interface/forms/vitalsM/templates/vitalsM/general_new.html

   1 <html>
   2 <head>
   3 {php}html_header_show();{/php}
   4 {literal}
   5 <script language="javascript">
   6 function calculateBMI()
   7 {
   8   var bmi = 0;
   9   var height = document.vitals.height.value;
  10   var weight = document.vitals.weight.value;
  11   if(height > 0 && weight > 0)
  12   {
  13     bmi = weight/height/height*10000;
  14   }
  15   document.vitals.BMI.value = bmi;
  16   return bmi;
  17 }
  18 </script>
  19 <style type="text/css" title="mystyles" media="all">
  20 <!--
  21 td {
  22   font-size: 12pt;
  23   font-family: helvetica;
  24 }
  25 li {
  26   font-size: 11pt;
  27   font-family: helvetica;
  28   margin-left: 15px;
  29 }
  30 a {
  31   font-size: 11pt;
  32   font-family: helvetica;
  33 }
  34 .title {
  35   font-family: sans-serif;
  36   font-size: 12pt;
  37   font-weight: bold;
  38   text-decoration: none;
  39   color: #000000;
  40 }
  41
  42 .form_text{
  43   font-family: sans-serif;
  44   font-size: 9pt;
  45   text-decoration: none;
  46   color: #000000;
  47 }
  48 -->
  49 </style>
  50 {/literal}
  51 </head>
  52
  53 <body bgcolor="{$STYLE.BGCOLOR2}">
  54 <p><span class="title">Vitals (Metric)</span></p>
  55 <form name="vitals" method="post" action="{$FORM_ACTION}/interface/forms/vitalsM/save.php"
  56  onsubmit="return top.restoreSession()">
  57 <table>
  58   <tr>
  59     <th align="left">Name</th><th align="left">Unit</th>
  60     <th align="right">{$vitals->get_date()|date_format:"%m/%d/%y"}</th>
  61   {foreach item=result from=$results}
  62     <th align='right'>{$result.date|date_format:"%m/%d/%y"}</th>
  63   {/foreach}
  64   </tr>
  65
  66   <tr>
  67     <td>Weight</td><td>kg</td>
  68     <td align='right'><input type="text"  size='5'
  69     name="weight" value="{$vitals->get_weight()}"/></td>
  70   {foreach item=result from=$results}
  71     <td  align='right'>{$result.weight}</td>
  72   {/foreach}
  73   </tr>
  74
  75   <tr>
  76     <td>Height</td><td>cm</td>
  77     <td align='right'><input type="text" size='5'
  78       name="height" value="{$vitals->get_height()}" onchange="calculateBMI();"/></td>
  79   {foreach item=result from=$results}
  80     <td  align='right'>{$result.height}</td>
  81   {/foreach}
  82   </tr>
  83
  84   <tr>
  85     <td>BP Systolic</td><td>mm/hg</td>
  86     <td align='right'><input type="text" size='5'
  87       name="bps" value="{$vitals->get_bps()}"/></td>
  88   {foreach item=result from=$results}
  89     <td  align='right'>{$result.bps}</td>
  90   {/foreach}
  91   </tr>
  92
  93   <tr>
  94     <td>BP Diastolic</td><td>mm/hg</td>
  95     <td align='right'><input type="text" size='5'
  96       name="bpd" value="{$vitals->get_bpd()}"/></td>
  97   {foreach item=result from=$results}
  98     <td  align='right'>{$result.bpd}</td>
  99   {/foreach}
 100   </tr>
 101
 102   <tr>
 103     <td>Pulse</td><td>per min</td>
 104     <td align='right'><input type="text" size='5'
 105       name="pulse" value="{$vitals->get_pulse()}"/></td>
 106   {foreach item=result from=$results}
 107     <td  align='right'>{$result.pulse}</td>
 108   {/foreach}
 109   </tr>
 110
 111   <tr><td>Respiration</td><td>per min</td>
 112     <td align='right'><input type="text" size='5'
 113       name="respiration" value="{$vitals->get_respiration()}"/></td>
 114   {foreach item=result from=$results}
 115     <td  align='right'>{$result.respiration}</td>
 116   {/foreach}
 117   </tr>
 118
 119   <tr>
