contrib/forms/gyn_ros/view.php

   1 <?php
   2 /*
   3  * The page shown when the user requests to see this form. Allows the user to edit form contents, and save. has a button for printing the saved form contents.
   4  */
   5
   6 /* for $GLOBALS[], ?? */
   7 require_once('../../globals.php');
   8 /* for acl_check(), ?? */
   9 require_once($GLOBALS['srcdir'].'/api.inc');
  10 /* for generate_form_field, ?? */
  11 require_once($GLOBALS['srcdir'].'/options.inc.php');
  12 /* note that we cannot include options_listadd.inc here, as it generates code before the <html> tag */
  13
  14 /** CHANGE THIS - name of the database table associated with this form **/
  15 $table_name = 'form_gyn_ros';
  16
  17 /** CHANGE THIS name to the name of your form. **/
  18 $form_name = 'Gyn Review of Systems';
  19
  20 /** CHANGE THIS to match the folder you created for this form. **/
  21 $form_folder = 'gyn_ros';
  22
  23 /* Check the access control lists to ensure permissions to this page */
  24 $thisauth = acl_check('patients', 'med');
  25 if (!$thisauth) {
  26  die($form_name.': Access Denied.');
  27 }
  28 /* perform a squad check for pages touching patients, if we're in 'athletic team' mode */
  29 if ($GLOBALS['athletic_team']!='false') {
  30   $tmp = getPatientData($pid, 'squad');
  31   if ($tmp['squad'] && ! acl_check('squads', $tmp['squad']))
  32    $thisauth = 0;
  33 }
  34
  35 if ($thisauth != 'write' && $thisauth != 'addonly')
  36   die($form_name.': Adding is not authorized.');
  37 /* Use the formFetch function from api.inc to load the saved record */
  38 $xyzzy = formFetch($table_name, $_GET['id']);
  39
  40 /* in order to use the layout engine's draw functions, we need a fake table of layout data. */
  41 $manual_layouts = array(
  42  'cardio_reviewed' =>
  43    array( 'field_id' => 'cardio_reviewed',
  44           'data_type' => '21',
  45           'fld_length' => '0',
  46           'description' => 'If CHECKED you must include a note',
  47           'list_id' => 'yesno' ),
  48  'cardio_note' =>
  49    array( 'field_id' => 'cardio_note',
  50           'data_type' => '3',
  51           'fld_length' => '160',
  52           'max_length' => '3',
  53           'description' => 'Described the results of the review',
  54           'list_id' => '' ),
  55  'gastro_reviewed' =>
  56    array( 'field_id' => 'gastro_reviewed',
  57           'data_type' => '21',
  58           'fld_length' => '0',
  59           'description' => 'If CHECKED you must include a note',
  60           'list_id' => 'yesno' ),
  61  'gastro_note' =>
  62    array( 'field_id' => 'gastro_note',
  63           'data_type' => '3',
  64           'fld_length' => '160',
  65           'max_length' => '3',
  66           'description' => 'Describe the results of the review',
  67           'list_id' => '' ),
  68  'Urinary_reviewed' =>
  69    array( 'field_id' => 'Urinary_reviewed',
  70           'data_type' => '21',
  71           'fld_length' => '0',
  72           'description' => 'If CHECKED you must include a note',
  73           'list_id' => 'yesno' ),
  74  'Urinary_note' =>
  75    array( 'field_id' => 'Urinary_note',
  76           'data_type' => '3',
  77           'fld_length' => '160',
  78           'max_length' => '3',
  79           'description' => 'Describe the results of the review',
  80           'list_id' => '' ),
  81  'cns_reviewed' =>
  82    array( 'field_id' => 'cns_reviewed',
  83           'data_type' => '21',
  84           'fld_length' => '0',
  85           'description' => 'If CHECKED you must include a note',
  86           'list_id' => 'yesno' ),
  87  'cns_note' =>
  88    array( 'field_id' => 'cns_note',
  89           'data_type' => '3',
  90           'fld_length' => '160',
  91           'max_length' => '3',
  92           'description' => 'Describe the results of the review',
  93           'list_id' => '' ),
  94  'other_reviewed' =>
  95    array( 'field_id' => 'other_reviewed',
  96           'data_type' => '21',
  97           'fld_length' => '0',
  98           'description' => 'If CHECKED you must include a note',
  99           'list_id' => 'yesno' ),
