﻿<?xml version="1.0" encoding="utf-8"?>
<GdForm Version="2">
  <Template Revision="36" Guid="{4D82762B-02BD-4BF2-B773-AE41EE638E9C}" Name="Stroke Alert" DateCreated="2016-04-04 21:52:13">
    <Page Width="768" Height="1008">
      <Image Name="Picture" Left="60" Top="12" Width="108" Height="73" MobileOrder="1" Path="C:\ProgramData\General Devices\Forms\Builder\Temp\GD-Logo-blue-transparent (5) (5).png">
        <Data>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</Data>
      </Image>
      <Label Name="STROKE_Alert_Intake_FormLabel" Left="24" Top="72" Width="720" Height="24" MobileOrder="2" Text="STROKE Alert Intake Form" FontName="Segoe UI" FontSize="22" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Label Name="EMS_ServiceLabel" Left="324" Top="120" Width="72" Height="24" MobileOrder="5" Text="EMS Service:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <ComboBox Name="EMS_Service" Left="408" Top="120" Width="108" Height="24" TabOrder="2" MobileOrder="6" IsRequired="True" 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>
      <Label Name="Other_EMSLabel" Left="324" Top="144" Width="72" Height="24" MobileOrder="7" Text="Other EMS:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="Other_EMS" Left="408" Top="144" Width="108" Height="24" TabOrder="3" MobileOrder="8" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="DateTimeLabel" Left="36" Top="120" Width="60" Height="24" MobileOrder="3" Text="Date/Time:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <DateTimePicker Name="DateTimePicker" Left="116" Top="125" Width="200" Height="25" TabOrder="1" MobileOrder="4" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="EMS_Unit_Label" Left="540" Top="120" Width="72" Height="24" MobileOrder="9" Text="EMS Unit #:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <ComboBox Name="EMS_Unit_" Left="625" Top="125" Width="100" Height="24" TabOrder="4" MobileOrder="10" IsRequired="True" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Select" IsSelected="True" />
        <ComboBoxItem Text="1" />
        <ComboBoxItem Text="2" />
        <ComboBoxItem Text="3" />
        <ComboBoxItem Text="4" />
        <ComboBoxItem Text="5" />
        <ComboBoxItem Text="6" />
        <ComboBoxItem Text="7" />
        <ComboBoxItem Text="8" />
        <ComboBoxItem Text="9" />
        <ComboBoxItem Text="10" />
        <ComboBoxItem Text="11" />
        <ComboBoxItem Text="12" />
        <ComboBoxItem Text="13" />
        <ComboBoxItem Text="14" />
        <ComboBoxItem Text="15" />
        <ComboBoxItem Text="16" />
        <ComboBoxItem Text="17" />
        <ComboBoxItem Text="18" />
        <ComboBoxItem Text="19" />
        <ComboBoxItem Text="20" />
        <ComboBoxItem Text="21" />
        <ComboBoxItem Text="22" />
        <ComboBoxItem Text="23" />
        <ComboBoxItem Text="24" />
        <ComboBoxItem Text="25" />
        <ComboBoxItem Text="26" />
        <ComboBoxItem Text="27" />
      </ComboBox>
      <Label Name="Patient_NameLabel" Left="36" Top="216" Width="48" Height="24" MobileOrder="12" Text="Name:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="Patient_Name" Left="84" Top="216" Width="300" Height="24" TabOrder="5" MobileOrder="13" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="Patient_InformationLabel" Left="24" Top="180" Width="120" Height="36" MobileOrder="11" Text="Patient Information:" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Label Name="GenderLabel" Left="492" Top="264" Width="60" Height="24" MobileOrder="22" Text="Gender:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <RadioButton Name="Gender_Male" Left="492" Top="288" Width="48" Height="24" TabOrder="15" MobileOrder="23" GroupName="Gender" Text="Male" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Gender_Female" Left="492" Top="312" Width="60" Height="24" TabOrder="16" MobileOrder="24" GroupName="Gender" Text="Female" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <EditBox Name="BP1" Left="48" Top="288" Width="60" Height="24" TabOrder="9" MobileOrder="28" FontName="Segoe UI" Background="#FFFFFFFF" />
