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      <Label Name="STICKERLabel" Left="468" Top="84" Width="324" Height="37" MobileOrder="-1" Text="STICKER" FontName="Segoe UI" IsBold="True" FontSize="18" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Label Name="ETALabel" Left="204" Top="113" Width="75" Height="25" MobileOrder="3" Text="ETA:" FontName="Segoe UI" IsBold="True" FontSize="16" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <ComboBox Name="ETA" Left="264" Top="113" Width="120" Height="25" TabOrder="1" MobileOrder="4" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="&lt; 1 Min" IsSelected="True" />
        <ComboBoxItem Text="1 - 5 Mins" />
        <ComboBoxItem Text="5 - 10 Mins" />
        <ComboBoxItem Text="10 - 15 Mins" />
        <ComboBoxItem Text="15 - 20 Mins" />
        <ComboBoxItem Text="20 - 25 Mins" />
        <ComboBoxItem Text="&gt; 30 Mins" />
      </ComboBox>
      <Line Name="Line10" Left="36" Top="144" Width="0" Height="876" ZIndex="1" LineThickness="3" />
      <Label Name="Ambulance_Patient_Report_and_SIGNIN_FormLabel" Left="50" Top="150" Width="744" Height="25" MobileOrder="5" Text="Ambulance Patient Report and SIGN-IN Form" FontName="Segoe UI" IsBold="True" IsUnderlined="True" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Label Name="DateTimeLabel" Left="84" Top="168" Width="63" Height="25" MobileOrder="6" Text="Date/Time:" FontName="Segoe UI" HorizontalTextAlignment="Right" VerticalTextAlignment="Center" />
      <DateTimePicker Name="DateTimePicker" Left="156" Top="168" Width="192" Height="24" TabOrder="2" MobileOrder="7" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="Control_Label" Left="360" Top="168" Width="63" Height="25" MobileOrder="8" Text="Control #:" FontName="Segoe UI" HorizontalTextAlignment="Right" VerticalTextAlignment="Center" />
      <EditBox Name="Control_" Left="432" Top="168" Width="72" Height="24" TabOrder="3" MobileOrder="9" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="TCC_Label" Left="552" Top="168" Width="36" Height="25" MobileOrder="10" Text="TCC #:" FontName="Segoe UI" HorizontalTextAlignment="Right" VerticalTextAlignment="Center" />
      <EditBox Name="TCC_" Left="600" Top="168" Width="72" Height="24" TabOrder="4" MobileOrder="11" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line11" Left="780" Top="144" Width="0" Height="876" ZIndex="2" LineThickness="3" Slope="Rising" />
      <Label Name="MedicLabel" Left="96" Top="192" Width="36" Height="25" MobileOrder="12" Text="Medic:" FontName="Segoe UI" HorizontalTextAlignment="Right" VerticalTextAlignment="Center" />
      <EditBox Name="Medic" Left="156" Top="192" Width="100" Height="25" TabOrder="5" MobileOrder="13" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="AgeLabel" Left="384" Top="192" Width="24" Height="25" MobileOrder="14" Text="Age:" FontName="Segoe UI" HorizontalTextAlignment="Right" VerticalTextAlignment="Center" />
      <EditBox Name="Age" Left="432" Top="192" Width="72" Height="25" TabOrder="6" MobileOrder="15" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="SexLabel" Left="564" Top="192" Width="36" Height="25" MobileOrder="17" Text="Sex:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <RadioButton Name="Ambulance_Company_Northstar" Left="90" Top="216" Width="60" Height="25" TabOrder="9" MobileOrder="21" GroupName="Ambulance_Company" Text="EMS 1" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Ambulance_Company_Fayette" Left="160" Top="216" Width="60" Height="25" TabOrder="10" MobileOrder="22" GroupName="Ambulance_Company" Text="EMS 2" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Ambulance_Company_Pickens" Left="230" Top="216" Width="60" Height="25" TabOrder="11" MobileOrder="23" GroupName="Ambulance_Company" Text="EMS 3" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Ambulance_Company_Hale" Left="300" Top="216" Width="63" Height="25" TabOrder="12" MobileOrder="24" GroupName="Ambulance_Company" Text="EMS 4" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Ambulance_Company_Greene" Left="370" Top="216" Width="60" Height="25" TabOrder="13" MobileOrder="25" GroupName="Ambulance_Company" Text="EMS 5" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Ambulance_Company_Lifecare" Left="440" Top="216" Width="60" Height="25" TabOrder="14" MobileOrder="26" GroupName="Ambulance_Company" Text="EMS 6" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Ambulance_Company_Care" Left="510" Top="216" Width="60" Height="25" TabOrder="15" MobileOrder="27" GroupName="Ambulance_Company" Text="EMS 7" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Ambulance_Company_AirEvac" Left="580" Top="216" Width="60" Height="25" TabOrder="16" MobileOrder="28" GroupName="Ambulance_Company" Text="EMS 8" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Ambulance_Company_Northflight" Left="650" Top="216" Width="60" Height="25" TabOrder="17" MobileOrder="29" GroupName="Ambulance_Company" Text="EMS 9" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <EditBox Name="Ambulance_Company_Other1" Left="144" Top="240" Width="588" Height="24" TabOrder="19" MobileOrder="31" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="TraumaLabel" Left="36" Top="264" Width="744" Height="25" MobileOrder="32" Text="Trauma" FontName="Segoe UI" IsBold="True" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" Background="#FFDCDCDC" />
      <Line Name="Line12" Left="36" Top="288" Width="744" Height="0" />
      <Label Name="InvolvedLabel" Left="41" Top="313" Width="75" Height="25" MobileOrder="34" Text="Involved" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <RadioButton Name="Involved_MVC" Left="41" Top="338" Width="75" Height="23" TabOrder="20" MobileOrder="35" GroupName="Involved" Text="MVC" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Involved_Motorcycle" Left="41" Top="361" Width="84" Height="24" TabOrder="21" MobileOrder="36" GroupName="Involved" Text="Motorcycle" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Involved_ATV" Left="41" Top="385" Width="72" Height="24" TabOrder="22" MobileOrder="37" GroupName="Involved" Text="ATV" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Involved_Bicycle" Left="41" Top="409" Width="75" Height="24" TabOrder="23" MobileOrder="38" GroupName="Involved" Text="Bicycle" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Involved_Pedestrian" Left="41" Top="433" Width="84" Height="24" TabOrder="24" MobileOrder="39" GroupName="Involved" Text="Pedestrian" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Involved_Watercraft" Left="41" Top="457" Width="79" Height="24" TabOrder="25" MobileOrder="40" GroupName="Involved" Text="Watercraft" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Involved_Sporting" Left="41" Top="481" Width="75" Height="24" TabOrder="26" MobileOrder="41" GroupName="Involved" Text="Sporting" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Line Name="Line13" Left="126" Top="312" Width="0" Height="240" Slope="Rising" />
      <Line Name="Line14" Left="252" Top="312" Width="1" Height="239" />
      <Label Name="Patient_WasLabel" Left="120" Top="312" Width="132" Height="25" MobileOrder="42" Text="Patient Was:" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <RadioButton Name="Patient_Was_Driver" Left="130" Top="337" Width="108" Height="25" TabOrder="27" MobileOrder="43" GroupName="Patient_Was" Text="Driver" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Patient_Was_Passenger__Front" Left="130" Top="361" Width="120" Height="24" TabOrder="28" MobileOrder="44" GroupName="Patient_Was" Text="Passenger - Front" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Patient_Was_Passenger__Back" Left="130" Top="385" Width="120" Height="24" TabOrder="29" MobileOrder="45" GroupName="Patient_Was" Text="Passenger - Back" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Patient_Was_Pedestrian_Struck" Left="130" Top="409" Width="120" Height="24" TabOrder="30" MobileOrder="46" GroupName="Patient_Was" Text="Pedestrian Struck" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Patient_Was_Bicycle_Struck" Left="130" Top="433" Width="108" Height="24" TabOrder="31" MobileOrder="47" GroupName="Patient_Was" Text="Bicycle Struck" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Patient_Was_Unknown" Left="130" Top="457" Width="84" Height="24" TabOrder="32" MobileOrder="48" GroupName="Patient_Was" Text="Unknown" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Seat_Belt" Left="258" Top="336" Width="72" Height="23" TabOrder="33" MobileOrder="49" Text="Seat