 100  'other_note' =>
 101    array( 'field_id' => 'other_note',
 102           'data_type' => '3',
 103           'fld_length' => '160',
 104           'max_length' => '3',
 105           'description' => 'Describe system reviewed and the results of the review',
 106           'list_id' => '' ),
 107  'complications_reviewed' =>
 108    array( 'field_id' => 'complications_reviewed',
 109           'data_type' => '21',
 110           'fld_length' => '0',
 111           'description' => 'If CHECKED you must include a note',
 112           'list_id' => 'yesno' ),
 113  'complications_note' =>
 114    array( 'field_id' => 'complications_note',
 115           'data_type' => '3',
 116           'fld_length' => '160',
 117           'max_length' => '3',
 118           'description' => 'Describe the complication',
 119           'list_id' => '' ),
 120  'lmpdate' =>
 121    array( 'field_id' => 'lmpdate',
 122           'data_type' => '4',
 123           'fld_length' => '0',
 124           'description' => 'When was the the first day of your last menstrual period?',
 125           'list_id' => '' ),
 126  'cycle_int' =>
 127    array( 'field_id' => 'cycle_int',
 128           'data_type' => '1',
 129           'fld_length' => '0',
 130           'description' => 'What is the Interval of your Flow?',
 131           'list_id' => 'menses_cycle' ),
 132  'cycle_int_note' =>
 133    array( 'field_id' => 'cycle_int_note',
 134           'data_type' => '3',
 135           'fld_length' => '100',
 136           'max_length' => '1',
 137           'description' => 'Enter any addtional interval information',
 138           'list_id' => '' ),
 139  'flowfhcount' =>
 140    array( 'field_id' => 'flowfhcount',
 141           'data_type' => '2',
 142           'fld_length' => '10',
 143           'max_length' => '2',
 144           'description' => 'How many tampons/pads per day',
 145           'list_id' => '' ),
 146  'flowhrs' =>
 147    array( 'field_id' => 'flowhrs',
 148           'data_type' => '2',
 149           'fld_length' => '10',
 150           'max_length' => '2',
 151           'description' => 'How many between tampons/pads changes',
 152           'list_id' => '' ),
 153  'pmb' =>
 154    array( 'field_id' => 'pmb',
 155           'data_type' => '21',
 156           'fld_length' => '0',
 157           'description' => '',
 158           'list_id' => 'yesno' ),
 159  'vag_discharge' =>
 160    array( 'field_id' => 'vag_discharge',
 161           'data_type' => '21',
 162           'fld_length' => '0',
 163           'description' => 'If CHECKED you must include a note',
 164           'list_id' => 'yesno' ),
 165  'vag_discharge_note' =>
 166    array( 'field_id' => 'vag_discharge_note',
 167           'data_type' => '3',
 168           'fld_length' => '160',
 169           'max_length' => '3',
 170           'description' => 'Describe the color and amount',
 171           'list_id' => '' ),
 172  'vag_itching' =>
 173    array( 'field_id' => 'vag_itching',
 174           'data_type' => '21',
 175           'fld_length' => '0',
 176           'description' => '',
 177           'list_id' => 'yesno' ),
 178  'vag_itching_note' =>
 179    array( 'field_id' => 'vag_itching_note',
 180           'data_type' => '3',
 181           'fld_length' => '160',
 182           'max_length' => '3',
 183           'description' => 'Describe',
 184           'list_id' => '' ),
 185  'vag_odor' =>
 186    array( 'field_id' => 'vag_odor',
 187           'data_type' => '21',
 188           'fld_length' => '0',
 189           'description' => '',
 190           'list_id' => 'yesno' ),
 191  'vag_odor_note' =>
 192    array( 'field_id' => 'vag_odor_note',
 193           'data_type' => '3',
 194           'fld_length' => '160',
 195           'max_length' => '3',
 196           'description' => 'Describe',
 197           'list_id' => '' ),
 198  'vag_irratation' =>
 199    array( 'field_id' => 'vag_irratation',
 200           'data_type' => '21',
 201           'fld_length' => '0',
 202           'description' => '',
 203           'list_id' => 'yesno' ),
 204  'vag_irratation_note' =>
 205    array( 'field_id' => 'vag_irratation_note',
