contrib/forms/routine_screening_record/view.php

   1 <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
   2
   3 "http://www.w3.org/TR/html4/loose.dtd">
   4
   5 <?php
   6
   7 include_once("../../globals.php");
   8
   9 include_once("$srcdir/api.inc");
  10
  11 include_once("$srcdir/forms.inc");
  12
  13 include_once("$srcdir/calendar.inc");formHeader("Form: Routine screening record");
  14
  15 ?>
  16
  17
  18
  19 <html>
  20
  21 <head>
  22 <?php html_header_show();?>
  23
  24 <title>Form: Routine screening record</title>
  25
  26 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  27
  28 <link rel="stylesheet" href="../../acog.css" type="text/css">
  29
  30 <script language="JavaScript" src="../../acog.js" type="text/JavaScript"></script>
  31
  32 <script language="JavaScript" type="text/JavaScript">
  33
  34 window.onload = initialize;
  35
  36 </script>
  37
  38 </head>
  39
  40
  41
  42 <?php
  43
  44    $fres=sqlStatement("select * from patient_data where pid='".$pid."'");
  45
  46    if ($fres){
  47
  48      $patient = sqlFetchArray($fres);
  49
  50    }
  51
  52    $fres=sqlStatement("select * from form_routine_screening_record where id=$id");
  53
  54    if ($fres){
  55
  56      $fdata = sqlFetchArray($fres);
  57
  58    }
  59
  60 ?>
  61
  62 <body class="body_top">
  63
  64
  65
  66 <form action="<?php echo $rootdir;?>/forms/routine_screening_record/save.php?mode=update&id=<?php echo $id;?>" method="post" enctype="multipart/form-data" name="my_form">
  67
  68 <?php include("../../acog_menu.inc"); ?>
  69
  70 <div class="srvChapter">Routine screening record <a href="#" onMouseOver="toolTip('The <strong>Routine Screening Record</strong> includes those screening tests recommended by ACOG for routine use and provides reminders for recommended frequency of services.', 300)" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></div>
  71
  72 <div style="border: solid 2px black; background-color:#FFFFFF;">
  73
  74   <table  border="0" cellpadding="2" cellspacing="0">
  75
  76     <tr align="left" valign="bottom">
  77
  78       <td colspan="4" class="fibody2" id="bordR">patient name:
  79
  80         <input name="pname" type="text" class="fullin" id="pname" style="width: 74%" value="<?php
  81
  82           echo $patient{'fname'}.' '.$patient{'mname'}.' '.$patient{'lname'};
  83
  84           ?>"></td>
  85
  86       <td colspan="4" class="fibody2" id="bordR">Birth date:
  87
  88         <input name="pbdate" type="text" class="fullin" id="pbdate" style="width: 65%" value="<?php
  89
  90           echo $patient{'DOB'};
  91
  92           ?>"></td>
  93
  94       <td colspan="3" class="fibody2">ID No:
  95
  96         <input name="rs_pid" type="text" class="fullin" id="rs_pid" style="width:80%" value="<?php
  97
  98           echo $patient{'id'};
  99
 100           ?>"></td>
 101
 102       </tr>
 103
 104     <tr align="center" valign="middle">
 105
 106       <td class="ficaption2" id="bordR">age</td>
 107
 108       <td width="9%" class="ficaption2" id="bordR">Cervical cytology </td>
 109
 110       <td width="9%" class="ficaption2" id="bordR">Lipid profile assessment<a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></td>
 111
 112       <td width="9%" class="ficaption2" id="bordR">Mammo-<br>
 113
 114         graphy<a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></td>
 115
 116       <td width="9%" class="ficaption2" id="bordR">Colorectal cancer screening <a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></td>
