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ESH/probationers_pdf.php

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first commit
2024-10-23 18:28:06 +05:30
<html>
<head>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script>
<div id="opd_form_div" style="display:none">
<form id="opd_form" name="opd_form">
<?php
//include autoloader;
include('includes/config/config.php');
include('log_entry.php');
include_once("includes/functions.php");
$checkup_id = $_REQUEST['checkup_id'];
$sql_employee_appointment = "SELECT * FROM checkup_form WHERE checkup_id ='" . $checkup_id . "'";
error_log("get_data:" . $sql_employee_appointment);
$res_emp_appoint = mysqli_query($conn, $sql_employee_appointment);
error_log($res_emp_appoint."eroorrrrrrrrrrrrrr");
$rows_emp_appoint = mysqli_fetch_array($res_emp_appoint);
@extract($rows_emp_appoint);
$patient_name = getFieldFromTable('patient_name', 'patient_master', 'id', $emp_id);
$gender = getFieldFromTable('gender', 'patient_master', 'id', $emp_id);
$dob = getFieldFromTable('dob', 'patient_master', 'id', $emp_id);
$c = date('Y');
$y = date('Y', strtotime($dob));
$age = $c - $y;
$checkup_date_date = date_format(date_create($checkup_date), "d-M-Y");
$sql_employee_key = "SELECT * FROM checkup_form_key_value WHERE checkup_form_id ='" . $checkup_id . "'";
error_log("get_data_key:" . $sql_employee_key);
$res_data_key = mysqli_query($conn, $sql_employee_key);
while ($rows_exa_key = mysqli_fetch_array($res_data_key)) {
if ($rows_exa_key['checkup_form_key'] == 'smoking_3') {
$smoking_3 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'others_2') {
$others_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'alcohol_4') {
$alcohol_4 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'tobacco_chewing_2') {
$tobacco_chewing_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'others_8') {
$others_8 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'diet_1') {
$diet_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'marital_status_3') {
$marital_status_3 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'no_of_children_male_2') {
$no_of_children_male_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'no_of_children_female_2') {
$no_of_children_female_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'f_p_history') {
$f_p_history = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'bronchial_asthma_1') {
$bronchial_asthma_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'jaundice') {
$jaundice = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'reccurent_ear_nose_throat_problem') {
$reccurent_ear_nose_throat_problem = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'arthritis_joint_pain') {
$arthritis_joint_pain = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_allergy_eosinophilia') {
$any_allergy_eosinophilia = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'tuberculosis_1') {
$tuberculosis_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'diabetes_2') {
$diabetes_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'kidney_urinary_tract_diseases') {
$kidney_urinary_tract_diseases = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'high_blood_pressure') {
$high_blood_pressure = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_skin_disease') {
$any_skin_disease = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'heart_disease_2') {
$heart_disease_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'leprocy') {
$leprocy = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'epilepsy') {
$epilepsy = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_eye_disorder') {
$any_eye_disorder = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'chronic_dysentery') {
$chronic_dysentery = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_veneral_disease') {
$any_veneral_disease = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'impairment_of_hearing') {
$impairment_of_hearing = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_major_operation') {
$any_major_operation = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_eye_disorder') {
$any_eye_disorder = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_major_accident') {
$any_major_accident = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_other_disorder_specify') {
$any_other_disorder_specify = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_exposure_to_chemicals') {
$any_exposure_to_chemicals = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'diabetes_3') {
$diabetes_3 = getCommaSeperatedValuesForInClause("select parameter_value_name from checkup_parameter_value", "parameter_value_id", $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'heart_disease_3') {
$heart_disease_3 = getCommaSeperatedValuesForInClause("select parameter_value_name from checkup_parameter_value", "parameter_value_id", $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'hypertension') {