 206           'data_type' => '3',
 207           'fld_length' => '160',
 208           'max_length' => '3',
 209           'description' => 'Describe',
 210           'list_id' => '' ),
 211  'vag_spotting' =>
 212    array( 'field_id' => 'vag_spotting',
 213           'data_type' => '21',
 214           'fld_length' => '0',
 215           'description' => '',
 216           'list_id' => 'yesno' ),
 217  'vag_spotting_note' =>
 218    array( 'field_id' => 'vag_spotting_note',
 219           'data_type' => '3',
 220           'fld_length' => '160',
 221           'max_length' => '3',
 222           'description' => 'Describe',
 223           'list_id' => '' ),
 224  'priortreatment' =>
 225    array( 'field_id' => 'priortreatment',
 226           'data_type' => '21',
 227           'fld_length' => '0',
 228           'description' => 'Have you tried to treat the symptoms prior to this visit',
 229           'list_id' => 'yesno' ),
 230  'priortreatment_note' =>
 231    array( 'field_id' => 'priortreatment_note',
 232           'data_type' => '3',
 233           'fld_length' => '160',
 234           'max_length' => '3',
 235           'description' => 'Describe',
 236           'list_id' => '' ),
 237  'pain_menses' =>
 238    array( 'field_id' => 'pain_menses',
 239           'data_type' => '1',
 240           'fld_length' => '0',
 241           'description' => 'Pain with or between menses?',
 242           'list_id' => 'menses_pain' ),
 243  'pain_level' =>
 244    array( 'field_id' => 'pain_level',
 245           'data_type' => '2',
 246           'fld_length' => '10',
 247           'max_length' => '2',
 248           'description' => 'Level of pain 1-10',
 249           'list_id' => '' ),
 250  'pain_location' =>
 251    array( 'field_id' => 'pain_location',
 252           'data_type' => '1',
 253           'fld_length' => '0',
 254           'description' => 'Select Quadrant',
 255           'list_id' => 'menses_pain_location' ),
 256  'pain_lenth' =>
 257    array( 'field_id' => 'pain_lenth',
 258           'data_type' => '2',
 259           'fld_length' => '10',
 260           'max_length' => '30',
 261           'description' => 'Enter Months, Years etc',
 262           'list_id' => '' ),
 263  'pain_drug_resp' =>
 264    array( 'field_id' => 'pain_drug_resp',
 265           'data_type' => '2',
 266           'fld_length' => '10',
 267           'max_length' => '30',
 268           'description' => 'Is the pain responsive to OTC drugs? Which?',
 269           'list_id' => '' ),
 270  'pain_intercourse' =>
 271    array( 'field_id' => 'pain_intercourse',
 272           'data_type' => '21',
 273           'fld_length' => '0',
 274           'description' => '',
 275           'list_id' => 'yesno' ),
 276  'pain_intercourse_time' =>
 277    array( 'field_id' => 'pain_intercourse_time',
 278           'data_type' => '3',
 279           'fld_length' => '120',
 280           'max_length' => '1',
 281           'description' => 'How Long, etc?',
 282           'list_id' => '' )
 283  );
 284 $submiturl = $GLOBALS['rootdir'].'/forms/'.$form_folder.'/save.php?mode=update&amp;return=encounter&amp;id='.$_GET['id'];
 285 if ($_GET['mode']) {
 286  if ($_GET['mode']=='noencounter') {
 287  $submiturl = $GLOBALS['rootdir'].'/forms/'.$form_folder.'/save.php?mode=new&amp;return=show&amp;id='.$_GET['id'];
 288  $returnurl = 'show.php';
 289  }
 290 }
 291 else
 292 {
 293  $returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
 294 }
 295
 296 /* remove the time-of-day from all date fields */
 297 if ($xyzzy['lmpdate'] != '') {
 298     $dateparts = split(' ', $xyzzy['lmpdate']);
 299     $xyzzy['lmpdate'] = $dateparts[0];
 300 }
 301
 302 /* define check field functions. used for translating from fields to html viewable strings */
 303
 304 function chkdata_Date(&$record, $var) {
 305         return htmlspecialchars($record{"$var"},ENT_QUOTES);
 306 }
 307
 308 function chkdata_Txt(&$record, $var) {
 309         return htmlspecialchars($record{"$var"},ENT_QUOTES);
 310 }
 311
 312 ?><!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.1//EN" "http://www.w3.org/TR/xhtml11/DTD/xhtml11.dtd">