 117
 118       <td width="9%" class="ficaption2" id="bordR">Bone density screening <a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"> <img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></td>
 119
 120       <td width="9%" class="ficaption2" id="bordR">Chlamydia screening <a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a> </td>
 121
 122       <td width="9%" class="ficaption2" id="bordR">Gonor-<br>
 123
 124         rhea screening <a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a> </td>
 125
 126       <td width="9%" class="ficaption2" id="bordR">Urinalysis</td>
 127
 128       <td width="9%" class="ficaption2" id="bordR">Fasting glucose test <a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></td>
 129
 130       <td width="9%" class="ficaption2">Thyroid stimulating hormone screening </td>
 131
 132     </tr>
 133
 134     <tr align="center" valign="middle">
 135
 136       <td class="fibody2" id="bordR">13-18</td>
 137
 138       <td class="fibody2" id="bordR">ANNUALLY BEGINNING
 139
 140         APPROXIMATELY 3 YEARS
 141
 142         AFTER INITIATION OF
 143
 144         SEXUAL INTERCOURSE</td>
 145
 146       <td class="fibody2" id="bordR">&nbsp; </td>
 147
 148       <td class="fibody2" id="bordR">&nbsp; </td>
 149
 150       <td class="fibody2" id="bordR">&nbsp; </td>
 151
 152       <td class="fibody2" id="bordR">&nbsp; </td>
 153
 154       <td class="fibody2" id="bordR">        SEXUALLY ACTIVE WOMEN
 155
 156         UNDER AGE 25</td>
 157
 158       <td class="fibody2" id="bordR">SEXUALLY ACTIVE
 159
 160         ADOLES-<br>
 161
 162         CENTS</td>
 163
 164       <td class="fibody2" id="bordR">&nbsp;</td>
 165
 166       <td class="fibody2" id="bordR">&nbsp;</td>
 167
 168       <td class="fibody2">&nbsp;</td>
 169
 170     </tr>
 171
 172     <tr align="center" valign="middle">
 173
 174       <td class="fibody2" id="bordR">19-39</td>
 175
 176       <td class="fibody2" id="bordR">ANNUALLY BEGINNING NO LATER THAN AGE 21 YEARS</td>
 177
 178       <td class="fibody2" id="bordR">&nbsp; </td>
 179
 180       <td class="fibody2" id="bordR">&nbsp; </td>
 181
 182       <td class="fibody2" id="bordR">&nbsp; </td>
 183
 184       <td class="fibody2" id="bordR">&nbsp; </td>
 185
 186       <td class="fibody2" id="bordR"> SEXUALLY ACTIVE WOMEN<br>
 187
 188 UNDER AGE 25</td>
 189
 190       <td class="fibody2" id="bordR">&nbsp; </td>
 191
 192       <td class="fibody2" id="bordR">&nbsp;</td>
 193
 194       <td class="fibody2" id="bordR">&nbsp;</td>
 195
 196       <td class="fibody2">&nbsp;</td>
 197
 198     </tr>
 199
 200     <tr align="center" valign="middle">
 201
 202       <td class="fibody2" id="bordR">40-64</td>
 203
 204       <td class="fibody2" id="bordR">EVERY 23 YEARS AFTER 3
 205
 206         CONSECuTIVE NEGATIVE TEST
 207
 208         RESULTS IF NO HISTORY OF
 209
 210         CIN 2 OR 3,
 211
 212         IMMUNOSUP-<br>
 213
 214         PRESSION,
 215
 216         HIV INFECTION, OR DES
 217
 218         EXPOSURE IN UTERO</td>
 219
 220       <td class="fibody2" id="bordR">EVERY 5 YEARS
 221
 222         BEGINNING
 223
 224         AT AGE 45</td>
 225
 226       <td class="fibody2" id="bordR">EVERY 12 YEARS UNTIL
 227
 228         AGE 50; YEARLY
 229
 230         BEGINNING AT AGE 50</td>
 231
 232       <td class="fibody2" id="bordR">        BEGINNING AT AGE 50
 233
 234         YEARLY FOBT OR FLEXIBLE
 235
 236         SIGMOIDOSCOPY EVERY
 237
 238         5 YEARS OR YEARLY FOBT
 239
 240         PLUS FLEXIBLE
 241
 242         SIGMOIDOSCOPY EVERY 5
