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  * @package   OpenEMR
   9  * @link      http://www.open-emr.org
  10  * @author    Rod Roark <rod@sunsetsystems.com>
  11  * @author    Ray Magauran <magauran@MedFetch.com>
  12  * @author    Brady Miller <brady.g.miller@gmail.com>
  13  * @copyright Copyright (c) 2005-2011 Rod Roark <rod@sunsetsystems.com>
  14  * @copyright Copyright (c) 2015-2016 Ray Magauran <magauran@MedFetch.com>
  15  * @copyright Copyright (c) 2017 Brady Miller <brady.g.miller@gmail.com>
  16  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  17  */
  18
  19 $form_folder= "eye_mag";
  20 require_once('../../globals.php');
  21 require_once($GLOBALS['srcdir'].'/lists.inc');
  22 require_once($GLOBALS['srcdir'].'/patient.inc');
  23 require_once($GLOBALS['srcdir'].'/acl.inc');
  24 require_once($GLOBALS['srcdir'].'/options.inc.php');
  25 require_once($GLOBALS['fileroot'].'/custom/code_types.inc.php');
  26 require_once($GLOBALS['srcdir'].'/csv_like_join.php');
  27 require_once($GLOBALS['srcdir'].'/log.inc');
  28 require_once("../../forms/".$form_folder."/php/".$form_folder."_functions.php");
  29
  30 $pid = 0 + (empty($_REQUEST['pid']) ? $pid : $_REQUEST['pid']);
  31 $info_msg = "";
  32
  33 // A nonempty thisenc means we are to link the issue to the encounter.
  34 // ie. we are going to use this as a billing issue?
  35 // The Coding Engine does not look at encounters and issue linkage, yet.  It could and perhaps should.
  36 $encounter = 0 + (empty($_REQUEST['encounter']) ? $_SESSION['encounter'] : $_REQUEST['encounter']);
  37
  38 $issue = $_REQUEST['issue'];
  39 $deletion = $_REQUEST['deletion'];
  40 $form_save = $_REQUEST['form_save'];
  41 if (!$pid) {
  42     $pid = $_SESSION['pid'];
  43 }
  44
  45 $form_id = $_REQUEST['form_id'];
  46 $form_type = $_REQUEST['form_type'];
  47 $uniqueID = $_REQUEST['uniqueID'];
  48
  49 if ($issue && !acl_check('patients', 'med', '', 'write')) {
  50     die(xlt("Edit is not authorized!"));
  51 }
  52
  53 if (!acl_check('patients', 'med', '', array('write','addonly'))) {
  54     die(xlt("Add is not authorized!"));
  55 }
  56
  57 $PMSFH = build_PMSFH($pid);
  58 $patient = getPatientData($pid, "*");
  59 $providerID   = findProvider($pid, $encounter);
  60 if (!$_SESSION['providerID'] && $providerID) {
  61     ($_SESSION['providerID'] = $providerID);
  62 }
  63
  64 $irow = array();
  65 if ($issue) {
  66     $irow = sqlQuery("SELECT * FROM lists WHERE id = ?", array($issue));
  67 } else if ($thistype) {
  68     $irow['type'] = $thistype;
  69     $irow['subtype'] = $subtype;
  70 }
  71
  72 if (!empty($irow['type'])) {
  73     foreach ($ISSUE_TYPES as $key => $value) {
  74         if ($key == $irow['type']) {
  75             break;
  76         }
  77
  78         ++$type_index;
  79     }
  80 }
  81
  82 $given="ROSGENERAL,ROSHEENT,ROSCV,ROSPULM,ROSGI,ROSGU,ROSDERM,ROSNEURO,ROSPSYCH,ROSMUSCULO,ROSIMMUNO,ROSENDOCRINE";
  83 $query="SELECT $given from form_eye_mag where id=? and pid=?";
  84 $rres = sqlQuery($query, array($form_id,$pid));
  85 foreach (explode(',', $given) as $item) {
  86     $$item = $rres[$item];
  87 }
  88
  89 ?><html>
  90   <head>
  91     <title><?php echo xlt('Add New Issue'); ?></title>
  92     <script language="JavaScript">
  93                     <?php       require_once("$srcdir/restoreSession.php");  ?>
  94     </script>
  95     <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/interface/main/tabs/js/include_opener.js?v=<?php echo $v_js_includes; ?>"></script>
  96     <meta name="viewport" content="width=device-width, initial-scale=1" />
  97     <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/textformat.js?v=<?php echo $v_js_includes; ?>"></script>
  98     <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/dialog.js?v=<?php echo $v_js_includes; ?>"></script>
  99     <script language="JavaScript">
 100      var aitypes = new Array(); // issue type attributes
 101      var aopts   = new Array(); // Option objects
 102         <?php
 103         //This builds the litle quick pick list in this section.
 104         // If the provider has more 2 items already defined in the last month, they are collated
 105         // and ranked by frequency, sort alphabetically and <=10 are listed.
 106         // If not, we use the defaults from list_options/
 107         $i='0';
 108
 109         foreach ($PMSFH[0] as $key => $value) {
 110             echo " aopts['" . attr($key) . "'] = [];\n";
 111             $local ='1';
 112             echo " aitypes['" . attr($key). "'] = '0';\n";
 113             if ($key =="PMH") { // "0" = medical_problem_issue_list leave out Dental "4"
 114                 $qry = sqlStatement("SELECT title, title as option_id, diagnosis as codes, count(title) AS freq  FROM `lists` WHERE `type` LIKE ? and
 115             subtype = '' and pid in (select pid from form_encounter where provider_id =?
 116             and date BETWEEN NOW() - INTERVAL 30 DAY AND NOW()) GROUP BY title order by freq desc limit 10", array("medical_problem",$_SESSION['providerID']));
 117
 118                 if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 119                       $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = ? and subtype not like 'eye'", array("medical_problem_issue_list"));
 120                 }
 121             } elseif ($key =="Medication") {
 122                 $qry = sqlStatement("SELECT title, title as option_id, diagnosis as codes, count(title) AS freq  FROM `lists` WHERE `type` LIKE ? and
 123             subtype = '' and pid in (select pid from form_encounter where provider_id =?
 124             and date BETWEEN NOW() - INTERVAL 30 DAY AND NOW()) GROUP BY title order by freq desc limit 10", array("medication",$_SESSION['providerID']));
 125                 if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 126                     $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = ? and subtype not like 'eye'", array("medication_issue_list"));
 127                 }
 128             } elseif ($key =="Surgery") {
 129                 $qry = sqlStatement("SELECT title, title as option_id, diagnosis as codes, count(title) AS freq  FROM `lists` WHERE `type` LIKE ? and
 130             subtype = '' and pid in (select pid from form_encounter where provider_id =?
 131             and date BETWEEN NOW() - INTERVAL 30 DAY AND NOW()) GROUP BY title order by freq desc limit 10", array("surgery",$_SESSION['providerID']));
 132                 if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 133                     $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = ? and subtype not like 'eye'", array("surgery_issue_list"));
 134                 }
 135             } elseif ($key =="Allergy") {
 136                 $qry = sqlStatement("SELECT title, title as option_id, diagnosis as codes, count(title) AS freq  FROM `lists` WHERE `type` LIKE ? and
 137             subtype = '' and pid in (select pid from form_encounter where provider_id =?
 138             and date BETWEEN NOW() - INTERVAL 30 DAY AND NOW()) GROUP BY title order by freq desc limit 10", array("allergy",$_SESSION['providerID']));
 139                 if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 140                     $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = ? and subtype not like 'eye'", array("allergy_issue_list"));
 141                 }
 142             } elseif ($key == "POH") { // POH medical group
 143                 $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";
 144                 $qry = sqlStatement($query, array($_SESSION['providerID']));
 145                 if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 146                     $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = 'medical_problem_issue_list' and subtype = 'eye'");
 147                 }
 148             } elseif ($key == "POS") { // POS surgery group
 149                 $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";
 150                 $qry = sqlStatement($query, array($_SESSION['providerID']));
 151                 if (sqlNumRows($qry) < '4') { //if they are just starting out, use the list_options for all
 152                     $qry = sqlStatement("SELECT * FROM list_options WHERE list_id = 'surgery_issue_list' and subtype = 'eye'");
 153                 }
 154             } elseif ($key == "FH") {
 155                 $local = "";
 156                 $qry = "";
 157             } elseif ($key == "SOCH") {
 158                 $local = "";
 159                 $qry = "";
 160             } elseif ($key == "ROS") {
 161                 $local = "";
 162                 $qry = "";
 163             }
 164
 165             if ($local =="1") { // leave FH/SocHx/ROS for later - done below separately
 166                 while ($res = sqlFetchArray($qry)) { //Should we take the top 10 and display alphabetically?
