From 3e7ec2c80b99e6dcf5fb236becd38d67756c28d5 Mon Sep 17 00:00:00 2001 From: vitsyn Date: Mon, 28 Mar 2005 18:25:44 +0000 Subject: [PATCH] Initial import. --- interface/forms/ankleinjury/info.txt | 1 + interface/forms/ankleinjury/new.php | 213 +++++++++++++++++++++++++++++++++ interface/forms/ankleinjury/report.php | 28 +++++ interface/forms/ankleinjury/save.php | 39 ++++++ interface/forms/ankleinjury/table.sql | 27 +++++ interface/forms/ankleinjury/view.php | 159 ++++++++++++++++++++++++ 6 files changed, 467 insertions(+) create mode 100755 interface/forms/ankleinjury/info.txt create mode 100755 interface/forms/ankleinjury/new.php create mode 100755 interface/forms/ankleinjury/report.php create mode 100755 interface/forms/ankleinjury/save.php create mode 100755 interface/forms/ankleinjury/table.sql create mode 100755 interface/forms/ankleinjury/view.php diff --git a/interface/forms/ankleinjury/info.txt b/interface/forms/ankleinjury/info.txt new file mode 100755 index 000000000..c69d0cdc9 --- /dev/null +++ b/interface/forms/ankleinjury/info.txt @@ -0,0 +1 @@ +Ankle Evaluation Form diff --git a/interface/forms/ankleinjury/new.php b/interface/forms/ankleinjury/new.php new file mode 100755 index 000000000..99fa436fe --- /dev/null +++ b/interface/forms/ankleinjury/new.php @@ -0,0 +1,213 @@ + + + + + + + + + +topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0> +
+Ankle Evaluation Form

+ +[Save] +            +" class="link" style="color: #483D8B">[Don't Save] +

+ +Date of Injury: + +Work related? + + +

+ +Foot: + Left + Right +

+ +Severity of Pain: + 1 + 2 + 3 +

+ +Significant Swelling: + + +

+ +Onset of Swelling: + within minutes + within hours +

+ +How did Injury Occur?:
+ +

+ + + + + + + + +
Ottawa Ankle Rules
Bone Tenderness: Medial MalleolusLateral MalleolusBase of fifth (5th) MetarsalAt the Navicular
+
+ +Able to Bear Weight four (4) steps: + Yes + No +
+ + + + + + + + + +
X-RAY Interpretation: Additional X-RAY Notes:
+ + + + +
+ + + + + + + + + + + + + + + +
Diagnosis:Additional Diagnosis:
+ + + +

