From 0094c351f2e0600d46dd18bee98d114ed1d4112e Mon Sep 17 00:00:00 2001 From: bradymiller Date: Sat, 8 Aug 2009 21:34:00 +0000 Subject: [PATCH] internationalization bug fix - translate submit button --- interface/forms/ros/templates/ros/general_new.html | 1186 ++++++++++---------- 1 file changed, 594 insertions(+), 592 deletions(-) diff --git a/interface/forms/ros/templates/ros/general_new.html b/interface/forms/ros/templates/ros/general_new.html index 09bf5a2ba..947fd1031 100755 --- a/interface/forms/ros/templates/ros/general_new.html +++ b/interface/forms/ros/templates/ros/general_new.html @@ -1,592 +1,594 @@ - - -{literal} - -{/literal} - - -
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-

Review Of Systems

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- - -
Constitutional - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Weight Change:{html_radios name="weight_change" options=$form->get_options() selected=$form->get_weight_change() separator=""}Weakness:{html_radios name="weakness" options=$form->get_options() selected=$form->get_weakness() separator=""}Fatigue:{html_radios name="fatigue" options=$form->get_options() selected=$form->get_fatigue() separator=""}
Anorexia:{html_radios name="anorexia" options=$form->get_options() selected=$form->get_anorexia() separator=""}Fever:{html_radios name="fever" options=$form->get_options() selected=$form->get_fever() separator=""}Chills:{html_radios name="chills" options=$form->get_options() selected=$form->get_chills() separator=""}
Night Sweats:{html_radios name="night_sweats" options=$form->get_options() selected=$form->get_night_sweats() separator=""}Insomnia:{html_radios name="insomnia" options=$form->get_options() selected=$form->get_insomnia() separator=""}Irritability:{html_radios name="irritability" options=$form->get_options() selected=$form->get_irritability() separator=""}
Heat or Cold:{html_radios name="heat_or_cold" options=$form->get_options() selected=$form->get_heat_or_cold() separator=""}Intolerance:{html_radios name="intolerance" options=$form->get_options() selected=$form->get_intolerance() separator=""}
- - -
- - -
Eyes - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Change in Vision:{html_radios name="change_in_vision" options=$form->get_options() selected=$form->get_weight_change() separator=""}Family History of Glaucoma:{html_radios name="glaucoma_history" options=$form->get_options() selected=$form->get_glaucoma_history() separator=""}Eye Pain:{html_radios name="eye_pain" options=$form->get_options() selected=$form->get_eye_pain() separator=""}
Irritation:{html_radios name="irritation" options=$form->get_options() selected=$form->get_irritation() separator=""}Redness:{html_radios name="redness" options=$form->get_options() selected=$form->get_redness() separator=""}Excessive Tearing:{html_radios name="excessive_tearing" options=$form->get_options() selected=$form->get_excessive_tearing() separator=""}
Double Vision:{html_radios name="double_vision" options=$form->get_options() selected=$form->get_double_vision() separator=""}Blind Spots:{html_radios name="blind_spots" options=$form->get_options() selected=$form->get_blind_spots() separator=""}Photophobia:{html_radios name="photophobia" options=$form->get_options() selected=$form->get_photophobia() separator=""}
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- - -
Ears, Nose, Mouth, Throat - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Hearing Loss:{html_radios name="hearing_loss" options=$form->get_options() selected=$form->get_hearing_loss() separator=""}Discharge:{html_radios name="discharge" options=$form->get_options() selected=$form->get_discharge() separator=""}Pain:{html_radios name="pain" options=$form->get_options() selected=$form->get_pain() separator=""}
Vertigo:{html_radios name="vertigo" options=$form->get_options() selected=$form->get_vertigo() separator=""}Tinnitus:{html_radios name="tinnitus" options=$form->get_options() selected=$form->get_tinnitus() separator=""}Frequent Colds:{html_radios name="frequent_colds" options=$form->get_options() selected=$form->get_frequent_colds() separator=""}
Sore Throat:{html_radios name="sore_throat" options=$form->get_options() selected=$form->get_sore_throat() separator=""}Sinus Problems:{html_radios name="sinus_problems" options=$form->get_options() selected=$form->get_sinus_problems() separator=""}Post Nasal Drip:{html_radios name="post_nasal_drip" options=$form->get_options() selected=$form->get_post_nasal_drip() separator=""}