 167                     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";
 168                     if ($res['codes']) {
 169                         echo " aopts['" .attr($key). "'][aopts['" .attr($key). "'].length-1].setAttribute('data-code','".attr(trim($res['codes']))."');\n";
 170                     }
 171                 }
 172             }
 173
 174             ++$i;
 175         }
 176
 177     ?>
 178
 179     <?php require($GLOBALS['srcdir'] . "/restoreSession.php"); ?>
 180
 181     function newtype(index) {
 182       var f = document.forms[0];
 183       var theopts = f.form_titles.options;
 184       theopts.length = 0;
 185       if (aopts[index]) {
 186         var i = 0;
 187         for (i = 0; i < aopts[index].length; ++i) {
 188           theopts[i] = aopts[index][i];
 189         }
 190       }
 191
 192        f.form_type.value = index;
 193        f.form_occur.options[0].selected = true;
 194
 195       document.getElementById('row_quick_picks'     ).style.display = i ? '' : 'none'; //select list of things
 196       document.getElementById('row_title'           ).style.display = '';
 197       document.getElementById('row_diagnosis'       ).style.display = 'none';
 198       document.getElementById('row_begindate'       ).style.display = 'none';
 199       document.getElementById('row_enddate'         ).style.display = 'none';
 200       document.getElementById('row_reaction'        ).style.display = 'none';
 201       document.getElementById('row_referredby'      ).style.display = 'none';
 202       document.getElementById('row_classification'  ).style.display = 'none';
 203       document.getElementById('row_occurrence'      ).style.display = 'none';
 204       document.getElementById('row_comments'        ).style.display = 'none';
 205       document.getElementById('row_outcome'         ).style.display = 'none';
 206       document.getElementById('row_destination'     ).style.display = 'none';
 207       document.getElementById('row_social'          ).style.display = 'none';
 208       document.getElementById('row_FH'              ).style.display = 'none';
 209       document.getElementById('row_ROS'             ).style.display = 'none';
 210       document.getElementById('row_PLACEHOLDER'     ).style.display = 'none';
 211       document.getElementById('cancel_button'       ).style.display = 'none';
 212       document.getElementById('row_eye_med'         ).style.display = 'none';
 213
 214
 215       if (index == 'PMH') {
 216         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('PMH Dx').":"; ?>";
 217         document.getElementById('row_diagnosis'     ).style.display = '';
 218         document.getElementById('row_begindate'     ).style.display = '';
 219         document.getElementById('row_enddate'       ).style.display = '';
 220         document.getElementById('row_occurrence'    ).style.display = '';
 221         f.form_occur.options[2].selected = true;
 222         document.getElementById('row_comments'      ).style.display = '';
 223
 224       } else if (index == 'Allergy') {
 225         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('Allergic to').":"; ?>";
 226         document.getElementById('row_reaction'      ).style.display = '';
 227         document.getElementById('row_begindate'     ).style.display = '';
 228         document.getElementById('row_comments'      ).style.display = '';
 229
 230       } else if (index == 'Medication') {
 231         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('Medication').":"; ?>";
 232         document.getElementById('row_begindate'     ).style.display = '';
 233         document.getElementById('row_enddate'       ).style.display = '';
 234         document.getElementById('row_comments'      ).style.display = '';
 235         document.getElementById('row_eye_med'       ).style.display = '';
 236
 237         //change Onset to started
 238         //change resolved to Completed
 239         document.getElementById('onset'             ).textContent = "<?php echo xlt('Start').':'; ?>";
 240         document.getElementById('resolved'          ).textContent = "<?php echo xlt('Finish').':'; ?>";
 241
 242       } else if ((index == 'Surgery')||(index =='POS')) {
 243         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('Procedure').':'; ?>";
 244         document.getElementById('row_diagnosis'     ).style.display = '';
 245
 246         document.getElementById('row_begindate'     ).style.display = '';
 247         document.getElementById('row_referredby'    ).style.display = '';
 248         document.getElementById('form_referredby'   ).title="<?php echo xla('Name of the Surgeon'); ?>";
 249         document.getElementById('by_whom'           ).textContent = "<?php echo xlt('Surgeon').':'; ?>";
 250         document.getElementById('onset'             ).textContent = "<?php echo xlt('Date').':'; ?>";
 251         document.getElementById('row_outcome'       ).style.display = '';
 252         document.getElementById('row_comments'      ).style.display = '';
 253
 254       } else if (index == 4) { //Dental so skip it
 255       } else if (index == 'POH') {
 256         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('Eye Dx{{eye diagnosis}}').":"; ?>";
 257         document.getElementById('row_diagnosis'     ).style.display = '';
 258         document.getElementById('row_begindate'     ).style.display = '';
 259         document.getElementById('row_referredby'    ).style.display = '';
 260         document.getElementById('by_whom'           ).textContent ="<?php echo xlt('Collaborator').":"; ?>";
 261         document.getElementById('form_referredby'   ).title="<?php echo xla('Co-managing/referring provider'); ?>";
 262         document.getElementById('onset'             ).textContent = "<?php echo xlt('Date').":"; ?>";
 263         document.getElementById('row_comments'      ).style.display = '';
 264
 265       } else if (index == 'FH') {
 266         document.getElementById('row_title'         ).style.display = 'none';
 267         document.getElementById('row_FH'            ).style.display = '';
 268
 269       } else if (index == 'SOCH') {
 270         document.getElementById('row_title'         ).style.display = 'none';
 271         document.getElementById('row_social'        ).style.display = '';
 272         document.getElementById('cancel_button'       ).style.display = '';
 273
 274       } else if (index == 'ROS') {
 275         document.getElementById('row_title'         ).style.display = 'none';
 276         document.getElementById('row_ROS'           ).style.display = '';
 277
 278       } else {
 279         document.getElementById('title_diagnosis'   ).textContent ="<?php echo xlt('Eye Dx{{eye diagnosis}}').":"; ?>";
 280         document.getElementById('row_diagnosis'     ).style.display = '';
 281         document.getElementById('row_begindate'     ).style.display = '';
 282         document.getElementById('row_referredby'    ).style.display = '';
 283         document.getElementById('form_referredby'   ).title="<?php echo xla('Referring provider'); ?>";
 284         document.getElementById('by_whom'           ).textContent ="<?php echo xlt('Collaborator').":"; ?>";
 285         document.getElementById('onset'             ).textContent = "<?php echo xlt('Date').":"; ?>";
 286         document.getElementById('row_comments'      ).style.display = '';
 287         document.getElementById('row_PLACEHOLDER'   ).style.display = '';
 288       }
 289       return false;
 290     }
 291      // If a clickoption title is selected, copy it to the title field.
 292      // We also want to copy any other fields present in obj.PMSFH_options
 293      // We need to build this object first.  The base install options will need ICD-10 codes attached
 294      // to make this work.
 295      // f.form_title.diagnosis = f.form_titles.options[f.form_titles.selectedIndex].text;
 296     function set_text() {
 297       var f = document.forms[0];
 298       f.form_title.value = f.form_titles.options[f.form_titles.selectedIndex].text;
 299       f.form_diagnosis.value = f.form_titles.options[f.form_titles.selectedIndex].getAttribute('data-code');
 300       f.form_titles.selectedIndex = -1;
 301     }
 302
 303     function refreshIssue() {  parent.refresh_page(); }
 304     function submit_this_form() {
 305         var url = "../../forms/eye_mag/save.php?PMSFH_save=1&mode=update&form_save=1";
 306         var formData = $("form#theform2").serialize();
 307         var f = document.forms[0];
 308         top.restoreSession();
 309         $.ajax({
 310                type   : 'POST',   // define the type of HTTP verb we want to use (POST for our form)
 311                url    : url,      // the url where we want to POST
 312                data   : formData  // our data object
 313             }).done(function(result){
 314               f.form_title.value = '';
 315               f.form_diagnosis.value = '';
 316               f.form_begin.value ='';
 317               f.form_end.value ='';
 318               f.form_referredby.value ='';
 319               f.form_reaction.value ='';
 320               f.form_classification.value ='';
 321               f.form_comments.value ='';
 322               f.form_outcome.value ='';
 323               f.form_destination.value ='';
 324               f.issue.value ='';
 325               parent.populate_form(result);
 326             });
 327     }
 328     // Process click on Delete link.
 329     function deleteme() {
 330       var url = "../../forms/eye_mag/save.php?PMSFH_save=1&mode=update&form_save=1";
 331       var f = document.forms[0];
 332       top.restoreSession();
 333       $.ajax({
 334                type    : 'POST',
 335                data    : {
 336                             pid    : <?php echo attr($pid); ?>,
 337                             issue  : f.issue.value,
 338                             deletion : '1',
 339                             PMSFH  : '1'
 340                           },
 341                 url    : url
 342                }).done(function (result){
 343                 // CLEAR THE FORM TOO...
 344                 f.form_title.value = '';
 345                 f.form_diagnosis.value = '';
 346                 f.form_begin.value ='';
 347                 f.form_end.value ='';
 348                 f.form_referredby.value ='';
 349                 f.form_reaction.value ='';
 350                 f.form_classification.value ='';
 351                 f.form_comments.value ='';
 352                 f.form_occur.options[0].selected = true;
 353                 f.form_outcome.value ='';
 354                 f.form_destination.value ='';
 355                 f.issue.value ='';
 356                 parent.populate_form(result);
 357                });}
 358
 359     function imdeleted() { closeme(); }
 360     function clearme() {
 361       negate_radio('radio_tobacco');
 362       var f = document.forms[0];
 363
 364      // f.radio_tobacco.value = '';
 365       f.form_diagnosis.value = '';
 366       f.form_begin.value ='';
 367       f.form_end.value ='';
 368       f.form_referredby.value ='';
 369       f.form_reaction.value ='';
 370       f.form_classification.value ='';
 371       f.form_comments.value ='';
 372       f.form_outcome.value ='';
 373       f.form_destination.value ='';
 374       f.issue.value ='';
 375     }
 376      // Called when the Active checkbox is clicked.  For consistency we
 377      // use the existence of an end date to indicate inactivity, even
 378      // though the simple verion of the form does not show an end date.
