contrib/forms/approved_physical/report.php

   1 <?php
   2 // Copyright (C) 2009 Aron Racho <aron@mi-squared.com>
   3 //
   4 // This program is free software; you can redistribute it and/or
   5 // modify it under the terms of the GNU General Public License
   6 // as published by the Free Software Foundation; either version 2
   7 //------------Forms generated from formsWiz
   8 include_once("../../globals.php");
   9 include_once($GLOBALS["srcdir"] . "/api.inc");
  10 function approved_physical_report( $pid, $encounter, $cols, $id) {
  11   $count = 0;
  12   $data = formFetch("form_approved_physical", $id);
  13   //echo "${data['general_headache']}";
  14   if ($data) {
  15
  16   print "<table cellpadding='3px' cellspacing='0px' border=0px>";
  17
  18 echo "<tr><td colspan='3'><span class='bold'><u>Constitutional</u></span></td></tr>";
  19 if ( ($data["col_1"] != "N/A" && $data["col_1"] != "" && $data["col_1"] != "--") || ( $data["col_1_textbox"] != "" && $data["col_1_textbox"] != null ) ) {
  20         echo "<tr>";
  21                 echo "<td valign='top'>";
  22                 if ( $data['col_1'] != null && $data['col_1'] != 'N/A' ) {
  23                         echo "<span class='text'>${data['col_1']}</span>";
  24                 } else {
  25                         echo "<br/>";
  26                 }
  27                 echo "</td>";
  28                 echo "<td width='300px' valign='top'>";
  29                 echo "<span class='text'><i>General Appearance (eg, development, nutrition, body habitus, deformities, attention to grooming)</i></span>";
  30                 echo "</td>";
  31                 echo "<td valign='top'>";
  32                 if ( $data['col_1_textbox'] != null ) {
  33                         echo "<span class='text'>${data['col_1_textbox']}</span>";
  34                 } else {
  35                         echo "<br/>";
  36                 }
  37                 echo "</td>";
  38         echo "</tr>";
  39 }
  40 echo "<tr><td colspan='3'><span class='bold'><u>Eyes</u></span></td></tr>";
  41 if ( ($data["col_2"] != "N/A" && $data["col_2"] != "" && $data["col_2"] != "--") || ( $data["col_2_textbox"] != "" && $data["col_2_textbox"] != null ) ) {
  42         echo "<tr>";
  43                 echo "<td valign='top'>";
  44                 if ( $data['col_2'] != null && $data['col_2'] != 'N/A' ) {
  45                         echo "<span class='text'>${data['col_2']}</span>";
  46                 } else {
  47                         echo "<br/>";
  48                 }
  49                 echo "</td>";
  50                 echo "<td width='300px' valign='top'>";
  51                 echo "<span class='text'><i>Inspection of conjunctiva and lids</i></span>";
  52                 echo "</td>";
  53                 echo "<td valign='top'>";
  54                 if ( $data['col_2_textbox'] != null ) {
  55                         echo "<span class='text'>${data['col_2_textbox']}</span>";
  56                 } else {
  57                         echo "<br/>";
  58                 }
  59                 echo "</td>";
  60         echo "</tr>";
  61 }
  62 if ( ($data["col_3"] != "N/A" && $data["col_3"] != "" && $data["col_3"] != "--") || ( $data["col_3_textbox"] != "" && $data["col_3_textbox"] != null ) ) {
  63         echo "<tr>";
  64                 echo "<td valign='top'>";
  65                 if ( $data['col_3'] != null && $data['col_3'] != 'N/A' ) {
  66                         echo "<span class='text'>${data['col_3']}</span>";
  67                 } else {
  68                         echo "<br/>";
  69                 }
  70                 echo "</td>";
  71                 echo "<td width='300px' valign='top'>";
  72                 echo "<span class='text'><i>Examination of pupils and irises (eg. Reaction to light and accommodation, size and symmetry)</i></span>";
  73                 echo "</td>";
  74                 echo "<td valign='top'>";
  75                 if ( $data['col_3_textbox'] != null ) {
  76                         echo "<span class='text'>${data['col_3_textbox']}</span>";
  77                 } else {
  78                         echo "<br/>";
  79                 }
  80                 echo "</td>";
  81         echo "</tr>";
  82 }
  83 if ( ($data["col_4"] != "N/A" && $data["col_4"] != "" && $data["col_4"] != "--") || ( $data["col_4_textbox"] != "" && $data["col_4_textbox"] != null ) ) {
  84         echo "<tr>";
  85                 echo "<td valign='top'>";
  86                 if ( $data['col_4'] != null && $data['col_4'] != 'N/A' ) {
  87                         echo "<span class='text'>${data['col_4']}</span>";
  88                 } else {
  89                         echo "<br/>";
  90                 }
  91                 echo "</td>";
  92                 echo "<td width='300px' valign='top'>";
  93                 echo "<span class='text'><i>Othalmoscopic examination of optic discs (eg size, C/D ratio, appearance) and posterior segments (eg, vessel changes, exudates, hemorrhages)</i></span>";
  94                 echo "</td>";
  95                 echo "<td valign='top'>";
  96                 if ( $data['col_4_textbox'] != null ) {
  97                         echo "<span class='text'>${data['col_4_textbox']}</span>";
  98                 } else {
  99                         echo "<br/>";
 100                 }
 101                 echo "</td>";
 102         echo "</tr>";
 103 }
 104 echo "<tr><td colspan='3'><span class='bold'><u>Ears, Nose, Mouth and Throat</u></span></td></tr>";
 105 if ( ($data["col_5"] != "N/A" && $data["col_5"] != "" && $data["col_5"] != "--") || ( $data["col_5_textbox"] != "" && $data["col_5_textbox"] != null ) ) {
 106         echo "<tr>";
 107                 echo "<td valign='top'>";
 108                 if ( $data['col_5'] != null && $data['col_5'] != 'N/A' ) {
 109                         echo "<span class='text'>${data['col_5']}</span>";
 110                 } else {
 111                         echo "<br/>";
 112                 }
 113                 echo "</td>";
 114                 echo "<td width='300px' valign='top'>";
 115                 echo "<span class='text'><i>External inspection of ears and nose (overall appearance, scars, lesions, masses)</i></span>";
 116                 echo "</td>";
 117                 echo "<td valign='top'>";
 118                 if ( $data['col_5_textbox'] != null ) {
 119                         echo "<span class='text'>${data['col_5_textbox']}</span>";
 120                 } else {
 121                         echo "<br/>";
 122                 }
 123                 echo "</td>";
 124         echo "</tr>";
 125 }
 126 if ( ($data["col_6"] != "N/A" && $data["col_6"] != "" && $data["col_6"] != "--") || ( $data["col_6_textbox"] != "" && $data["col_6_textbox"] != null ) ) {
 127         echo "<tr>";
 128                 echo "<td valign='top'>";
 129                 if ( $data['col_6'] != null && $data['col_6'] != 'N/A' ) {
 130                         echo "<span class='text'>${data['col_6']}</span>";
 131                 } else {
 132                         echo "<br/>";
 133                 }
 134                 echo "</td>";
 135                 echo "<td width='300px' valign='top'>";
 136                 echo "<span class='text'><i>Otoscopic examination of external auditory canals and tympanic membranes</i></span>";
 137                 echo "</td>";
 138                 echo "<td valign='top'>";
 139                 if ( $data['col_6_textbox'] != null ) {
 140                         echo "<span class='text'>${data['col_6_textbox']}</span>";
 141                 } else {
 142                         echo "<br/>";
 143                 }
 144                 echo "</td>";
 145         echo "</tr>";
 146 }
 147 if ( ($data["col_7"] != "N/A" && $data["col_7"] != "" && $data["col_7"] != "--") || ( $data["col_7_textbox"] != "" && $data["col_7_textbox"] != null ) ) {
 148         echo "<tr>";
 149                 echo "<td valign='top'>";
 150                 if ( $data['col_7'] != null && $data['col_7'] != 'N/A' ) {
 151                         echo "<span class='text'>${data['col_7']}</span>";
 152                 } else {
 153                         echo "<br/>";
 154                 }
 155                 echo "</td>";
 156                 echo "<td width='300px' valign='top'>";
 157                 echo "<span class='text'><i>Assessment of hearing (eg, whispered voice, finger rub, tuning fork)</i></span>";
 158                 echo "</td>";
 159                 echo "<td valign='top'>";
 160                 if ( $data['col_7_textbox'] != null ) {
 161                         echo "<span class='text'>${data['col_7_textbox']}</span>";
 162                 } else {
 163                         echo "<br/>";
 164                 }
 165                 echo "</td>";
 166         echo "</tr>";
 167 }
