2 //================================================
4 //Z&H Healthcare Solutions, LLC.
7 //Initial New Patient Physical Exam
8 //================================================
9 include_once("../../globals.php");
10 include_once("$srcdir/api.inc");
11 $obj = formFetch("form_Initial_New_Patient_Physical_Exam", $_GET["id"]); //#Use the formFetch function from api.inc to get values for existing form.
13 function chkdata_Txt(&$obj, $var) {
14 return htmlspecialchars($obj{"$var"},ENT_QUOTES
);
16 function chkdata_Date(&$obj, $var) {
17 return htmlspecialchars($obj{"$var"},ENT_QUOTES
);
19 function chkdata_CB(&$obj, $nam, $var) {
20 if (preg_match("/Negative.*$var/",$obj{$nam})) {return;} else {return "checked";}
22 function chkdata_Radio(&$obj, $nam, $var) {
23 if (strpos($obj{$nam},$var) !== false) {return "checked";}
25 function chkdata_PopOrScroll(&$obj, $nam, $var) {
26 if (preg_match("/Negative.*$var/",$obj{$nam})) {return;} else {return "selected";}
28 $returnurl = $GLOBALS['concurrent_layout'] ?
'encounter_top.php' : 'patient_encounter.php';
31 <link rel
="stylesheet" href
="<?php echo $css_header;?>" type
="text/css">
33 <body
class="body_top">
34 <form method
=post action
="<?echo $rootdir?>/forms/Initial_New_Patient_Physical_Exam/save.php?mode=update&id=<?echo $_GET["id
"];?>" name
="my_form" onSubmit
="return top.restoreSession()">
35 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="0">
37 <td align
="center" colspan
="5"><h3
> <?php
xl("015 Initial New Patient Physical Exam - ",'e') ?
> </h3
></td
>
41 <td align
="right"><b
class="text"> <?php
xl("EATING HABITS:",'e') ?
> </b
></td
>
42 <td align
="left"> 
;</td
>
43 <td align
="left"> 
;</td
>
44 <td align
="left"> 
;</td
>
45 <td align
="left"> 
;</td
>
50 <tr
><td align
="center" colspan
="5">
51 <table border
="0" cellspacing
="0" cellpadding
="0">
52 <tr
><td
><label
class="text"><?php
xl("% Sweeter",'e') ?
></label
> </td
> <td
> 
;<input type
="text" name
="sweeter" value
="<?php $result = chkdata_Txt($obj,"sweeter
"); echo $result;?>"></td
></tr
>
54 <tr
><td
> <label
class="text"><?php
xl("% Bloater",'e') ?
></label
> </td
> <td
> 
;<input type
="text" name
="bloater" value
="<?php $result = chkdata_Txt($obj,"bloater
"); echo $result;?>"></td
></tr
>
56 <tr
><td
> <label
class="text"><?php
xl("% Grazer",'e') ?
></label
> </td
> <td
> 
;<input type
="text" name
="grazer" value
="<?php $result = chkdata_Txt($obj,"grazer
"); echo $result;?>"></td
></tr
>
60 <td align
="left" colspan
="5"> 
;</td
>
64 <td align
="left" colspan
="5"><b
class="text"> <?php
xl("PHYSICAL EXAMINATION:",'e') ?
> </b
></td
>
68 <td align
="left" colspan
="5"> 
;</td
>
72 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("GENERAL:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="general[]" value
="Alert" <?php
$result = chkdata_CB($obj,"general","Alert"); echo $result;?
>> <?php
xl("Alert",'e') ?
> </label
></td
><td
>
73 <label
class="text"><input type
="checkbox" name
="general[]" value
="Oriented X3" <?php
$result = chkdata_CB($obj,"general","Oriented X3"); echo $result;?
>> <?php
xl("Oriented X3",'e') ?
> </label
></td
><td
>
74 <label
class="text"><input type
="checkbox" name
="general[]" value
="Not in distress" <?php
$result = chkdata_CB($obj,"general","Not in distress"); echo $result;?
>> <?php
xl("Not in distress",'e') ?
> </label
></td
><td
>
75 <label
class="text"><input type
="checkbox" name
="general[]" value
="In distress" <?php
$result = chkdata_CB($obj,"general","In distress"); echo $result;?
>> <?php
xl("In distress",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
76 <label
class="text"><input type
="checkbox" name
="general[]" value
="Well developed" <?php
$result = chkdata_CB($obj,"general","Well developed"); echo $result;?
>> <?php
xl("Well developed",'e') ?
> </label
></td
><td
>
77 <label
class="text"><input type
="checkbox" name
="general[]" value
="Well nourished" <?php
$result = chkdata_CB($obj,"general","Well nourished"); echo $result;?
>> <?php
xl("Well nourished",'e') ?
> </label
></td
><td
>
78 <label
class="text"><input type
="checkbox" name
="general[]" value
="Petite" <?php
$result = chkdata_CB($obj,"general","Petite"); echo $result;?
>> <?php
xl("Petite",'e') ?
> </label
></td
><td
>
79 <label
class="text"><input type
="checkbox" name
="general[]" value
="Obese" <?php
$result = chkdata_CB($obj,"general","Obese"); echo $result;?
>> <?php
xl("Obese",'e') ?
> </label
></td
></tr
>
81 <td align
="left" colspan
="5"> 
;</td
>
86 <td align
="right"><b
class="text"> <?php
xl("HEENT:",'e') ?
> </b
></td
>
87 <td align
="left"> 
;</td
>
88 <td align
="left"> 
;</td
>
89 <td align
="left"> 
;</td
>
90 <td align
="left"> 
;</td
>
93 <td align
="left" colspan
="5"> 
;</td
>
98 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Head",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="head[]" value
="AT NC" <?php
$result = chkdata_CB($obj,"head","AT NC"); echo $result;?
>> <?php
xl("AT/NC",'e') ?
> </label
></td
><td
>
99 <label
class="text"><input type
="checkbox" name
="head[]" value
="Hirsutism Facial hairs" <?php
$result = chkdata_CB($obj,"head","Hirsutism Facial hairs"); echo $result;?
>> <?php
xl("Hirsutism/Facial hairs",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
></tr
>
105 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Eyes",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="eyes[]" value
="PERRLA" <?php
$result = chkdata_CB($obj,"eyes","PERRLA"); echo $result;?
>> <?php
xl("PERRLA",'e') ?
> </label
></td
><td
>
106 <label
class="text"><input type
="checkbox" name
="eyes[]" value
="EOMI" <?php
$result = chkdata_CB($obj,"eyes","EOMI"); echo $result;?
>> <?php
xl("EOMI",'e') ?
> </label
></td
><td
>
107 <label
class="text"><input type
="checkbox" name
="eyes[]" value
="Anicteric" <?php
$result = chkdata_CB($obj,"eyes","Anicteric"); echo $result;?