$hypertension = getCommaSeperatedValuesForInClause("select parameter_value_name from checkup_parameter_value", "parameter_value_id", $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'tuberculosis_2') {
$tuberculosis_2 = getCommaSeperatedValuesForInClause("select parameter_value_name from checkup_parameter_value", "parameter_value_id", $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'bronchial_asthma_2') {
$bronchial_asthma_2 = getCommaSeperatedValuesForInClause("select parameter_value_name from checkup_parameter_value", "parameter_value_id", $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'covid_19_vaccination_1st_dose_date') {
$covid_19_vaccination_1st_dose_date = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'covid_19_vaccination_2nd_dose_date') {
$covid_19_vaccination_2nd_dose_date = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'diabetes_2') {
$diabetes_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'heart_disease_3') {
$heart_disease_3 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'tuberculosis_1') {
$tuberculosis_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'comments') {
$comments = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'excessive_or_irregular_menstrual_period') {
$excessive_or_irregular_menstrual_period = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'lump_in_the_breast') {
$lump_in_the_breast = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_complications_during_pregnancy') {
$any_complications_during_pregnancy = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'gynaec_surgery') {
$gynaec_surgery = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'whether_on_oral_pills_cap_tab') {
$whether_on_oral_pills_cap_tab = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'hernia_2') {
$hernia_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'hydrocele_2') {
$hydrocele_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'bult_1') {
$bult_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'height_4') {
$height_4 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'since_11') {
$since_11 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'since_12') {
$since_12 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'since_13') {
$since_13 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'since_14') {
$since_14 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'since_15') {
$since_15 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'weight_8') {
$weight_8 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'ent') {
$ent = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'teeth_2') {
$teeth_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'tongue_2') {
$tongue_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'nails_2') {
$nails_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'deformities_1') {
$deformities_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'skin_3') {
$skin_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'conjuctiva_1') {
$conjuctiva_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'lymph_nodes_1') {
$lymph_nodes_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'smoking_remarks_3') {
$smoking_remarks_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'alcohol_remarks_3') {
$alcohol_remarks_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'tobacco_chewing_remarks_1') {
$tobacco_chewing_remarks_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'others_2') {
$others_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'bronchial_asthma_remarks') {
$bronchial_asthma_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'reccurent_ear_nose_and_throat_problem_remarks') {
$reccurent_ear_nose_and_throat_problem_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'diabetes_remarks') {
$diabetes_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_allergy_eosinophilia_remarks') {
$any_allergy_eosinophilia_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'high_blood_pressure_remarks') {
$high_blood_pressure_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'heart_disease_remarks') {
$heart_disease_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'epilepsy_remarks') {
$epilepsy_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'chronic_dysentery_remarks') {
$chronic_dysentery_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'jaundice_remarks') {
$jaundice_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'arthritis_joint_pain_remarks') {
$arthritis_joint_pain_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'tuberculosis_remarks') {
$tuberculosis_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'kidney_urinary_tract_diseases_remarks') {
$kidney_urinary_tract_diseases_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_skin_disease_remarks') {
$any_skin_disease_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'leprocy_remarks') {
$leprocy_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_mental_disorder_remarks') {
$any_mental_disorder_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_veneral_disease_remarks') {
