Contributed by Mark Leds at mail_at_doc99_dot_com
[openemr.git] / contrib / forms / formmaker / sample.txt
blob53a7d4fe09001cec0c42a969c411bbf50f18b549
1 a1_preop_physical
3 chief_complaints::textarea
5 <h3>past surgical history</h3>
6 +surgical history::checkbox_group::cholecystectomy::tonsillectomy::apendectomy
7 <h4>other</h4>
8 surgical history other::textfield
10 <h3>past surgical history</h3>
11 +medical history::scrolling_list_multiples::asthma::diabetes::hypertension
12 <h4>other</h4>
13 medical history other::textfield
15 <h2>Allergies</h2>
16 +allergies::checkbox_group::penicillin::sulfa::iodine
17 <h4>other</h4>
18 allergies other::textfield
20 <h2>Social History</h2>
21 <h3>smoking</h3>
22 smoke history::radio_group::non-smoker::smoker
23 <h3>alcohol</h3>
24 etoh history::scrolling_list::none::occasional::daily::heavy use