>> <?php
xl("Anicteric",'e') ?
> </label
></td
><td
>
108 </td
></tr
><tr
><td
></td
><td
><label
class="text"><input type
="checkbox" name
="eyes[]" value
="Pink" <?php
$result = chkdata_CB($obj,"eyes","Pink"); echo $result;?
>> <?php
xl("Pink",'e') ?
> </label
>
109 </td
><td
> <label
class="text"><input type
="checkbox" name
="eyes[]" value
="Pale" <?php
$result = chkdata_CB($obj,"eyes","Pale"); echo $result;?
>> <?php
xl("Pale",'e') ?
> </label
>
110 </td
><td
><label
class="text"><input type
="checkbox" name
="eyes[]" value
="Icteric" <?php
$result = chkdata_CB($obj,"eyes","Icteric"); echo $result;?
>> <?php
xl("Icteric",'e') ?
> </label
>
111 </td
><td
><label
class="text"><input type
="checkbox" name
="eyes[]" value
="Cataracts" <?php
$result = chkdata_CB($obj,"eyes","Cataracts"); echo $result;?
>> <?php
xl("Cataracts",'e') ?
> </label
></td
></tr
>
117 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Ears",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="ears[]" value
="Normal" <?php
$result = chkdata_CB($obj,"ears","Normal"); echo $result;?
>> <?php
xl("Normal",'e') ?
> </label
></td
><td
>
118 <label
class="text"><input type
="checkbox" name
="ears[]" value
="TM w good light reflex" <?php
$result = chkdata_CB($obj,"ears","TM w good light reflex"); echo $result;?
>> <?php
xl("TM w/ good light reflex",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
></tr
>
124 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Nose",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="nose[]" value
="Normal" <?php
$result = chkdata_CB($obj,"nose","Normal"); echo $result;?
>> <?php
xl("Normal",'e') ?
> </label
></td
><td
>
125 <label
class="text"><input type
="checkbox" name
="nose[]" value
="Patent" <?php
$result = chkdata_CB($obj,"nose","Patent"); echo $result;?
>> <?php
xl("Patent",'e') ?
> </label
></td
><td
>
126 <label
class="text"><input type
="checkbox" name
="nose[]" value
="No discharge" <?php
$result = chkdata_CB($obj,"nose","No discharge"); echo $result;?
>> <?php
xl("No discharge",'e') ?
> </label
></td
><td
>
127 <label
class="text"><input type
="checkbox" name
="nose[]" value
="Discharge" <?php
$result = chkdata_CB($obj,"nose","Discharge"); echo $result;?
>> <?php
xl("Discharge",'e') ?
> </label
></td
></tr
>
133 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Throat",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="throat[]" value
="Normal" <?php
$result = chkdata_CB($obj,"throat","Normal"); echo $result;?
>> <?php
xl("Normal",'e') ?
> </label
></td
><td
>
134 <label
class="text"><input type
="checkbox" name
="throat[]" value
="Erythematous" <?php
$result = chkdata_CB($obj,"throat","Erythematous"); echo $result;?
>> <?php
xl("Erythematous",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
></tr
>
140 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Oral cavity",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="oral_cavity[]" value
="No lesions" <?php
$result = chkdata_CB($obj,"oral_cavity","No lesions"); echo $result;?
>> <?php
xl("No lesions",'e') ?
> </label
></td
><td
>
141 <label
class="text"><input type
="checkbox" name
="oral_cavity[]" value
="Lesions" <?php
$result = chkdata_CB($obj,"oral_cavity","Lesions"); echo $result;?
>> <?php
xl("Lesions",'e') ?
> </label
></td
><td
>
142 <label
class="text"><input type
="checkbox" name
="oral_cavity[]" value
="Friable gums" <?php
$result = chkdata_CB($obj,"oral_cavity","Friable gums"); echo $result;?
>> <?php
xl("Friable gums",'e') ?
> </label
></td
><td
> 
;</td
></tr
>
148 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Dentition",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="dentition[]" value
="Good" <?php
$result = chkdata_CB($obj,"dentition","Good"); echo $result;?
>> <?php
xl("Good",'e') ?
> </label
></td
><td
>
149 <label
class="text"><input type
="checkbox" name
="dentition[]" value
="Fair" <?php
$result = chkdata_CB($obj,"dentition","Fair"); echo $result;?
>> <?php
xl("Fair",'e') ?
> </label
></td
><td
>
150 <label
class="text"><input type
="checkbox" name
="dentition[]" value
="Poor" <?php
$result = chkdata_CB($obj,"dentition","Poor"); echo $result;?
>> <?php
xl("Poor",'e') ?
> </label
></td
><td
> 
;</td
></tr
>
155 <td align
="left" colspan
="5"> 
;</td
>
159 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("NECK:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="neck[]" value
="No lymphadenopathy" <?php
$result = chkdata_CB($obj,"neck","No lymphadenopathy"); echo $result;?
>> <?php
xl("No lymphadenopathy",'e') ?
> </label
></td
><td
>
160 <label
class="text"><input type
="checkbox" name
="neck[]" value
="No thyromegally" <?php
$result = chkdata_CB($obj,"neck","No thyromegally"); echo $result;?
>> <?php
xl("No thyromegally",'e') ?
> </label
></td
><td
>
161 <label
class="text"><input type
="checkbox" name
="neck[]" value
="No Bruit" <?php
$result = chkdata_CB($obj,"neck","No Bruit"); echo $result;?
>> <?php
xl("No Bruit",'e') ?
> </label
></td
><td
>
162 <label
class="text"><input type
="checkbox" name
="neck[]" value
="FROM" <?php
$result = chkdata_CB($obj,"neck","FROM"); echo $result;?
>> <?php
xl("FROM",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
163 <label
class="text"><input type
="checkbox" name
="neck[]" value
="Lymphadenopathy" <?php
$result = chkdata_CB($obj,"neck","Lymphadenopathy"); echo $result;?
>> <?php
xl("Lymphadenopathy",'e') ?
> </label
></td
><td
>
164 <label
class="text"><input type
="checkbox" name
="neck[]" value
="Thyromegally" <?php
$result = chkdata_CB($obj,"neck","Thyromegally"); echo $result;?
>> <?php
xl("Thyromegally",'e') ?
> </label
></td
><td
>
165 <label
class="text"><input type
="checkbox" name
="neck[]" value
="Right Bruit" <?php
$result = chkdata_CB($obj,"neck","Right Bruit"); echo $result;?
>> <?php
xl("Right Bruit",'e') ?
> </label
></td
><td
>
166 <label
class="text"><input type
="checkbox" name
="neck[]" value
="Left Bruit" <?php
$result = chkdata_CB($obj,"neck","Left Bruit"); echo $result;?
>> <?php
xl("Left Bruit",'e') ?