Nosebleed:{html_radios name="nosebleed" options=$form->get_options() selected=$form->get_nosebleed() separator=""}Snoring:{html_radios name="snoring" options=$form->get_options() selected=$form->get_snoring() separator=""}Apnea:{html_radios name="apnea" options=$form->get_options() selected=$form->get_apnea() separator=""}
- - -
- - -
Breast - - - - - - - - - - - - - - - -
Breast Mass:{html_radios name="breast_mass" options=$form->get_options() selected=$form->get_breast_mass() separator=""}Discharge:{html_radios name="breast_discharge" options=$form->get_options() selected=$form->get_breast_discharge() separator=""}Biopsy:{html_radios name="biopsy" options=$form->get_options() selected=$form->get_biopsy() separator=""}
Abnormal Mammogram:{html_radios name="abnormal_mammogram" options=$form->get_options() selected=$form->get_abnormal_mammogram() separator=""}
- - -
- - -
Respiratory - - - - - - - - - - - - - - - - - - - - - - - -
Cough:{html_radios name="cough" options=$form->get_options() selected=$form->get_cough() separator=""}Sputum:{html_radios name="sputum" options=$form->get_options() selected=$form->get_sputum() separator=""}Shortness of Breath:{html_radios name="shortness_of_breath" options=$form->get_options() selected=$form->get_shortness_of_breath() separator=""}
Wheezing:{html_radios name="wheezing" options=$form->get_options() selected=$form->get_wheezing() separator=""}Hemoptsyis:{html_radios name="hemoptsyis" options=$form->get_options() selected=$form->get_hemoptsyis() separator=""}Asthma:{html_radios name="asthma" options=$form->get_options() selected=$form->get_asthma() separator=""}
COPD:{html_radios name="copd" options=$form->get_options() selected=$form->get_copd() separator=""}
- - -
- - -
Cardiovascular - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Chest Pain:{html_radios name="chest_pain" options=$form->get_options() selected=$form->get_chest_pain() separator=""}Palpitation:{html_radios name="palpitation" options=$form->get_options() selected=$form->get_palpitation() separator=""}Syncope:{html_radios name="syncope" options=$form->get_options() selected=$form->get_syncope() separator=""}
PND:{html_radios name="pnd" options=$form->get_options() selected=$form->get_pnd() separator=""}DOE:{html_radios name="doe" options=$form->get_options() selected=$form->get_doe() separator=""}Orthopnea:{html_radios name="orthopnea" options=$form->get_options() selected=$form->get_orthopnea() separator=""}
Peripheal:{html_radios name="peripheal" options=$form->get_options() selected=$form->get_peripheal() separator=""}Edema:{html_radios name="edema" options=$form->get_options() selected=$form->get_edema() separator=""}Leg Pain/Cramping:{html_radios name="legpain_cramping" options=$form->get_options() selected=$form->get_legpain_cramping() separator=""}
History of Heart Murmur:{html_radios name="history_murmur" options=$form->get_options() selected=$form->get_history_murmur() separator=""}Arrythmia:{html_radios name="arrythmia" options=$form->get_options() selected=$form->get_arrythmia() separator=""}Heart Problems:{html_radios name="heart_problems" options=$form->get_options() selected=$form->get_heart_problem() separator=""}
- - -
- - -
Gastrointestinal - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Dysphagia:{html_radios name="dysphagia" options=$form->get_options() selected=$form->get_dysphagia() separator=""}Heartburn:{html_radios name="heartburn" options=$form->get_options() selected=$form->get_heartburn() separator=""}Bloating:{html_radios name="bloating" options=$form->get_options() selected=$form->get_bloating() separator=""}
Belching:{html_radios name="belching" options=$form->get_options() selected=$form->get_belching() separator=""}Flatulence:{html_radios name="flatulence" options=$form->get_options() selected=$form->get_flatulence() separator=""}Nausea:{html_radios name="nausea" options=$form->get_options() selected=$form->get_nausea() separator=""}
Vomiting:{html_radios name="vomiting" options=$form->get_options() selected=$form->get_vomiting() separator=""}Hematemesis:{html_radios name="hematemesis" options=$form->get_options() selected=$form->get_hematemesis() separator=""}Pain:{html_radios name="gastro_pain" options=$form->get_options() selected=$form->get_gastro_pain() separator=""}
Food Intolerance:{html_radios name="food_intolerance" options=$form->get_options() selected=$form->get_food_intolerance() separator=""}H/O Hepatitis:{html_radios name="hepatitis" options=$form->get_options() selected=$form->get_hepatitis() separator=""}Jaundice:{html_radios name="jaundice" options=$form->get_options() selected=$form->get_jaundice() separator=""}
