1 <!-- Form created by Nikolai Vitsyn by
2004/01/23 -->
3 include_once("../../globals.php");
4 $returnurl = $GLOBALS['concurrent_layout'] ?
'encounter_top.php' : 'patient_encounter.php';
7 <?php
html_header_show();?
>
8 <link rel
="stylesheet" href
="<?php echo $css_header;?>" type
="text/css">
10 <body
class="body_top">
12 include_once("$srcdir/api.inc");
13 $obj = formFetch("form_bronchitis", $_GET["id"]);
15 <form method
=post action
="<?php echo $rootdir?>/forms/bronchitis/save.php?mode=update&id=<?php echo $_GET["id
"];?>" name
="my_form">
16 <span
class="title"><?php
xl('Bronchitis Form','e'); ?
></span
><br
><br
>
18 <a href
="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[<?php
xl('Save','e'); ?
>]</a
>
20 <a href
="<?php echo "$rootdir/patient_file
/encounter
/$returnurl";?>" class="link"
21 onclick
="top.restoreSession()">[<?php
xl('Don\'t Save Changes','e'); ?
>]</a
>
24 <span
class=text
><?php
xl('Onset of Ilness: ','e'); ?
></span
><input type
=entry name
="bronchitis_date_of_illness" value
="<?php echo stripslashes($obj{"bronchitis_date_of_illness
"});?>" ><br
></br
>
26 <span
class=text
><?php
xl('HPI:','e'); ?
> </span
><br
><textarea cols
=67 rows
=8 wrap
=virtual name
="bronchitis_hpi" ><?php
echo stripslashes($obj{"bronchitis_hpi"});?
></textarea
><br
></br
>
29 <table
><th colspan
="5">"<?php xl('Other Pertinent Symptoms','e'); ?> ":</th
>
31 <td width
="60" align
="right"><?php
xl('Fever:','e'); ?
> </td
>
32 <td
><input type
=checkbox name
="bronchitis_ops_fever" <?php
if ($obj{"bronchitis_ops_fever"} == "on")
33 {echo "checked";};?
>><span
class=text
></span
><br
>
35 <td width
="140" align
="right"><?php
xl('Cough:','e'); ?
> </td
>
36 <td
><input type
=checkbox name
="bronchitis_ops_cough" <?php
if ($obj{"bronchitis_ops_cough"} == "on")
37 {echo "checked";};?
>><span
class=text
></span
><br
>
39 <td width
="170" align
="right"><?php
xl('Dizziness:','e'); ?
> </td
>
40 <td
><input type
=checkbox name
="bronchitis_ops_dizziness" <?php
if ($obj{"bronchitis_ops_dizziness"} == "on")
41 {echo "checked";};?
>><span
class=text
></span
><br
>
45 <td width
="60" align
="right"><?php
xl('Chest Pain:','e'); ?
> </td
>
46 <td
><input type
=checkbox name
="bronchitis_ops_chest_pain" <?php
if ($obj{"bronchitis_ops_chest_pain"} == "on")
47 {echo "checked";};?
>><span
class=text
></span
><br
>
48 <td width
="130" align
="right"><?php
xl('Dyspnea:','e'); ?
> </td
>
49 <td
><input type
=checkbox name
="bronchitis_ops_dyspnea" <?php
if ($obj{"bronchitis_ops_dyspnea"} == "on")
50 {echo "checked";};?
>><span
class=text
></span
><br
>
51 <td width
="180" align
="right"><?php
xl('Sweating:','e'); ?
> </td
>
52 <td
><input type
=checkbox name
="bronchitis_ops_sweating" <?php
if ($obj{"bronchitis_ops_sweating"} == "on")
53 {echo "checked";};?
>><span
class=text
></span
><br
>
57 <td width
="60" align
="right"><?php
xl('Wheezing:','e'); ?
> </td
>
58 <td
><input type
=checkbox name
="bronchitis_ops_wheezing" <?php
if ($obj{"bronchitis_ops_wheezing"} == "on")
59 {echo "checked";};?
