1 <!DOCTYPE HTML
PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
3 "http://www.w3.org/TR/html4/loose.dtd">
7 include_once("../../globals.php");
9 include_once("$srcdir/api.inc");
11 include_once("$srcdir/forms.inc");
13 include_once("$srcdir/calendar.inc");
20 <?php
html_header_show();?
>
22 <title
>Physical examination
</title
>
24 <link rel
="stylesheet" href
="<?php echo $css_header;?>" type
="text/css">
26 <link rel
="stylesheet" href
="../../acog.css" type
="text/css">
28 <script language
="JavaScript" src
="../../acog.js" type
="text/JavaScript"></script
>
30 <script language
="JavaScript" type
="text/JavaScript">
32 window
.onload
= initialize
;
40 <body
class="body_top">
48 The <b>Physical Examination</b> section
50 should be completed by the physician each time a
52 physical examination is provided. The form offers prompts to
54 aid in documenting the services that are provided. This form
56 is based on the 1997 CMS (formerly, HCFA) guidelines for
58 the female genitourinary system examination and can be
60 used to document any level of examination.<br><br>
64 The female genitourinary examination template includes 9 organ systems/body areas with 3 shaded boxes and 6 unshaded boxes. The shading only becomes important when a comprehensive
66 examination is performed. For all other levels of examination, the total number of bulleted elements documented in the medical record will determine the level that can be
72 <tr><td>LEVEL OF EXAMINATION</td><td>PERFORM AND DOCUMENT</td></tr>
74 <tr><td>PROBLEM FOCUSED</td><td>15 ELEMENTS IDENTIFIED BY A BULLET</td></tr>
76 <tr><td>EXPANDED PROBLEM FOCUSED</td><td>611 ELEMENTS IDENTIFIED BY A BULLET</td></tr>
78 <tr><td>DETAILED</td><td>12 OR MORE ELEMENTS IDENTIFIED BY A BULLET</td></tr>
80 <tr><td>COMPREHENSIVE</td><td>ALL ELEMENTS IDENTIFIED BY A BULLET IN CONSTITUTIONAL AND GASTROINTESTINAL,
82 ANY 7 BULLETS IN GYNECOLOGIC, AT LEAST 1 BULLET IN ALL OTHER SYSTEMS</td></tr>
88 $tip1 = strtr($tip1, "\n\r", " ");
92 <div
class="srvChapter">Physical examination
<a href
="#" onMouseOver
="toolTip('<?php echo $tip1; ?>', 300)" onMouseOut
="toolTip();"><img src
="../../pic/mark_q.png" width
="13" height
="13" border
="0" align
="texttop"></a
></div
>
96 $fres=sqlStatement("select * from patient_data where pid='".$pid."'");
100 $patient = sqlFetchArray($fres);
104 $fres=sqlStatement("select * from form_physical_examination where id=$id");
108 $fdata = sqlFetchArray($fres);
114 <form action
="<?php echo $rootdir;?>/forms/physical_examination/save.php?mode=update&id=<?php echo $id; ?>" method
="post" enctype
="multipart/form-data" name
="my_form">
116 <?php
include("../../acog_menu.inc"); ?