      <EditBox Name="BP2" Left="48" Top="312" Width="60" Height="24" TabOrder="10" MobileOrder="29" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="BPLabel" Left="48" Top="264" Width="60" Height="24" MobileOrder="27" Text="BP" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Line Name="Line" Left="36" Top="312" Width="84" Height="0" LineThickness="5" />
      <Label Name="DOBLabel" Left="456" Top="204" Width="36" Height="24" MobileOrder="15" Text="D.O.B." FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Line Name="Line1" Left="576" Top="204" Width="12" Height="24" LineThickness="2" Slope="Rising" />
      <Line Name="Line2" Left="648" Top="204" Width="12" Height="24" LineThickness="2" Slope="Rising" />
      <Label Name="ETALabel" Left="492" Top="588" Width="36" Height="24" MobileOrder="79" Text="ETA:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <ComboBox Name="ETA" Left="540" Top="588" Width="156" Height="24" TabOrder="47" MobileOrder="80" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Select" IsSelected="True" />
        <ComboBoxItem Text="&lt; 5 Mins" />
        <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="Staff_Completing_MessageLabel" Left="36" Top="588" Width="144" Height="24" MobileOrder="75" Text="Staff Completing Message:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <ComboBox Name="Staff_Completing_Message" Left="192" Top="588" Width="180" Height="24" TabOrder="45" MobileOrder="76" IsRequired="True" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Select" IsSelected="True" />
        <ComboBoxItem Text="Call Taker 1" />
        <ComboBoxItem Text="Call Taker 2" />
        <ComboBoxItem Text="Call Taker 3" />
        <ComboBoxItem Text="Other" />
      </ComboBox>
      <Label Name="OtherLabel1" Left="144" Top="612" Width="36" Height="24" MobileOrder="77" Text="Other:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="Other1" Left="192" Top="612" Width="180" Height="24" TabOrder="46" MobileOrder="78" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="Additional_NotesLabel" Left="36" Top="648" Width="96" Height="24" MobileOrder="81" Text="Additional Notes:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="Additional_Notes" Left="144" Top="648" Width="588" Height="48" TabOrder="48" MobileOrder="82" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Rectangle Name="Rectangle3" Left="36" Top="264" Width="420" Height="84" ZIndex="-3" />
      <Line Name="Line3" Left="288" Top="264" Width="0" Height="84" Slope="Rising" />
      <Line Name="Line4" Left="204" Top="264" Width="0" Height="84" Slope="Rising" />
      <Line Name="Line5" Left="120" Top="264" Width="0" Height="84" Slope="Rising" />
      <Label Name="MonthLabel" Left="492" Top="228" Width="75" Height="25" MobileOrder="16" Text="Month" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <ComboBox Name="Month" Left="492" Top="204" Width="84" Height="24" TabOrder="6" MobileOrder="17" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Select" IsSelected="True" />
        <ComboBoxItem Text="1 - Jan" />
        <ComboBoxItem Text="2 - Feb" />
        <ComboBoxItem Text="3 - Mar" />
        <ComboBoxItem Text="4 - April" />
        <ComboBoxItem Text="5 - May" />
        <ComboBoxItem Text="6 - June" />
        <ComboBoxItem Text="7 - July" />
        <ComboBoxItem Text="8 - Aug" />
        <ComboBoxItem Text="9 - Sept" />
        <ComboBoxItem Text="10 - Oct" />
        <ComboBoxItem Text="11 - Nov" />
        <ComboBoxItem Text="12 - Dec" />
      </ComboBox>
      <Label Name="DayLabel" Left="588" Top="228" Width="48" Height="24" MobileOrder="18" Text="Day" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <ComboBox Name="Day" Left="588" Top="204" Width="60" Height="24" TabOrder="7" MobileOrder="19" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Select" IsSelected="True" />
        <ComboBoxItem Text="1" />
        <ComboBoxItem Text="2" />
        <ComboBoxItem Text="3" />
        <ComboBoxItem Text="4" />
        <ComboBoxItem Text="5" />
        <ComboBoxItem Text="6" />
        <ComboBoxItem Text="7" />
        <ComboBoxItem Text="8" />
        <ComboBoxItem Text="9" />
        <ComboBoxItem Text="10" />