>><span
class=text
></span
><br
>
61 <td width
="130" align
="right"><?php
xl('Malaise:','e'); ?
> </td
>
62 <td
><input type
=checkbox name
="bronchitis_ops_malaise" <?php
if ($obj{"bronchitis_ops_malaise"} == "on")
63 {echo "checked";};?
>><span
class=text
></span
><br
>
67 <td width
="60" align
="right"><?php
xl('Sputum:','e'); ?
> </td
>
68 <td
><input type
=checkbox name
="bronchitis_ops_sputum" <?php
if ($obj{"bronchitis_ops_sputum"} == "on")
69 {echo "checked";};?
>><span
class=text
></span
><br
></td
>
71 <td width
="130" align
="right"><?php
xl('Appearance:','e'); ?
> <span
class="text"></span
></td
>
72 <td
><input type
=entry name
="bronchitis_ops_appearance" value
="<?php echo
73 stripslashes($obj{"bronchitis_ops_appearance
"});?>" size
="15"></td
>
78 <td width
="227" align
="right"><?php
xl('All Reviewed and Negative:','e'); ?
> </td
>
79 <td
><input type
=checkbox name
="bronchitis_ops_all_reviewed" <?php
if ($obj{"bronchitis_ops_all_reviewed"} == "on")
80 {echo "checked";};?
>><span
class=text
></span
><br
>
87 <td width
="60" align
="right"><?php
xl('Review of PMH:','e'); ?
> </td
>
88 <td
><input type
=checkbox name
="bronchitis_review_of_pmh" <?php
if ($obj{"bronchitis_review_of_pmh"} == "on")
89 {echo "checked";};?
>><span
class=text
></span
><br
></td
>
90 <td align
="right"><?php
xl('Medications:','e'); ?
> </td
>
91 <td
><input type
=checkbox name
="bronchitis_review_of_medications" <?php
if ($obj{"bronchitis_review_of_medications"} == "on")
92 {echo "checked";};?
>><span
class=text
></span
><br
></td
>
93 <td align
="right"><?php
xl('Allergies:','e'); ?
> </td
>
94 <td
><input type
=checkbox name
="bronchitis_review_of_allergies" <?php
if ($obj{"bronchitis_review_of_allergies"} == "on")
95 {echo "checked";};?
>><span
class=text
></span
><br
></td
>
96 <td align
="right"><?php
xl('Social History:','e'); ?
> </td
>
97 <td
><input type
=checkbox name
="bronchitis_review_of_sh" <?php
if ($obj{"bronchitis_review_of_sh"} == "on")
98 {echo "checked";};?
>><span
class=text
></span
><br
></td
>
99 <td align
="right"><?php
xl('Family History:','e'); ?
> </td
>
100 <td
><input type
=checkbox name
="bronchitis_review_of_fh" <?php
if ($obj{"bronchitis_review_of_fh"} == "on")
101 {echo "checked";};?
>><span
class=text
></span
><br
></td
>
109 <td width
="60"><?php
xl('TM\'S:','e'); ?
> </td
>
110 <td align
="right"><?php
xl('Normal Right:','e'); ?
> </td
>
111 <td
><input type
=checkbox name
="bronchitis_tms_normal_right" <?php
if ($obj{"bronchitis_tms_normal_right"} == "on")
112 {echo "checked";};?
>><span
class=text
></span
><br
>
113 <td align
="right"><?php
xl('Left:','e'); ?
> </td
>
114 <td
><input type
=checkbox name
="bronchitis_tms_normal_left" <?php
if ($obj{"bronchitis_tms_normal_left"} == "on")
115 {echo "checked";};?
>><span
class=text
></span
><br
>
116 <td align
="right"><?php
xl('NARES: Normal Right','e'); ?
> </td
>
117 <td
><input type
=checkbox name
="bronchitis_nares_normal_right" <?php
if ($obj{"bronchitis_nares_normal_right"} == "on")
118 {echo "checked";};?
>><span
class=text
></span
><br
>
119 <td align
="right"><?php
xl('Left:','e'); ?
