contrib/forms/progressnotes/view.php

   1 <?php
   2
   3 #######################################################
   4
   5 # Progress Notes Form created by Kam Sharifi          #
   6
   7 # kam@sharmen.com                                     #
   8
   9 #######################################################
  10
  11 include_once("../../globals.php");
  12
  13 ?>
  14
  15 <html><head>
  16 <? html_header_show();?>
  17
  18 <link rel=stylesheet href="<?echo $css_header;?>" type="text/css">
  19
  20 </head>
  21
  22 <body <?echo $top_bg_line;?> topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
  23
  24 <?php
  25
  26 include_once("$srcdir/api.inc");
  27
  28 $obj = formFetch("form_progressnotes", $_GET["id"]);
  29
  30 ?>
  31
  32 <form method=post action="<?echo $rootdir?>/forms/progressnotes/save.php?mode=update&id=<?echo $_GET["id"];?>" name="my_form">
  33
  34 <span class="title">Progress Notes</span><Br><br>
  35
  36
  37
  38 <table width=100%>
  39
  40 <b>
  41
  42 <span class=text>P: </span><input size=3 type=entry name="prog_p" value="<?echo $obj{"prog_p"};?>" >
  43
  44 <span class=text>R: </span><input size=3 type=entry name="prog_r" value="<?echo $obj{"prog_r"};?>" >
  45
  46 <span class=text>BP: </span><input size=3 type=entry name="prog_bp" value="<?echo $obj{"prog_bp"};?>" >
  47
  48 <span class=text>HT: </span><input size=3 type=entry name="prog_ht" value="<?echo $obj{"prog_ht"};?>" >
  49
  50 <span class=text>WT: </span><input size=3 type=entry name="prog_wt" value="<?echo $obj{"prog_wt"};?>" >
  51
  52 <span class=text>TEMP: </span><input size=3 type=entry name="prog_temp" value="<?echo $obj{"prog_temp"};?>" >
  53
  54 <span class=text>LMP: </span><input size=3 type=entry name="prog_lmp" value="<?echo $obj{"prog_lmp"};?>" >
  55
  56 <br><span class=text>Last Pap Smear: </span><input size=3 type=entry name="prog_last_pap_smear" value="<?echo $obj{"prog_last_pap_smear"};?>" >
  57
  58 <span class=text>Last Td. Booster: </span><input size=3 type=entry name="prog_last_td_booster" value="<?echo $obj{"prog_last_td_booster"};?>" >
  59
  60 <span class=text>Allergies: </span><input size=3 type=entry name="prog_allergies" value="<?echo $obj{"prog_allergies"};?>" >
  61
  62 <span class=text>Last Mammogram: </span><input size=3 type=entry name="prog_last_mammogram" value="<?echo $obj{"prog_last_mammogram"};?>" >
  63
  64 </b>
  65
  66 </table>
  67
  68 <br>
  69
  70
  71
  72 <span class=text><b>Present Complaint*:</b> </span><br><textarea cols=40 rows=8 wrap=virtual name="prog_present_complaint" ><?echo $obj{"prog_present_complaint"};?></textarea>
  73
  74
  75
  76 <br><br>
  77
  78 <b>Past Medical History</b>
  79
  80
  81
  82     <TABLE ID="Table1" BORDER=1 CELLSPACING=2 CELLPADDING=1 WIDTH="100%" >
  83
  84         <TR>
  85
  86             <TD WIDTH=53>
  87
  88                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
  89
  90             </TD>
  91
  92             <TD WIDTH=40>
  93
  94                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>ABN</B></FONT><B></B></P>
  95
  96             </TD>
  97
  98             <TD WIDTH=34>
  99
 100                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>NE</B></FONT><B></B></P>
 101
 102             </TD>
 103
 104             <TD WIDTH=324>
 105
 106                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>PHYSICAL EXAMINATION -Comments</B></FONT><B></B></P>
 107
 108             </TD>
 109
 110         </TR>
 111
 112         <TR>
 113
 114             <TD HEIGHT=14>
 115
 116                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 117
 118             </TD>
 119
 120             <TD WIDTH=40>
 121
 122                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 123
 124                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 125
 126                         <TR>
 127
 128                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox2" TYPE=CHECKBOX NAME="prog_skin_abn" <?if ($obj{"prog_skin_abn"} == "on") {echo "checked";};?>></TD>
 129
 130                         </TR>
 131
 132                     </TABLE>
 133
 134                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 135
 136             <TD WIDTH=34>
 137
 138                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 139
 140                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 141
 142                         <TR>
 143
 144                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox8" TYPE=CHECKBOX NAME="prog_skin_ne" <?if ($obj{"prog_skin_ne"} == "on") {echo "checked";};?>></TD>
 145
 146                         </TR>
 147
 148                     </TABLE>
 149
 150                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 151
 152             <TD WIDTH=324>
 153
 154                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>SKIN: no significant lesions</B></FONT><B></B></P>
 155
 156             </TD>
 157
 158         </TR>
 159
 160         <TR>
 161
 162             <TD HEIGHT=14>
 163
 164                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 165
 166             </TD>
 167
 168             <TD WIDTH=40>
 169
 170                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 171
 172                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 173
 174                         <TR>
 175
 176                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox7" TYPE=CHECKBOX NAME="prog_head_abn" <?if ($obj{"prog_head_abn"} == "on") {echo "checked";};?>></TD>
 177
 178                         </TR>
 179
 180                     </TABLE>
 181
 182                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 183
