interface/forms/eye_mag/a_issue.php

   1 <?php
   2 /**
   3  * This file presents the PMSFH control panel.
   4  * It uses ajax/javascript to add, delete or edit an issue.
   5  *
   6  * Originally culled from /interface/patient_file/summary and adapted...
   7  *
   8  * Copyright (C) 2005-2011 Rod Roark <rod@sunsetsystems.com>
   9  * Copyright (C) 2015-6 Ray Magauran <magauran@MedFetch.com>
  10  *
  11  * This program is free software; you can redistribute it and/or
  12  * modify it under the terms of the GNU General Public License
  13  * as published by the Free Software Foundation; either version 2
  14  * of the License, or (at your option) any later version.
  15  *
  16  * @package OpenEMR
  17  * @author  Rod Roark <rod@sunsetsystems.com>
  18  * @author Ray Magauran <magauran@MedFetch.com>
  19  * @link    http://www.open-emr.org
  20  */
  21
  22 //SANITIZE ALL ESCAPES
  23 $sanitize_all_escapes=true;
  24 //STOP FAKE REGISTER GLOBALS
  25 $fake_register_globals=false;
  26 $form_folder= "eye_mag";
  27 require_once('../../globals.php');
  28 require_once($GLOBALS['srcdir'].'/lists.inc');
  29 require_once($GLOBALS['srcdir'].'/patient.inc');
  30 require_once($GLOBALS['srcdir'].'/acl.inc');
  31 require_once($GLOBALS['srcdir'].'/sql.inc');
  32 require_once($GLOBALS['srcdir'].'/options.inc.php');
  33 require_once($GLOBALS['fileroot'].'/custom/code_types.inc.php');
  34 require_once($GLOBALS['srcdir'].'/csv_like_join.php');
  35 require_once($GLOBALS['srcdir'].'/htmlspecialchars.inc.php');
  36 require_once($GLOBALS['srcdir'].'/formdata.inc.php');
  37 require_once($GLOBALS['srcdir'].'/log.inc');
  38 require_once("../../forms/".$form_folder."/php/".$form_folder."_functions.php");
  39
  40 $pid = 0 + (empty($_REQUEST['pid']) ? $pid : $_REQUEST['pid']);
  41 $info_msg = "";
  42
  43 // A nonempty thisenc means we are to link the issue to the encounter.
  44 // ie. we are going to use this as a billing issue?
  45 // The Coding Engine does not look at encounters and issue linkage, yet.  It could and perhaps should.
  46 $encounter = 0 + (empty($_REQUEST['encounter']) ? $_SESSION['encounter'] : $_REQUEST['encounter']);
  47
  48 $issue = $_REQUEST['issue'];
  49 $deletion = $_REQUEST['deletion'];
  50 $form_save = $_REQUEST['form_save'];
  51 if (!$pid) $pid = $_SESSION['pid'];
  52 $form_id = $_REQUEST['form_id'];
  53 $form_type = $_REQUEST['form_type'];
  54 $uniqueID = $_REQUEST['uniqueID'];
  55
  56 if ($issue && !acl_check('patients','med','','write') ) die(xlt("Edit is not authorized!"));
  57 if ( !acl_check('patients','med','',array('write','addonly') )) die(xlt("Add is not authorized!"));
  58 $PMSFH = build_PMSFH($pid);
  59 $patient = getPatientData($pid, "*");
  60 $providerID   = findProvider($pid,$encounter);
  61 if (!$_SESSION['providerID'] && $providerID)  ($_SESSION['providerID'] = $providerID);
  62
  63 $irow = array();
  64 if ($issue) {
  65   $irow = sqlQuery("SELECT * FROM lists WHERE id = ?",array($issue));
  66 } else if ($thistype) {
  67   $irow['type'] = $thistype;
  68   $irow['subtype'] = $subtype;
  69 }
  70 if (!empty($irow['type'])) {
  71   foreach ($ISSUE_TYPES as $key => $value) {
  72     if ($key == $irow['type']) break;
  73     ++$type_index;
  74   }
  75 }
  76 $given="ROSGENERAL,ROSHEENT,ROSCV,ROSPULM,ROSGI,ROSGU,ROSDERM,ROSNEURO,ROSPSYCH,ROSMUSCULO,ROSIMMUNO,ROSENDOCRINE";
  77 $query="SELECT $given from form_eye_mag where id=? and pid=?";
  78 $rres = sqlQuery($query,array($form_id,$pid));
  79 foreach (explode(',',$given) as $item) {
  80     $$item = $rres[$item];
  81 }
  82
  83 ?><html>
  84   <head>
  85     <title><?php echo xlt('Add New Issue'); ?></title>
  86     <script language="JavaScript">
  87                     <?php       require_once("$srcdir/restoreSession.php");  ?>
  88     </script>
  89     <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/interface/main/tabs/js/include_opener.js"></script>
  90     <meta name="viewport" content="width=device-width, initial-scale=1" />
  91     <style type="text/css">@import url(<?php echo $GLOBALS['webroot']; ?>/library/dynarch_calendar.css);</style>
  92     <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/dynarch_calendar.js"></script>
  93     <?php require_once($GLOBALS['srcdir'].'/dynarch_calendar_en.inc.php'); ?>
  94     <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/dynarch_calendar_setup.js"></script>
  95     <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/textformat.js"></script>
  96     <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/dialog.js"></script>
  97     <script language="JavaScript">
  98      var mypcc = '<?php echo $GLOBALS['phone_country_code'] ?>';
  99      var aitypes = new Array(); // issue type attributes
 100      var aopts   = new Array(); // Option objects
 101         <?php
 102         //This builds the litle quick pick list in this section.
 103         // If the provider has more 2 items already defined in the last month, they are collated
 104         // and ranked by frequency, sort alphabetically and <=10 are listed.
 105         // If not, we use the defaults from list_options/
 106       $i='0';
 107
 108       foreach ($PMSFH[0] as $key => $value) {
 109         echo " aopts['" . attr($key) . "'] = [];\n";
 110         $local ='1';
 111         echo " aitypes['" . attr($key). "'] = '0';\n";
 112         if ($key =="PMH") { // "0" = medical_problem_issue_list leave out Dental "4"
 113           $qry = sqlStatement("SELECT title, title as option_id, diagnosis as codes, count(title) AS freq  FROM `lists` WHERE `type` LIKE ? and
 114             subtype = '' and pid in (select pid from form_encounter where provider_id =?
 115             and date BETWEEN NOW() - INTERVAL 30 DAY AND NOW()) GROUP BY title order by freq desc limit 10", array("medical_problem",$_SESSION['providerID']));
 116
 117           if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 118             $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = ? and subtype not like 'eye'",array("medical_problem_issue_list"));
 119           }
 120         } elseif ($key =="Medication") {
 121           $qry = sqlStatement("SELECT title, title as option_id, diagnosis as codes, count(title) AS freq  FROM `lists` WHERE `type` LIKE ? and
 122             subtype = '' and pid in (select pid from form_encounter where provider_id =?
 123             and date BETWEEN NOW() - INTERVAL 30 DAY AND NOW()) GROUP BY title order by freq desc limit 10", array("medication",$_SESSION['providerID']));
 124           if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 125             $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = ? and subtype not like 'eye'",array("medication_issue_list"));
 126           }
 127         } elseif ($key =="Surgery") {
 128           $qry = sqlStatement("SELECT title, title as option_id, diagnosis as codes, count(title) AS freq  FROM `lists` WHERE `type` LIKE ? and
 129             subtype = '' and pid in (select pid from form_encounter where provider_id =?
 130             and date BETWEEN NOW() - INTERVAL 30 DAY AND NOW()) GROUP BY title order by freq desc limit 10", array("surgery",$_SESSION['providerID']));
 131           if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 132             $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = ? and subtype not like 'eye'",array("surgery_issue_list"));
 133           }
 134         } elseif ($key =="Allergy") {
 135           $qry = sqlStatement("SELECT title, title as option_id, diagnosis as codes, count(title) AS freq  FROM `lists` WHERE `type` LIKE ? and
 136             subtype = '' and pid in (select pid from form_encounter where provider_id =?
 137             and date BETWEEN NOW() - INTERVAL 30 DAY AND NOW()) GROUP BY title order by freq desc limit 10", array("allergy",$_SESSION['providerID']));
 138           if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 139             $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = ? and subtype not like 'eye'",array("allergy_issue_list"));
 140           }
 141         } elseif ($key == "POH") { // POH medical group
 142           $query = "SELECT title, title as option_id, diagnosis as codes, count(title) AS freq  FROM `lists` WHERE `type` LIKE 'medical_problem' and subtype = 'eye' and pid in (select pid from form_encounter where provider_id =? and date BETWEEN NOW() - INTERVAL 30 DAY AND NOW()) GROUP BY title order by freq desc limit 10";
 143           $qry = sqlStatement($query,array($_SESSION['providerID']));
 144           if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 145             $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = 'medical_problem_issue_list' and subtype = 'eye'");
 146           }
 147         } elseif ($key == "POS") { // POS surgery group
 148           $query = "SELECT title, title as option_id, diagnosis as codes, count(title) AS freq  FROM `lists` WHERE `type` LIKE 'surgery' and subtype = 'eye' and pid in (select pid from form_encounter where provider_id =? and date BETWEEN NOW() - INTERVAL 30 DAY AND NOW()) GROUP BY title order by freq desc limit 10";
 149           $qry = sqlStatement($query,array($_SESSION['providerID']));
 150           if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 151             $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = 'surgery_issue_list' and subtype = 'eye'");
 152           }
 153         } elseif ($key == "FH") {
 154           $local = "";
 155           $qry = "";
 156         } elseif ($key == "SOCH") {
 157           $local = "";
 158           $qry = "";
 159         } elseif ($key == "ROS") {
 160           $local = "";
 161           $qry = "";
 162         }
 163         if ($local =="1") { // leave FH/SocHx/ROS for later - done below separately
 164           while($res = sqlFetchArray($qry)){ //Should we take the top 10 and display alphabetically?