> </td
>
120 <td
><input type
=checkbox name
="bronchitis_nares_normal_left" <?php
if ($obj{"bronchitis_nares_normal_left"} == "on")
121 {echo "checked";};?
>><span
class=text
></span
><br
>
126 <td align
="right"> <?php
xl('Thickened Right:','e'); ?
> </td
>
127 <td
><input type
=checkbox name
="bronchitis_tms_thickened_right" <?php
if ($obj{"bronchitis_tms_thickened_right"} == "on")
128 {echo "checked";};?
>><span
class=text
></span
><br
>
129 <td align
="right"><?php
xl('Left:','e'); ?
> </td
>
130 <td
><input type
=checkbox name
="bronchitis_tms_thickened_left" <?php
if ($obj{"bronchitis_tms_thickened_left"} == "on")
131 {echo "checked";};?
>><span
class=text
></span
><br
>
133 <td align
="right"><?php
xl('Swelling Right','e'); ?
> </td
>
134 <td
><input type
=checkbox name
="bronchitis_nares_swelling_right" <?php
if ($obj{"bronchitis_nares_swelling_right"} == "on")
135 {echo "checked";};?
>><span
class=text
></span
><br
>
136 <td align
="right"><?php
xl('Left: ','e'); ?
> </td
>
137 <td
><input type
=checkbox name
="bronchitis_nares_swelling_left" <?php
if ($obj{"bronchitis_nares_swelling_left"} == "on")
138 {echo "checked";};?
>><span
class=text
></span
><br
>
143 <td align
="right"><?php
xl('A/F Level Right:','e'); ?
> </td
>
144 <td
><input type
=checkbox name
="bronchitis_tms_af_level_right" <?php
if ($obj{"bronchitis_tms_af_level_right"} == "on")
145 {echo "checked";};?
>><span
class=text
></span
><br
>
146 <td align
="right"><?php
xl('Left:','e'); ?
> </td
>
147 <td
><input type
=checkbox name
="bronchitis_tms_af_level_left" <?php
if ($obj{"bronchitis_tms_af_level_left"} == "on")
148 {echo "checked";};?
>><span
class=text
></span
><br
>
150 <td align
="right"><?php
xl('Discharge Right','e'); ?
> </td
>
151 <td
><input type
=checkbox name
="bronchitis_nares_discharge_right" <?php
if ($obj{"bronchitis_nares_discharge_right"} == "on")
152 {echo "checked";};?
>><span
class=text
></span
><br
>
153 <td align
="right"><?php
xl('Left: ','e'); ?
> </td
>
154 <td
><input type
=checkbox name
="bronchitis_nares_discharge_left" <?php
if ($obj{"bronchitis_nares_discharge_left"} == "on")
155 {echo "checked";};?
>><span
class=text
></span
><br
>
160 <td align
="right"><?php
xl('Retracted Right:','e'); ?
> </td
>
161 <td
><input type
=checkbox name
="bronchitis_tms_retracted_right" <?php
if ($obj{"bronchitis_tms_retracted_right"} == "on")
162 {echo "checked";};?
>><span
class=text
></span
><br
>
163 <td align
="right"><?php
xl('Left:','e'); ?
> </td
>
164 <td
><input type
=checkbox name
="bronchitis_tms_retracted_left" <?php
if ($obj{"bronchitis_tms_retracted_left"} == "on")
165 {echo "checked";};?
>><span
class=text
></span
><br
>
170 <td align
="right"><?php
xl('Bulging Right:','e'); ?
> </td
>
171 <td
><input type
=checkbox name
="bronchitis_tms_bulging_right" <?php
if ($obj{"bronchitis_tms_bulging_right"} == "on")
172 {echo "checked";};?
>><span
class=text
></span
><br
>
173 <td align
="right"><?php
xl('Left:','e'); ?
> </td
>
174 <td
><input type
=checkbox name
="bronchitis_tms_bulging_left" <?php
if ($obj{"bronchitis_tms_bulging_left"} == "on")
175 {echo "checked";};?
>><span
class=text
></span
><br
>
180 <td align
="right"><?php
xl('Perforated Right:','e'); ?