 168 if ( ($data["col_8"] != "N/A" && $data["col_8"] != "" && $data["col_8"] != "--") || ( $data["col_8_textbox"] != "" && $data["col_8_textbox"] != null ) ) {
 169         echo "<tr>";
 170                 echo "<td valign='top'>";
 171                 if ( $data['col_8'] != null && $data['col_8'] != 'N/A' ) {
 172                         echo "<span class='text'>${data['col_8']}</span>";
 173                 } else {
 174                         echo "<br/>";
 175                 }
 176                 echo "</td>";
 177                 echo "<td width='300px' valign='top'>";
 178                 echo "<span class='text'><i>Inspection of nasal mucosa, septum and turbinates</i></span>";
 179                 echo "</td>";
 180                 echo "<td valign='top'>";
 181                 if ( $data['col_8_textbox'] != null ) {
 182                         echo "<span class='text'>${data['col_8_textbox']}</span>";
 183                 } else {
 184                         echo "<br/>";
 185                 }
 186                 echo "</td>";
 187         echo "</tr>";
 188 }
 189 if ( ($data["col_9"] != "N/A" && $data["col_9"] != "" && $data["col_9"] != "--") || ( $data["col_9_textbox"] != "" && $data["col_9_textbox"] != null ) ) {
 190         echo "<tr>";
 191                 echo "<td valign='top'>";
 192                 if ( $data['col_9'] != null && $data['col_9'] != 'N/A' ) {
 193                         echo "<span class='text'>${data['col_9']}</span>";
 194                 } else {
 195                         echo "<br/>";
 196                 }
 197                 echo "</td>";
 198                 echo "<td width='300px' valign='top'>";
 199                 echo "<span class='text'><i>Inspection of lips, teeth and gums</i></span>";
 200                 echo "</td>";
 201                 echo "<td valign='top'>";
 202                 if ( $data['col_9_textbox'] != null ) {
 203                         echo "<span class='text'>${data['col_9_textbox']}</span>";
 204                 } else {
 205                         echo "<br/>";
 206                 }
 207                 echo "</td>";
 208         echo "</tr>";
 209 }
 210 if ( ($data["col_10"] != "N/A" && $data["col_10"] != "" && $data["col_10"] != "--") || ( $data["col_10_textbox"] != "" && $data["col_10_textbox"] != null ) ) {
 211         echo "<tr>";
 212                 echo "<td valign='top'>";
 213                 if ( $data['col_10'] != null && $data['col_10'] != 'N/A' ) {
 214                         echo "<span class='text'>${data['col_10']}</span>";
 215                 } else {
 216                         echo "<br/>";
 217                 }
 218                 echo "</td>";
 219                 echo "<td width='300px' valign='top'>";
 220                 echo "<span class='text'><i>Examination of oropharynx: oral mucosa, salivary glands, hard and soft palates, tongue, tonsils and posterior pharynx</i></span>";
 221                 echo "</td>";
 222                 echo "<td valign='top'>";
 223                 if ( $data['col_10_textbox'] != null ) {
 224                         echo "<span class='text'>${data['col_10_textbox']}</span>";
 225                 } else {
 226                         echo "<br/>";
 227                 }
 228                 echo "</td>";
 229         echo "</tr>";
 230 }
 231 echo "<tr><td colspan='3'><span class='bold'><u>Neck</u></span></td></tr>";
 232 if ( ($data["col_11"] != "N/A" && $data["col_11"] != "" && $data["col_11"] != "--") || ( $data["col_11_textbox"] != "" && $data["col_11_textbox"] != null ) ) {
 233         echo "<tr>";
 234                 echo "<td valign='top'>";
 235                 if ( $data['col_11'] != null && $data['col_11'] != 'N/A' ) {
 236                         echo "<span class='text'>${data['col_11']}</span>";
 237                 } else {
 238                         echo "<br/>";
 239                 }
 240                 echo "</td>";
 241                 echo "<td width='300px' valign='top'>";
 242                 echo "<span class='text'><i>Examination of neck (eg, masses, overall appearance, symmetry, tracheal position, crepitus)</i></span>";
 243                 echo "</td>";
 244                 echo "<td valign='top'>";
 245                 if ( $data['col_11_textbox'] != null ) {
 246                         echo "<span class='text'>${data['col_11_textbox']}</span>";
 247                 } else {
 248                         echo "<br/>";
 249                 }
 250                 echo "</td>";
 251         echo "</tr>";
 252 }
 253 if ( ($data["col_12"] != "N/A" && $data["col_12"] != "" && $data["col_12"] != "--") || ( $data["col_12_textbox"] != "" && $data["col_12_textbox"] != null ) ) {
 254         echo "<tr>";
 255                 echo "<td valign='top'>";
 256                 if ( $data['col_12'] != null && $data['col_12'] != 'N/A' ) {
 257                         echo "<span class='text'>${data['col_12']}</span>";
 258                 } else {
 259                         echo "<br/>";
 260                 }
 261                 echo "</td>";
 262                 echo "<td width='300px' valign='top'>";
 263                 echo "<span class='text'><i>Examination of thyroid (eg, enlargement, tenderness, mass)</i></span>";
 264                 echo "</td>";
 265                 echo "<td valign='top'>";
 266                 if ( $data['col_12_textbox'] != null ) {
 267                         echo "<span class='text'>${data['col_12_textbox']}</span>";
 268                 } else {
 269                         echo "<br/>";
 270                 }
 271                 echo "</td>";
 272         echo "</tr>";
 273 }
 274 echo "<tr><td colspan='3'><span class='bold'><u>Respiratory</u></span></td></tr>";
 275 if ( ($data["col_13"] != "N/A" && $data["col_13"] != "" && $data["col_13"] != "--") || ( $data["col_13_textbox"] != "" && $data["col_13_textbox"] != null ) ) {
 276         echo "<tr>";
 277                 echo "<td valign='top'>";
 278                 if ( $data['col_13'] != null && $data['col_13'] != 'N/A' ) {
 279                         echo "<span class='text'>${data['col_13']}</span>";
 280                 } else {
 281                         echo "<br/>";
 282                 }
 283                 echo "</td>";
 284                 echo "<td width='300px' valign='top'>";
 285                 echo "<span class='text'><i>Assessment of respiratory effort (eg, intercostal retractions, use of accessory muscles, diaphragmatic movement)</i></span>";
 286                 echo "</td>";
 287                 echo "<td valign='top'>";
 288                 if ( $data['col_13_textbox'] != null ) {
 289                         echo "<span class='text'>${data['col_13_textbox']}</span>";
 290                 } else {
 291                         echo "<br/>";
 292                 }
 293                 echo "</td>";
 294         echo "</tr>";
 295 }
 296 if ( ($data["col_14"] != "N/A" && $data["col_14"] != "" && $data["col_14"] != "--") || ( $data["col_14_textbox"] != "" && $data["col_14_textbox"] != null ) ) {
 297         echo "<tr>";
 298                 echo "<td valign='top'>";
 299                 if ( $data['col_14'] != null && $data['col_14'] != 'N/A' ) {
 300                         echo "<span class='text'>${data['col_14']}</span>";
 301                 } else {
 302                         echo "<br/>";
 303                 }
 304                 echo "</td>";
 305                 echo "<td width='300px' valign='top'>";
 306                 echo "<span class='text'><i>Percussion of chest (eg, dullness, flatness, hyperresonance)</i></span>";
 307                 echo "</td>";
 308                 echo "<td valign='top'>";
 309                 if ( $data['col_14_textbox'] != null ) {
 310                         echo "<span class='text'>${data['col_14_textbox']}</span>";
 311                 } else {
 312                         echo "<br/>";
 313                 }
 314                 echo "</td>";
 315         echo "</tr>";
 316 }
 317 if ( ($data["col_15"] != "N/A" && $data["col_15"] != "" && $data["col_15"] != "--") || ( $data["col_15_textbox"] != "" && $data["col_15_textbox"] != null ) ) {
 318         echo "<tr>";
 319                 echo "<td valign='top'>";
 320                 if ( $data['col_15'] != null && $data['col_15'] != 'N/A' ) {
 321                         echo "<span class='text'>${data['col_15']}</span>";
 322                 } else {
 323                         echo "<br/>";
 324                 }
 325                 echo "</td>";
 326                 echo "<td width='300px' valign='top'>";
 327                 echo "<span class='text'><i>Palpation of chest (eg, tactile fremitus)</i></span>";
 328                 echo "</td>";
 329                 echo "<td valign='top'>";
 330                 if ( $data['col_15_textbox'] != null ) {
 331                         echo "<span class='text'>${data['col_15_textbox']}</span>";
 332                 } else {
