﻿<?xml version="1.0" encoding="utf-8"?>
<GdForm Version="2">
  <Template Revision="43" Guid="{6D4BC487-3DCD-433C-AD68-F3C854BD202D}" Name="EMS Report 3" DateCreated="2016-07-12 18:45:52">
    <Page Width="768" Height="1008">
      <Label Name="EMS_RAPID_INITIAL_ASSESSMENT_FORMLabel" Left="456" Top="12" Width="300" Height="25" MobileOrder="1" Text="EMS RAPID INITIAL ASSESSMENT FORM" FontName="Segoe UI" IsBold="True" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Label Name="PREHOSPITAL_NOTIFICATION_PART_ONELabel" Left="456" Top="36" Width="300" Height="24" MobileOrder="2" Text="PREHOSPITAL NOTIFICATION" FontName="Segoe UI" IsBold="True" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Rectangle Name="Rectangle" Left="24" Top="12" Width="420" Height="60" Background="#FFFFFFFF" />
      <Label Name="Arrival_StampLabel" Left="36" Top="12" Width="72" Height="24" MobileOrder="-1" Text="Arrival Stamp" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <DateTimePicker Name="DateTimePicker" Left="24" Top="108" Width="192" Height="25" TabOrder="1" MobileOrder="4" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line" Left="24" Top="84" Width="720" Height="0" LineThickness="2" />
      <Line Name="Line1" Left="24" Top="84" Width="0" Height="120" LineThickness="2" />
      <Line Name="Line2" Left="24" Top="132" Width="720" Height="0" ZIndex="1" LineThickness="2" />
      <Label Name="DateTimeLabel" Left="36" Top="84" Width="75" Height="25" MobileOrder="3" Text="Date/Time:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Line Name="Line3" Left="216" Top="84" Width="0" Height="48" LineThickness="2" Slope="Rising" />
      <EditBox Name="EMS_OTHER2" Left="336" Top="108" Width="168" Height="24" TabOrder="3" MobileOrder="8" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line4" Left="516" Top="84" Width="0" Height="48" LineThickness="2" Slope="Rising" />
      <Label Name="EMS_UNITLabel" Left="528" Top="84" Width="48" Height="24" MobileOrder="9" Text="UNIT#:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="EMS_UNIT" Left="528" Top="108" Width="96" Height="24" TabOrder="4" MobileOrder="10" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line5" Left="744" Top="84" Width="0" Height="120" ZIndex="5" LineThickness="2" Slope="Rising" />
      <Label Name="AGELabel" Left="36" Top="132" Width="36" Height="24" MobileOrder="13" Text="AGE:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="AGE" Left="24" Top="168" Width="60" Height="24" TabOrder="6" MobileOrder="14" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="SEXLabel" Left="96" Top="132" Width="36" Height="24" MobileOrder="15" Text="SEX:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <RadioButton Name="SEX_Male" Left="96" Top="156" Width="48" Height="24" TabOrder="7" MobileOrder="16" GroupName="SEX" Text="Male" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="SEX_Female" Left="96" Top="180" Width="60" Height="24" TabOrder="8" MobileOrder="17" GroupName="SEX" Text="Female" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Line Name="Line6" Left="84" Top="132" Width="0" Height="72" LineThickness="2" Slope="Rising" />
      <Line Name="Line7" Left="24" Top="216" Width="60" Height="0" LineThickness="2" />
      <Line Name="Line8" Left="168" Top="132" Width="0" Height="72" LineThickness="2" Slope="Rising" />
      <Label Name="RestrainedLabel" Left="612" Top="144" Width="48" Height="12" MobileOrder="32" Text="Restrained:" FontName="Segoe UI" FontSize="9" VerticalTextAlignment="Center" />
      <RadioButton Name="Restrained_Y" Left="672" Top="144" Width="36" Height="12" TabOrder="21" MobileOrder="33" GroupName="Restrained" Text="Y" FontName="Segoe UI" FontSize="9" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Restrained_N" Left="708" Top="144" Width="36" Height="12" TabOrder="22" MobileOrder="34" GroupName="Restrained" Text="N" FontName="Segoe UI" FontSize="9" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="AirbagLabel" Left="612" Top="158" Width="48" Height="12" MobileOrder="35" Text="Airbag:" FontName="Segoe UI" FontSize="9" VerticalTextAlignment="Center" />
      <RadioButton Name="Airbag_Y" Left="672" Top="158" Width="36" Height="12" TabOrder="23" MobileOrder="36" GroupName="Airbag" Text="Y" FontName="Segoe UI" FontSize="9" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Airbag_N" Left="708" Top="158" Width="36" Height="12" TabOrder="24" MobileOrder="37" GroupName="Airbag" Text="N" FontName="Segoe UI" FontSize="9" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="LOCLabel" Left="612" Top="172" Width="36" Height="12" MobileOrder="38" Text="LOC:" FontName="Segoe UI" FontSize="9" VerticalTextAlignment="Center" />