> </td
>
181 <td
><input type
=checkbox name
="bronchitis_tms_perforated_right" <?php
if ($obj{"bronchitis_tms_perforated_right"} == "on")
182 {echo "checked";};?
>><span
class=text
></span
><br
>
183 <td align
="right"><?php
xl('Left:','e'); ?
> </td
>
184 <td
><input type
=checkbox name
="bronchitis_tms_perforated_left" <?php
if ($obj{"bronchitis_tms_perforated_left"} == "on")
185 {echo "checked";};?
>><span
class=text
></span
><br
>
190 <td width
="127"></td
>
191 <td align
="right"><?php
xl('Not Examined:','e'); ?
> </td
>
192 <td
><input type
=checkbox name
="bronchitis_tms_nares_not_examined" <?php
if ($obj{"bronchitis_tms_nares_not_examined"} == "on")
193 {echo "checked";};?
>><span
class=text
></span
><br
>
199 <td width
="90"><?php
xl('SINUS TENDERNESS:','e'); ?
> </td
>
200 <td align
="right"><?php
xl('No Sinus Tenderness:','e'); ?
> </td
>
201 <td
><input type
=checkbox name
="bronchitis_no_sinus_tenderness" <?php
if ($obj{"bronchitis_no_sinus_tenderness"} == "on")
202 {echo "checked";};?
>><span
class=text
></span
><br
>
203 <td width
="90"><?php
xl('OROPHARYNX: ','e'); ?
> </td
>
204 <td align
="right"><?php
xl('Normal Oropharynx:','e'); ?
> </td
>
205 <td
><input type
=checkbox name
="bronchitis_oropharynx_normal"<?php
if ($obj{"bronchitis_oropharynx_normal"} == "on")
206 {echo "checked";};?
>><span
class=text
></span
><br
>
210 <td width
="90" align
="right"><?php
xl('Frontal Right:','e'); ?
> </td
>
211 <td
><input type
=checkbox name
="bronchitis_sinus_tenderness_frontal_right" <?php
if ($obj{"bronchitis_sinus_tenderness_frontal_right"} == "on")
212 {echo "checked";};?
>><span
class=text
></span
><br
>
213 <td align
="right"><?php
xl('Left:','e'); ?
> </td
>
214 <td
><input type
=checkbox name
="bronchitis_sinus_tenderness_frontal_left" <?php
if ($obj{"bronchitis_sinus_tenderness_frontal_left"} == "on")
215 {echo "checked";};?
>><span
class=text
></span
><br
>
216 <td align
="right"><?php
xl('Erythema:','e'); ?
> </td
>
217 <td
><input type
=checkbox name
="bronchitis_oropharynx_erythema" <?php
if ($obj{"bronchitis_oropharynx_erythema"} == "on")
218 {echo "checked";};?
>><span
class=text
></span
><br
>
219 <td align
="right"><?php
xl('Exudate:','e'); ?
> </td
>
220 <td
><input type
=checkbox name
="bronchitis_oropharynx_exudate" <?php
if ($obj{"bronchitis_oropharynx_exudate"} == "on")
221 {echo "checked";};?
>><span
class=text
></span
><br
>
222 <td align
="right"><?php
xl('Abcess:','e'); ?
> </td
>
223 <td
><input type
=checkbox name
="bronchitis_oropharynx_abcess" <?php
if ($obj{"bronchitis_oropharynx_abcess"} == "on")
224 {echo "checked";};?
>><span
class=text
></span
><br
>
225 <td align
="right"><?php
xl('Ulcers:','e'); ?
> </td
>
226 <td
><input type
=checkbox name
="bronchitis_oropharynx_ulcers" <?php
if ($obj{"bronchitis_oropharynx_ulcers"} == "on")
227 {echo "checked";};?
>><span
class=text
></span
><br
>
231 <td width
="90" align
="right"><?php
xl('Maxillary Right:','e'); ?
> </td
>
232 <td
><input type
=checkbox name
="bronchitis_sinus_tenderness_maxillary_right" <?php
if ($obj{"bronchitis_sinus_tenderness_maxillary_right"} == "on")
233 {echo "checked";};?
