[textarea default="Patient requests contraception. She is not currently taking any birth control."]
Tobacco Use: [select value="no|yes"]
[textarea default="Vital Signs Within Normal Limits.
GENERAL: Well Developed and Well Nourished Female, Alert and oriented x 3, in no distress."]
[textarea default="discussed contraceptive means available including IUD, nuvaring, combination oral contraceptives, and implanon.
She wishes to proceed with ***.
Urine HCG obtained and is ***NEGATIVE***
Benefits and risks discussed with patient."]
There are 5 form elements.
Result - Copy and paste this output: