contrib/forms/pain/view.php

   1 <?php
   2 /**
   3  * Generated DocBlock
   4  *
   5  * @package OpenEMR
   6  * @link    http://www.open-emr.org
   7  * @author  andres_paglayan <andres_paglayan>
   8  * @author  cfapress <cfapress>
   9  * @author  Robert Down <robertdown@live.com>
  10  * @author  sunsetsystems <sunsetsystems>
  11  * @copyright Copyright (c) 2005 andres_paglayan <andres_paglayan>
  12  * @copyright Copyright (c) 2008 cfapress <cfapress>
  13  * @copyright Copyright (c) 2017 Robert Down <robertdown@live.com>
  14  * @copyright Copyright (c) 2007 sunsetsystems <sunsetsystems>
  15  * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  16  */
  17 ?>
  18 <?php
  19 include_once("../../globals.php");
  20 ?>
  21 <html><head>
  22 <?php html_header_show();?>
  23 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  24 </head>
  25 <body class="body_top">
  26 <?php
  27 include_once("$srcdir/api.inc");
  28 $obj = formFetch("form_pain", $_GET["id"]);
  29 ?>
  30 <form method=post action="<?php echo $rootdir?>/forms/pain/save.php?mode=update&id=<?php echo $_GET["id"];?>" name="my_form">
  31 <span class="title">Pain Evaluation</span><Br><br>
  32
  33
  34
  35
  36 <input type=checkbox name="dull"  <?php if ($obj{"dull"} == "on") {
  37     echo "checked";
  38 };?>><span class=text>Dull</span>
  39 <input type=checkbox name="colicky"  <?php if ($obj{"colicky"} == "on") {
  40     echo "checked";
  41 };?>><span class=text>Colicky</span>
  42 <input type=checkbox name="sharp"  <?php if ($obj{"sharp"} == "on") {
  43     echo "checked";
  44 };?>><span class=text>Sharp</span>
  45 <span class=text>Duration of Pain: </span><input type=entry name="duration_of_pain" value="<?php echo stripslashes($obj{"duration_of_pain"});?>" ><br>
  46
  47
  48 <span class=text>History of Pain: </span><br><textarea cols=40 rows=8 wrap=virtual name="history_of_pain" ><?php echo stripslashes($obj{"history_of_pain"});?></textarea><br>
  49
  50
  51 <table><tr><td>
  52 <table><tr>
  53 <td><span class=text>Accompanying Symptoms Vomitting: </span></td><td><input type=entry name="accompanying_symptoms_vomitting" value="<?php echo stripslashes($obj{"accompanying_symptoms_vomitting"});?>" ></td>
  54 </tr><tr>
  55 <td><span class=text>Accompanying Symptoms Nausea: </span></td><td><input type=entry name="accompanying_symptoms_nausea" value="<?php echo stripslashes($obj{"accompanying_symptoms_nausea"});?>" ></td>
  56 </tr><tr>
  57 <td><span class=text>Accompanying Symptoms Headache: </span></td><td><input type=entry name="accompanying_symptoms_headache" value="<?php echo stripslashes($obj{"accompanying_symptoms_headache"});?>" ></td>
  58 </tr></table>
  59 </td><td>
  60 <span class=text>Accompanying Symptoms Other: </span><br><textarea cols=40 rows=8 wrap=virtual name="accompanying_symptoms_other" ><?php echo stripslashes($obj{"accompanying_symptoms_other"});?></textarea><br>
  61 </td></tr></table>
  62
  63 <table>
  64 <tr><td>
  65 <span class=text>Pain Referred to Other Sites?: </span><br><textarea cols=40 rows=4 wrap=virtual name="pain_referred_to_other_sites" ><?php echo stripslashes($obj{"pain_referred_to_other_sites"});?></textarea>
  66 </td><td>
  67 <span class=text>What Relieves Pain?: </span><br><textarea cols=40 rows=4 wrap=virtual name="what_relieves_pain" ><?php echo stripslashes($obj{"what_relieves_pain"});?></textarea>
  68 </td></tr><tr><td>
  69 <span class=text>What Makes Pain Worse (Movement/Positions/Activities)?: </span><br><textarea cols=40 rows=4 wrap=virtual name="what_makes_pain_worse" ><?php echo stripslashes($obj{"what_makes_pain_worse"});?></textarea>
  70 </td><td>
  71 <span class=text>Additional Notes: </span><br><textarea cols=40 rows=4 wrap=virtual name="additional_notes" ><?php echo stripslashes($obj{"additional_notes"});?></textarea>
  72 </td></tr></table>
  73
  74
  75
  76 <br>
  77 <a href="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save]</a>
  78 <br>
  79 <a href="<?php echo $GLOBALS['form_exit_url']; ?>" class="link"
  80  onclick="top.restoreSession()">[Don't Save Changes]</a>
  81 </form>
  82 <?php
  83 formFooter();
  84 ?>