 120     <td>Temperature</td><td>C</td>
 121     <td align='right'><input type="text" size='5'
 122       name="temperature" value="{$vitals->get_temperature()}"/></td>
 123   {foreach item=result from=$results}
 124     <td  align='right'>{$result.temperature}</td>
 125   {/foreach}
 126   </tr>
 127
 128   <tr>
 129     <td>Temp Location</td>
 130     <td colspan='2' >
 131       <select name="temp_method"/><option value=""> </option>
 132       <option value="Oral"              {if $vitals->get_temp_method() == "Oral"              || $vitals->get_temp_method() == 2 } selected{/if}>Oral
 133       <option value="Tympanic Membrane" {if $vitals->get_temp_method() == "Tympanic Membrane" || $vitals->get_temp_method() == 1 } selected{/if}>Tympanic Membrane
 134       <option value="Rectal"            {if $vitals->get_temp_method() == "Rectal"            || $vitals->get_temp_method() == 3 } selected{/if}>Rectal
 135       <option value="Axillary"          {if $vitals->get_temp_method() == "Axillary"          || $vitals->get_temp_method() == 4 } selected{/if}>Axillary
 136       <option value="Temporal Artery"   {if $vitals->get_temp_method() == "Temporal Artery" } selected{/if}>Temporal Artery
 137       </select>
 138     </td>
 139     <td align='right'>{$result.temp_method}</td>
 140   </tr>
 141
 142   <tr><td>Oxygen Saturation</td><td>%</td>
 143     <td align='right'><input type="text" size='5'
 144       name="oxygen_saturation" value="{$vitals->get_oxygen_saturation()}"/></td>
 145   {foreach item=result from=$results}
 146     <td  align='right'>{$result.oxygen_saturation}</td>
 147   {/foreach}
 148   </tr>
 149
 150   <tr><td>Head Circumference</td><td>cm</td>
 151     <td align='right'><input type="text" size='5'
 152       name="head_circ" value="{$vitals->get_head_circ()}"/></td>
 153   {foreach item=result from=$results}
 154     <td  align='right'>{$result.head_circ}</td>
 155   {/foreach}
 156   </tr>
 157
 158   <tr><td>Waist Circumference</td><td>cm</td>
 159     <td align='right'><input type="text" size='5'
 160       name="waist_circ" value="{$vitals->get_waist_circ()}"/></td>
 161   {foreach item=result from=$results}
 162     <td align='right'>{$result.waist_circ}</td>
 163   {/foreach}
 164   </tr>
 165
 166   <tr><td>BMI</td><td>%</td>
 167     <td align='right'><input type="text" size='5'
 168       name="BMI" value="{$vitals->get_BMI()}"/></td>
 169   {foreach item=result from=$results}
 170     <td  align='right'>{$result.BMI}</td>
 171   {/foreach}</tr>
 172
 173   <tr><td>BMI Status</td><td>Type</td>
 174     <td align='right'>{$vitals->get_BMI_status()}</td>
 175   {foreach item=result from=$results}
 176     <td  align='right'>{$result.BMI_status}</td>
 177   {/foreach}
 178   </tr>
 179
 180   <tr><td>Other Notes</td>
 181     <td colspan='2' align='right'><input type="text" size='20'
 182       name="note" value="{$vitals->get_note()}" /></td>
 183   {foreach item=result from=$results}
 184     <td align='right'>{$result.note}</td>
 185   {/foreach}</tr>
 186
 187   <tr>
 188     <td><input type="submit" name="Submit" value="Save Form">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<a href="{$DONT_SAVE_LINK}" class="link">[Don't Save]</a></td>
 189   </tr>
 190 </table>
 191 <input type="hidden" name="id" value="{$vitals->get_id()}" />
 192 <input type="hidden" name="activity" value="{$vitals->get_activity()}">
 193 <input type="hidden" name="pid" value="{$vitals->get_pid()}">
 194 <input type="hidden" name="process" value="true">
 195 </form>
 196 </body>
 197 </html>