 243
 244         YEARS OR DCBE EVERY 5
 245
 246         YEARS OR COLONOSCOPY
 247
 248         EVERY 10 YEARS</td>
 249
 250       <td class="fibody2" id="bordR">&nbsp; </td>
 251
 252       <td class="fibody2" id="bordR">&nbsp; </td>
 253
 254       <td class="fibody2" id="bordR">&nbsp; </td>
 255
 256       <td class="fibody2" id="bordR">&nbsp;</td>
 257
 258       <td class="fibody2" id="bordR">EVERY 3 YEARS
 259
 260         AFTER AGE 45</td>
 261
 262       <td class="fibody2">EVERY 5 YEARS
 263
 264         BEGINNING AT AGE 50</td>
 265
 266     </tr>
 267
 268     <tr align="center" valign="middle">
 269
 270       <td class="fibody2" id="bordR">65 and older </td>
 271
 272       <td class="fibody2" id="bordR">EVERY 23 YEARS AFTER 3<br>
 273
 274         CONSECUTIVE NEGATIVE TEST
 275
 276         RESULTS IF NO HISTORY OF
 277
 278         CIN 2 OR 3,
 279
 280         IMMUNOSUP-<br>
 281
 282         PRESSION,
 283
 284         HIV INFECTION, OR DES
 285
 286         EXPOSURE IN UTERO</td>
 287
 288       <td class="fibody2" id="bordR">EVERY 5 YEARS</td>
 289
 290       <td class="fibody2" id="bordR">YEARLY OR AS
 291
 292         APPROPRIATE</td>
 293
 294       <td class="fibody2" id="bordR">        YEARLY FOBT OR FLEXIBLE
 295
 296         SIGMOIDOSCOPY EVERY
 297
 298         5 YEARS OR YEARLY FOBT
 299
 300         PLUS FLEXIBLE
 301
 302         SIGMOIDOSCOPY EVERY
 303
 304         YEARS OR DCBE EVERY
 305
 306         YEARS OR COLONOSCOPY
 307
 308         EVERY 10 YEARS</td>
 309
 310       <td class="fibody2" id="bordR">        IN THE ABSENCE OF
 311
 312         NEW RISK FACTORS,
 313
 314         SUBSEQUENT SCREENING
 315
 316         NOT MORE FREQUENTLY
 317
 318         THAN EVERY 2 YEARS</td>
 319
 320       <td class="fibody2" id="bordR">&nbsp; </td>
 321
 322       <td class="fibody2" id="bordR">&nbsp; </td>
 323
 324       <td class="fibody2" id="bordR">YEARLY OR AS
 325
 326         APPROPRIATE</td>
 327
 328       <td class="fibody2" id="bordR">EVERY 3 YEARS</td>
 329
 330       <td class="fibody2">EVERY 5 YEARS</td>
 331
 332     </tr>
 333
 334     <tr align="left" valign="bottom">
 335
 336       <td colspan="11" class="fibody2" style="border-bottom: 2px solid black;">&nbsp;</td>
 337
 338       </tr>
 339
 340 <?php
 341
 342 $factors = array("cervical", "lipid", "mammo", "colorectal",
 343
 344 "bone", "chlamyd", "gonor", "urinal", "glucose", "thyroid");
 345
 346 $rsi = 1;
 347
 348 while ($rsi < 9){
 349
 350 $chunks = explode("|~", $fdata["record_$rsi"]);
 351
 352 list($cervical_date, $cervical_res) = explode('|', $chunks[0]);
 353
 354 list($lipid_date, $lipid_res) = explode('|', $chunks[1]);
 355
 356 list($mammo_date,$mammo_res) = explode('|', $chunks[2]);
 357
 358 list($colorectal_date,$colorectal_res) = explode('|', $chunks[3]);
 359
 360 list($bone_date,$bone_res) = explode('|', $chunks[4]);
 361
 362 list($chlamyd_date,$chlamyd_res) = explode('|', $chunks[5]);
 363
 364 list($gonor_date,$gonor_res) = explode('|', $chunks[6]);
 365
 366 list($urinal_date,$urinal_res) = explode('|', $chunks[7]);
 367
 368 list($glucose_date,$glucose_res) = explode('|', $chunks[8]);
 369
 370 list($thyroid_date,$thyroid_res) = explode('|', $chunks[9]);
 371
 372
 373
 374
 375
 376 print <<<EOL
 377
 378     <tr align="left" valign="bottom">
 379
 380       <td class="fibody2" id="bordR">Date</td>
 381
 382       <td class="fibody3" id="bordR"><input name="cervical_date_${rsi}" value="${cervical_date}" type="text" class="fullin2"></td>
 383