>
118 <div style
="border: solid 2px black; background-color: white;">
120 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="3">
124 <td align
="left" valign
="top" style
="border-bottom: 2px solid black;"><table width
="100%" border
="0" cellspacing
="0" cellpadding
="5">
126 <tr align
="left" valign
="bottom" class="fibody">
128 <td width
="40%" class="bordR">Patient name
<br
>
130 <input name
="pname" type
="text" class="fullin" id
="pname" value
="<?php
132 echo $patient{'fname'}.' '.$patient{'mname'}.' '.$patient{'lname'};
136 <td width
="20%" class="bordR">birth date
140 <input name
="pbdate" type
="text" class="fullin" id
="pbdate" value
="<?php
142 echo $patient{'DOB'};
146 <td width
="20%" class="bordR">ID No
<br
>
148 <input name
="pe_id" type
="text" class="fullin" id
="pe_id" size
="12" value
="<?php
154 <td width
="20%">date
<br
>
156 <input name
="pe_date" type
="text" class="fullin" id
="pe_date" value
="<?php
170 <td align
="left" valign
="top" bgcolor
="#EDEDED"><h2
>Constitutional
</h2
>
172 <li
>Vital
signs (record
<u
><strong
>>
;</strong
></u
> 3 vital signs
)</li
>
174 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="0">
176 <tr align
="left" valign
="top" class="fibody">
178 <td width
="14%" nowrap
>Height
<br
>
180 <input name
="height" type
="text" class="fullin" value
="<?php echo $fdata{'height'}; ?>"></td
>
182 <td width
="14%" nowrap
>Weight
<br
>
184 <input name
="weight" type
="text" class="fullin" value
="<?php echo $fdata{'weight'}; ?>"></td
>
186 <td width
="14%" nowrap
>BMI
<br
>
188 <input name
="bmi" type
="text" class="fullin" value
="<?php echo $fdata{'bmi'}; ?>"></td
>
190 <td nowrap
>Blood
pressure (sitting
) <br
>
192 <input name
="blood_pressure" type
="text" class="fullin" value
="<?php echo $fdata{'blood_pressure'}; ?>"></td
>
194 <td width
="14%" nowrap
>Temperature
<br
>
196 <input name
="temperature" type
="text" class="fullin" value
="<?php echo $fdata{'temperature'}; ?>"></td
>
198 <td width
="14%" nowrap
>Pulse
<br
>
200 <input name
="pulse" type
="text" class="fullin" value
="<?php echo $fdata{'pulse'}; ?>"></td
>
202 <td width
="14%" nowrap
>Respiration
<br
>
204 <input name
="respiration" type
="text" class="fullin" value
="<?php echo $fdata{'respiration'}; ?>"></td
>
210 <li
>General
appearance (Note all that apply
):</li
> <table width
="100%" border
="0" cellspacing
="0" cellpadding
="2">
214 <td width
="150" nowrap
><input name
="general_well_developed" type
="radio" value
="0" <?php
echo (($fdata{'general_well_developed'} == '0')?
' checked ':''); ?
>>
220 <td width
="90" nowrap
><input name
="general_well_developed" type
="radio" value
="1" <?php
echo (($fdata{'general_well_developed'} == '1')?
' checked ':''); ?
>>
226 <td width
="100" nowrap
> 
;</td
>
230 <td width
="120"><input name
="general_no_deformities" type
="radio" value
="0" <?php
echo (($fdata{'general_no_deformities'} == '0')?
' checked ':''); ?
>>
236 <td width
="100"><input name
="general_no_deformities" type
="radio" value
="1" <?php
echo (($fdata{'general_no_deformities'} == '1')?
' checked ':''); ?
>>
248 <td width
="150" nowrap
><input name
="general_well_nourished" type
="radio" value
="0" <?php
echo (($fdata{'general_well_nourished'} == '0')?
' checked ':''); ?
>>
254 <td width
="90" nowrap
><input name
="general_well_nourished" type
="radio" value
="1" <?php
echo (($fdata{'general_well_nourished'} == '1')?
' checked ':''); ?
>>
260 <td width
="100" nowrap
> 
;</td
>
264 <td width
="120"><input name
="general_well_groomed" type
="radio" value
="0" <?php
echo (($fdata{'general_well_groomed'} == '0')?
' checked ':''); ?
>>
270 <td width
="100"><input name
="general_well_groomed" type
="radio" value
="1" <?php
echo (($fdata{'general_well_groomed'} == '1')?
' checked ':''); ?
>>
282 <td width
="150" nowrap
><input name
="general_normal_habitus" type
="radio" value
="0" <?php
echo (($fdata{'general_normal_habitus'} == '0')?
' checked ':''); ?
>>
286 <td width
="90" nowrap
><input name
="general_normal_habitus" type
="radio" value
="2" <?php
echo (($fdata{'general_normal_habitus'} == '2')?
' checked ':''); ?
