1 <!-- Forms generated from formsWiz
-->
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_reviewofs", $_GET["id"]);
15 <form method
=post action
="<?php echo $rootdir?>/forms/reviewofs/save.php?mode=update&id=<?php echo $_GET["id
"];?>"
16 name
="my_form" onsubmit
="return top.restoreSession()">
17 <span
class="title"><?php
xl('Review of Systems Checks','e'); ?
></span
><Br
><br
>
22 <span
class=bold
><?php
xl('General','e'); ?
></span
><br
>
23 <input type
=checkbox name
="fever" <?php
if ($obj{"fever"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Fever','e'); ?
></span
><br
>
24 <input type
=checkbox name
="chills" <?php
if ($obj{"chills"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Chills','e'); ?
></span
><br
>
25 <input type
=checkbox name
="night_sweats" <?php
if ($obj{"night_sweats"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Night Sweats','e'); ?
></span
><br
>
26 <input type
=checkbox name
="weight_loss" <?php
if ($obj{"weight_loss"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Weight Loss','e'); ?
></span
><br
>
27 <input type
=checkbox name
="poor_appetite" <?php
if ($obj{"poor_appetite"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Poor Appetite','e'); ?
></span
><br
>
28 <input type
=checkbox name
="insomnia" <?php
if ($obj{"insomnia"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Insomnia','e'); ?
></span
><br
>
29 <input type
=checkbox name
="fatigued" <?php
if ($obj{"fatigued"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Fatigued','e'); ?
></span
><br
>
30 <input type
=checkbox name
="depressed" <?php
if ($obj{"depressed"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Depressed','e'); ?
></span
><br
>
31 <input type
=checkbox name
="hyperactive" <?php
if ($obj{"hyperactive"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Hyperactive','e'); ?
></span
><br
>
32 <input type
=checkbox name
="exposure_to_foreign_countries" <?php
if ($obj{"exposure_to_foreign_countries"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Exposure to Foreign Countries','e'); ?
></span
><br
>
33 <span
class=bold
><?php
xl('Skin','e'); ?
></span
><br
>
34 <input type
=checkbox name
="rashes" <?php
if ($obj{"rashes"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Rashes','e'); ?
></span
><br
>
35 <input type
=checkbox name
="infections" <?php
if ($obj{"infections"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Infections','e'); ?
></span
><br
>
36 <input type
=checkbox name
="ulcerations" <?php
if ($obj{"ulcerations"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Ulcerations','e'); ?
></span
><br
>
37 <input type
=checkbox name
="pemphigus" <?php
if ($obj{"pemphigus"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Pemphigus','e'); ?
></span
><br
>
38 <input type
=checkbox name
="herpes" <?php
if ($obj{"herpes"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Herpes','e'); ?
></span
><br
>
41 <span
class=bold
><?php
xl('HEENT','e'); ?
></span
><br
>
42 <input type
=checkbox name
="cataracts" <?php
if ($obj{"cataracts"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Cataracts','e'); ?
></span
><br
>
43 <input type
=checkbox name
="cataract_surgery" <?php
if ($obj{"cataract_surgery"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Cataract Surgery','e'); ?
></span
><br
>
44 <input type
=checkbox name
="glaucoma" <?php
if ($obj{"glaucoma"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Glaucoma','e'); ?
></span
><br
>
45 <input type
=checkbox name
="double_vision" <?php
if ($obj{"double_vision"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Double Vision','e'); ?
></span
><br
>
46 <input type
=checkbox name
="blurred_vision" <?php
if ($obj{"blurred_vision"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Blurred Vision','e'); ?
></span
><br
>
47 <input type
=checkbox name
="poor_hearing" <?php
if ($obj{"poor_hearing"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Poor Hearing','e'); ?
></span
><br
>
48 <input type
=checkbox name
="headaches" <?php
if ($obj{"headaches"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Headaches','e'); ?
></span
><br
>
49 <input type
=checkbox name
="ringing_in_ears" <?php
if ($obj{"ringing_in_ears"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Ringing in Ears','e'); ?
></span
><br
>
50 <input type
=checkbox name
="bloody_nose" <?php
if ($obj{"bloody_nose"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Bloody Nose','e'); ?
></span
><br
>
51 <input type
=checkbox name
="sinusitis" <?php
if ($obj{"sinusitis"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Sinusitis','e'); ?
></span
><br
>
52 <input type
=checkbox name
="sinus_surgery" <?php
if ($obj{"sinus_surgery"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Sinus Surgery','e'); ?
></span
><br
>
53 <input type
=checkbox name
="dry_mouth" <?php
if ($obj{"dry_mouth"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Dry Mouth','e'); ?