 184             <TD WIDTH=34>
 185
 186                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 187
 188                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 189
 190                         <TR>
 191
 192                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox9" TYPE=CHECKBOX NAME="prog_head_ne" <?if ($obj{"prog_head_ne"} == "on") {echo "checked";};?>></TD>
 193
 194                         </TR>
 195
 196                     </TABLE>
 197
 198                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 199
 200             <TD WIDTH=324>
 201
 202                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>HEAD: normocephalic. no headache</B></FONT><B></B></P>
 203
 204             </TD>
 205
 206         </TR>
 207
 208         <TR>
 209
 210             <TD HEIGHT=11>
 211
 212                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 213
 214             </TD>
 215
 216             <TD WIDTH=40>
 217
 218                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 219
 220                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 221
 222                         <TR>
 223
 224                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox10" TYPE=CHECKBOX NAME="prog_eyes_abn" <?if ($obj{"prog_eyes_abn"} == "on") {echo "checked";};?>></TD>
 225
 226                         </TR>
 227
 228                     </TABLE>
 229
 230                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 231
 232             <TD WIDTH=34>
 233
 234                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 235
 236                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 237
 238                         <TR>
 239
 240                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox11" TYPE=CHECKBOX NAME="prog_eyes_ne" <?if ($obj{"prog_eyes_ne"} == "on") {echo "checked";};?>></TD>
 241
 242                         </TR>
 243
 244                     </TABLE>
 245
 246                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 247
 248             <TD WIDTH=324>
 249
 250                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>EYES: perla. eom satisfactory</B></FONT><B></B></P>
 251
 252             </TD>
 253
 254         </TR>
 255
 256         <TR>
 257
 258             <TD>
 259
 260                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 261
 262             </TD>
 263
 264             <TD WIDTH=40>
 265
 266                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 267
 268                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 269
 270                         <TR>
 271
 272                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox12" TYPE=CHECKBOX NAME="prog_ears_abn" <?if ($obj{"prog_ears_abn"} == "on") {echo "checked";};?>></TD>
 273
 274                         </TR>
 275
 276                     </TABLE>
 277
 278                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 279
 280             <TD WIDTH=34>
 281
 282                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 283
 284                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 285
 286                         <TR>
 287
 288                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox13" TYPE=CHECKBOX NAME="prog_ears_ne" <?if ($obj{"prog_ears_ne"} == "on") {echo "checked";};?>></TD>
 289
 290                         </TR>
 291
 292                     </TABLE>
 293
 294                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 295
 296             <TD WIDTH=324>
 297
 298                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>EARS: drums intact</B></FONT><B></B></P>
 299
 300             </TD>
 301
 302         </TR>
 303
 304         <TR>
 305
 306             <TD HEIGHT=19>
 307
 308                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 309
 310             </TD>
 311
 312             <TD WIDTH=40>
 313
 314                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 315
 316                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 317
 318                         <TR>
 319
 320                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox14" TYPE=CHECKBOX NAME="prog_nose_abn" <?if ($obj{"prog_nose_abn"} == "on") {echo "checked";};?>></TD>
 321
 322                         </TR>
 323
 324                     </TABLE>
 325
 326                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 327
 328             <TD WIDTH=34>
 329
 330                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 331
 332                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 333
 334                         <TR>
 335
 336                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox16" TYPE=CHECKBOX NAME="prog_nose_ne" <?if ($obj{"prog_nose_ne"} == "on") {echo "checked";};?>></TD>
 337
 338                         </TR>
 339
 340                     </TABLE>
 341
 342                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 343
 344             <TD WIDTH=324>
 345
 346                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>NOSE: no abnormality</B></FONT><B></B></P>
 347
 348             </TD>
 349
 350         </TR>
 351
 352         <TR>
 353
 354             <TD>
 355
 356                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 357
 358             </TD>
 359
 360             <TD WIDTH=40>
 361
 362                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 363
 364                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 365
 366                         <TR>
 367