 313 <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en">
 314 <head>
 315
 316 <!-- declare this document as being encoded in UTF-8 -->
 317 <meta http-equiv="Content-Type" content="text/html;charset=utf-8" ></meta>
 318
 319 <!-- supporting javascript code -->
 320 <!-- for dialog -->
 321 <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/dialog.js"></script>
 322 <!-- For jquery, required by the save, discard, and print buttons. -->
 323 <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/js/jquery.js"></script>
 324 <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/textformat.js"></script>
 325
 326 <!-- Global Stylesheet -->
 327 <link rel="stylesheet" href="<?php echo $css_header; ?>" type="text/css"/>
 328 <!-- Form Specific Stylesheet. -->
 329 <link rel="stylesheet" href="../../forms/<?php echo $form_folder; ?>/style.css" type="text/css"/>
 330
 331 <!-- supporting code for the pop up calendar(date picker) -->
 332 <style type="text/css">@import url(<?php echo $GLOBALS['webroot']; ?>/library/dynarch_calendar.css);</style>
 333 <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/dynarch_calendar.js"></script>
 334 <?php include_once("{$GLOBALS['srcdir']}/dynarch_calendar_en.inc.php"); ?>
 335 <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/dynarch_calendar_setup.js"></script>
 336
 337
 338 <script type="text/javascript">
 339 // this line is to assist the calendar text boxes
 340 var mypcc = '<?php echo $GLOBALS['phone_country_code']; ?>';
 341
 342 <!-- support code for collapsing sections -->
 343 function divclick(cb, divid) {
 344  var divstyle = document.getElementById(divid).style;
 345  if (cb.checked) {
 346   divstyle.display = 'block';
 347  } else {
 348   divstyle.display = 'none';
 349  }
 350  return true;
 351 }
 352
 353 <!-- FIXME: this needs to detect access method, and construct a URL appropriately! -->
 354 function PrintForm() {
 355     newwin = window.open("<?php echo $rootdir.'/forms/'.$form_folder.'/print.php?id='.$_GET['id']; ?>","print_<?php echo $form_name; ?>");
 356 }
 357
 358 </script>
 359 <title><?php echo htmlspecialchars('View '.$form_name); ?></title>
 360
 361 </head>
 362 <body class="body_top">
 363
 364 <div id="title">
 365 <a href="<?php echo $returnurl; ?>" onclick="top.restoreSession()">
 366 <span class="title"><?php htmlspecialchars(xl($form_name,'e')); ?></span>
 367 <span class="back">(<?php xl('Back','e'); ?>)</span>
 368 </a>
 369 </div>
 370
 371 <form method="post" action="<?php echo $submiturl; ?>" id="<?php echo $form_folder; ?>">
 372
 373 <!-- Save/Cancel buttons -->
 374 <div id="top_buttons" class="top_buttons">
 375 <fieldset class="top_buttons">
 376 <input type="button" class="save" value="<?php xl('Save Changes','e'); ?>" />
 377 <input type="button" class="dontsave" value="<?php xl('Don\'t Save Changes','e'); ?>" />
 378 <input type="button" class="print" value="<?php xl('Print','e'); ?>" />
 379 </fieldset>
 380 </div><!-- end top_buttons -->
 381
 382 <!-- container for the main body of the form -->
 383 <div id="form_container">
 384 <fieldset>
 385
 386 <!-- display the form's manual based fields -->
 387 <table border='0' cellpadding='0' width='100%'>
 388 <tr><td class='sectionlabel'><input type='checkbox' id='form_cb_m_1' value='1' onclick='return divclick(this,"cardio")' checked="checked" />Cardio - Respiratory System</td></tr><tr><td><div id="cardio" class='section'><table>
 389 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!-- generating not($fields[$checked+1]) and calling last --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Reviewed','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['cardio_reviewed'], $xyzzy['cardio_reviewed']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['cardio_note'], $xyzzy['cardio_note']); ?></td><!-- called consumeRows 425--> <!-- Exiting not($fields) and generating 1 empty fields --><td class='emptycell' colspan='1'></td></tr>
 390 </table></div>
 391 </td></tr> <!-- end section cardio -->
 392 <tr><td class='sectionlabel'><input type='checkbox' id='form_cb_m_2' value='1' onclick='return divclick(this,"gastro")' checked="checked" />Gastro - Intestinal System</td></tr><tr><td><div id="gastro" class='section'><table>
