contrib/forms/high_risk_screening_record/printable.php

   1 <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
   2
   3 "http://www.w3.org/TR/html4/loose.dtd">
   4
   5 <?php
   6
   7 include_once("../../globals.php");
   8
   9 include_once("$srcdir/api.inc");
  10
  11 include_once("$srcdir/forms.inc");
  12
  13 include_once("$srcdir/calendar.inc");
  14
  15 ?>
  16
  17
  18
  19 <html>
  20
  21 <head>
  22 <? html_header_show();?>
  23
  24 <title>Form: High risk screening record</title>
  25
  26 <? include("../../acog_printable_h.css"); ?>
  27
  28 </head>
  29
  30
  31
  32 <?
  33
  34    $fres=sqlStatement("select * from patient_data where pid='".$pid."'");
  35
  36    if ($fres){
  37
  38      $patient = sqlFetchArray($fres);
  39
  40    }
  41
  42    $fres=sqlStatement("select * from form_high_risk_screening_record where id=$id");
  43
  44    if ($fres){
  45
  46      $fdata = sqlFetchArray($fres);
  47
  48    }
  49
  50 ?>
  51
  52 <body <?echo $top_bg_line;?>>
  53
  54
  55
  56 <div class="srvChapter">High risk screening  record* </div>
  57
  58 <div style="border: solid 2px black; background-color:#FFFFFF;">
  59
  60   <table  border="0" cellpadding="2" cellspacing="0">
  61
  62     <tr align="left" valign="bottom">
  63
  64       <td colspan="6" class="fibody2" id="bordR">Patient name: <?  echo $patient{'fname'}.' '.$patient{'mname'}.' '.$patient{'lname'};  ?></td>
  65
  66       <td colspan="5" class="fibody2" id="bordR">Birth date: <?  echo $patient{'DOB'}; ?></td>
  67
  68       <td colspan="4" class="fibody2">ID No: <? echo $patient{'id'}; ?></td>
  69
  70       </tr>
  71
  72     <tr align="center" valign="middle">
  73
  74       <td class="ficaption2" id="bordR">&nbsp;</td>
  75
  76       <td width="6%" class="ficaption2" id="bordR">HEMO-<br>
  77
  78         GLOBIN<br>
  79
  80         TEST</td>
  81
  82       <td width="6%" class="ficaption2" id="bordR">BONE DENSITY<br>
  83
  84         SCREENING</td>
  85
  86       <td width="6%" class="ficaption2" id="bordR">BACTERI-<br>
  87
  88         URIA&nbsp;TEST</td>
  89
  90       <td width="6%" class="ficaption2" id="bordR">STD<br>
  91
  92         TESTING</td>
  93
  94       <td width="6%" class="ficaption2" id="bordR">HIV test* </td>
  95
  96       <td width="6%" class="ficaption2" id="bordR">Genetic testing </td>
  97
  98       <td width="6%" class="ficaption2" id="bordR">Rubella titer </td>
  99
 100       <td width="6%" class="ficaption2" id="bordR">TB skin test </td>
 101
 102       <td width="6%" class="ficaption2" id="bordR">Lipid profile assessment </td>
 103
 104       <td width="6%" class="ficaption2" id="bordR">Mammo-<br>
 105
 106         graphy</td>
 107
 108       <td width="6%" class="ficaption2" id="bordR">Fasting<br>
 109
 110         GLUCOSE TEST</td>
 111
 112       <td width="6%" class="ficaption2" id="bordR">TSH<br>
 113
 114         TEST</td>
 115
 116       <td width="6%" class="ficaption2" id="bordR">COLORECTAL<br>
 117
 118         CANCER<br>
 119
 120         SCREENING</td>
 121
 122       <td width="6%" class="ficaption2">HEPATITIS C<br>
 123
 124         VIRUS TEST</td>
 125
 126     </tr>
 127
 128 <?
