contrib/forms/physical_examination/printable.php

   1 <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
   2
   3 "http://www.w3.org/TR/html4/loose.dtd">
   4
   5 <?php
   6
   7 include_once("../../globals.php");
   8
   9 include_once("$srcdir/api.inc");
  10
  11 include_once("$srcdir/forms.inc");
  12
  13 include_once("$srcdir/calendar.inc");
  14
  15 ?>
  16
  17
  18
  19 <html>
  20
  21 <head>
  22 <? html_header_show();?>
  23
  24 <title>Physical examination</title>
  25
  26 <? include("../../acog_printable_v.css"); ?>
  27
  28 </head>
  29
  30
  31
  32 <body>
  33
  34 <div class="srvChapter">Physical examination  </div>
  35
  36 <?
  37
  38    $fres=sqlStatement("select * from patient_data where pid='".$pid."'");
  39
  40    if ($fres){  $patient = sqlFetchArray($fres);  }
  41
  42    $fres=sqlStatement("select * from form_physical_examination where id=$id");
  43
  44    if ($fres){  $fdata = sqlFetchArray($fres);  }
  45
  46 ?>
  47
  48 <div style="border: solid 1.5pt black; background-color: white;">
  49
  50 <table width="100%"  border="0" cellspacing="0" cellpadding="3">
  51
  52   <tr>
  53
  54     <td align="left" valign="top" style="border-bottom: 2px solid black;"><table width="100%"  border="0" cellspacing="0" cellpadding="5">
  55
  56       <tr align="left" valign="top" class="fibody">
  57
  58         <td width="40%" nowrap id="bordR">Patient name: <b><?  echo $patient{'fname'}.' '.$patient{'mname'}.' '.$patient{'lname'};  ?></b></td>
  59
  60         <td width="20%" nowrap id="bordR">Birth date: <? echo $patient{'DOB'}; ?></td>
  61
  62         <td width="20%" nowrap id="bordR">ID No: <? echo $patient{'id'};  ?></td>
  63
  64         <td width="20%" nowrap>Date: <? echo date('Y-m-d');  ?></td>
  65
  66       </tr>
  67
  68     </table></td>
  69
  70   </tr>
  71
  72   <tr>
  73
  74     <td align="left" valign="top" bgcolor="#EDEDED"><h2>Constitutional</h2>
  75
  76       <li>Vital signs (record <u><strong>&gt;</strong></u> 3 vital signs)</li>
  77
  78       <table width="100%"  border="0" cellspacing="0" cellpadding="0">
  79
  80         <tr align="left" valign="top" class="fibody">
  81
  82           <td width="14%" nowrap>Height<br>
  83
  84             <? echo $fdata{'height'}; ?></td>
  85
  86           <td width="14%" nowrap>Weight<br>
  87
  88             <? echo $fdata{'weight'}; ?></td>
  89
  90           <td width="14%" nowrap>BMI<br>
  91
  92             <? echo $fdata{'bmi'}; ?></td>
  93
  94           <td nowrap>Blood pressure (sitting) <br>
  95
  96             <? echo $fdata{'blood_pressure'}; ?></td>
  97
  98           <td width="14%" nowrap>Temperature<br>
  99
 100             <? echo $fdata{'temperature'}; ?></td>
 101
 102           <td width="14%" nowrap>Pulse<br>
 103
 104             <? echo $fdata{'pulse'}; ?></td>
 105
 106           <td width="14%" nowrap>Respiration<br>
 107
 108             <? echo $fdata{'respiration'}; ?></td>
 109
 110         </tr>
 111
 112       </table>
 113
 114       <li>General appearance (Note all that apply):</li> <table width="100%"  border="0" cellspacing="0" cellpadding="2">
 115
 116         <tr class="fibody">
 117
 118           <td width="150" nowrap><? echo (($fdata{'general_well_developed'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 119
 120             Well-developed
 121
 122 </td>
 123
 124           <td width="90" nowrap><? echo (($fdata{'general_well_developed'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 125
 126             Other
 127
 128 </td>
 129
 130           <td width="100" nowrap>&nbsp;</td>
 131
 132           <td>&nbsp;</td>
 133
 134           <td width="120"><? echo (($fdata{'general_no_deformities'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 135
 136             No deformities
 137
 138 </td>
 139
 140           <td width="100"><? echo (($fdata{'general_no_deformities'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 141
 142             Other
 143
 144 </td>
 145
 146           <td>&nbsp;</td>
 147
 148         </tr>
 149
 150         <tr class="fibody">
 151
 152           <td width="150" nowrap><? echo (($fdata{'general_well_nourished'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 153
 154             Well-nourished
 155
 156 </td>
 157
