Resp: No expectoration, dyspnea with rest or exertion, increased puffer use, orthopnea, PND, wheeze|
GI: No abdominal pain, nausea, vomiting, diarrhea, constipation, melena, appetite changes, dyspepsia, belching|
GU: No dysuria, frequency, urgency, hematuria, nocturia, incontinence, dribbling, hesitancy, retention, flank pain|
Male: Denies discharge, lesions, testicular pain, hernias|
Female: Denies discharge, lesions, changes in dysmenorrhea, PMS, menstrual frequency, duration, flow, or symptoms|
MSK: No new weakness, arthralgias, myalgias|
Neuro: No weakness, confusion, numbness, dizziness, imbalance|
Endocrine: No polydipsia, polyuria, heat/cold sensitivity|
Pain: No new or unexplained pain|
Psychology: No new or worsening depression, anxiety, or insomnia, stress, anger|
Social: No change in home, relationships, employment, substance use, exercise, exposure|
Function: No change in ADLs or IADLS, memory, capacity"]

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 1, 1 form elements, 1 checkboxes, 21 total clicks
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