      <RadioButton Name="LOC_Y" Left="672" Top="172" Width="36" Height="12" TabOrder="25" MobileOrder="39" GroupName="LOC" Text="Y" FontName="Segoe UI" FontSize="9" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="LOC_N" Left="708" Top="172" Width="36" Height="12" TabOrder="26" MobileOrder="40" GroupName="LOC" Text="N" FontName="Segoe UI" FontSize="9" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="Chief_ComplaintLabel" Left="180" Top="132" Width="96" Height="24" MobileOrder="18" Text="Chief Complaint:" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <CheckBox Name="Chief_Complaint_MVC" Left="288" Top="132" Width="48" Height="24" TabOrder="9" MobileOrder="19" Text="MVC" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Chief_Complaint_Fall" Left="348" Top="132" Width="48" Height="24" TabOrder="10" MobileOrder="20" Text="Fall" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Chief_Complaint_Weakness" Left="396" Top="132" Width="84" Height="24" TabOrder="11" MobileOrder="21" Text="Weakness" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Chief_Complaint_NV" Left="480" Top="132" Width="45" Height="24" TabOrder="12" MobileOrder="22" Text="N/V" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Chief_Complaint_ABD_Pain" Left="528" Top="132" Width="72" Height="24" TabOrder="13" MobileOrder="23" Text="ABD Pain" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Chief_Complaint_Cardiac_Arrest" Left="180" Top="156" Width="96" Height="24" TabOrder="14" MobileOrder="24" Text="Cardiac Arrest" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Chief_Complaint_SOB" Left="288" Top="156" Width="48" Height="24" TabOrder="15" MobileOrder="25" Text="SOB" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Chief_Complaint_AMS" Left="336" Top="156" Width="48" Height="24" TabOrder="16" MobileOrder="26" Text="AMS" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Chief_Complaint_HTN" Left="396" Top="156" Width="48" Height="25" TabOrder="17" MobileOrder="27" Text="HTN" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Other" Left="180" Top="180" Width="60" Height="24" TabOrder="19" MobileOrder="30" Text="Other" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="BPLabel" Left="36" Top="240" Width="24" Height="24" MobileOrder="42" Text="BP:" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <EditBox Name="BP" Left="36" Top="264" Width="36" Height="24" TabOrder="27" MobileOrder="43" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line9" Left="36" Top="288" Width="36" Height="0" ZIndex="2" LineThickness="5" />
      <EditBox Name="BP2" Left="36" Top="288" Width="36" Height="24" TabOrder="28" MobileOrder="44" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line10" Left="84" Top="216" Width="0" Height="96" LineThickness="2" Slope="Rising" />
      <Label Name="HRLabel" Left="96" Top="240" Width="24" Height="24" MobileOrder="45" Text="HR:" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <EditBox Name="HR" Left="96" Top="276" Width="36" Height="24" TabOrder="29" MobileOrder="46" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line11" Left="144" Top="240" Width="0" Height="72" LineThickness="2" Slope="Rising" />
      <Label Name="RRLabel" Left="156" Top="240" Width="24" Height="24" MobileOrder="47" Text="RR:" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <EditBox Name="RR" Left="156" Top="276" Width="36" Height="24" TabOrder="30" MobileOrder="48" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line12" Left="204" Top="240" Width="0" Height="72" LineThickness="2" Slope="Rising" />
      <Label Name="SPO2Label" Left="216" Top="240" Width="36" Height="24" MobileOrder="-1" Text="SPO2" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <EditBox Name="SPO2" Left="216" Top="276" Width="36" Height="24" TabOrder="31" MobileOrder="50" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="Label" Left="252" Top="276" Width="12" Height="24" MobileOrder="-1" Text="%" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <CheckBox Name="RA" Left="264" Top="252" Width="48" Height="24" TabOrder="32" MobileOrder="51" Text="RA" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="O2_" Left="264" Top="276" Width="48" Height="24" TabOrder="33" MobileOrder="52" Text="O2@" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <EditBox Name="EditBox" Left="312" Top="276" Width="36" Height="24" TabOrder="34" MobileOrder="53" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="LMinLabel" Left="348" Top="276" Width="36" Height="24" MobileOrder="54" Text="L/Min" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Line Name="Line13" Left="396" Top="240" Width="0" Height="72" LineThickness="2" Slope="Rising" />