></span
><br
>
54 <input type
=checkbox name
="strep_throat" <?php
if ($obj{"strep_throat"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Strep Throat','e'); ?
></span
><br
>
55 <input type
=checkbox name
="tonsillectomy" <?php
if ($obj{"tonsillectomy"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Tonsillectomy','e'); ?
></span
><br
>
56 <input type
=checkbox name
="swollen_lymph_nodes" <?php
if ($obj{"swollen_lymph_nodes"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Swollen Lymph Nodes','e'); ?
></span
><br
>
57 <input type
=checkbox name
="throat_cancer" <?php
if ($obj{"throat_cancer"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Throat Cancer','e'); ?
></span
><br
>
58 <input type
=checkbox name
="throat_cancer_surgery" <?php
if ($obj{"throat_cancer_surgery"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Throat Cancer Surgery','e'); ?
></span
><br
>
61 <span
class=bold
><?php
xl('Cardiovascular','e'); ?
></span
><br
>
62 <input type
=checkbox name
="heart_attack" <?php
if ($obj{"heart_attack"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Heart Attack','e'); ?
></span
><br
>
63 <input type
=checkbox name
="irregular_heart_beat" <?php
if ($obj{"irregular_heart_beat"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Irregular Heart Beat','e'); ?
></span
><br
>
64 <input type
=checkbox name
="chest_pains" <?php
if ($obj{"chest_pains"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Chest Pains','e'); ?
></span
><br
>
65 <input type
=checkbox name
="shortness_of_breath" <?php
if ($obj{"shortness_of_breath"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Shortness of Breath','e'); ?
></span
><br
>
66 <input type
=checkbox name
="high_blood_pressure" <?php
if ($obj{"high_blood_pressure"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('High Blood Pressure','e'); ?
></span
><br
>
67 <input type
=checkbox name
="heart_failure" <?php
if ($obj{"heart_failure"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Heart Failure','e'); ?
></span
><br
>
68 <input type
=checkbox name
="poor_circulation" <?php
if ($obj{"poor_circulation"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Poor Circulation','e'); ?
></span
><br
>
69 <input type
=checkbox name
="vascular_surgery" <?php
if ($obj{"vascular_surgery"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Vascular Surgery','e'); ?
></span
><br
>
70 <input type
=checkbox name
="cardiac_catheterization" <?php
if ($obj{"cardiac_catheterization"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Cardiac Catheterization','e'); ?
></span
><br
>
71 <input type
=checkbox name
="coronary_artery_bypass" <?php
if ($obj{"coronary_artery_bypass"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Coronary Artery Bypass','e'); ?
></span
><br
>
72 <input type
=checkbox name
="heart_transplant" <?php
if ($obj{"heart_transplant"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Heart Transplant','e'); ?
></span
><br
>
73 <input type
=checkbox name
="stress_test" <?php
if ($obj{"stress_test"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Stress Test','e'); ?
></span
><br
>
74 <span
class=bold
><?php
xl('Endocrine','e'); ?
></span
><br
>
75 <input type
=checkbox name
="insulin_dependent_diabetes" <?php
if ($obj{"insulin_dependent_diabetes"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Insulin Dependent Diabetes','e'); ?
></span
><br
>
76 <input type
=checkbox name
="noninsulin_dependent_diabetes" <?php
if ($obj{"noninsulin_dependent_diabetes"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Non-Insulin Dependent Diabetes','e'); ?
></span
><br
>
77 <input type
=checkbox name
="hypothyroidism" <?php
if ($obj{"hypothyroidism"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Hypothyroidism','e'); ?
></span
><br
>
78 <input type
=checkbox name
="hyperthyroidism" <?php
if ($obj{"hyperthyroidism"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Hyperthyroidism','e'); ?
></span
><br
>
79 <input type
=checkbox name
="cushing_syndrom" <?php
if ($obj{"cushing_syndrom"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Cushing Syndrom','e'); ?
></span
><br
>
80 <input type
=checkbox name
="addison_syndrom" <?php
if ($obj{"addison_syndrom"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Addison Syndrom','e'); ?
></span
><br
>
83 <span
class=bold
><?php
xl('Pulmonary','e'); ?
></span
><br
>
84 <input type
=checkbox name
="emphysema" <?php
if ($obj{"emphysema"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Emphysema','e'); ?
></span
><br
>
85 <input type
=checkbox name
="chronic_bronchitis" <?php
if ($obj{"chronic_bronchitis"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Chronic Bronchitis','e'); ?
></span
><br
>
86 <input type
=checkbox name
="interstitial_lung_disease" <?php
if ($obj{"interstitial_lung_disease"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Interstitial Lung Disease','e'); ?
></span
><br
>
87 <input type
=checkbox name
="shortness_of_breath_2" <?php
if ($obj{"shortness_of_breath_2"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Shortness of Breath','e'); ?