        <ComboBoxItem Text="11" />
        <ComboBoxItem Text="12" />
        <ComboBoxItem Text="13" />
        <ComboBoxItem Text="14" />
        <ComboBoxItem Text="15" />
        <ComboBoxItem Text="16" />
        <ComboBoxItem Text="17" />
        <ComboBoxItem Text="18" />
        <ComboBoxItem Text="19" />
        <ComboBoxItem Text="20" />
        <ComboBoxItem Text="21" />
        <ComboBoxItem Text="22" />
        <ComboBoxItem Text="23" />
        <ComboBoxItem Text="24" />
        <ComboBoxItem Text="25" />
        <ComboBoxItem Text="26" />
        <ComboBoxItem Text="27" />
        <ComboBoxItem Text="28" />
        <ComboBoxItem Text="29" />
        <ComboBoxItem Text="30" />
        <ComboBoxItem Text="31" />
      </ComboBox>
      <Label Name="First_LastLabel" Left="84" Top="240" Width="48" Height="24" MobileOrder="14" Text="(Last, First)" FontName="Segoe UI" FontSize="9" />
      <Label Name="YearLabel" Left="660" Top="228" Width="60" Height="24" MobileOrder="20" Text="Year" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <ComboBox Name="Year" Left="660" Top="204" Width="60" Height="24" TabOrder="8" MobileOrder="21" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Select" IsSelected="True" />
        <ComboBoxItem Text="1920" />
        <ComboBoxItem Text="1921" />
        <ComboBoxItem Text="1922" />
        <ComboBoxItem Text="1923" />
        <ComboBoxItem Text="1924" />
        <ComboBoxItem Text="1925" />
        <ComboBoxItem Text="1926" />
        <ComboBoxItem Text="1927" />
        <ComboBoxItem Text="1928" />
        <ComboBoxItem Text="1929" />
        <ComboBoxItem Text="1930" />
        <ComboBoxItem Text="1931" />
        <ComboBoxItem Text="1932" />
        <ComboBoxItem Text="1933" />
        <ComboBoxItem Text="1934" />
        <ComboBoxItem Text="1935" />
        <ComboBoxItem Text="1936" />
        <ComboBoxItem Text="1937" />
        <ComboBoxItem Text="1938" />
        <ComboBoxItem Text="1939" />
        <ComboBoxItem Text="1940" />
        <ComboBoxItem Text="1941" />
        <ComboBoxItem Text="1942" />
        <ComboBoxItem Text="1943" />
        <ComboBoxItem Text="1944" />
        <ComboBoxItem Text="1945" />
        <ComboBoxItem Text="1946" />
        <ComboBoxItem Text="1947" />
        <ComboBoxItem Text="1948" />
        <ComboBoxItem Text="1949" />
        <ComboBoxItem Text="1950" />
        <ComboBoxItem Text="1951" />
        <ComboBoxItem Text="1952" />
        <ComboBoxItem Text="1953" />
        <ComboBoxItem Text="1954" />
        <ComboBoxItem Text="1955" />
        <ComboBoxItem Text="1956" />
        <ComboBoxItem Text="1957" />
        <ComboBoxItem Text="1958" />
        <ComboBoxItem Text="1959" />
        <ComboBoxItem Text="1960" />
        <ComboBoxItem Text="1961" />
        <ComboBoxItem Text="1962" />
        <ComboBoxItem Text="1963" />
        <ComboBoxItem Text="1964" />
        <ComboBoxItem Text="1965" />
        <ComboBoxItem Text="1966" />
        <ComboBoxItem Text="1967" />
        <ComboBoxItem Text="1968" />
        <ComboBoxItem Text="1969" />
        <ComboBoxItem Text="1970" />
        <ComboBoxItem Text="1971" />
        <ComboBoxItem Text="1972" />
        <ComboBoxItem Text="1973" />
        <ComboBoxItem Text="1974" />
        <ComboBoxItem Text="1975" />
        <ComboBoxItem Text="1976" />
        <ComboBoxItem Text="1977" />
        <ComboBoxItem Text="1978" />
        <ComboBoxItem Text="1979" />
        <ComboBoxItem Text="1980" />
        <ComboBoxItem Text="1981" />
        <ComboBoxItem Text="1982" />
        <ComboBoxItem Text="1983" />
        <ComboBoxItem Text="1984" />
        <ComboBoxItem Text="1985" />
        <ComboBoxItem Text="1986" />
        <ComboBoxItem Text="1987" />
        <ComboBoxItem Text="1988" />
        <ComboBoxItem Text="1989" />
        <ComboBoxItem Text="1990" />
        <ComboBoxItem Text="1991" />
        <ComboBoxItem Text="1992" />
        <ComboBoxItem Text="1993" />
        <ComboBoxItem Text="1994" />
        <ComboBoxItem Text="1995" />
        <ComboBoxItem Text="1996" />
        <ComboBoxItem Text="1997" />
        <ComboBoxItem Text="1998" />