 333                         echo "<br/>";
 334                 }
 335                 echo "</td>";
 336         echo "</tr>";
 337 }
 338 if ( ($data["col_16"] != "N/A" && $data["col_16"] != "" && $data["col_16"] != "--") || ( $data["col_16_textbox"] != "" && $data["col_16_textbox"] != null ) ) {
 339         echo "<tr>";
 340                 echo "<td valign='top'>";
 341                 if ( $data['col_16'] != null && $data['col_16'] != 'N/A' ) {
 342                         echo "<span class='text'>${data['col_16']}</span>";
 343                 } else {
 344                         echo "<br/>";
 345                 }
 346                 echo "</td>";
 347                 echo "<td width='300px' valign='top'>";
 348                 echo "<span class='text'><i>Auscultation of lungs (eg, breath sounds, adventitious sounds, rubs)</i></span>";
 349                 echo "</td>";
 350                 echo "<td valign='top'>";
 351                 if ( $data['col_16_textbox'] != null ) {
 352                         echo "<span class='text'>${data['col_16_textbox']}</span>";
 353                 } else {
 354                         echo "<br/>";
 355                 }
 356                 echo "</td>";
 357         echo "</tr>";
 358 }
 359 echo "<tr><td colspan='3'><span class='bold'><u>Cardiovascular</u></span></td></tr>";
 360 if ( ($data["col_17"] != "N/A" && $data["col_17"] != "" && $data["col_17"] != "--") || ( $data["col_17_textbox"] != "" && $data["col_17_textbox"] != null ) ) {
 361         echo "<tr>";
 362                 echo "<td valign='top'>";
 363                 if ( $data['col_17'] != null && $data['col_17'] != 'N/A' ) {
 364                         echo "<span class='text'>${data['col_17']}</span>";
 365                 } else {
 366                         echo "<br/>";
 367                 }
 368                 echo "</td>";
 369                 echo "<td width='300px' valign='top'>";
 370                 echo "<span class='text'><i>Palpation of heart (eg, location, size, thrills)</i></span>";
 371                 echo "</td>";
 372                 echo "<td valign='top'>";
 373                 if ( $data['col_17_textbox'] != null ) {
 374                         echo "<span class='text'>${data['col_17_textbox']}</span>";
 375                 } else {
 376                         echo "<br/>";
 377                 }
 378                 echo "</td>";
 379         echo "</tr>";
 380 }
 381 if ( ($data["col_18"] != "N/A" && $data["col_18"] != "" && $data["col_18"] != "--") || ( $data["col_18_textbox"] != "" && $data["col_18_textbox"] != null ) ) {
 382         echo "<tr>";
 383                 echo "<td valign='top'>";
 384                 if ( $data['col_18'] != null && $data['col_18'] != 'N/A' ) {
 385                         echo "<span class='text'>${data['col_18']}</span>";
 386                 } else {
 387                         echo "<br/>";
 388                 }
 389                 echo "</td>";
 390                 echo "<td width='300px' valign='top'>";
 391                 echo "<span class='text'><i>Auscultation of heart with notation of abnormal sounds and murmurs</i></span>";
 392                 echo "</td>";
 393                 echo "<td valign='top'>";
 394                 if ( $data['col_18_textbox'] != null ) {
 395                         echo "<span class='text'>${data['col_18_textbox']}</span>";
 396                 } else {
 397                         echo "<br/>";
 398                 }
 399                 echo "</td>";
 400         echo "</tr>";
 401 }
 402 if ( ($data["col_19"] != "N/A" && $data["col_19"] != "" && $data["col_19"] != "--") || ( $data["col_19_textbox"] != "" && $data["col_19_textbox"] != null ) ) {
 403         echo "<tr>";
 404                 echo "<td valign='top'>";
 405                 if ( $data['col_19'] != null && $data['col_19'] != 'N/A' ) {
 406                         echo "<span class='text'>${data['col_19']}</span>";
 407                 } else {
 408                         echo "<br/>";
 409                 }
 410                 echo "</td>";
 411                 echo "<td width='300px' valign='top'>";
 412                 echo "<span class='text'><i>Examination of: carotid arteries (eg, pulse amplitude, bruits)</i></span>";
 413                 echo "</td>";
 414                 echo "<td valign='top'>";
 415                 if ( $data['col_19_textbox'] != null ) {
 416                         echo "<span class='text'>${data['col_19_textbox']}</span>";
 417                 } else {
 418                         echo "<br/>";
 419                 }
 420                 echo "</td>";
 421         echo "</tr>";
 422 }
 423 if ( ($data["col_20"] != "N/A" && $data["col_20"] != "" && $data["col_20"] != "--") || ( $data["col_20_textbox"] != "" && $data["col_20_textbox"] != null ) ) {
 424         echo "<tr>";
 425                 echo "<td valign='top'>";
 426                 if ( $data['col_20'] != null && $data['col_20'] != 'N/A' ) {
 427                         echo "<span class='text'>${data['col_20']}</span>";
 428                 } else {
 429                         echo "<br/>";
 430                 }
 431                 echo "</td>";
 432                 echo "<td width='300px' valign='top'>";
 433                 echo "<span class='text'><i>abdominal aorta (eg, size, bruits)</i></span>";
 434                 echo "</td>";
 435                 echo "<td valign='top'>";
 436                 if ( $data['col_20_textbox'] != null ) {
 437                         echo "<span class='text'>${data['col_20_textbox']}</span>";
 438                 } else {
 439                         echo "<br/>";
 440                 }
 441                 echo "</td>";
 442         echo "</tr>";
 443 }
 444 if ( ($data["col_21"] != "N/A" && $data["col_21"] != "" && $data["col_21"] != "--") || ( $data["col_21_textbox"] != "" && $data["col_21_textbox"] != null ) ) {
 445         echo "<tr>";
 446                 echo "<td valign='top'>";
 447                 if ( $data['col_21'] != null && $data['col_21'] != 'N/A' ) {
 448                         echo "<span class='text'>${data['col_21']}</span>";
 449                 } else {
 450                         echo "<br/>";
 451                 }
 452                 echo "</td>";
 453                 echo "<td width='300px' valign='top'>";
 454                 echo "<span class='text'><i>femoral arteries (eg, pulse amplitude, bruits)</i></span>";
 455                 echo "</td>";
 456                 echo "<td valign='top'>";
 457                 if ( $data['col_21_textbox'] != null ) {
 458                         echo "<span class='text'>${data['col_21_textbox']}</span>";
 459                 } else {
 460                         echo "<br/>";
 461                 }
 462                 echo "</td>";
 463         echo "</tr>";
 464 }
 465 if ( ($data["col_22"] != "N/A" && $data["col_22"] != "" && $data["col_22"] != "--") || ( $data["col_22_textbox"] != "" && $data["col_22_textbox"] != null ) ) {
 466         echo "<tr>";
 467                 echo "<td valign='top'>";
 468                 if ( $data['col_22'] != null && $data['col_22'] != 'N/A' ) {
 469                         echo "<span class='text'>${data['col_22']}</span>";
 470                 } else {
 471                         echo "<br/>";
 472                 }
 473                 echo "</td>";
 474                 echo "<td width='300px' valign='top'>";
 475                 echo "<span class='text'><i>pedal pulses (eg, pulse amplitude)</i></span>";
 476                 echo "</td>";
 477                 echo "<td valign='top'>";
 478                 if ( $data['col_22_textbox'] != null ) {
 479                         echo "<span class='text'>${data['col_22_textbox']}</span>";
 480                 } else {
 481                         echo "<br/>";
 482                 }
 483                 echo "</td>";
 484         echo "</tr>";
 485 }
 486 if ( ($data["col_23"] != "N/A" && $data["col_23"] != "" && $data["col_23"] != "--") || ( $data["col_23_textbox"] != "" && $data["col_23_textbox"] != null ) ) {
 487         echo "<tr>";
 488                 echo "<td valign='top'>";
 489                 if ( $data['col_23'] != null && $data['col_23'] != 'N/A' ) {
 490                         echo "<span class='text'>${data['col_23']}</span>";
 491                 } else {
 492                         echo "<br/>";
 493                 }
 494                 echo "</td>";
 495                 echo "<td width='300px' valign='top'>";
 496                 echo "<span class='text'><i>extremities for edema and/or varicosities</i></span>";
 497                 echo "</td>";
 498                 echo "<td valign='top'>";
 499                 if ( $data['col_23_textbox'] != null ) {
 500                         echo "<span class='text'>${data['col_23_textbox']}</span>";
 501                 } else {
 502                         echo "<br/>";