>><span
class=text
></span
><br
></td
>
234 <td align
="right"><?php
xl('Left:','e'); ?
> </td
>
235 <td
><input type
=checkbox name
="bronchitis_sinus_tenderness_maxillary_left" <?php
if ($obj{"bronchitis_sinus_tenderness_maxillary_left"} == "on")
236 {echo "checked";};?
>><span
class=text
></span
><br
></td
>
237 <td width
="130" align
="right"><?php
xl('Appearance:','e'); ?
> <span
class="text"></span
></td
>
238 <td
><input type
=entry name
="bronchitis_oropharynx_appearance" value
="<?php echo
239 stripslashes($obj{"bronchitis_oropharynx_appearance
"});?>" size
="15"></td
>
245 <td width
="256" align
="right"><?php
xl('Not Examined:','e'); ?
> </td
>
246 <td
><input type
=checkbox name
="bronchitis_sinus_tenderness_not_examined" <?php
if ($obj{"bronchitis_sinus_tenderness_not_examined"} == "on")
247 {echo "checked";};?
>><span
class=text
></span
><br
>
248 <td width
="208" align
="right"><?php
xl('Not Examined:','e'); ?
> </td
>
249 <td
><input type
=checkbox name
="bronchitis_oropharynx_not_examined" <?php
if ($obj{"bronchitis_oropharynx_not_examined"} == "on")
250 {echo "checked";};?
>><span
class=text
></span
><br
>
257 <td width
="60"><?php
xl('HEART:','e'); ?
> </td
>
258 <td align
="right"><?php
xl('laterally displaced PMI:','e'); ?
> </td
>
259 <td
><input type
=checkbox name
="bronchitis_heart_pmi" <?php
if ($obj{"bronchitis_heart_pmi"} == "on")
260 {echo "checked";};?
>><span
class=text
></span
><br
>
261 <td align
="right"><?php
xl('S3:','e'); ?
> </td
>
262 <td
><input type
=checkbox name
="bronchitis_heart_s3" <?php
if ($obj{"bronchitis_heart_s3"} == "on")
263 {echo "checked";};?
>><span
class=text
></span
><br
>
264 <td align
="right"><?php
xl('S4:','e'); ?
> </td
>
265 <td
><input type
=checkbox name
="bronchitis_heart_s4" <?php
if ($obj{"bronchitis_heart_s4"} == "on")
266 {echo "checked";};?
>><span
class=text
></span
><br
>
271 <td align
="right"><?php
xl('Click:','e'); ?
> </td
>
272 <td
><input type
=checkbox name
="bronchitis_heart_click" <?php
if ($obj{"bronchitis_heart_click"} == "on")
273 {echo "checked";};?
>><span
class=text
></span
><br
>
274 <td align
="right"><?php
xl('Rub:','e'); ?
> </td
>
275 <td
><input type
=checkbox name
="bronchitis_heart_rub" <?php
if ($obj{"bronchitis_heart_rub"} == "on")
276 {echo "checked";};?
>><span
class=text
></span
><br
>
281 <td width
="200" align
="right"><?php
xl('Murmur:','e'); ?
> <span
class="text"></span
></td
>
282 <td
><input type
=entry name
="bronchitis_heart_murmur" value
="<?php echo
283 stripslashes($obj{"bronchitis_heart_murmur
"});?>" size
="15"></td
>
285 <td
><span
class="text"><?php
xl('Grade:','e'); ?
> </span
></td
><td
>
286 <input type
=entry name
="bronchitis_heart_grade" value
="<?php echo
287 stripslashes($obj{"bronchitis_heart_grade
"});?>" size
="15"></td
>
289 <td
><span
class="text"><?php
xl('Location:','e'); ?
> </span
></td
><td
>
290 <input type
=entry name
="bronchitis_heart_location" value
="<?php echo
291 stripslashes($obj{"bronchitis_heart_location
"});?>" size
="15"></td
>
296 <td width
="205" align
="right"><?php
xl('Normal Cardiac Exam:','e'); ?
