contrib/forms/formmaker/sample.txt

   1 physical_sample
   2
   3 chief_complaints::textarea
   4
   5 <h3>past surgical history</h3>
   6 +surgical history::checkbox_group::cholecystectomy::tonsillectomy::apendectomy::hernia
   7 <h4>other</h4>
   8 surgical history other::textfield
   9
  10 <h3>past medical history</h3>
  11 +medical history::scrolling_list_multiples::asthma::diabetes::hypertension::GERD
  12 <h4>other</h4>
  13 medical history other::textfield
  14
  15 <h2>Allergies</h2>
  16 +allergies::checkbox_group::penicillin::sulfa::iodine
  17 <h4>other</h4>
  18 allergies other::textfield
  19
  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
  25 <h3>last mammogram</h3>
  26 last mammogram::date