        <ComboBoxItem Text="1999" />
        <ComboBoxItem Text="2000" />
        <ComboBoxItem Text="2001" />
        <ComboBoxItem Text="2002" />
        <ComboBoxItem Text="2003" />
        <ComboBoxItem Text="2004" />
        <ComboBoxItem Text="2005" />
        <ComboBoxItem Text="2006" />
        <ComboBoxItem Text="2007" />
        <ComboBoxItem Text="2008" />
        <ComboBoxItem Text="2009" />
        <ComboBoxItem Text="2010" />
        <ComboBoxItem Text="2011" />
        <ComboBoxItem Text="2012" />
        <ComboBoxItem Text="2013" />
        <ComboBoxItem Text="2014" />
        <ComboBoxItem Text="2015" />
        <ComboBoxItem Text="2016" />
        <ComboBoxItem Text="2017" />
        <ComboBoxItem Text="2018" />
        <ComboBoxItem Text="2019" />
        <ComboBoxItem Text="2020" />
      </ComboBox>
      <Label Name="PulseLabel1" Left="120" Top="264" Width="84" Height="24" MobileOrder="30" Text="Pulse" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <ComboBox Name="Pulse1" Left="132" Top="300" Width="60" Height="24" TabOrder="11" MobileOrder="31" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Select" IsSelected="True" />
        <ComboBoxItem Text="20" />
        <ComboBoxItem Text="21" />
        <ComboBoxItem Text="22" />
        <ComboBoxItem Text="23" />
        <ComboBoxItem Text="24" />
        <ComboBoxItem Text="25" />
        <ComboBoxItem Text="26" />
        <ComboBoxItem Text="27" />
        <ComboBoxItem Text="28" />
        <ComboBoxItem Text="29" />
        <ComboBoxItem Text="30" />
        <ComboBoxItem Text="31" />
        <ComboBoxItem Text="32" />
        <ComboBoxItem Text="33" />
        <ComboBoxItem Text="34" />
        <ComboBoxItem Text="35" />
        <ComboBoxItem Text="36" />
        <ComboBoxItem Text="37" />
        <ComboBoxItem Text="38" />
        <ComboBoxItem Text="39" />
        <ComboBoxItem Text="40" />
        <ComboBoxItem Text="41" />
        <ComboBoxItem Text="42" />
        <ComboBoxItem Text="43" />
        <ComboBoxItem Text="44" />
        <ComboBoxItem Text="45" />
        <ComboBoxItem Text="46" />
        <ComboBoxItem Text="47" />
        <ComboBoxItem Text="48" />
        <ComboBoxItem Text="49" />
        <ComboBoxItem Text="50" />
        <ComboBoxItem Text="51" />
        <ComboBoxItem Text="52" />
        <ComboBoxItem Text="53" />
        <ComboBoxItem Text="54" />
        <ComboBoxItem Text="55" />
        <ComboBoxItem Text="56" />
        <ComboBoxItem Text="57" />
        <ComboBoxItem Text="58" />
        <ComboBoxItem Text="59" />
        <ComboBoxItem Text="60" />
        <ComboBoxItem Text="61" />
        <ComboBoxItem Text="62" />
        <ComboBoxItem Text="63" />
        <ComboBoxItem Text="64" />
        <ComboBoxItem Text="65" />
        <ComboBoxItem Text="66" />
        <ComboBoxItem Text="67" />
        <ComboBoxItem Text="68" />
        <ComboBoxItem Text="69" />
        <ComboBoxItem Text="70" />
        <ComboBoxItem Text="71" />
        <ComboBoxItem Text="72" />
        <ComboBoxItem Text="73" />
        <ComboBoxItem Text="74" />
        <ComboBoxItem Text="75" />
        <ComboBoxItem Text="76" />
        <ComboBoxItem Text="77" />
        <ComboBoxItem Text="78" />
        <ComboBoxItem Text="79" />
        <ComboBoxItem Text="80" />
        <ComboBoxItem Text="81" />
        <ComboBoxItem Text="82" />
        <ComboBoxItem Text="83" />
        <ComboBoxItem Text="84" />
        <ComboBoxItem Text="85" />
        <ComboBoxItem Text="86" />
        <ComboBoxItem Text="87" />
        <ComboBoxItem Text="88" />
        <ComboBoxItem Text="89" />
        <ComboBoxItem Text="90" />
        <ComboBoxItem Text="91" />
        <ComboBoxItem Text="92" />
        <ComboBoxItem Text="93" />
        <ComboBoxItem Text="94" />
        <ComboBoxItem Text="95" />
        <ComboBoxItem Text="96" />
        <ComboBoxItem Text="97" />
        <ComboBoxItem Text="98" />
        <ComboBoxItem Text="99" />
        <ComboBoxItem Text="100" />
        <ComboBoxItem Text="101" />
        <ComboBoxItem Text="102" />
        <ComboBoxItem Text="103" />
        <ComboBoxItem Text="104" />
        <ComboBoxItem Text="105" />