 503                 }
 504                 echo "</td>";
 505         echo "</tr>";
 506 }
 507 echo "<tr><td colspan='3'><span class='bold'><u>Chest (Breasts)</u></span></td></tr>";
 508 if ( ($data["col_24"] != "N/A" && $data["col_24"] != "" && $data["col_24"] != "--") || ( $data["col_24_textbox"] != "" && $data["col_24_textbox"] != null ) ) {
 509         echo "<tr>";
 510                 echo "<td valign='top'>";
 511                 if ( $data['col_24'] != null && $data['col_24'] != 'N/A' ) {
 512                         echo "<span class='text'>${data['col_24']}</span>";
 513                 } else {
 514                         echo "<br/>";
 515                 }
 516                 echo "</td>";
 517                 echo "<td width='300px' valign='top'>";
 518                 echo "<span class='text'><i>Inspection of breasts (eg, symmetry, nipple discharge)</i></span>";
 519                 echo "</td>";
 520                 echo "<td valign='top'>";
 521                 if ( $data['col_24_textbox'] != null ) {
 522                         echo "<span class='text'>${data['col_24_textbox']}</span>";
 523                 } else {
 524                         echo "<br/>";
 525                 }
 526                 echo "</td>";
 527         echo "</tr>";
 528 }
 529 if ( ($data["col_25"] != "N/A" && $data["col_25"] != "" && $data["col_25"] != "--") || ( $data["col_25_textbox"] != "" && $data["col_25_textbox"] != null ) ) {
 530         echo "<tr>";
 531                 echo "<td valign='top'>";
 532                 if ( $data['col_25'] != null && $data['col_25'] != 'N/A' ) {
 533                         echo "<span class='text'>${data['col_25']}</span>";
 534                 } else {
 535                         echo "<br/>";
 536                 }
 537                 echo "</td>";
 538                 echo "<td width='300px' valign='top'>";
 539                 echo "<span class='text'><i>Palpation of breasts and axillae (eg, masses or lumps, tenderness)</i></span>";
 540                 echo "</td>";
 541                 echo "<td valign='top'>";
 542                 if ( $data['col_25_textbox'] != null ) {
 543                         echo "<span class='text'>${data['col_25_textbox']}</span>";
 544                 } else {
 545                         echo "<br/>";
 546                 }
 547                 echo "</td>";
 548         echo "</tr>";
 549 }
 550 echo "<tr><td colspan='3'><span class='bold'><u>Gastrointestinal (Abdomen)</u></span></td></tr>";
 551 if ( ($data["col_26"] != "N/A" && $data["col_26"] != "" && $data["col_26"] != "--") || ( $data["col_26_textbox"] != "" && $data["col_26_textbox"] != null ) ) {
 552         echo "<tr>";
 553                 echo "<td valign='top'>";
 554                 if ( $data['col_26'] != null && $data['col_26'] != 'N/A' ) {
 555                         echo "<span class='text'>${data['col_26']}</span>";
 556                 } else {
 557                         echo "<br/>";
 558                 }
 559                 echo "</td>";
 560                 echo "<td width='300px' valign='top'>";
 561                 echo "<span class='text'><i>Examination of abdomen with notation of presence of masses or tenderness</i></span>";
 562                 echo "</td>";
 563                 echo "<td valign='top'>";
 564                 if ( $data['col_26_textbox'] != null ) {
 565                         echo "<span class='text'>${data['col_26_textbox']}</span>";
 566                 } else {
 567                         echo "<br/>";
 568                 }
 569                 echo "</td>";
 570         echo "</tr>";
 571 }
 572 if ( ($data["col_27"] != "N/A" && $data["col_27"] != "" && $data["col_27"] != "--") || ( $data["col_27_textbox"] != "" && $data["col_27_textbox"] != null ) ) {
 573         echo "<tr>";
 574                 echo "<td valign='top'>";
 575                 if ( $data['col_27'] != null && $data['col_27'] != 'N/A' ) {
 576                         echo "<span class='text'>${data['col_27']}</span>";
 577                 } else {
 578                         echo "<br/>";
 579                 }
 580                 echo "</td>";
 581                 echo "<td width='300px' valign='top'>";
 582                 echo "<span class='text'><i>Examination of liver and spleen</i></span>";
 583                 echo "</td>";
 584                 echo "<td valign='top'>";
 585                 if ( $data['col_27_textbox'] != null ) {
 586                         echo "<span class='text'>${data['col_27_textbox']}</span>";
 587                 } else {
 588                         echo "<br/>";
 589                 }
 590                 echo "</td>";
 591         echo "</tr>";
 592 }
 593 if ( ($data["col_28"] != "N/A" && $data["col_28"] != "" && $data["col_28"] != "--") || ( $data["col_28_textbox"] != "" && $data["col_28_textbox"] != null ) ) {
 594         echo "<tr>";
 595                 echo "<td valign='top'>";
 596                 if ( $data['col_28'] != null && $data['col_28'] != 'N/A' ) {
 597                         echo "<span class='text'>${data['col_28']}</span>";
 598                 } else {
 599                         echo "<br/>";
 600                 }
 601                 echo "</td>";
 602                 echo "<td width='300px' valign='top'>";
 603                 echo "<span class='text'><i>Examination for presence or absence of hernia</i></span>";
 604                 echo "</td>";
 605                 echo "<td valign='top'>";
 606                 if ( $data['col_28_textbox'] != null ) {
 607                         echo "<span class='text'>${data['col_28_textbox']}</span>";
 608                 } else {
 609                         echo "<br/>";
 610                 }
 611                 echo "</td>";
 612         echo "</tr>";
 613 }
 614 if ( ($data["col_29"] != "N/A" && $data["col_29"] != "" && $data["col_29"] != "--") || ( $data["col_29_textbox"] != "" && $data["col_29_textbox"] != null ) ) {
 615         echo "<tr>";
 616                 echo "<td valign='top'>";
 617                 if ( $data['col_29'] != null && $data['col_29'] != 'N/A' ) {
 618                         echo "<span class='text'>${data['col_29']}</span>";
 619                 } else {
 620                         echo "<br/>";
 621                 }
 622                 echo "</td>";
 623                 echo "<td width='300px' valign='top'>";
 624                 echo "<span class='text'><i>Examination (when indicated) of anus, perineum and rectum, including sphincter tone, presence of hemorrhoids, rectal masses</i></span>";
 625                 echo "</td>";
 626                 echo "<td valign='top'>";
 627                 if ( $data['col_29_textbox'] != null ) {
 628                         echo "<span class='text'>${data['col_29_textbox']}</span>";
 629                 } else {
 630                         echo "<br/>";
 631                 }
 632                 echo "</td>";
 633         echo "</tr>";
 634 }
 635 if ( ($data["col_30"] != "N/A" && $data["col_30"] != "" && $data["col_30"] != "--") || ( $data["col_30_textbox"] != "" && $data["col_30_textbox"] != null ) ) {
 636         echo "<tr>";
 637                 echo "<td valign='top'>";
 638                 if ( $data['col_30'] != null && $data['col_30'] != 'N/A' ) {
 639                         echo "<span class='text'>${data['col_30']}</span>";
 640                 } else {
 641                         echo "<br/>";
 642                 }
 643                 echo "</td>";
 644                 echo "<td width='300px' valign='top'>";
 645                 echo "<span class='text'><i>Obtain stool sample for occult blood test when indicated</i></span>";
 646                 echo "</td>";
 647                 echo "<td valign='top'>";
 648                 if ( $data['col_30_textbox'] != null ) {
 649                         echo "<span class='text'>${data['col_30_textbox']}</span>";
 650                 } else {
 651                         echo "<br/>";
 652                 }
 653                 echo "</td>";
 654         echo "</tr>";
 655 }
 656 echo "<tr><td colspan='3'><span class='bold'><u>Male Genitourinary </u></span></td></tr>";
 657 if ( ($data["col_31"] != "N/A" && $data["col_31"] != "" && $data["col_31"] != "--") || ( $data["col_31_textbox"] != "" && $data["col_31_textbox"] != null ) ) {
 658         echo "<tr>";
 659                 echo "<td valign='top'>";
 660                 if ( $data['col_31'] != null && $data['col_31'] != 'N/A' ) {
 661                         echo "<span class='text'>${data['col_31']}</span>";
 662                 } else {
 663                         echo "<br/>";
 664                 }
 665                 echo "</td>";
 666                 echo "<td width='300px' valign='top'>";
 667                 echo "<span class='text'><i>Examination of the scrotal contents (eg, hydrocele, spermatocele, tenderness of cord, testicular mass)</i></span>";