$any_veneral_disease_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'impairment_of_hearing_remarks') {
$impairment_of_hearing_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_eye_disorder_remarks') {
$any_eye_disorder_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_other_disorder_specify_remarks') {
$any_other_disorder_specify_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_major_operation_remarks_1') {
$any_major_operation_remarks_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_accident_remarks_1') {
$any_accident_remarks_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_exposure_to_chemicals_remarks') {
$any_exposure_to_chemicals_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'lump_in_the_breast_remarks') {
$lump_in_the_breast_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'excessive_or_irregular_menstrual_period_remarks') {
$excessive_or_irregular_menstrual_period_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_complications_during_pregnancy_remarks') {
$any_complications_during_pregnancy_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'gynaec_surgery_remarks') {
$gynaec_surgery_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'oral_pills_cap_tab_remarks') {
$oral_pills_cap_tab_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'if_the_answer_is_yes_to_any_of_the_above_questions_please_give_details_regarding_nature_of_illness_d') {
$if_the_answer_is_yes_to_any_of_the_above_questions_please_give_details_regarding_nature_of_illness_d = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'liver_remarks') {
$liver_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'spleen_remarks') {
$spleen_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'ascitis_remarks') {
$ascitis_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_lumps_remarks') {
$any_lumps_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'higher_functions_remarks') {
$higher_functions_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'cranial_nerves_remarks') {
$cranial_nerves_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'sensory_system_remarks') {
$sensory_system_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'motor_functions_remarks') {
$motor_functions_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'reflexes_remarks') {
$reflexes_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'posture_remarks') {
$posture_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'gait_remarks') {
$gait_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'spine_remarks') {
$spine_remarks = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'thyroid_gland_1') {
$thyroid_gland_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'any_other_abnormalityes_3') {
$any_other_abnormalityes_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'eyes_external_examination') {
$eyes_external_examination = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'color_vision_1') {
$color_vision_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'distant_rt_uncorrected_2') {
$distant_rt_uncorrected_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'distant_lt_uncorrected_2') {
$distant_lt_uncorrected_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'near_rt_uncorrected_2') {
$near_rt_uncorrected_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'near_lt_uncorrected_2') {
$near_lt_uncorrected_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'distant_rt_corrected_2') {
$distant_rt_corrected_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'near_rt_corrected_3') {
$near_rt_corrected_3 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'near_lt_corrected_2') {
$near_lt_corrected_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'distant_lt_corrected_2') {
$distant_lt_corrected_2 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'near_rt_uncorrected_3') {
$near_rt_uncorrected_3 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'pulse_3') {
$pulse_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'blood_pressure_4') {
$blood_pressure_4 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'murmurs_2') {
$murmurs_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'heart_sound_3') {
$heart_sound_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'peripheral_pulsations') {
$peripheral_pulsations = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'liver') {
$liver = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'spleen') {
$spleen = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'ascitis') {
$ascitis = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'any_lumps') {
$any_lumps = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'trachea') {
$trachea = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'breath_sounds') {
$breath_sounds = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'abnormal_sounds') {
$abnormal_sounds = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'shape_of_chest') {
$shape_of_chest = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'chest_of_movements') {