 379     function resolvedClicked(cb) {
 380       var f = document.forms[0];
 381       if (!cb.checked) {
 382        f.form_end.value = '';
 383        f.delete_button.classList.remove("nodisplay");
 384       } else {
 385        var today = new Date();
 386        f.form_end.value = '' + (today.getYear() + 1900) + '-' +
 387         (today.getMonth() + 1) + '-' + today.getDate();
 388         f.delete_button.classList.add("nodisplay");
 389       }}
 390
 391     // Called when resolved outcome is chosen and the end date is entered.
 392     function outcomeClicked(cb) {
 393       var f = document.forms[0];
 394       if (cb.value == '1'){
 395        var today = new Date();
 396        f.form_end.value = '' + (today.getYear() + 1900) + '-' +
 397         ("0" + (today.getMonth() + 1)).slice(-2) + '-' + ("0" + today.getDate()).slice(-2);
 398        f.form_end.focus();
 399       }}
 400     // This is for callback by the find-code popup.
 401     // Appends to or erases the current list of diagnoses.
 402     function set_related(codetype, code, selector, codedesc) {
 403      var f = document.forms[0];
 404      var s = f.form_diagnosis.value;
 405      var title = f.form_title.value;
 406      if (code) {
 407       if (s.length > 0) s += ';';
 408       s += codetype + ':' + code;
 409      } else {
 410       s = '';
 411      }
 412      f.form_diagnosis.value = s;
 413      if(title == '') f.form_title.value = codedesc;
 414     }
 415
 416     // This invokes the find-code popup.
 417     function sel_diagnosis() {
 418       var f = document.forms[0];
 419       term = f.form_title.value;
 420         <?php
 421         if (($irow['type'] == 'PMH') ||($irow['type'] == 'POH')) {
 422             ?>
 423           dlgopen('../../patient_file/encounter/find_code_popup.php?codetype=<?php echo attr(collect_codetypes("medical_problem", "csv")) ?>&search_term='+term, '_blank', 500, 400);
 424             <?php
 425         } else {
 426             ?>
 427           dlgopen('../../patient_file/encounter/find_code_popup.php?codetype=<?php echo attr(collect_codetypes("diagnosis", "csv")) ?>&search_term='+term, '_blank', 500, 400);
 428             <?php
 429         }
 430         ?>
 431       f.form_save.focus();
 432     }
 433
 434     // Check for errors when the form is submitted.
 435     function validate() {
 436       var f = document.forms[0];
 437       if(f.form_begin.value > f.form_end.value && (f.form_end.value)) {
 438         alert("<?php echo addslashes(xl('Please Enter End Date greater than Begin Date!')); ?>");
 439         return false;
 440       }
 441       if (f.form_type.value != 'ROS' && f.form_type.value != 'FH' && f.form_type.value !='SOCH') {
 442         if (! f.form_title.value) {
 443           alert("<?php echo addslashes(xl('Please enter a title!')); ?>");
 444           return false;
 445         }
 446       }
 447      return true;
 448     }
 449
 450     // Supports customizable forms (currently just for IPPF).
 451     function divclick(cb, divid) {
 452      var divstyle = document.getElementById(divid).style;
 453      if (cb.checked) {
 454       divstyle.display = 'block';
 455      } else {
 456       divstyle.display = 'none';
 457      }
 458      return true;}
 459     //function for selecting the smoking status in drop down list based on the selection in radio button.
 460     function smoking_statusClicked(cb) {
 461       if (cb.value == 'currenttobacco')
 462       {
 463       document.getElementById('form_tobacco').selectedIndex = 1;
 464       }
 465       else if (cb.value == 'nevertobacco')
 466       {
 467       document.getElementById('form_tobacco').selectedIndex = 4;
 468       }
 469       else if (cb.value == 'quittobacco')
 470       {
 471       document.getElementById('form_tobacco').selectedIndex = 3;
 472       }
 473       else if (cb.value == 'not_applicabletobacco')
 474       {
 475       document.getElementById('form_tobacco').selectedIndex = 6;
 476       }
 477       radioChange(document.getElementById('form_tobacco').value);   }
 478     //function for selecting the smoking status in radio button based on the selection of drop down list.
 479     function radioChange(rbutton){
 480         if (rbutton == 1 || rbutton == 2 || rbutton == 15 || rbutton == 16)
 481          {
 482          document.getElementById('radio_tobacco[current]').checked = true;
 483          }
 484          else if (rbutton == 3)
 485          {
 486          document.getElementById('radio_tobacco[quit]').checked = true;
 487          }
 488          else if (rbutton == 4)
 489          {
 490          document.getElementById('radio_tobacco[never]').checked = true;
 491          }
 492          else if (rbutton == 5 || rbutton == 9)
 493          {
 494          document.getElementById('radio_tobacco[not_applicable]').checked = true;
 495          }
 496          else if (rbutton == '')
 497          {
 498          var radList = document.getElementsByName('radio_tobacco');
 499          for (var i = 0; i < radList.length; i++) {
 500          if(radList[i].checked) radList[i].checked = false;
 501          }
 502          }
 503          //Added on 5-jun-2k14 (regarding 'Smoking Status - display SNOMED code description')
 504          if(rbutton!=""){
 505              if(code_options_js[rbutton]!="")
 506                 $("#smoke_code").html(" ( "+code_options_js[rbutton]+" )");
 507              else
 508                  $("#smoke_code").html("");
 509          }
 510          else
 511             $("#smoke_code").html("");
 512       }
 513
 514     function setSelectBoxByText(eid, etxt) {
 515         var eid = document.getElementById(eid);
 516         for (var i = 0; i < eid.options.length; ++i) {
 517             if (eid.options[i].text === etxt)
 518                 eid.options[i].selected = true;
 519         }
 520     }
 521     function clear_option(section) {
 522       //click the field, erase the Negative radio and input Y
 523       var f = document.forms[0];
 524       var name = 'radio_'+section.name;
 525       var radio = document.getElementById(name);
 526         radio.checked = false;
 527       if (section.value==''){
 528         section.value="Y";
 529         section.select();
 530       }}
 531     function negate_radio(section) {
 532       if (section.checked ==true){
 533         var rfield = section.name.match(/radio_(.*)/);
 534         document.getElementById(rfield[1]).value='';
 535       } }
 536       //Added on 5-jun-2k14 (regarding 'Smoking Status - display SNOMED code description')
 537      var code_options_js = Array();
 538
 539         <?php
 540         $smoke_codes = getSmokeCodes();
 541
 542         foreach ($smoke_codes as $val => $code) {
 543                 echo "code_options_js"."['" . attr($val) . "']='" . attr($code) . "';\n";
 544         }
 545         ?>
 546
 547     </script>
 548     <!-- Add Font stuff for the look and feel.  -->
 549
 550       <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative'] ?>/bootstrap-3-3-4/dist/css/bootstrap.min.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-datetimepicker-2-5-4/build/jquery.datetimepicker.min.css">
 553       <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative'] ?>/jquery-ui-1-11-4/themes/excite-bike/jquery-ui.css">
 554       <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative'] ?>/pure-0-5-0/pure-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       <link rel="stylesheet" href="../../forms/<?php echo $form_folder; ?>/css/style.css" type="text/css">
 558       <style>
 559           td, select, textarea, input  {
 560          font-family: Fontawesome, Arial, Helvetica, sans-serif;
 561          font-size: 8pt;
 562          }
 563
 564          input[type="text"],textarea{
 565             text-align:left;
 566             Xbackground-color: cornsilk;
 567             text-align: left;
 568             display: inline-block;
 569             border: 1px solid #CCC !important;
 570             box-shadow: 0px 1px 3px #DDD inset !important;
 571             border-radius: 4px;
 572             margin:3px 3px 3px 5px;
 573             box-sizing: border-box;
 574             width:100%;
 575            }
 576
 577           div.section {
 578            border: solid;
 579            border-width: 1px;
 580            border-color: #0000ff;
 581            margin: 0 0 0 10pt;
 582            padding: 5pt;
 583           }
 584           .ROS_class input[type="text"] {
 585             width:100px;
 586           }
 587           .label {
 588             color:black;
 589           }
 590           .issues {
 591             font-size:0.8em;
 592           }
 593          select {
 594             text-align:left;
 595             text-align: left;
 596             border: 1px solid #CCC !important;
 597             box-shadow: 0px 1px 3px #DDD inset !important;
 598             border-radius: 4px;
 599             margin:1px 3px 1px 5px;
 600             box-sizing: border-box;
 601          }
 602          .navy {
 603           background-color: navy !important;
 604          }
 605          form {
 606           margin:7px auto;
 607          }
 608
 609       </style>
 610
 611       <link rel="shortcut icon" href="<?php echo $GLOBALS['images_static_relative']; ?>/favicon.ico" />
 612       <script src="<?php echo $GLOBALS['assets_static_relative'] ?>/jquery-min-1-11-3/index.js"></script>
 613       <script src="<?php echo $GLOBALS['assets_static_relative'] ?>/bootstrap-3-3-4/dist/js/bootstrap.min.js"></script>
 614       <script src="<?php echo $GLOBALS['assets_static_relative'] ?>/jquery-ui-1-11-4/jquery-ui.min.js"></script>
 615       <script src="<?php echo $GLOBALS['assets_static_relative'] ?>/qtip2-2-2-1/jquery.qtip.min.js"></script>
 616       <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative'] ?>/manual-added-packages/shortcut.js-2-01-B/shortcut.js"></script>
 617       <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-datetimepicker-2-5-4/build/jquery.datetimepicker.full.min.js"></script>
 618       <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($providerID); ?>"></script>
 619   </head>
 620   <body>
 621     <div id="page" style="text-align: justify; text-justify: newspaper;">
 622       <form method='POST' name='theform2' id='theform2'
 623       action='a_issue.php?pid=<?php echo attr($pid); ?>&encounter=<?php echo attr($encounter); ?>'
 624        onsubmit='return validate();'
 625        >
 626        <input type="hidden" name="form_id" id="form_id" value = "<?php echo attr($form_id); ?>">
 627        <input type="hidden" name="issue" id="issue" value = "<?php echo attr($issue); ?>">
 628        <input type="hidden" name="uniqueID" id="uniqueID" value = "<?php echo attr($uniqueID); ?>">
 629        <div class="issues">
 630             <?php
 631             $output ='';
 632             global $counter_header;
 633             $count_header='0';
 634             $output= array();
 635             foreach ($PMSFH[0] as $key => $value) {
 636                 $checked = '';
 637                 if ($key == "POH") {
 638                     $checked = " checked='checked' ";
 639                 }
 640
 641                 $key_short_title = $key;
 642                 if ($key == "Medication") {
 643                     $key_short_title = "Meds";
 644                     $title = "Medications";
 645                 }
 646
 647                 if ($key == "Problem") {
 648                     $key_short_title = "PMH";
 649                     $title = "Past Medical History";
 650                 }
 651
 652                 if ($key == "Surgery") {
 653                     $key_short_title = "Surg";
 654                     $title = "Surgery History";
 655                 }
 656
 657                 if ($key == "SOCH") {
 658                     $key_short_title = "Soc";
 659                     $title = "Social History";
 660                 }
 661
 662                 $HELLO[attr($key)] = '<input type="radio" name="form_type" id="PMSFH_'.attr($key).'" value="'.attr($key).'" '.$checked.' onclick="top.restoreSession();newtype(\''.attr($key).'\');" /><span>'.
