contrib/forms/medical_decision/report.php

   1 <? function medical_decision_report( $pid, $encounter, $cols, $id) {
   2 include_once("../../globals.php");
   3 include_once("$srcdir/api.inc");
   4 include_once("$srcdir/forms.inc");
   5 include_once("$srcdir/calendar.inc");
   6    $fres=sqlStatement("select * from patient_data where pid='".$pid."'");
   7    if ($fres){
   8      $patient = sqlFetchArray($fres);
   9    }
  10    $fres=sqlStatement("select * from form_medical_decision where id='".$id."'");
  11    if ($fres){
  12      $fdata = sqlFetchArray($fres);
  13    }
  14 ?>
  15 <div class="srvChapter">Medical decision making</div>
  16 <div style="border: solid 2px black; background-color: white;">
  17 <table width="100%"  border="0" cellspacing="0" cellpadding="0">
  18   <tr>
  19     <td align="left" valign="top" class="fibody2"><table width="100%"  border="0" cellspacing="0" cellpadding="5">
  20       <tr align="left" valign="bottom">
  21         <td width="40%" class="fibody2" id="bordR">Patient name:  <? echo $patient{'fname'}.' '.$patient{'mname'}.' '.$patient{'lname'};          ?></td>
  22         <td width="20%" class="fibody2" id="bordR">Birth date: <? echo $patient{'DOB'};         ?></td>
  23         <td width="20%" class="fibody2" id="bordR">ID No: <?  echo $patient{'id'};  ?></td>
  24         <td width="20%" class="fibody2">date: <? echo date('Y-m-d'); ?></td>
  25       </tr>
  26     </table> </td>
  27   </tr>
  28   <tr>
  29     <td align="center" valign="middle" class="fibody2"><h2>Amount and complexility of data reviewed </h2></td>
  30   </tr>
  31   <tr>
  32     <td align="left" valign="top">&nbsp;</td>
  33   </tr>
  34 </table>
  35 <table width="100%"  border="0" cellspacing="0" cellpadding="2">
  36   <tr align="left" valign="top">
  37     <td width="29%" class="ficaption3">Tests ordered </td>
  38     <td class="ficaption3">review of records </td>
  39   </tr>
  40   <tr align="left" valign="top">
  41     <td class="fibody3"><p>
  42       <? echo (($fdata{'test_lab'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  43       Laboratory</p>
  44       <blockquote>
  45         <p>
  46           <? echo (($fdata{'test_lab_cervical'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  47           cervical cytology</p>
  48         <p>
  49           <? echo (($fdata{'test_lab_hpv'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  50           HPV test</p>
  51         <p>
  52           <? echo (($fdata{'test_lab_wet_mount'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  53           wet mount</p>
  54         <p>
  55           <? echo (($fdata{'test_lab_chlamydia'} == 'checkbox')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  56           chlamydia</p>
  57         <p>
  58           <? echo (($fdata{'test_lab_gonorrhea'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  59           gonorrhea</p>
  60         <p>
  61           <? echo (($fdata{'test_lab_other'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  62           other <span class="ficaption2">
  63           <? echo $fdata{'test_lab_other_data'}; ?>
  64           </span></p>
  65         </blockquote>
  66       <p>
  67         <? echo (($fdata{'test_rad'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  68         Radiology / Ultrasound</p>
  69       <blockquote>
  70         <p>
  71           <? echo (($fdata{'test_rad_mammogram'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  72           mammogram</p>
  73         <p>
  74           <? echo (($fdata{'test_rad_other'} == 'checkbox')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  75           other <span class="ficaption2">
  76           <? echo $fdata{'test_rad_other_data'}; ?>
  77           </span> </p>
  78       </blockquote></td>
  79     <td class="fibody3"><p>
  80       <? echo (($fdata{'previous_test_results'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  81       previous test results:</p>
  82       <p>
  83         <? echo $fdata{'previous_test_results_data'}; ?>
  84       </p> <p>
  85         <? echo (($fdata{'test_results_discussion'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  86         discussion of test results with performing physician:</p>
  87       <p>
  88         <? echo $fdata{'test_results_discussion_data'}; ?>
  89       </p> <p>
  90         <? echo (($fdata{'old_records_reviewed'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  91         old records reviewed and summarized:</p>
  92       <p>
  93         <? echo $fdata{'old_records_reviewed_data'}; ?>
  94       </p> <p>
  95         <? echo (($fdata{'history_other_source'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
  96         history obtained from other source:</p>
  97       <p>
  98         <? echo $fdata{'history_other_source_data'}; ?>
  99       </p> <p>
 100         <? echo (($fdata{'independent_review'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 101         independent review of image/specimen:</p>
 102       <p>
 103         <? echo $fdata{'independent_review_data'}; ?>
 104       </p></td>
 105   </tr>
 106 </table>
 107 </div>
 108   <p align="center">&nbsp;</p>
 109   <h2 align="center">Diagnoses / Management option </h2>