$chest_of_movements = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'higher_functions') {
$higher_functions = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'cranial_nerves') {
$cranial_nerves = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'sensory_system') {
$sensory_system = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'motor_functions') {
$motor_functions = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'reflexes') {
$reflexes = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
}
if ($rows_exa_key['checkup_form_key'] == 'posture_3') {
$posture_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'gait') {
$gait = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'spine') {
$spine = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'sgpt_3') {
$sgpt_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'rbs_1') {
$rbs_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'ppbs_1') {
$ppbs_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'fasting_1') {
$fasting_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'serum_creatinine_3') {
$serum_creatinine_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'total_cholesterol_2') {
$total_cholesterol_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'x_ray_chest_pa_view_once_in_year') {
$x_ray_chest_pa_view_once_in_year = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'ecg_1') {
$ecg_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'fvc') {
$fvc = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'fvc_1') {
$fvc_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'fev_1') {
$fev_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'fvc_1x') {
$fvc_1x = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'fev_1_2') {
$fev_1_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'fev_1_fvc_1') {
$fev_1_fvc_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'fev_1_fvc') {
$fev_1_fvc = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'mmf_fef_25_75_1') {
$mmf_fef_25_75_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'mmf_fef_25_75') {
$mmf_fef_25_75 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'pefr_1') {
$pefr_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'pefr') {
$pefr = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_250') {
$frequency_250 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_500') {
$frequency_500 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_1k_1') {
$frequency_1k_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_2k_1') {
$frequency_2k_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_4k_1') {
$frequency_4k_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_4k_1') {
$frequency_4k_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_250_1') {
$frequency_250_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_500_1') {
$frequency_500_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_1k_2') {
$frequency_1k_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_2k_2') {
$frequency_2k_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_4k_2') {
$frequency_4k_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_4k_2') {
$frequency_4k_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_8k_2') {
$frequency_8k_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'frequency_8k_1') {
$frequency_8k_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'albumin') {
$albumin = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'sugar') {
$sugar = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'bile_salts') {
$bile_salts = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'bile_pigments') {
$bile_pigments = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'microscopy') {
$microscopy = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'haemoglobin_4') {
$haemoglobin_4 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'tlc_wbc_2') {
$tlc_wbc_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'polymorphs_1') {
$polymorphs_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'lymphocytes_5') {
$lymphocytes_5 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'eosinophil_4') {
$eosinophil_4 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'basophils_5') {
$basophils_5 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'crp_1') {
$crp_1 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'acetone') {
$acetone = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'monocyte_3') {
$monocyte_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'tlc_wbc_2') {
$tlc_wbc_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'blood_group') {
$blood_group = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'stool_r_m') {
$stool_r_m = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'cyst_3') {
$cyst_3 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'others_4') {
$others_4 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'history_of_illness') {
$history_of_illness = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'advice_remarks_2') {