 165             echo " aopts['" .attr($key). "'][aopts['" .attr($key). "'].length] = new Option('".attr(trim($res['option_id']))."', '".attr(xl_list_label(trim($res['title'])))."', false, false);\n";
 166             if ($res['codes']) {
 167               echo " aopts['" .attr($key). "'][aopts['" .attr($key). "'].length-1].setAttribute('data-code','".attr(trim($res['codes']))."');\n";
 168             }
 169           }
 170         }
 171         ++$i;
 172       }
 173
 174     ?>
 175
 176     <?php require($GLOBALS['srcdir'] . "/restoreSession.php"); ?>
 177
 178     function newtype(index) {
 179       var f = document.forms[0];
 180       var theopts = f.form_titles.options;
 181       theopts.length = 0;
 182       if (aopts[index]) {
 183         var i = 0;
 184         for (i = 0; i < aopts[index].length; ++i) {
 185           theopts[i] = aopts[index][i];
 186         }
 187       }
 188
 189        f.form_type.value = index;
 190        f.form_occur.options[0].selected = true;
 191
 192       document.getElementById('row_quick_picks'     ).style.display = i ? '' : 'none'; //select list of things
 193       document.getElementById('row_title'           ).style.display = '';
 194       document.getElementById('row_diagnosis'       ).style.display = 'none';
 195       document.getElementById('row_begindate'       ).style.display = 'none';
 196       document.getElementById('row_enddate'         ).style.display = 'none';
 197       document.getElementById('row_reaction'        ).style.display = 'none';
 198       document.getElementById('row_referredby'      ).style.display = 'none';
 199       document.getElementById('row_classification'  ).style.display = 'none';
 200       document.getElementById('row_occurrence'      ).style.display = 'none';
 201       document.getElementById('row_comments'        ).style.display = 'none';
 202       document.getElementById('row_outcome'         ).style.display = 'none';
 203       document.getElementById('row_destination'     ).style.display = 'none';
 204       document.getElementById('row_social'          ).style.display = 'none';
 205       document.getElementById('row_FH'              ).style.display = 'none';
 206       document.getElementById('row_ROS'             ).style.display = 'none';
 207       document.getElementById('row_PLACEHOLDER'     ).style.display = 'none';
 208       document.getElementById('cancel_button'       ).style.display = 'none';
 209       document.getElementById('row_eye_med'         ).style.display = 'none';
 210
 211
 212       if (index == 'PMH') {
 213         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('PMH Dx').":"; ?>";
 214         document.getElementById('row_diagnosis'     ).style.display = '';
 215         document.getElementById('row_begindate'     ).style.display = '';
 216         document.getElementById('row_enddate'       ).style.display = '';
 217         document.getElementById('row_occurrence'    ).style.display = '';
 218         f.form_occur.options[2].selected = true;
 219         document.getElementById('row_comments'      ).style.display = '';
 220
 221       } else if (index == 'Allergy') {
 222         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('Allergic to').":"; ?>";
 223         document.getElementById('row_reaction'      ).style.display = '';
 224         document.getElementById('row_begindate'     ).style.display = '';
 225         document.getElementById('row_comments'      ).style.display = '';
 226
 227       } else if (index == 'Medication') {
 228         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('Medication').":"; ?>";
 229         document.getElementById('row_begindate'     ).style.display = '';
 230         document.getElementById('row_enddate'       ).style.display = '';
 231         document.getElementById('row_comments'      ).style.display = '';
 232         document.getElementById('row_eye_med'       ).style.display = '';
 233
 234         //change Onset to started
 235         //change resolved to Completed
 236         document.getElementById('onset'             ).textContent = "<?php echo xlt('Start').':'; ?>";
 237         document.getElementById('resolved'          ).textContent = "<?php echo xlt('Finish').':'; ?>";
 238
 239       } else if ((index == 'Surgery')||(index =='POS')) {
 240         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('Procedure').':'; ?>";
 241         document.getElementById('row_diagnosis'     ).style.display = '';
 242
 243         document.getElementById('row_begindate'     ).style.display = '';
 244         document.getElementById('row_referredby'    ).style.display = '';
 245         document.getElementById('form_referredby'   ).title="<?php echo xla('Name of the Surgeon'); ?>";
 246         document.getElementById('by_whom'           ).textContent = "<?php echo xlt('Surgeon').':'; ?>";
 247         document.getElementById('onset'             ).textContent = "<?php echo xlt('Date').':'; ?>";
 248         document.getElementById('row_outcome'       ).style.display = '';
 249         document.getElementById('row_comments'      ).style.display = '';
 250
 251       } else if (index == 4) { //Dental so skip it
 252       } else if (index == 'POH') {
 253         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('Eye Dx{{eye diagnosis}}').":"; ?>";
 254         document.getElementById('row_diagnosis'     ).style.display = '';
 255         document.getElementById('row_begindate'     ).style.display = '';
 256         document.getElementById('row_referredby'    ).style.display = '';
 257         document.getElementById('by_whom'           ).textContent ="<?php echo xlt('Collaborator').":"; ?>";
 258         document.getElementById('form_referredby'   ).title="<?php echo xla('Co-managing/referring provider'); ?>";
 259         document.getElementById('onset'             ).textContent = "<?php echo xlt('Date').":"; ?>";
 260         document.getElementById('row_comments'      ).style.display = '';
 261
 262       } else if (index == 'FH') {
 263         document.getElementById('row_title'         ).style.display = 'none';
 264         document.getElementById('row_FH'            ).style.display = '';
 265
 266       } else if (index == 'SOCH') {
 267         document.getElementById('row_title'         ).style.display = 'none';
 268         document.getElementById('row_social'        ).style.display = '';
 269         document.getElementById('cancel_button'       ).style.display = '';
 270
 271       } else if (index == 'ROS') {
 272         document.getElementById('row_title'         ).style.display = 'none';
 273         document.getElementById('row_ROS'           ).style.display = '';
 274
 275       } else {
 276         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('Eye Dx{{eye diagnosis}}').":"; ?>";
 277         document.getElementById('row_diagnosis'     ).style.display = '';
 278         document.getElementById('row_begindate'     ).style.display = '';
 279         document.getElementById('row_referredby'    ).style.display = '';
 280         document.getElementById('form_referredby'   ).title="<?php echo xla('Referring provider'); ?>";
 281         document.getElementById('by_whom'           ).textContent ="<?php echo xlt('Collaborator').":"; ?>";
 282         document.getElementById('onset'             ).textContent = "<?php echo xlt('Date').":"; ?>";
 283         document.getElementById('row_comments'      ).style.display = '';
 284         document.getElementById('row_PLACEHOLDER'   ).style.display = '';
 285       }
 286       return false;
 287     }
 288      // If a clickoption title is selected, copy it to the title field.
 289      // We also want to copy any other fields present in obj.PMSFH_options
 290      // We need to build this object first.  The base install options will need ICD-10 codes attached
 291      // to make this work.
 292      // f.form_title.diagnosis = f.form_titles.options[f.form_titles.selectedIndex].text;
 293     function set_text() {
 294       var f = document.forms[0];
 295       f.form_title.value = f.form_titles.options[f.form_titles.selectedIndex].text;
 296       f.form_diagnosis.value = f.form_titles.options[f.form_titles.selectedIndex].getAttribute('data-code');
 297       f.form_titles.selectedIndex = -1;
 298     }
 299
 300     function refreshIssue() {  parent.refresh_page(); }
 301     function submit_this_form() {
 302         var url = "../../forms/eye_mag/save.php?PMSFH_save=1&mode=update&form_save=1";
 303         var formData = $("form#theform").serialize();
 304         var f = document.forms[0];
 305         top.restoreSession();
 306         $.ajax({
 307                type   : 'POST',   // define the type of HTTP verb we want to use (POST for our form)
 308                url    : url,      // the url where we want to POST
 309                data   : formData  // our data object
 310             }).done(function(result){
 311               f.form_title.value = '';
 312               f.form_diagnosis.value = '';
 313               f.form_begin.value ='';
 314               f.form_end.value ='';
 315               f.form_referredby.value ='';
 316               f.form_reaction.value ='';
 317               f.form_classification.value ='';
 318               f.form_comments.value ='';
 319               f.form_outcome.value ='';
 320               f.form_destination.value ='';
 321               f.issue.value ='';
 322               parent.populate_form(result);
 323             });
 324     }
 325     // Process click on Delete link.
 326     function deleteme() {
 327       var url = "../../forms/eye_mag/save.php?PMSFH_save=1&mode=update&form_save=1";
 328       var f = document.forms[0];
 329       top.restoreSession();
 330       $.ajax({
 331                type    : 'POST',
 332                data    : {
 333                             pid    : <?php echo attr($pid); ?>,
 334                             issue  : f.issue.value,
 335                             deletion : '1',
 336                             PMSFH  : '1'
 337                           },
 338                 url    : url
 339                }).done(function (result){
 340                 // CLEAR THE FORM TOO...
 341                 f.form_title.value = '';
 342                 f.form_diagnosis.value = '';
 343                 f.form_begin.value ='';
 344                 f.form_end.value ='';
 345                 f.form_referredby.value ='';
 346                 f.form_reaction.value ='';
 347                 f.form_classification.value ='';
 348                 f.form_comments.value ='';
 349                 f.form_occur.options[0].selected = true;
 350                 f.form_outcome.value ='';
 351                 f.form_destination.value ='';
 352                 f.issue.value ='';
 353                 parent.populate_form(result);
 354                });}
 355
 356     function imdeleted() { closeme(); }
 357     function clearme() {
 358       negate_radio('radio_tobacco');
 359       var f = document.forms[0];
 360
 361      // f.radio_tobacco.value = '';
 362       f.form_diagnosis.value = '';
 363       f.form_begin.value ='';
 364       f.form_end.value ='';
 365       f.form_referredby.value ='';
 366       f.form_reaction.value ='';
 367       f.form_classification.value ='';
 368       f.form_comments.value ='';
 369       f.form_outcome.value ='';
 370       f.form_destination.value ='';
 371       f.issue.value ='';
 372     }
 373      // Called when the Active checkbox is clicked.  For consistency we
 374      // use the existence of an end date to indicate inactivity, even
 375      // though the simple verion of the form does not show an end date.
