contrib/forms/vitals/form.php

   1 <?
   2 /*
   3
   4 This form works as new and editing,
   5 */
   6 ?>
   7 <TABLE span class=text>
   8 <th><H2><U>Vital Signs</U></H2></th>
   9 <TR>
  10         <TD >Blood Presure:</TD>
  11         <TD>
  12         <INPUT TYPE="text" NAME="bps" size="3" value="<? if ($obj["bps"]!='') print $obj["bps"]; ?>">/<INPUT TYPE="text" NAME="bpd" size="3" value="<? if ($obj["bpd"]!='') print $obj["bpd"]; ?>">
  13         </TD>
  14         <TD >Weight (pounds):</TD>
  15         <TD><INPUT TYPE="text" NAME="weight" size="6" value="<? if ($obj["weight"]!='') print $obj["weight"]; ?>"></TD>
  16         <TD >Height (inches):</TD>
  17         <TD><INPUT TYPE="text" NAME="height" size="6" value="<? if ($obj["height"]!='') print $obj["height"]; ?>"></TD>
  18 </TR>
  19 <TR>
  20         <TD >Temperature:</TD>
  21         <TD><INPUT TYPE="text" NAME="temperature" size="6" value="<? if ($obj["temperature"]!='') print $obj["temperature"]; ?>">
  22                 <select name="temp_method">
  23                 <option <? if ($obj["temp_method"]=='ear') print 'selected'; ?>>ear
  24                 <option <? if ($obj["temp_method"]=='axillary') print 'selected'; ?>>axillary
  25                 <option <? if ($obj["temp_method"]=='mouth') print 'selected'; ?>>mouth
  26                 <option <? if ($obj["temp_method"]=='rectal') print 'selected'; ?>>rectal
  27                 </SELECT>
  28         </TD>
  29         <TD >Pulse (bps):</TD>
  30         <TD><INPUT TYPE="text" NAME="pulse" size="3" value="<? if ($obj["pulse"]!='') print $obj["pulse"]; ?>"></TD>
  31         <TD >Respiration:</TD>
  32         <TD><INPUT TYPE="text" NAME="respiration" size="2" value="<? if ($obj["respiration"]!='') print $obj["respiration"]; ?>"></TD>
  33 </TR>
  34 <TR>
  35         <TD>Note:</TD>
  36         <TD><INPUT TYPE="text" NAME="note" value="<? if ($obj["note"]!='') print $obj["note"]; ?>"></TD>
  37         <TD>Body Mass Index:</TD>
  38         <TD><INPUT TYPE="text" NAME="BMI" size="6" value="<? if ($obj["BMI"]!='') print $obj["BMI"]; ?>"><? if ($obj["BMI_status"]!='') print $obj["BMI_status"]; ?></TD>
  39         <TD>Waist circ (inch):</TD>
  40         <TD><INPUT TYPE="text" NAME="waist_circ" size="6" value="<? if ($obj["waist_circ"]!='') print $obj["waist_circ"]; ?>"></TD>
  41 </TR>
  42 </TABLE>