$advice_remarks_2 = $rows_exa_key['checkup_form_value'];
}
if ($rows_exa_key['checkup_form_key'] == 'advice_remarks') {
$advice_remarks = $rows_exa_key['checkup_form_value'];
}
}
?>
<style>
div b {
text-transform: capitalize;
}
.tbl1 {
width: 100%;
}
th {
background-color: #e1e1e1;
font-size: 12px;
font-style: bold;
vertical-align: top;
}
td {
text-align: left;
font-size: 12px;
vertical-align: top;
}
h1 {
text-align: left;
font-size: 12px;
vertical-align: top;
}
.page-break {
page-break-before: always;
/* or use page-break-after: always; */
}
/* .tbl_tbl {
border: 1px solid black;
border-collapse: collapse;
} */
</style>
</head>
<?php
$queryc = "select * from company_profile ";
$resultc = mysqli_query($conn, $queryc);
$row_company = mysqli_fetch_array($resultc);
@extract($row_company);
?>
<table width="100%" cellspacing="0">
<tr>
<td width="20%">
<?php if (isset($row_company['company_logo']) && $row_company['company_logo'] != null) { ?>
<img src="data:<?php echo $row_company['image_type'] ?>;base64,<?php echo base64_encode($row_company['company_logo']) ?>" style="width: 100px; height: 60px; margin: 0px; padding: 0px;">
<?php } ?>
</td>
<td width="60%" align="center">
<div style="margin-left: 20px; margin-top: 5px; line-height: 1;">
<center style="font-size: 18px ; text-transform: capitalize;"><b>
<?php echo ($row_company['company_name']) ?>
<br> <span style="font-size: 15px; ;"><?php echo ($row_company['address']) ?></span>
<br>
</b>
</center>
</div>
</td>
<!-- <td width="20%" align="right">
<span style="color: #1f0981;"> DOM/OHC/PE/01
<br>Eff.Dt.:01-11-97
<br>Rev.No.: 00</span>
</td> -->
</tr>
<tr rowspan="2">
<td colspan="1"></td>
<td colspan="2"></td>
</tr>
<tr>
<td colspan="1"></td>
<td colspan="2"></td>
</tr>
<tr>
<td colspan="1"></td>
<td colspan="2"></td>
</tr>
</table>
<table style="width: 100%;">
<tr>
<td style="width: 50%;"><b>PRE-EMPLOYMENT MEDICAL <br> EXAMINATION RECORD FOR PROBATIONERS</b></td>
<td style="width: 30%;">SR. NO. <?php echo $ticket_no ?></td>
<td style="width: 20%;">DATE: <?php echo $checkup_date_date ?></td>
</tr>
</table>
<br>
<table border="1" width="100%" cellspacing="0">
<tr>
<td style="width: 60%;" colspan="5">NAME: <?php echo $patient_name; ?> </td>
<td style="width: 20%;" colspan="1">AGE: <?php echo $age ?></td>
<td style="width: 20%;" colspan="2">SEX: <?php if ($gender == 'M') {
echo 'MALE';
} else if ($gender == 'F') {
echo 'FEMALE';
} ?></td>
</tr>
<tr>
<td style="width: 100%; padding: 15px;" colspan="8">PRESENT HISTORY OF ILLNESS </td>
</tr>
<tr>
<td style="width: 33%; padding: 15px;" rowspan="2" colspan="2"><b>PERSONAL HABIT</b> <br>SMOKING: <u><?php echo $smoking_3 ?> </u><br>ALCOHOL: <u><?php echo $alcohol_4 ?></u><br>TOBACCO CHEWING: <u><?php echo $tobacco_chewing_2 ?></u><br> OTHER: <u><?php echo $others_2 ?></u><br>DIET:<u><?php echo $diet_1 ?></u> </td>
<td style="width: 33%; padding: 15px;" rowspan="2" colspan="3"><b>MARITAL STATUS:</b> <u><?php echo $marital_status_3 ?></u> </td>
<td style="width: 33%; padding: 15px;" colspan="3"><b>NO. OF CHILDREN</b> <br> MALE: <u><?php echo $no_of_children_male_2 ?></u> <br> FEMALE:<?php echo $no_of_children_female_2 ?> </td>
</tr>
<tr>
<td style="width: 33%; padding: 15px;" colspan="3"><b>F.P. HISTORY: </b> <br> <?php echo $f_p_history ?> </td>
</tr>
<tr>
<td style="width: 100%;" colspan="8"> <br> HAVE YOU SUFFERED OR ARE YOU SUFFERING FROM ANY OF THE ILLNESSES GIVEN BELOW. GIVE DETAILS IF ANSWER IS YES.</td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">DISEASE</td>
<td style="width: 15%;" colspan="1">YES</td>
<td style="width: 5%;" colspan="1">NO</td>
<td style="width: 40%;" colspan="2">DISEASE</td>
<td style="width: 15%;" colspan="1">YES</td>
<td style="width: 5%;" colspan="1">NO</td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">BRONCHIL ASTHMA</td>
<td style="width: 15%;" colspan="1"><?php if ($bronchial_asthma_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($bronchial_asthma_1 == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%;" colspan="2">JAUNDICE</td>
<td style="width: 15%;" colspan="1"><?php if ($jaundice == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($jaundice == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">RECURRENT EAR, NOSE, & THORAT PROBLEM</td>
<td style="width: 15%;" colspan="1"><?php if ($reccurent_ear_nose_throat_problem == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($reccurent_ear_nose_throat_problem == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%;" colspan="2">ARTHRITIS/JOINT PAIN</td>
<td style="width: 15%;" colspan="1"><?php if ($arthritis_joint_pain == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($arthritis_joint_pain == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">ANY ALLERGY/EOSINOPHILIA
</td>
<td style="width: 15%;" colspan="1"><?php if ($any_allergy_eosinophilia == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($any_allergy_eosinophilia == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%;" colspan="2">TUBERCULOSIS</td>