 393 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!-- generating not($fields[$checked+1]) and calling last --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Reviewed','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['gastro_reviewed'], $xyzzy['gastro_reviewed']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['gastro_note'], $xyzzy['gastro_note']); ?></td><!-- called consumeRows 425--> <!-- Exiting not($fields) and generating 1 empty fields --><td class='emptycell' colspan='1'></td></tr>
 394 </table></div>
 395 </td></tr> <!-- end section gastro -->
 396 <tr><td class='sectionlabel'><input type='checkbox' id='form_cb_m_3' value='1' onclick='return divclick(this,"urinary")' checked="checked" />Urinary System</td></tr><tr><td><div id="urinary" class='section'><table>
 397 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!-- generating not($fields[$checked+1]) and calling last --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Reviewed','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['Urinary_reviewed'], $xyzzy['Urinary_reviewed']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['Urinary_note'], $xyzzy['Urinary_note']); ?></td><!-- called consumeRows 425--> <!-- Exiting not($fields) and generating 1 empty fields --><td class='emptycell' colspan='1'></td></tr>
 398 </table></div>
 399 </td></tr> <!-- end section urinary -->
 400 <tr><td class='sectionlabel'><input type='checkbox' id='form_cb_m_4' value='1' onclick='return divclick(this,"cns")' checked="checked" />Central Nervous System</td></tr><tr><td><div id="cns" class='section'><table>
 401 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!-- generating not($fields[$checked+1]) and calling last --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Reviewed','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['cns_reviewed'], $xyzzy['cns_reviewed']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['cns_note'], $xyzzy['cns_note']); ?></td><!-- called consumeRows 425--> <!-- Exiting not($fields) and generating 1 empty fields --><td class='emptycell' colspan='1'></td></tr>
 402 </table></div>
 403 </td></tr> <!-- end section cns -->
 404 <tr><td class='sectionlabel'><input type='checkbox' id='form_cb_m_5' value='1' onclick='return divclick(this,"othersys")' checked="checked" />Other Systems</td></tr><tr><td><div id="othersys" class='section'><table>
 405 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!-- generating not($fields[$checked+1]) and calling last --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Reviewed','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['other_reviewed'], $xyzzy['other_reviewed']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['other_note'], $xyzzy['other_note']); ?></td><!-- called consumeRows 425--> <!-- Exiting not($fields) and generating 1 empty fields --><td class='emptycell' colspan='1'></td></tr>
 406 </table></div>
 407 </td></tr> <!-- end section othersys -->
 408 <tr><td class='sectionlabel'><input type='checkbox' id='form_cb_m_6' value='1' onclick='return divclick(this,"complications")' checked="checked" />Complications</td></tr><tr><td><div id="complications" class='section'><table>
 409 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!-- generating not($fields[$checked+1]) and calling last --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Reviewed','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['complications_reviewed'], $xyzzy['complications_reviewed']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['complications_note'], $xyzzy['complications_note']); ?></td><!-- called consumeRows 425--> <!-- Exiting not($fields) and generating 1 empty fields --><td class='emptycell' colspan='1'></td></tr>
 410 </table></div>
 411 </td></tr> <!-- end section complications -->
 412 <tr><td class='sectionlabel'><input type='checkbox' id='form_cb_m_7' value='1' onclick='return divclick(this,"menstrual")' checked="checked" />Menstrual History</td></tr><tr><td><div id="menstrual" class='section'><table>
 413 <!-- called consumeRows 015--> <!--  generating 5 cells and calling --><td>