 376     function resolvedClicked(cb) {
 377       var f = document.forms[0];
 378       if (!cb.checked) {
 379        f.form_end.value = '';
 380        f.delete_button.classList.remove("nodisplay");
 381       } else {
 382        var today = new Date();
 383        f.form_end.value = '' + (today.getYear() + 1900) + '-' +
 384         (today.getMonth() + 1) + '-' + today.getDate();
 385         f.delete_button.classList.add("nodisplay");
 386       }}
 387
 388     // Called when resolved outcome is chosen and the end date is entered.
 389     function outcomeClicked(cb) {
 390       var f = document.forms[0];
 391       if (cb.value == '1'){
 392        var today = new Date();
 393        f.form_end.value = '' + (today.getYear() + 1900) + '-' +
 394         ("0" + (today.getMonth() + 1)).slice(-2) + '-' + ("0" + today.getDate()).slice(-2);
 395        f.form_end.focus();
 396       }}
 397     // This is for callback by the find-code popup.
 398     // Appends to or erases the current list of diagnoses.
 399     function set_related(codetype, code, selector, codedesc) {
 400      var f = document.forms[0];
 401      var s = f.form_diagnosis.value;
 402      var title = f.form_title.value;
 403      if (code) {
 404       if (s.length > 0) s += ';';
 405       s += codetype + ':' + code;
 406      } else {
 407       s = '';
 408      }
 409      f.form_diagnosis.value = s;
 410      if(title == '') f.form_title.value = codedesc;
 411     }
 412
 413     // This invokes the find-code popup.
 414     function sel_diagnosis() {
 415       var f = document.forms[0];
 416       term = f.form_title.value;
 417       <?php
 418       if(($irow['type'] == 'PMH') ||($irow['type'] == 'POH'))
 419       {
 420         ?>
 421       dlgopen('../../patient_file/encounter/find_code_popup.php?codetype=<?php echo attr(collect_codetypes("medical_problem","csv")) ?>&search_term='+term, '_blank', 500, 400);
 422         <?php
 423       }
 424       else{
 425         ?>
 426       dlgopen('../../patient_file/encounter/find_code_popup.php?codetype=<?php echo attr(collect_codetypes("diagnosis","csv")) ?>&search_term='+term, '_blank', 500, 400);
 427         <?php
 428       }
 429       ?>
 430       f.form_save.focus();
 431     }
 432
 433     // Check for errors when the form is submitted.
 434     function validate() {
 435       var f = document.forms[0];
 436       if(f.form_begin.value > f.form_end.value && (f.form_end.value)) {
 437         alert("<?php echo addslashes(xl('Please Enter End Date greater than Begin Date!')); ?>");
 438         return false;
 439       }
 440       if (f.form_type.value != 'ROS' && f.form_type.value != 'FH' && f.form_type.value !='SOCH') {
 441         if (! f.form_title.value) {
 442           alert("<?php echo addslashes(xl('Please enter a title!')); ?>");
 443           return false;
 444         }
 445       }
 446      return true;
 447     }
 448
 449     // Supports customizable forms (currently just for IPPF).
 450     function divclick(cb, divid) {
 451      var divstyle = document.getElementById(divid).style;
 452      if (cb.checked) {
 453       divstyle.display = 'block';
 454      } else {
 455       divstyle.display = 'none';
 456      }
 457      return true;}
 458     //function for selecting the smoking status in drop down list based on the selection in radio button.
 459     function smoking_statusClicked(cb) {
 460       if (cb.value == 'currenttobacco')
 461       {
 462       document.getElementById('form_tobacco').selectedIndex = 1;
 463       }
 464       else if (cb.value == 'nevertobacco')
 465       {
 466       document.getElementById('form_tobacco').selectedIndex = 4;
 467       }
 468       else if (cb.value == 'quittobacco')
 469       {
 470       document.getElementById('form_tobacco').selectedIndex = 3;
 471       }
 472       else if (cb.value == 'not_applicabletobacco')
 473       {
 474       document.getElementById('form_tobacco').selectedIndex = 6;
 475       }
 476       radioChange(document.getElementById('form_tobacco').value);   }
 477     //function for selecting the smoking status in radio button based on the selection of drop down list.
 478     function radioChange(rbutton){
 479         if (rbutton == 1 || rbutton == 2 || rbutton == 15 || rbutton == 16)
 480          {
 481          document.getElementById('radio_tobacco[current]').checked = true;
 482          }
 483          else if (rbutton == 3)
 484          {
 485          document.getElementById('radio_tobacco[quit]').checked = true;
 486          }
 487          else if (rbutton == 4)
 488          {
 489          document.getElementById('radio_tobacco[never]').checked = true;
 490          }
 491          else if (rbutton == 5 || rbutton == 9)
 492          {
 493          document.getElementById('radio_tobacco[not_applicable]').checked = true;
 494          }
 495          else if (rbutton == '')
 496          {
 497          var radList = document.getElementsByName('radio_tobacco');
 498          for (var i = 0; i < radList.length; i++) {
 499          if(radList[i].checked) radList[i].checked = false;
 500          }
 501          }
 502          //Added on 5-jun-2k14 (regarding 'Smoking Status - display SNOMED code description')
 503          if(rbutton!=""){
 504              if(code_options_js[rbutton]!="")
 505                 $("#smoke_code").html(" ( "+code_options_js[rbutton]+" )");
 506              else
 507                  $("#smoke_code").html("");
 508          }
 509          else
 510             $("#smoke_code").html("");
 511       }
 512
 513     function setSelectBoxByText(eid, etxt) {
 514         var eid = document.getElementById(eid);
 515         for (var i = 0; i < eid.options.length; ++i) {
 516             if (eid.options[i].text === etxt)
 517                 eid.options[i].selected = true;
 518         }
 519     }
 520     function clear_option(section) {
 521       //click the field, erase the Negative radio and input Y
 522       var f = document.forms[0];
 523       var name = 'radio_'+section.name;
 524       var radio = document.getElementById(name);
 525         radio.checked = false;
 526       if (section.value==''){
 527         section.value="Y";
 528         section.select();
 529       }}
 530     function negate_radio(section) {
 531       if (section.checked ==true){
 532         var rfield = section.name.match(/radio_(.*)/);
 533         document.getElementById(rfield[1]).value='';
 534       } }
 535       //Added on 5-jun-2k14 (regarding 'Smoking Status - display SNOMED code description')
 536      var code_options_js = Array();
 537
 538      <?php
 539      $smoke_codes = getSmokeCodes();
 540
 541      foreach ($smoke_codes as $val => $code) {
 542                 echo "code_options_js"."['" . attr($val) . "']='" . attr($code) . "';\n";
 543           }
 544      ?>
 545
 546     </script>
 547     <!-- Add Font stuff for the look and feel.  -->
 548
 549       <link rel="stylesheet" href="../../forms/<?php echo $form_folder; ?>/css/style.css" type="text/css">
 550       <link rel="stylesheet" href="<?php echo $GLOBALS['css_header']; ?>" type="text/css">
 551       <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
 552       <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative'] ?>/jquery-ui-1-11-4/themes/excite-bike/jquery-ui.css">
 553       <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative'] ?>/pure-0-5-0/pure-min.css">
 554       <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative'] ?>/bootstrap-3-3-4/dist/css/bootstrap.min.css">
 555       <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative'] ?>/qtip2-2-2-1/jquery.qtip.min.css" />
 556       <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative'] ?>/font-awesome-4-6-3/css/font-awesome.min.css">
 557       <style>
 558           td, select, textarea, input  {
 559          font-family: Fontawesome, Arial, Helvetica, sans-serif;
 560          font-size: 8pt;
 561          }
 562
 563          input[type="text"],textarea{
 564             text-align:left;
 565             Xbackground-color: cornsilk;
 566             text-align: left;
 567             display: inline-block;
 568             border: 1px solid #CCC !important;
 569             box-shadow: 0px 1px 3px #DDD inset !important;
 570             border-radius: 4px;
 571             margin:3px 3px 3px 5px;
 572             box-sizing: border-box;
 573             width:100%;
 574            }
 575
 576           div.section {
 577            border: solid;
 578            border-width: 1px;
 579            border-color: #0000ff;
 580            margin: 0 0 0 10pt;
 581            padding: 5pt;
 582           }
 583           .ROS_class input[type="text"] {
 584             width:100px;
 585           }
 586           .label {
 587             color:black;
 588           }
 589           .issues {
 590             font-size:0.8em;
 591           }
 592          select {
 593             text-align:left;
 594             text-align: left;
 595             border: 1px solid #CCC !important;
 596             box-shadow: 0px 1px 3px #DDD inset !important;
 597             border-radius: 4px;
 598             margin:1px 3px 1px 5px;
 599             box-sizing: border-box;
 600          }
 601          .navy {
 602           background-color: navy !important;
 603          }
 604
 605       </style>
 606
 607       <link rel="shortcut icon" href="<?php echo $GLOBALS['images_static_relative']; ?>/favicon.ico" />
 608       <script src="<?php echo $GLOBALS['assets_static_relative'] ?>/jquery-min-1-11-1/index.js"></script>
 609       <script src="<?php echo $GLOBALS['assets_static_relative'] ?>/bootstrap-3-3-4/dist/js/bootstrap.min.js"></script>
 610       <script src="<?php echo $GLOBALS['assets_static_relative'] ?>/jquery-ui-1-11-4/jquery-ui.min.js"></script>
 611       <script src="<?php echo $GLOBALS['assets_static_relative'] ?>/qtip2-2-2-1/jquery.qtip.min.js"></script>
 612       <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative'] ?>/manual-added-packages/shortcut.js-2-01-B/shortcut.js"></script>
 613       <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/interface/forms/<?php echo $form_folder; ?>/js/eye_base.php?enc=<?php echo attr($encounter); ?>&providerID=<?php echo attr($providerID); ?>"></script>
 614   </head>
 615   <body>
 616     <div id="page" style="text-align: justify; text-justify: newspaper;">
 617       <form method='POST' name='theform' id='theform'
 618       action='a_issue.php?pid=<?php echo attr($pid); ?>&encounter=<?php echo attr($encounter); ?>'
 619        onsubmit='return validate();'
 620        >
 621        <input type="hidden" name="form_id" id="form_id" value = "<?php echo attr($form_id); ?>">
 622        <input type="hidden" name="issue" id="issue" value = "<?php echo attr($issue); ?>">
 623        <input type="hidden" name="uniqueID" id="uniqueID" value = "<?php echo attr($uniqueID); ?>">
 624        <div class="issues">
 625           <?php
 626           $output ='';
 627           global $counter_header;
 628           $count_header='0';
 629           $output= array();
 630           foreach ($PMSFH[0] as $key => $value) {
 631             $checked = '';
 632             if ($key == "POH") {  $checked = " checked='checked' "; }
 633             $key_short_title = $key;
 634             if ($key == "Medication") {$key_short_title = "Meds"; $title = "Medications"; }
 635             if ($key == "Problem") {$key_short_title = "PMH"; $title = "Past Medical History"; }
 636             if ($key == "Surgery") {$key_short_title = "Surg"; $title = "Surgery History"; }
 637             if ($key == "SOCH") {$key_short_title = "Soc"; $title = "Social History"; }
 638             $HELLO[attr($key)] = '<input type="radio" name="form_type" id="PMSFH_'.attr($key).'" value="'.attr($key).'" '.$checked.' onclick="top.restoreSession();newtype(\''.attr($key).'\');" /><span>'.