Hematochezia:{html_radios name="hematochezia" options=$form->get_options() selected=$form->get_hematochezia() separator=""}Changed Bowel:{html_radios name="changed_bowel" options=$form->get_options() selected=$form->get_changed_bowel() separator=""}Diarrhea:{html_radios name="diarrhea" options=$form->get_options() selected=$form->get_diarrhea() separator=""}
Constipation:{html_radios name="constipation" options=$form->get_options() selected=$form->get_constipation() separator=""}
- - -
- - -
Genitourinary General - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Polyuria:{html_radios name="polyuria" options=$form->get_options() selected=$form->get_polyuria() separator=""}Polydypsia:{html_radios name="polydypsia" options=$form->get_options() selected=$form->get_polydypsia() separator=""}Dysuria:{html_radios name="dysuria" options=$form->get_options() selected=$form->get_dysuria() separator=""}
Hematuria:{html_radios name="hematuria" options=$form->get_options() selected=$form->get_hematuria() separator=""}Frequency:{html_radios name="frequency" options=$form->get_options() selected=$form->get_frequency() separator=""}Urgency:{html_radios name="urgency" options=$form->get_options() selected=$form->get_urgency() separator=""}
Incontinence:{html_radios name="incontinence" options=$form->get_options() selected=$form->get_incontinence() separator=""}Renal Stones:{html_radios name="renal_stones" options=$form->get_options() selected=$form->get_renal_stones() separator=""}UTIs:{html_radios name="utis" options=$form->get_options() selected=$form->get_utis() separator=""}
- - -
- - -
Genitourinary Male - - - - - - - - - - - - - - - - - - - -
Hesitancy:{html_radios name="hesitancy" options=$form->get_options() selected=$form->get_hesitancy() separator=""}Dribbling:{html_radios name="dribbling" options=$form->get_options() selected=$form->get_dribbling() separator=""}Stream:{html_radios name="stream" options=$form->get_options() selected=$form->get_stream() separator=""}
Nocturia:{html_radios name="nocturia" options=$form->get_options() selected=$form->get_nocturia() separator=""}Erections:{html_radios name="erections" options=$form->get_options() selected=$form->get_erections() separator=""}Ejaculations:{html_radios name="ejaculations" options=$form->get_options() selected=$form->get_ejaculations() separator=""}
-
- - -
Genitourinary Female - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
G:{html_radios name="g" options=$form->get_options() selected=$form->get_g() separator=""}P:{html_radios name="p" options=$form->get_options() selected=$form->get_p() separator=""}AP:{html_radios name="ap" options=$form->get_options() selected=$form->get_ap() separator=""}
LC:{html_radios name="lc" options=$form->get_options() selected=$form->get_lc() separator=""}Mearche:{html_radios name="mearche" options=$form->get_options() selected=$form->get_mearche() separator=""}Menopause:{html_radios name="menopause" options=$form->get_options() selected=$form->get_menopause() separator=""}
LMP:{html_radios name="lmp" options=$form->get_options() selected=$form->get_lmp() separator=""}Frequency:{html_radios name="f_frequency" options=$form->get_options() selected=$form->get_f_frequency() separator=""}Flow:{html_radios name="f_flow" options=$form->get_options() selected=$form->get_f_flow() separator=""}
Symptoms:{html_radios name="f_symptoms" options=$form->get_options() selected=$form->get_f_symptoms() separator=""}Abnormal Hair Growth:{html_radios name="abnormal_hair_growth" options=$form->get_options() selected=$form->get_abnormal_hair_growth() separator=""}F/H Female Hirsutism/Striae:{html_radios name="f_hirsutism" options=$form->get_options() selected=$form->get_f_hirsutism() separator=""}
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- - -
Musculoskeletal - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Chronic Joint Pain:{html_radios name="joint_pain" options=$form->get_options() selected=$form->get_joint_pain() separator=""}Swelling:{html_radios name="swelling" options=$form->get_options() selected=$form->get_swelling() separator=""}Redness:{html_radios name="m_redness" options=$form->get_options() selected=$form->get_m_redness() separator=""}
Warm:{html_radios name="m_warm" options=$form->get_options() selected=$form->get_m_warm() separator=""}Stiffness:{html_radios name="m_stiffness" options=$form->get_options() selected=$form->get_m_stiffness() separator=""}Muscle:{html_radios name="muscle" options=$form->get_options() selected=$form->get_muscle() separator=""}