Belt" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Airbag" Left="258" Top="360" Width="72" Height="22" TabOrder="34" MobileOrder="50" Text="Airbag" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Helmet" Left="258" Top="384" Width="72" Height="24" TabOrder="35" MobileOrder="51" Text="Helmet" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Ejected" Left="258" Top="408" Width="72" Height="24" TabOrder="36" MobileOrder="52" Text="Ejected" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Extracted" Left="258" Top="432" Width="84" Height="24" TabOrder="37" MobileOrder="53" Text="Extracted" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Death_of_another_Occupant" Left="258" Top="456" Width="115" Height="24" TabOrder="38" MobileOrder="54" Text="Death of another" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Unknown" Left="258" Top="504" Width="84" Height="24" TabOrder="39" MobileOrder="55" Text="Unknown" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="OccupantLabel" Left="282" Top="480" Width="60" Height="23" MobileOrder="-1" Text="occupant" FontName="Segoe UI" FontSize="11" VerticalTextAlignment="Center" />
      <Line Name="Line15" Left="372" Top="312" Width="0" Height="240" Slope="Rising" />
      <Label Name="ImpactLabel" Left="389" Top="313" Width="48" Height="24" MobileOrder="56" Text="Impact" FontName="Segoe UI" FontSize="11" VerticalTextAlignment="Center" />
      <RadioButton Name="Impact_Front" Left="382" Top="339" Width="72" Height="23" TabOrder="40" MobileOrder="57" GroupName="Impact" Text="Front" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Impact_Driver_Side" Left="382" Top="362" Width="84" Height="24" TabOrder="41" MobileOrder="58" GroupName="Impact" Text="Driver Side" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Impact_Passenger_Side" Left="382" Top="386" Width="108" Height="24" TabOrder="42" MobileOrder="59" GroupName="Impact" Text="Passenger Side" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Impact_Rear" Left="382" Top="410" Width="60" Height="24" TabOrder="43" MobileOrder="60" GroupName="Impact" Text="Rear" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Impact_Rollover" Left="382" Top="434" Width="72" Height="24" TabOrder="44" MobileOrder="61" GroupName="Impact" Text="Rollover" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Impact_Tbone" Left="382" Top="458" Width="72" Height="24" TabOrder="45" MobileOrder="62" GroupName="Impact" Text="T-bone" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Impact_Unknown" Left="382" Top="482" Width="72" Height="24" TabOrder="46" MobileOrder="63" GroupName="Impact" Text="Unknown" FontName="Segoe UI" FontSize="11" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Line Name="Line16" Left="486" Top="288" Width="0" Height="264" Slope="Rising" />
      <Image Name="Picture1" Left="204" Top="36" Width="252" Height="68" MobileOrder="-1" ZIndex="-2" Path="C:\ProgramData\General Devices\Forms\Builder\Temp\Bar Code2 (1) (1) (1) (1).png">
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      <Line Name="Line21" Left="36" Top="336" Width="451" Height="0" />
      <Label Name="MedicalLabel" Left="36" Top="552" Width="744" Height="25" MobileOrder="95" Text="Medical" FontName="Segoe UI" IsBold="True" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" Background="#FFDCDCDC" />
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      <CheckBox Name="Hypoglycemia" Left="336" Top="600" Width="108" Height="24" TabOrder="81" MobileOrder="109" Text="Hypoglycemia" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
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      <Label Name="AirwayLabel" Left="48" Top="672" Width="75" Height="25" MobileOrder="127" Text="Airway:" FontName="Segoe UI" IsBold="True" VerticalTextAlignment="Center" />
