contrib/forms/high_risk_screening_record/printable.php

   1 <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
   2 "http://www.w3.org/TR/html4/loose.dtd">
   3 <?php
   4 include_once("../../globals.php");
   5 include_once("$srcdir/api.inc");
   6 include_once("$srcdir/forms.inc");
   7 include_once("$srcdir/calendar.inc");
   8 ?>
   9
  10 <html>
  11 <head>
  12 <title>Form: High risk screening record</title>
  13 <? include("../../acog_printable_h.css"); ?>
  14 </head>
  15
  16 <?
  17    $fres=sqlStatement("select * from patient_data where pid='".$pid."'");
  18    if ($fres){
  19      $patient = sqlFetchArray($fres);
  20    }
  21    $fres=sqlStatement("select * from form_high_risk_screening_record where id=$id");
  22    if ($fres){
  23      $fdata = sqlFetchArray($fres);
  24    }
  25 ?>
  26 <body <?echo $top_bg_line;?>>
  27
  28 <div class="srvChapter">High risk screening  record* </div>
  29 <div style="border: solid 2px black; background-color:#FFFFFF;">
  30   <table  border="0" cellpadding="2" cellspacing="0">
  31     <tr align="left" valign="bottom">
  32       <td colspan="6" class="fibody2" id="bordR">Patient name: <?  echo $patient{'fname'}.' '.$patient{'mname'}.' '.$patient{'lname'};  ?></td>
  33       <td colspan="5" class="fibody2" id="bordR">Birth date: <?  echo $patient{'DOB'}; ?></td>
  34       <td colspan="4" class="fibody2">ID No: <? echo $patient{'id'}; ?></td>
  35       </tr>
  36     <tr align="center" valign="middle">
  37       <td class="ficaption2" id="bordR">&nbsp;</td>
  38       <td width="6%" class="ficaption2" id="bordR">HEMO-<br>
  39         GLOBIN<br>
  40         TEST</td>
  41       <td width="6%" class="ficaption2" id="bordR">BONE DENSITY<br>
  42         SCREENING</td>
  43       <td width="6%" class="ficaption2" id="bordR">BACTERI-<br>
  44         URIA&nbsp;TEST</td>
  45       <td width="6%" class="ficaption2" id="bordR">STD<br>
  46         TESTING</td>
  47       <td width="6%" class="ficaption2" id="bordR">HIV test* </td>
  48       <td width="6%" class="ficaption2" id="bordR">Genetic testing </td>
  49       <td width="6%" class="ficaption2" id="bordR">Rubella titer </td>
  50       <td width="6%" class="ficaption2" id="bordR">TB skin test </td>
  51       <td width="6%" class="ficaption2" id="bordR">Lipid profile assessment </td>
  52       <td width="6%" class="ficaption2" id="bordR">Mammo-<br>
  53         graphy</td>
  54       <td width="6%" class="ficaption2" id="bordR">Fasting<br>
  55         GLUCOSE TEST</td>
  56       <td width="6%" class="ficaption2" id="bordR">TSH<br>
  57         TEST</td>
  58       <td width="6%" class="ficaption2" id="bordR">COLORECTAL<br>
  59         CANCER<br>
  60         SCREENING</td>
  61       <td width="6%" class="ficaption2">HEPATITIS C<br>
  62         VIRUS TEST</td>
  63     </tr>
  64 <?