<td style="width: 15%;" colspan="1"><?php if ($tuberculosis_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?> </td>
<td style="width: 5%;" colspan="1"><?php if ($tuberculosis_1 == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?> </td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">DIABETES
</td>
<td style="width: 15%;" colspan="1"><?php if ($diabetes_2 == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($diabetes_2 == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%;" colspan="2">KIDNEY/URINARY TRACT DISEASES</td>
<td style="width: 15%;" colspan="1"><?php if ($kidney_urinary_tract_diseases == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($kidney_urinary_tract_diseases == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">HIGH BLOOD PRESSURE
</td>
<td style="width: 15%;" colspan="1"><?php if ($high_blood_pressure == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($high_blood_pressure == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%;" colspan="2">ANY SKIN DISEASE</td>
<td style="width: 15%;" colspan="1"><?php if ($any_skin_disease == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($any_skin_disease == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">HEART DISEASE
</td>
<td style="width: 15%;" colspan="1"><?php if ($heart_disease_2 == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($heart_disease_2 == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%;" colspan="2">LEPROSY</td>
<td style="width: 15%;" colspan="1"><?php if ($leprocy == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($leprocy == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">EPILEPSY</td>
<td style="width: 15%;" colspan="1"><?php if ($epilepsy == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($epilepsy == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%;" colspan="2">ANY MENTAL DISORDER</td>
<td style="width: 15%;" colspan="1"><?php if ($comments == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($comments == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">CHRONIC DYSENTERY</td>
<td style="width: 15%;" colspan="1"><?php if ($chronic_dysentery == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($chronic_dysentery == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%;" colspan="2">ANY VENEREAL DISEASE</td>
<td style="width: 15%;" colspan="1"><?php if ($chronic_dysentery == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($chronic_dysentery == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%;" colspan="4">AT PRESENT ARE YOU SUFFERING FROM ANY OF CONDITIONS GIVEN BELOW GIVE DETAILS IF ANSWER IS YES</td>
<!-- <td style="width: 10%;" colspan="1"></td> -->
<!-- <td style="width: 10%;" colspan="1"></td> -->
<td style="width: 40%;" colspan="4">IS THEREANY HISTORY OF FOLLOWING THINGS IF YES, GIVE DETAILS</td>
<!-- <td style="width: 10%;" colspan="1"></td> -->
<!-- <td style="width: 10%;" colspan="1"></td> -->
</tr>
<tr>
<td style="width: 40%;" colspan="2">IMPAIRMENT OF HEARING</td>
<td style="width: 15%;" colspan="1"><?php if ($impairment_of_hearing == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($impairment_of_hearing == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%;" colspan="2">ANY MAJOR OPERATION</td>
<td style="width: 15%;" colspan="1"><?php if ($any_major_operation == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($any_major_operation == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">ANY EYE DISORDER</td>
<td style="width: 15%;" colspan="1"></td>
<td style="width: 5%;" colspan="1"></td>
<td style="width: 40%;" colspan="2">ANY ACCIDENT</td>
<td style="width: 15%;" colspan="1"><?php if ($any_major_accident == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($any_major_accident == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">ANY OTHER DISORDER (SPECIFY)</td>
<td style="width: 15%;" colspan="1"><?php if ($any_other_disorder_specify == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($any_other_disorder_specify == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%;" colspan="2">ANY EXPOSURE TO CHEMICALS</td>
<td style="width: 15%;" colspan="1"><?php if ($any_exposure_to_chemicals == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 5%;" colspan="1"><?php if ($tuberculosis_1 == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%;" colspan="2">COVID-19</td>
<td style="width: 15%;" colspan="1"></td>
<td style="width: 5%;" colspan="1"></td>
<td style="width: 40%;" colspan="2">VACCINATION</td>
<td style="width: 15%;" colspan="1"></td>
<td style="width: 5%;" colspan="1"></td>
</tr>
<tr>
<td style="width: 40%;" rowspan="2" colspan="2">DATE</td>
<td style="width: 15%;" rowspan="2" colspan="2"></td>
<td style="width: 40%;" colspan="1">1st DOSE</td>
<td style="width: 40%;" colspan="1">2st DOSE</td>
<td style="width: 10%;" rowspan="2" colspan="1"></td>
<td style="width: 10%;" rowspan="2" colspan="1"></td>
</tr>
<tr>
<td style="width: 40%;" colspan="1"><?php echo $covid_19_vaccination_1st_dose_date ?></td>