 110   <div style="border: solid 2px black; background-color: white;">
 111     <table width="100%"  border="0" cellspacing="0" cellpadding="2">
 112       <tr>
 113         <td colspan="2" align="left" valign="top" class="fibody2"> <? echo (($fdata{'established_problem'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 114           Established problem&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
 115           <? echo (($fdata{'established_problem'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 116         New problem </td>
 117       </tr>
 118       <tr>
 119         <td colspan="2" align="left" valign="top" class="ficaption2">Assessment and plan:</td>
 120       </tr>
 121       <tr>
 122         <td colspan="2" align="left" valign="top" class="fibody5"><? echo $fdata{'assessment_and_plan'}; ?></td>
 123       </tr>
 124       <tr>
 125         <td colspan="2" align="left" valign="top" class="fibody2"><p>Risk of complications and/or morbidity/mortality:</p>
 126           <blockquote>
 127             <p>
 128             <? echo (($fdata{'md_risk'} == 'minimal')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 129             Minimal (EG, cold, aches and pains, over-the-counter medications)</p>
 130             <p>
 131             <? echo (($fdata{'md_risk'} == 'low')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 132             low (EG, cystitis, vaginitis, prescription renewal, minor surgery without risk factors) </p>
 133             <p>
 134               <? echo (($fdata{'md_risk'} == 'moderate')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 135             moderate (EG, breast mass, irregular bleeding, headaches, minor surgery with risk factors, major surgery without risk factors, new prescription)</p>
 136             <p>
 137               <? echo (($fdata{'md_risk'} == 'high')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 138             high (EG, pelvic pain, rectal bleeding, multiple complaints, major surgery with risk factors, chemotherapy, emergency surgery)  </p>
 139         </blockquote></td>
 140       </tr>
 141       <tr>
 142         <td colspan="2" align="left" valign="top" class="fibody2"><table width="100%"  border="0" cellspacing="0" cellpadding="0">
 143           <tr>
 144             <td width="20%" rowspan="3" align="left" valign="top" class="ficaption3">Patient counseled about:</td>
 145             <td width="15%" align="left" valign="baseline" nowrap class="fibody3"><? echo (($fdata{'pc_smoking'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 146               smoking cessation </td>
 147             <td width="15%" align="left" valign="baseline" nowrap class="fibody3"><? echo (($fdata{'pc_contraception'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 148               contraception</td>
 149             <td width="15%" align="left" valign="bottom" nowrap>&nbsp;</td>
 150             <td width="15%" align="left" valign="bottom" nowrap>&nbsp;</td>
 151           </tr>
 152           <tr>
 153             <td align="left" valign="baseline" nowrap class="fibody3"><? echo (($fdata{'pc_weight'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 154               weight management </td>
 155             <td align="left" valign="baseline" nowrap class="fibody3"><? echo (($fdata{'pc_safe_sex'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 156               safe sex </td>
 157             <td align="left" valign="bottom" nowrap>&nbsp;</td>
 158             <td align="left" valign="bottom" nowrap>&nbsp;</td>
 159           </tr>
 160           <tr>
 161             <td align="left" valign="baseline" nowrap class="fibody3"><? echo (($fdata{'pc_exercise'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 162               exercise</td>
 163             <td align="left" valign="baseline" nowrap class="fibody3"><? echo (($fdata{'pc_other'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 164               other</td>
 165             <td align="left" valign="bottom" nowrap>&nbsp;</td>
 166             <td align="left" valign="bottom" nowrap>&nbsp;</td>
 167           </tr>
 168         </table></td>
 169       </tr>
 170       <tr>
 171         <td width="50%" align="left" valign="top" class="ficaption2" id="bordR"><? echo (($fdata{'patient_education'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 172         Patient education materials provided</td>
 173         <td width="50%" align="left" valign="top" class="fibody2">&nbsp;</td>
 174       </tr>
 175       <tr>
 176         <td align="left" valign="top" class="fibody2" id="bordR">&nbsp;</td>
 177         <td align="left" valign="top" class="fibody2">&nbsp;</td>
 178       </tr>
 179       <tr>
 180         <td align="left" valign="top" class="ficaption2" id="bordR">Minutes counseled:
 181         <? echo $fdata{'minutes_counseled'}; ?></td>
 182         <td align="left" valign="top" class="ficaption2">Total encounter time:
 183         <? echo $fdata{'total_encounter_time'}; ?></td>
 184       </tr>
 185       <tr valign="bottom">
 186         <td height="50" align="left" class="ficaption2" id="bordR">Signature:</td>
 187         <td align="left" class="ficaption2">Date: <? echo $fdata['date']; ?></td>
 188       </tr>
 189     </table>
 190   </div>
 191 <? } ?>