 663                             '<label class="input-helper input-helper--checkbox" for="PMSFH_'.attr($key).'" title="'.xla($title).'">' . xlt($key_short_title) . '</label></span>&nbsp;';
 664             }
 665
 666           //put them in the desired display order
 667             echo $HELLO['POH'].$HELLO['POS'].$HELLO['PMH'].$HELLO['Medication'].$HELLO['Surgery'].$HELLO['Allergy'].$HELLO['FH'].$HELLO['SOCH'].$HELLO['ROS'];
 668             ?>
 669         </div>
 670       <div class="borderShadow" style="text-align:left;margin-top:7px;width:95%;">
 671         <table  border='0' width='95%'>
 672           <tr id='row_quick_picks'>
 673             <td valign='top' nowrap>&nbsp;</td>
 674             <td valign='top'  colspan="2">
 675               <select name='form_titles' size='5' onchange='top.restoreSession();set_text();'>
 676               </select>
 677             </td>
 678             <td>
 679           </tr>
 680           <tr id="row_title">
 681             <td valign='top' class="right" id='title_diagnosis' nowrap style="font-weight:bold;vertical-align:middle;"><?php echo xlt('Title'); ?>:</td>
 682             <td  colspan="3">
 683               <input type='text' size='40' name='form_title' id='form_title' value='<?php echo attr($irow['title']) ?>' />
 684             </td>
 685           </tr>
 686           <tr id="row_diagnosis">
 687             <td valign='top' class="right" nowrap style="font-weight:bold;vertical-align:middle;"><b><?php echo xlt('Code'); ?>:</b></td>
 688             <td colspan="3">
 689               <input type='text' size='50' name='form_diagnosis' id='form_diagnosis'
 690                 value='<?php echo attr($irow['diagnosis']) ?>' onclick='top.restoreSession();sel_diagnosis();'
 691                 title='<?php echo xla('Click to select or change diagnoses'); ?>' />
 692             </td>
 693           </tr>
 694           <tr id='row_begindate'>
 695             <td nowrap class="right"><b id="onset"><?php echo xlt('Onset'); ?>:</b></td>
 696             <td>
 697              <input type='text' class='datepicker' size='10' name='form_begin' id='form_begin'
 698               value='<?php echo attr($irow['begdate']) ?>'¸
 699               style="width: 80px;"
 700               title='<?php echo xla('yyyy-mm-dd date of onset, surgery or start of medication'); ?>' />
 701             </td>
 702             <td id='row_enddate' nowrap><input type='checkbox' name='form_active' id='form_active' value='1' <?php echo attr($irow['enddate']) ? "checked" : ""; ?>
 703               onclick='top.restoreSession();resolvedClicked(this);'
 704               title='<?php echo xla('Indicates if this issue is currently active'); ?>' />
 705               <b id="resolved"><?php echo xlt('Resolved'); ?>:</b>&nbsp;<input type='text' class='datepicker' size='10' name='form_end' id='form_end'
 706               style="width: 80px;"
 707               value='<?php echo attr($irow['enddate']) ?>'
 708               title='<?php echo xla('yyyy-mm-dd date of recovery or end of medication'); ?>' />
 709             </td>
 710            </tr>
 711
 712            <tr id='row_occurrence'>
 713             <td valign='top'  class="right" nowrap><b><?php echo xlt('Course'); ?>:</b></td>
 714             <td colspan="3">
 715                 <?php
 716               // Modified 6/2009 by BM to incorporate the occurrence items into the list_options listings
 717                 generate_form_field(array('data_type'=>1,'field_id'=>'occur','list_id'=>'occurrence','empty_title'=>'SKIP'), $irow['occurrence']);
 718                 ?><a href="<?php echo $GLOBALS['webroot']; ?>/interface/super/edit_list.php?list_id=occurrence" target="RTop"
 719                 title="<?php echo xla('Click here to Edit the Course/Occurrence List'); ?>" style="color:black;"><i class="fa fa-pencil fa-fw"></i></a>
 720             </td>
 721            </tr>
 722
 723            <tr id='row_classification'>
 724             <td valign='top'  class="right" nowrap><b><?php echo xlt('Classification'); ?>:</b></td>
 725             <td colspan="3">
 726              <select name='form_classification' id='form_classification'>
 727                 <?php
 728                 foreach ($ISSUE_CLASSIFICATIONS as $key => $value) {
 729                     echo "   <option value='".attr($key)."'";
 730                     if ($key == $irow['classification']) {
 731                         echo " selected";
 732                     }
 733
 734                     echo ">".text($value)."\n";
 735                 }
 736                 ?>
 737              </select>
 738             </td>
 739           </tr>
 740           <tr id='row_reaction'>
 741              <td valign='top'  class="right" nowrap><b><?php echo xlt('Reaction'); ?>:</b></td>
 742              <td  colspan="3">
 743               <input type='text' size='40' name='form_reaction' id='form_reaction' value='<?php echo attr($irow['reaction']) ?>'
 744                title='<?php echo xla('Allergy Reaction'); ?>' />
 745              </td>
 746           </tr>
 747           <tr id='row_referredby'>
 748             <td class="right" nowrap><b id="by_whom"><?php echo xlt('Referred by'); ?>:</b></td>
 749             <td  colspan="3">
 750               <input type='text' size='40' name='form_referredby' id='form_referredby' value='<?php echo attr($irow['referredby']) ?>'
 751               title='<?php echo xla('Referring physician and practice'); ?>' />
 752             </td>
 753           </tr>
 754           <tr id='row_eye_med'>
 755             <td class="right" nowrap><b id="by_whom"><?php echo xlt('Eye Med'); ?>:</b></td>
 756             <td  colspan="3"><?php echo $irow['subtype']; ?>
 757               <input type='checkbox' name='form_eye_subtype' id='form_eye_subtype' value='1'
 758                 <?php
 759                 if ($irow['subtype'] =='eye') {
 760                     echo "checked";
 761                 }
 762                 ?> style="margin:3px 3px 3px 5px;"
 763               title='<?php echo xla('Indicates if this issue is an ophthalmic-specific medication'); ?>' />
 764             </td>
 765           </tr>
 766
 767           <tr id='row_comments'>
 768             <td valign='top' class="right" nowrap><b><?php echo xlt('Comments'); ?>:</b></td>
 769             <td colspan="3">
 770              <textarea name='form_comments' id='form_comments' cols='40' wrap='virtual'><?php echo text($irow['comments']) ?></textarea>
 771             </td>
 772           </tr>
 773           <tr id="row_outcome">
 774             <td valign='top'  class="right" nowrap><b><?php echo xlt('Outcome'); ?>:</b></td>
 775             <td>
 776                 <?php
 777                 echo generate_select_list('form_outcome', 'outcome', $irow['outcome'], '', '', '', 'outcomeClicked(this);');
 778                 ?>
 779             </td>
 780           </tr>
 781           <tr id="row_destination">
 782             <td valign='top'  class="right" nowrap><b><?php echo xlt('Destination'); ?>:</b></td>
 783             <td colspan="3">
 784             <?php if (true) { ?>
 785              <input type='text' size='40' name='form_destination' value='<?php echo attr($irow['destination']) ?>'
 786               title='GP, Secondary care specialist, etc.' />
 787             <?php } else { // leave this here for now, please -- Rod ?>
 788                 <?php echo rbinput('form_destination', '1', 'GP', 'destination') ?>&nbsp;
 789                 <?php echo rbinput('form_destination', '2', 'Secondary care spec', 'destination') ?>&nbsp;
 790                 <?php echo rbinput('form_destination', '3', 'GP via physio', 'destination') ?>&nbsp;
 791                 <?php echo rbinput('form_destination', '4', 'GP via podiatry', 'destination') ?>
 792             <?php } ?>
 793             </td>
 794           </tr>
 795         </table>
 796         <table id="row_social" width="100%">
 797                 <?php
 798                 $given ="*";
 799                 $dateStart=$_POST['dateState'];
 800                 $dateEnd=$_POST['dateEnd'];
 801                 if ($dateStart && $dateEnd) {
 802                       $result1 = sqlQuery("select $given from history_data where pid = ? and date >= ? and date <= ? order by date DESC limit 0,1", array($pid,$dateStart,$dateEnd));
 803                 } else if ($dateStart && !$dateEnd) {
 804                     $result1 = sqlQuery("select $given from history_data where pid = ? and date >= ? order by date DESC limit 0,1", array($pid,$dateStart));
 805                 } else if (!$dateStart && $dateEnd) {
 806                     $result1 = sqlQuery("select $given from history_data where pid = ? and date <= ? order by date DESC limit 0,1", array($pid,$dateEnd));
 807                 } else {
 808                     $result1 = sqlQuery("select $given from history_data where pid=? order by date DESC limit 0,1", array($pid));
 809                 }
 810
 811                     $group_fields_query = sqlStatement("SELECT * FROM layout_options " .