 158           <td width="90" nowrap><? echo (($fdata{'general_well_nourished'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 159
 160             Other
 161
 162 </td>
 163
 164           <td width="100" nowrap>&nbsp;</td>
 165
 166           <td>&nbsp;</td>
 167
 168           <td width="120"><? echo (($fdata{'general_well_groomed'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 169
 170             Well-groomed
 171
 172 </td>
 173
 174           <td width="100"><? echo (($fdata{'general_well_groomed'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 175
 176             Other
 177
 178 </td>
 179
 180           <td>&nbsp;</td>
 181
 182         </tr>
 183
 184         <tr class="fibody">
 185
 186           <td width="150" nowrap><? echo (($fdata{'general_normal_habitus'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 187
 188             Normal habitus</td>
 189
 190           <td width="90" nowrap><? echo (($fdata{'general_normal_habitus'} == '2')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 191
 192             Obese</td>
 193
 194           <td width="100" nowrap><? echo (($fdata{'general_normal_habitus'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 195
 196             Other</td>
 197
 198           <td>&nbsp;</td>
 199
 200           <td width="120">&nbsp;</td>
 201
 202           <td width="100">&nbsp;</td>
 203
 204           <td>&nbsp;</td>
 205
 206         </tr>
 207
 208       </table> </td>
 209
 210   </tr>
 211
 212   <tr>
 213
 214     <td align="left" valign="top"><h2>Neck</h2>
 215
 216       <table width="100%"  border="0" cellspacing="0" cellpadding="1">
 217
 218         <tr align="left" valign="bottom" class="fibody">
 219
 220           <td width="150" nowrap><li>Neck</li></td>
 221
 222           <td width="90" nowrap> <? echo (($fdata{'neck_neck'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 223
 224       Normal</td>
 225
 226           <td width="100" nowrap><? echo (($fdata{'neck_neck'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 227
 228             ABNormal</td>
 229
 230           <td><? echo $fdata{'neck_neck_data'}; ?></td>
 231
 232           </tr>
 233
 234         <tr align="left" valign="bottom" class="fibody">
 235
 236           <td width="150" nowrap><li>Thyroid</li></td>
 237
 238           <td width="90" nowrap>
 239
 240             <? echo (($fdata{'neck_thyroid'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 241
 242   Normal</td>
 243
 244           <td width="100" nowrap><? echo (($fdata{'neck_thyroid'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 245
 246 ABNormal</td>
 247
 248           <td><? echo $fdata{'neck_thyroid_data'}; ?></td>
 249
 250           </tr>
 251
 252       </table> </td>
 253
 254   </tr>
 255
 256   <tr>
 257
 258     <td align="left" valign="top"><h2>Respiratory</h2>
 259
 260       <table width="100%"  border="0" cellspacing="0" cellpadding="1">
 261
 262         <tr align="left" valign="bottom" class="fibody">
 263
 264           <td width="150" nowrap><li>Respiratory effort </li></td>
 265
 266           <td nowrap>
 267
 268             <? echo (($fdata{'respiratory_effort'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 269
 270   Normal</td>
 271
 272           <td nowrap><? echo (($fdata{'respiratory_effort'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 273
 274   ABNormal</td>
 275
 276           <td><? echo $fdata{'respiratory_effort_data'}; ?></td>
 277
 278         </tr>
 279
 280         <tr align="left" valign="bottom" class="fibody">
 281
 282           <td width="150" nowrap><li>Auscultated lungs </li></td>
 283
 284           <td width="90" nowrap><? echo (($fdata{'auscultated_lungs'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 285
 286 Normal</td>
 287
 288           <td width="100" nowrap><? echo (($fdata{'auscultated_lungs'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 289
 290 ABNormal</td>
 291
 292           <td><? echo $fdata{'auscultated_lungs_data'}; ?></td>
 293
 294         </tr>
 295
 296       </table> </td>
 297
 298   </tr>
 299
 300   <tr>
 301
 302     <td align="left" valign="top"><h2>Cardiovascular</h2>
 303
 304       <table width="100%"  border="0" cellspacing="0" cellpadding="1">
 305
 306         <tr align="left" valign="bottom" class="fibody">