 414 <span class="fieldlabel"><?php xl('LMP Start Date','e'); ?> (yyyy-mm-dd): </span>
 415 </td><td>
 416    <input type='text' size='10' name='lmpdate' id='lmpdate' title='When was the the first day of your last menstrual period?'
 417     value="<?php $result=chkdata_Date($xyzzy,'lmpdate'); echo $result; ?>"
 418     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
 419    <img src='../../pic/show_calendar.gif' width='24' height='22'
 420     id='img_lmpdate' alt='[?]' style='cursor:pointer'
 421     title="<?php xl('Click here to choose a date','e'); ?>" />
 422 <script type="text/javascript">
 423 Calendar.setup({inputField:'lmpdate', ifFormat:'%Y-%m-%d', button:'img_lmpdate'});
 424 </script>
 425 </td>
 426 <!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 427 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!--  generating 5 cells and calling --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Cycle Interval','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['cycle_int'], $xyzzy['cycle_int']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['cycle_int_note'], $xyzzy['cycle_int_note']); ?></td><!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 428 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!--  generating 5 cells and calling --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Flow - FH count','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['flowfhcount'], $xyzzy['flowfhcount']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Flow - Hrs between changes','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['flowhrs'], $xyzzy['flowhrs']); ?></td><!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 429 <!-- called consumeRows 015--> <!-- generating not($fields[$checked+1]) and calling last --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Post Menapausal Bleeding','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['pmb'], $xyzzy['pmb']); ?></td><!-- called consumeRows 215--> <!-- Exiting not($fields) and generating 3 empty fields --><td class='emptycell' colspan='1'></td></tr>
 430 </table></div>
 431 </td></tr> <!-- end section menstrual -->
 432 <tr><td class='sectionlabel'><input type='checkbox' id='form_cb_m_8' value='1' onclick='return divclick(this,"infection")' checked="checked" />Vaginal Infection</td></tr><tr><td><div id="infection" class='section'><table>
 433 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!--  generating 5 cells and calling --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Discharge','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['vag_discharge'], $xyzzy['vag_discharge']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['vag_discharge_note'], $xyzzy['vag_discharge_note']); ?></td><!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 434 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!--  generating 5 cells and calling --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Itching','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['vag_itching'], $xyzzy['vag_itching']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['vag_itching_note'], $xyzzy['vag_itching_note']); ?></td><!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 435 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!--  generating 5 cells and calling --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Odor','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['vag_odor'], $xyzzy['vag_odor']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['vag_odor_note'], $xyzzy['vag_odor_note']); ?></td><!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 436 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!--  generating 5 cells and calling --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Irritation','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['vag_irratation'], $xyzzy['vag_irratation']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['vag_irratation_note'], $xyzzy['vag_irratation_note']); ?></td><!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 437 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!