      <Label Name="BGLLabel" Left="408" Top="240" Width="36" Height="24" MobileOrder="55" Text="BGL:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="BGL" Left="408" Top="276" Width="36" Height="24" TabOrder="35" MobileOrder="56" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line14" Left="456" Top="240" Width="0" Height="72" LineThickness="2" Slope="Rising" />
      <Label Name="MonitorLabel" Left="468" Top="240" Width="60" Height="24" MobileOrder="57" Text="Monitor:" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <EditBox Name="Monitor" Left="480" Top="276" Width="60" Height="24" TabOrder="36" MobileOrder="58" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line15" Left="552" Top="240" Width="0" Height="72" LineThickness="2" Slope="Rising" />
      <Label Name="GCSLabel" Left="564" Top="240" Width="36" Height="24" MobileOrder="59" Text="GCS:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="GCS" Left="564" Top="276" Width="72" Height="24" TabOrder="37" MobileOrder="60" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="AAOXLabel" Left="660" Top="240" Width="36" Height="24" MobileOrder="61" Text="AAOX:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="AAOX" Left="660" Top="276" Width="72" Height="24" TabOrder="38" MobileOrder="62" FontName="Segoe UI" Background="#FFFFFFFF" />
      <EditBox Name="CC_Other" Left="240" Top="180" Width="360" Height="24" TabOrder="20" MobileOrder="31" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="Other_Info_PMH_AllergiesLabel" Left="24" Top="324" Width="144" Height="24" MobileOrder="63" Text="Other Info (PMH Allergies):" FontName="Segoe UI" HorizontalTextAlignment="Right" VerticalTextAlignment="Center" />
      <EditBox Name="Other_Info_PMH_Allergies" Left="204" Top="324" Width="348" Height="48" TabOrder="41" MobileOrder="64" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="TreatmentLabel" Left="564" Top="324" Width="60" Height="24" MobileOrder="68" Text="Treatment:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="Treatment" Left="624" Top="324" Width="120" Height="24" TabOrder="42" MobileOrder="69" FontName="Segoe UI" Background="#FFFFFFFF" />
      <CheckBox Name="Packaged" Left="564" Top="348" Width="75" Height="25" TabOrder="43" MobileOrder="70" Text="Packaged" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="IV" Left="660" Top="348" Width="40" Height="25" TabOrder="44" MobileOrder="71" Text="IV" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="Blood_ThinnersLabel" Left="24" Top="348" Width="84" Height="24" MobileOrder="65" Text="Blood Thinners:" FontName="Segoe UI" HorizontalTextAlignment="Right" VerticalTextAlignment="Center" />
      <RadioButton Name="Blood_Thinners_Y" Left="132" Top="348" Width="36" Height="24" TabOrder="39" MobileOrder="66" GroupName="Blood_Thinners" Text="Y" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Blood_Thinners_N" Left="168" Top="348" Width="36" Height="24" TabOrder="40" MobileOrder="67" GroupName="Blood_Thinners" Text="N" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Line Name="Line17" Left="24" Top="372" Width="720" Height="0" LineThickness="2" />
      <Label Name="Reason_for_DivertLabel" Left="36" Top="420" Width="108" Height="24" MobileOrder="77" Text="Reason for Divert:" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <EditBox Name="Reason_for_Divert" Left="144" Top="420" Width="204" Height="24" TabOrder="49" MobileOrder="78" FontName="Segoe UI" Background="#FFFFFFFF" />
      <CheckBox Name="Sent_to_Womens_Services" Left="48" Top="444" Width="168" Height="24" TabOrder="50" MobileOrder="79" Text="Sent to Women's Services" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Line Name="Line18" Left="372" Top="420" Width="0" Height="48" LineThickness="2" Slope="Rising" />
      <Label Name="Report_Taken_ByLabel" Left="372" Top="420" Width="96" Height="24" MobileOrder="80" Text="Report Taken By:" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <EditBox Name="Report_Taken_By" Left="372" Top="444" Width="360" Height="24" TabOrder="51" MobileOrder="81" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="Charge_RN_NotifiedLabel" Left="576" Top="372" Width="120" Height="24" MobileOrder="74" Text="Charge RN Notified:" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <RadioButton Name="Charge_RN_Notified_Y" Left="600" Top="396" Width="36" Height="24" TabOrder="47" MobileOrder="75" GroupName="Charge_RN_Notified" Text="Y" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Charge_RN_Notified_N" Left="648" Top="396" Width="36" Height="24" TabOrder="48" MobileOrder="76" GroupName="Charge_RN_Notified" Text="N" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Line Name="Line21" Left="372" Top="372" Width="0" Height="48" ZIndex="4" LineThickness="2" Slope="Rising" />
