428948 Auto-populate pdf form fields based on user choices

I have a pdf form that I need to auto-populate fields based on user choices from combo drop down boxes. I would like to have it in a database or table format so that new data can be added or deleted without having to change a script in the pdf form. My current form has three fields that will need to auto-populate other fields. The first will populate 5 other fields, the second will populate 1 other field, and the last will populate 1 additonal field. The 3 fields are: Physician Name, HCPCS Code, and ICD-9. I will need to be provided all scripting and/or table format used in order to accomplish this project so if any changes need to be made in the future I have all the information. I have attached the orignal blank form. Any finished product (auto-populating form) will be my property and no further distribution of this form will be allowed. Once the bid is accepted I will provide my custom form of this pdf so that the auto-populate features may be added.