      <RadioButton Name="Airway_Non_Rebreather" Left="120" Top="672" Width="108" Height="25" TabOrder="91" MobileOrder="128" GroupName="Airway" Text="Non Rebreather" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Airway_Cannula" Left="228" Top="672" Width="75" Height="25" TabOrder="92" MobileOrder="129" GroupName="Airway" Text="Cannula" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Airway_Nasal" Left="300" Top="672" Width="60" Height="25" TabOrder="93" MobileOrder="130" GroupName="Airway" Text="Nasal" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Airway_Oral" Left="360" Top="672" Width="48" Height="25" TabOrder="94" MobileOrder="131" GroupName="Airway" Text="Oral" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Airway_King" Left="408" Top="672" Width="48" Height="25" TabOrder="95" MobileOrder="132" GroupName="Airway" Text="King" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Airway_Trach" Left="456" Top="672" Width="60" Height="25" TabOrder="96" MobileOrder="133" GroupName="Airway" Text="Trach" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Airway_ETT_Size" Left="516" Top="672" Width="75" Height="25" TabOrder="97" MobileOrder="134" GroupName="Airway" Text="ETT Size" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="VSLabel" Left="48" Top="648" Width="36" Height="25" MobileOrder="113" Text="VS:" FontName="Segoe UI" IsBold="True" VerticalTextAlignment="Center" />
      <Label Name="BreathingLabel" Left="48" Top="696" Width="75" Height="25" MobileOrder="135" Text="Breathing:" FontName="Segoe UI" IsBold="True" VerticalTextAlignment="Center" />
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      <RadioButton Name="Breathing_Labored" Left="192" Top="696" Width="75" Height="25" TabOrder="99" MobileOrder="137" GroupName="Breathing" Text="Labored" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Breathing_Apneic" Left="264" Top="696" Width="75" Height="25" TabOrder="100" MobileOrder="138" GroupName="Breathing" Text="Apneic" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Breathing_Assisted" Left="336" Top="696" Width="75" Height="25" TabOrder="101" MobileOrder="139" GroupName="Breathing" Text="Assisted" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="CirculationLabel" Left="48" Top="720" Width="75" Height="25" MobileOrder="140" Text="Circulation:" FontName="Segoe UI" IsBold="True" VerticalTextAlignment="Center" />
      <CheckBox Name="IV_Left_Check" Left="120" Top="720" Width="60" Height="25" TabOrder="102" MobileOrder="141" Text="IV Left" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="IV_Left_Fluid_Check" Left="252" Top="720" Width="48" Height="25" TabOrder="104" MobileOrder="143" Text="Fluid" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="IV_Right_Check" Left="372" Top="720" Width="72" Height="25" TabOrder="106" MobileOrder="145" Text="IV Right" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="IV_Right_Fluid_Check" Left="516" Top="720" Width="48" Height="25" TabOrder="108" MobileOrder="147" Text="Fluid" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Total" Left="648" Top="720" Width="48" Height="25" TabOrder="110" MobileOrder="149" Text="Total" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <EditBox Name="Circ_IV_Left" Left="180" Top="720" Width="60" Height="25" TabOrder="103" MobileOrder="142" FontName="Segoe UI" Background="#FFFFFFFF" />
      <EditBox Name="IV_Left_Fluid" Left="300" Top="720" Width="60" Height="25" TabOrder="105" MobileOrder="144" FontName="Segoe UI" Background="#FFFFFFFF" />
      <EditBox Name="Circ_IV_Right" Left="444" Top="720" Width="60" Height="25" TabOrder="107" MobileOrder="146" FontName="Segoe UI" Background="#FFFFFFFF" />
      <EditBox Name="IV_Right_Fluid" Left="576" Top="720" Width="60" Height="25" TabOrder="109" MobileOrder="148" FontName="Segoe UI" Background="#FFFFFFFF" />
      <EditBox Name="IV_Total" Left="696" Top="720" Width="60" Height="25" TabOrder="111" MobileOrder="150" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="DisabilityLabel" Left="48" Top="744" Width="60" Height="25" MobileOrder="151" Text="Disability:" FontName="Segoe UI" IsBold="True" VerticalTextAlignment="Center" />
      <Label Name="AOX3Label" Left="120" Top="744" Width="36" Height="25" MobileOrder="152" Text="A/OX3" FontName="Segoe UI" IsBold="True" VerticalTextAlignment="Center" />
      <RadioButton Name="AOX3_Yes" Left="168" Top="744" Width="48" Height="25" TabOrder="112" MobileOrder="153" GroupName="AOX3" Text="Yes" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="AOX3_No" Left="216" Top="744" Width="36" Height="25" TabOrder="113" MobileOrder="154" GroupName="AOX3" Text="No" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="Responds_to_CommandsLabel" Left="264" Top="744" Width="132" Height="25" MobileOrder="155" Text="Responds to Commands" FontName="Segoe UI" IsBold="True" VerticalTextAlignment="Center" />