 668                 echo "</td>";
 669                 echo "<td valign='top'>";
 670                 if ( $data['col_31_textbox'] != null ) {
 671                         echo "<span class='text'>${data['col_31_textbox']}</span>";
 672                 } else {
 673                         echo "<br/>";
 674                 }
 675                 echo "</td>";
 676         echo "</tr>";
 677 }
 678 if ( ($data["col_32"] != "N/A" && $data["col_32"] != "" && $data["col_32"] != "--") || ( $data["col_32_textbox"] != "" && $data["col_32_textbox"] != null ) ) {
 679         echo "<tr>";
 680                 echo "<td valign='top'>";
 681                 if ( $data['col_32'] != null && $data['col_32'] != 'N/A' ) {
 682                         echo "<span class='text'>${data['col_32']}</span>";
 683                 } else {
 684                         echo "<br/>";
 685                 }
 686                 echo "</td>";
 687                 echo "<td width='300px' valign='top'>";
 688                 echo "<span class='text'><i>Examination of the penis</i></span>";
 689                 echo "</td>";
 690                 echo "<td valign='top'>";
 691                 if ( $data['col_32_textbox'] != null ) {
 692                         echo "<span class='text'>${data['col_32_textbox']}</span>";
 693                 } else {
 694                         echo "<br/>";
 695                 }
 696                 echo "</td>";
 697         echo "</tr>";
 698 }
 699 if ( ($data["col_33"] != "N/A" && $data["col_33"] != "" && $data["col_33"] != "--") || ( $data["col_33_textbox"] != "" && $data["col_33_textbox"] != null ) ) {
 700         echo "<tr>";
 701                 echo "<td valign='top'>";
 702                 if ( $data['col_33'] != null && $data['col_33'] != 'N/A' ) {
 703                         echo "<span class='text'>${data['col_33']}</span>";
 704                 } else {
 705                         echo "<br/>";
 706                 }
 707                 echo "</td>";
 708                 echo "<td width='300px' valign='top'>";
 709                 echo "<span class='text'><i>Digital rectal examination of prostate gland (eg, size, symmetry, nodularity, tenderness)</i></span>";
 710                 echo "</td>";
 711                 echo "<td valign='top'>";
 712                 if ( $data['col_33_textbox'] != null ) {
 713                         echo "<span class='text'>${data['col_33_textbox']}</span>";
 714                 } else {
 715                         echo "<br/>";
 716                 }
 717                 echo "</td>";
 718         echo "</tr>";
 719 }
 720 echo "<tr><td colspan='3'><span class='bold'><u>Female Genitourinary </u></span></td></tr>";
 721 if ( ($data["col_34"] != "N/A" && $data["col_34"] != "" && $data["col_34"] != "--") || ( $data["col_34_textbox"] != "" && $data["col_34_textbox"] != null ) ) {
 722         echo "<tr>";
 723                 echo "<td valign='top'>";
 724                 if ( $data['col_34'] != null && $data['col_34'] != 'N/A' ) {
 725                         echo "<span class='text'>${data['col_34']}</span>";
 726                 } else {
 727                         echo "<br/>";
 728                 }
 729                 echo "</td>";
 730                 echo "<td width='300px' valign='top'>";
 731                 echo "<span class='text'><i>Pelvic examination (with or without specimen collection for smears and cultures), including</i></span>";
 732                 echo "</td>";
 733                 echo "<td valign='top'>";
 734                 if ( $data['col_34_textbox'] != null ) {
 735                         echo "<span class='text'>${data['col_34_textbox']}</span>";
 736                 } else {
 737                         echo "<br/>";
 738                 }
 739                 echo "</td>";
 740         echo "</tr>";
 741 }
 742 if ( ($data["col_35"] != "N/A" && $data["col_35"] != "" && $data["col_35"] != "--") || ( $data["col_35_textbox"] != "" && $data["col_35_textbox"] != null ) ) {
 743         echo "<tr>";
 744                 echo "<td valign='top'>";
 745                 if ( $data['col_35'] != null && $data['col_35'] != 'N/A' ) {
 746                         echo "<span class='text'>${data['col_35']}</span>";
 747                 } else {
 748                         echo "<br/>";
 749                 }
 750                 echo "</td>";
 751                 echo "<td width='300px' valign='top'>";
 752                 echo "<span class='text'><i>Examination of external genitalia (eg, general appearance, hair distribution, lesions) and vagina (eg, general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele, rectocele)</i></span>";
 753                 echo "</td>";
 754                 echo "<td valign='top'>";
 755                 if ( $data['col_35_textbox'] != null ) {
 756                         echo "<span class='text'>${data['col_35_textbox']}</span>";
 757                 } else {
 758                         echo "<br/>";
 759                 }
 760                 echo "</td>";
 761         echo "</tr>";
 762 }
 763 if ( ($data["col_36"] != "N/A" && $data["col_36"] != "" && $data["col_36"] != "--") || ( $data["col_36_textbox"] != "" && $data["col_36_textbox"] != null ) ) {
 764         echo "<tr>";
 765                 echo "<td valign='top'>";
 766                 if ( $data['col_36'] != null && $data['col_36'] != 'N/A' ) {
 767                         echo "<span class='text'>${data['col_36']}</span>";
 768                 } else {
 769                         echo "<br/>";
 770                 }
 771                 echo "</td>";
 772                 echo "<td width='300px' valign='top'>";
 773                 echo "<span class='text'><i>Examination of urethra (eg, masses, tenderness, scarring)</i></span>";
 774                 echo "</td>";
 775                 echo "<td valign='top'>";
 776                 if ( $data['col_36_textbox'] != null ) {
 777                         echo "<span class='text'>${data['col_36_textbox']}</span>";
 778                 } else {
 779                         echo "<br/>";
 780                 }
 781                 echo "</td>";
 782         echo "</tr>";
 783 }
 784 if ( ($data["col_37"] != "N/A" && $data["col_37"] != "" && $data["col_37"] != "--") || ( $data["col_37_textbox"] != "" && $data["col_37_textbox"] != null ) ) {
 785         echo "<tr>";
 786                 echo "<td valign='top'>";
 787                 if ( $data['col_37'] != null && $data['col_37'] != 'N/A' ) {
 788                         echo "<span class='text'>${data['col_37']}</span>";
 789                 } else {
 790                         echo "<br/>";
 791                 }
 792                 echo "</td>";
 793                 echo "<td width='300px' valign='top'>";
 794                 echo "<span class='text'><i>Examination of bladder (eg, fullness, masses, tenderness)</i></span>";
 795                 echo "</td>";
 796                 echo "<td valign='top'>";
 797                 if ( $data['col_37_textbox'] != null ) {
 798                         echo "<span class='text'>${data['col_37_textbox']}</span>";
 799                 } else {
 800                         echo "<br/>";
 801                 }
 802                 echo "</td>";
 803         echo "</tr>";
 804 }
 805 if ( ($data["col_38"] != "N/A" && $data["col_38"] != "" && $data["col_38"] != "--") || ( $data["col_38_textbox"] != "" && $data["col_38_textbox"] != null ) ) {
 806         echo "<tr>";
 807                 echo "<td valign='top'>";
 808                 if ( $data['col_38'] != null && $data['col_38'] != 'N/A' ) {
 809                         echo "<span class='text'>${data['col_38']}</span>";
 810                 } else {
 811                         echo "<br/>";
 812                 }
 813                 echo "</td>";
 814                 echo "<td width='300px' valign='top'>";
 815                 echo "<span class='text'><i>Cervix (eg, general appearance, lesions, discharge)</i></span>";
 816                 echo "</td>";
 817                 echo "<td valign='top'>";
 818                 if ( $data['col_38_textbox'] != null ) {
 819                         echo "<span class='text'>${data['col_38_textbox']}</span>";
 820                 } else {
 821                         echo "<br/>";
 822                 }
 823                 echo "</td>";
 824         echo "</tr>";
 825 }
 826 if ( ($data["col_39"] != "N/A" && $data["col_39"] != "" && $data["col_39"] != "--") || ( $data["col_39_textbox"] != "" && $data["col_39_textbox"] != null ) ) {
 827         echo "<tr>";
 828                 echo "<td valign='top'>";
 829                 if ( $data['col_39'] != null && $data['col_39'] != 'N/A' ) {
 830                         echo "<span class='text'>${data['col_39']}</span>";
 831                 } else {
 832                         echo "<br/>";
 833                 }
 834                 echo "</td>";