 812                     "WHERE form_id = 'HIS' AND group_id = '4' AND uor > 0 " .
 813                     "ORDER BY seq");
 814                     while ($group_fields = sqlFetchArray($group_fields_query)) {
 815                         $titlecols  = $group_fields['titlecols'];
 816                         $datacols   = $group_fields['datacols'];
 817                         $data_type  = $group_fields['data_type'];
 818                         $field_id   = $group_fields['field_id'];
 819                         $list_id    = $group_fields['list_id'];
 820                         $currvalue  = '';
 821                         if (isset($result1[$field_id])) {
 822                             $currvalue = $result1[$field_id];
 823                         }
 824
 825                         if ($data_type == 28 || $data_type == 32) {
 826                             $tmp = explode('|', $currvalue);
 827                             switch (count($tmp)) {
 828                                 case "4":
 829                                     $result2[$field_id]['resnote'] = $tmp[0];
 830                                     $result2[$field_id]['restype'] = $tmp[1];
 831                                     $result2[$field_id]['resdate'] = $tmp[2];
 832                                     $result2[$field_id]['reslist'] = $tmp[3];
 833                                     break;
 834                                 case "3":
 835                                     $result2[$field_id]['resnote'] = $tmp[0];
 836                                     $result2[$field_id]['restype'] = $tmp[1];
 837                                     $result2[$field_id]['resdate'] = $tmp[2];
 838                                     break;
 839                                 case "2":
 840                                     $result2[$field_id]['resnote'] = $tmp[0];
 841                                     $result2[$field_id]['restype'] = $tmp[1];
 842                                     $result2[$field_id]['resdate'] = "";
 843                                     break;
 844                                 case "1":
 845                                     $result2[$field_id]['resnote'] = $tmp[0];
 846                                     $result2[$field_id]['resdate'] = $result2[$field_id]['restype'] = "";
 847                                     break;
 848                                 default:
 849                                     $result2[$field_id]['restype'] = $result2[$field_id]['resdate'] = $result2[$field_id]['resnote'] = "";
 850                                     break;
 851                             }
 852
 853                             $fldlength = empty($frow['fld_length']) ?  20 : $frow['fld_length'];
 854                             $fldlength = htmlspecialchars($fldlength, ENT_QUOTES);
 855                             $result2[$field_id]['resnote'] = htmlspecialchars($result2[$field_id]['resnote'], ENT_QUOTES);
 856                             $result2[$field_id]['resdate'] = htmlspecialchars($result2[$field_id]['resdate'], ENT_QUOTES);
 857                         } else if ($data_type == 2) {
 858                              $result2[$field_id]['resnote'] = nl2br(htmlspecialchars($currvalue, ENT_NOQUOTES));
 859                         }
 860                     }
 861                 ?>
 862               <style>
 863                 .data td{
 864                   font-size:0.7em;
 865                 }
 866                 .data input[type="text"] {
 867                  width:90px;
 868                 }
 869                 #form_box {
 870                   width:90px;
 871                 }
 872               </style>
 873
 874               <tbody>
 875                   <tr>
 876                     <td class="right" nowrap><?php echo xlt('Marital'); ?>:</td>
 877                     <td colspan="3"><input type="text" style="width:75px;" name="marital_status" id="marital_status" value="<?php echo attr($patient['status']); ?>">
 878                     &nbsp;<?php echo xlt('Occupation'); ?>:&nbsp;<input type="text" style="width:175px;" name="occupation" id="occupation" value="<?php echo attr($patient['occupation']); ?>"></td>
 879                   </tr>
 880                   <tr>
 881                     <td></td>
 882                     <td colspan="2">
 883                       <select name="form_tobacco" id="form_tobacco" onchange="radioChange(this.options[this.selectedIndex].value)" title="<?php xla('Tobacco use'); ?>">
 884                         <option value="" <?php if ($result2['tobacco']['reslist'] =='') {
 885                             echo "selected";
 886 } ?>><?php echo xlt('Unassigned'); ?></option>
 887                         <option value="1" <?php if ($result2['tobacco']['reslist'] =='1') {
 888                             echo "selected";
 889 } ?>><?php echo xlt('Current every day smoker'); ?></option>
 890                         <option value="2" <?php if ($result2['tobacco']['reslist'] =='2') {
 891                             echo "selected";
 892 } ?>><?php echo xlt('Current some day smoker'); ?></option>
 893                         <option value="3" <?php if ($result2['tobacco']['reslist'] =='3') {
 894                             echo "selected";
 895 } ?>><?php echo xlt('Former smoker'); ?></option>
 896                         <option value="4" <?php if ($result2['tobacco']['reslist'] =='4') {
 897                             echo "selected";
 898 } ?>><?php echo xlt('Never smoker'); ?></option>
 899                         <option value="5" <?php if ($result2['tobacco']['reslist'] =='5') {
 900                             echo "selected";
 901 } ?>><?php echo xlt('Smoker, current status unknown'); ?></option>
 902                         <option value="9" <?php if ($result2['tobacco']['reslist'] =='9') {
 903                             echo "selected";
 904 } ?>><?php echo xlt('Unknown if ever smoked'); ?></option>
 905                         <option value="15" <?php if ($result2['tobacco']['reslist'] =='15') {
 906                             echo "selected";
 907 } ?>><?php echo xlt('Heavy tobacco smoker'); ?></option>
 908                         <option value="16" <?php if ($result2['tobacco']['reslist'] =='16') {
 909                             echo "selected";
 910 } ?>><?php echo xlt('Light tobacco smoker'); ?></option>
 911                       </select>
 912                     </td>
 913                     <td nowrap><span style="text-decoration:underline;padding-right:3px;">Never</span></td>
 914                     <td>
 915                       <span style="text-decoration:underline;"><?php echo xlt('N/A{{not applicable}}'); ?></span></td>
 916                   </tr>
 917
 918                   <tr>
 919                     <td class="right"  nowrap><?php echo xlt('Tobacco'); ?>:</td>
 920                     <td class="text data" colspan="4">
 921                       <table cellpadding="0" cellspacing="0">
 922                         <tr>
 923                           <td><input type="text" name="form_text_tobacco" id="form_box" size="20" value="<?php echo attr($PMSFH[0]['SOCH']['tobacco']['resnote']); ?>">&nbsp;</td>
 924                           <td class="bold">&nbsp;&nbsp;</td>
 925                           <td class="text">
 926                             <input type="radio" name="radio_tobacco" id="radio_tobacco[current]" value="currenttobacco" onclick="smoking_statusClicked(this)" <?php if ($result2['tobacco']['restype'] =='currenttobacco') {
 927                                 echo "checked";
 928 } ?>><?php echo xlt('Current'); ?>&nbsp;</td>
 929                           <td class="text"><input type="radio" name="radio_tobacco" id="radio_tobacco[quit]" value="quittobacco" onclick="smoking_statusClicked(this)" <?php if ($result2['tobacco']['restype'] =='quittobacco') {
 930                                 echo "checked";
 931 } ?>><?php echo xlt('Quit'); ?>&nbsp;</td>
 932                           <td class="text" onclick='top.restoreSession();resolvedClicked(this);'>
 933                             <input type="text" class="datepicker" size="6"
 934                             name="date_tobacco" id="date_tobacco"
 935                             value="<?php echo attr($result2['tobacco']['resdate']); ?>"
 936                             title="<?php echo xla('Tobacco use'); ?>">
 937                           </td>
 938                           <td class="text">
 939                             <input type="radio" name="radio_tobacco" id="radio_tobacco[never]" value="nevertobacco" onclick="smoking_statusClicked(this)" <?php if ($result2['tobacco']['restype'] =='nevertobacco') {
 940                                 echo "checked";
 941 } ?>><?php echo xlt('Never'); ?>&nbsp;
 942                           </td>
 943                           <td><input name="radio_tobacco" type="radio" id="radio_tobacco[not_applicable]" <?php if ($PMSFH[0]['SOCH']['tobacco']['restype'] =='not_applicable') {
 944                                 echo "checked";
 945 } ?> value="not_applicabletobacco">
 946                           <label class="fa fa-history input-helper  nodisplay" for="radio_tobacco[not_applicable]"></label>
 947                           </td>
 948                         </tr>
 949                       </table>
 950                     </td>
 951                   </tr>
 952
 953                   <tr>
 954                     <td  class="right" nowrap><?php echo xlt('Coffee'); ?>:</td>
 955                     <td class="text data" colspan="4">
 956                       <table cellpadding="0" cellspacing="0">
 957                         <tbody>
 958                           <tr>
 959                             <td><input type="text" name="form_coffee" id="form_box" size="20" value="<?php echo attr($result2['coffee']['resnote']); ?>">&nbsp;</td>
