syphillis tertiary

Tertiary syphilis symptoms history:
[checklist name=""Symptoms" value="early neurosyphilis - symtomatic syphilitic meningitis resembles aseptic meningitis may include fever, headache, stiff neck with basilar involvement, cranial nerve abnormalities (*CNII (Visual acuity),VI (follow finger to nose trochlear), VIII(auditory rub fingers)| ocular syphilis-uveitis anterior, posterior, or panuveitis; lid involvement,episcleritis,vitrtis, papilliatis, "]
-Symptoms started [text size="3"] [select value="day(s)|week(s)|hour(s)|month(s)|year(s)"] ago.[text size="80"].
-Related activities or events that occured at or right before symptoms started: [text size="80"].
Tertiary syphilis symptoms history:

-Symptoms started ago..
-Related activities or events that occured at or right before symptoms started: .

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.4, 5 form elements, 19 boilerplate words, 3 text boxes, 1 check lists, 1 drop downs, 6 total clicks
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