<?xml version="1.0"?>
<?xml-stylesheet type="text/xsl" href="formgen.xsl" ?>
<form>
<variable name="XF" value="ONLHNP"/>
<default-fields />
<field type="choose" name="laterality">
	<option value="Right" />
	<option value="Left" />
</field>
<field type="choose" name="Interspace">
	<option value="L3-4" />
	<option value="L4-5" />
	<option value="L5-S1" selected="true"/>
</field>
<field type="option" name="annulus" label="Annulus incised?" selected='true' />
<field type="option" name="xray" label="Localizing X-ray?" selected='true' />
<field type="block" name="disc-appearance" label="Disc Appearance" rows="3" cols="60" value="" />
<field type="block" name="discectomy" label="Discectomy Description" rows="3" cols="60" value="" />
<field type="option" name="depomedrol" label="Depomedrol?" selected='true' />
<field type="text" name="EBL" size="16" maxLength="64" value="minimal"/>
</form>