 960                             <td class="bold">&nbsp;&nbsp;</td>
 961                             <td class="text"><input type="radio" name="radio_coffee" id="radio_coffee[current]" value="currentcoffee" <?php if ($PMSFH[0]['SOCH']['coffee']['restype'] =='currentcoffee') {
 962                                 echo "checked";
 963 } ?>><?php echo xlt('Current'); ?>&nbsp;</td>
 964                             <td class="text"><input type="radio" name="radio_coffee" id="radio_coffee[quit]" value="quitcoffee" <?php if ($PMSFH[0]['SOCH']['coffee']['restype'] =='quitcoffee') {
 965                                 echo "checked";
 966 } ?>><?php echo xlt('Quit'); ?>&nbsp;</td>
 967                             <td class="text"><input type="text" class="datepicker" size="6" name="date_coffee" id="date_coffee" value="" title="<?php echo xla('Caffeine consumption'); ?>">&nbsp;</td>
 968                             <td class="text"><input type="radio" name="radio_coffee" id="radio_coffee[never]" value="nevercoffee" <?php if ($PMSFH[0]['SOCH']['coffee']['restype'] =='nevercoffee') {
 969                                 echo "checked";
 970 } ?>><?php echo xlt('Never'); ?>&nbsp;</td>
 971                             <td><input name="radio_coffee" type="radio" id="radio_coffee[not_applicable]" <?php if ($PMSFH[0]['SOCH']['coffee']['restype'] =='not_applicable') {
 972                                 echo "checked";
 973 } ?> value="not_applicablecoffee">
 974                               <label class="fa fa-history input-helper nodisplay" for="radio_coffee[not_applicable]"></label>
 975                               </td>
 976                           </tr>
 977                         </tbody>
 978                       </table>
 979                     </td>
 980                   </tr>
 981
 982                   <tr>
 983                     <td class="right"  nowrap><?php echo xlt('Alcohol'); ?>:</td>
 984                     <td class="text data" colspan="4">
 985                       <table cellpadding="0" cellspacing="0">
 986                         <tbody>
 987                           <tr><td><input type="text" name="form_alcohol" id="form_box" size="20" value="<?php echo attr($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 ($PMSFH[0]['SOCH']['alcohol']['restype'] =='currentalcohol') {
 988                                 echo "checked";
 989 } ?>><?php echo xlt('Current'); ?>&nbsp;</td>
 990                             <td class="text"><input type="radio" name="radio_alcohol" id="radio_alcohol[quit]" value="quitalcohol" <?php if ($PMSFH[0]['SOCH']['alcohol']['restype'] =='quitalcohol') {
 991                                 echo "checked";
 992 } ?>><?php echo xlt('Quit'); ?>&nbsp;</td>
 993                             <td class="text"><input type="text" size="6" class="datepicker" name="date_alcohol" id="date_alcohol" value="" title="<?php echo xla('Alcohol consumption'); ?>">&nbsp;</td>
 994                             <td class="text"><input type="radio" name="radio_alcohol" id="radio_alcohol[never]" value="neveralcohol" <?php if ($PMSFH[0]['SOCH']['alcohol']['restype'] =='neveralcohol') {
 995                                 echo "checked";
 996 } ?>><?php echo xlt('Never'); ?>&nbsp;</td>
 997                             <td><input name="radio_alcohol" type="radio" id="radio_alcohol[not_applicable]" value="not_applicablealcohol" <?php if ($PMSFH[0]['SOCH']['alcohol']['restype'] =='not_applicable') {
 998                                 echo "checked";
 999 } ?>>
1000                           <label class="fa fa-history input-helper nodisplay" for="radio_alcohol[not_applicable]"></label>
1001
1002                           </td>
1003                           </tr>
1004                         </tbody>
1005                       </table>
1006                     </td>
1007                   </tr>
1008
1009                   <tr>
1010                     <td class="right"  nowrap><?php echo xlt('Drugs'); ?>:</td>
1011                     <td class="text data" colspan="4">
1012                       <table cellpadding="0" cellspacing="0">
1013                         <tbody>
1014                           <tr>
1015                             <td><input type="text" name="form_recreational_drugs" id="form_box" size="20" value="<?php echo attr($result2['recreational_drugs']['resnote']); ?>">&nbsp;</td><td class="bold">&nbsp;&nbsp;</td>
1016                             <td class="text"><input type="radio" name="radio_recreational_drugs" id="radio_recreational_drugs[current]" value="currentrecreational_drugs" <?php if ($PMSFH[0]['SOCH']['recreational_drugs']['restype'] =='currentrecreational_drugs') {
1017                                 echo "checked";
1018 } ?>><?php echo xlt('Current'); ?>&nbsp;</td>
1019                             <td class="text"><input type="radio" name="radio_recreational_drugs" id="radio_recreational_drugs[quit]" value="quitrecreational_drugs" <?php if ($PMSFH[0]['SOCH']['recreational_drugs']['restype'] =='quitrecreational_drugs') {
1020                                 echo "checked";
1021 } ?>><?php echo xlt('Quit'); ?>&nbsp;</td>
1022                             <td class="text"><input type="text" size="6" class="datepicker" name="date_recreational_drugs" id="date_recreational_drugs" value="" title="<?php echo xla('Recreational drug use'); ?>">&nbsp;</td>
1023                             <td class="text"><input type="radio" name="radio_recreational_drugs" id="radio_recreational_drugs[never]" value="neverrecreational_drugs" <?php if ($PMSFH[0]['SOCH']['recreational_drugs']['restype'] =='neverrecreational_drugs') {
1024                                 echo "checked";
1025 } ?>><?php echo xlt('Never'); ?>&nbsp;</td>
1026                             <td><input name="radio_recreational_drugs" type="radio" id="radio_recreational_drugs[not_applicable]" <?php if ($PMSFH[0]['SOCH']['recreational_drugs']['restype'] =='not_applicable') {
1027                                 echo "checked";
1028 } ?> value="not_applicablerecreational_drugs">
1029                           <label class="fa fa-history input-helper nodisplay" for="radio_recreational_drugs[not_applicable]"></label>
1030                         </td>
1031                           </tr>
1032                         </tbody>
1033                       </table>
1034                     </td>
1035                   </tr>
1036
1037                   <tr class="nodisplay" >
1038                     <td class="right"  nowrap><?php echo xlt('Counseling'); ?>:</td>
1039                     <td class="text data" colspan="4">
1040                       <table cellpadding="0" cellspacing="0"><tbody><tr><td><input type="text" name="form_counseling" id="form_box" size="20" value="<?php echo attr($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 ($PMSFH[0]['SOCH']['counseling']['restype'] =='currentcounseling') {
1041                             echo "checked";
1042 } ?>><?php echo xlt('Current'); ?>&nbsp;</td>
1043                     <td class="text"><input type="radio" name="radio_counseling" id="radio_counseling[quit]" value="quitcounseling" <?php if ($PMSFH[0]['SOCH']['counseling']['restype'] =='quitcounseling') {
1044                         echo "checked";
1045 } ?>><?php echo xlt('Quit'); ?>&nbsp;</td>
1046                     <td class="text"><input type="text" size="6" class="datepicker" name="date_counseling" id="date_counseling" value="" title="<?php echo xla('Counseling activities') ?>">&nbsp;</td>
1047                     <td class="text"><input type="radio" name="radio_counseling" id="radio_counseling[never]" value="nevercounseling" <?php if ($PMSFH[0]['SOCH']['counseling']['restype'] =='nevercounseling') {
1048                         echo "checked";
1049 } ?>><?php echo xlt('Never'); ?>&nbsp;</td>
1050                     <td><input name="radio_counseling" type="radio" id="radio_counseling[not_applicable]" value="not_applicablecounseling" <?php if ($PMSFH[0]['SOCH']['counseling']['restype'] =='not_applicable') {
1051                         echo "checked";
1052 } ?>>
1053                       <label class="fa fa-history input-helper nodisplay" for="radio_counseling[not_applicable]"></label>
1054                     </td>
1055                   </tr></tbody></table></td></tr>
1056
1057                   <tr>
1058                     <td class="right" nowrap>
1059                     <?php echo xlt('Exercise'); ?>:</td>
1060                     <td class="text data" colspan="4">
1061                       <table cellpadding="0" cellspacing="0">
1062                         <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') {
1063                             echo "checked";
1064 } ?>><?php echo xlt('Current'); ?>&nbsp;</td>
1065                         <td class="text"><input type="radio" name="radio_exercise_patterns" id="radio_exercise_patterns[quit]" value="quitexercise_patterns" <?php if ($PMSFH[0]['SOCH']['exercise_patterns']['restype'] =='quitexercise_patterns') {
1066                             echo "checked";
1067 } ?>><?php echo xlt('Quit') ?>&nbsp;</td>
1068                         <td class="text"><input type="text" class="datepicker" name="date_exercise_patterns" id="date_exercise_patterns" value="" title="<?php echo xla('Exercise patterns') ?>">&nbsp;</td>
1069                         <td class="text"><input type="radio" name="radio_exercise_patterns" id="radio_exercise_patterns[never]" value="neverexercise_patterns"<?php if ($PMSFH[0]['SOCH']['exercise_patterns']['restype'] =='neverexercise_patterns') {
1070                             echo "checked";
1071 } ?>><?php echo xlt('Never') ?>&nbsp;</td>
1072                         <td><input name="radio_exercise_patterns" type="radio" id="radio_exercise_patterns[not_applicable]" <?php if ($PMSFH[0]['SOCH']['exercise_patterns']['restype'] =='not_applicable') {
1073                             echo "checked";