>>
290 <td width
="100" nowrap
><input name
="general_normal_habitus" type
="radio" value
="1" <?php
echo (($fdata{'general_normal_habitus'} == '1')?
' checked ':''); ?
>>
296 <td width
="120"> 
;</td
>
298 <td width
="100"> 
;</td
>
310 <td align
="left" valign
="top"><h2
>Neck
</h2
>
312 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="1">
314 <tr align
="left" valign
="bottom" class="fibody">
316 <td width
="150" nowrap
><li
>Neck
</li
></td
>
318 <td width
="90" nowrap
> <input name
="neck_neck" type
="radio" value
="0" <?php
echo (($fdata{'neck_neck'} == '0')?
' checked ':''); ?
>>
322 <td width
="100" nowrap
><input name
="neck_neck" type
="radio" value
="1" <?php
echo (($fdata{'neck_neck'} == '1')?
' checked ':''); ?
>>
326 <td
><input name
="neck_neck_data" type
="text" class="fullin" value
="<?php echo $fdata{'neck_neck_data'}; ?>"></td
>
330 <tr align
="left" valign
="bottom" class="fibody">
332 <td width
="150" nowrap
><li
>Thyroid
</li
></td
>
334 <td width
="90" nowrap
>
336 <input name
="neck_thyroid" type
="radio" value
="0" <?php
echo (($fdata{'neck_thyroid'} == '0')?
' checked ':''); ?
>>
340 <td width
="100" nowrap
><input name
="neck_thyroid" type
="radio" value
="1" <?php
echo (($fdata{'neck_thyroid'} == '1')?
' checked ':''); ?
>>
344 <td
><input name
="neck_thyroid_data" type
="text" class="fullin" value
="<?php echo $fdata{'neck_thyroid_data'}; ?>"></td
>
354 <td align
="left" valign
="top"><h2
>Respiratory
</h2
>
356 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="1">
358 <tr align
="left" valign
="bottom" class="fibody">
360 <td width
="150" nowrap
><li
>Respiratory effort
</li
></td
>
364 <input name
="respiratory_effort" type
="radio" value
="0" <?php
echo (($fdata{'respiratory_effort'} == '0')?
' checked ':''); ?
>>
368 <td nowrap
><input name
="respiratory_effort" type
="radio" value
="1" <?php
echo (($fdata{'respiratory_effort'} == '1')?
' checked ':''); ?
>>
372 <td
><input name
="respiratory_effort_data" type
="text" class="fullin" value
="<?php echo $fdata{'respiratory_effort_data'}; ?>"></td
>
376 <tr align
="left" valign
="bottom" class="fibody">
378 <td width
="150" nowrap
><li
>Auscultated lungs
</li
></td
>
380 <td width
="90" nowrap
><input name
="auscultated_lungs" type
="radio" value
="0" <?php
echo (($fdata{'auscultated_lungs'} == '0')?
' checked ':''); ?
>>
384 <td width
="100" nowrap
><input name
="auscultated_lungs" type
="radio" value
="1" <?php
echo (($fdata{'auscultated_lungs'} == '1')?
' checked ':''); ?
>>
388 <td
><input name
="auscultated_lungs_data" type
="text" class="fullin" value
="<?php echo $fdata{'auscultated_lungs_data'}; ?>"></td
>
398 <td align
="left" valign
="top"><h2
>Cardiovascular
</h2
>
400 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="1">
402 <tr align
="left" valign
="bottom" class="fibody">
404 <td width
="150" nowrap
><li
>Auscultated heart
</li
></td
>
406 <td width
="90" nowrap
> 
;</td
>
408 <td width
="100" nowrap
> 
;</td
>
414 <tr align
="left" valign
="bottom" class="fibody">
416 <td width
="150" nowrap
><blockquote
> Sounds
</blockquote
></td
>
418 <td width
="90" nowrap
><input name
="auscultated_heart_sounds" type
="radio" value
="0" <?php
echo (($fdata{'auscultated_heart_sounds'} == '0')?
' checked ':''); ?