> </label
></td
></tr
>
170 <td align
="left" colspan
="5"> 
;</td
>
175 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("HEART:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="heart[]" value
="NSR" <?php
$result = chkdata_CB($obj,"heart","NSR"); echo $result;?
>> <?php
xl("NSR",'e') ?
> </label
></td
><td
>
176 <label
class="text"><input type
="checkbox" name
="heart[]" value
="S1 S2" <?php
$result = chkdata_CB($obj,"heart","S1 S2"); echo $result;?
>> <?php
xl("S1/S2",'e') ?
> </label
></td
><td
>
177 <label
class="text"><input type
="checkbox" name
="heart[]" value
="No murmur" <?php
$result = chkdata_CB($obj,"heart","No murmur"); echo $result;?
>> <?php
xl("No murmur",'e') ?
> </label
></td
><td
>
178 </td
></tr
><tr
><td
></td
><td
><label
class="text"><input type
="checkbox" name
="heart[]" value
="Irregular rate" <?php
$result = chkdata_CB($obj,"heart","Irregular rate"); echo $result;?
>> <?php
xl("Irregular rate",'e') ?
> </label
>
179 </td
><td
> <label
class="text"><input type
="checkbox" name
="heart[]" value
="Irreg rhythm" <?php
$result = chkdata_CB($obj,"heart","Irreg rhythm"); echo $result;?
>> <?php
xl("Irreg rhythm",'e') ?
> </label
>
180 </td
><td
> <label
class="text"><input type
="checkbox" name
="heart[]" value
="Murmur" <?php
$result = chkdata_CB($obj,"heart","Murmur"); echo $result;?
>> <?php
xl("Murmur",'e') ?
> </label
>
181 </td
><td
><label
class="text"><input type
="checkbox" name
="heart[]" value
="Gallop" <?php
$result = chkdata_CB($obj,"heart","Gallop"); echo $result;?
>> <?php
xl("Gallop",'e') ?
> </label
></td
></tr
>
185 <td align
="left" colspan
="5"> 
;</td
>
190 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("LUNG:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="lung[]" value
="Clear to ascultation" <?php
$result = chkdata_CB($obj,"lung","Clear to ascultation"); echo $result;?
>> <?php
xl("Clear to ascultation",'e') ?
> </label
></td
><td
>
191 <label
class="text"><input type
="checkbox" name
="lung[]" value
="No rales" <?php
$result = chkdata_CB($obj,"lung","No rales"); echo $result;?
>> <?php
xl("No rales",'e') ?
> </label
></td
><td
>
192 <label
class="text"><input type
="checkbox" name
="lung[]" value
="No wheezes" <?php
$result = chkdata_CB($obj,"lung","No wheezes"); echo $result;?
>> <?php
xl("No wheezes",'e') ?
> </label
></td
><td
>
193 <label
class="text"><input type
="checkbox" name
="lung[]" value
="No rhonchi" <?php
$result = chkdata_CB($obj,"lung","No rhonchi"); echo $result;?
>> <?php
xl("No rhonchi",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
194 <label
class="text"><input type
="checkbox" name
="lung[]" value
="Distant" <?php
$result = chkdata_CB($obj,"lung","Distant"); echo $result;?
>> <?php
xl("Distant",'e') ?
> </label
></td
><td
>
195 <label
class="text"><input type
="checkbox" name
="lung[]" value
="Rales" <?php
$result = chkdata_CB($obj,"lung","Rales"); echo $result;?
>> <?php
xl("Rales",'e') ?
> </label
></td
><td
>
196 <label
class="text"><input type
="checkbox" name
="lung[]" value
="Wheezes" <?php
$result = chkdata_CB($obj,"lung","Wheezes"); echo $result;?
>> <?php
xl("Wheezes",'e') ?
> </label
></td
><td
>
197 <label
class="text"><input type
="checkbox" name
="lung[]" value
="Rhonchi" <?php
$result = chkdata_CB($obj,"lung","Rhonchi"); echo $result;?
>> <?php
xl("Rhonchi",'e') ?
> </label
></td
></tr
>
201 <td align
="left" colspan
="5"> 
;</td
>
206 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("CHEST:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="chest[]" value
="No palpable tenderness" <?php
$result = chkdata_CB($obj,"chest","No palpable tenderness"); echo $result;?
>> <?php
xl("No palpable tenderness",'e') ?
> </label
></td
><td
>
207 <label
class="text"><input type
="checkbox" name
="chest[]" value
="Palpable tenderness" <?php
$result = chkdata_CB($obj,"chest","Palpable tenderness"); echo $result;?
>> <?php
xl("Palpable tenderness",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
></tr
>
211 <td align
="left" colspan
="5"> 
;</td
>
216 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("BREAST:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="breast[]" value
="Did not examine" <?php
$result = chkdata_CB($obj,"breast","Did not examine"); echo $result;?
>> <?php
xl("Did not examine",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
><td
> 
;</td
></tr
>
222 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Male",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="male[]" value
="Normal" <?php
$result = chkdata_CB($obj,"male","Normal"); echo $result;?
>> <?php
xl("Normal",'e') ?
> </label
></td
><td
>
223 <label
class="text"><input type
="checkbox" name
="male[]" value
="Gynecomastia" <?php
$result = chkdata_CB($obj,"male","Gynecomastia"); echo $result;?
>> <?php
xl("Gynecomastia",'e') ?
> </label
></td
><td
>
224 <label
class="text"><input type
="checkbox" name
="male[]" value
="Palpable mass" <?php
$result = chkdata_CB($obj,"male","Palpable mass"); echo $result;?
>> <?php
xl("Palpable mass",'e') ?
> </label
></td
><td
> 
;</td
></tr
>
230 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Female",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="female[]" value
="Normal size" <?php
$result = chkdata_CB($obj,"female","Normal size"); echo $result;?
>> <?php
xl("Normal size",'e') ?
> </label
></td
><td
>
231 <label
class="text"><input type
="checkbox" name
="female[]" value
="Normal exam" <?php
$result = chkdata_CB($obj,"female","Normal exam"); echo $result;?
>> <?php
xl("Normal exam",'e') ?
> </label
></td
><td
>
232 <label
class="text"><input type
="checkbox" name
="female[]" value
="Enlarged" <?php
$result = chkdata_CB($obj,"female","Enlarged"); echo $result;?
>> <?php
xl("Enlarged",'e') ?
> </label
></td
><td
>
233 <label
class="text"><input type
="checkbox" name
="female[]" value
="Pendulous" <?php
$result = chkdata_CB($obj,"female","Pendulous"); echo $result;?
>> <?php
xl("Pendulous",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
234 <label
class="text"><input type
="checkbox" name
="female[]" value
="Palpable mass" <?php
$result = chkdata_CB($obj,"female","Palpable mass"); echo $result;?
>> <?php
xl("Palpable mass",'e') ?
> </label
></td
><td
>
235 <label
class="text"><input type
="checkbox" name
="female[]" value
="Tender" <?php
$result = chkdata_CB($obj,"female","Tender"); echo $result;?