1074 } ?> value="not_applicableexercise_patterns"><label class="fa fa-history input-helper nodisplay" for="radio_exercise_patterns[not_applicable]"></label>
1075                         </td>
1076                           </tr>
1077                         </tbody>
1078                       </table>
1079                     </td>
1080                   </tr>
1081
1082                   <tr class="nodisplay">
1083                     <td class="right"  nowrap><?php echo xlt('Hazardous Activities'); ?>:</td>
1084                     <td class="text data" colspan="4">
1085                       <table cellpadding="0" cellspacing="0">
1086                         <tbody><tr><td><input type="text" name="form_hazardous_activities" id="form_box" size="20" value="<?php echo attr($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 ($PMSFH[0]['SOCH']['hazardous_activities']['restype'] =='currenthazardous_activities') {
1087                             echo "checked";
1088 } ?>><?php echo xlt('Current'); ?>&nbsp;</td>
1089                         <td class="text"><input type="radio" name="radio_hazardous_activities" id="radio_hazardous_activities[quit]" value="quithazardous_activities" <?php if ($PMSFH[0]['SOCH']['hazardous_activities']['restype'] =='quithazardous_activities') {
1090                             echo "checked";
1091 } ?>><?php echo xlt('Quit') ?>&nbsp;</td>
1092                         <td class="text"><input type="text" class="datepicker" name="date_hazardous_activities" id="date_hazardous_activities" value="" title="<?php echo xla('Hazardous activities') ?>">&nbsp;</td>
1093                         <td class="text"><input type="radio" name="radio_hazardous_activities" id="radio_hazardous_activities[never]" value="neverhazardous_activities" <?php if ($PMSFH[0]['SOCH']['hazardous_activities']['restype'] =='neverhazardous_activities') {
1094                             echo "checked";
1095 } ?>><?php echo xlt('Never') ?>&nbsp;</td>
1096                         <td><input name="radio_hazardous_activities" type="radio" id="radio_hazardous_activities[not_applicable]" <?php if ($PMSFH[0]['SOCH']['hazardous_activities']['restype'] =='not_applicable') {
1097                             echo "checked";
1098 } ?> value="not_applicablehazardous_activities" onclick="hazardous_activities_statusClicked(this)"><label class="fa fa-history input-helper nodisplay" for="radio_hazardous_activities[not_applicable]"></label>
1099                         </td>
1100                         </tr>
1101                         </tbody>
1102                       </table>
1103                     </td>
1104                   </tr>
1105
1106                   <tr>
1107                     <td class="right"  nowrap><?php echo xlt('Sleep'); ?>:</td>
1108                     <td class="text data" colspan="4">
1109                       <table cellpadding="0" cellspacing="0">
1110                         <tbody>
1111                           <tr><td><input type="text" name="form_sleep_patterns" id="form_box" size="20" title="<?php echo xla('Sleep patterns'); ?>" value="<?php echo attr($result2['sleep_patterns']['resnote']); ?>"></td>
1112                             <td class="left"  nowrap><?php echo xlt('Seatbelt'); ?>:
1113                             </td>
1114                             <td><input type="text" name="form_seatbelt_use" id="form_box" size="20" title="<?php echo xla('Seatbelt use'); ?>" value="<?php echo attr($result2['seatbelt_use']['resnote']); ?>">
1115                             </td>
1116                           </tr>
1117                         </tbody>
1118                       </table>
1119                     </td>
1120                   </tr>
1121               </tbody>
1122         </table>
1123         <table id="row_FH" name="row_FH" width="90%">
1124           <tr>
1125             <td class="right" nowrap><?php echo xlt('Glaucoma'); ?>:</td>
1126             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext11" name="radio_usertext11" <?php if (!$result1['usertext11']) {
1127                 echo "checked='checked'";
1128 } ?>>
1129               <input type="text" name="usertext11" id="usertext11" onclick='clear_option(this)' value="<?php echo attr($result1['usertext11']); ?>"></td>
1130             <td class="right" nowrap><?php echo xlt('Cataract'); ?>:</td>
1131             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext12" name="radio_usertext12" <?php if (!$result1['usertext12']) {
1132                 echo "checked='checked'";
1133 } ?>>
1134               <input type="text" name="usertext12" id="usertext12" onclick='clear_option(this)' value="<?php echo attr($result1['usertext12']); ?>"></td>
1135           </tr>
1136           <tr>
1137             <td class="right" nowrap><?php echo xlt('AMD{{age related macular degeneration}}'); ?>:</td>
1138             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext13" name="radio_usertext13" <?php if (!$result1['usertext13']) {
1139                 echo "checked='checked'";
1140 } ?>>
1141               <input type="text" name="usertext13" id="usertext13" onclick='clear_option(this)' value="<?php echo attr($result1['usertext13']); ?>"></td>
1142             <td class="right" nowrap><?php echo xlt('RD{{retinal detachment}}'); ?>:</td>
1143             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext14" name="radio_usertext14" <?php if (!$result1['usertext14']) {
1144                 echo "checked='checked'";
1145 } ?>>
1146               <input type="text" name="usertext14" id="usertext14" onclick='clear_option(this)' value="<?php echo attr($result1['usertext14']); ?>"></td>
1147           </tr>
1148           <tr>
1149             <td class="right" nowrap><?php echo xlt('Blindness'); ?>:</td>
1150             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext15" name="radio_usertext15" <?php if (!$result1['usertext15']) {
1151                 echo "checked='checked'";
1152 } ?>>
1153               <input type="text" name="usertext15" id="usertext15" onclick='clear_option(this)' value="<?php echo attr($result1['usertext15']); ?>"></td>
1154             <td class="right" nowrap><?php echo xlt('Amblyopia'); ?>:</td>
1155             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext16" name="radio_usertext16" <?php if (!$result1['usertext16']) {
1156                 echo "checked='checked'";
1157 } ?>>
1158               <input type="text" name="usertext16" id="usertext16" onclick='clear_option(this)' value="<?php echo attr($result1['usertext16']); ?>"></td>
1159           </tr>
1160           <tr>
1161             <td class="right" nowrap><?php echo xlt('Strabismus'); ?>:</td>
1162             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext17" name="radio_usertext17" <?php if (!$result1['usertext17']) {
1163                 echo "checked='checked'";
1164 } ?>>
1165               <input type="text" name="usertext17" id="usertext17" onclick='clear_option(this)' value="<?php echo attr($result1['usertext17']); ?>"></td>
1166             <td class="right" nowrap><?php echo xlt('Epilepsy'); ?>:</td>
1167             <td class="text data">
1168               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_epilepsy" name="radio_relatives_epilepsy" <?php if (!$result1['relatives_epilepsy']) {
1169                     echo "checked='checked'";
1170 } ?>>
1171               <input type="text" name="relatives_epilepsy" id="relatives_epilepsy" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_epilepsy']); ?>"></td>
1172           </tr>
1173           <tr>
1174             <td class="right" nowrap><?php echo xlt('Cancer'); ?>:</td>
1175             <td class="text data">
1176               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_cancer" name="radio_relatives_cancer" <?php if (!$result1['relatives_cancer']) {
1177                     echo "checked='checked'";
1178 } ?>>
1179               <input type="text" name="relatives_cancer" id="relatives_cancer" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_cancer']); ?>"></td>
1180             <td class="right" nowrap><?php echo xlt('Diabetes'); ?>:</td>
1181             <td class="text data">
1182               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_diabetes" name="radio_relatives_diabetes" <?php if (!$result1['relatives_diabetes']) {
1183                     echo "checked='checked'";
1184 } ?>>
1185               <input type="text" name="relatives_diabetes" id="relatives_diabetes" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_diabetes']); ?>"></td>
1186           </tr>
1187           <tr>
1188             <td class="right" nowrap><?php echo xlt('HTN{{hypertension}}'); ?>:</td>
1189             <td class="text data">
1190               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_high_blood_pressure" name="radio_relatives_high_blood_pressure" <?php if (!$result1['relatives_high_blood_pressure']) {
1191                     echo "checked='checked'";
1192 } ?>>
1193               <input type="text" name="relatives_high_blood_pressure" id="relatives_high_blood_pressure" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_high_blood_pressure']); ?>"></td>
1194             <td class="right" nowrap><?php echo xlt('Cardiac'); ?>:</td>
1195             <td class="text data">
1196               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_heart_problems" name="radio_relatives_heart_problems" <?php if (!$result1['relatives_heart_problems']) {
1197                     echo "checked='checked'";
1198 } ?>>
1199               <input type="text" name="relatives_heart_problems" id="relatives_heart_problems" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_heart_problems']); ?>"></td>
1200           </tr>
1201           <tr>
1202             <td class="right" nowrap><?php echo xlt('Stroke'); ?>:</td>
1203             <td class="text data">