Aches:{html_radios name="m_aches" options=$form->get_options() selected=$form->get_m_aches() separator=""}FMS:{html_radios name="fms" options=$form->get_options() selected=$form->get_fms() separator=""}Arthritis:{html_radios name="arthritis" options=$form->get_options() selected=$form->get_arthritis() separator=""}
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Neurologic - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
LOC:{html_radios name="loc" options=$form->get_options() selected=$form->get_loc() separator=""}Seizures:{html_radios name="seizures" options=$form->get_options() selected=$form->get_seizures() separator=""}Stroke:{html_radios name="stroke" options=$form->get_options() selected=$form->get_stroke() separator=""}
TIA:{html_radios name="tia" options=$form->get_options() selected=$form->get_tia() separator=""}Numbness:{html_radios name="n_numbness" options=$form->get_options() selected=$form->get_n_numbness() separator=""}Weakness:{html_radios name="n_weakness" options=$form->get_options() selected=$form->get_n_weakness() separator=""}
Paralysis:{html_radios name="paralysis" options=$form->get_options() selected=$form->get_paralysis() separator=""}Intellectual Decline:{html_radios name="intellectual_decline" options=$form->get_options() selected=$form->get_intellectual_decline() separator=""}Memory Problems:{html_radios name="memory_problems" options=$form->get_options() selected=$form->get_memory_problems() separator=""}
Dementia:{html_radios name="dementia" options=$form->get_options() selected=$form->get_dementia() separator=""}Headache:{html_radios name="n_headache" options=$form->get_options() selected=$form->get_n_headache() separator=""}
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- - -
Skin - - - - - - - - - - - - - - - - - -
Cancer:{html_radios name="s_cancer" options=$form->get_options() selected=$form->get_s_cancer() separator=""}Psoriasis:{html_radios name="psoriasis" options=$form->get_options() selected=$form->get_psoriasis() separator=""}Acne:{html_radios name="s_acne" options=$form->get_options() selected=$form->get_s_acne() separator=""}
Other:{html_radios name="s_other" options=$form->get_options() selected=$form->get_s_other() separator=""}Disease:{html_radios name="s_disease" options=$form->get_options() selected=$form->get_s_disease() separator=""}
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Psychiatric - - - - - - - - - - - - - - - - - -
Psychiatric Diagnosis:{html_radios name="p_diagnosis" options=$form->get_options() selected=$form->get_p_diagnosis() separator=""}Psychiatric Medication:{html_radios name="p_medication" options=$form->get_options() selected=$form->get_p_medication() separator=""}Depression:{html_radios name="depression" options=$form->get_options() selected=$form->get_depression() separator=""}
Anxiety:{html_radios name="anxiety" options=$form->get_options() selected=$form->get_anxiety() separator=""}Social Difficulties:{html_radios name="social_difficulties" options=$form->get_options() selected=$form->get_social_difficulties() separator=""}
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Endocirne - - - - - - - - - - - -
Thyroid Problems:{html_radios name="thyroid_problems" options=$form->get_options() selected=$form->get_thyroid_problems() separator=""}Diabetes:{html_radios name="diabetes" options=$form->get_options() selected=$form->get_diabetes() separator=""}Abnormal Blood Test:{html_radios name="abnormal_blood" options=$form->get_options() selected=$form->get_abnormal_blood() separator=""}
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Hematologic/Allegic/Immunologic - - - - - - - - - - - - - - - - - - - - - - - -
Anemia:{html_radios name="anemia" options=$form->get_options() selected=$form->get_anemia() separator=""}F/H Blood Problems:{html_radios name="fh_blood_problems" options=$form->get_options() selected=$form->get_fh_blood_problems() separator=""}Bleeding Problems:{html_radios name="bleeding_problems" options=$form->get_options() selected=$form->get_bleeding_problems() separator=""}
Allergies:{html_radios name="allergies" options=$form->get_options() selected=$form->get_allergies() separator=""}Frequent Illness:{html_radios name="frequent_illness" options=$form->get_options() selected=$form->get_frequent_illness() separator=""}HIV:{html_radios name="hiv" options=$form->get_options() selected=$form->get_hiv() separator=""}
Status:{html_radios name="hai_status" options=$form->get_options() selected=$form->get_hai_status() separator=""}
-
- - - - -
- - - + + +{php}html_header_show();{/php} +{literal} + +{/literal} + + +
+ + + +
+

{xl t="Review Of Systems"}

+
+ + +