>>
422 <td width
="100" nowrap
><input name
="auscultated_heart_sounds" type
="radio" value
="1" <?php
echo (($fdata{'auscultated_heart_sounds'} == '1')?
' checked ':''); ?
>>
426 <td
><input name
="auscultated_heart_sounds_data" type
="text" class="fullin" value
="<?php echo $fdata{'auscultated_heart_sounds_data'}; ?>"></td
>
430 <tr align
="left" valign
="bottom" class="fibody">
432 <td nowrap
><blockquote
> Murmurs
</blockquote
></td
>
434 <td nowrap
><input name
="auscultated_heart_murmurs" type
="radio" value
="0" <?php
echo (($fdata{'auscultated_heart_murmurs'} == '0')?
' checked ':''); ?
>>
438 <td nowrap
><input name
="auscultated_heart_murmurs" type
="radio" value
="1" <?php
echo (($fdata{'auscultated_heart_murmurs'} == '1')?
' checked ':''); ?
>>
442 <td
><input name
="auscultated_heart_murmurs_data" type
="text" class="fullin" value
="<?php echo $fdata{'auscultated_heart_murmurs_data'}; ?>"></td
>
446 <tr align
="left" valign
="bottom" class="fibody">
448 <td nowrap
><li
>Perirheral vascular
</li
></td
>
450 <td nowrap
><input name
="peripheral_vascular" type
="radio" value
="0" <?php
echo (($fdata{'peripheral_vascular'} == '0')?
' checked ':''); ?
>>
454 <td nowrap
><input name
="peripheral_vascular" type
="radio" value
="1" <?php
echo (($fdata{'peripheral_vascular'} == '1')?
' checked ':''); ?
>>
458 <td
><input name
="peripheral_vascular_data" type
="text" class="fullin" value
="<?php echo $fdata{'peripheral_vascular_data'}; ?>"></td
>
468 <td align
="left" valign
="top" bgcolor
="#EDEDED"><h2
>Gastrointestinal
</h2
>
470 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="1">
472 <tr align
="left" valign
="bottom" class="fibody">
474 <td width
="150" nowrap
><li
>Abdomen
</li
></td
>
476 <td width
="90" nowrap
><input name
="gastr_abdomen" type
="radio" value
="0" <?php
echo (($fdata{'gastr_abdomen'} == '0')?
' checked ':''); ?
>>
480 <td width
="100" nowrap
><input name
="gastr_abdomen" type
="radio" value
="1" <?php
echo (($fdata{'gastr_abdomen'} == '1')?
' checked ':''); ?
>>
484 <td
><input name
="gastr_abdomen_data" type
="text" class="fullin" value
="<?php echo $fdata{'gastr_abdomen_data'}; ?>"></td
>
488 <tr align
="left" valign
="bottom" class="fibody">
490 <td width
="150" nowrap
><li
>Hernia
</li
></td
>
492 <td width
="90" nowrap
><input name
="gastr_hernia" type
="radio" value
="0" <?php
echo (($fdata{'gastr_hernia'} == '0')?
' checked ':''); ?
>>
496 <td width
="100" nowrap
><input name
="gastr_hernia" type
="radio" value
="1" <?php
echo (($fdata{'gastr_hernia'} == '1')?
' checked ':''); ?
>>
500 <td
><input name
="gastr_hernia_data" type
="text" class="fullin" value
="<?php echo $fdata{'gastr_hernia_data'}; ?>"></td
>
504 <tr align
="left" valign
="bottom" class="fibody">
506 <td nowrap
><li
>Liver
/Spleen
</li
></td
>
508 <td nowrap
> 
;</td
>
510 <td nowrap
> 
;</td
>
516 <tr align
="left" valign
="bottom" class="fibody">
518 <td nowrap
><blockquote
> Liver
</blockquote
></td
>
520 <td nowrap
><input name
="gastr_liver" type
="radio" value
="0" <?php
echo (($fdata{'gastr_liver'} == '0')?
' checked ':''); ?
>>
524 <td nowrap
><input name
="gastr_liver" type
="radio" value
="1" <?php
echo (($fdata{'gastr_liver'} == '1')?