1204               <input type="radio" onclick='negate_radio(this);' id="radio_relatives_stroke" name="radio_relatives_stroke" <?php if (!$result1['relatives_stroke']) {
1205                     echo "checked='checked'";
1206 } ?>>
1207               <input type="text" name="relatives_stroke" id="relatives_stroke" onclick='clear_option(this)' value="<?php echo attr($result1['relatives_stroke']); ?>"></td>
1208             <td class="right" nowrap><?php echo xlt('Other'); ?>:</td>
1209             <td class="text data"><input type="radio" onclick='negate_radio(this);' id="radio_usertext18" name="radio_usertext18" <?php if (!$result1['usertext18']) {
1210                 echo "checked='checked'";
1211 } ?>>
1212               <input type="text" name="usertext18" id="usertext18" onclick='clear_option(this)' value="<?php echo attr($result1['usertext18']); ?>"></td>
1213           </tr>
1214         </table>
1215         <table id="row_ROS" name="row_ROS" class="ROS_class">
1216           <tr>
1217             <td>
1218              &nbsp;
1219             </td>
1220           </tr>
1221           <tr>
1222             <td></td>
1223             <td>
1224               <span class="underline"><?php echo xlt('Neg{{negative}}'); ?></span><span class="underline" style="margin:30px;"><?php echo xlt('Positive'); ?></span>
1225             </td>
1226             <td></td>
1227             <td><span class="underline"><?php echo xlt('Neg{{negative}}'); ?></span><span class="underline" style="margin:30px;"><?php echo xlt('Positive'); ?></span>
1228             </td>
1229           </tr>
1230           <tr>
1231             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('General'); ?>:</label></td>
1232             <td>
1233               <input type="radio" onclick='negate_radio(this);' id="radio_ROSGENERAL" name="radio_ROSGENERAL" <?php if (!$ROSGENERAL) {
1234                     echo "checked='checked'";
1235 } ?>>
1236               <input type="text" name="ROSGENERAL" id="ROSGENERAL" onclick='clear_option(this)' value="<?php echo attr($ROSGENERAL); ?>"></td>
1237             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('HEENT'); ?>:</td>
1238             <td>
1239               <input type="radio" onclick='negate_radio(this);' id="radio_ROSHEENT" name="radio_ROSHEENT"<?php if (!$ROSHEENT) {
1240                     echo "checked='checked'";
1241 } ?>>
1242               <input type="text" name="ROSHEENT" id="ROSHEENT" onclick='clear_option(this)' value="<?php echo attr($ROSHEENT); ?>"></td>
1243           </tr>
1244           <tr>
1245             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('CV{{Cardiovascular}}'); ?>:</td>
1246             <td>
1247               <input type="radio" onclick='negate_radio(this);' id="radio_ROSCV" name="radio_ROSCV"<?php if (!$ROSCV) {
1248                     echo "checked='checked'";
1249 } ?>>
1250               <input type="text" name="ROSCV" id="ROSCV" onclick='clear_option(this)' value="<?php echo attr($ROSCV); ?>"></td>
1251             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Pulmonary'); ?>:</td>
1252             <td>
1253               <input type="radio" onclick='negate_radio(this);' id="radio_ROSPULM" name="radio_ROSPULM"<?php if (!$ROSPULM) {
1254                     echo "checked='checked'";
1255 } ?>>
1256               <input type="text" name="ROSPULM" id="ROSPULM" onclick='clear_option(this)' value="<?php echo attr($ROSPULM); ?>"></td>
1257             </tr>
1258           <tr>
1259             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('GI{{Gastrointestinal}}'); ?>:</td>
1260             <td>
1261               <input type="radio" onclick='negate_radio(this);' id="radio_ROSGI" name="radio_ROSGI"<?php if (!$ROSGI) {
1262                     echo "checked='checked'";
1263 } ?>>
1264               <input type="text" name="ROSGI" id="ROSGI" onclick='clear_option(this)' value="<?php echo attr($ROSGI); ?>"></td>
1265             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('GU{{Genitourinary}}'); ?>:</td>
1266             <td>
1267               <input type="radio" onclick='negate_radio(this);' id="radio_ROSGU" name="radio_ROSGU"<?php if (!$ROSGU) {
1268                     echo "checked='checked'";
1269 } ?>>
1270               <input type="text" name="ROSGU" id="ROSGU" onclick='clear_option(this)' value="<?php echo attr($ROSGU); ?>"></td>
1271           </tr>
1272           <tr>
1273             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Derm{{dermatologic}}'); ?>:</td>
1274             <td>
1275               <input type="radio" onclick='negate_radio(this);' id="radio_ROSDERM" name="radio_ROSDERM"<?php if (!$ROSDERM) {
1276                     echo "checked='checked'";
1277 } ?>>
1278               <input type="text" name="ROSDERM" id="ROSDERM" onclick='clear_option(this)' value="<?php echo attr($ROSDERM); ?>"></td>
1279             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Neuro{{neurologic}}'); ?>:</td>
1280             <td>
1281               <input type="radio" onclick='negate_radio(this);' id="radio_ROSNEURO" name="radio_ROSNEURO"<?php if (!$ROSNEURO) {
1282                     echo "checked='checked'";
1283 } ?>>
1284               <input type="text" name="ROSNEURO" id="ROSNEURO" onclick='clear_option(this)' value="<?php echo attr($ROSNEURO); ?>"></td>
1285           </tr>
1286           <tr>
1287             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Psych{{psychiatric}}'); ?>:</td>
1288             <td>
1289               <input type="radio" onclick='negate_radio(this);' id="radio_ROSPSYCH" name="radio_ROSPSYCH"<?php if (!$ROSPSYCH) {
1290                     echo "checked='checked'";
1291 } ?>>
1292               <input type="text" name="ROSPSYCH" id="ROSPSYCH" onclick='clear_option(this)' value="<?php echo attr($ROSPSYCH); ?>"></td>
1293             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Musculo{{musculoskeletal}}'); ?>:</td>
1294             <td>
1295               <input type="radio" onclick='negate_radio(this);' id="radio_ROSMUSCULO" name="radio_ROSMUSCULO"<?php if (!$ROSMUSCULO) {
1296                     echo "checked='checked'";
1297 } ?>>
1298               <input type="text" name="ROSMUSCULO" id="ROSMUSCULO" onclick='clear_option(this)' value="<?php echo attr($ROSMUSCULO); ?>"></td>
1299             </tr>
1300           <tr>
1301             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Immuno{{immunologic}}'); ?>:</td>
1302             <td>
1303               <input type="radio" onclick='negate_radio(this);' id="radio_ROSIMMUNO" name="radio_ROSIMMUNO"<?php if (!$ROSIMMUNO) {
1304                     echo "checked='checked'";
1305 } ?>>
1306               <input type="text" name="ROSIMMUNO" id="ROSIMMUNO" onclick='clear_option(this)' value="<?php echo attr($ROSIMMUNO); ?>"></td>
1307             <td class="right" nowrap><label for="ROSGENERAL" class="input-helper input-helper--checkbox"><?php echo xlt('Endocrine'); ?>:</td>
1308             <td>
1309               <input type="radio" onclick='negate_radio(this);' id="radio_ROSENDOCRINE" name="radio_ROSENDOCRINE"<?php if (!$ROSENDOCRINE) {
1310                     echo "checked='checked'";
1311 } ?>>
1312               <input type="text" name="ROSENDOCRINE" id="ROSENDOCRINE" onclick='clear_option(this)' value="<?php echo attr($ROSENDOCRINE); ?>"></td>
1313             </tr>
1314           <tr><td></td></tr>
1315         </table>
1316         <table id="row_PLACEHOLDER" name="row_PLACEHOLDER" width="90%">
1317           <tr>
1318             <td>
1319             </td>
1320           </tr>
1321         </table>
1322       </div>
1323       <center>
1324         <p style="margin-top:10px;">
1325           <input type="hidden" type="text" id="issue_js" name="issue_js" value="test">
1326           <input type="hidden" type="text" id="pid" name="pid" value="<?php echo $pid; ?>">
1327           <input type='button' id='form_save' name='form_save'
1328           class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only navy"
1329           onclick='top.restoreSession();submit_this_form();' value='<?php echo xla('Save'); ?>' />
1330             <?php
1331               $display_delete = "nodisplay";
1332             ?>
1333           &nbsp;
1334           <input type='button' name='delete_button' id='delete_button'
1335           class="<?php echo $display_delete; ?> ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only navy"
1336           onclick='top.restoreSession();deleteme();' value='<?php echo xla('Delete'); ?>' />
1337           &nbsp;
1338           <input type='button' name='cancel_button' id='cancel_button'
1339           class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only navy"
1340           value='<?php echo xla('Cancel'); ?>' onclick='clearme();' />
1341           </p>
1342         </center>
1343       </form>
1344     </div>
1345     <script language='JavaScript'>
1346        newtype('<?php if (!$form_index) {
1347             echo "POH";
1348 } else {
1349     echo $type_index;
1350 } ?>');
1351
1352         $(document).ready(function() {
1353             $('[title]').qtip({
1354                 position: {
1355                     my: 'top Right',  // Position my top left...
1356                     at: 'bottom Left', // at the bottom right of...
1357                     target: 'mouse' // my target
1358                 }
1359             });
1360             //$("textarea,text").css("background-color","#FFF8DC");
1361
1362             $('.datepicker').datetimepicker({
1363                 <?php $datetimepicker_timepicker = false; ?>
1364                 <?php $datetimepicker_showseconds = false; ?>
1365                 <?php $datetimepicker_formatInput = false; ?>
1366                 <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
1367                 <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
1368             });
1369         });
1370     </script>
1371   </body>
1372 </html>
1373