>> <?php
xl("Tender",'e') ?
> </label
></td
><td
>
236 <label
class="text"><input type
="checkbox" name
="female[]" value
="Erythematous" <?php
$result = chkdata_CB($obj,"female","Erythematous"); echo $result;?
>> <?php
xl("Erythematous",'e') ?
> </label
></td
><td
>
237 <label
class="text"><input type
="checkbox" name
="female[]" value
="Peau d orange" <?php
$result = chkdata_CB($obj,"female","Peau d orange"); echo $result;?
>> <?php
xl("Peau d'orange",'e') ?
> </label
></td
></tr
>
243 <tr
><td align
="right" width
="150"></td
> <td colspan
="4"><input size
="80" type
="text" name
="note" value
="<?php $result = chkdata_Txt($obj,"note
"); echo $result;?>"></td
></tr
>
246 <td align
="left" colspan
="5"> 
;</td
>
252 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("ABDOMEN:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="abdomen[]" value
="NABS" <?php
$result = chkdata_CB($obj,"abdomen","NABS"); echo $result;?
>> <?php
xl("NABS",'e') ?
> </label
></td
><td
>
253 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="Soft" <?php
$result = chkdata_CB($obj,"abdomen","Soft"); echo $result;?
>> <?php
xl("Soft",'e') ?
> </label
></td
><td
>
254 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="Non tender" <?php
$result = chkdata_CB($obj,"abdomen","Non tender"); echo $result;?
>> <?php
xl("Non-tender",'e') ?
> </label
></td
><td
>
255 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="Non distended" <?php
$result = chkdata_CB($obj,"abdomen","Non distended"); echo $result;?
>> <?php
xl("Non-distended",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
256 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="Obese" <?php
$result = chkdata_CB($obj,"abdomen","Obese"); echo $result;?
>> <?php
xl("Obese",'e') ?
> </label
></td
><td
>
257 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="Hepatomegaly" <?php
$result = chkdata_CB($obj,"abdomen","Hepatomegaly"); echo $result;?
>> <?php
xl("Hepatomegaly",'e') ?
> </label
></td
><td
>
258 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="Ascites" <?php
$result = chkdata_CB($obj,"abdomen","Ascites"); echo $result;?
>> <?php
xl("Ascites",'e') ?
> </label
></td
><td
>
259 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="Tender" <?php
$result = chkdata_CB($obj,"abdomen","Tender"); echo $result;?
>> <?php
xl("Tender",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
260 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="Distended" <?php
$result = chkdata_CB($obj,"abdomen","Distended"); echo $result;?
>> <?php
xl("Distended",'e') ?
> </label
></td
><td
>
261 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="Guarding" <?php
$result = chkdata_CB($obj,"abdomen","Guarding"); echo $result;?
>> <?php
xl("Guarding",'e') ?
> </label
></td
><td
>
262 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="Rebound tenderness" <?php
$result = chkdata_CB($obj,"abdomen","Rebound tenderness"); echo $result;?
>> <?php
xl("Rebound tenderness",'e') ?
> </label
></td
><td
>
263 <label
class="text"><input type
="checkbox" name
="abdomen[]" value
="CVA tenderness" <?php
$result = chkdata_CB($obj,"abdomen","CVA tenderness"); echo $result;?
>> <?php
xl("CVA tenderness",'e') ?
> </label
></td
></tr
>
269 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Scar",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="scar[]" value
="Upper midline" <?php
$result = chkdata_CB($obj,"scar","Upper midline"); echo $result;?
>> <?php
xl("Upper midline",'e') ?
> </label
></td
><td
>
270 <label
class="text"><input type
="checkbox" name
="scar[]" value
="Lower midline" <?php
$result = chkdata_CB($obj,"scar","Lower midline"); echo $result;?
>> <?php
xl("Lower midline",'e') ?
> </label
></td
><td
>
271 <label
class="text"><input type
="checkbox" name
="scar[]" value
="Rt subcostal" <?php
$result = chkdata_CB($obj,"scar","Rt subcostal"); echo $result;?
>> <?php
xl("Rt subcostal",'e') ?
> </label
></td
><td
>
272 <label
class="text"><input type
="checkbox" name
="scar[]" value
="Lt subcostal" <?php
$result = chkdata_CB($obj,"scar","Lt subcostal"); echo $result;?
>> <?php
xl("Lt subcostal",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
273 <label
class="text"><input type
="checkbox" name
="scar[]" value
="Rt inguinal" <?php
$result = chkdata_CB($obj,"scar","Rt inguinal"); echo $result;?
>> <?php
xl("Rt inguinal",'e') ?
> </label
></td
><td
>
274 <label
class="text"><input type
="checkbox" name
="scar[]" value
="Lt inguinal" <?php
$result = chkdata_CB($obj,"scar","Lt inguinal"); echo $result;?
>> <?php
xl("Lt inguinal",'e') ?
> </label
></td
><td
>
275 <label
class="text"><input type
="checkbox" name
="scar[]" value
="Paramedian" <?php
$result = chkdata_CB($obj,"scar","Paramedian"); echo $result;?
>> <?php
xl("Paramedian",'e') ?
> </label
></td
><td
>
276 <label
class="text"><input type
="checkbox" name
="scar[]" value
="Pfanennsteil" <?php
$result = chkdata_CB($obj,"scar","Pfanennsteil"); echo $result;?
>> <?php
xl("Pfanennsteil",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
277 <label
class="text"><input type
="checkbox" name
="scar[]" value
="Upper Transverse" <?php
$result = chkdata_CB($obj,"scar","Upper Transverse"); echo $result;?
>> <?php
xl("Upper Transverse",'e') ?
> </label
></td
><td
>
278 <label
class="text"><input type
="checkbox" name
="scar[]" value
="Lower Transverse" <?php
$result = chkdata_CB($obj,"scar","Lower Transverse"); echo $result;?
>> <?php
xl("Lower Transverse",'e') ?
> </label
></td
><td
>
279 <label
class="text"><input type
="checkbox" name
="scar[]" value
="Laparoscopic" <?php
$result = chkdata_CB($obj,"scar","Laparoscopic"); echo $result;?
>> <?php
xl("Laparoscopic",'e') ?
> </label
></td
><td
>
280 <label
class="text"><input type
="checkbox" name
="scar[]" value
="McBurney s" <?php
$result = chkdata_CB($obj,"scar","McBurney s"); echo $result;?
>> <?php
xl("McBurney's",'e') ?
> </label
></td
></tr
>
284 <td align
="left" colspan
="5"> 
;</td
>
289 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("UMBILIUS:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="umbilius[]" value
="Normal" <?php
$result = chkdata_CB($obj,"umbilius","Normal"); echo $result;?
>> <?php
xl("Normal",'e') ?