 129
 130 $rsi = 1;
 131
 132 while ($rsi < 13){
 133
 134 list(
 135
 136 $hemoglobin, $bone_density, $bacteriuria, $std, $hiv, $genetic, $rubella, $tb_skin,
 137
 138 $lipid, $mammography, $fasting_glucose, $tsh, $cancer, $hepatitis_c
 139
 140 ) = explode("|~",$fdata["record_".$rsi]);
 141
 142 list( $hemoglobin_date, $hemoglobin_res) = explode(';', $hemoglobin);
 143
 144 list( $bone_density_date, $bone_density_res) = explode(';', $bone_density);
 145
 146 list( $bacteriuria_date, $bacteriuria_res) = explode(';', $bacteriuria);
 147
 148 list( $std_date, $std_res) = explode(';', $std);
 149
 150 list( $hiv_date, $hiv_res) = explode(';', $hiv);
 151
 152 list( $genetic_date, $genetic_res) = explode(';', $genetic);
 153
 154 list( $rubella_date, $rubella_res) = explode(';', $rubella);
 155
 156 list( $tb_skin_date, $tdb_skin_res) = explode(';', $tdb_skin);
 157
 158 list( $lipid_date, $lipid_res) = explode(';', $lipid);
 159
 160 list( $mammography_date, $mammography_res) = explode(';', $mammography);
 161
 162 list( $fasting_glucose_date, $fasting_glucose_res) = explode(';', $fasting_glucose);
 163
 164 list( $tsh_date, $tsh_res) = explode(';', $tsh);
 165
 166 list( $cancer_date, $cancer_res) = explode(';', $cancer);
 167
 168 list( $hepatitis_c_date, $hepatitis_c_res) = explode(';', $hepatitis_c);
 169
 170
 171
 172 print <<<EOL
 173
 174     <tr align="left" valign="bottom">
 175
 176       <td class="fibody3" id="bordR">Date:</td>
 177
 178       <td class="fibody3" id="bordR">${hemoglobin_date}&nbsp;</td>
 179
 180       <td class="fibody3" id="bordR">${bone_density_date}&nbsp;</td>
 181
 182       <td class="fibody3" id="bordR">${bacteriuria_date}&nbsp;</td>
 183
 184       <td class="fibody3" id="bordR">${std_date}&nbsp;</td>
 185
 186       <td class="fibody3" id="bordR">${hiv_date}&nbsp;</td>
 187
 188       <td class="fibody3" id="bordR">${genetic_date}&nbsp;</td>
 189
 190       <td class="fibody3" id="bordR">${rubella_date}&nbsp;</td>
 191
 192       <td class="fibody3" id="bordR">${tb_skin_date}&nbsp;</td>
 193
 194       <td class="fibody3" id="bordR">${lipid_date}&nbsp;</td>
 195
 196       <td class="fibody3" id="bordR">${mammography_date}&nbsp;</td>
 197
 198       <td class="fibody3" id="bordR">${fasting_glucose_date}&nbsp;</td>
 199
 200       <td class="fibody3" id="bordR">${tsh_date}&nbsp;</td>
 201
 202       <td class="fibody3" id="bordR">${cancer_date}&nbsp;</td>
 203
 204       <td class="fibody3">${hepatitis_c_date}&nbsp;</td>
 205
 206     </tr>
 207
 208     <tr align="left" valign="bottom">
 209
 210       <td class="fibody2" id="bordR">Result:</td>
 211
 212       <td class="fibody2" id="bordR">${hemoglobin_res}&nbsp;</td>
 213
 214       <td class="fibody2" id="bordR">${bone_density_res}&nbsp;</td>
 215
 216       <td class="fibody2" id="bordR">${bacteriuria_res}&nbsp;</td>
 217
 218       <td class="fibody2" id="bordR">${std_res}&nbsp;</td>
 219
 220       <td class="fibody2" id="bordR">${hiv_res}&nbsp;</td>
 221
 222       <td class="fibody2" id="bordR">${genetic_res}&nbsp;</td>
 223
 224       <td class="fibody2" id="bordR">${rubella_res}&nbsp;</td>
 225
 226       <td class="fibody2" id="bordR">${tb_skin_res}&nbsp;</td>
 227
 228       <td class="fibody2" id="bordR">${lipid_res}&nbsp;</td>
 229
 230       <td class="fibody2" id="bordR">${mammography_res}&nbsp;</td>
 231
 232       <td class="fibody2" id="bordR">${fasting_glucose_res}&nbsp;</td>
 233
 234       <td class="fibody2" id="bordR">${tsh_res}&nbsp;</td>
 235
 236       <td class="fibody2" id="bordR">${cancer_res}&nbsp;</td>
 237
 238       <td class="fibody2">${hepatitis_c_res}&nbsp;</td>
 239
 240     </tr>
 241
 242 EOL;
 243
 244 $rsi++;
 245
 246 }
 247
 248 ?>
 249
 250   </table>
 251
 252 </div>
 253
 254 <p><sup>*</sup>See Table of High-Risk Factors.</p>
 255
 256 <p><sup>**</sup>Check state requirements before recording results.</p>
 257
 258 </body>
 259
 260 </html>