{xl t="Constitutional"} + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="Weight Change"}:{html_radios name="weight_change" options=$form->get_options() selected=$form->get_weight_change() separator=""}{xl t="Weakness"}:{html_radios name="weakness" options=$form->get_options() selected=$form->get_weakness() separator=""}{xl t="Fatigue"}:{html_radios name="fatigue" options=$form->get_options() selected=$form->get_fatigue() separator=""}
{xl t="Anorexia"}:{html_radios name="anorexia" options=$form->get_options() selected=$form->get_anorexia() separator=""}{xl t="Fever"}:{html_radios name="fever" options=$form->get_options() selected=$form->get_fever() separator=""}{xl t="Chills"}:{html_radios name="chills" options=$form->get_options() selected=$form->get_chills() separator=""}
{xl t="Night Sweats"}:{html_radios name="night_sweats" options=$form->get_options() selected=$form->get_night_sweats() separator=""}{xl t="Insomnia"}:{html_radios name="insomnia" options=$form->get_options() selected=$form->get_insomnia() separator=""}{xl t="Irritability"}:{html_radios name="irritability" options=$form->get_options() selected=$form->get_irritability() separator=""}
{xl t="Heat or Cold"}:{html_radios name="heat_or_cold" options=$form->get_options() selected=$form->get_heat_or_cold() separator=""}{xl t="Intolerance"}:{html_radios name="intolerance" options=$form->get_options() selected=$form->get_intolerance() separator=""}
+ + +
+ + +
{xl t="Eyes"} + + + + + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="Change in Vision"}:{html_radios name="change_in_vision" options=$form->get_options() selected=$form->get_weight_change() separator=""}{xl t="Family History of Glaucoma"}:{html_radios name="glaucoma_history" options=$form->get_options() selected=$form->get_glaucoma_history() separator=""}{xl t="Eye Pain"}:{html_radios name="eye_pain" options=$form->get_options() selected=$form->get_eye_pain() separator=""}
{xl t="Irritation"}:{html_radios name="irritation" options=$form->get_options() selected=$form->get_irritation() separator=""}{xl t="Redness"}:{html_radios name="redness" options=$form->get_options() selected=$form->get_redness() separator=""}{xl t="Excessive Tearing"}:{html_radios name="excessive_tearing" options=$form->get_options() selected=$form->get_excessive_tearing() separator=""}
{xl t="Double Vision"}:{html_radios name="double_vision" options=$form->get_options() selected=$form->get_double_vision() separator=""}{xl t="Blind Spots"}:{html_radios name="blind_spots" options=$form->get_options() selected=$form->get_blind_spots() separator=""}{xl t="Photophobia"}:{html_radios name="photophobia" options=$form->get_options() selected=$form->get_photophobia() separator=""}
+ + +
+ + +
{xl t="Ears"}, {xl t="Nose"}, {xl t="Mouth"}, {xl t="Throat"} + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="Hearing Loss"}:{html_radios name="hearing_loss" options=$form->get_options() selected=$form->get_hearing_loss() separator=""}{xl t="Discharge"}:{html_radios name="discharge" options=$form->get_options() selected=$form->get_discharge() separator=""}{xl t="Pain"}:{html_radios name="pain" options=$form->get_options() selected=$form->get_pain() separator=""}
{xl t="Vertigo"}:{html_radios name="vertigo" options=$form->get_options() selected=$form->get_vertigo() separator=""}{xl t="Tinnitus"}:{html_radios name="tinnitus" options=$form->get_options() selected=$form->get_tinnitus() separator=""}{xl t="Frequent Colds"}:{html_radios name="frequent_colds" options=$form->get_options() selected=$form->get_frequent_colds() separator=""}
{xl t="Sore Throat"}:{html_radios name="sore_throat" options=$form->get_options() selected=$form->get_sore_throat() separator=""}{xl t="Sinus Problems"}:{html_radios name="sinus_problems" options=$form->get_options() selected=$form->get_sinus_problems() separator=""}{xl t="Post Nasal Drip"}:{html_radios name="post_nasal_drip" options=$form->get_options() selected=$form->get_post_nasal_drip() separator=""}
{xl t="Nosebleed"}:{html_radios name="nosebleed" options=$form->get_options() selected=$form->get_nosebleed() separator=""}{xl t="Snoring"}:{html_radios name="snoring" options=$form->get_options() selected=$form->get_snoring() separator=""}{xl t="Apnea"}:{html_radios name="apnea" options=$form->get_options() selected=$form->get_apnea() separator=""}
+ + +
+ + +
{xl t="Breast"} + + + + + + + + + + + + + + + +
{xl t="Breast Mass"}:{html_radios name="breast_mass" options=$form->get_options() selected=$form->get_breast_mass() separator=""}{xl t="Discharge"}:{html_radios name="breast_discharge" options=$form->get_options() selected=$form->get_breast_discharge() separator=""}{xl t="Biopsy"}:{html_radios name="biopsy" options=$form->get_options() selected=$form->get_biopsy() separator=""}