 639                             '<label class="input-helper input-helper--checkbox" for="PMSFH_'.attr($key).'" title="'.xla($title).'">' . xlt($key_short_title) . '</label></span>&nbsp;';
 640           }
 641           //put them in the desired display order
 642           echo $HELLO['POH'].$HELLO['POS'].$HELLO['PMH'].$HELLO['Medication'].$HELLO['Surgery'].$HELLO['Allergy'].$HELLO['FH'].$HELLO['SOCH'].$HELLO['ROS'];
 643           ?>
 644         </div>
 645       <div class="borderShadow" style="text-align:left;margin-top:7px;width:95%;">
 646         <table  border='0' width='95%'>
 647           <tr id='row_quick_picks'>
 648             <td valign='top' nowrap>&nbsp;</td>
 649             <td valign='top'  colspan="2">
 650               <select name='form_titles' size='5' onchange='top.restoreSession();set_text();'>
 651               </select>
 652             </td>
 653             <td>
 654           </tr>
 655           <tr id="row_title">
 656             <td valign='top' class="right" id='title_diagnosis' nowrap style="font-weight:bold;vertical-align:middle;"><?php echo xlt('Title'); ?>:</td>
 657             <td  colspan="3">
 658               <input type='text' size='40' name='form_title' id='form_title' value='<?php echo attr($irow['title']) ?>' />
 659             </td>
 660           </tr>
 661           <tr id="row_diagnosis">
 662             <td valign='top' class="right" nowrap style="font-weight:bold;vertical-align:middle;"><b><?php echo xlt('Code'); ?>:</b></td>
 663             <td colspan="3">
 664               <input type='text' size='50' name='form_diagnosis' id='form_diagnosis'
 665                 value='<?php echo attr($irow['diagnosis']) ?>' onclick='top.restoreSession();sel_diagnosis();'
 666                 title='<?php echo xla('Click to select or change diagnoses'); ?>' />
 667             </td>
 668           </tr>
 669           <tr id='row_begindate'>
 670             <td nowrap class="right"><b id="onset"><?php echo xlt('Onset'); ?>:</b></td>
 671             <td>
 672              <input type='text' size='10' name='form_begin' id='form_begin'
 673               value='<?php echo attr($irow['begdate']) ?>'¸
 674               style="width: 80px;"
 675               onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)'
 676               title='<?php echo xla('yyyy-mm-dd date of onset, surgery or start of medication'); ?>' />
 677              <img src='<?php echo $GLOBALS['webroot']; ?>/interface/pic/show_calendar.gif' align='absbottom' width='15' height='15'
 678               id='img_begin' border='0' alt='[?]' style='cursor:pointer'
 679               title='<?php echo xla('Click here to choose a date'); ?>' />
 680             </td>
 681             <td id='row_enddate' nowrap><input type='checkbox' name='form_active' id='form_active' value='1' <?php echo attr($irow['enddate']) ? "checked" : ""; ?>
 682               onclick='top.restoreSession();resolvedClicked(this);'
 683               title='<?php echo xla('Indicates if this issue is currently active'); ?>' />
 684               <b id="resolved"><?php echo xlt('Resolved'); ?>:</b>&nbsp;<input type='text' size='10' name='form_end' id='form_end'
 685               style="width: 80px;"
 686               value='<?php echo attr($irow['enddate']) ?>'
 687               onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)'
 688               title='<?php echo xla('yyyy-mm-dd date of recovery or end of medication'); ?>' />
 689              <img src='<?php echo $GLOBALS['webroot']; ?>/interface/pic/show_calendar.gif' align='absbottom' width='15' height='15'
 690               id='img_end' border='0' alt='[?]' style='cursor:pointer'
 691               title='<?php echo xla('Click here to choose a date'); ?>' />
 692             </td>
 693            </tr>
 694
 695            <tr id='row_occurrence'>
 696             <td valign='top'  class="right" nowrap><b><?php echo xlt('Course'); ?>:</b></td>
 697             <td colspan="3">
 698              <?php
 699               // Modified 6/2009 by BM to incorporate the occurrence items into the list_options listings
 700               generate_form_field(array('data_type'=>1,'field_id'=>'occur','list_id'=>'occurrence','empty_title'=>'SKIP'), $irow['occurrence']);
 701              ?><a href="<?php echo $GLOBALS['webroot']; ?>/interface/super/edit_list.php?list_id=occurrence" target="RTop"
 702                 title="<?php echo xla('Click here to Edit the Course/Occurrence List'); ?>" style="color:black;"><i class="fa fa-pencil fa-fw"></i></a>
 703             </td>
 704            </tr>
 705
 706            <tr id='row_classification'>
 707             <td valign='top'  class="right" nowrap><b><?php echo xlt('Classification'); ?>:</b></td>
 708             <td colspan="3">
 709              <select name='form_classification' id='form_classification'>
 710                 <?php
 711                foreach ($ISSUE_CLASSIFICATIONS as $key => $value) {
 712                 echo "   <option value='".attr($key)."'";
 713                 if ($key == $irow['classification']) echo " selected";
 714                 echo ">".text($value)."\n";
 715                }
 716                 ?>
 717              </select>
 718             </td>
 719           </tr>
 720           <tr id='row_reaction'>
 721              <td valign='top'  class="right" nowrap><b><?php echo xlt('Reaction'); ?>:</b></td>
 722              <td  colspan="3">
 723               <input type='text' size='40' name='form_reaction' id='form_reaction' value='<?php echo attr($irow['reaction']) ?>'
 724                title='<?php echo xla('Allergy Reaction'); ?>' />
 725              </td>
 726           </tr>
 727           <tr id='row_referredby'>
 728             <td class="right" nowrap><b id="by_whom"><?php echo xlt('Referred by'); ?>:</b></td>
 729             <td  colspan="3">
 730               <input type='text' size='40' name='form_referredby' id='form_referredby' value='<?php echo attr($irow['referredby']) ?>'
 731               title='<?php echo xla('Referring physician and practice'); ?>' />
 732             </td>
 733           </tr>
 734           <tr id='row_eye_med'>
 735             <td class="right" nowrap><b id="by_whom"><?php echo xlt('Eye Med'); ?>:</b></td>
 736             <td  colspan="3"><?php echo $irow['subtype']; ?>
 737               <input type='checkbox' name='form_eye_subtype' id='form_eye_subtype' value='1'
 738               <?php if ($irow['subtype'] =='eye') echo "checked"; ?> style="margin:3px 3px 3px 5px;"
 739               title='<?php echo xla('Indicates if this issue is an ophthalmic-specific medication'); ?>' />
 740             </td>
 741           </tr>
 742
 743           <tr id='row_comments'>
 744             <td valign='top' class="right" nowrap><b><?php echo xlt('Comments'); ?>:</b></td>
 745             <td colspan="3">
 746              <textarea name='form_comments' id='form_comments' cols='40' wrap='virtual'><?php echo text($irow['comments']) ?></textarea>
 747             </td>
 748           </tr>
 749           <tr id="row_outcome">
 750             <td valign='top'  class="right" nowrap><b><?php echo xlt('Outcome'); ?>:</b></td>
 751             <td>
 752              <?php
 753               echo generate_select_list('form_outcome', 'outcome', $irow['outcome'], '', '', '', 'outcomeClicked(this);');
 754              ?>
 755             </td>
 756           </tr>
 757           <tr id="row_destination">
 758             <td valign='top'  class="right" nowrap><b><?php echo xlt('Destination'); ?>:</b></td>
 759             <td colspan="3">
 760             <?php if (true) { ?>
 761              <input type='text' size='40' name='form_destination' value='<?php echo attr($irow['destination']) ?>'
 762               title='GP, Secondary care specialist, etc.' />
 763             <?php } else { // leave this here for now, please -- Rod ?>
 764              <?php echo rbinput('form_destination', '1', 'GP'                 , 'destination') ?>&nbsp;
 765              <?php echo rbinput('form_destination', '2', 'Secondary care spec', 'destination') ?>&nbsp;
 766              <?php echo rbinput('form_destination', '3', 'GP via physio'      , 'destination') ?>&nbsp;
 767              <?php echo rbinput('form_destination', '4', 'GP via podiatry'    , 'destination') ?>
 768             <?php } ?>
 769             </td>
 770           </tr>
 771         </table>
 772         <table id="row_social" width="100%">
 773               <?php
 774                 $given ="*";
 775                 $dateStart=$_POST['dateState'];
 776                 $dateEnd=$_POST['dateEnd'];
 777                 if ($dateStart && $dateEnd) {
 778                       $result1 = sqlQuery("select $given from history_data where pid = ? and date >= ? and date <= ? order by date DESC limit 0,1", array($pid,$dateStart,$dateEnd) );
 779                   }
 780                   else if ($dateStart && !$dateEnd) {
 781                       $result1 = sqlQuery("select $given from history_data where pid = ? and date >= ? order by date DESC limit 0,1", array($pid,$dateStart) );
 782                   }
 783                   else if (!$dateStart && $dateEnd) {
 784                       $result1 = sqlQuery("select $given from history_data where pid = ? and date <= ? order by date DESC limit 0,1", array($pid,$dateEnd) );
 785                   }
 786                   else {
 787                       $result1 = sqlQuery("select $given from history_data where pid=? order by date DESC limit 0,1", array($pid) );
 788                   }
 789
 790                   $group_fields_query = sqlStatement("SELECT * FROM layout_options " .