<td style="width: 40%;" colspan="1"><?php echo $covid_19_vaccination_2nd_dose_date ?></td>
</tr>
</table>
<br>
<div class="page-break"></div>
<table style="width: 100%;">
<tr>
<td style="text-align: left;">HAS ANY ONE IN YOUR FAMILY SUFFERED/SUFFERING FROM THE DISEASES GIVEN BELOW</td>
<td style="text-align: right;">GIVE DETAILS IF YES</td>
</tr>
</table>
<table border="1" width="100%" cellspacing="0">
<tr>
<td style="width: 40%; padding: 20px; ">DISEASE</td>
<td style="width: 10%; padding: 20px;">YES</td>
<td style="width: 10%; padding: 20px;">NO</td>
<td style="width: 40%; padding: 20px;">DISEASE</td>
<td style="width: 10%; padding: 20px;">YES</td>
<td style="width: 10%; padding: 20px;">NO</td>
</tr>
<tr>
<td style="width: 40%; padding: 20px;">DIABETES</td>
<td style="width: 10%; padding: 20px;"><?php if ($diabetes_2 == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 10%; padding: 20px;"><?php if ($diabetes_2 == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%; padding: 20px;">HEART DISEASE</td>
<td style="width: 10%; padding: 20px;"><?php if ($heart_disease_2 == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 10%; padding: 20px;"><?php if ($heart_disease_2 == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%; padding: 20px;">HYPERTENSION</td>
<td style="width: 10%; padding: 20px;"><?php if (false) { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 10%; padding: 20px;"><?php if (false) { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%; padding: 20px;">TUBERCULOSIS</td>
<td style="width: 10%; padding: 20px;"><?php if ($tuberculosis_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 10%; padding: 20px;"><?php if ($tuberculosis_1 == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%; padding: 20px;">BRONCHIAL ASTHAMA</td>
<td style="width: 10%; padding: 20px;"><?php if ($bronchial_asthma_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 10%; padding: 20px;"><?php if ($bronchial_asthma_1 == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%; padding: 20px;"></td>
<td style="width: 10%; padding: 20px;"></td>
<td style="width: 10%; padding: 20px;"></td>
</tr>
</table>
<table style="width: 100%;">
<tr>
<td style="text-align: left;">FOR FEMALE CANDIDATES ONLY</td>
</tr>
</table>
<table border="1" width="100%" cellspacing="0">
<tr>
<td style="width: 40%; padding: 20px;"></td>
<td style="width: 10%; padding: 20px;">YES</td>
<td style="width: 10%; padding: 20px;">NO</td>
<td style="width: 40%; padding: 20px;"></td>
<td style="width: 10%; padding: 20px;">YES</td>
<td style="width: 10%; padding: 20px;">NO</td>
</tr>
<tr>
<td style="width: 40%; padding: 20px;">EXCESSIVE OR IRREGULAR MENSTRUAL PERIODS</td>
<td style="width: 10%; padding: 20px;"><?php if ($excessive_or_irregular_menstrual_period == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 10%; padding: 20px;"><?php if ($excessive_or_irregular_menstrual_period == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%; padding: 20px;">LUMP IN THE BREAST</td>
<td style="width: 10%; padding: 20px;"><?php if ($lump_in_the_breast == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 10%; padding: 20px;"><?php if ($lump_in_the_breast == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%; padding: 20px;">ANY COMPLICATIONS DURING PREGNANCY</td>
<td style="width: 10%; padding: 20px;"><?php if ($any_complications_during_pregnancy == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 10%; padding: 20px;"><?php if ($any_complications_during_pregnancy == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 40%; padding: 20px;">GYNAEC SURGERY</td>
<td style="width: 10%; padding: 20px;"><?php if ($gynaec_surgery == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 10%; padding: 20px;"><?php if ($gynaec_surgery == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
<tr>
<td style="width: 40%; padding: 20px;"></td>
<td style="width: 10%; padding: 20px;"></td>
<td style="width: 10%; padding: 20px;"></td>
<td style="width: 40%; padding: 20px;">WHETHER ON ORAL PILLS/cu-T</td>
<td style="width: 10%; padding: 20px;" <?php if ($whether_on_oral_pills_cap_tab == 'Yes') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
<td style="width: 10%; padding: 20px;"><?php if ($whether_on_oral_pills_cap_tab == 'No') { ?> <input checked type="checkbox" name="" id=""> <?php } ?></td>
</tr>
</table>
<br><br>
<table border="1" width="100%" cellspacing="0">
<tr>
<td style="width: 100%; height: 200px;">IF THE ANSWER IS "YES" TO ANY OF THE ABOVE QUESTIONS, PLEASE GIVE DETAILS REGARDING NATURE OF ILLNESS DURATION AND YEAR OF OCCURANCE</td>
</tr>
</table>
<br>
<table border="1" width="100%" cellspacing="0">
<tr>
<td style="width: 100%; height: 100px;"><b>DECLARATION BY THE CANDIDATE</b>
<br>I DECLARE THAT THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
<br><br>
I CERTIFY THAT I HAVE NOT RECEIVED A DISABILITY CERTIFICATE/ PENSION OR COMPENSATION ON ACCOUNT OF ANY DISEASE OR OTHER CONDITION.
<br><br>
Date:
<br><br>