> </label
></td
><td
>
290 <label
class="text"><input type
="checkbox" name
="umbilius[]" value
="Hernia" <?php
$result = chkdata_CB($obj,"umbilius","Hernia"); echo $result;?
>> <?php
xl("Hernia",'e') ?
> </label
></td
><td
>
291 <label
class="text"><input type
="checkbox" name
="umbilius[]" value
="Lymphadenopathy" <?php
$result = chkdata_CB($obj,"umbilius","Lymphadenopathy"); echo $result;?
>> <?php
xl("Lymphadenopathy",'e') ?
> </label
></td
><td
> 
;</td
></tr
>
295 <td align
="left" colspan
="5"> 
;</td
>
300 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("GROINS:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="groins[]" value
="Normal" <?php
$result = chkdata_CB($obj,"groins","Normal"); echo $result;?
>> <?php
xl("Normal",'e') ?
> </label
></td
><td
>
301 <label
class="text"><input type
="checkbox" name
="groins[]" value
="Rt hernia" <?php
$result = chkdata_CB($obj,"groins","Rt hernia"); echo $result;?
>> <?php
xl("Rt hernia",'e') ?
> </label
></td
><td
>
302 <label
class="text"><input type
="checkbox" name
="groins[]" value
="Lt hernia" <?php
$result = chkdata_CB($obj,"groins","Lt hernia"); echo $result;?
>> <?php
xl("Lt hernia",'e') ?
> </label
></td
><td
>
303 <label
class="text"><input type
="checkbox" name
="groins[]" value
="Rash" <?php
$result = chkdata_CB($obj,"groins","Rash"); echo $result;?
>> <?php
xl("Rash",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
304 <label
class="text"><input type
="checkbox" name
="groins[]" value
="Lymphadenopathy" <?php
$result = chkdata_CB($obj,"groins","Lymphadenopathy"); echo $result;?
>> <?php
xl("Lymphadenopathy",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
><td
> 
;</td
></tr
>
307 <td align
="left" colspan
="5"> 
;</td
>
313 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("EXTREMITIES:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="extremities[]" value
="Warm" <?php
$result = chkdata_CB($obj,"extremities","Warm"); echo $result;?
>> <?php
xl("Warm",'e') ?
> </label
></td
><td
>
314 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="Dry" <?php
$result = chkdata_CB($obj,"extremities","Dry"); echo $result;?
>> <?php
xl("Dry",'e') ?
> </label
></td
><td
>
315 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="No edema" <?php
$result = chkdata_CB($obj,"extremities","No edema"); echo $result;?
>> <?php
xl("No edema",'e') ?
> </label
></td
><td
>
316 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="No calf tenderness" <?php
$result = chkdata_CB($obj,"extremities","No calf tenderness"); echo $result;?
>> <?php
xl("No calf tenderness",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
317 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="Pitting edema" <?php
$result = chkdata_CB($obj,"extremities","Pitting edema"); echo $result;?
>> <?php
xl("Pitting edema",'e') ?
> </label
></td
><td
>
318 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="Stasis dermatitis" <?php
$result = chkdata_CB($obj,"extremities","Stasis dermatitis"); echo $result;?
>> <?php
xl("Stasis dermatitis",'e') ?
> </label
></td
><td
>
319 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="Varicosities" <?php
$result = chkdata_CB($obj,"extremities","Varicosities"); echo $result;?
>> <?php
xl("Varicosities",'e') ?
> </label
></td
><td
>
320 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="Calf tenderness" <?php
$result = chkdata_CB($obj,"extremities","Calf tenderness"); echo $result;?
>> <?php
xl("Calf tenderness",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
321 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="Acanthosis Nigricans" <?php
$result = chkdata_CB($obj,"extremities","Acanthosis Nigricans"); echo $result;?
>> <?php
xl("Acanthosis Nigricans",'e') ?
> </label
></td
><td
>
322 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="Spider Angiomas" <?php
$result = chkdata_CB($obj,"extremities","Spider Angiomas"); echo $result;?
>> <?php
xl("Spider Angiomas",'e') ?
> </label
></td
><td
>
323 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="Palmar Erythema" <?php
$result = chkdata_CB($obj,"extremities","Palmar Erythema"); echo $result;?
>> <?php
xl("Palmar Erythema",'e') ?
> </label
></td
><td
>
324 <label
class="text"><input type
="checkbox" name
="extremities[]" value
="Hirsutism" <?php
$result = chkdata_CB($obj,"extremities","Hirsutism"); echo $result;?
>> <?php
xl("Hirsutism",'e') ?
> </label
></td
></tr
>
326 <td align
="left" colspan
="5"> 
;</td
>
331 <td align
="right"><b
class="text"> <?php
xl("VASCULAR:",'e') ?
> </b
></td
>
332 <td align
="left"> 
;</td
>
333 <td align
="left"> 
;</td
>
334 <td align
="left"> 
;</td
>
335 <td align
="left"> 
;</td
>
340 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Peripheral pulses",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="peripheral_pulses[]" value
="Did not examine" <?php
$result = chkdata_CB($obj,"peripheral_pulses","Did not examine"); echo $result;?
>> <?php
xl("Did not examine",'e') ?
> </label
></td
><td
>
341 <label
class="text"><input type
="checkbox" name
="peripheral_pulses[]" value
="2 pulses" <?php
$result = chkdata_CB($obj,"peripheral_pulses","2 pulses"); echo $result;?
>> <?php
xl("2+ pulses",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
></tr
>
347 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Right",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="right_peripheral_pulses[]" value
="Radial" <?php
$result = chkdata_CB($obj,"right_peripheral_pulses","Radial"); echo $result;?
>> <?php
xl("Radial",'e') ?
> </label
></td
><td
>
348 <label
class="text"><input type
="checkbox" name
="right_peripheral_pulses[]" value
="Inguinal" <?php
$result = chkdata_CB($obj,"right_peripheral_pulses","Inguinal"); echo $result;?
>> <?php
xl("Inguinal",'e') ?
> </label
></td
><td
>
349 <label
class="text"><input type
="checkbox" name
="right_peripheral_pulses[]" value
="Popliteal" <?php
$result = chkdata_CB($obj,"right_peripheral_pulses","Popliteal"); echo $result;?
>> <?php
xl("Popliteal",'e') ?
> </label
></td
><td
>
350 <label
class="text"><input type
="checkbox" name
="right_peripheral_pulses[]" value
="DP" <?php
$result = chkdata_CB($obj,"right_peripheral_pulses","DP"); echo $result;?
>> <?php
xl("DP",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
351 <label
class="text"><input type
="checkbox" name
="right_peripheral_pulses[]" value
="PT" <?php
$result = chkdata_CB($obj,"right_peripheral_pulses","PT"); echo $result;?
>> <?php
xl("PT",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
><td
> 
;</td
></tr
>
357 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Left",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="left_peripheral_pulses[]" value
="Radial" <?php
$result = chkdata_CB($obj,"left_peripheral_pulses","Radial"); echo $result;?