{xl t="Abnormal Mammogram"}:{html_radios name="abnormal_mammogram" options=$form->get_options() selected=$form->get_abnormal_mammogram() separator=""}
+ + +
+ + +
{xl t="Respiratory"} + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="Cough"}:{html_radios name="cough" options=$form->get_options() selected=$form->get_cough() separator=""}{xl t="Sputum"}:{html_radios name="sputum" options=$form->get_options() selected=$form->get_sputum() separator=""}{xl t="Shortness of Breath"}:{html_radios name="shortness_of_breath" options=$form->get_options() selected=$form->get_shortness_of_breath() separator=""}
{xl t="Wheezing"}:{html_radios name="wheezing" options=$form->get_options() selected=$form->get_wheezing() separator=""}{xl t="Hemoptysis"}:{html_radios name="hemoptsyis" options=$form->get_options() selected=$form->get_hemoptsyis() separator=""}{xl t="Asthma"}:{html_radios name="asthma" options=$form->get_options() selected=$form->get_asthma() separator=""}
{xl t="COPD"}:{html_radios name="copd" options=$form->get_options() selected=$form->get_copd() separator=""}
+ + +
+ + +
{xl t="Cardiovascular"} + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="Chest Pain"}:{html_radios name="chest_pain" options=$form->get_options() selected=$form->get_chest_pain() separator=""}{xl t="Palpitation"}:{html_radios name="palpitation" options=$form->get_options() selected=$form->get_palpitation() separator=""}{xl t="Syncope"}:{html_radios name="syncope" options=$form->get_options() selected=$form->get_syncope() separator=""}
{xl t="PND"}:{html_radios name="pnd" options=$form->get_options() selected=$form->get_pnd() separator=""}{xl t="DOE"}:{html_radios name="doe" options=$form->get_options() selected=$form->get_doe() separator=""}{xl t="Orthopnea"}:{html_radios name="orthopnea" options=$form->get_options() selected=$form->get_orthopnea() separator=""}
{xl t="Peripheral"}:{html_radios name="peripheal" options=$form->get_options() selected=$form->get_peripheal() separator=""}{xl t="Edema"}:{html_radios name="edema" options=$form->get_options() selected=$form->get_edema() separator=""}{xl t="Leg Pain/Cramping"}:{html_radios name="legpain_cramping" options=$form->get_options() selected=$form->get_legpain_cramping() separator=""}
{xl t="History of Heart Murmur"}:{html_radios name="history_murmur" options=$form->get_options() selected=$form->get_history_murmur() separator=""}{xl t="Arrythmia"}:{html_radios name="arrythmia" options=$form->get_options() selected=$form->get_arrythmia() separator=""}{xl t="Heart Problem"}:{html_radios name="heart_problem" options=$form->get_options() selected=$form->get_heart_problem() separator=""}
+ + +
+ + +
{xl t="Gastrointestinal"} + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="Dysphagia"}:{html_radios name="dysphagia" options=$form->get_options() selected=$form->get_dysphagia() separator=""}{xl t="Heartburn"}:{html_radios name="heartburn" options=$form->get_options() selected=$form->get_heartburn() separator=""}{xl t="Bloating"}:{html_radios name="bloating" options=$form->get_options() selected=$form->get_bloating() separator=""}
{xl t="Belching"}:{html_radios name="belching" options=$form->get_options() selected=$form->get_belching() separator=""}{xl t="Flatulence"}:{html_radios name="flatulence" options=$form->get_options() selected=$form->get_flatulence() separator=""}{xl t="Nausea"}:{html_radios name="nausea" options=$form->get_options() selected=$form->get_nausea() separator=""}
{xl t="Vomiting"}:{html_radios name="vomiting" options=$form->get_options() selected=$form->get_vomiting() separator=""}{xl t="Hematemesis"}:{html_radios name="hematemesis" options=$form->get_options() selected=$form->get_hematemesis() separator=""}{xl t="Pain"}:{html_radios name="gastro_pain" options=$form->get_options() selected=$form->get_gastro_pain() separator=""}
{xl t="Food Intolerance"}:{html_radios name="food_intolerance" options=$form->get_options() selected=$form->get_food_intolerance() separator=""}{xl t="H/O Hepatitis"}:{html_radios name="hepatitis" options=$form->get_options() selected=$form->get_hepatitis() separator=""}{xl t="Jaundice"}:{html_radios name="jaundice" options=$form->get_options() selected=$form->get_jaundice() separator=""}
{xl t="Hematochezia"}:{html_radios name="hematochezia" options=$form->get_options() selected=$form->get_hematochezia() separator=""}{xl t="Changed Bowel"}:{html_radios name="changed_bowel" options=$form->get_options() selected=$form->get_changed_bowel() separator=""}{xl t="Diarrhea"}:{html_radios name="diarrhea" options=$form->get_options() selected=$form->get_diarrhea() separator=""}