 791                   "WHERE form_id = 'HIS' AND group_name = '4Lifestyle' AND uor > 0 " .
 792                   "ORDER BY seq");
 793                 while ($group_fields = sqlFetchArray($group_fields_query)) {
 794                     $titlecols  = $group_fields['titlecols'];
 795                     $datacols   = $group_fields['datacols'];
 796                     $data_type  = $group_fields['data_type'];
 797                     $field_id   = $group_fields['field_id'];
 798                     $list_id    = $group_fields['list_id'];
 799                     $currvalue  = '';
 800                 if (isset($result1[$field_id])) $currvalue = $result1[$field_id];
 801                 if ($data_type == 28 || $data_type == 32) {
 802                     $tmp = explode('|', $currvalue);
 803                     switch(count($tmp)) {
 804                       case "4": {
 805                         $result2[$field_id]['resnote'] = $tmp[0];
 806                         $result2[$field_id]['restype'] = $tmp[1];
 807                         $result2[$field_id]['resdate'] = $tmp[2];
 808                         $result2[$field_id]['reslist'] = $tmp[3];
 809                       } break;
 810                       case "3": {
 811                         $result2[$field_id]['resnote'] = $tmp[0];
 812                         $result2[$field_id]['restype'] = $tmp[1];
 813                         $result2[$field_id]['resdate'] = $tmp[2];
 814                       } break;
 815                       case "2": {
 816                         $result2[$field_id]['resnote'] = $tmp[0];
 817                         $result2[$field_id]['restype'] = $tmp[1];
 818                         $result2[$field_id]['resdate'] = "";
 819                       } break;
 820                       case "1": {
 821                         $result2[$field_id]['resnote'] = $tmp[0];
 822                         $result2[$field_id]['resdate'] = $result2[$field_id]['restype'] = "";
 823                       } break;
 824                       default: {
 825                         $result2[$field_id]['restype'] = $result2[$field_id]['resdate'] = $result2[$field_id]['resnote'] = "";
 826                       } break;
 827                     }
 828                     $fldlength = empty($frow['fld_length']) ?  20 : $frow['fld_length'];
 829                     $fldlength = htmlspecialchars( $fldlength, ENT_QUOTES);
 830                     $result2[$field_id]['resnote'] = htmlspecialchars( $result2[$field_id]['resnote'], ENT_QUOTES);
 831                     $result2[$field_id]['resdate'] = htmlspecialchars( $result2[$field_id]['resdate'], ENT_QUOTES);
 832                   } else if ($data_type == 2) {
 833                      $result2[$field_id]['resnote'] = nl2br(htmlspecialchars($currvalue,ENT_NOQUOTES));
 834                   }
 835                 }
 836               ?>
 837               <style>
 838                 .data td{
 839                   font-size:0.7em;
 840                 }
 841                 .data input[type="text"] {
 842                  width:90px;
 843                 }
 844                 #form_box {
 845                   width:90px;
 846                 }
 847               </style>
 848
 849               <tbody>
 850                   <tr>
 851                     <td class="right" nowrap><?php echo xlt('Marital'); ?>:</td>
 852                     <td colspan="3"><input type="text" style="width:75px;" name="marital_status" id="marital_status" value="<?php echo attr($patient['status']); ?>">
 853                     &nbsp;<?php echo xlt('Occupation'); ?>:&nbsp;<input type="text" style="width:175px;" name="occupation" id="occupation" value="<?php echo attr($patient['occupation']); ?>"></td>
 854                   </tr>
 855                   <tr>
 856                     <td></td>
 857                     <td colspan="2">
 858                       <select name="form_tobacco" id="form_tobacco" onchange="radioChange(this.options[this.selectedIndex].value)" title="<?php xla('Tobacco use'); ?>">
 859                         <option value="" <?php if ($result2['tobacco']['reslist'] =='') echo "selected"; ?>><?php echo xlt('Unassigned'); ?></option>
 860                         <option value="1" <?php if ($result2['tobacco']['reslist'] =='1') echo "selected"; ?>><?php echo xlt('Current every day smoker'); ?></option>
 861                         <option value="2" <?php if ($result2['tobacco']['reslist'] =='2') echo "selected"; ?>><?php echo xlt('Current some day smoker<'); ?>/option>
 862                         <option value="3" <?php if ($result2['tobacco']['reslist'] =='3') echo "selected"; ?>><?php echo xlt('Former smoker'); ?></option>
 863                         <option value="4" <?php if ($result2['tobacco']['reslist'] =='4') echo "selected"; ?>><?php echo xlt('Never smoker'); ?></option>
 864                         <option value="5" <?php if ($result2['tobacco']['reslist'] =='5') echo "selected"; ?>><?php echo xlt('Smoker, current status unknown'); ?></option>
 865                         <option value="9" <?php if ($result2['tobacco']['reslist'] =='9') echo "selected"; ?>><?php echo xlt('Unknown if ever smoked'); ?></option>
 866                         <option value="15" <?php if ($result2['tobacco']['reslist'] =='15') echo "selected"; ?>><?php echo xlt('Heavy tobacco smoker'); ?></option>
 867                         <option value="16" <?php if ($result2['tobacco']['reslist'] =='16') echo "selected"; ?>><?php echo xlt('Light tobacco smoker'); ?></option>
 868                       </select>
 869                     </td>
 870                     <td nowrap><span style="text-decoration:underline;padding-right:3px;">Never</span></td>
 871                     <td>
 872                       <span style="text-decoration:underline;"><?php echo xlt('N/A{{not applicable}}'); ?></span></td>
 873                   </tr>
 874
 875                   <tr>
 876                     <td class="right"  nowrap><?php echo xlt('Tobacco'); ?>:</td>
 877                     <td class="text data" colspan="4">
 878                       <table cellpadding="0" cellspacing="0">
 879                         <tr>
 880                           <td><input type="text" name="form_text_tobacco" id="form_box" size="20" value="<?php echo attr($PMSFH[0]['SOCH']['tobacco']['resnote']); ?>">&nbsp;</td>
 881                           <td class="bold">&nbsp;&nbsp;</td>
 882                           <td class="text">
 883                             <input type="radio" name="radio_tobacco" id="radio_tobacco[current]" value="currenttobacco" onclick="smoking_statusClicked(this)" <?php if ($result2['tobacco']['restype'] =='currenttobacco') echo "checked"; ?>><?php echo xlt('Current'); ?>&nbsp;</td>
 884                           <td class="text"><input type="radio" name="radio_tobacco" id="radio_tobacco[quit]" value="quittobacco" onclick="smoking_statusClicked(this)" <?php if ($result2['tobacco']['restype'] =='quittobacco') echo "checked"; ?>><?php echo xlt('Quit'); ?>&nbsp;</td>
 885                           <td class="text" onclick='top.restoreSession();resolvedClicked(this);'>
 886                             <input type="text" size="6"
 887                             name="date_tobacco" id="date_tobacco"
 888                             value="<?php echo attr($result2['tobacco']['resdate']); ?>"
 889                             title="<?php echo xla('Tobacco use'); ?>"
 890                             onkeyup="datekeyup(this,mypcc)"
 891                             onblur="dateblur(this,mypcc)"><img src="<?php echo $GLOBALS['webroot']; ?>/interface/pic/show_calendar.gif" align="absbottom"
 892                             width="15" height="15"
 893                             id="img_tobacco"
 894                             border="0" alt="[?]" style="cursor:pointer"
 895                             title="<?php echo xla('Click here to choose a date'); ?>">&nbsp;
 896                           </td>
 897                           <td class="text">
 898                             <input type="radio" name="radio_tobacco" id="radio_tobacco[never]" value="nevertobacco" onclick="smoking_statusClicked(this)" <?php if ($result2['tobacco']['restype'] =='nevertobacco') echo "checked"; ?>><?php echo xlt('Never'); ?>&nbsp;
 899                           </td>
 900                           <td><input name="radio_tobacco" type="radio" id="radio_tobacco[not_applicable]" <?php if ($PMSFH[0]['SOCH']['tobacco']['restype'] =='not_applicable') echo "checked"; ?> value="not_applicabletobacco">
 901                           <label class="fa fa-history input-helper  nodisplay" for="radio_tobacco[not_applicable]"></label>
 902                           </td>
 903                         </tr>
 904                       </table>
 905                     </td>
 906                   </tr>
 907
 908                   <tr>
 909                     <td  class="right" nowrap><?php echo xlt('Coffee'); ?>:</td>
 910                     <td class="text data" colspan="4">
 911                       <table cellpadding="0" cellspacing="0">
 912                         <tbody>
 913                           <tr>
 914                             <td><input type="text" name="form_coffee" id="form_box" size="20" value="<?php echo attr($result2['coffee']['resnote']); ?>">&nbsp;</td>
 915                             <td class="bold">&nbsp;&nbsp;</td>
 916                             <td class="text"><input type="radio" name="radio_coffee" id="radio_coffee[current]" value="currentcoffee" <?php if ($PMSFH[0]['SOCH']['coffee']['restype'] =='currentcoffee') echo "checked"; ?>><?php echo xlt('Current'); ?>&nbsp;</td>
 917                             <td class="text"><input type="radio" name="radio_coffee" id="radio_coffee[quit]" value="quitcoffee" <?php if ($PMSFH[0]['SOCH']['coffee']['restype'] =='quitcoffee') echo "checked"; ?>><?php echo xlt('Quit'); ?>&nbsp;</td>
