contrib/forms/vitalsigns/view.php

   1 <!-- Forms generated from formsWiz -->
   2 <?php
   3 include_once("../../globals.php");
   4 ?>
   5 <html><head>
   6 <link rel=stylesheet href="<?echo $css_header;?>" type="text/css">
   7 </head>
   8 <body <?echo $top_bg_line;?> topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
   9 <?php
  10 include_once("$srcdir/api.inc");
  11 $obj = formFetch("form_vitalsigns", $_GET["id"]);
  12 ?>
  13 <form method=post action="<?echo $rootdir?>/forms/vitalsigns/save.php?mode=update&id=<?echo $_GET["id"];?>" name="my_form">
  14 <span class="title">Vital Signs</span><Br><br>
  15 <span class=bold>Blood Pressure</span><br>
  16
  17 <table width=100%>
  18 <tr><td>
  19 <span class=text>Standing: </span><input size=3 type=entry name="standing_bp_1" value="<?echo $obj{"standing_bp_1"};?>" >
  20 <input size=3 type=entry name="standing_bp_2" value="<?echo $obj{"standing_bp_2"};?>" >
  21 </td><td>
  22 <span class=text>Sitting: </span><input size=3 type=entry name="sitting_bp_1" value="<?echo $obj{"sitting_bp_1"};?>" >
  23 <input size=3 type=entry name="sitting_bp_2" value="<?echo $obj{"sitting_bp_2"};?>" >
  24 </td><td>
  25 <span class=text>Supine: </span><input size=3 type=entry name="supine_bp_1" value="<?echo $obj{"supine_bp_1"};?>" >
  26 <input size=3 type=entry name="supine_bp_2" value="<?echo $obj{"supine_bp_2"};?>" >
  27 </td><td>
  28 <span class=text>Systolic: </span><input size=3 type=entry name="systolic_bp_1" value="<?echo $obj{"systolic_bp_1"};?>" >
  29 <input size=3 type=entry name="systolic_bp_2" value="<?echo $obj{"systolic_bp_2"};?>" >
  30 </td><td>
  31 <span class=text>Diastolic: </span><input size=3 type=entry name="diastolic_bp_1" value="<?echo $obj{"diastolic_bp_1"};?>" >
  32 <input size=3 type=entry name="diastolic_bp_2" value="<?echo $obj{"diastolic_bp_2"};?>" >
  33 </tr>
  34 </table>
  35
  36 <table><tr><td>
  37 <span class=text>Heart Rate (Beats/Minute): </span></td><td><input size=3 type=entry name="heart_rate_beats_per_minute" value="<?echo $obj{"heart_rate_beats_per_minute"};?>" ></td>
  38 <td><span class=text>Respiration (Breaths/Minute): </span></td><td><input size=3 type=entry name="respiration_beats_per_minute" value="<?echo $obj{"respiration_beats_per_minute"};?>" ></td></tr>
  39 </table>
  40
  41 <table>
  42 <tr>
  43 <td><span class=text>Temperature (C): </span><input size=3 type=entry name="temperature_c" value="<?echo $obj{"temperature_c"};?>" ></td>
  44 <td><span class=text>Temperature (F): </span><input size=3 type=entry name="temperature_f" value="<?echo $obj{"temperature_f"};?>" ></td>
  45 <td><span class=text>Temperature Method: </span><input type=entry name="temperature_method" value="<?echo $obj{"temperature_method"};?>" ></td>
  46 </tr><tr>
  47 <td><span class=text>Height (Feet): </span><input size=3 type=entry name="height_feet" value="<?echo $obj{"height_feet"};?>" ></td>
  48 <td><span class=text>Height (Inches): </span><input size=3 type=entry name="height_inches" value="<?echo $obj{"height_inches"};?>" ></td>
  49 <td><span class=text>Height (Centimeters): </span><input size=3 type=entry name="height_centimeters" value="<?echo $obj{"height_centimeters"};?>" ></td>
  50 </tr><tr>
  51 <td><span class=text>Weight (Lbs): </span><input size=3 type=entry name="weight_lbs" value="<?echo $obj{"weight_lbs"};?>" ></td>
  52 <td><span class=text>Weight (Ozs): </span><input size=3 type=entry name="weight_ozs" value="<?echo $obj{"weight_ozs"};?>" ></td>
  53 <td><span class=text>Weight (Kgs): </span><input size=3 type=entry name="weight_kgs" value="<?echo $obj{"weight_kgs"};?>" ></td>
  54 </tr>
  55 </table>
  56
  57
  58 <span class=text>Body Mass Index: </span><input size=5 type=entry name="body_mass_index" value="<?echo $obj{"body_mass_index"};?>" >
  59 <span class=text>Figure Shape (If Overweight): </span><input type=entry name="figure_shape" value="<?echo $obj{"figure_shape"};?>" >
  60 <span class=text>Additional Notes: </span><br><textarea cols=40 rows=8 wrap=virtual name="additional_notes" ><?echo $obj{"additional_notes"};?></textarea>
  61 <br>
  62 <a href="javascript:document.my_form.submit();" class="link_submit">[Save]</a>
  63 <br>
  64 <a href="<?php echo $GLOBALS['form_exit_url']; ?>" class="link">[Don't Save Changes]</a>
  65 </form>
  66 <?php
  67 formFooter();
  68 ?>