 835                 echo "<td width='300px' valign='top'>";
 836                 echo "<span class='text'><i>Uterus (eg, size, contour, position, mobility, tenderness, consistency, descent or support)</i></span>";
 837                 echo "</td>";
 838                 echo "<td valign='top'>";
 839                 if ( $data['col_39_textbox'] != null ) {
 840                         echo "<span class='text'>${data['col_39_textbox']}</span>";
 841                 } else {
 842                         echo "<br/>";
 843                 }
 844                 echo "</td>";
 845         echo "</tr>";
 846 }
 847 if ( ($data["col_40"] != "N/A" && $data["col_40"] != "" && $data["col_40"] != "--") || ( $data["col_40_textbox"] != "" && $data["col_40_textbox"] != null ) ) {
 848         echo "<tr>";
 849                 echo "<td valign='top'>";
 850                 if ( $data['col_40'] != null && $data['col_40'] != 'N/A' ) {
 851                         echo "<span class='text'>${data['col_40']}</span>";
 852                 } else {
 853                         echo "<br/>";
 854                 }
 855                 echo "</td>";
 856                 echo "<td width='300px' valign='top'>";
 857                 echo "<span class='text'><i>Adnexa/parametria (eg, masses, tenderness, organomegaly, nodularity)</i></span>";
 858                 echo "</td>";
 859                 echo "<td valign='top'>";
 860                 if ( $data['col_40_textbox'] != null ) {
 861                         echo "<span class='text'>${data['col_40_textbox']}</span>";
 862                 } else {
 863                         echo "<br/>";
 864                 }
 865                 echo "</td>";
 866         echo "</tr>";
 867 }
 868 echo "<tr><td colspan='3'><span class='bold'><u>Lymphatic</u></span></td></tr>";
 869 if ( ($data["col_41"] != "N/A" && $data["col_41"] != "" && $data["col_41"] != "--") || ( $data["col_41_textbox"] != "" && $data["col_41_textbox"] != null ) ) {
 870         echo "<tr>";
 871                 echo "<td valign='top'>";
 872                 if ( $data['col_41'] != null && $data['col_41'] != 'N/A' ) {
 873                         echo "<span class='text'>${data['col_41']}</span>";
 874                 } else {
 875                         echo "<br/>";
 876                 }
 877                 echo "</td>";
 878                 echo "<td width='300px' valign='top'>";
 879                 echo "<span class='text'><i>Palpation of lymph nodes in or more areas:</i></span>";
 880                 echo "</td>";
 881                 echo "<td valign='top'>";
 882                 if ( $data['col_41_textbox'] != null ) {
 883                         echo "<span class='text'>${data['col_41_textbox']}</span>";
 884                 } else {
 885                         echo "<br/>";
 886                 }
 887                 echo "</td>";
 888         echo "</tr>";
 889 }
 890 if ( ($data["col_42"] != "N/A" && $data["col_42"] != "" && $data["col_42"] != "--") || ( $data["col_42_textbox"] != "" && $data["col_42_textbox"] != null ) ) {
 891         echo "<tr>";
 892                 echo "<td valign='top'>";
 893                 if ( $data['col_42'] != null && $data['col_42'] != 'N/A' ) {
 894                         echo "<span class='text'>${data['col_42']}</span>";
 895                 } else {
 896                         echo "<br/>";
 897                 }
 898                 echo "</td>";
 899                 echo "<td width='300px' valign='top'>";
 900                 echo "<span class='text'><i>Neck</i></span>";
 901                 echo "</td>";
 902                 echo "<td valign='top'>";
 903                 if ( $data['col_42_textbox'] != null ) {
 904                         echo "<span class='text'>${data['col_42_textbox']}</span>";
 905                 } else {
 906                         echo "<br/>";
 907                 }
 908                 echo "</td>";
 909         echo "</tr>";
 910 }
 911 if ( ($data["col_43"] != "N/A" && $data["col_43"] != "" && $data["col_43"] != "--") || ( $data["col_43_textbox"] != "" && $data["col_43_textbox"] != null ) ) {
 912         echo "<tr>";
 913                 echo "<td valign='top'>";
 914                 if ( $data['col_43'] != null && $data['col_43'] != 'N/A' ) {
 915                         echo "<span class='text'>${data['col_43']}</span>";
 916                 } else {
 917                         echo "<br/>";
 918                 }
 919                 echo "</td>";
 920                 echo "<td width='300px' valign='top'>";
 921                 echo "<span class='text'><i>Axillae</i></span>";
 922                 echo "</td>";
 923                 echo "<td valign='top'>";
 924                 if ( $data['col_43_textbox'] != null ) {
 925                         echo "<span class='text'>${data['col_43_textbox']}</span>";
 926                 } else {
 927                         echo "<br/>";
 928                 }
 929                 echo "</td>";
 930         echo "</tr>";
 931 }
 932 if ( ($data["col_44"] != "N/A" && $data["col_44"] != "" && $data["col_44"] != "--") || ( $data["col_44_textbox"] != "" && $data["col_44_textbox"] != null ) ) {
 933         echo "<tr>";
 934                 echo "<td valign='top'>";
 935                 if ( $data['col_44'] != null && $data['col_44'] != 'N/A' ) {
 936                         echo "<span class='text'>${data['col_44']}</span>";
 937                 } else {
 938                         echo "<br/>";
 939                 }
 940                 echo "</td>";
 941                 echo "<td width='300px' valign='top'>";
 942                 echo "<span class='text'><i>Groin</i></span>";
 943                 echo "</td>";
 944                 echo "<td valign='top'>";
 945                 if ( $data['col_44_textbox'] != null ) {
 946                         echo "<span class='text'>${data['col_44_textbox']}</span>";
 947                 } else {
 948                         echo "<br/>";
 949                 }
 950                 echo "</td>";
 951         echo "</tr>";
 952 }
 953 if ( ($data["col_45"] != "N/A" && $data["col_45"] != "" && $data["col_45"] != "--") || ( $data["col_45_textbox"] != "" && $data["col_45_textbox"] != null ) ) {
 954         echo "<tr>";
 955                 echo "<td valign='top'>";
 956                 if ( $data['col_45'] != null && $data['col_45'] != 'N/A' ) {
 957                         echo "<span class='text'>${data['col_45']}</span>";
 958                 } else {
 959                         echo "<br/>";
 960                 }
 961                 echo "</td>";
 962                 echo "<td width='300px' valign='top'>";
 963                 echo "<span class='text'><i>Other</i></span>";
 964                 echo "</td>";
 965                 echo "<td valign='top'>";
 966                 if ( $data['col_45_textbox'] != null ) {
 967                         echo "<span class='text'>${data['col_45_textbox']}</span>";
 968                 } else {
 969                         echo "<br/>";
 970                 }
 971                 echo "</td>";
 972         echo "</tr>";
 973 }
 974 echo "<tr><td colspan='3'><span class='bold'><u>Musculoskeletal</u></span></td></tr>";
 975 if ( ($data["col_46"] != "N/A" && $data["col_46"] != "" && $data["col_46"] != "--") || ( $data["col_46_textbox"] != "" && $data["col_46_textbox"] != null ) ) {
 976         echo "<tr>";
 977                 echo "<td valign='top'>";
 978                 if ( $data['col_46'] != null && $data['col_46'] != 'N/A' ) {
 979                         echo "<span class='text'>${data['col_46']}</span>";
 980                 } else {
 981                         echo "<br/>";
 982                 }
 983                 echo "</td>";
 984                 echo "<td width='300px' valign='top'>";
 985                 echo "<span class='text'><i>Examination of gait and station</i></span>";
 986                 echo "</td>";
 987                 echo "<td valign='top'>";
 988                 if ( $data['col_46_textbox'] != null ) {
 989                         echo "<span class='text'>${data['col_46_textbox']}</span>";
 990                 } else {
 991                         echo "<br/>";
 992                 }
 993                 echo "</td>";
 994         echo "</tr>";
 995 }
 996 if ( ($data["col_47"] != "N/A" && $data["col_47"] != "" && $data["col_47"] != "--") || ( $data["col_47_textbox"] != "" && $data["col_47_textbox"] != null ) ) {
 997         echo "<tr>";
 998                 echo "<td valign='top'>";
 999                 if ( $data['col_47'] != null && $data['col_47'] != 'N/A' ) {
1000                         echo "<span class='text'>${data['col_47']}</span>";
1001                 } else {
1002                         echo "<br/>";
1003                 }
1004                 echo "</td>";
1005                 echo "<td width='300px' valign='top'>";