+ + + + + + + + + + +
CPT Codes
+    none
+    99212 Established - Uncomplicated
+    99213 Established - Low Complexity
+
+ +
+ +
+ +
+ +
+ + + + +
Plan:
+ +
+ +[Save]            +" class="link" style="color: #483D8B">[Don't Save] +
+ diff --git a/interface/forms/ankleinjury/report.php b/interface/forms/ankleinjury/report.php new file mode 100755 index 000000000..cda2136e8 --- /dev/null +++ b/interface/forms/ankleinjury/report.php @@ -0,0 +1,28 @@ +"; +foreach($data as $key => $value) { +if ($key == "id" || $key == "pid" || $key == "user" || $key == "groupname" || $key == "authorized" || $key == "activity" || $key == "date" || $value == "" || $value == "0000-00-00 00:00:00") { + continue; +} +if ($value == "on") { +$value = "yes"; +} +$key=ucwords(str_replace("_"," ",$key)); +print "$key: $value"; +$count++; +if ($count == $cols) { +$count = 0; +print "\n"; +} +} +} +print ""; +} +?> diff --git a/interface/forms/ankleinjury/save.php b/interface/forms/ankleinjury/save.php new file mode 100755 index 000000000..bc8508a2c --- /dev/null +++ b/interface/forms/ankleinjury/save.php @@ -0,0 +1,39 @@ + $var) { +$_POST[$k] = mysql_escape_string($var); +//echo "$var\n"; +} +if ($encounter == "") +$encounter = date("Ymd"); +if ($_GET["mode"] == "new"){ +$newid = formSubmit("form_ankleinjury", $_POST, $_GET["id"], $userauthorized); +addForm($encounter, "Ankle Evaluation Form", $newid, "ankleinjury", $pid, $userauthorized); +}elseif ($_GET["mode"] == "update") { +sqlInsert("update form_ankleinjury set pid = {$_SESSION["pid"]},groupname='".$_SESSION["authProvider"]."',user='".$_SESSION["authUser"]."',authorized=$userauthorized,activity=1, date = NOW(), +ankle_date_of_injuary='".$_POST["ankle_date_of_injuary"]."', +ankle_work_related='".$_POST["ankle_work_related"]."', +ankle_foot='".$_POST["ankle_foot"]."', +ankle_severity_of_pain='".$_POST["ankle_severity_of_pain"]."', +ankle_significant_swelling='".$_POST["ankle_significant_swelling"]."', +ankle_onset_of_swelling='".$_POST["ankle_onset_of_swelling"]."', +ankle_how_did_injury_occur='".$_POST["ankle_how_did_injury_occur"]."', +ankle_ottawa_bone_tenderness='".$_POST["ankle_ottawa_bone_tenderness"]."', +ankle_able_to_bear_weight_steps='".$_POST["ankle_able_to_bear_weight_steps"]."', +ankle_x_ray_interpretation='".$_POST["ankle_x_ray_interpretation"]."', +ankle_additional_x_ray_notes='".$_POST["ankle_additional_x_ray_notes"]."', +ankle_diagnosis1='".$_POST["ankle_diagnosis1"]."', +ankle_diagnosis2='".$_POST["ankle_diagnosis2"]."', +ankle_diagnosis3='".$_POST["ankle_diagnosis3"]."', +ankle_diagnosis4='".$_POST["ankle_diagnosis4"]."', +ankle_plan='".$_POST["ankle_plan"]."', +ankle_additional_diagnisis='".$_POST["ankle_additional_diagnisis"]."' where id=$id"); +} +$_SESSION["encounter"] = $encounter; +formHeader("Redirecting...."); +formJump(); +formFooter(); +?> diff --git a/interface/forms/ankleinjury/table.sql b/interface/forms/ankleinjury/table.sql new file mode 100755 index 000000000..7e6b2d8b2 --- /dev/null +++ b/interface/forms/ankleinjury/table.sql @@ -0,0 +1,27 @@ +CREATE TABLE IF NOT EXISTS `form_ankleinjury` ( +id bigint(20) NOT NULL auto_increment, +date datetime default NULL, +pid bigint(20) default NULL, +user varchar(255) default NULL, +groupname varchar(255) default NULL, +authorized tinyint(4) default NULL, +activity tinyint(4) default NULL, +ankle_date_of_injuary datetime default NULL, +ankle_work_related varchar(255), +ankle_foot varchar(255), +ankle_severity_of_pain varchar(255), +ankle_significant_swelling varchar(255), +ankle_onset_of_swelling varchar(255), +ankle_how_did_injury_occur longtext, +ankle_ottawa_bone_tenderness varchar(255), +ankle_able_to_bear_weight_steps varchar(255), +ankle_x_ray_interpretation varchar(255), +ankle_additional_x_ray_notes longtext, +ankle_diagnosis1 varchar(255), +ankle_diagnosis2 varchar(255), +ankle_diagnosis3 varchar(255), +ankle_diagnosis4 varchar(255), +ankle_plan longtext, +ankle_additional_diagnisis longtext, +PRIMARY KEY (id) +) TYPE=MyISAM; diff --git a/interface/forms/ankleinjury/view.php b/interface/forms/ankleinjury/view.php new file mode 100755 index 000000000..41117330a --- /dev/null +++ b/interface/forms/ankleinjury/view.php @@ -0,0 +1,159 @@ + + + + + + topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0> + +
" name="my_form"> +Ankle Evaluation Form

+ +[Save] +
+" class="link" target=Main>[Don't Save Changes] +

+ +Date of Injury: " > +Work related?: +>
+ + + + + + + + + +
Foot:>
Left:>
Right:
+ + + + + + + + + + + + + +
Severity of Pain:1:>
2:>
3:>
+ + + + +
Significant Swelling:>
+
+ + + + + + + + + + +
Onset of Swelling:>
within minutes:>
within hours:
+ +How did Injury Occur?:
+ +
+ + + + + + + + + + + + + +
Ottawa Ankle Rules
Bone Tenderness:Medial malleolus:>
Lateral malleolus:>
Base of fifth (5th) Metarsal:>
At the Navicular:>
+ + + + + + + + + +
Able to Bear Weight four (4) steps:Yes:>
No:>
+ + + + + + +
X-Ray Interpretation: Additional X-RAY Notes:
+" size="50"> + + + +
+ + + + + + + + + + + + + + +
Diagnosis:Additional Diagnosis:
" size="50"> + + +
" size="50">
" size="50">
" size="50">
+ + +
Plan:
+ +
+ +[Save] +
+" class="link" target=Main>[Don't Save Changes] +
+ -- 2.11.4.GIT