contrib/forms/pain/view.php

   1 <?php
   2
   3 /**
   4  * Generated DocBlock
   5  *
   6  * @package OpenEMR
   7  * @link    http://www.open-emr.org
   8  * @author  andres_paglayan <andres_paglayan>
   9  * @author  cfapress <cfapress>
  10  * @author  Robert Down <robertdown@live.com>
  11  * @author  sunsetsystems <sunsetsystems>
  12  * @copyright Copyright (c) 2005 andres_paglayan <andres_paglayan>
  13  * @copyright Copyright (c) 2008 cfapress <cfapress>
  14  * @copyright Copyright (c) 2017-2023 Robert Down <robertdown@live.com>
  15  * @copyright Copyright (c) 2007 sunsetsystems <sunsetsystems>
  16  * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  17  */
  18
  19 ?>
  20 <?php
  21 require_once("../../globals.php");
  22
  23 use OpenEMR\Core\Header;
  24
  25 ?>
  26 <html><head>
  27     <?php Header::setupHeader(); ?>
  28 </head>
  29 <body class="body_top">
  30 <?php
  31 require_once("$srcdir/api.inc.php");
  32 $obj = formFetch("form_pain", $_GET["id"]);
  33 ?>
  34 <form method=post action="<?php echo $rootdir?>/forms/pain/save.php?mode=update&id=<?php echo attr_url($_GET["id"]); ?>" name="my_form">
  35 <span class="title">Pain Evaluation</span><br /><br />
  36
  37
  38
  39
  40 <input type=checkbox name="dull"  <?php if ($obj["dull"] == "on") {
  41     echo "checked";
  42                                   };?>><span class=text>Dull</span>
  43 <input type=checkbox name="colicky"  <?php if ($obj["colicky"] == "on") {
  44     echo "checked";
  45                                      };?>><span class=text>Colicky</span>
  46 <input type=checkbox name="sharp"  <?php if ($obj["sharp"] == "on") {
  47     echo "checked";
  48                                    };?>><span class=text>Sharp</span>
  49 <span class=text>Duration of Pain: </span><input type="text" name="duration_of_pain" value="<?php echo attr($obj["duration_of_pain"]);?>" ><br />
  50
  51
  52 <span class=text>History of Pain: </span><br /><textarea cols=40 rows=8 wrap=virtual name="history_of_pain" ><?php echo text($obj["history_of_pain"]);?></textarea><br />
  53
  54
  55 <table><tr><td>
  56 <table><tr>
  57 <td><span class=text>Accompanying Symptoms Vomitting: </span></td><td><input type="text" name="accompanying_symptoms_vomitting" value="<?php echo attr($obj["accompanying_symptoms_vomitting"]);?>" ></td>
  58 </tr><tr>
  59 <td><span class=text>Accompanying Symptoms Nausea: </span></td><td><input type="text" name="accompanying_symptoms_nausea" value="<?php echo attr($obj["accompanying_symptoms_nausea"]);?>" ></td>
  60 </tr><tr>
  61 <td><span class=text>Accompanying Symptoms Headache: </span></td><td><input type="text" name="accompanying_symptoms_headache" value="<?php echo attr($obj["accompanying_symptoms_headache"]);?>" ></td>
  62 </tr></table>
  63 </td><td>
  64 <span class=text>Accompanying Symptoms Other: </span><br /><textarea cols=40 rows=8 wrap=virtual name="accompanying_symptoms_other" ><?php echo text($obj["accompanying_symptoms_other"]);?></textarea><br />
  65 </td></tr></table>
  66
  67 <table>
  68 <tr><td>
  69 <span class=text>Pain Referred to Other Sites?: </span><br /><textarea cols=40 rows=4 wrap=virtual name="pain_referred_to_other_sites" ><?php echo text($obj["pain_referred_to_other_sites"]);?></textarea>
  70 </td><td>
  71 <span class=text>What Relieves Pain?: </span><br /><textarea cols=40 rows=4 wrap=virtual name="what_relieves_pain" ><?php echo text($obj["what_relieves_pain"]);?></textarea>
  72 </td></tr><tr><td>
  73 <span class=text>What Makes Pain Worse (Movement/Positions/Activities)?: </span><br /><textarea cols=40 rows=4 wrap=virtual name="what_makes_pain_worse" ><?php echo text($obj["what_makes_pain_worse"]);?></textarea>
  74 </td><td>
  75 <span class=text>Additional Notes: </span><br /><textarea cols=40 rows=4 wrap=virtual name="additional_notes" ><?php echo text($obj["additional_notes"]);?></textarea>
  76 </td></tr></table>
  77
  78
  79
  80 <br />
  81 <a href="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save]</a>
  82 <br />
  83 <a href="<?php echo $GLOBALS['form_exit_url']; ?>" class="link"
  84  onclick="top.restoreSession()">[Don't Save Changes]</a>
  85 </form>
  86 <?php
  87 formFooter();
  88 ?>