      <RadioButton Name="Responds_to_Commands_Yes" Left="408" Top="744" Width="48" Height="25" TabOrder="114" MobileOrder="156" GroupName="Responds_to_Commands" Text="Yes" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Responds_to_Commands_No" Left="456" Top="744" Width="36" Height="25" TabOrder="115" MobileOrder="157" GroupName="Responds_to_Commands" Text="No" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="LOCLabel" Left="504" Top="744" Width="36" Height="25" MobileOrder="158" Text="+LOC" FontName="Segoe UI" IsBold="True" VerticalTextAlignment="Center" />
      <RadioButton Name="LOC_Yes" Left="540" Top="744" Width="48" Height="25" TabOrder="116" MobileOrder="159" GroupName="LOC" Text="Yes" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="LOC_No" Left="588" Top="744" Width="36" Height="25" TabOrder="117" MobileOrder="160" GroupName="LOC" Text="No" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="LOC_Unk" Left="636" Top="744" Width="48" Height="25" TabOrder="118" MobileOrder="161" GroupName="LOC" Text="Unk" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="GCSLabel" Left="684" Top="744" Width="36" Height="25" MobileOrder="162" Text="GCS:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="GCS" Left="720" Top="744" Width="36" Height="25" TabOrder="119" MobileOrder="163" FontName="Segoe UI" Background="#FFFFFFFF" />
      <CheckBox Name="Backboard" Left="48" Top="768" Width="84" Height="25" TabOrder="120" MobileOrder="164" Text="Backboard" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="CCollar" Left="132" Top="768" Width="75" Height="25" TabOrder="121" MobileOrder="165" Text="C-Collar" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Splint" Left="204" Top="768" Width="60" Height="25" TabOrder="122" MobileOrder="166" Text="Splint" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <EditBox Name="Splint_Text" Left="264" Top="768" Width="204" Height="24" TabOrder="123" MobileOrder="167" FontName="Segoe UI" Background="#FFFFFFFF" />
      <CheckBox Name="Dressing" Left="480" Top="768" Width="75" Height="25" TabOrder="124" MobileOrder="168" Text="Dressing" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <EditBox Name="Dressing_Label" Left="552" Top="768" Width="204" Height="25" TabOrder="125" MobileOrder="169" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line27" Left="36" Top="792" Width="744" Height="0" LineThickness="2" />
      <Label Name="Signature_of_RNLabel" Left="48" Top="792" Width="96" Height="25" MobileOrder="170" Text="Signature of RN:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="Signature_of_RN" Left="144" Top="792" Width="252" Height="25" TabOrder="126" MobileOrder="171" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="DoctorLabel" Left="456" Top="792" Width="48" Height="25" MobileOrder="172" Text="Doctor:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="Doctor" Left="500" Top="792" Width="256" Height="25" TabOrder="127" MobileOrder="173" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="DestinationLabel" Left="48" Top="816" Width="75" Height="25" MobileOrder="174" Text="Destination:" FontName="Segoe UI" HorizontalTextAlignment="Right" VerticalTextAlignment="Center" />
      <ComboBox Name="Destination" Left="144" Top="816" Width="108" Height="24" TabOrder="128" MobileOrder="175" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Hospital 1" IsSelected="True" />
        <ComboBoxItem Text="Hospital 2" />
        <ComboBoxItem Text="Hospital 3" />
        <ComboBoxItem Text="Other" />
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      <EditBox Name="Other_Hospital" Left="252" Top="816" Width="144" Height="24" TabOrder="129" MobileOrder="176" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line28" Left="36" Top="840" Width="744" Height="0" LineThickness="2" />
      <Label Name="Arrival_TimeLabel" Left="72" Top="857" Width="75" Height="25" MobileOrder="177" Text="Arrival Time:" FontName="Segoe UI" HorizontalTextAlignment="Right" VerticalTextAlignment="Center" />
      <EditBox Name="Arrival_Time" Left="168" Top="857" Width="108" Height="25" TabOrder="130" MobileOrder="178" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="Room_NumberLabel" Left="564" Top="857" Width="96" Height="25" MobileOrder="179" Text="Room Number:" FontName="Segoe UI" VerticalTextAlignment="Center" />