 384       <td class="fibody3" id="bordR"><input name="lipid_date_${rsi}" value="${lipid_date}" type="text" class="fullin2"></td>
 385
 386       <td class="fibody3" id="bordR"><input name="mammo_date_${rsi}" value="${mammo_date}" type="text" class="fullin2"></td>
 387
 388       <td class="fibody3" id="bordR"><input name="colorectal_date_${rsi}" value="${colorectal_date}" type="text" class="fullin2"></td>
 389
 390       <td class="fibody3" id="bordR"><input name="bone_date_${rsi}" value="${bone_date}" type="text" class="fullin2"></td>
 391
 392       <td class="fibody3" id="bordR"><input name="chlamyd_date_${rsi}" value="${chlamyd_date}" type="text" class="fullin2"></td>
 393
 394       <td class="fibody3" id="bordR"><input name="gonor_date_${rsi}" value="${gonor_date}" type="text" class="fullin2"></td>
 395
 396       <td class="fibody3" id="bordR"><input name="urinal_date_${rsi}" value="${urinal_date}" type="text" class="fullin2"></td>
 397
 398       <td class="fibody3" id="bordR"><input name="glucose_date_${rsi}" value="${glucose_date}" type="text" class="fullin2"></td>
 399
 400       <td class="fibody3"><input name="thyroid_date_${rsi}" value="${thyroid_date}" type="text" class="fullin2"></td>
 401
 402     </tr>
 403
 404     <tr align="left" valign="bottom">
 405
 406       <td class="fibody2" id="bordR">result</td>
 407
 408       <td class="fibody5" id="bordR"><input name="cervical_res_${rsi}" value="${cervical_res}" type="text" class="fullin2"></td>
 409
 410       <td class="fibody5" id="bordR"><input name="lipid_res_${rsi}" value="${lipid_res}" type="text" class="fullin2"></td>
 411
 412       <td class="fibody5" id="bordR"><input name="mammo_res_${rsi}" value="${mammo_res}" type="text" class="fullin2"></td>
 413
 414       <td class="fibody5" id="bordR"><input name="colorectal_res_${rsi}" value="${colorectal_res}" type="text" class="fullin2"></td>
 415
 416       <td class="fibody5" id="bordR"><input name="bone_res_${rsi}" value="${bone_res}" type="text" class="fullin2"></td>
 417
 418       <td class="fibody5" id="bordR"><input name="chlamyd_res_${rsi}" value="${chlamyd_res}" type="text" class="fullin2"></td>
 419
 420       <td class="fibody5" id="bordR"><input name="gonor_res_${rsi}" value="${gonor_res}" type="text" class="fullin2"></td>
 421
 422       <td class="fibody5" id="bordR"><input name="urinal_res_${rsi}" value="${urinal_res}" type="text" class="fullin2"></td>
 423
 424       <td class="fibody5" id="bordR"><input name="glucose_res_${rsi}" value="${glucose_res}" type="text" class="fullin2"></td>
 425
 426       <td class="fibody5"><input name="thyroid_res_${rsi}" value="${thyroid_res}" type="text" class="fullin2"></td>
 427
 428     </tr>
 429
 430 EOL;
 431
 432 $rsi++;
 433
 434 }
 435
 436 ?>
 437
 438   </table>
 439
 440 </div>
 441
 442 <p>&nbsp;</p>
 443
 444 <table width="100%" border="0">
 445
 446   <tr><td align="left" width="120"> <a href="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save Data]</a> </td>
 447
 448   <td align="left" nowrap> <a href="<?php echo $rootdir; ?>/patient_file/encounter/print_form.php?id=<?php echo $id; ?>&formname=<?php echo $formname; ?>"
 449
 450    target="_blank" class="link_submit" onclick="top.restoreSession()">[Printable form]</a> </td>
 451
 452   <td align="right"> <a href="<?php echo $GLOBALS['form_exit_url']; ?>" class="link_submit"
 453
 454    onclick="top.restoreSession()">[Don't Save]</a> </td></tr>
 455
 456 </table>
 457
 458 </form>
 459
 460 <?php
 461
 462 formFooter();
 463
 464 ?>
 465
 466 </body>
 467
 468 </html>
 469