>> <?php
xl("Radial",'e') ?
> </label
></td
><td
>
358 <label
class="text"><input type
="checkbox" name
="left_peripheral_pulses[]" value
="Inguinal" <?php
$result = chkdata_CB($obj,"left_peripheral_pulses","Inguinal"); echo $result;?
>> <?php
xl("Inguinal",'e') ?
> </label
></td
><td
>
359 <label
class="text"><input type
="checkbox" name
="left_peripheral_pulses[]" value
="Popliteal" <?php
$result = chkdata_CB($obj,"left_peripheral_pulses","Popliteal"); echo $result;?
>> <?php
xl("Popliteal",'e') ?
> </label
></td
><td
>
360 <label
class="text"><input type
="checkbox" name
="left_peripheral_pulses[]" value
="DP" <?php
$result = chkdata_CB($obj,"left_peripheral_pulses","DP"); echo $result;?
>> <?php
xl("DP",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
361 <label
class="text"><input type
="checkbox" name
="left_peripheral_pulses[]" value
="PT" <?php
$result = chkdata_CB($obj,"left_peripheral_pulses","PT"); echo $result;?
>> <?php
xl("PT",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
><td
> 
;</td
></tr
>
366 <td align
="left" colspan
="5"> 
;</td
>
370 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("NEUROLOGICAL:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="neurological[]" value
="Did not examine" <?php
$result = chkdata_CB($obj,"neurological","Did not examine"); echo $result;?
>> <?php
xl("Did not examine",'e') ?
> </label
></td
><td
>
371 <label
class="text"><input type
="checkbox" name
="neurological[]" value
="Grossly normal" <?php
$result = chkdata_CB($obj,"neurological","Grossly normal"); echo $result;?
>> <?php
xl("Grossly normal",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
></tr
>
377 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Right",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="right_neurological[]" value
="Normal strength DTR s" <?php
$result = chkdata_CB($obj,"right_neurological","Normal strength DTR s"); echo $result;?
>> <?php
xl("Normal strength & DTR's",'e') ?
> </label
></td
><td
>
378 <label
class="text"><input type
="checkbox" name
="right_neurological[]" value
="Abn grip strength" <?php
$result = chkdata_CB($obj,"right_neurological","Abn grip strength"); echo $result;?
>> <?php
xl("Abn grip strength",'e') ?
> </label
></td
><td
>
379 <label
class="text"><input type
="checkbox" name
="right_neurological[]" value
="Abn arm strength" <?php
$result = chkdata_CB($obj,"right_neurological","Abn arm strength"); echo $result;?
>> <?php
xl("Abn arm strength",'e') ?
> </label
></td
><td
>
380 <label
class="text"><input type
="checkbox" name
="right_neurological[]" value
="Abn leg strength" <?php
$result = chkdata_CB($obj,"right_neurological","Abn leg strength"); echo $result;?
>> <?php
xl("Abn leg strength",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
381 <label
class="text"><input type
="checkbox" name
="right_neurological[]" value
="Abn DTR s" <?php
$result = chkdata_CB($obj,"right_neurological","Abn DTR s"); echo $result;?
>> <?php
xl("Abn DTR's",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
><td
> 
;</td
></tr
>
387 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("Left",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="left_neurological[]" value
="Normal strength DTR s" <?php
$result = chkdata_CB($obj,"left_neurological","Normal strength DTR s"); echo $result;?
>> <?php
xl("Normal strength & DTR's",'e') ?
> </label
></td
><td
>
388 <label
class="text"><input type
="checkbox" name
="left_neurological[]" value
="Abn grip strength" <?php
$result = chkdata_CB($obj,"left_neurological","Abn grip strength"); echo $result;?
>> <?php
xl("Abn grip strength",'e') ?
> </label
></td
><td
>
389 <label
class="text"><input type
="checkbox" name
="left_neurological[]" value
="Abn arm strength" <?php
$result = chkdata_CB($obj,"left_neurological","Abn arm strength"); echo $result;?
>> <?php
xl("Abn arm strength",'e') ?
> </label
></td
><td
>
390 <label
class="text"><input type
="checkbox" name
="left_neurological[]" value
="Abn leg strength" <?php
$result = chkdata_CB($obj,"left_neurological","Abn leg strength"); echo $result;?
>> <?php
xl("Abn leg strength",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
391 <label
class="text"><input type
="checkbox" name
="left_neurological[]" value
="Abn DTR s" <?php
$result = chkdata_CB($obj,"left_neurological","Abn DTR s"); echo $result;?
>> <?php
xl("Abn DTR's",'e') ?
> </label
></td
><td
> 
;</td
><td
> 
;</td
><td
> 
;</td
></tr
>
395 <td align
="left" colspan
="5"> 
;</td
>
400 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("RECTUM:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="rectum[]" value
="Did not examine" <?php
$result = chkdata_CB($obj,"rectum","Did not examine"); echo $result;?
>> <?php
xl("Did not examine",'e') ?
> </label
></td
><td
>
401 <label
class="text"><input type
="checkbox" name
="rectum[]" value
="Normal" <?php
$result = chkdata_CB($obj,"rectum","Normal"); echo $result;?
>> <?php
xl("Normal",'e') ?
> </label
></td
><td
>
403 </td
></tr
><tr
><td
></td
><td
> <label
class="text"><input type
="checkbox" name
="rectum[]" value
="Palpable mass" <?php
$result = chkdata_CB($obj,"rectum","Palpable mass"); echo $result;?
>> <?php
xl("Palpable mass",'e') ?
> </label
>
404 </td
><td
><label
class="text"><input type
="checkbox" name
="rectum[]" value
="Enlarged prostate" <?php
$result = chkdata_CB($obj,"rectum","Enlarged prostate"); echo $result;?
>> <?php
xl("Enlarged prostate",'e') ?
> </label
>
405 </td
><td
><label
class="text"><input type
="checkbox" name
="rectum[]" value
="Hemorrhoids" <?php
$result = chkdata_CB($obj,"rectum","Hemorrhoids"); echo $result;?
>> <?php
xl("Hemorrhoids",'e') ?
> </label
></td
><td
><label
class="text"><input type
="checkbox" name
="rectum[]" value
="Fissure Fistula" <?php
$result = chkdata_CB($obj,"rectum","Fissure Fistula"); echo $result;?
>> <?php
xl("Fissure/Fistula",'e') ?
> </label
></td
></tr
>
409 <td align
="left" colspan
="5"> 
;</td
>
414 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("PELVIC:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="pelvic[]" value
="Did not examine" <?php
$result = chkdata_CB($obj,"pelvic","Did not examine"); echo $result;?
>> <?php
xl("Did not examine",'e') ?