 368                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox17" TYPE=CHECKBOX NAME="prog_throat_abn" <?if ($obj{"prog_throat_abn"} == "on") {echo "checked";};?>></TD>
 369
 370                         </TR>
 371
 372                     </TABLE>
 373
 374                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 375
 376             <TD WIDTH=34>
 377
 378                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 379
 380                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 381
 382                         <TR>
 383
 384                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox15" TYPE=CHECKBOX NAME="prog_throat_ne" <?if ($obj{"prog_throat_ne"} == "on") {echo "checked";};?>></TD>
 385
 386                         </TR>
 387
 388                     </TABLE>
 389
 390                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 391
 392             <TD WIDTH=324>
 393
 394                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>THROAT: dear, no infection</B></FONT><B></B></P>
 395
 396             </TD>
 397
 398         </TR>
 399
 400         <TR>
 401
 402             <TD HEIGHT=18>
 403
 404                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 405
 406             </TD>
 407
 408             <TD WIDTH=40>
 409
 410                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 411
 412                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 413
 414                         <TR>
 415
 416                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox19" TYPE=CHECKBOX NAME="prog_teeth_abn" <?if ($obj{"prog_teeth_abn"} == "on") {echo "checked";};?>></TD>
 417
 418                         </TR>
 419
 420                     </TABLE>
 421
 422                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 423
 424             <TD WIDTH=34>
 425
 426                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 427
 428                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 429
 430                         <TR>
 431
 432                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox20" TYPE=CHECKBOX NAME="prog_teeth_ne" <?if ($obj{"prog_teeth_ne"} == "on") {echo "checked";};?>></TD>
 433
 434                         </TR>
 435
 436                     </TABLE>
 437
 438                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 439
 440             <TD WIDTH=324>
 441
 442                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>TEETH: good repair, no dentures</B></FONT><B></B></P>
 443
 444             </TD>
 445
 446         </TR>
 447
 448         <TR>
 449
 450             <TD>
 451
 452                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 453
 454             </TD>
 455
 456             <TD WIDTH=40>
 457
 458                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 459
 460                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 461
 462                         <TR>
 463
 464                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox18" TYPE=CHECKBOX NAME="prog_neck_abn" <?if ($obj{"prog_neck_abn"} == "on") {echo "checked";};?>></TD>
 465
 466                         </TR>
 467
 468                     </TABLE>
 469
 470                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 471
 472             <TD WIDTH=34>
 473
 474                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 475
 476                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 477
 478                         <TR>
 479
 480                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox21" TYPE=CHECKBOX NAME="prog_neck_ne" <?if ($obj{"prog_neck_ne"} == "on") {echo "checked";};?>></TD>
 481
 482                         </TR>
 483
 484                     </TABLE>
 485
 486                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 487
 488             <TD WIDTH=324>
 489
 490                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>NECK: supple, no adenopathy</B></FONT><B></B></P>
 491
 492             </TD>
 493
 494         </TR>
 495
 496         <TR>
 497
 498             <TD>
 499
 500                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 501
 502             </TD>
 503
 504             <TD WIDTH=40>
 505
 506                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 507
 508                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 509
 510                         <TR>
 511
 512                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox22" TYPE=CHECKBOX NAME="prog_chest_abn" <?if ($obj{"prog_chest_abn"} == "on") {echo "checked";};?>></TD>
 513
 514                         </TR>
 515
 516                     </TABLE>
 517
 518                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 519
 520             <TD WIDTH=34>
 521
 522                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 523
 524                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 525
 526                         <TR>
 527
 528                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox23" TYPE=CHECKBOX NAME="prog_chest_ne" <?if ($obj{"prog_chest_ne"} == "on") {echo "checked";};?>></TD>
 529
 530                         </TR>
 531
 532                     </TABLE>
 533
 534                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 535
 536             <TD WIDTH=324>
 537
 538                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>CHEST: symmetrical, no pain</B></FONT><B></B></P>
 539
 540             </TD>
 541
 542         </TR>
 543
 544         <TR>
 545
 546             <TD>
 547
 548                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 549
 550             </TD>
 551
 552             <TD WIDTH=40>
 553
 554                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 555
 556                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 557
 558                         <TR>
 559
 560                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox24" TYPE=CHECKBOX NAME="prog_breast_abn" <?if ($obj{"prog_breast_abn"} == "on") {echo "checked";};?>></TD>
 561
 562                         </TR>
 563
 564                     </TABLE>
 565
 566                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 567
 568             <TD WIDTH=34>
 569
 570                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 571
 572                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 573
 574                         <TR>
 575
 576                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox25" TYPE=CHECKBOX NAME="prog_breast_ne" <?if ($obj{"prog_breast_ne"} == "on") {echo "checked";};?>></TD>
 577
 578                         </TR>
 579
 580                     </TABLE>
 581
 582                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 583
 584             <TD WIDTH=324>
 585
 586                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>BREAST: no masses</B></FONT><B></B></P>
 587
 588             </TD>
 589
 590         </TR>
 591
 592         <TR>
 593
 594             <TD>
 595
 596                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 597
 598             </TD>
 599
 600             <TD WIDTH=40>
 601
 602                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 603
 604                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 605
 606                         <TR>
 607
 608                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox26" TYPE=CHECKBOX NAME="prog_lungs_abn" <?if ($obj{"prog_lungs_abn"} == "on") {echo "checked";};?>></TD>
 609
 610                         </TR>
 611
 612                     </TABLE>
 613
 614                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 615
 616             <TD WIDTH=34>
 617
 618                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 619
 620                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 621
 622                         <TR>
 623
 624                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox27" TYPE=CHECKBOX NAME="prog_lungs_ne" <?if ($obj{"prog_lungs_ne"} == "on") {echo "checked";};?>></TD>
 625
 626                         </TR>
 627
 628                     </TABLE>
 629
 630                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 631
 632             <TD WIDTH=324>
 633
 634                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>LUNGS: dear to P&amp;a. no mono, no rales</B></FONT><B></B></P>
 635
 636             </TD>
 637
 638         </TR>
 639
 640         <TR>
 641
 642             <TD>
 643
 644                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 645
 646             </TD>
 647
 648             <TD WIDTH=40>
 649
 650                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 651
 652                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 653
 654                         <TR>
 655
 656                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox28" TYPE=CHECKBOX NAME="prog_heart_abn" <?if ($obj{"prog_heart_abn"} == "on") {echo "checked";};?>></TD>
 657
 658                         </TR>
 659
 660                     </TABLE>
 661
 662                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 663
 664             <TD WIDTH=34>
 665
 666                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 667
 668                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 669
 670                         <TR>
 671
 672                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox29" TYPE=CHECKBOX NAME="prog_heart_ne" <?if ($obj{"prog_heart_ne"} == "on") {echo "checked";};?>></TD>
 673
 674                         </TR>
 675
 676                     </TABLE>
 677
 678                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 679
 680             <TD WIDTH=324>
 681
 682                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>HEART: rsr. no cardiomegaly</B></FONT><B></B></P>
 683
 684             </TD>
 685
 686         </TR>
 687
 688         <TR>
 689
 690             <TD>
 691
 692                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 693
 694             </TD>
 695
 696             <TD WIDTH=40>
 697
 698                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 699
 700                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 701
 702                         <TR>
 703
 704                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox30" TYPE=CHECKBOX NAME="prog_abdomen_abn" <?if ($obj{"prog_abdomen_abn"} == "on") {echo "checked";};?>></TD>
 705
 706                         </TR>
 707
 708                     </TABLE>
 709
 710                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 711
 712             <TD WIDTH=34>
 713
 714                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 715
 716                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 717
 718                         <TR>
 719
 720                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox31" TYPE=CHECKBOX NAME="prog_abdomen_ne" <?if ($obj{"prog_abdomen_ne"} == "on") {echo "checked";};?>></TD>
 721
 722                         </TR>
 723
 724                     </TABLE>
 725
 726                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 727
 728             <TD WIDTH=324>
 729
 730                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>ABDOMEN: non-tender, soft, no masses</B></FONT><B></B></P>
 731
 732             </TD>
 733
 734         </TR>
 735
 736         <TR>
 737
 738             <TD>
 739
 740                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 741
 742             </TD>
 743
 744             <TD WIDTH=40>
 745
 746                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 747
 748                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 749
 750                         <TR>
 751
 752                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox32" TYPE=CHECKBOX NAME="prog_spine_abn" <?if ($obj{"prog_spine_abn"} == "on") {echo "checked";};?>></TD>
 753
 754                         </TR>
 755
 756                     </TABLE>
 757
 758                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 759
 760             <TD WIDTH=34>
 761
 762                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 763
 764                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 765
 766                         <TR>
 767
 768                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox33" TYPE=CHECKBOX NAME="prog_spine_ne" <?if ($obj{"prog_spine_ne"} == "on") {echo "checked";};?>></TD>
 769
 770                         </TR>
 771
 772                     </TABLE>
 773
 774                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 775
 776             <TD WIDTH=324>
 777
 778                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>SPINE: no abnormalities</B></FONT><B></B></P>
 779
 780             </TD>
 781
 782         </TR>
 783
 784         <TR>
 785
 786             <TD>
 787
 788                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 789
 790             </TD>
 791
 792             <TD WIDTH=40>
 793
 794                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 795
 796                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 797
 798                         <TR>
 799
 800                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox34" TYPE=CHECKBOX NAME="prog_extremeities_abn" <?if ($obj{"prog_extremeities_abn"} == "on") {echo "checked";};?>></TD>
 801
 802                         </TR>
 803
 804                     </TABLE>
 805
 806                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 807
 808             <TD WIDTH=34>
 809
 810                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 811
 812                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 813
 814                         <TR>
 815
 816                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox35" TYPE=CHECKBOX NAME="prog_extremeities_ne" <?if ($obj{"prog_extremeities_ne"} == "on") {echo "checked";};?>></TD>
 817
 818                         </TR>
 819
 820                     </TABLE>
 821
 822                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 823
 824             <TD WIDTH=324>
 825
 826                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>EXTREMEITIES: no abnormalities</B></FONT><B></B></P>
 827
 828             </TD>
 829
 830         </TR>
 831
 832         <TR>
 833
 834             <TD>
 835
 836                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 837
 838             </TD>
 839
 840             <TD WIDTH=40>
 841
 842                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 843
 844                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 845
 846                         <TR>
 847
 848                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox36" TYPE=CHECKBOX NAME="prog_lowback_abn" <?if ($obj{"prog_lowback_abn"} == "on") {echo "checked";};?>></TD>
 849
 850                         </TR>
 851
 852                     </TABLE>
 853
 854                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 855
 856             <TD WIDTH=34>
 857
 858                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 859
 860                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 861
 862                         <TR>
 863
 864                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox37" TYPE=CHECKBOX NAME="prog_lowback_ne" <?if ($obj{"prog_lowback_ne"} == "on") {echo "checked";};?>></TD>
 865
 866                         </TR>
 867
 868                     </TABLE>
 869
 870                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 871
 872             <TD WIDTH=324>
 873
 874                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>LOW BACK: rom normal</B></FONT><B></B></P>
 875
 876             </TD>
 877
 878         </TR>
 879
 880         <TR>
 881
 882             <TD>
 883
 884                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 885
 886             </TD>
 887
 888             <TD WIDTH=40>
 889
 890                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 891
 892                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 893
 894                         <TR>
 895
 896                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox38" TYPE=CHECKBOX NAME="prog_neuro_abn" <?if ($obj{"prog_neuro_abn"} == "on") {echo "checked";};?>></TD>
 897
 898                         </TR>
 899
 900                     </TABLE>
 901
 902                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 903
 904             <TD WIDTH=34>
 905
 906                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 907
 908                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 909
 910                         <TR>
 911
 912                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox39" TYPE=CHECKBOX NAME="prog_neuro_ne" <?if ($obj{"prog_neuro_ne"} == "on") {echo "checked";};?>></TD>
 913
 914                         </TR>
 915
 916                     </TABLE>
 917
 918                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 919
 920             <TD WIDTH=324>
 921
 922                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>NEURO: d(r&gt;&gt;2&gt;&gt;. no abnormal findings</B></FONT><B></B></P>
 923
 924             </TD>
 925
 926         </TR>
 927
 928         <TR>
 929
 930             <TD>
 931
 932                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 933
 934             </TD>
 935
 936             <TD WIDTH=40>
 937
 938                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 939
 940                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 941
 942                         <TR>
 943
 944                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox40" TYPE=CHECKBOX NAME="prog_rectal_abn" <?if ($obj{"prog_rectal_abn"} == "on") {echo "checked";};?>></TD>
 945
 946                         </TR>
 947
 948                     </TABLE>
 949
 950                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 951
 952             <TD WIDTH=34>
 953
 954                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 955
 956                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 957
 958                         <TR>
 959
 960                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox41" TYPE=CHECKBOX NAME="prog_rectal_ne" <?if ($obj{"prog_rectal_ne"} == "on") {echo "checked";};?>></TD>
 961
 962                         </TR>
 963
 964                     </TABLE>
 965
 966                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 967
 968             <TD WIDTH=324>
 969
 970                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>RECTAL: no abnormalities</B></FONT><B></B></P>
 971
 972             </TD>
 973
 974         </TR>
 975
 976         <TR>
 977
 978             <TD>
 979
 980                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
 981
 982             </TD>
 983
 984             <TD WIDTH=40>
 985
 986                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
 987
 988                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
 989
 990                         <TR>
 991
 992                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox42" TYPE=CHECKBOX NAME="prog_pelvic_abn" <?if ($obj{"prog_pelvic_abn"} == "on") {echo "checked";};?>></TD>
 993
 994                         </TR>
 995
 996                     </TABLE>
 997
 998                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
 999
1000             <TD WIDTH=34>
1001
1002                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
1003
1004                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
1005
1006                         <TR>
1007
1008                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox43" TYPE=CHECKBOX NAME="prog_pelvic_ne" <?if ($obj{"prog_pelvic_ne"} == "on") {echo "checked";};?>></TD>
1009
1010                         </TR>
1011
1012                     </TABLE>
1013
1014                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
1015
1016             <TD WIDTH=324>
1017
1018                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>PELVIC:</B></FONT><B></B></P>
1019
1020             </TD>
1021
1022         </TR>
1023
1024     </TABLE>
1025
1026
1027
1028 <br>
1029
1030
1031
1032
1033
1034 <span class=text><b>HEALTH EDUCATION PROVIDED<br>ASSESSMENT:</b></span><br><textarea cols=40 rows=8 wrap=virtual name="prog_assessment" ><?echo $obj{"prog_assessment"};?></textarea>
1035
1036
1037
1038 <br><br>
1039
1040
1041
1042 <span class=text><b>Plan:</b></span><br><textarea cols=40 rows=8 wrap=virtual name="prog_plan" ><?echo $obj{"prog_plan"};?></textarea>
1043
1044
1045
1046 <br><br>
1047
1048 <td><input size=3 type=entry name="prog_breast_se" value="<?echo $obj{"prog_breast_se"};?>" >&nbsp;<span class=text><b>Breast Self Examination </span></td><br></b>
1049
1050 <td><input size=3 type=entry name="prog_dental_h" value="<?echo $obj{"prog_dental_h"};?>" >&nbsp;<span class=text><b>Dental Health </span></td><br></b>
1051
1052 <td><input size=3 type=entry name="prog_diagnosis" value="<?echo $obj{"prog_diagnosis"};?>" >&nbsp;<span class=text><b>Diagnosis/Prognosis </span></td><br></b>
1053
1054 <td><input size=3 type:entry name="prog_injur_p" value="<?echo $obj{"prog_injur_p"};?>" >&nbsp;<span class=text><b>Injury Prevention </span></td><br></b>
1055
1056 <td><input size=3 type=entry name="prog_new_treat" value="<?echo $obj{"prog_new_treat"};?>" >&nbsp;<span class=text><b>New Treatment/Medication </span></td><br></b>
1057
1058 <td><input size=3 type=entry name="prog_nutrition_e" value="<?echo $obj{"prog_nutrition_e"};?>" >&nbsp;<span class=text><b>Nutrition/Exercise </span></td><br></b>
1059
1060 <td><input size=3 type=entry name="prog_sexual_p" value="<?echo $obj{"prog_sexual_p"};?>" >&nbsp;<span class=text><b>Sexual Practice </span></td><br></b>
1061
1062 <td><input size=3 type=entry name="prog_substance_a" value="<?echo $obj{"prog_substance_a"};?>" >&nbsp;<span class=text><b>Substance Abuse </span></td><br></b>
1063
1064
1065
1066
1067
1068
1069
1070 <a href="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save]</a>
1071
1072 <br>
1073
1074 <a href="<?php echo $GLOBALS['form_exit_url']; ?>" class="link" onclick="top.restoreSession()">[Don't Save]</a>
1075
1076 </form>
1077
1078 <?php
1079
1080 formFooter();
1081
1082 ?>
1083