      <Label Name="ETALabel" Left="648" Top="84" Width="84" Height="25" MobileOrder="11" Text="ETA:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <ComboBox Name="ETA" Left="648" Top="108" Width="84" Height="24" TabOrder="5" MobileOrder="12" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="&lt; 5 Mins" IsSelected="True" />
        <ComboBoxItem Text="5 - 10 Mins" />
        <ComboBoxItem Text="10 - 15 Mins" />
        <ComboBoxItem Text="15 - 20 Mins" />
        <ComboBoxItem Text="20 - 25 Mins" />
        <ComboBoxItem Text="25 - 30 Mins" />
        <ComboBoxItem Text="&gt; 30 Mins" />
      </ComboBox>
      <Label Name="Room_AssignmentLabel" Left="36" Top="372" Width="108" Height="24" MobileOrder="72" Text="Room Assignment:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="Other_Location" Left="36" Top="396" Width="336" Height="24" TabOrder="45" MobileOrder="73" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line28" Left="24" Top="876" Width="720" Height="0" LineThickness="2" />
      <Label Name="Medical_Center_ArlingtonLabel" Left="36" Top="876" Width="336" Height="24" MobileOrder="82" Text="General Devices" FontName="Segoe UI" IsBold="True" FontSize="14" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Label Name="3301_Matlock_Rd__Arlington_TX_76015__8174653241Label" Left="36" Top="900" Width="336" Height="24" MobileOrder="83" Text="1000 River Street, Ridgefield NJ 07013" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Line Name="Line29" Left="384" Top="876" Width="0" Height="120" LineThickness="2" />
      <Label Name="EMS_RAPID_INITIAL_ASSESSMENT_FORMLabel1" Left="36" Top="924" Width="336" Height="24" MobileOrder="84" Text="EMS RAPID INITIAL ASSESSMENT FORM" FontName="Segoe UI" IsBold="True" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Label Name="PREHOSPITAL_NOTIFICATION_PAGE_1Label" Left="36" Top="948" Width="336" Height="24" MobileOrder="85" Text="PREHOSPITAL NOTIFICATION (PAGE 1)" FontName="Segoe UI" IsBold="True" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Label Name="Patient_IdentificationLabel" Left="396" Top="888" Width="120" Height="24" MobileOrder="86" Text="Patient Identification" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Line Name="Line19" Left="24" Top="420" Width="720" Height="0" LineThickness="2" />
      <Line Name="Line20" Left="552" Top="372" Width="0" Height="48" LineThickness="2" Slope="Rising" />
      <Line Name="Line22" Left="24" Top="468" Width="720" Height="0" LineThickness="2" />
      <Label Name="ProviderLabel" Left="228" Top="84" Width="48" Height="24" MobileOrder="5" Text="Provider:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <ComboBox Name="Provider" Left="228" Top="108" Width="96" Height="24" TabOrder="2" MobileOrder="6" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Select" IsSelected="True" />
        <ComboBoxItem Text="EMS 1" />
        <ComboBoxItem Text="EMS 2" />
        <ComboBoxItem Text="EMS 3" />
        <ComboBoxItem Text="Other" />
      </ComboBox>
      <Line Name="Line23" Left="636" Top="84" Width="0" Height="48" LineThickness="2" Slope="Rising" />
      <Label Name="OtherLabel" Left="336" Top="84" Width="75" Height="25" MobileOrder="7" Text="Other:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="VitalsLabel" Left="36" Top="216" Width="36" Height="24" MobileOrder="41" Text="Vitals:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Line Name="Line24" Left="648" Top="240" Width="0" Height="72" LineThickness="2" Slope="Rising" />
      <Line Name="Line25" Left="24" Top="312" Width="720" Height="0" LineThickness="2" />
      <Line Name="Line26" Left="24" Top="204" Width="720" Height="0" LineThickness="2" />
      <Line Name="Line16" Left="24" Top="324" Width="720" Height="0" LineThickness="2" />
      <Line Name="Line27" Left="24" Top="324" Width="0" Height="144" LineThickness="2" />
      <Line Name="Line30" Left="744" Top="324" Width="0" Height="144" LineThickness="2" Slope="Rising" />
      <Line Name="Line31" Left="24" Top="216" Width="0" Height="96" LineThickness="2" />
      <Line Name="Line32" Left="84" Top="240" Width="660" Height="0" LineThickness="2" />
      <Line Name="Line33" Left="744" Top="240" Width="0" Height="72" LineThickness="2" Slope="Rising" />
      <CheckBox Name="Chief_Complaint_CP" Left="456" Top="156" Width="48" Height="25" TabOrder="18" MobileOrder="28" Text="CP" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Chief_Complaint_Psych_OD" Left="504" Top="156" Width="84" Height="24" TabOrder="18" MobileOrder="29" Text="Psych / OD" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
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