> </label
></td
><td
>
415 <label
class="text"><input type
="checkbox" name
="pelvic[]" value
="Nomal" <?php
$result = chkdata_CB($obj,"pelvic","Nomal"); echo $result;?
>> <?php
xl("Nomal",'e') ?
> </label
></td
><td
>
417 </td
></tr
><tr
><td
></td
><td
> <label
class="text"><input type
="checkbox" name
="pelvic[]" value
="CM tenderness" <?php
$result = chkdata_CB($obj,"pelvic","CM tenderness"); echo $result;?
>> <?php
xl("CM tenderness",'e') ?
> </label
>
418 </td
><td
> <label
class="text"><input type
="checkbox" name
="pelvic[]" value
="Rt adnexal mass" <?php
$result = chkdata_CB($obj,"pelvic","Rt adnexal mass"); echo $result;?
>> <?php
xl("Rt adnexal mass",'e') ?
> </label
></td
><td
><label
class="text"><input type
="checkbox" name
="pelvic[]" value
="Lt adnexal mass" <?php
$result = chkdata_CB($obj,"pelvic","Lt adnexal mass"); echo $result;?
>> <?php
xl("Lt adnexal mass",'e') ?
> </label
></td
><td
> 
;</td
></tr
>
421 <td align
="left" colspan
="5"> 
;</td
>
424 <td align
="left" colspan
="5"> 
;</td
>
430 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("ASSESSMENT:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="assessment[]" value
="Morbid obesity" <?php
$result = chkdata_CB($obj,"assessment","Morbid obesity"); echo $result;?
>> <?php
xl("Morbid obesity",'e') ?
> </label
></td
><td
>
431 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="DVT" <?php
$result = chkdata_CB($obj,"assessment","DVT"); echo $result;?
>> <?php
xl("DVT",'e') ?
> </label
></td
><td
>
432 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Hernia Inguinal" <?php
$result = chkdata_CB($obj,"assessment","Hernia Inguinal"); echo $result;?
>> <?php
xl("Hernia, Inguinal",'e') ?
> </label
></td
><td
>
433 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Lower Back Pain" <?php
$result = chkdata_CB($obj,"assessment","Lower Back Pain"); echo $result;?
>> <?php
xl("Lower Back Pain",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
434 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Asthma" <?php
$result = chkdata_CB($obj,"assessment","Asthma"); echo $result;?
>> <?php
xl("Asthma",'e') ?
> </label
></td
><td
>
435 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Failed prev wt loss surgery" <?php
$result = chkdata_CB($obj,"assessment","Failed prev wt loss surgery"); echo $result;?
>> <?php
xl("Failed prev wt loss surgery",'e') ?
> </label
></td
><td
>
436 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Hernia Internal" <?php
$result = chkdata_CB($obj,"assessment","Hernia Internal"); echo $result;?
>> <?php
xl("Hernia, Internal",'e') ?
> </label
></td
><td
>
437 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Osteoarthritis" <?php
$result = chkdata_CB($obj,"assessment","Osteoarthritis"); echo $result;?
>> <?php
xl("Osteoarthritis",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
438 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="CHF" <?php
$result = chkdata_CB($obj,"assessment","CHF"); echo $result;?
>> <?php
xl("CHF",'e') ?
> </label
></td
><td
>
439 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Fatty Liver" <?php
$result = chkdata_CB($obj,"assessment","Fatty Liver"); echo $result;?
>> <?php
xl("Fatty Liver",'e') ?
> </label
></td
><td
>
440 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Hypercholesterolemia" <?php
$result = chkdata_CB($obj,"assessment","Hypercholesterolemia"); echo $result;?
>> <?php
xl("Hypercholesterolemia",'e') ?
> </label
></td
><td
>
441 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Panniculitis" <?php
$result = chkdata_CB($obj,"assessment","Panniculitis"); echo $result;?
>> <?php
xl("Panniculitis",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
442 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Coronary Artery Dz" <?php
$result = chkdata_CB($obj,"assessment","Coronary Artery Dz"); echo $result;?
>> <?php
xl("Coronary Artery Dz",'e') ?
> </label
></td
><td
>
443 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Gallbladder Dz" <?php
$result = chkdata_CB($obj,"assessment","Gallbladder Dz"); echo $result;?
>> <?php
xl("Gallbladder Dz",'e') ?
> </label
></td
><td
>
444 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Hernia Umbilical" <?php
$result = chkdata_CB($obj,"assessment","Hernia Umbilical"); echo $result;?
>> <?php
xl("Hernia, Umbilical",'e') ?
> </label
></td
><td
>
445 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="PVD" <?php
$result = chkdata_CB($obj,"assessment","PVD"); echo $result;?
>> <?php
xl("PVD",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
446 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="COPD" <?php
$result = chkdata_CB($obj,"assessment","COPD"); echo $result;?
>> <?php
xl("COPD",'e') ?
> </label
></td
><td
>
447 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="GERD" <?php
$result = chkdata_CB($obj,"assessment","GERD"); echo $result;?
>> <?php
xl("GERD",'e') ?
> </label
></td
><td
>
448 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Hypertension" <?php
$result = chkdata_CB($obj,"assessment","Hypertension"); echo $result;?
>> <?php
xl("Hypertension",'e') ?
> </label
></td
><td
>
449 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Sleep Apnea" <?php
$result = chkdata_CB($obj,"assessment","Sleep Apnea"); echo $result;?
>> <?php
xl("Sleep Apnea",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
450 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Depression" <?php
$result = chkdata_CB($obj,"assessment","Depression"); echo $result;?
>> <?php
xl("Depression",'e') ?
> </label
></td
><td
>
451 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Hernia Hiatal" <?php
$result = chkdata_CB($obj,"assessment","Hernia Hiatal"); echo $result;?
>> <?php
xl("Hernia, Hiatal",'e') ?
> </label
></td
><td
>
452 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Hypertriglyceridemia" <?php
$result = chkdata_CB($obj,"assessment","Hypertriglyceridemia"); echo $result;?
>> <?php
xl("Hypertriglyceridemia",'e') ?
> </label
></td
><td
>
453 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Urinary Incontinence" <?php
$result = chkdata_CB($obj,"assessment","Urinary Incontinence"); echo $result;?
>> <?php
xl("Urinary Incontinence",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
454 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Diabetes" <?php
$result = chkdata_CB($obj,"assessment","Diabetes"); echo $result;?
>> <?php
xl("Diabetes",'e') ?
> </label
></td
><td
>
455 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Hernia Incisional" <?php
$result = chkdata_CB($obj,"assessment","Hernia Incisional"); echo $result;?
>> <?php
xl("Hernia, Incisional",'e') ?
> </label
></td
><td
>
456 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Hypothyroidism" <?php
$result = chkdata_CB($obj,"assessment","Hypothyroidism"); echo $result;?
>> <?php
xl("Hypothyroidism",'e') ?