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      <Line Name="Line29" Left="36" Top="852" Width="744" Height="0" LineThickness="2" />
      <Label Name="PatientGuardian_SignatureLabel" Left="48" Top="984" Width="156" Height="25" MobileOrder="-1" Text="Patient/Guardian Signature:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Line Name="Line30" Left="204" Top="1008" Width="324" Height="0" />
      <Label Name="DateTimeLabel1" Left="528" Top="984" Width="60" Height="25" MobileOrder="-1" Text="Date/Time:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Line Name="Line31" Left="588" Top="1008" Width="168" Height="0" />
      <Line Name="Line32" Left="36" Top="1020" Width="744" Height="0" LineThickness="3" />
      <Label Name="9996300Label" Left="48" Top="1020" Width="75" Height="25" MobileOrder="-1" Text="9996300" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="Burn_Electrical_VoltageLabel" Left="624" Top="456" Width="48" Height="25" MobileOrder="82" Text="Voltage" FontName="Segoe UI" FontSize="11" VerticalTextAlignment="Center" />
      <EditBox Name="Burn_Electrical_Voltage" Left="624" Top="480" Width="48" Height="25" TabOrder="60" MobileOrder="83" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="The_undersigned_consents_to_any_diagnosis_procedures_anesthesia_emergency_medical_or_surgical_treatment_or_hospital_servicesLabel" Left="54" Top="894" Width="720" Height="18" MobileOrder="-1" Text="The undersigned consents to any diagnosis procedures, anesthesia, emergency, medical or surgical treatment or hospital services" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="rendered_the_patient_under_the_general_and_specific_instructions_of_the_physician_The_undersigned_recognizes_that_all_physiciansLabel" Left="54" Top="906" Width="720" Height="18" MobileOrder="-1" Text="rendered the patient under the general and specific instructions of the physician. The undersigned recognizes that all physicians" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="including_their_employed_or_contracted_physician_assistants_surgical_assistants_and_nurse_practitioners_providing_consultative_servicesLabel" Left="54" Top="918" Width="720" Height="18" MobileOrder="-1" Text="(including their employed or contracted physician assistants, surgical assistants and nurse practitioners) providing consultative services" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="to_the_patient_including_the_radiologist_pathologist_anesthesiologist_and_the_like_are_independent_contractors_and_are_not_employeesLabel" Left="54" Top="930" Width="720" Height="18" MobileOrder="-1" Text="to the patient, including the radiologist, pathologist, anesthesiologist and the like are independent contractors and are not employees" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="or_agents_of_the_hospitalLabel" Left="54" Top="942" Width="144" Height="18" MobileOrder="-1" Text="or agents of the hospital." FontName="Segoe UI" VerticalTextAlignment="Center" />
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      <Line Name="Line34" Left="48" Top="960" Width="720" Height="0" />
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      <Line Name="Line36" Left="48" Top="894" Width="0" Height="66" />
      <Label Name="MobileLabel" Left="0" Top="0" Width="0" Height="0" MobileOrder="16" VisibilityMode="MobileOnly" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <RadioButton Name="Sex_Male" Left="597" Top="194" Width="50" Height="25" TabOrder="7" MobileOrder="18" GroupName="Sex" Text="Male" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Sex_Female" Left="654" Top="195" Width="65" Height="25" TabOrder="8" MobileOrder="19" GroupName="Sex" Text="Female" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="MobileLabel2" Left="0" Top="0" Width="0" Height="0" MobileOrder="20" VisibilityMode="MobileOnly" Text="EMS Providers" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <CheckBox Name="Other1" Left="84" Top="239" Width="75" Height="25" TabOrder="18" MobileOrder="30" Text="Other:" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="MobileLabel1" Left="0" Top="0" Width="0" Height="0" MobileOrder="74" VisibilityMode="MobileOnly" Text="Burn" FontName="Segoe UI" VerticalTextAlignment="Center" />
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