Sample encounter form with radio buttons
Demographics
Family Name:
Given Name:
Middle Name:
Gender:
...
Male
Female
Date Of Birth:
Medical Record Number :
*
Blood Group Information
Blood Group:
A+
A-
B+
B-
O+
O-
AB+
AB-
Encounter Details
Provider Name:
*
Provider Name
*
...
Encounter Location:
*
Encounter Location:
*
...
Encounter Date
*