        <ComboBoxItem Text="106" />
        <ComboBoxItem Text="107" />
        <ComboBoxItem Text="108" />
        <ComboBoxItem Text="109" />
        <ComboBoxItem Text="110" />
        <ComboBoxItem Text="111" />
        <ComboBoxItem Text="112" />
        <ComboBoxItem Text="113" />
        <ComboBoxItem Text="114" />
        <ComboBoxItem Text="115" />
        <ComboBoxItem Text="116" />
        <ComboBoxItem Text="117" />
        <ComboBoxItem Text="118" />
        <ComboBoxItem Text="119" />
        <ComboBoxItem Text="120" />
        <ComboBoxItem Text="121" />
        <ComboBoxItem Text="122" />
        <ComboBoxItem Text="123" />
        <ComboBoxItem Text="124" />
        <ComboBoxItem Text="125" />
        <ComboBoxItem Text="126" />
        <ComboBoxItem Text="127" />
        <ComboBoxItem Text="128" />
        <ComboBoxItem Text="129" />
        <ComboBoxItem Text="130" />
        <ComboBoxItem Text="131" />
        <ComboBoxItem Text="132" />
        <ComboBoxItem Text="133" />
        <ComboBoxItem Text="134" />
        <ComboBoxItem Text="135" />
        <ComboBoxItem Text="136" />
        <ComboBoxItem Text="137" />
        <ComboBoxItem Text="138" />
        <ComboBoxItem Text="139" />
        <ComboBoxItem Text="140" />
        <ComboBoxItem Text="141" />
        <ComboBoxItem Text="142" />
        <ComboBoxItem Text="143" />
        <ComboBoxItem Text="144" />
        <ComboBoxItem Text="145" />
        <ComboBoxItem Text="146" />
        <ComboBoxItem Text="147" />
        <ComboBoxItem Text="148" />
        <ComboBoxItem Text="149" />
        <ComboBoxItem Text="150" />
        <ComboBoxItem Text="151" />
        <ComboBoxItem Text="152" />
        <ComboBoxItem Text="153" />
        <ComboBoxItem Text="154" />
        <ComboBoxItem Text="155" />
        <ComboBoxItem Text="156" />
        <ComboBoxItem Text="157" />
        <ComboBoxItem Text="158" />
        <ComboBoxItem Text="159" />
        <ComboBoxItem Text="160" />
      </ComboBox>
      <Label Name="RespLabel" Left="204" Top="264" Width="84" Height="24" MobileOrder="32" Text="Resp." FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <ComboBox Name="Resp" Left="216" Top="300" Width="60" Height="24" TabOrder="12" MobileOrder="33" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Select" IsSelected="True" />
        <ComboBoxItem Text="0" />
        <ComboBoxItem Text="Agonal" />
        <ComboBoxItem Text="Assisted" />
        <ComboBoxItem Text="5" />
        <ComboBoxItem Text="6" />
        <ComboBoxItem Text="7" />
        <ComboBoxItem Text="8" />
        <ComboBoxItem Text="9" />
        <ComboBoxItem Text="10" />
        <ComboBoxItem Text="11" />
        <ComboBoxItem Text="12" />
        <ComboBoxItem Text="13" />
        <ComboBoxItem Text="14" />
        <ComboBoxItem Text="15" />
        <ComboBoxItem Text="16" />
        <ComboBoxItem Text="17" />
        <ComboBoxItem Text="18" />
        <ComboBoxItem Text="19" />
        <ComboBoxItem Text="20" />
        <ComboBoxItem Text="21" />
        <ComboBoxItem Text="22" />
        <ComboBoxItem Text="23" />
        <ComboBoxItem Text="24" />
        <ComboBoxItem Text="25" />
        <ComboBoxItem Text="26" />
        <ComboBoxItem Text="27" />
        <ComboBoxItem Text="28" />
        <ComboBoxItem Text="29" />
        <ComboBoxItem Text="30" />
        <ComboBoxItem Text="31" />
        <ComboBoxItem Text="32" />
        <ComboBoxItem Text="33" />
        <ComboBoxItem Text="34" />
        <ComboBoxItem Text="35" />
        <ComboBoxItem Text="36" />
        <ComboBoxItem Text="37" />
        <ComboBoxItem Text="38" />
        <ComboBoxItem Text="39" />
        <ComboBoxItem Text="40" />
        <ComboBoxItem Text="41" />
        <ComboBoxItem Text="42" />
        <ComboBoxItem Text="43" />
        <ComboBoxItem Text="44" />
        <ComboBoxItem Text="45" />
      </ComboBox>
      <Label Name="Sa02Label" Left="300" Top="264" Width="60" Height="24" MobileOrder="34" Text="Sa02" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <ComboBox Name="Sa02" Left="300" Top="300" Width="60" Height="24" TabOrder="13" MobileOrder="35" FontName="Segoe UI" VerticalTextAlignment="Center">