></span
><br
>
88 <input type
=checkbox name
="lung_cancer" <?php
if ($obj{"lung_cancer"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Lung Cancer','e'); ?
></span
><br
>
89 <input type
=checkbox name
="lung_cancer_surgery" <?php
if ($obj{"lung_cancer_surgery"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Lung Cancer Surgery','e'); ?
></span
><br
>
90 <input type
=checkbox name
="pheumothorax" <?php
if ($obj{"pheumothorax"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Pheumothorax','e'); ?
></span
><br
>
91 <span
class=bold
><?php
xl('Genitourinary','e'); ?
></span
><br
>
92 <input type
=checkbox name
="kidney_failure" <?php
if ($obj{"kidney_failure"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Kidney Failure','e'); ?
></span
><br
>
93 <input type
=checkbox name
="kidney_stones" <?php
if ($obj{"kidney_stones"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Kidney Stones','e'); ?
></span
><br
>
94 <input type
=checkbox name
="kidney_cancer" <?php
if ($obj{"kidney_cancer"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Kidney Cancer','e'); ?
></span
><br
>
95 <input type
=checkbox name
="kidney_infections" <?php
if ($obj{"kidney_infections"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Kidney Infections','e'); ?
></span
><br
>
96 <input type
=checkbox name
="bladder_infections" <?php
if ($obj{"bladder_infections"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Bladder Infections','e'); ?
></span
><br
>
97 <input type
=checkbox name
="bladder_cancer" <?php
if ($obj{"bladder_cancer"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Bladder Cancer','e'); ?
></span
><br
>
98 <input type
=checkbox name
="prostate_problems" <?php
if ($obj{"prostate_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Prostate Problems','e'); ?
></span
><br
>
99 <input type
=checkbox name
="prostate_cancer" <?php
if ($obj{"prostate_cancer"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Prostate Cancer','e'); ?
></span
><br
>
100 <input type
=checkbox name
="kidney_transplant" <?php
if ($obj{"kidney_transplant"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Kidney Transplant','e'); ?
></span
><br
>
101 <input type
=checkbox name
="sexually_transmitted_disease" <?php
if ($obj{"sexually_transmitted_disease"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Sexually Transmitted Disease','e'); ?
></span
><br
>
102 <input type
=checkbox name
="burning_with_urination" <?php
if ($obj{"burning_with_urination"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Burning with Urination','e'); ?
></span
><br
>
103 <input type
=checkbox name
="discharge_from_urethra" <?php
if ($obj{"discharge_from_urethra"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Discharge From Urethra','e'); ?
></span
><br
>
106 <span
class=bold
><?php
xl('Gastrointestinal','e'); ?
></span
><br
>
107 <input type
=checkbox name
="stomach_pains" <?php
if ($obj{"stomach_pains"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Stomach Pains','e'); ?
></span
><br
>
108 <input type
=checkbox name
="peptic_ulcer_disease" <?php
if ($obj{"peptic_ulcer_disease"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Peptic Ulcer Disease','e'); ?
></span
><br
>
109 <input type
=checkbox name
="gastritis" <?php
if ($obj{"gastritis"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Gastritis','e'); ?
></span
><br
>
110 <input type
=checkbox name
="endoscopy" <?php
if ($obj{"endoscopy"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Endoscopy','e'); ?
></span
><br
>
111 <input type
=checkbox name
="polyps" <?php
if ($obj{"polyps"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Polyps','e'); ?
></span
><br
>
112 <input type
=checkbox name
="colonoscopy" <?php
if ($obj{"colonoscopy"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('colonoscopy','e'); ?
></span
><br
>
113 <input type
=checkbox name
="colon_cancer" <?php
if ($obj{"colon_cancer"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Colon Cancer','e'); ?
></span
><br
>
114 <input type
=checkbox name
="colon_cancer_surgery" <?php
if ($obj{"colon_cancer_surgery"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Colon Cancer Surgery','e'); ?
></span
><br
>
115 <input type
=checkbox name
="ulcerative_colitis" <?php
if ($obj{"ulcerative_colitis"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Ulcerative Colitis','e'); ?
></span
><br
>
116 <input type
=checkbox name
="crohns_disease" <?php
if ($obj{"crohns_disease"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Crohn\'s Disease','e'); ?
></span
><br
>
117 <input type
=checkbox name
="appendectomy" <?php
if ($obj{"appendectomy"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Appendectomy','e'); ?
></span
><br
>
118 <input type
=checkbox name
="divirticulitis" <?php
if ($obj{"divirticulitis"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Divirticulitis','e'); ?