 307
 308           <td width="150" nowrap><li>Auscultated heart </li></td>
 309
 310           <td width="90" nowrap>&nbsp;</td>
 311
 312           <td width="100" nowrap>&nbsp;</td>
 313
 314           <td>&nbsp;</td>
 315
 316         </tr>
 317
 318         <tr align="left" valign="bottom" class="fibody">
 319
 320           <td width="150" nowrap><blockquote> Sounds</blockquote></td>
 321
 322           <td width="90" nowrap><? echo (($fdata{'auscultated_heart_sounds'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 323
 324 Normal</td>
 325
 326           <td width="100" nowrap><? echo (($fdata{'auscultated_heart_sounds'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 327
 328 ABNormal</td>
 329
 330           <td><? echo $fdata{'auscultated_heart_sounds_data'}; ?></td>
 331
 332         </tr>
 333
 334         <tr align="left" valign="bottom" class="fibody">
 335
 336           <td nowrap><blockquote> Murmurs</blockquote></td>
 337
 338           <td nowrap><? echo (($fdata{'auscultated_heart_murmurs'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 339
 340 Normal</td>
 341
 342           <td nowrap><? echo (($fdata{'auscultated_heart_murmurs'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 343
 344 ABNormal</td>
 345
 346           <td><? echo $fdata{'auscultated_heart_murmurs_data'}; ?></td>
 347
 348         </tr>
 349
 350         <tr align="left" valign="bottom" class="fibody">
 351
 352           <td nowrap><li>Perirheral vascular </li></td>
 353
 354           <td nowrap><? echo (($fdata{'peripheral_vascular'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 355
 356 Normal</td>
 357
 358           <td nowrap><? echo (($fdata{'peripheral_vascular'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 359
 360 ABNormal</td>
 361
 362           <td><? echo $fdata{'peripheral_vascular_data'}; ?></td>
 363
 364         </tr>
 365
 366       </table> </td>
 367
 368   </tr>
 369
 370   <tr>
 371
 372     <td align="left" valign="top" bgcolor="#EDEDED"><h2>Gastrointestinal</h2>
 373
 374       <table width="100%"  border="0" cellspacing="0" cellpadding="1">
 375
 376         <tr align="left" valign="bottom" class="fibody">
 377
 378           <td width="150" nowrap><li>Abdomen</li></td>
 379
 380           <td width="90" nowrap><? echo (($fdata{'gastr_abdomen'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 381
 382 Normal</td>
 383
 384           <td width="100" nowrap><? echo (($fdata{'gastr_abdomen'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 385
 386 ABNormal</td>
 387
 388           <td><? echo $fdata{'gastr_abdomen_data'}; ?></td>
 389
 390         </tr>
 391
 392         <tr align="left" valign="bottom" class="fibody">
 393
 394           <td width="150" nowrap><li>Hernia</li></td>
 395
 396           <td width="90" nowrap><? echo (($fdata{'gastr_hernia'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 397
 398       none</td>
 399
 400           <td width="100" nowrap><? echo (($fdata{'gastr_hernia'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 401
 402       present</td>
 403
 404           <td><? echo $fdata{'gastr_hernia_data'}; ?></td>
 405
 406         </tr>
 407
 408         <tr align="left" valign="bottom" class="fibody">
 409
 410           <td nowrap><li>Liver/Spleen</li></td>
 411
 412           <td nowrap>&nbsp;</td>
 413
 414           <td nowrap>&nbsp;</td>
 415
 416           <td>&nbsp;</td>
 417
 418         </tr>
 419
 420         <tr align="left" valign="bottom" class="fibody">
 421
 422           <td nowrap><blockquote> Liver </blockquote></td>
 423
 424           <td nowrap><? echo (($fdata{'gastr_liver'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 425
 426     Normal</td>
 427
 428           <td nowrap><? echo (($fdata{'gastr_liver'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 429
 430     ABNormal</td>
 431
 432           <td><? echo $fdata{'gastr_liver_data'}; ?></td>
 433
 434         </tr>
 435
 436         <tr align="left" valign="bottom" class="fibody">
 437
 438           <td nowrap><blockquote> Spleen </blockquote></td>
 439
 440           <td nowrap><? echo (($fdata{'gastr_spleen'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 441
 442     Normal</td>
 443
 444           <td nowrap><? echo (($fdata{'gastr_spleen'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 445
 446     ABNormal</td>
 447
 448           <td><? echo $fdata{'gastr_spleen_data'}; ?></td>
 449
 450         </tr>
 451
 452         <tr align="left" valign="bottom" class="fibody">
 453
 454           <td nowrap><li><a name="sg"></a>Stool guaIac, if indic.</li></td>
 455
 456           <td nowrap><? echo (($fdata{'gastr_stool_guaiac'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 457
 458     positive</td>
 459
 460           <td nowrap><? echo (($fdata{'gastr_stool_guaiac'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 461
 462     negative</td>
 463
 464           <td><? echo $fdata{'gastr_stool_guaiac_data'}; ?></td>
 465
 466         </tr>
 467
 468       </table> </td>
 469
 470   </tr>
 471
 472   <tr>
 473
 474     <td align="left" valign="top"><h2>Lymphatic</h2>
 475
 476       <table width="100%"  border="0" cellspacing="0" cellpadding="1">
 477
 478         <tr align="left" valign="bottom" class="fibody">
 479
 480           <td colspan="4" nowrap><li>Palpation of nodes (Choose all, that are applicable) </li></td>
 481
 482           </tr>
 483
 484         <tr align="left" valign="bottom" class="fibody">
 485
 486           <td width="150" nowrap><blockquote> Neck </blockquote></td>
 487
 488           <td width="90" nowrap><? echo (($fdata{'lymph_neck'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 489
 490       Normal</td>
 491
 492           <td width="100" nowrap><? echo (($fdata{'lymph_neck'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 493
 494       ABNormal</td>
 495
 496           <td><? echo $fdata{'lymph_neck_data'}; ?></td>
 497
 498         </tr>
 499
 500         <tr align="left" valign="bottom" class="fibody">
 501
 502           <td nowrap><blockquote> Axilla </blockquote></td>
 503
 504           <td nowrap><? echo (($fdata{'lymph_axilla'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 505
 506       Normal</td>
 507
 508           <td nowrap><? echo (($fdata{'lymph_axilla'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 509
 510       ABNormal</td>
 511
 512           <td><? echo $fdata{'lymph_axilla_data'}; ?></td>
 513
 514         </tr>
 515
 516         <tr align="left" valign="bottom" class="fibody">
 517
 518           <td nowrap><blockquote> Groin </blockquote></td>
 519
 520           <td nowrap><? echo (($fdata{'lymph_groin'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 521
 522     Normal</td>
 523
 524           <td nowrap><? echo (($fdata{'lymph_groin'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 525
 526     ABNormal</td>
 527
 528           <td><? echo $fdata{'lymph_groin_data'}; ?></td>
 529
 530         </tr>
 531
 532         <tr align="left" valign="bottom" class="fibody">
 533
 534           <td nowrap><blockquote> Other site </blockquote></td>
 535
 536           <td nowrap><? echo (($fdata{'lymph_other'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 537
 538     Normal</td>
 539
 540           <td nowrap><? echo (($fdata{'lymph_other'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 541
 542     ABNormal</td>
 543
 544           <td><? echo $fdata{'lymph_other_data'}; ?></td>
 545
 546         </tr>
 547
 548       </table> </td>
 549
 550   </tr>
 551
 552   <tr>
 553
 554     <td align="left" valign="top"><h2>Skin</h2>
 555
 556       <table width="100%"  border="0" cellspacing="0" cellpadding="1">
 557
 558         <tr align="left" valign="bottom" class="fibody">
 559
 560           <td width="150" nowrap><li>inspected/palpated</li></td>
 561
 562           <td width="90" nowrap><? echo (($fdata{'skin_inspected'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 563
 564       Normal</td>
 565
 566           <td width="100" nowrap><? echo (($fdata{'skin_inspected'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 567
 568       ABNormal</td>
 569
 570           <td><? echo $fdata{'skin_inspected_data'}; ?></td>
 571
 572         </tr>
 573
 574       </table> </td>
 575
 576   </tr>
 577
 578   <tr>
 579
 580     <td align="left" valign="top"><h2>Neurologic/psychiatric</h2>
 581
 582       <table width="100%"  border="0" cellspacing="0" cellpadding="1">
 583
 584         <tr align="left" valign="bottom" class="fibody">
 585
 586           <td width="150" nowrap><li>Orientation</li></td>
 587
 588           <td width="90" nowrap><? echo (($fdata{'neur_orient_time'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 589
 590       Time</td>
 591
 592           <td width="100" nowrap><? echo (($fdata{'neur_orient_place'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 593
 594       Place</td>
 595
 596           <td width="100"><? echo (($fdata{'neur_orient_person'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 597
 598             Person
 599
 600 </td>
 601
 602           <td width="100"><? echo (($fdata{'neur_orient_comments'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 603
 604             Comments
 605
 606 </td>
 607
 608           <td>&nbsp;</td>
 609
 610           </tr>
 611
 612         <tr align="left" valign="bottom" class="fibody">
 613
 614           <td width="150" nowrap><li>Mood and affect </li></td>
 615
 616           <td width="90" nowrap><? echo (($fdata{'neur_mood_normal'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 617
 618       Normal</td>
 619
 620           <td width="100" nowrap><? echo (($fdata{'neur_mood_depressed'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 621
 622       Depressed</td>
 623
 624           <td width="100"><? echo (($fdata{'neur_mood_anxious'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 625
 626             Anxious
 627
 628 </td>
 629
 630           <td width="100"><? echo (($fdata{'neur_mood_agitated'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 631
 632             Agitated
 633
 634 </td>
 635
 636           <td><? echo (($fdata{'neur_mood_other'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 637
 638             Other
 639
 640 </td>
 641
 642           </tr>
 643
 644       </table> </td>
 645
 646   </tr>
 647
 648   <tr>
 649
 650     <td align="left" valign="top" bgcolor="#EDEDED"><h2>Gynecologic (at least 7) </h2>
 651
 652       <table width="100%"  border="0" cellspacing="0" cellpadding="1">
 653
 654         <tr align="left" valign="bottom" class="fibody">
 655
 656           <td width="150" nowrap><li>Breasts</li></td>
 657
 658           <td width="90" nowrap><? echo (($fdata{'gynec_breasts'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 659
 660       Normal</td>
 661
 662           <td width="100" nowrap><? echo (($fdata{'gynec_breasts'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 663
 664       ABNormal</td>
 665
 666           <td><? echo $fdata{'gynec_breasts_data'}; ?></td>
 667
 668           <td width="231" rowspan="12" align="center" valign="middle">
 669
 670           <img src="<?
 671
 672           echo "$rootdir/forms/$formname/";
 673
 674           ?>genit01.gif" width="231" height="222"></td>
 675
 676         </tr>
 677
 678         <tr align="left" valign="bottom" class="fibody">
 679
 680           <td nowrap><li>External genitalia </li></td>
 681
 682           <td nowrap><? echo (($fdata{'gynec_ext_genitalia'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 683
 684   Normal</td>
 685
 686           <td nowrap><? echo (($fdata{'gynec_ext_genitalia'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 687
 688   ABNormal</td>
 689
 690           <td><? echo $fdata{'gynec_ext_genitalia_data'}; ?></td>
 691
 692           </tr>
 693
 694         <tr align="left" valign="bottom" class="fibody">
 695
 696           <td nowrap><li>Urethral meatus </li></td>
 697
 698           <td nowrap><? echo (($fdata{'gynec_urethral_meatus'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 699
 700   Normal</td>
 701
 702           <td nowrap><? echo (($fdata{'gynec_urethral_meatus'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 703
 704   ABNormal</td>
 705
 706           <td><? echo $fdata{'gynec_urethral_meatus_data'}; ?></td>
 707
 708           </tr>
 709
 710         <tr align="left" valign="bottom" class="fibody">
 711
 712           <td width="150" nowrap><li>Urethra</li></td>
 713
 714           <td width="90" nowrap><? echo (($fdata{'gynec_urethra'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 715
 716   Normal</td>
 717
 718           <td width="100" nowrap><? echo (($fdata{'gynec_urethra'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 719
 720   ABNormal</td>
 721
 722           <td><? echo $fdata{'gynec_urethra_data'}; ?></td>