> </label
></td
><td
>
457 <label
class="text"><input type
="checkbox" name
="assessment[]" value
="Venous Stasis Dz" <?php
$result = chkdata_CB($obj,"assessment","Venous Stasis Dz"); echo $result;?
>> <?php
xl("Venous Stasis Dz",'e') ?
> </label
></td
></tr
>
462 <td align
="left" colspan
="5"> 
;</td
>
466 <tr
><td align
="right" width
="150"></td
> <td colspan
="4"><textarea name
="note2" rows
="4" cols
="60"><?php
$result = chkdata_Txt($obj,"note2"); echo $result;?
></textarea
></td
></tr
>
468 <td align
="left" colspan
="5"> 
;</td
>
475 <tr
><td align
="right" width
="150"> <b
class="text"><?php
xl("RECOMMENDATIONS:",'e') ?
></b
> </td
> <td
><label
class="text"><input type
="checkbox" name
="recommendations[]" value
="VBG Vertical Banded Gastroplasty" <?php
$result = chkdata_CB($obj,"recommendations","VBG Vertical Banded Gastroplasty"); echo $result;?
>> <?php
xl("VBG (Vertical Banded Gastroplasty)",'e') ?
> </label
></td
><td
>
476 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="PRYGBP Proximal Roux en Y Gastric Bypass" <?php
$result = chkdata_CB($obj,"recommendations","PRYGBP Proximal Roux en Y Gastric Bypass"); echo $result;?
>> <?php
xl("PRYGBP (Proximal Roux-en-Y Gastric Bypass)",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
477 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="SG Sleeve Gastrectomy" <?php
$result = chkdata_CB($obj,"recommendations","SG Sleeve Gastrectomy"); echo $result;?
>> <?php
xl("SG (Sleeve Gastrectomy)",'e') ?
> </label
></td
><td
>
478 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="MRYGBP Medial Roux en Y Gastric Bypass" <?php
$result = chkdata_CB($obj,"recommendations","MRYGBP Medial Roux en Y Gastric Bypass"); echo $result;?
>> <?php
xl("MRYGBP (Medial Roux-en-Y Gastric Bypass)",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
479 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="ABG Adjustable Banded Gastroplasty" <?php
$result = chkdata_CB($obj,"recommendations","ABG Adjustable Banded Gastroplasty"); echo $result;?
>> <?php
xl("ABG (Adjustable Banded Gastroplasty)",'e') ?
> </label
></td
><td
>
480 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="DRYGBP Distal Roux en Y Gastric Bypass" <?php
$result = chkdata_CB($obj,"recommendations","DRYGBP Distal Roux en Y Gastric Bypass"); echo $result;?
>> <?php
xl("DRYGBP (Distal Roux-en-Y Gastric Bypass)",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
481 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Gastric Restrictive Procedure other than VBG ABG" <?php
$result = chkdata_CB($obj,"recommendations","Gastric Restrictive Procedure other than VBG ABG"); echo $result;?
>> <?php
xl("Gastric Restrictive Procedure other than VBG/ ABG",'e') ?
> </label
></td
><td
>
482 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Duodenal Switch Procedure" <?php
$result = chkdata_CB($obj,"recommendations","Duodenal Switch Procedure"); echo $result;?
>> <?php
xl("Duodenal Switch Procedure",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
483 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Revision of Gastric Restrictive Procedure" <?php
$result = chkdata_CB($obj,"recommendations","Revision of Gastric Restrictive Procedure"); echo $result;?
>> <?php
xl("Revision of Gastric Restrictive Procedure",'e') ?
> </label
></td
><td
>
484 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="BPD Biliopancreatic Diversion" <?php
$result = chkdata_CB($obj,"recommendations","BPD Biliopancreatic Diversion"); echo $result;?
>> <?php
xl("BPD (Biliopancreatic Diversion)",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
485 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Lysis of Adhesions" <?php
$result = chkdata_CB($obj,"recommendations","Lysis of Adhesions"); echo $result;?
>> <?php
xl("Lysis of Adhesions",'e') ?
> </label
></td
><td
>
486 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Liver Biopsy" <?php
$result = chkdata_CB($obj,"recommendations","Liver Biopsy"); echo $result;?
>> <?php
xl("Liver Biopsy",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
487 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Hiatal Hernia Repair w Fundoplication" <?php
$result = chkdata_CB($obj,"recommendations","Hiatal Hernia Repair w Fundoplication"); echo $result;?
>> <?php
xl("Hiatal Hernia Repair w/ Fundoplication",'e') ?
> </label
></td
><td
>
488 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Hiatal Hernia Repair w o Fundoplication" <?php
$result = chkdata_CB($obj,"recommendations","Hiatal Hernia Repair w o Fundoplication"); echo $result;?
>> <?php
xl("Hiatal Hernia Repair w/o Fundoplication",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
489 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Vagotomy Pyloraplasty" <?php
$result = chkdata_CB($obj,"recommendations","Vagotomy Pyloraplasty"); echo $result;?
>> <?php
xl("Vagotomy & Pyloraplasty",'e') ?
> </label
></td
><td
>
490 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Abdominoplasty" <?php
$result = chkdata_CB($obj,"recommendations","Abdominoplasty"); echo $result;?
>> <?php
xl("Abdominoplasty",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
491 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Appendectomy possible" <?php
$result = chkdata_CB($obj,"recommendations","Appendectomy possible"); echo $result;?
>> <?php
xl("Appendectomy (possible)",'e') ?
> </label
></td
><td
>
492 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Cholecystectomy possible" <?php
$result = chkdata_CB($obj,"recommendations","Cholecystectomy possible"); echo $result;?
>> <?php
xl("Cholecystectomy (possible)",'e') ?
> </label
></td
></tr
><tr
><td
></td
><td
>
493 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="EGD Esophagogastroduodenoscopy" <?php
$result = chkdata_CB($obj,"recommendations","EGD Esophagogastroduodenoscopy"); echo $result;?
>> <?php
xl("EGD (Esophagogastroduodenoscopy)",'e') ?
> </label
></td
><td
>
494 <label
class="text"><input type
="checkbox" name
="recommendations[]" value
="Colonoscopy" <?php
$result = chkdata_CB($obj,"recommendations","Colonoscopy"); echo $result;?
>> <?php
xl("Colonoscopy",'e') ?
> </label
></td
></tr
>
500 <td align
="left" colspan
="2"> 
;</td
>
503 <tr
><td align
="right" width
="150"></td
> <td
><textarea name
="note3" rows
="4" cols
="60"><?php
$result = chkdata_Txt($obj,"note3"); echo $result;?
></textarea
></td
></tr
>
506 <input type
="submit" name
="submit form" value
="submit form" />
509 <a href
='<?php echo $GLOBALS['webroot
']?>/interface/patient_file/encounter/<?php echo $returnurl?>' onclick
='top.restoreSession()'> <?php
xl("[do not save]",'e') ?
> </a
>