        <ComboBoxItem Text="Select" IsSelected="True" />
        <ComboBoxItem Text="40" />
        <ComboBoxItem Text="41" />
        <ComboBoxItem Text="42" />
        <ComboBoxItem Text="43" />
        <ComboBoxItem Text="44" />
        <ComboBoxItem Text="45" />
        <ComboBoxItem Text="46" />
        <ComboBoxItem Text="47" />
        <ComboBoxItem Text="48" />
        <ComboBoxItem Text="49" />
        <ComboBoxItem Text="50" />
        <ComboBoxItem Text="51" />
        <ComboBoxItem Text="52" />
        <ComboBoxItem Text="53" />
        <ComboBoxItem Text="54" />
        <ComboBoxItem Text="55" />
        <ComboBoxItem Text="56" />
        <ComboBoxItem Text="57" />
        <ComboBoxItem Text="58" />
        <ComboBoxItem Text="59" />
        <ComboBoxItem Text="60" />
        <ComboBoxItem Text="61" />
        <ComboBoxItem Text="62" />
        <ComboBoxItem Text="63" />
        <ComboBoxItem Text="64" />
        <ComboBoxItem Text="65" />
        <ComboBoxItem Text="66" />
        <ComboBoxItem Text="67" />
        <ComboBoxItem Text="68" />
        <ComboBoxItem Text="69" />
        <ComboBoxItem Text="70" />
        <ComboBoxItem Text="71" />
        <ComboBoxItem Text="72" />
        <ComboBoxItem Text="73" />
        <ComboBoxItem Text="74" />
        <ComboBoxItem Text="75" />
        <ComboBoxItem Text="76" />
        <ComboBoxItem Text="77" />
        <ComboBoxItem Text="78" />
        <ComboBoxItem Text="79" />
        <ComboBoxItem Text="80" />
        <ComboBoxItem Text="81" />
        <ComboBoxItem Text="82" />
        <ComboBoxItem Text="83" />
        <ComboBoxItem Text="84" />
        <ComboBoxItem Text="85" />
        <ComboBoxItem Text="86" />
        <ComboBoxItem Text="87" />
        <ComboBoxItem Text="88" />
        <ComboBoxItem Text="89" />
        <ComboBoxItem Text="90" />
        <ComboBoxItem Text="91" />
        <ComboBoxItem Text="92" />
        <ComboBoxItem Text="93" />
        <ComboBoxItem Text="94" />
        <ComboBoxItem Text="95" />
        <ComboBoxItem Text="96" />
        <ComboBoxItem Text="97" />
        <ComboBoxItem Text="98" />
        <ComboBoxItem Text="99" />
        <ComboBoxItem Text="100" />
      </ComboBox>
      <Line Name="Line6" Left="24" Top="108" Width="0" Height="600" LineThickness="3" />
      <Line Name="Line7" Left="744" Top="108" Width="0" Height="600" LineThickness="3" Slope="Rising" />
      <Line Name="Line8" Left="24" Top="372" Width="720" Height="0" ZIndex="1" LineThickness="3" />
      <Line Name="Line10" Left="24" Top="180" Width="720" Height="0" LineThickness="3" />
      <Line Name="Line11" Left="24" Top="108" Width="720" Height="0" LineThickness="3" />
      <Label Name="Field_AssesmentLabel" Left="36" Top="384" Width="96" Height="24" MobileOrder="38" Text="Field Assesment:" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="Facial_DroopLabel" Left="36" Top="420" Width="72" Height="24" MobileOrder="42" Text="Facial Droop" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <RadioButton Name="Facial_Droop_Right" Left="36" Top="445" Width="75" Height="25" TabOrder="19" MobileOrder="43" GroupName="Facial_Droop" Text="Right" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Facial_Droop_Left" Left="36" Top="470" Width="75" Height="25" TabOrder="20" MobileOrder="44" GroupName="Facial_Droop" Text="Left" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Facial_Droop_Normal" Left="36" Top="495" Width="75" Height="25" TabOrder="21" MobileOrder="45" GroupName="Facial_Droop" Text="Normal" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="Arm_DriftLabel" Left="120" Top="420" Width="60" Height="24" MobileOrder="46" Text="Arm Drift" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <RadioButton Name="Arm_Drift_Right" Left="120" Top="445" Width="75" Height="25" TabOrder="22" MobileOrder="47" GroupName="Arm_Drift" Text="Right" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Arm_Drift_Left" Left="120" Top="470" Width="75" Height="25" TabOrder="23" MobileOrder="48" GroupName="Arm_Drift" Text="Left" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Arm_Drift_Both" Left="120" Top="495" Width="75" Height="25" TabOrder="24" MobileOrder="49" GroupName="Arm_Drift" Text="Both" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Arm_Drift_Normal" Left="120" Top="520" Width="75" Height="25" TabOrder="25" MobileOrder="50" GroupName="Arm_Drift" Text="Normal" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="Sudden_HeadacheLabel" Left="204" Top="408" Width="60" Height="24" MobileOrder="51" Text="Sudden Headache" TextColor="#00FFFFFF" FontName="Segoe UI" VerticalTextAlignment="Bottom" />