 723
 724           </tr>
 725
 726         <tr align="left" valign="bottom" class="fibody">
 727
 728           <td nowrap><li>Bladder</li></td>
 729
 730           <td nowrap><? echo (($fdata{'gynec_bladder'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 731
 732   Normal</td>
 733
 734           <td nowrap><? echo (($fdata{'gynec_bladder'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 735
 736   ABNormal</td>
 737
 738           <td><? echo $fdata{'gynec_bladder_data'}; ?></td>
 739
 740           </tr>
 741
 742         <tr align="left" valign="bottom" class="fibody">
 743
 744           <td nowrap><li>Vagina/Pelvic support</li></td>
 745
 746           <td nowrap><? echo (($fdata{'gynec_vagina_support'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 747
 748   Normal</td>
 749
 750           <td nowrap><? echo (($fdata{'gynec_vagina_support'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 751
 752   ABNormal</td>
 753
 754           <td><? echo $fdata{'gynec_vagina_support_data'}; ?></td>
 755
 756           </tr>
 757
 758         <tr align="left" valign="bottom" class="fibody">
 759
 760           <td width="150" nowrap><li>Cervix</li></td>
 761
 762           <td width="90" nowrap><? echo (($fdata{'gynec_cervix'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 763
 764   Normal</td>
 765
 766           <td width="100" nowrap><? echo (($fdata{'gynec_cervix'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 767
 768   ABNormal</td>
 769
 770           <td><? echo $fdata{'gynec_cervix_data'}; ?></td>
 771
 772           </tr>
 773
 774         <tr align="left" valign="bottom" class="fibody">
 775
 776           <td nowrap><li>Uterus</li></td>
 777
 778           <td nowrap><? echo (($fdata{'gynec_uterus'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 779
 780   Normal</td>
 781
 782           <td nowrap><? echo (($fdata{'gynec_uterus'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 783
 784   ABNormal</td>
 785
 786           <td><? echo $fdata{'gynec_uterus_data'}; ?></td>
 787
 788           </tr>
 789
 790         <tr align="left" valign="bottom" class="fibody">
 791
 792           <td nowrap><li>Adnexa/Parametria</li></td>
 793
 794           <td nowrap><? echo (($fdata{'gynec_adnexa'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 795
 796   Normal</td>
 797
 798           <td nowrap><? echo (($fdata{'gynec_adnexa'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 799
 800   ABNormal</td>
 801
 802           <td><? echo $fdata{'gynec_adnexa_data'}; ?></td>
 803
 804           </tr>
 805
 806         <tr align="left" valign="bottom" class="fibody">
 807
 808           <td width="150" nowrap><li>Anus/Perineum</li></td>
 809
 810           <td width="90" nowrap><? echo (($fdata{'gynec_anus'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 811
 812   Normal</td>
 813
 814           <td width="100" nowrap><? echo (($fdata{'gynec_anus'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 815
 816   ABNormal</td>
 817
 818           <td><? echo $fdata{'gynec_anus_data'}; ?></td>
 819
 820           </tr>
 821
 822         <tr align="left" valign="bottom" class="fibody">
 823
 824           <td nowrap><li>Rectal</li></td>
 825
 826           <td nowrap><? echo (($fdata{'gynec_rectal'} == '0')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 827
 828   Normal</td>
 829
 830           <td nowrap><? echo (($fdata{'gynec_rectal'} == '1')?'<img src="../../pic/mrkcheck.png" width="12" height="11"> ':'<img src="../../pic/mrkempty.png" width="12" height="11"> '); ?>
 831
 832   ABNormal</td>
 833
 834           <td><? echo $fdata{'gynec_rectal_data'}; ?></td>
 835
 836           </tr>
 837
 838         <tr align="left" valign="bottom" class="fibody">
 839
 840           <td colspan="4" nowrap><br>
 841
 842             (See also &quot;<a href="#sg">Stool guaiac</a>&quot; above ) </td>
 843
 844           </tr>
 845
 846       </table> </td>
 847
 848   </tr>
 849
 850   <tr class="fibody">
 851
 852     <td align="left" valign="top" style="border-bottom:2px solid black;border-top:2px solid black;">Total number of bulleted elements examined
 853
 854       <? echo $fdata{'tot_num_examined'}; ?></td>
 855
 856   </tr>
 857
 858 </table>
 859
 860 </div>
 861
 862 </body>
 863
 864 </html>