1006                 echo "<span class='text'><i>Inspection and/or palpation of digits and nails (eg, clubbing, cyanosis, inflammatory conditions, petechiae, ischemia, infections, nodes)</i></span>";
1007                 echo "</td>";
1008                 echo "<td valign='top'>";
1009                 if ( $data['col_47_textbox'] != null ) {
1010                         echo "<span class='text'>${data['col_47_textbox']}</span>";
1011                 } else {
1012                         echo "<br/>";
1013                 }
1014                 echo "</td>";
1015         echo "</tr>";
1016 }
1017 if ( ($data["col_48"] != "N/A" && $data["col_48"] != "" && $data["col_48"] != "--") || ( $data["col_48_textbox"] != "" && $data["col_48_textbox"] != null ) ) {
1018         echo "<tr>";
1019                 echo "<td valign='top'>";
1020                 if ( $data['col_48'] != null && $data['col_48'] != 'N/A' ) {
1021                         echo "<span class='text'>${data['col_48']}</span>";
1022                 } else {
1023                         echo "<br/>";
1024                 }
1025                 echo "</td>";
1026                 echo "<td width='300px' valign='top'>";
1027                 echo "<span class='text'><i>Examination of joints, bones and muscles of or more of the following six areas: 1) head and neck; 2) spine, ribs and pelvis; 3) right upper extremity; 4) left upper extremity; 5) right lower extremity; and 6) left lower extremity. The examination of a given area includes:</i></span>";
1028                 echo "</td>";
1029                 echo "<td valign='top'>";
1030                 if ( $data['col_48_textbox'] != null ) {
1031                         echo "<span class='text'>${data['col_48_textbox']}</span>";
1032                 } else {
1033                         echo "<br/>";
1034                 }
1035                 echo "</td>";
1036         echo "</tr>";
1037 }
1038 if ( ($data["col_49"] != "N/A" && $data["col_49"] != "" && $data["col_49"] != "--") || ( $data["col_49_textbox"] != "" && $data["col_49_textbox"] != null ) ) {
1039         echo "<tr>";
1040                 echo "<td valign='top'>";
1041                 if ( $data['col_49'] != null && $data['col_49'] != 'N/A' ) {
1042                         echo "<span class='text'>${data['col_49']}</span>";
1043                 } else {
1044                         echo "<br/>";
1045                 }
1046                 echo "</td>";
1047                 echo "<td width='300px' valign='top'>";
1048                 echo "<span class='text'><i>Inspection and/or palpation with notation of presence of any misalignment, asymmetry, crepitation, defects, tenderness, masses, effusions</i></span>";
1049                 echo "</td>";
1050                 echo "<td valign='top'>";
1051                 if ( $data['col_49_textbox'] != null ) {
1052                         echo "<span class='text'>${data['col_49_textbox']}</span>";
1053                 } else {
1054                         echo "<br/>";
1055                 }
1056                 echo "</td>";
1057         echo "</tr>";
1058 }
1059 if ( ($data["col_50"] != "N/A" && $data["col_50"] != "" && $data["col_50"] != "--") || ( $data["col_50_textbox"] != "" && $data["col_50_textbox"] != null ) ) {
1060         echo "<tr>";
1061                 echo "<td valign='top'>";
1062                 if ( $data['col_50'] != null && $data['col_50'] != 'N/A' ) {
1063                         echo "<span class='text'>${data['col_50']}</span>";
1064                 } else {
1065                         echo "<br/>";
1066                 }
1067                 echo "</td>";
1068                 echo "<td width='300px' valign='top'>";
1069                 echo "<span class='text'><i>Assessment of range of motion with notation of any pain, crepitation or contracture</i></span>";
1070                 echo "</td>";
1071                 echo "<td valign='top'>";
1072                 if ( $data['col_50_textbox'] != null ) {
1073                         echo "<span class='text'>${data['col_50_textbox']}</span>";
1074                 } else {
1075                         echo "<br/>";
1076                 }
1077                 echo "</td>";
1078         echo "</tr>";
1079 }
1080 if ( ($data["col_51"] != "N/A" && $data["col_51"] != "" && $data["col_51"] != "--") || ( $data["col_51_textbox"] != "" && $data["col_51_textbox"] != null ) ) {
1081         echo "<tr>";
1082                 echo "<td valign='top'>";
1083                 if ( $data['col_51'] != null && $data['col_51'] != 'N/A' ) {
1084                         echo "<span class='text'>${data['col_51']}</span>";
1085                 } else {
1086                         echo "<br/>";
1087                 }
1088                 echo "</td>";
1089                 echo "<td width='300px' valign='top'>";
1090                 echo "<span class='text'><i>Assessment of stability with notation of any dislocation (luxation), subluxation or laxity</i></span>";
1091                 echo "</td>";
1092                 echo "<td valign='top'>";
1093                 if ( $data['col_51_textbox'] != null ) {
1094                         echo "<span class='text'>${data['col_51_textbox']}</span>";
1095                 } else {
1096                         echo "<br/>";
1097                 }
1098                 echo "</td>";
1099         echo "</tr>";
1100 }
1101 if ( ($data["col_52"] != "N/A" && $data["col_52"] != "" && $data["col_52"] != "--") || ( $data["col_52_textbox"] != "" && $data["col_52_textbox"] != null ) ) {
1102         echo "<tr>";
1103                 echo "<td valign='top'>";
1104                 if ( $data['col_52'] != null && $data['col_52'] != 'N/A' ) {
1105                         echo "<span class='text'>${data['col_52']}</span>";
1106                 } else {
1107                         echo "<br/>";
1108                 }
1109                 echo "</td>";
1110                 echo "<td width='300px' valign='top'>";
1111                 echo "<span class='text'><i>Assessment of muscle strength and tone (eg, flaccid, cog wheel, spastic) with notation of any atrophy or abnormal movements</i></span>";
1112                 echo "</td>";
1113                 echo "<td valign='top'>";
1114                 if ( $data['col_52_textbox'] != null ) {
1115                         echo "<span class='text'>${data['col_52_textbox']}</span>";
1116                 } else {
1117                         echo "<br/>";
1118                 }
1119                 echo "</td>";
1120         echo "</tr>";
1121 }
1122 echo "<tr><td colspan='3'><span class='bold'><u>Skin</u></span></td></tr>";
1123 if ( ($data["col_53"] != "N/A" && $data["col_53"] != "" && $data["col_53"] != "--") || ( $data["col_53_textbox"] != "" && $data["col_53_textbox"] != null ) ) {
1124         echo "<tr>";
1125                 echo "<td valign='top'>";
1126                 if ( $data['col_53'] != null && $data['col_53'] != 'N/A' ) {
1127                         echo "<span class='text'>${data['col_53']}</span>";
1128                 } else {
1129                         echo "<br/>";
1130                 }
1131                 echo "</td>";
1132                 echo "<td width='300px' valign='top'>";
1133                 echo "<span class='text'><i>Inspection of skin and subcutaneous tissue (eg, rashes, lesions, ulcers)</i></span>";
1134                 echo "</td>";
1135                 echo "<td valign='top'>";
1136                 if ( $data['col_53_textbox'] != null ) {
1137                         echo "<span class='text'>${data['col_53_textbox']}</span>";
1138                 } else {
1139                         echo "<br/>";
1140                 }
1141                 echo "</td>";
1142         echo "</tr>";
1143 }
1144 if ( ($data["col_54"] != "N/A" && $data["col_54"] != "" && $data["col_54"] != "--") || ( $data["col_54_textbox"] != "" && $data["col_54_textbox"] != null ) ) {
1145         echo "<tr>";
1146                 echo "<td valign='top'>";
1147                 if ( $data['col_54'] != null && $data['col_54'] != 'N/A' ) {
1148                         echo "<span class='text'>${data['col_54']}</span>";
1149                 } else {
1150                         echo "<br/>";
1151                 }
1152                 echo "</td>";
1153                 echo "<td width='300px' valign='top'>";
1154                 echo "<span class='text'><i>Palpation of skin and subcutaneous tissue (eg, induration, subcutaneous nodules, tightening)</i></span>";
1155                 echo "</td>";
1156                 echo "<td valign='top'>";
1157                 if ( $data['col_54_textbox'] != null ) {
1158                         echo "<span class='text'>${data['col_54_textbox']}</span>";
1159                 } else {
1160                         echo "<br/>";
1161                 }
1162                 echo "</td>";
1163         echo "</tr>";
1164 }
1165 echo "<tr><td colspan='3'><span class='bold'><u>Neurologic</u></span></td></tr>";