' checked ':''); ?
>>
528 <td
><input name
="gastr_liver_data" type
="text" class="fullin" value
="<?php echo $fdata{'gastr_liver_data'}; ?>"></td
>
532 <tr align
="left" valign
="bottom" class="fibody">
534 <td nowrap
><blockquote
> Spleen
</blockquote
></td
>
536 <td nowrap
><input name
="gastr_spleen" type
="radio" value
="0" <?php
echo (($fdata{'gastr_spleen'} == '0')?
' checked ':''); ?
>>
540 <td nowrap
><input name
="gastr_spleen" type
="radio" value
="1" <?php
echo (($fdata{'gastr_spleen'} == '1')?
' checked ':''); ?
>>
544 <td
><input name
="gastr_spleen_data" type
="text" class="fullin" value
="<?php echo $fdata{'gastr_spleen_data'}; ?>"></td
>
548 <tr align
="left" valign
="bottom" class="fibody">
550 <td nowrap
><li
><a name
="sg"></a
>Stool guaIac
, if indic
.</li
></td
>
552 <td nowrap
><input name
="gastr_stool_guaiac" type
="radio" value
="0" <?php
echo (($fdata{'gastr_stool_guaiac'} == '0')?
' checked ':''); ?
>>
556 <td nowrap
><input name
="gastr_stool_guaiac" type
="radio" value
="1" <?php
echo (($fdata{'gastr_stool_guaiac'} == '1')?
' checked ':''); ?
>>
560 <td
><input name
="gastr_stool_guaiac_data" type
="text" class="fullin" value
="<?php echo $fdata{'gastr_stool_guaiac_data'}; ?>"></td
>
570 <td align
="left" valign
="top"><h2
>Lymphatic
</h2
>
572 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="1">
574 <tr align
="left" valign
="bottom" class="fibody">
576 <td colspan
="4" nowrap
><li
>Palpation of
nodes (Choose all
, that are applicable
) </li
></td
>
580 <tr align
="left" valign
="bottom" class="fibody">
582 <td width
="150" nowrap
><blockquote
> Neck
</blockquote
></td
>
584 <td width
="90" nowrap
><input name
="lymph_neck" type
="radio" value
="0" <?php
echo (($fdata{'lymph_neck'} == '0')?
' checked ':''); ?
>>
588 <td width
="100" nowrap
><input name
="lymph_neck" type
="radio" value
="1" <?php
echo (($fdata{'lymph_neck'} == '1')?
' checked ':''); ?
>>
592 <td
><input name
="lymph_neck_data" type
="text" class="fullin" value
="<?php echo $fdata{'lymph_neck_data'}; ?>"></td
>
596 <tr align
="left" valign
="bottom" class="fibody">
598 <td nowrap
><blockquote
> Axilla
</blockquote
></td
>
600 <td nowrap
><input name
="lymph_axilla" type
="radio" value
="0" <?php
echo (($fdata{'lymph_axilla'} == '0')?
' checked ':''); ?
>>
604 <td nowrap
><input name
="lymph_axilla" type
="radio" value
="1" <?php
echo (($fdata{'lymph_axilla'} == '1')?
' checked ':''); ?
>>
608 <td
><input name
="lymph_axilla_data" type
="text" class="fullin" value
="<?php echo $fdata{'lymph_axilla_data'}; ?>"></td
>
612 <tr align
="left" valign
="bottom" class="fibody">
614 <td nowrap
><blockquote
> Groin
</blockquote
></td
>
616 <td nowrap
><input name
="lymph_groin" type
="radio" value
="0" <?php
echo (($fdata{'lymph_groin'} == '0')?
' checked ':''); ?
>>
620 <td nowrap
><input name
="lymph_groin" type
="radio" value
="1" <?php
echo (($fdata{'lymph_groin'} == '1')?
' checked ':''); ?
