- - Top checkbox, patient information (tab 1)
- - Middle checkbox, patient information (tab 1)
- - Lowest checkbox, patient information (tab 1)
- - Top checkbox, patient information (tab 2)
- - Middle checkbox, patient information (tab 2)
- - Lowest checkbox, patient information (tab 2)
- - Top checkbox, case information (coverage tab)
- - Middle checkbox, case information (coverage tab)
- - Lowest checkbox, case information (coverage tab)
- - Top drop down, patient information (tab 1)
- - Middle drop down, patient information (tab 1)
- - Lowest drop down, patient information (tab 1)
- - Top drop down, patient information (tab 2)
- - Middle drop down, patient information (tab 2)
- - Lowest drop down, patient information (tab 2)
- - Top drop down, case information (coverage tab)
- - Middle drop down, case information (coverage tab)
- - Lowest drop down, case information (coverage tab)
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