--  generating 5 cells and calling --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Spotting','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['vag_spotting'], $xyzzy['vag_spotting']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['vag_spotting_note'], $xyzzy['vag_spotting_note']); ?></td><!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 438 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 225--> <!-- generating not($fields[$checked+1]) and calling last --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Prior Treatment','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['priortreatment'], $xyzzy['priortreatment']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Note','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['priortreatment_note'], $xyzzy['priortreatment_note']); ?></td><!-- called consumeRows 525--> <!-- Exiting not($fields) and generating 0 empty fields --></tr>
 439 </table></div>
 440 </td></tr> <!-- end section infection -->
 441 <tr><td class='sectionlabel'><input type='checkbox' id='form_cb_m_9' value='1' onclick='return divclick(this,"pelvic pain")' checked="checked" />Pelvic Pain</td></tr><tr><td><div id="pelvic pain" class='section'><table>
 442 <!-- called consumeRows 015--> <!--  generating 5 cells and calling --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Menses Pain','e').':'; ?></td><td class='text data' colspan='4'><?php echo generate_form_field($manual_layouts['pain_menses'], $xyzzy['pain_menses']); ?></td><!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 443 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 325--> <!--  generating 5 cells and calling --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Pain Level','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['pain_level'], $xyzzy['pain_level']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Pain Location','e').':'; ?></td><td class='text data' colspan='1'><?php echo generate_form_field($manual_layouts['pain_location'], $xyzzy['pain_location']); ?></td><!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 444 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 325--> <!--  generating 7 cells and calling --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Pain Length of Time','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['pain_lenth'], $xyzzy['pain_lenth']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Pain OTC/NSAIDS Response','e').':'; ?></td><td class='text data' colspan='3'><?php echo generate_form_field($manual_layouts['pain_drug_resp'], $xyzzy['pain_drug_resp']); ?></td><!--  generating empties --><td class='emptycell' colspan='1'></td></tr>
 445 <!-- called consumeRows 015--> <!-- just calling --><!-- called consumeRows 325--> <!-- generating not($fields[$checked+1]) and calling last --><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('Pain with Intercourse','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['pain_intercourse'], $xyzzy['pain_intercourse']); ?></td><td class='fieldlabel' colspan='1'><?php echo xl_layout_label('How Long','e').':'; ?></td><td class='text data' colspan='2'><?php echo generate_form_field($manual_layouts['pain_intercourse_time'], $xyzzy['pain_intercourse_time']); ?></td><!-- called consumeRows 625--> <!-- Exiting not($fields) and generating -1 empty fields --></tr>
 446 </table></div>
 447 </td></tr> <!-- end section pelvic pain -->
 448 </table>
 449
 450 </fieldset>
 451 </div> <!-- end form_container -->
 452
 453 <!-- Save/Cancel buttons -->
 454 <div id="bottom_buttons" class="button_bar">
 455 <fieldset>
 456 <input type="button" class="save" value="<?php xl('Save Changes','e'); ?>" />
 457 <input type="button" class="dontsave" value="<?php xl('Don\'t Save Changes','e'); ?>" />
 458 </fieldset>
 459 </div><!-- end bottom_buttons -->
 460 </form>
 461 <script type="text/javascript">
 462 // jQuery stuff to make the page a little easier to use
 463
 464 $(document).ready(function(){
 465     $(".save").click(function() { top.restoreSession(); document.forms["<?php echo $form_folder; ?>"].submit(); });
 466     $(".dontsave").click(function() { location.href='<?php echo $returnurl; ?>'; });
 467 });
 468 </script>
 469 </body>
 470 </html>
 471