>>
624 <td
><input name
="lymph_groin_data" type
="text" class="fullin" value
="<?php echo $fdata{'lymph_groin_data'}; ?>"></td
>
628 <tr align
="left" valign
="bottom" class="fibody">
630 <td nowrap
><blockquote
> Other site
</blockquote
></td
>
632 <td nowrap
><input name
="lymph_other" type
="radio" value
="0" <?php
echo (($fdata{'lymph_other'} == '0')?
' checked ':''); ?
>>
636 <td nowrap
><input name
="lymph_other" type
="radio" value
="1" <?php
echo (($fdata{'lymph_other'} == '1')?
' checked ':''); ?
>>
640 <td
><input name
="lymph_other_data" type
="text" class="fullin" value
="<?php echo $fdata{'lymph_other_data'}; ?>"></td
>
650 <td align
="left" valign
="top"><h2
>Skin
</h2
>
652 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="1">
654 <tr align
="left" valign
="bottom" class="fibody">
656 <td width
="150" nowrap
><li
>inspected
/palpated
</li
></td
>
658 <td width
="90" nowrap
><input name
="skin_inspected" type
="radio" value
="0" <?php
echo (($fdata{'skin_inspected'} == '0')?
' checked ':''); ?
>>
662 <td width
="100" nowrap
><input name
="skin_inspected" type
="radio" value
="1" <?php
echo (($fdata{'skin_inspected'} == '1')?
' checked ':''); ?
>>
666 <td
><input name
="skin_inspected_data" type
="text" class="fullin" value
="<?php echo $fdata{'skin_inspected_data'}; ?>"></td
>
676 <td align
="left" valign
="top"><h2
>Neurologic
/psychiatric
</h2
>
678 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="1">
680 <tr align
="left" valign
="bottom" class="fibody">
682 <td width
="150" nowrap
><li
>Orientation
</li
></td
>
684 <td width
="90" nowrap
><input name
="neur_orient_time" type
="checkbox" value
="1" <?php
echo (($fdata{'neur_orient_time'} == '1')?
' checked ':''); ?
>>
688 <td width
="100" nowrap
><input name
="neur_orient_place" type
="checkbox" value
="1" <?php
echo (($fdata{'neur_orient_place'} == '1')?
' checked ':''); ?
>>
692 <td width
="100"><input name
="neur_orient_person" type
="checkbox" value
="1" <?php
echo (($fdata{'neur_orient_person'} == '1')?
' checked ':''); ?
>>
698 <td width
="100"><input name
="neur_orient_comments" type
="checkbox" value
="1" <?php
echo (($fdata{'neur_orient_comments'} == '1')?
' checked ':''); ?
>>
708 <tr align
="left" valign
="bottom" class="fibody">
710 <td width
="150" nowrap
><li
>Mood
and affect
</li
></td
>
712 <td width
="90" nowrap
><input name
="neur_mood_normal" type
="checkbox" value
="1" <?php
echo (($fdata{'neur_mood_normal'} == '1')?
' checked ':''); ?
>>
716 <td width
="100" nowrap
><input name
="neur_mood_depressed" type
="checkbox" value
="1" <?php
echo (($fdata{'neur_mood_depressed'} == '1')?
' checked ':''); ?
>>
720 <td width
="100"><input name
="neur_mood_anxious" type
="checkbox" value
="1" <?php
echo (($fdata{'neur_mood_anxious'} == '1')?
' checked ':''); ?
>>
726 <td width
="100"><input name
="neur_mood_agitated" type
="checkbox" value
="1" <?php
echo (($fdata{'neur_mood_agitated'} == '1')?
' checked ':''); ?
>>
732 <td
><input name
="neur_mood_other" type
="checkbox" value
="1" <?php
echo (($fdata{'neur_mood_other'} == '1')?
' checked ':''); ?
>>
746 <td align
="left" valign
="top" bgcolor
="#EDEDED"><h2
>Gynecologic (at least
7) </h2
>
748 <table width
="100%" border
="0" cellspacing
="0" cellpadding
="1">
750 <tr align
="left" valign
="bottom" class="fibody">
752 <td width
="150" nowrap
><li
>Breasts
</li
></td
>
754 <td width
="90" nowrap
><input name
="gynec_breasts" type
="radio" value
="0" <?php
echo (($fdata{'gynec_breasts'} == '0')?
