Abstract: A healthcare system that includes a form engine configured to generate an interface specifically for individuals with differing cognitive abilities (e.g., children). The interface includes form fields and visual elements to receive health care and feedback data for storage in persistent data store. The visual elements can relate to requests for information and can also relate to responses to those requests. The visual elements are mapped to form fields. The healthcare system automatically populates field values corresponding to the form fields based on detected interactions with the visual elements at the interface.