 918                             <td class="text"><input type="text" size="6" name="date_coffee" id="date_coffee" value="" title="<?php echo xla('Caffeine consumption'); ?>" onkeyup="datekeyup(this,mypcc)" onblur="dateblur(this,mypcc)"><img src="<?php echo $GLOBALS['webroot']; ?>/interface/pic/show_calendar.gif" align="absbottom" width="15" height="15" id="img_coffee" border="0" alt="[?]" style="cursor:pointer" title="<?php echo xla('Click here to choose a date'); ?>">&nbsp;</td>
 919                             <td class="text"><input type="radio" name="radio_coffee" id="radio_coffee[never]" value="nevercoffee" <?php if ($PMSFH[0]['SOCH']['coffee']['restype'] =='nevercoffee') echo "checked"; ?>><?php echo xlt('Never'); ?>&nbsp;</td>
 920                             <td><input name="radio_coffee" type="radio" id="radio_coffee[not_applicable]" <?php if ($PMSFH[0]['SOCH']['coffee']['restype'] =='not_applicable') echo "checked"; ?> value="not_applicablecoffee">
 921                               <label class="fa fa-history input-helper nodisplay" for="radio_coffee[not_applicable]"></label>
 922                               </td>
 923                           </tr>
 924                         </tbody>
 925                       </table>
 926                     </td>
 927                   </tr>
 928
 929                   <tr>
 930                     <td class="right"  nowrap><?php echo xlt('Alcohol'); ?>:</td>
 931                     <td class="text data" colspan="4">
 932                       <table cellpadding="0" cellspacing="0">
 933                         <tbody>
 934                           <tr><td><input type="text" name="form_alcohol" id="form_box" size="20" value="<?php echo attr($result2['alcohol']['resnote']); ?>">&nbsp;</td><td class="bold">&nbsp;&nbsp;</td><td class="text"><input type="radio" name="radio_alcohol" id="radio_alcohol[current]" value="currentalcohol" <?php if ($PMSFH[0]['SOCH']['alcohol']['restype'] =='currentalcohol') echo "checked"; ?>><?php echo xlt('Current'); ?>&nbsp;</td>
 935                             <td class="text"><input type="radio" name="radio_alcohol" id="radio_alcohol[quit]" value="quitalcohol" <?php if ($PMSFH[0]['SOCH']['alcohol']['restype'] =='quitalcohol') echo "checked"; ?>><?php echo xlt('Quit'); ?>&nbsp;</td>
 936                             <td class="text"><input type="text" size="6" name="date_alcohol" id="date_alcohol" value="" title="<?php echo xla('Alcohol consumption'); ?>" onkeyup="datekeyup(this,mypcc)" onblur="dateblur(this,mypcc)"><img src="<?php echo $GLOBALS['webroot']; ?>/interface/pic/show_calendar.gif" align="absbottom" width="15" height="15" id="img_alcohol" border="0" alt="[?]" style="cursor:pointer" title="<?php echo attr('Click here to choose a date'); ?>">&nbsp;</td>
 937                             <td class="text"><input type="radio" name="radio_alcohol" id="radio_alcohol[never]" value="neveralcohol" <?php if ($PMSFH[0]['SOCH']['alcohol']['restype'] =='neveralcohol') echo "checked"; ?>><?php echo xlt('Never'); ?>&nbsp;</td>
 938                             <td><input name="radio_alcohol" type="radio" id="radio_alcohol[not_applicable]" value="not_applicablealcohol" <?php if ($PMSFH[0]['SOCH']['alcohol']['restype'] =='not_applicable') echo "checked"; ?>>
 939                           <label class="fa fa-history input-helper nodisplay" for="radio_alcohol[not_applicable]"></label>
 940
 941                           </td>
 942                           </tr>
 943                         </tbody>
 944                       </table>
 945                     </td>
 946                   </tr>
 947
 948                   <tr>
 949                     <td class="right"  nowrap><?php echo xlt('Drugs'); ?>:</td>
 950                     <td class="text data" colspan="4">
 951                       <table cellpadding="0" cellspacing="0">
 952                         <tbody>
 953                           <tr>
 954                             <td><input type="text" name="form_recreational_drugs" id="form_box" size="20" value="<?php echo attr($result2['recreational_drugs']['resnote']); ?>">&nbsp;</td><td class="bold">&nbsp;&nbsp;</td>
 955                             <td class="text"><input type="radio" name="radio_recreational_drugs" id="radio_recreational_drugs[current]" value="currentrecreational_drugs" <?php if ($PMSFH[0]['SOCH']['recreational_drugs']['restype'] =='currentrecreational_drugs') echo "checked"; ?>><?php echo xlt('Current'); ?>&nbsp;</td>
 956                             <td class="text"><input type="radio" name="radio_recreational_drugs" id="radio_recreational_drugs[quit]" value="quitrecreational_drugs" <?php if ($PMSFH[0]['SOCH']['recreational_drugs']['restype'] =='quitrecreational_drugs') echo "checked"; ?>><?php echo xlt('Quit'); ?>&nbsp;</td>
 957                             <td class="text"><input type="text" size="6" name="date_recreational_drugs" id="date_recreational_drugs" value="" title="<?php echo xla('Recreational drug use'); ?>" onkeyup="datekeyup(this,mypcc)" onblur="dateblur(this,mypcc)"><img src="<?php echo $GLOBALS['webroot']; ?>/interface/pic/show_calendar.gif" align="absbottom" width="15" height="15" id="img_recreational_drugs" border="0" alt="[?]" style="cursor:pointer" title="<?php echo xla('Click here to choose a date'); ?>">&nbsp;</td>
 958                             <td class="text"><input type="radio" name="radio_recreational_drugs" id="radio_recreational_drugs[never]" value="neverrecreational_drugs" <?php if ($PMSFH[0]['SOCH']['recreational_drugs']['restype'] =='neverrecreational_drugs') echo "checked"; ?>><?php echo xlt('Never'); ?>&nbsp;</td>
 959                             <td><input name="radio_recreational_drugs" type="radio" id="radio_recreational_drugs[not_applicable]" <?php if ($PMSFH[0]['SOCH']['recreational_drugs']['restype'] =='not_applicable') echo "checked"; ?> value="not_applicablerecreational_drugs">
 960                           <label class="fa fa-history input-helper nodisplay" for="radio_recreational_drugs[not_applicable]"></label>
 961                         </td>
 962                           </tr>
 963                         </tbody>
 964                       </table>
 965                     </td>
 966                   </tr>
 967
 968                   <tr class="nodisplay" >
 969                     <td class="right"  nowrap><?php echo xlt('Counseling'); ?>:</td>
 970                     <td class="text data" colspan="4">
 971                       <table cellpadding="0" cellspacing="0"><tbody><tr><td><input type="text" name="form_counseling" id="form_box" size="20" value="<?php echo attr($result2['counseling']['resnote']); ?>">&nbsp;</td><td class="bold">&nbsp;&nbsp;</td><td class="text"><input type="radio" name="radio_counseling" id="radio_counseling[current]" value="currentcounseling" <?php if ($PMSFH[0]['SOCH']['counseling']['restype'] =='currentcounseling') echo "checked"; ?>><?php echo xlt('Current'); ?>&nbsp;</td>
 972                     <td class="text"><input type="radio" name="radio_counseling" id="radio_counseling[quit]" value="quitcounseling" <?php if ($PMSFH[0]['SOCH']['counseling']['restype'] =='quitcounseling') echo "checked"; ?>><?php echo xlt('Quit'); ?>&nbsp;</td>
 973                     <td class="text"><input type="text" size="6" name="date_counseling" id="date_counseling" value="" title="<?php echo xla('Counseling activities') ?>" onkeyup="datekeyup(this,mypcc)" onblur="dateblur(this,mypcc)"><img src="<?php echo $GLOBALS['webroot']; ?>/interface/pic/show_calendar.gif" align="absbottom" width="15" height="15" id="img_counseling" border="0" alt="[?]" style="cursor:pointer" title="<?php echo xla('Click here to choose a date'); ?>">&nbsp;</td>
 974                     <td class="text"><input type="radio" name="radio_counseling" id="radio_counseling[never]" value="nevercounseling" <?php if ($PMSFH[0]['SOCH']['counseling']['restype'] =='nevercounseling') echo "checked"; ?>><?php echo xlt('Never'); ?>&nbsp;</td>
 975                     <td><input name="radio_counseling" type="radio" id="radio_counseling[not_applicable]" value="not_applicablecounseling" <?php if ($PMSFH[0]['SOCH']['counseling']['restype'] =='not_applicable') echo "checked"; ?>>
 976                       <label class="fa fa-history input-helper nodisplay" for="radio_counseling[not_applicable]"></label>
 977                     </td>
 978                   </tr></tbody></table></td></tr>
 979
 980                   <tr>
 981                     <td class="right" nowrap>
 982                     <?php echo xlt('Exercise'); ?>:</td>
 983                     <td class="text data" colspan="4">
 984                       <table cellpadding="0" cellspacing="0">
 985                         <tbody><tr><td><input type="text" name="form_exercise_patterns" id="form_box" size="20" value="<?php echo attr($result2['exercise_patterns']['resnote']); ?>">&nbsp;</td><td class="bold">&nbsp;&nbsp;</td><td class="text"><input type="radio" name="radio_exercise_patterns" id="radio_exercise_patterns[current]" value="currentexercise_patterns" <?php if ($PMSFH[0]['SOCH']['exercise_patterns']['restype'] =='currentexercise_patterns') echo "checked"; ?>><?php echo xlt('Current'); ?>&nbsp;</td>
 986                         <td class="text"><input type="radio" name="radio_exercise_patterns" id="radio_exercise_patterns[quit]" value="quitexercise_patterns" <?php if ($PMSFH[0]['SOCH']['exercise_patterns']['restype'] =='quitexercise_patterns') echo "checked"; ?>><?php echo xlt('Quit') ?>&nbsp;</td>
 987                         <td class="text"><input type="text" name="date_exercise_patterns" id="date_exercise_patterns" value="" title="<?php echo xla('Exercise patterns') ?>" onkeyup="datekeyup(this,mypcc)" onblur="dateblur(this,mypcc)"><img src="<?php echo $GLOBALS['webroot']; ?>/interface/pic/show_calendar.gif" align="absbottom" width="15" height="15" id="img_exercise_patterns" border="0" alt="[?]" style="cursor:pointer" title="<?php echo xla('Click here to choose a date'); ?>">&nbsp;</td>