' checked ':''); ?
>>
758 <td width
="100" nowrap
><input name
="gynec_breasts" type
="radio" value
="1" <?php
echo (($fdata{'gynec_breasts'} == '1')?
' checked ':''); ?
>>
762 <td
><input name
="gynec_breasts_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_breasts_data'}; ?>"></td
>
764 <td width
="231" rowspan
="12" align
="center" valign
="middle">
768 echo "$rootdir/forms
/$formname/";
770 ?>genit01.gif" width
="231" height
="222"></td
>
774 <tr align
="left" valign
="bottom" class="fibody">
776 <td nowrap
><li
>External genitalia
</li
></td
>
778 <td nowrap
><input name
="gynec_ext_genitalia" type
="radio" value
="0" <?php
echo (($fdata{'gynec_ext_genitalia'} == '0')?
' checked ':''); ?
>>
782 <td nowrap
><input name
="gynec_ext_genitalia" type
="radio" value
="1" <?php
echo (($fdata{'gynec_ext_genitalia'} == '1')?
' checked ':''); ?
>>
786 <td
><input name
="gynec_ext_genitalia_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_ext_genitalia_data'}; ?>"></td
>
790 <tr align
="left" valign
="bottom" class="fibody">
792 <td nowrap
><li
>Urethral meatus
</li
></td
>
794 <td nowrap
><input name
="gynec_urethral_meatus" type
="radio" value
="0" <?php
echo (($fdata{'gynec_urethral_meatus'} == '0')?
' checked ':''); ?
>>
798 <td nowrap
><input name
="gynec_urethral_meatus" type
="radio" value
="1" <?php
echo (($fdata{'gynec_urethral_meatus'} == '1')?
' checked ':''); ?
>>
802 <td
><input name
="gynec_urethral_meatus_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_urethral_meatus_data'}; ?>"></td
>
806 <tr align
="left" valign
="bottom" class="fibody">
808 <td width
="150" nowrap
><li
>Urethra
</li
></td
>
810 <td width
="90" nowrap
><input name
="gynec_urethra" type
="radio" value
="0" <?php
echo (($fdata{'gynec_urethra'} == '0')?
' checked ':''); ?
>>
814 <td width
="100" nowrap
><input name
="gynec_urethra" type
="radio" value
="1" <?php
echo (($fdata{'gynec_urethra'} == '1')?
' checked ':''); ?
>>
818 <td
><input name
="gynec_urethra_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_urethra_data'}; ?>"></td
>
822 <tr align
="left" valign
="bottom" class="fibody">
824 <td nowrap
><li
>Bladder
</li
></td
>
826 <td nowrap
><input name
="gynec_bladder" type
="radio" value
="0" <?php
echo (($fdata{'gynec_bladder'} == '0')?
' checked ':''); ?
>>
830 <td nowrap
><input name
="gynec_bladder" type
="radio" value
="1" <?php
echo (($fdata{'gynec_bladder'} == '1')?
' checked ':''); ?
>>
834 <td
><input name
="gynec_bladder_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_bladder_data'}; ?>"></td
>
838 <tr align
="left" valign
="bottom" class="fibody">
840 <td nowrap
><li
>Vagina
/Pelvic support
</li
></td
>
842 <td nowrap
><input name
="gynec_vagina_support" type
="radio" value
="0" <?php
echo (($fdata{'gynec_vagina_support'} == '0')?
' checked ':''); ?
>>
846 <td nowrap
><input name
="gynec_vagina_support" type
="radio" value
="1" <?php
echo (($fdata{'gynec_vagina_support'} == '1')?
' checked ':''); ?
>>
850 <td
><input name
="gynec_vagina_support_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_vagina_support_data'}; ?>"></td
>
854 <tr align
="left" valign
="bottom" class="fibody">
856 <td width
="150" nowrap
><li
>Cervix
</li
></td
>
858 <td width
="90" nowrap
><input name
="gynec_cervix" type
="radio" value
="0" <?php
echo (($fdata{'gynec_cervix'} == '0')?
