Patient Name {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Patient DOB {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If the child is > 3 years of age have they had a physical exam in the past 12 months? {{ Cognito.resources["required-asterisk"] }}, { binding firstError.message }