{xl t="Constipation"}:{html_radios name="constipation" options=$form->get_options() selected=$form->get_constipation() separator=""}
+ + +
+ + +
{xl t="Genitourinary"} {xl t="General"} + + + + + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="Polyuria"}:{html_radios name="polyuria" options=$form->get_options() selected=$form->get_polyuria() separator=""}{xl t="Polydypsia"}:{html_radios name="polydypsia" options=$form->get_options() selected=$form->get_polydypsia() separator=""}{xl t="Dysuria"}:{html_radios name="dysuria" options=$form->get_options() selected=$form->get_dysuria() separator=""}
{xl t="Hematuria"}:{html_radios name="hematuria" options=$form->get_options() selected=$form->get_hematuria() separator=""}{xl t="Frequency"}:{html_radios name="frequency" options=$form->get_options() selected=$form->get_frequency() separator=""}{xl t="Urgency"}:{html_radios name="urgency" options=$form->get_options() selected=$form->get_urgency() separator=""}
{xl t="Incontinence"}:{html_radios name="incontinence" options=$form->get_options() selected=$form->get_incontinence() separator=""}{xl t="Renal Stones"}:{html_radios name="renal_stones" options=$form->get_options() selected=$form->get_renal_stones() separator=""}{xl t="UTIs"}:{html_radios name="utis" options=$form->get_options() selected=$form->get_utis() separator=""}
+ + +
+ + +
{xl t="Genitourinary"} {xl t="Male"} + + + + + + + + + + + + + + + + + + + +
{xl t="Hesitancy"}:{html_radios name="hesitancy" options=$form->get_options() selected=$form->get_hesitancy() separator=""}{xl t="Dribbling"}:{html_radios name="dribbling" options=$form->get_options() selected=$form->get_dribbling() separator=""}{xl t="Stream"}:{html_radios name="stream" options=$form->get_options() selected=$form->get_stream() separator=""}
{xl t="Nocturia"}:{html_radios name="nocturia" options=$form->get_options() selected=$form->get_nocturia() separator=""}{xl t="Erections"}:{html_radios name="erections" options=$form->get_options() selected=$form->get_erections() separator=""}{xl t="Ejaculations"}:{html_radios name="ejaculations" options=$form->get_options() selected=$form->get_ejaculations() separator=""}
+
+ + +
{xl t="Genitourinary"} {xl t="Female"} + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="Female G"}:{html_radios name="g" options=$form->get_options() selected=$form->get_g() separator=""}{xl t="Female P"}:{html_radios name="p" options=$form->get_options() selected=$form->get_p() separator=""}{xl t="Female AP"}:{html_radios name="ap" options=$form->get_options() selected=$form->get_ap() separator=""}
{xl t="Female LC"}:{html_radios name="lc" options=$form->get_options() selected=$form->get_lc() separator=""}{xl t="Menarche"}:{html_radios name="mearche" options=$form->get_options() selected=$form->get_mearche() separator=""}{xl t="Menopause"}:{html_radios name="menopause" options=$form->get_options() selected=$form->get_menopause() separator=""}
{xl t="LMP"}:{html_radios name="lmp" options=$form->get_options() selected=$form->get_lmp() separator=""}{xl t="Frequency"}:{html_radios name="f_frequency" options=$form->get_options() selected=$form->get_f_frequency() separator=""}{xl t="Flow"}:{html_radios name="f_flow" options=$form->get_options() selected=$form->get_f_flow() separator=""}
{xl t="Symptoms"}:{html_radios name="f_symptoms" options=$form->get_options() selected=$form->get_f_symptoms() separator=""}{xl t="Abnormal Hair Growth"}:{html_radios name="abnormal_hair_growth" options=$form->get_options() selected=$form->get_abnormal_hair_growth() separator=""}{xl t="F/H Female Hirsutism/Striae"}:{html_radios name="f_hirsutism" options=$form->get_options() selected=$form->get_f_hirsutism() separator=""}
+
+ + +
{xl t="Musculoskeletal"} + + + + + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="Chronic Joint Pain"}:{html_radios name="joint_pain" options=$form->get_options() selected=$form->get_joint_pain() separator=""}{xl t="Swelling"}:{html_radios name="swelling" options=$form->get_options() selected=$form->get_swelling() separator=""}{xl t="Redness"}:{html_radios name="m_redness" options=$form->get_options() selected=$form->get_m_redness() separator=""}
{xl t="Warm"}:{html_radios name="m_warm" options=$form->get_options() selected=$form->get_m_warm() separator=""}{xl t="Stiffness"}:{html_radios name="m_stiffness" options=$form->get_options() selected=$form->get_m_stiffness() separator=""}{xl t="Muscle"}:{html_radios name="muscle" options=$form->get_options() selected=$form->get_muscle() separator=""}