      <RadioButton Name="Sudden_Headache_Yes" Left="204" Top="444" Width="75" Height="25" TabOrder="26" MobileOrder="52" GroupName="Sudden_Headache" Text="Yes" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Sudden_Headache_No" Left="204" Top="469" Width="75" Height="25" TabOrder="27" MobileOrder="53" GroupName="Sudden_Headache" Text="No" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Sudden_Headache_Unknown" Left="204" Top="497" Width="75" Height="25" TabOrder="28" MobileOrder="54" GroupName="Sudden_Headache" Text="Unknown" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="PlegiaLabel" Left="300" Top="420" Width="75" Height="25" MobileOrder="55" Text="Plegia" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <RadioButton Name="Plegia_Right" Left="300" Top="445" Width="75" Height="25" TabOrder="29" MobileOrder="56" GroupName="Plegia" Text="Right" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Plegia_Left" Left="300" Top="470" Width="75" Height="25" TabOrder="30" MobileOrder="57" GroupName="Plegia" Text="Left" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Plegia_Both" Left="300" Top="495" Width="75" Height="25" TabOrder="31" MobileOrder="58" GroupName="Plegia" Text="Both" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Plegia_Normal" Left="300" Top="520" Width="75" Height="25" TabOrder="32" MobileOrder="59" GroupName="Plegia" Text="Normal" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="SpeechLabel" Left="384" Top="420" Width="75" Height="25" MobileOrder="60" Text="Speech" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <RadioButton Name="Speech_No_slurring__correct_words" Left="384" Top="456" Width="108" Height="35" TabOrder="33" MobileOrder="61" GroupName="Speech" Text="No slurring/correct words" TextColor="#00FFFFFF" FontName="Segoe UI" HorizontalTextAlignment="Stretch" />
      <RadioButton Name="Speech_Slurred_inappropriate__mute" Left="384" Top="492" Width="130" Height="35" TabOrder="34" MobileOrder="62" GroupName="Speech" Text="Slurred, inapporiate/mute" TextColor="#00FFFFFF" FontName="Segoe UI" HorizontalTextAlignment="Stretch" />
      <RadioButton Name="Speech_Aphasia" Left="384" Top="526" Width="75" Height="25" TabOrder="35" MobileOrder="63" GroupName="Speech" Text="Aphasia" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="Problems_WithLabel" Left="528" Top="420" Width="84" Height="24" MobileOrder="64" Text="Problems With" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <CheckBox Name="Problems_With_Walking" Left="528" Top="444" Width="72" Height="24" TabOrder="36" MobileOrder="65" Text="Walking" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Problems_With_Loss_of_Balance" Left="528" Top="468" Width="108" Height="24" TabOrder="37" MobileOrder="66" Text="Loss of Balance" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Problems_With_Loss_of_Coordination" Left="528" Top="492" Width="96" Height="36" TabOrder="38" MobileOrder="67" Text="Loss of Coordination" TextColor="#00FFFFFF" FontName="Segoe UI" HorizontalTextAlignment="Stretch" />