  65 $rsi = 1;
  66 while ($rsi < 13){
  67 list(
  68 $hemoglobin, $bone_density, $bacteriuria, $std, $hiv, $genetic, $rubella, $tb_skin,
  69 $lipid, $mammography, $fasting_glucose, $tsh, $cancer, $hepatitis_c
  70 ) = explode("|~",$fdata["record_".$rsi]);
  71 list( $hemoglobin_date, $hemoglobin_res) = explode(';', $hemoglobin);
  72 list( $bone_density_date, $bone_density_res) = explode(';', $bone_density);
  73 list( $bacteriuria_date, $bacteriuria_res) = explode(';', $bacteriuria);
  74 list( $std_date, $std_res) = explode(';', $std);
  75 list( $hiv_date, $hiv_res) = explode(';', $hiv);
  76 list( $genetic_date, $genetic_res) = explode(';', $genetic);
  77 list( $rubella_date, $rubella_res) = explode(';', $rubella);
  78 list( $tb_skin_date, $tdb_skin_res) = explode(';', $tdb_skin);
  79 list( $lipid_date, $lipid_res) = explode(';', $lipid);
  80 list( $mammography_date, $mammography_res) = explode(';', $mammography);
  81 list( $fasting_glucose_date, $fasting_glucose_res) = explode(';', $fasting_glucose);
  82 list( $tsh_date, $tsh_res) = explode(';', $tsh);
  83 list( $cancer_date, $cancer_res) = explode(';', $cancer);
  84 list( $hepatitis_c_date, $hepatitis_c_res) = explode(';', $hepatitis_c);
  85
  86 print <<<EOL
  87     <tr align="left" valign="bottom">
  88       <td class="fibody3" id="bordR">Date:</td>
  89       <td class="fibody3" id="bordR">${hemoglobin_date}&nbsp;</td>
  90       <td class="fibody3" id="bordR">${bone_density_date}&nbsp;</td>
  91       <td class="fibody3" id="bordR">${bacteriuria_date}&nbsp;</td>
  92       <td class="fibody3" id="bordR">${std_date}&nbsp;</td>
  93       <td class="fibody3" id="bordR">${hiv_date}&nbsp;</td>
  94       <td class="fibody3" id="bordR">${genetic_date}&nbsp;</td>
  95       <td class="fibody3" id="bordR">${rubella_date}&nbsp;</td>
  96       <td class="fibody3" id="bordR">${tb_skin_date}&nbsp;</td>
  97       <td class="fibody3" id="bordR">${lipid_date}&nbsp;</td>
  98       <td class="fibody3" id="bordR">${mammography_date}&nbsp;</td>
  99       <td class="fibody3" id="bordR">${fasting_glucose_date}&nbsp;</td>
 100       <td class="fibody3" id="bordR">${tsh_date}&nbsp;</td>
 101       <td class="fibody3" id="bordR">${cancer_date}&nbsp;</td>
 102       <td class="fibody3">${hepatitis_c_date}&nbsp;</td>
 103     </tr>
 104     <tr align="left" valign="bottom">
 105       <td class="fibody2" id="bordR">Result:</td>
 106       <td class="fibody2" id="bordR">${hemoglobin_res}&nbsp;</td>
 107       <td class="fibody2" id="bordR">${bone_density_res}&nbsp;</td>
 108       <td class="fibody2" id="bordR">${bacteriuria_res}&nbsp;</td>
 109       <td class="fibody2" id="bordR">${std_res}&nbsp;</td>
 110       <td class="fibody2" id="bordR">${hiv_res}&nbsp;</td>
 111       <td class="fibody2" id="bordR">${genetic_res}&nbsp;</td>
 112       <td class="fibody2" id="bordR">${rubella_res}&nbsp;</td>
 113       <td class="fibody2" id="bordR">${tb_skin_res}&nbsp;</td>
 114       <td class="fibody2" id="bordR">${lipid_res}&nbsp;</td>
 115       <td class="fibody2" id="bordR">${mammography_res}&nbsp;</td>
 116       <td class="fibody2" id="bordR">${fasting_glucose_res}&nbsp;</td>
 117       <td class="fibody2" id="bordR">${tsh_res}&nbsp;</td>
 118       <td class="fibody2" id="bordR">${cancer_res}&nbsp;</td>
 119       <td class="fibody2">${hepatitis_c_res}&nbsp;</td>
 120     </tr>
 121 EOL;
 122 $rsi++;
 123 }
 124 ?>
 125   </table>
 126 </div>
 127 <p><sup>*</sup>See Table of High-Risk Factors.</p>
 128 <p><sup>**</sup>Check state requirements before recording results.</p>
 129 </body>
 130 </html>