> </td
>
297 <td
><input type
=checkbox name
="bronchitis_heart_normal" <?php
if ($obj{"bronchitis_heart_normal"} == "on")
298 {echo "checked";};?
>><span
class=text
></span
><br
>
299 <td width
="95" align
="right"><?php
xl('Not Examined:','e'); ?
> </td
>
300 <td
><input type
=checkbox name
="bronchitis_heart_not_examined" <?php
if ($obj{"bronchitis_heart_not_examined"} == "on")
301 {echo "checked";};?
>><span
class=text
></span
><br
>
306 <td width
="60"><?php
xl('Lungs:','e'); ?
> </td
>
307 <td width
="106"><?php
xl('Breath Sounds:','e'); ?
> </td
>
308 <td align
="right"> <?php
xl('normal:','e'); ?
> </td
>
309 <td
><input type
=checkbox name
="bronchitis_lungs_bs_normal" <?php
if ($obj{"bronchitis_lungs_bs_normal"} == "on")
310 {echo "checked";};?
>><span
class=text
></span
><br
>
312 <td align
="right"><?php
xl('reduced:','e'); ?
> </td
>
313 <td
><input type
=checkbox name
="bronchitis_lungs_bs_reduced" <?php
if ($obj{"bronchitis_lungs_bs_reduced"} == "on")
314 {echo "checked";};?
>><span
class=text
></span
><br
>
316 <td align
="right"><?php
xl('increased:','e'); ?
> </td
>
317 <td
><input type
=checkbox name
="bronchitis_lungs_bs_increased" <?php
if ($obj{"bronchitis_lungs_bs_increased"} == "on")
318 {echo "checked";};?
>><span
class=text
></span
><br
>
323 <td
><?php
xl('Crackles:','e'); ?
> </td
>
324 <td align
="right"><?php
xl(' LLL:','e'); ?
> </td
>
325 <td
><input type
=checkbox name
="bronchitis_lungs_crackles_lll" <?php
if ($obj{"bronchitis_lungs_crackles_lll"} == "on")
326 {echo "checked";};?
>><span
class=text
></span
><br
>
328 <td align
="right"><?php
xl('RLL:','e'); ?
> </td
>
329 <td
><input type
=checkbox name
="bronchitis_lungs_crackles_rll" <?php
if ($obj{"bronchitis_lungs_crackles_rll"} == "on")
330 {echo "checked";};?
>><span
class=text
></span
><br
>
332 <td align
="right"><?php
xl('Bilateral:','e'); ?
> </td
>
333 <td
><input type
=checkbox name
="bronchitis_lungs_crackles_bll" <?php
if ($obj{"bronchitis_lungs_crackles_bll"} == "on")
334 {echo "checked";};?
>><span
class=text
></span
><br
>
339 <td
><?php
xl('Rubs:','e'); ?
> </td
>
340 <td align
="right"><?php
xl('LLL:','e'); ?
> </td
>
341 <td
><input type
=checkbox name
="bronchitis_lungs_rubs_lll" <?php
if ($obj{"bronchitis_lungs_rubs_lll"} == "on")
342 {echo "checked";};?
>><span
class=text
></span
><br
>
344 <td align
="right"><?php
xl('RLL:','e'); ?
> </td
>
345 <td
><input type
=checkbox name
="bronchitis_lungs_rubs_rll" <?php
if ($obj{"bronchitis_lungs_rubs_rll"} == "on")
346 {echo "checked";};?
>><span
class=text
></span
><br
>
348 <td align
="right"><?php
xl('Bilateral:','e'); ?
> </td
>
349 <td
><input type
=checkbox name
="bronchitis_lungs_rubs_bll" <?php
if ($obj{"bronchitis_lungs_rubs_bll"} == "on")
350 {echo "checked";};?
>><span
class=text
></span
><br
>
355 <td
><?php
xl('Wheezes:','e'); ?
> </td
>
356 <td align
="right"><?php
xl('LLL:','e'); ?