 988                         <td class="text"><input type="radio" name="radio_exercise_patterns" id="radio_exercise_patterns[never]" value="neverexercise_patterns"<?php if ($PMSFH[0]['SOCH']['exercise_patterns']['restype'] =='neverexercise_patterns') echo "checked"; ?>><?php echo xlt('Never') ?>&nbsp;</td>
 989                         <td><input name="radio_exercise_patterns" type="radio" id="radio_exercise_patterns[not_applicable]" <?php if ($PMSFH[0]['SOCH']['exercise_patterns']['restype'] =='not_applicable') echo "checked"; ?> value="not_applicableexercise_patterns"><label class="fa fa-history input-helper nodisplay" for="radio_exercise_patterns[not_applicable]"></label>
 990                         </td>
 991                           </tr>
 992                         </tbody>
 993                       </table>
 994                     </td>
 995                   </tr>
 996
 997                   <tr class="nodisplay">
 998                     <td class="right"  nowrap><?php echo xlt('Hazardous Activities'); ?>:</td>
 999                     <td class="text data" colspan="4">
1000                       <table cellpadding="0" cellspacing="0">
1001                         <tbody><tr><td><input type="text" name="form_hazardous_activities" id="form_box" size="20" value="<?php echo attr($result2['hazardous_activities']['resnote']); ?>">&nbsp;</td><td class="bold">&nbsp;&nbsp;</td><td class="text"><input type="radio" name="radio_hazardous_activities" id="radio_hazardous_activities[current]" value="currenthazardous_activities" <?php if ($PMSFH[0]['SOCH']['hazardous_activities']['restype'] =='currenthazardous_activities') echo "checked"; ?>><?php echo xlt('Current'); ?>&nbsp;</td>
1002                         <td class="text"><input type="radio" name="radio_hazardous_activities" id="radio_hazardous_activities[quit]" value="quithazardous_activities" <?php if ($PMSFH[0]['SOCH']['hazardous_activities']['restype'] =='quithazardous_activities') echo "checked"; ?>><?php echo xlt('Quit') ?>&nbsp;</td>
1003                         <td class="text"><input type="text" name="date_hazardous_activities" id="date_hazardous_activities" value="" title="<?php echo xla('Hazardous activities') ?>" onkeyup="datekeyup(this,mypcc)" onblur="dateblur(this,mypcc)"><img src="<?php echo $GLOBALS['webroot']; ?>/interface/pic/show_calendar.gif" align="absbottom" width="15" height="15" id="img_hazardous_activities" border="0" alt="[?]" style="cursor:pointer" title="<?php echo xla('Click here to choose a date'); ?>">&nbsp;</td>
1004                         <td class="text"><input type="radio" name="radio_hazardous_activities" id="radio_hazardous_activities[never]" value="neverhazardous_activities" <?php if ($PMSFH[0]['SOCH']['hazardous_activities']['restype'] =='neverhazardous_activities') echo "checked"; ?>><?php echo xlt('Never') ?>&nbsp;</td>
1005                         <td><input name="radio_hazardous_activities" type="radio" id="radio_hazardous_activities[not_applicable]" <?php if ($PMSFH[0]['SOCH']['hazardous_activities']['restype'] =='not_applicable') echo "checked"; ?> value="not_applicablehazardous_activities" onclick="hazardous_activities_statusClicked(this)"><label class="fa fa-history input-helper nodisplay" for="radio_hazardous_activities[not_applicable]"></label>
1006                         </td>
1007                         </tr>
1008                         </tbody>
1009                       </table>
1010                     </td>
1011                   </tr>
1012
1013                   <tr>
1014                     <td class="right"  nowrap><?php echo xlt('Sleep'); ?>:</td>
1015                     <td class="text data" colspan="4">
1016                       <table cellpadding="0" cellspacing="0">
1017                         <tbody>
1018                           <tr><td><input type="text" name="form_sleep_patterns" id="form_box" size="20" title="<?php echo xla('Sleep patterns'); ?>" value="<?php echo attr($result2['sleep_patterns']['resnote']); ?>"></td>
1019                             <td class="left"  nowrap><?php echo xlt('Seatbelt'); ?>:
1020                             </td>
1021                             <td><input type="text" name="form_seatbelt_use" id="form_box" size="20" title="<?php echo xla('Seatbelt use'); ?>" value="<?php echo attr($result2['seatbelt_use']['resnote']); ?>">
1022                             </td>
1023                           </tr>
1024                         </tbody>
1025                       </table>
1026                     </td>
1027                   </tr>
1028               </tbody>
1029         </table>
1030         <table id="row_FH" name="row_FH" width="90%">
1031           <tr>
1032             <td class="right" nowrap><?php echo xlt('Glaucoma'); ?>:</td>
1033             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext11" name="radio_usertext11" <?php if (!$result1['usertext11']) echo "checked='checked'"; ?>>
1034               <input type="text" name="usertext11" id="usertext11" onclick='clear_option(this)' value="<?php echo attr($result1['usertext11']); ?>"></td>
1035             <td class="right" nowrap><?php echo xlt('Cataract'); ?>:</td>
1036             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext12" name="radio_usertext12" <?php if (!$result1['usertext12']) echo "checked='checked'"; ?>>
1037               <input type="text" name="usertext12" id="usertext12" onclick='clear_option(this)' value="<?php echo attr($result1['usertext12']); ?>"></td>
1038           </tr>
1039           <tr>
1040             <td class="right" nowrap><?php echo xlt('AMD{{age related macular degeneration}}'); ?>:</td>
1041             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext13" name="radio_usertext13" <?php if (!$result1['usertext13']) echo "checked='checked'"; ?>>
1042               <input type="text" name="usertext13" id="usertext13" onclick='clear_option(this)' value="<?php echo attr($result1['usertext13']); ?>"></td>
1043             <td class="right" nowrap><?php echo xlt('RD{{retinal detachment}}'); ?>:</td>
1044             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext14" name="radio_usertext14" <?php if (!$result1['usertext14']) echo "checked='checked'"; ?>>
1045               <input type="text" name="usertext14" id="usertext14" onclick='clear_option(this)' value="<?php echo attr($result1['usertext14']); ?>"></td>
1046           </tr>
1047           <tr>
1048             <td class="right" nowrap><?php echo xlt('Blindness'); ?>:</td>
1049             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext15" name="radio_usertext15" <?php if (!$result1['usertext15']) echo "checked='checked'"; ?>>
1050               <input type="text" name="usertext15" id="usertext15" onclick='clear_option(this)' value="<?php echo attr($result1['usertext15']); ?>"></td>
1051             <td class="right" nowrap><?php echo xlt('Amblyopia'); ?>:</td>
1052             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext16" name="radio_usertext16" <?php if (!$result1['usertext16']) echo "checked='checked'"; ?>>
1053               <input type="text" name="usertext16" id="usertext16" onclick='clear_option(this)' value="<?php echo attr($result1['usertext16']); ?>"></td>
1054           </tr>
1055           <tr>
1056             <td class="right" nowrap><?php echo xlt('Strabismus'); ?>:</td>
1057             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext17" name="radio_usertext17" <?php if (!$result1['usertext17']) echo "checked='checked'"; ?>>
1058               <input type="text" name="usertext17" id="usertext17" onclick='clear_option(this)' value="<?php echo attr($result1['usertext17']); ?>"></td>
1059             <td class="right" nowrap><?php echo xlt('Epilepsy'); ?>:</td>
1060             <td class="text data">
1061               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_epilepsy" name="radio_relatives_epilepsy" <?php if (!$result1['relatives_epilepsy']) echo "checked='checked'"; ?>>
1062               <input type="text" name="relatives_epilepsy" id="relatives_epilepsy" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_epilepsy']); ?>"></td>
1063           </tr>
1064           <tr>
1065             <td class="right" nowrap><?php echo xlt('Cancer'); ?>:</td>
1066             <td class="text data">
1067               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_cancer" name="radio_relatives_cancer" <?php if (!$result1['relatives_cancer']) echo "checked='checked'"; ?>>
1068               <input type="text" name="relatives_cancer" id="relatives_cancer" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_cancer']); ?>"></td>
1069             <td class="right" nowrap><?php echo xlt('Diabetes'); ?>:</td>
1070             <td class="text data">
1071               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_diabetes" name="radio_relatives_diabetes" <?php if (!$result1['relatives_diabetes']) echo "checked='checked'"; ?>>
1072               <input type="text" name="relatives_diabetes" id="relatives_diabetes" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_diabetes']); ?>"></td>
1073           </tr>
1074           <tr>
1075             <td class="right" nowrap><?php echo xlt('HTN{{hypertension}}'); ?>:</td>
1076             <td class="text data">
1077               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_high_blood_pressure" name="radio_relatives_high_blood_pressure" <?php if (!$result1['relatives_high_blood_pressure']) echo "checked='checked'"; ?>>
1078               <input type="text" name="relatives_high_blood_pressure" id="relatives_high_blood_pressure" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_high_blood_pressure']); ?>"></td>
1079             <td class="right" nowrap><?php echo xlt('Cardiac'); ?>:</td>
1080             <td class="text data">