{xl t="Aches"}:{html_radios name="m_aches" options=$form->get_options() selected=$form->get_m_aches() separator=""}{xl t="FMS"}:{html_radios name="fms" options=$form->get_options() selected=$form->get_fms() separator=""}{xl t="Arthritis"}:{html_radios name="arthritis" options=$form->get_options() selected=$form->get_arthritis() separator=""}
+
+ + +
{xl t="Neurologic"} + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="LOC"}:{html_radios name="loc" options=$form->get_options() selected=$form->get_loc() separator=""}{xl t="Seizures"}:{html_radios name="seizures" options=$form->get_options() selected=$form->get_seizures() separator=""}{xl t="Stroke"}:{html_radios name="stroke" options=$form->get_options() selected=$form->get_stroke() separator=""}
{xl t="TIA"}:{html_radios name="tia" options=$form->get_options() selected=$form->get_tia() separator=""}{xl t="Numbness"}:{html_radios name="n_numbness" options=$form->get_options() selected=$form->get_n_numbness() separator=""}{xl t="Weakness"}:{html_radios name="n_weakness" options=$form->get_options() selected=$form->get_n_weakness() separator=""}
{xl t="Paralysis"}:{html_radios name="paralysis" options=$form->get_options() selected=$form->get_paralysis() separator=""}{xl t="Intellectual Decline"}:{html_radios name="intellectual_decline" options=$form->get_options() selected=$form->get_intellectual_decline() separator=""}{xl t="Memory Problems"}:{html_radios name="memory_problems" options=$form->get_options() selected=$form->get_memory_problems() separator=""}
{xl t="Dementia"}:{html_radios name="dementia" options=$form->get_options() selected=$form->get_dementia() separator=""}{xl t="Headache"}:{html_radios name="n_headache" options=$form->get_options() selected=$form->get_n_headache() separator=""}
+
+ + +
{xl t="Skin"} + + + + + + + + + + + + + + + + + +
{xl t="Cancer"}:{html_radios name="s_cancer" options=$form->get_options() selected=$form->get_s_cancer() separator=""}{xl t="Psoriasis"}:{html_radios name="psoriasis" options=$form->get_options() selected=$form->get_psoriasis() separator=""}{xl t="Acne"}:{html_radios name="s_acne" options=$form->get_options() selected=$form->get_s_acne() separator=""}
{xl t="Other"}:{html_radios name="s_other" options=$form->get_options() selected=$form->get_s_other() separator=""}{xl t="Disease"}:{html_radios name="s_disease" options=$form->get_options() selected=$form->get_s_disease() separator=""}
+
+ + +
{xl t="Psychiatric"} + + + + + + + + + + + + + + + + + +
{xl t="Psychiatric Diagnosis"}:{html_radios name="p_diagnosis" options=$form->get_options() selected=$form->get_p_diagnosis() separator=""}{xl t="Psychiatric Medication"}:{html_radios name="p_medication" options=$form->get_options() selected=$form->get_p_medication() separator=""}{xl t="Depression"}:{html_radios name="depression" options=$form->get_options() selected=$form->get_depression() separator=""}
{xl t="Anxiety"}:{html_radios name="anxiety" options=$form->get_options() selected=$form->get_anxiety() separator=""}{xl t="Social Difficulties"}:{html_radios name="social_difficulties" options=$form->get_options() selected=$form->get_social_difficulties() separator=""}
+
+ + +
{xl t="Endocrine"} + + + + + + + + + + + +
{xl t="Thyroid Problems"}:{html_radios name="thyroid_problems" options=$form->get_options() selected=$form->get_thyroid_problems() separator=""}{xl t="Diabetes"}:{html_radios name="diabetes" options=$form->get_options() selected=$form->get_diabetes() separator=""}{xl t="Abnormal Blood Test"}:{html_radios name="abnormal_blood" options=$form->get_options() selected=$form->get_abnormal_blood() separator=""}
+
+ + +
{xl t="Hematologic"}/{xl t="Allergic"}/{xl t="Immunologic"} + + + + + + + + + + + + + + + + + + + + + + + +
{xl t="Anemia"}:{html_radios name="anemia" options=$form->get_options() selected=$form->get_anemia() separator=""}{xl t="F/H Blood Problems"}:{html_radios name="fh_blood_problems" options=$form->get_options() selected=$form->get_fh_blood_problems() separator=""}{xl t="Bleeding Problems"}:{html_radios name="bleeding_problems" options=$form->get_options() selected=$form->get_bleeding_problems() separator=""}
{xl t="Allergies"}:{html_radios name="allergies" options=$form->get_options() selected=$form->get_allergies() separator=""}{xl t="Frequent Illness"}:{html_radios name="frequent_illness" options=$form->get_options() selected=$form->get_frequent_illness() separator=""}{xl t="HIV"}:{html_radios name="hiv" options=$form->get_options() selected=$form->get_hiv() separator=""}
{xl t="HAI Status"}:{html_radios name="hai_status" options=$form->get_options() selected=$form->get_hai_status() separator=""}
+
+ + + + +
+ + + -- 2.11.4.GIT