> </td
>
357 <td
><input type
=checkbox name
="bronchitis_lungs_wheezes_lll" <?php
if ($obj{"bronchitis_lungs_wheezes_lll"} == "on")
358 {echo "checked";};?
>><span
class=text
></span
><br
>
360 <td align
="right"><?php
xl('RLL:','e'); ?
> </td
>
361 <td
><input type
=checkbox name
="bronchitis_lungs_wheezes_rll" <?php
if ($obj{"bronchitis_lungs_wheezes_rll"} == "on")
362 {echo "checked";};?
>><span
class=text
></span
><br
>
364 <td align
="right"><?php
xl('Bilateral:','e'); ?
> </td
>
365 <td
><input type
=checkbox name
="bronchitis_lungs_wheezes_bll" <?php
if ($obj{"bronchitis_lungs_wheezes_bll"} == "on")
366 {echo "checked";};?
>><span
class=text
></span
><br
>
368 <td align
="right"><?php
xl('Diffuse:','e'); ?
> </td
>
369 <td
><input type
=checkbox name
="bronchitis_lungs_wheezes_dll" <?php
if ($obj{"bronchitis_lungs_wheezes_dll"} == "on")
370 {echo "checked";};?
>><span
class=text
></span
><br
>
376 <td width
="218" align
="right"><?php
xl('Normal Lung Exam:','e'); ?
> </td
>
377 <td
><input type
=checkbox name
="bronchitis_lungs_normal_exam" <?php
if ($obj{"bronchitis_lungs_normal_exam"} == "on")
378 {echo "checked";};?
>><span
class=text
></span
><br
>
379 <td width
="140" align
="right"><?php
xl('Not Examined','e'); ?
> </td
>
380 <td
><input type
=checkbox name
="bronchitis_lungs_not_examined" <?php
if ($obj{"bronchitis_lungs_not_examined"} == "on")
381 {echo "checked";};?
>><span
class=text
></span
><br
>
385 <span
class="text"><?php
xl('Diagnostic Tests:','e'); ?
> </span
></br
>
386 <textarea name
="bronchitis_diagnostic_tests" cols
="67" rows
="4" wrap
="virtual name">
387 <?php
echo stripslashes($obj{"bronchitis_diagnostic_tests"});?
></textarea
>
391 <span
class="text"><?php
xl('Diagnosis: ','e'); ?
> </span
>
392 <br
><input type
=entry name
="diagnosis1_bronchitis_form" value
="<?php echo
393 stripslashes($obj{"diagnosis1_bronchitis_form
"});?>" size
="40"><br
>
397 <input type
=entry name
="diagnosis2_bronchitis_form" value
="<?php echo
398 stripslashes($obj{"diagnosis2_bronchitis_form
"});?>" size
="40"><br
>
402 <input type
=entry name
="diagnosis3_bronchitis_form" value
="<?php echo
403 stripslashes($obj{"diagnosis3_bronchitis_form
"});?>" size
="40"><br
>
407 <input type
=entry name
="diagnosis4_bronchitis_form" value
="<?php echo
408 stripslashes($obj{"diagnosis4_bronchitis_form
"});?>" size
="40"><br
>
413 <span
class="text"><?php
xl('Additional Diagnosis:','e'); ?
> </span
></br
>
414 <textarea name
="bronchitis_additional_diagnosis" rows
="4" cols
="67" wrap
="virtual name">
415 <?php
echo stripslashes($obj{"bronchitis_additional_diagnosis"});?
></textarea
>
418 <span
class="text"><?php
xl('Treatment: ','e'); ?
> </span
></br
>
419 <textarea name
="bronchitis_treatment" rows
="4" cols
="67" wrap
="virtual name">
420 <?php
echo stripslashes($obj{"bronchitis_treatment"});?
></textarea
>
423 <a href
="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[<?php
xl('Save','e'); ?
> ]</a
>
425 <a href
="<?php echo "$rootdir/patient_file
/encounter
/$returnurl";?>" class="link"
426 onclick
="top.restoreSession()">[<?php
xl('Don\'t Save Changes','e'); ?
> ]</a
>