AP/Chart Review

[checkbox name="variable_20" value="AP/Chart Review|AP/In-person Visit"]
[textarea name="variable_21" default=""]
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Immunizations:
MMR: [checkbox name="variable_1" value="vaccine x 2|hx of pos titers|not required|not provided|titers today|other"]
Varicella: [checkbox name="variable_2" value="vaccine x 2|hx of pos titer|not required|not provided|titer today|other"]
Hep B: [checkbox name="variable_3" value="vaccine x 3|hx of pos titer|declination signed|not required|not provided|VIS reviewed, consent signed, administered today|titer today|other"]
Tdap: [checkbox name="variable_4" value="UTD|last immunization >10 years|not provided|VIS reviewed, consent signed, administered today|other"]
Flu: [checkbox name="variable_5" value="UTD|not provided|VIS reviewed, consent signed, administered today|not    currently    needed,    outside    flu    season|other"]

COVID: [checkbox name="variable_6" value="COVID vaccine '24-25 x1|not provided|VIS reviewed, consent signed, administered today|not currently    needed, outside season|other"]
TB: [checkbox name="variable_7" value="Neg IGRA w/i 90 doh|TST x 2, most current w/i 90 doh|IGRA today|not provided|hx of pos TST or IGRA|Neg CXR provided|TB SA negative|not required|other"]
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Arch Baseline Questionnaire: [checkbox name="variable_9" value="clear|added to annual surveillance|working with large animals, Q-fever required|not required|not provided|other"]
Respiratory Baseline Questionnaire: [checkbox name="variable_10" value="clear|not clear|not required|not provided|other"]
[text name="variable_1" default="comments"]
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Recommended: [textarea name="variable_11" default=" "]
Needs: [textarea name="variable_18" default=" "]
OHS clearance: [checkbox name="variable_19" value="clear|pending|clear for badge"]