></span
><br
>
119 <input type
=checkbox name
="divirticulitis_surgery" <?php
if ($obj{"divirticulitis_surgery"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Divirticulitis Surgery','e'); ?
></span
><br
>
120 <input type
=checkbox name
="gall_stones" <?php
if ($obj{"gall_stones"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Gall Stones','e'); ?
></span
><br
>
121 <input type
=checkbox name
="cholecystectomy" <?php
if ($obj{"cholecystectomy"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Cholecystectomy','e'); ?
></span
><br
>
122 <input type
=checkbox name
="hepatitis" <?php
if ($obj{"hepatitis"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Hepatitis','e'); ?
></span
><br
>
123 <input type
=checkbox name
="cirrhosis_of_the_liver" <?php
if ($obj{"cirrhosis_of_the_liver"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Cirrhosis of the Liver','e'); ?
></span
><br
>
124 <input type
=checkbox name
="splenectomy" <?php
if ($obj{"splenectomy"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Splenectomy','e'); ?
></span
><br
>
127 <span
class=bold
><?php
xl('Musculoskeletal','e'); ?
></span
><br
>
128 <input type
=checkbox name
="osetoarthritis" <?php
if ($obj{"osetoarthritis"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Osetoarthritis','e'); ?
></span
><br
>
129 <input type
=checkbox name
="rheumotoid_arthritis" <?php
if ($obj{"rheumotoid_arthritis"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Rheumotoid Arthritis','e'); ?
></span
><br
>
130 <input type
=checkbox name
="lupus" <?php
if ($obj{"lupus"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Lupus','e'); ?
></span
><br
>
131 <input type
=checkbox name
="ankylosing_sondlilitis" <?php
if ($obj{"ankylosing_sondlilitis"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Ankylosing Sondlilitis','e'); ?
></span
><br
>
132 <input type
=checkbox name
="swollen_joints" <?php
if ($obj{"swollen_joints"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Swollen Joints','e'); ?
></span
><br
>
133 <input type
=checkbox name
="stiff_joints" <?php
if ($obj{"stiff_joints"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Stiff Joints','e'); ?
></span
><br
>
134 <input type
=checkbox name
="broken_bones" <?php
if ($obj{"broken_bones"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Broken Bones','e'); ?
></span
><br
>
135 <input type
=checkbox name
="neck_problems" <?php
if ($obj{"neck_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Neck Problems','e'); ?
></span
><br
>
136 <input type
=checkbox name
="back_problems" <?php
if ($obj{"back_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Back Problems','e'); ?
></span
><br
>
137 <input type
=checkbox name
="back_surgery" <?php
if ($obj{"back_surgery"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Back Surgery','e'); ?
></span
><br
>
138 <input type
=checkbox name
="scoliosis" <?php
if ($obj{"scoliosis"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Scoliosis','e'); ?
></span
><br
>
139 <input type
=checkbox name
="herniated_disc" <?php
if ($obj{"herniated_disc"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Herniated Disc','e'); ?
></span
><br
>
140 <input type
=checkbox name
="shoulder_problems" <?php
if ($obj{"shoulder_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Shoulder Problems','e'); ?
></span
><br
>
141 <input type
=checkbox name
="elbow_problems" <?php
if ($obj{"elbow_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Elbow Problems','e'); ?
></span
><br
>
142 <input type
=checkbox name
="wrist_problems" <?php
if ($obj{"wrist_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Wrist Problems','e'); ?
></span
><br
>
143 <input type
=checkbox name
="hand_problems" <?php
if ($obj{"hand_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Hand Problems','e'); ?
></span
><br
>
144 <input type
=checkbox name
="hip_problems" <?php
if ($obj{"hip_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Hip Problems','e'); ?
></span
><br
>
145 <input type
=checkbox name
="knee_problems" <?php
if ($obj{"knee_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Knee Problems','e'); ?
></span
><br
>
146 <input type
=checkbox name
="ankle_problems" <?php
if ($obj{"ankle_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Ankle Problems','e'); ?
></span
><br
>
147 <input type
=checkbox name
="foot_problems" <?php
if ($obj{"foot_problems"} == "on") {echo "checked";};?
>><span
class=text
><?php
xl('Foot Problems','e'); ?
></span
><br
>
152 <span
class=text
><?php
xl('Additional Notes: ','e'); ?
></span
><br
><textarea cols
=40 rows
=8 wrap
=virtual name
="additional_notes" ><?php
echo $obj{"additional_notes"};?
></textarea
><br
>
154 <a href
="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[<?php
xl('Save','e'); ?
>]</a
>
156 <a href
="<?php echo "$rootdir/patient_file
/encounter
/$returnurl";?>" class="link"
157 onclick
="top.restoreSession()">[<?php
xl('Don\'t Save Changes','e'); ?
>]</a
>