contrib/forms/plist/view.php

   1 <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
   2
   3 "http://www.w3.org/TR/html4/loose.dtd">
   4
   5 <?php
   6
   7 include_once("../../globals.php");
   8
   9 include_once("$srcdir/api.inc");
  10
  11 include_once("$srcdir/forms.inc");
  12
  13 include_once("$srcdir/calendar.inc");
  14
  15 ?>
  16
  17
  18
  19 <html>
  20
  21 <head>
  22 <?php html_header_show();?>
  23
  24 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  25
  26 <link rel="stylesheet" href="../../acog.css" type="text/css">
  27
  28 <script language="JavaScript" src="../../acog.js" type="text/JavaScript"></script>
  29
  30 <script language="JavaScript" type="text/JavaScript">
  31
  32 <!--
  33
  34 window.onload = initialize;
  35
  36 //-->
  37
  38 </script>
  39
  40 </head>
  41
  42 <?php
  43
  44    $fres = sqlStatement("select * from form_plist where id=$id");
  45
  46    $obj = sqlFetchArray($fres);
  47
  48    $fres=sqlStatement("select * from patient_data where pid=".$_SESSION["pid"]);
  49
  50    if ($fres){
  51
  52      $patient = sqlFetchArray($fres);
  53
  54    }
  55
  56
  57
  58 ?>
  59
  60 <body class="body_top">
  61
  62
  63
  64 <form action="<?php echo $rootdir;?>/forms/plist/save.php?mode=update&id=<?php echo $_GET["id"];?>" method="post" enctype="multipart/form-data" name="my_form">
  65
  66 <?php include("../../acog_menu.inc"); ?>
  67
  68   <table width="70%"  border="0" cellspacing="0" cellpadding="4">
  69
  70   <tr>
  71
  72     <td width="120" align="left" valign="bottom" class="srvCaption">Patient name:</td>
  73
  74     <td align="left" valign="bottom"><input name="pname" type="text" class="fullin" id="pname" value="<?php echo $patient{'fname'}.' '.$patient{'mname'}.' '.$patient{'lname'}; ?>"></td>
  75
  76   </tr>
  77
  78   <tr>
  79
  80     <td width="120" align="left" valign="bottom" class="srvCaption">Birth date: </td>
  81
  82     <td align="left" valign="bottom"><input name="pbdate" type="text" class="fullin" id="pbdate" value="<?php  echo $patient{'DOB'};  ?>"></td>
  83
  84   </tr>
  85
  86   <tr>
  87
  88     <td width="120" align="left" valign="bottom" class="srvCaption">ID No:</td>
  89
  90     <td align="left" valign="bottom"><input name="pl_pid" type="text" class="fullin" id="pl_pid" value="<?php echo $patient{'id'};  ?>" readonly="true"></td>
  91
  92   </tr>
  93
  94   <tr>
  95
  96     <td width="120" align="left" valign="bottom" class="srvCaption">Date</td>
  97
  98     <td align="left" valign="bottom"><input name="pl_date" type="text" class="fullin" id="pl_date" value="<?php echo date('Y-m-d'); ?>"></td>
  99
 100   </tr>
 101
 102 </table>
 103
 104 <div class="srvChapter">Problem list <a href="#" onMouseOver="toolTip('The Problem List captures problems, allergies, family history, and current medication use.')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0"></a></div>
 105
 106 <div style="border: solid 2px black; background-color:#FFFFFF;">
 107
 108   <table width="100%"  border="0" cellspacing="0" cellpadding="2">
 109
 110     <tr>
 111
 112       <td width="50%" class="ficaption3" id="bordR">High risk:</td>
 113
 114       <td width="50%" class="ficaption3">Family history:</td>
 115
 116     </tr>
 117
 118     <tr>
 119
 120       <td class="fibody2" id="bordR"><textarea name="pl_high_risk" rows="6" wrap="VIRTUAL" class="fullin2" id="pl_high_risk"><?php echo $obj{'pl_high_risk'} ?></textarea></td>
 121
 122       <td class="fibody2"><textarea name="pl_family_history" rows="6" wrap="VIRTUAL" class="fullin2" id="pl_family_history"><?php echo $obj{'pl_family_history'} ?></textarea></td>
 123
 124     </tr>
 125
 126     <tr>
 127
 128       <td class="ficaption3" id="bordR">Drug/Latex/Transfusion/Allergic reactions: </td>
 129
 130       <td class="ficaption3">Current medications:</td>
 131
 132     </tr>
 133
 134     <tr>
 135
 136       <td class="fibody3" id="bordR"><textarea name="pl_reactions" rows="6" wrap="VIRTUAL" class="fullin2" id="pl_reactions"><?php echo $obj{'pl_reactions'} ?></textarea></td>
 137
 138       <td class="fibody3"><textarea name="pl_medications" rows="6" wrap="VIRTUAL" class="fullin2" id="pl_medications"><?php echo $obj{'pl_medications'} ?></textarea></td>
 139
 140     </tr>
 141
 142   </table>
 143
 144 </div>
 145
 146 <p>&nbsp;</p>
 147
 148 <div style="border: solid 2px black; background-color:#FFFFFF;">
 149
 150   <table width="100%"  border="0" cellspacing="0" cellpadding="2">
 151
 152     <tr>
 153
 154       <td width="20" align="left" valign="bottom" class="ficaption2" id="bordR">No</td>
 155
 156       <td width="120" align="center" valign="bottom" class="ficaption2" id="bordR">Entry date </td>
 157
 158       <td align="center" valign="bottom" class="ficaption2" id="bordR">Problem/Resolution</td>
 159
 160       <td width="120" align="center" valign="bottom" class="ficaption2" id="bordR">Onset age and date </td>
 161
 162       <td width="120" align="center" valign="bottom" class="ficaption2">Resolution date </td>
 163
 164     </tr>
 165
 166 <?php
 167
 168 $pli = 1;
 169
 170
 171
 172 while ($pli < 26){
 173
 174 //print $obj["pl_problem_$pli"];
 175
 176 list($pl_ed, $pl_problem, $pl_onset, $pl_rd) = explode('|~', $obj["pl_problem_${pli}"]);
 177
 178 print <<<EOL
 179
 180     <tr>
 181
 182       <td align="left" valign="bottom" class="fibody2" id="bordR">${pli}.</td>
 183
 184       <td align="left" valign="bottom" class="fibody2" id="bordR"><input name="pl_ed_${pli}" type="text" class="fullin2" value="${pl_ed}"></td>
 185
 186       <td align="left" valign="bottom" class="fibody2" id="bordR"><input name="pl_problem_${pli}" type="text" class="fullin2" value="${pl_problem}"></td>
 187
 188       <td align="left" valign="bottom" class="fibody2" id="bordR"><input name="pl_onset_${pli}" type="text" class="fullin2" value="${pl_onset}"></td>
 189
 190       <td align="left" valign="bottom" class="fibody2"><input name="pl_rd_${pli}" type="text" class="fullin2" value="${pl_rd}"></td>
 191
 192     </tr>
 193
 194 EOL;
 195
 196 $pli++;
 197
 198 }
 199
 200 ?>
 201
 202   </table>
 203
 204 </div>
 205
 206 <p>&nbsp;</p>
 207
 208 <table width="100%" border="0">
 209
 210   <tr>
 211
 212     <td align="left" width="100"> <a href="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save Data]</a> </td>
 213
 214     <td align="left" nowrap> <a href="<?php echo $rootdir; ?>/patient_file/encounter/print_form.php?id=<?php echo $id; ?>&formname=plist"
 215
 216      target="_blank" class="link_submit" onclick="top.restoreSession()">[Printable form]</a> </td>
 217
 218     <td align="right"> <a href="<?php echo $GLOBALS['form_exit_url']; ?>" class="link_submit"
 219
 220      onclick="top.restoreSession()">[Don't Save]</a> </td>
 221
 222   </tr>
 223
 224 </table>
 225
 226 </form>
 227
 228 <?php
 229
 230 formFooter();
 231
 232 ?>
 233
 234 </body>
 235
 236 </html>
 237