      <CheckBox Name="Problems_With_Dizziness" Left="528" Top="528" Width="72" Height="24" TabOrder="39" MobileOrder="68" Text="Dizziness" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <CheckBox Name="Problems_With_Unknown" Left="528" Top="552" Width="72" Height="24" TabOrder="40" MobileOrder="69" Text="Unknown" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="Problems_SeeingLabel" Left="648" Top="420" Width="96" Height="24" MobileOrder="70" Text="Problems Seeing" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <RadioButton Name="Problems_Seeing_One_Eye" Left="648" Top="444" Width="72" Height="23" TabOrder="41" MobileOrder="71" GroupName="Problems_Seeing" Text="One Eye" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Problems_Seeing_Both_Eyes" Left="648" Top="468" Width="72" Height="24" TabOrder="42" MobileOrder="72" GroupName="Problems_Seeing" Text="Both Eyes" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Problems_Seeing_Normal" Left="649" Top="492" Width="72" Height="24" TabOrder="43" MobileOrder="73" GroupName="Problems_Seeing" Text="Normal" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <RadioButton Name="Problems_Seeing_Unknown" Left="650" Top="517" Width="72" Height="24" TabOrder="44" MobileOrder="74" GroupName="Problems_Seeing" Text="Unknown" FontName="Segoe UI" HorizontalTextAlignment="Stretch" VerticalTextAlignment="Center" />
      <Label Name="muteLabel" Left="408" Top="502" Width="108" Height="26" MobileOrder="-1" Text="inappropriate/mute" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="correct_wordsLabel" Left="408" Top="467" Width="72" Height="24" MobileOrder="-1" Text="correct words" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="CoordinationLabel" Left="540" Top="504" Width="72" Height="24" MobileOrder="-1" Text="Coordination" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Line Name="Line9" Left="24" Top="444" Width="720" Height="0" />
      <Line Name="Line12" Left="108" Top="444" Width="0" Height="132" />
      <Line Name="Line13" Left="192" Top="444" Width="0" Height="132" />
      <Label Name="HeadacheLabel" Left="204" Top="420" Width="75" Height="25" MobileOrder="-1" Text="Headache" FontName="Segoe UI" VerticalTextAlignment="Bottom" />
      <Line Name="Line14" Left="288" Top="444" Width="0" Height="132" Slope="Rising" />
      <Line Name="Line15" Left="372" Top="444" Width="0" Height="132" Slope="Rising" />
      <Line Name="Line16" Left="516" Top="444" Width="0" Height="132" Slope="Rising" />
      <Line Name="Line17" Left="636" Top="444" Width="0" Height="132" Slope="Rising" />
      <Label Name="Last_Known_Well_TimeLabel" Left="432" Top="384" Width="135" Height="24" MobileOrder="39" Text="Last Known Well Time:" FontName="Segoe UI" HorizontalTextAlignment="Right" VerticalTextAlignment="Center" />
      <EditBox Name="Last_Known_Well_Time" Left="576" Top="384" Width="96" Height="24" TabOrder="18" MobileOrder="40" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Label Name="Military_timeLabel" Left="672" Top="384" Width="60" Height="24" MobileOrder="41" Text="(Military time)" FontName="Segoe UI" FontSize="8" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <Label Name="SSN_Last_4Label" Left="576" Top="264" Width="60" Height="24" MobileOrder="25" Text="SSN Last 4" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <EditBox Name="SSN_Last_4" Left="576" Top="288" Width="72" Height="24" TabOrder="17" MobileOrder="26" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line18" Left="24" Top="576" Width="720" Height="0" LineThickness="3" />
      <Label Name="BGLabel" Left="372" Top="264" Width="84" Height="24" MobileOrder="36" Text="BG" FontName="Segoe UI" HorizontalTextAlignment="Center" VerticalTextAlignment="Center" />
      <EditBox Name="BG" Left="384" Top="300" Width="60" Height="24" TabOrder="14" MobileOrder="37" FontName="Segoe UI" Background="#FFFFFFFF" />
      <Line Name="Line19" Left="372" Top="264" Width="0" Height="84" Slope="Rising" />
      <Line Name="Line20" Left="24" Top="708" Width="720" Height="0" LineThickness="3" />
      <Label Name="SuddenLabel" Left="204" Top="412" Width="75" Height="25" MobileOrder="-1" Text="Sudden" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="No_slurring_Label" Left="407" Top="450" Width="75" Height="25" MobileOrder="-1" Text="No slurring/" FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="SlurringLabel" Left="406" Top="486" Width="75" Height="25" MobileOrder="-1" Text="Slurring," FontName="Segoe UI" VerticalTextAlignment="Center" />
      <Label Name="Loss_ofLabel" Left="547" Top="486" Width="75" Height="25" MobileOrder="-1" Text="Loss of" FontName="Segoe UI" VerticalTextAlignment="Center" />
    </Page>
  </Template>
</GdForm>