contrib/forms/vitals/form.php

   1 <?php
   2
   3 /*
   4
   5 This form works as new and editing,
   6 */
   7 ?>
   8 <TABLE span class=text>
   9 <th><H2><U>Vital Signs</U></H2></th>
  10 <TR>
  11         <TD >Blood Presure:</TD>
  12         <TD>
  13         <INPUT TYPE="text" NAME="bps" size="3" value="<?php if ($obj["bps"]!='') print $obj["bps"]; ?>">/<INPUT TYPE="text" NAME="bpd" size="3" value="<?php if ($obj["bpd"]!='') print $obj["bpd"]; ?>">
  14         </TD>
  15         <TD >Weight (pounds):</TD>
  16         <TD><INPUT TYPE="text" NAME="weight" size="6" value="<?php if ($obj["weight"]!='') print $obj["weight"]; ?>"></TD>
  17         <TD >Height (inches):</TD>
  18         <TD><INPUT TYPE="text" NAME="height" size="6" value="<?php if ($obj["height"]!='') print $obj["height"]; ?>"></TD>
  19 </TR>
  20 <TR>
  21         <TD >Temperature:</TD>
  22         <TD><INPUT TYPE="text" NAME="temperature" size="6" value="<?php if ($obj["temperature"]!='') print $obj["temperature"]; ?>">
  23                 <select name="temp_method">
  24                 <option <?php if ($obj["temp_method"]=='ear') print 'selected'; ?>>ear
  25                 <option <?php if ($obj["temp_method"]=='axillary') print 'selected'; ?>>axillary
  26                 <option <?php if ($obj["temp_method"]=='mouth') print 'selected'; ?>>mouth
  27                 <option <?php if ($obj["temp_method"]=='rectal') print 'selected'; ?>>rectal
  28                 </SELECT>
  29         </TD>
  30         <TD >Pulse (bps):</TD>
  31         <TD><INPUT TYPE="text" NAME="pulse" size="3" value="<?php if ($obj["pulse"]!='') print $obj["pulse"]; ?>"></TD>
  32         <TD >Respiration:</TD>
  33         <TD><INPUT TYPE="text" NAME="respiration" size="2" value="<?php if ($obj["respiration"]!='') print $obj["respiration"]; ?>"></TD>
  34 </TR>
  35 <TR>
  36         <TD>Note:</TD>
  37         <TD><INPUT TYPE="text" NAME="note" value="<?php if ($obj["note"]!='') print $obj["note"]; ?>"></TD>
  38         <TD>Body Mass Index:</TD>
  39         <TD><INPUT TYPE="text" NAME="BMI" size="6" value="<?php if ($obj["BMI"]!='') print $obj["BMI"]; ?>"><?php if ($obj["BMI_status"]!='') print $obj["BMI_status"]; ?></TD>
  40         <TD>Waist circ (inch):</TD>
  41         <TD><INPUT TYPE="text" NAME="waist_circ" size="6" value="<?php if ($obj["waist_circ"]!='') print $obj["waist_circ"]; ?>"></TD>
  42 </TR>
  43 </TABLE>