1166 if ( ($data["col_55"] != "N/A" && $data["col_55"] != "" && $data["col_55"] != "--") || ( $data["col_55_textbox"] != "" && $data["col_55_textbox"] != null ) ) {
1167         echo "<tr>";
1168                 echo "<td valign='top'>";
1169                 if ( $data['col_55'] != null && $data['col_55'] != 'N/A' ) {
1170                         echo "<span class='text'>${data['col_55']}</span>";
1171                 } else {
1172                         echo "<br/>";
1173                 }
1174                 echo "</td>";
1175                 echo "<td width='300px' valign='top'>";
1176                 echo "<span class='text'><i>Test cranial nerves with notation of any deficits</i></span>";
1177                 echo "</td>";
1178                 echo "<td valign='top'>";
1179                 if ( $data['col_55_textbox'] != null ) {
1180                         echo "<span class='text'>${data['col_55_textbox']}</span>";
1181                 } else {
1182                         echo "<br/>";
1183                 }
1184                 echo "</td>";
1185         echo "</tr>";
1186 }
1187 if ( ($data["col_56"] != "N/A" && $data["col_56"] != "" && $data["col_56"] != "--") || ( $data["col_56_textbox"] != "" && $data["col_56_textbox"] != null ) ) {
1188         echo "<tr>";
1189                 echo "<td valign='top'>";
1190                 if ( $data['col_56'] != null && $data['col_56'] != 'N/A' ) {
1191                         echo "<span class='text'>${data['col_56']}</span>";
1192                 } else {
1193                         echo "<br/>";
1194                 }
1195                 echo "</td>";
1196                 echo "<td width='300px' valign='top'>";
1197                 echo "<span class='text'><i>Examination of deep tendon reflexes with notation of pathological reflexes (eg, Babinski)</i></span>";
1198                 echo "</td>";
1199                 echo "<td valign='top'>";
1200                 if ( $data['col_56_textbox'] != null ) {
1201                         echo "<span class='text'>${data['col_56_textbox']}</span>";
1202                 } else {
1203                         echo "<br/>";
1204                 }
1205                 echo "</td>";
1206         echo "</tr>";
1207 }
1208 if ( ($data["col_57"] != "N/A" && $data["col_57"] != "" && $data["col_57"] != "--") || ( $data["col_57_textbox"] != "" && $data["col_57_textbox"] != null ) ) {
1209         echo "<tr>";
1210                 echo "<td valign='top'>";
1211                 if ( $data['col_57'] != null && $data['col_57'] != 'N/A' ) {
1212                         echo "<span class='text'>${data['col_57']}</span>";
1213                 } else {
1214                         echo "<br/>";
1215                 }
1216                 echo "</td>";
1217                 echo "<td width='300px' valign='top'>";
1218                 echo "<span class='text'><i>Examination of sensation (eg, by touch, pin, vibration, proprioception)</i></span>";
1219                 echo "</td>";
1220                 echo "<td valign='top'>";
1221                 if ( $data['col_57_textbox'] != null ) {
1222                         echo "<span class='text'>${data['col_57_textbox']}</span>";
1223                 } else {
1224                         echo "<br/>";
1225                 }
1226                 echo "</td>";
1227         echo "</tr>";
1228 }
1229 echo "<tr><td colspan='3'><span class='bold'><u>Psychiatric</u></span></td></tr>";
1230 if ( ($data["col_58"] != "N/A" && $data["col_58"] != "" && $data["col_58"] != "--") || ( $data["col_58_textbox"] != "" && $data["col_58_textbox"] != null ) ) {
1231         echo "<tr>";
1232                 echo "<td valign='top'>";
1233                 if ( $data['col_58'] != null && $data['col_58'] != 'N/A' ) {
1234                         echo "<span class='text'>${data['col_58']}</span>";
1235                 } else {
1236                         echo "<br/>";
1237                 }
1238                 echo "</td>";
1239                 echo "<td width='300px' valign='top'>";
1240                 echo "<span class='text'><i>Description of patient’s judgment and insight</i></span>";
1241                 echo "</td>";
1242                 echo "<td valign='top'>";
1243                 if ( $data['col_58_textbox'] != null ) {
1244                         echo "<span class='text'>${data['col_58_textbox']}</span>";
1245                 } else {
1246                         echo "<br/>";
1247                 }
1248                 echo "</td>";
1249         echo "</tr>";
1250 }
1251 if ( ($data["col_59"] != "N/A" && $data["col_59"] != "" && $data["col_59"] != "--") || ( $data["col_59_textbox"] != "" && $data["col_59_textbox"] != null ) ) {
1252         echo "<tr>";
1253                 echo "<td valign='top'>";
1254                 if ( $data['col_59'] != null && $data['col_59'] != 'N/A' ) {
1255                         echo "<span class='text'>${data['col_59']}</span>";
1256                 } else {
1257                         echo "<br/>";
1258                 }
1259                 echo "</td>";
1260                 echo "<td width='300px' valign='top'>";
1261                 echo "<span class='text'><i>Brief assessment of mental status including:</i></span>";
1262                 echo "</td>";
1263                 echo "<td valign='top'>";
1264                 if ( $data['col_59_textbox'] != null ) {
1265                         echo "<span class='text'>${data['col_59_textbox']}</span>";
1266                 } else {
1267                         echo "<br/>";
1268                 }
1269                 echo "</td>";
1270         echo "</tr>";
1271 }
1272 if ( ($data["col_60"] != "N/A" && $data["col_60"] != "" && $data["col_60"] != "--") || ( $data["col_60_textbox"] != "" && $data["col_60_textbox"] != null ) ) {
1273         echo "<tr>";
1274                 echo "<td valign='top'>";
1275                 if ( $data['col_60'] != null && $data['col_60'] != 'N/A' ) {
1276                         echo "<span class='text'>${data['col_60']}</span>";
1277                 } else {
1278                         echo "<br/>";
1279                 }
1280                 echo "</td>";
1281                 echo "<td width='300px' valign='top'>";
1282                 echo "<span class='text'><i>orientation to time, place and person</i></span>";
1283                 echo "</td>";
1284                 echo "<td valign='top'>";
1285                 if ( $data['col_60_textbox'] != null ) {
1286                         echo "<span class='text'>${data['col_60_textbox']}</span>";
1287                 } else {
1288                         echo "<br/>";
1289                 }
1290                 echo "</td>";
1291         echo "</tr>";
1292 }
1293 if ( ($data["col_61"] != "N/A" && $data["col_61"] != "" && $data["col_61"] != "--") || ( $data["col_61_textbox"] != "" && $data["col_61_textbox"] != null ) ) {
1294         echo "<tr>";
1295                 echo "<td valign='top'>";
1296                 if ( $data['col_61'] != null && $data['col_61'] != 'N/A' ) {
1297                         echo "<span class='text'>${data['col_61']}</span>";
1298                 } else {
1299                         echo "<br/>";
1300                 }
1301                 echo "</td>";
1302                 echo "<td width='300px' valign='top'>";
1303                 echo "<span class='text'><i>recent and remote memory</i></span>";
1304                 echo "</td>";
1305                 echo "<td valign='top'>";
1306                 if ( $data['col_61_textbox'] != null ) {
1307                         echo "<span class='text'>${data['col_61_textbox']}</span>";
1308                 } else {
1309                         echo "<br/>";
1310                 }
1311                 echo "</td>";
1312         echo "</tr>";
1313 }
1314 if ( ($data["col_62"] != "N/A" && $data["col_62"] != "" && $data["col_62"] != "--") || ( $data["col_62_textbox"] != "" && $data["col_62_textbox"] != null ) ) {
1315         echo "<tr>";
1316                 echo "<td valign='top'>";
1317                 if ( $data['col_62'] != null && $data['col_62'] != 'N/A' ) {
1318                         echo "<span class='text'>${data['col_62']}</span>";
1319                 } else {
1320                         echo "<br/>";
1321                 }
1322                 echo "</td>";
1323                 echo "<td width='300px' valign='top'>";
1324                 echo "<span class='text'><i>mood and affect (eg, depression, anxiety, agitation)</i></span>";
1325                 echo "</td>";
1326                 echo "<td valign='top'>";
1327                 if ( $data['col_62_textbox'] != null ) {
1328                         echo "<span class='text'>${data['col_62_textbox']}</span>";
1329                 } else {
1330                         echo "<br/>";
1331                 }
1332                 echo "</td>";
1333         echo "</tr>";
1334 }
1335
1336
1337   print "</table>";
1338   }
1339
1340 }
1341 ?>