1081               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_heart_problems" name="radio_relatives_heart_problems" <?php if (!$result1['relatives_heart_problems']) echo "checked='checked'"; ?>>
1082               <input type="text" name="relatives_heart_problems" id="relatives_heart_problems" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_heart_problems']); ?>"></td>
1083           </tr>
1084           <tr>
1085             <td class="right" nowrap><?php echo xlt('Stroke'); ?>:</td>
1086             <td class="text data">
1087               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_stroke" name="radio_relatives_stroke" <?php if (!$result1['relatives_stroke']) echo "checked='checked'"; ?>>
1088               <input type="text" name="relatives_stroke" id="relatives_stroke" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_stroke']); ?>"></td>
1089             <td class="right" nowrap><?php echo xlt('Other'); ?>:</td>
1090             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext18" name="radio_usertext18" <?php if (!$result1['usertext18']) echo "checked='checked'"; ?>>
1091               <input type="text" name="usertext18" id="usertext18" onclick='clear_option(this)' value="<?php echo attr($result1['usertext18']); ?>"></td>
1092           </tr>
1093         </table>
1094         <table id="row_ROS" name="row_ROS" class="ROS_class">
1095           <tr>
1096             <td>
1097              &nbsp;
1098             </td>
1099           </tr>
1100           <tr>
1101             <td></td>
1102             <td>
1103               <span class="underline"><?php echo xlt('Neg{{negative}}'); ?></span><span class="underline" style="margin:30px;"><?php echo xlt('Positive'); ?></span>
1104             </td>
1105             <td></td>
1106             <td><span class="underline"><?php echo xlt('Neg{{negative}}'); ?></span><span class="underline" style="margin:30px;"><?php echo xlt('Positive'); ?></span>
1107             </td>
1108           </tr>
1109           <tr>
1110             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('General'); ?>:</label></td>
1111             <td>
1112               <input type="radio" onclick='negate_radio(this);' id="radio_ROSGENERAL" name="radio_ROSGENERAL" <?php if (!$ROSGENERAL) echo "checked='checked'"; ?>>
1113               <input type="text" name="ROSGENERAL" id="ROSGENERAL" onclick='clear_option(this)' value="<?php echo attr($ROSGENERAL); ?>"></td>
1114             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('HEENT'); ?>:</td>
1115             <td>
1116               <input type="radio" onclick='negate_radio(this);' id="radio_ROSHEENT" name="radio_ROSHEENT"<?php if (!$ROSHEENT) echo "checked='checked'"; ?>>
1117               <input type="text" name="ROSHEENT" id="ROSHEENT" onclick='clear_option(this)' value="<?php echo attr($ROSHEENT); ?>"></td>
1118           </tr>
1119           <tr>
1120             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('CV{{cardiovascular}}'); ?>:</td>
1121             <td>
1122               <input type="radio" onclick='negate_radio(this);' id="radio_ROSCV" name="radio_ROSCV"<?php if (!$ROSCV) echo "checked='checked'"; ?>>
1123               <input type="text" name="ROSCV" id="ROSCV" onclick='clear_option(this)' value="<?php echo attr($ROSCV); ?>"></td>
1124             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Pulmonary'); ?>:</td>
1125             <td>
1126               <input type="radio" onclick='negate_radio(this);' id="radio_ROSPULM" name="radio_ROSPULM"<?php if (!$ROSPULM) echo "checked='checked'"; ?>>
1127               <input type="text" name="ROSPULM" id="ROSPULM" onclick='clear_option(this)' value="<?php echo attr($ROSPULM); ?>"></td>
1128             </tr>
1129           <tr>
1130             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('GI{{gastroenterology}}'); ?>:</td>
1131             <td>
1132               <input type="radio" onclick='negate_radio(this);' id="radio_ROSGI" name="radio_ROSGI"<?php if (!$ROSGI) echo "checked='checked'"; ?>>
1133               <input type="text" name="ROSGI" id="ROSGI" onclick='clear_option(this)' value="<?php echo attr($ROSGI); ?>"></td>
1134             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('GU{{genitourinary}}'); ?>:</td>
1135             <td>
1136               <input type="radio" onclick='negate_radio(this);' id="radio_ROSGU" name="radio_ROSGU"<?php if (!$ROSGU) echo "checked='checked'"; ?>>
1137               <input type="text" name="ROSGU" id="ROSGU" onclick='clear_option(this)' value="<?php echo attr($ROSGU); ?>"></td>
1138           </tr>
1139           <tr>
1140             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Derm{{dematologic}}'); ?>:</td>
1141             <td>
1142               <input type="radio" onclick='negate_radio(this);' id="radio_ROSDERM" name="radio_ROSDERM"<?php if (!$ROSDERM) echo "checked='checked'"; ?>>
1143               <input type="text" name="ROSDERM" id="ROSDERM" onclick='clear_option(this)' value="<?php echo attr($ROSDERM); ?>"></td>
1144             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Neuro{{neurologic}}'); ?>:</td>
1145             <td>
1146               <input type="radio" onclick='negate_radio(this);' id="radio_ROSNEURO" name="radio_ROSNEURO"<?php if (!$ROSNEURO) echo "checked='checked'"; ?>>
1147               <input type="text" name="ROSNEURO" id="ROSNEURO" onclick='clear_option(this)' value="<?php echo attr($ROSNEURO); ?>"></td>
1148           </tr>
1149           <tr>
1150             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Psych{{psychiatric}}'); ?>:</td>
1151             <td>
1152               <input type="radio" onclick='negate_radio(this);' id="radio_ROSPSYCH" name="radio_ROSPSYCH"<?php if (!$ROSPSYCH) echo "checked='checked'"; ?>>
1153               <input type="text" name="ROSPSYCH" id="ROSPSYCH" onclick='clear_option(this)' value="<?php echo attr($ROSPSYCH); ?>"></td>
1154             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Musculo{{musculoskeletal}}'); ?>:</td>
1155             <td>
1156               <input type="radio" onclick='negate_radio(this);' id="radio_ROSMUSCULO" name="radio_ROSMUSCULO"<?php if (!$ROSMUSCULO) echo "checked='checked'"; ?>>
1157               <input type="text" name="ROSMUSCULO" id="ROSMUSCULO" onclick='clear_option(this)' value="<?php echo attr($ROSMUSCULO); ?>"></td>
1158             </tr>
1159           <tr>
1160             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Immuno{{immunologic}}'); ?>:</td>
1161             <td>
1162               <input type="radio" onclick='negate_radio(this);' id="radio_ROSIMMUNO" name="radio_ROSIMMUNO"<?php if (!$ROSIMMUNO) echo "checked='checked'"; ?>>
1163               <input type="text" name="ROSIMMUNO" id="ROSIMMUNO" onclick='clear_option(this)' value="<?php echo attr($ROSIMMUNO); ?>"></td>
1164             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Endocrine'); ?>:</td>
1165             <td>
1166               <input type="radio" onclick='negate_radio(this);' id="radio_ROSENDOCRINE" name="radio_ROSENDOCRINE"<?php if (!$ROSENDOCRINE) echo "checked='checked'"; ?>>
1167               <input type="text" name="ROSENDOCRINE" id="ROSENDOCRINE" onclick='clear_option(this)' value="<?php echo attr($ROSENDOCRINE); ?>"></td>
1168             </tr>
1169           <tr><td></td></tr>
1170         </table>
1171         <table id="row_PLACEHOLDER" name="row_PLACEHOLDER" width="90%">
1172           <tr>
1173             <td>
1174             </td>
1175           </tr>
1176         </table>
1177       </div>
1178       <center>
1179         <p style="margin-top:10px;">
1180           <input type="hidden" type="text" id="issue_js" name="issue_js" value="test">
1181           <input type="hidden" type="text" id="pid" name="pid" value="<?php echo $pid; ?>">
1182           <input type='button' id='form_save' name='form_save'
1183           class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only navy"
1184           onclick='top.restoreSession();submit_this_form();' value='<?php echo xla('Save'); ?>' />
1185           <?php
1186               $display_delete = "nodisplay";
1187             ?>
1188           &nbsp;
1189           <input type='button' name='delete_button' id='delete_button'
1190           class="<?php echo $display_delete; ?> ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only navy"
1191           onclick='top.restoreSession();deleteme();' value='<?php echo xla('Delete'); ?>' />
1192           &nbsp;
1193           <input type='button' name='cancel_button' id='cancel_button'
1194           class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only navy"
1195           value='<?php echo xla('Cancel'); ?>' onclick='clearme();' />
1196           </p>
1197         </center>
1198       </form>
1199     </div>
1200     <script language='JavaScript'>
1201        newtype('<?php if (!$form_index) { echo "POH"; } else { echo $type_index; } ?>');
1202        Calendar.setup({inputField:"form_begin", ifFormat:"%Y-%m-%d", button:"img_begin"});
1203        Calendar.setup({inputField:"form_end", ifFormat:"%Y-%m-%d", button:"img_end"});
1204        <?php
1205        $has_cal ="tobacco,coffee,alcohol,recreational_drugs,exercise_patterns";
1206        foreach (explode(',',$has_cal) as $item) {
1207         echo 'Calendar.setup({inputField:"date_'.$item.'", ifFormat:"%Y-%m-%d", button:"img_'.$item.'"});';
1208        } ?>
1209
1210       $(document).ready(function() {
1211         $('[title]').qtip({
1212                       position: {
1213                         my: 'top Right',  // Position my top left...
1214                         at: 'bottom Left', // at the bottom right of...
1215                         target: 'mouse' // my target
1216                       }
1217                     });
1218         //$("textarea,text").css("background-color","#FFF8DC");
1219
1220       });
1221     </script>
1222   </body>
1223 </html>
1224