' checked ':''); ?
>>
862 <td width
="100" nowrap
><input name
="gynec_cervix" type
="radio" value
="1" <?php
echo (($fdata{'gynec_cervix'} == '1')?
' checked ':''); ?
>>
866 <td
><input name
="gynec_cervix_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_cervix_data'}; ?>"></td
>
870 <tr align
="left" valign
="bottom" class="fibody">
872 <td nowrap
><li
>Uterus
</li
></td
>
874 <td nowrap
><input name
="gynec_uterus" type
="radio" value
="0" <?php
echo (($fdata{'gynec_uterus'} == '0')?
' checked ':''); ?
>>
878 <td nowrap
><input name
="gynec_uterus" type
="radio" value
="1" <?php
echo (($fdata{'gynec_uterus'} == '1')?
' checked ':''); ?
>>
882 <td
><input name
="gynec_uterus_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_uterus_data'}; ?>"></td
>
886 <tr align
="left" valign
="bottom" class="fibody">
888 <td nowrap
><li
>Adnexa
/Parametria
</li
></td
>
890 <td nowrap
><input name
="gynec_adnexa" type
="radio" value
="0" <?php
echo (($fdata{'gynec_adnexa'} == '0')?
' checked ':''); ?
>>
894 <td nowrap
><input name
="gynec_adnexa" type
="radio" value
="1" <?php
echo (($fdata{'gynec_adnexa'} == '1')?
' checked ':''); ?
>>
898 <td
><input name
="gynec_adnexa_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_adnexa_data'}; ?>"></td
>
902 <tr align
="left" valign
="bottom" class="fibody">
904 <td width
="150" nowrap
><li
>Anus
/Perineum
</li
></td
>
906 <td width
="90" nowrap
><input name
="gynec_anus" type
="radio" value
="0" <?php
echo (($fdata{'gynec_anus'} == '0')?
' checked ':''); ?
>>
910 <td width
="100" nowrap
><input name
="gynec_anus" type
="radio" value
="1" <?php
echo (($fdata{'gynec_anus'} == '1')?
' checked ':''); ?
>>
914 <td
><input name
="gynec_anus_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_anus_data'}; ?>"></td
>
918 <tr align
="left" valign
="bottom" class="fibody">
920 <td nowrap
><li
>Rectal
</li
></td
>
922 <td nowrap
><input name
="gynec_rectal" type
="radio" value
="0" <?php
echo (($fdata{'gynec_rectal'} == '0')?
' checked ':''); ?
>>
926 <td nowrap
><input name
="gynec_rectal" type
="radio" value
="1" <?php
echo (($fdata{'gynec_rectal'} == '1')?
' checked ':''); ?
>>
930 <td
><input name
="gynec_rectal_data" type
="text" class="fullin" value
="<?php echo $fdata{'gynec_rectal_data'}; ?>"></td
>
934 <tr align
="left" valign
="bottom" class="fibody">
936 <td colspan
="4" nowrap
><br
>
938 (See also
"
;<a href
="#sg">Stool guaiac
</a
>"
; above
) </td
>
948 <td align
="left" valign
="top" style
="border-bottom:2px solid black;border-top:2px solid black;">Total number of bulleted elements examined
950 <input name
="tot_num_examined" type
="text" value
="<?php echo $fdata{'tot_num_examined'}; ?>"></td
>
960 <table width
="100%" border
="0">
962 <tr
><td align
="left" width
="120"> <a href
="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save Data
]</a
> </td
>
964 <td align
="left" nowrap
> <a href
="<?php echo $rootdir; ?>/patient_file/encounter/print_form.php?id=<?php echo $id; ?>&formname=<?php echo $formname; ?>"
966 target
="_blank" class="link_submit" onclick
="top.restoreSession()">[Printable form
]</a
> </td
>
968 <td align
="right"> <a href
="<?php echo $GLOBALS['form_exit_url']; ?>" class="link_submit"
970 onclick
="top.restoreSession()">[Don
't Save]</a> </td></tr>