<span style="text-align: right;">SIGNATURE OF CANDIDATE</span>
</td>
</tr>
</table>
<div class="page-break"></div>
<h2 style="font-size: 12px;"><b>3. GENERAL EXAMINATION:</b></h2>
<table border="1" width="100%" cellspacing="0">
<tr>
<td style="width:20%;">HEIGHT: <u><?php echo $height_4 ?> cms</u></td>
<td style="width:20%;">WEIGHT: <u><?php echo $weight_8 ?> kg</u></td>
<td style="width:60%;" colspan="5">BUILT: <u><?php echo $bult_1 ?></u></td>
</tr>
<tr>
<td style="width:20%;">ENT: <u><?php echo $ent ?> </u></td>
<td style="width:20%;">TEETH: <u><?php echo $teeth_2 ?></u></td>
<td style="width:20%;">TONGUE: <u><?php echo $tongue_2 ?></u></td>
<td style="width:20%;" colspan="2">NAILS: <u><?php echo $nails_2 ?></u></td>
<td style="width:20%;" colspan="2">DEFORMITIES: <u><?php echo $deformities_1 ?></u></td>
</tr>
<tr>
<td style="width:20%;">CONJUNCTIVA: <u><?php echo $conjuctiva_1 ?> </u></td>
<td style="width:20%;">SKIN: <u><?php echo $skin_3 ?></u></td>
<td style="width:20%;">LYMPH NODES: <u><?php echo $lymph_nodes_1 ?></u></td>
<td style="width:20%;" colspan="2">THYROID GLAND: <u><?php echo $thyroid_gland_1 ?></u></td>
<td style="width:20%;" colspan="2">ANY OTHER ABNORMALITIES: <u><?php echo $any_other_abnormalityes_3 ?></u></td>
</tr>
<tr>
<td style="width:40%; padding: 10px;" colspan="2" rowspan="4">EYES <br><br>EXTERNAL EXAMINATION: <?php echo $eyes_external_examination ?> <br><br>COLOUR VISION: <?php echo $color_vision_1 ?></td>
<td style="width:20%;" rowspan="2">VISION</td>
<td style="width:20%;" colspan="2">DISTANT</td>
<td style="width:10%;" colspan="2">NEAR</td>
</tr>
<tr>
<td>R</td>
<td>L</td>
<td>R</td>
<td>L</td>
</tr>
<tr>
<td>UNCORRECTED</td>
<td> <?php echo $distant_rt_uncorrected_2 ?></td>
<td> <?php echo $near_lt_uncorrected_2 ?></td>
<td> <?php echo $near_rt_uncorrected_2 ?></td>
<td> <?php echo $distant_lt_uncorrected_2 ?></td>
</tr>
<tr>
<td>CORRECTED</td>
<td> <?php echo $distant_rt_corrected_2 ?></td>
<td> <?php echo $near_lt_corrected_2 ?></td>
<td> <?php echo $near_rt_corrected_3 ?></td>
<td> <?php echo $distant_lt_corrected_2 ?></td>
</tr>
<tr>
<td style="width:20%;" colspan="2">GENITO-URINARY SYSTEM </td>
<td style="width:80%;" colspan="5">HERNIA: <?php echo $hernia_2 ?><br>HYDROCELE: <?php echo $hydrocele_2 ?></td>
</tr>
</table>
<br><br>
<table border="1" width="100%" cellspacing="0">
<tr>
<td style="width: 40%;">DISEASE</td>
<td style="width: 20%;">RESULT</td>
<td style="width: 40%;">REMARKS</td>
</tr>
<tr>
<td style="width: 40%;"><b>ABDOMEN</b></td>
<td style="width: 20%;"></td>
<td style="width: 40%;"></td>
</tr>
<tr>
<td style="width: 40%;">LIVER</td>
<td style="width: 20%;"><?php echo $liver; ?></td>
<td style="width: 40%;"><?php echo $liver_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;">SPLEEN</td>
<td style="width: 20%;"><?php echo $spleen; ?></td>
<td style="width: 40%;"><?php echo $spleen_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;">ASCITIS</td>
<td style="width: 20%;"><?php echo $ascitis; ?></td>
<td style="width: 40%;"><?php echo $ascitis_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;">ANY LUMPS</td>
<td style="width: 20%;"><?php echo $any_lumps; ?></td>
<td style="width: 40%;"><?php echo $any_lumps_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;"><b>CENTRAL NERVOUS SYSTEM</b></td>
<td style="width: 20%;"></td>
<td style="width: 40%;"></td>
</tr>
<tr>
<td style="width: 40%;">HIGHER FUNCTIONS</td>
<td style="width: 20%;"><?php echo $higher_functions; ?></td>
<td style="width: 40%;"><?php echo $higher_functions_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;">CRANIAL NERVES</td>
<td style="width: 20%;"><?php echo $cranial_nerves; ?></td>
<td style="width: 40%;"><?php echo $cranial_nerves_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;">SENSORY SYSTEM</td>
<td style="width: 20%;"><?php echo $sensory_system; ?></td>
<td style="width: 40%;"><?php echo $sensory_system_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;">MOTOR FUNCTIONS</td>
<td style="width: 20%;"><?php echo $motor_functions; ?></td>
<td style="width: 40%;"><?php echo $motor_functions_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;">REFLEXES</td>
<td style="width: 20%;"><?php echo $reflexes; ?></td>
<td style="width: 40%;"><?php echo $reflexes_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;"><b>LOCOMOTOR SYSTEM</b></td>
<td style="width: 20%;"></td>
<td style="width: 40%;"></td>
</tr>
<tr>
<td style="width: 40%;">POSTURE</td>
<td style="width: 20%;"><?php echo $posture_3; ?></td>
<td style="width: 40%;"><?php echo $posture_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;">GAIT</td>
<td style="width: 20%;"><?php echo $gait; ?></td>
<td style="width: 40%;"><?php echo $gait_remarks ?></td>
</tr>
<tr>
<td style="width: 40%;">SPINE</td>
<td style="width: 20%;"><?php echo $spine; ?></td>
<td style="width: 40%;"><?php echo $spine_remarks ?></td>
</tr>
</table>
<br>
<table border="1" width="100%" cellspacing="0">
<tr>
<td style="width: 50%;"> <b> CARDIO VASCULAR SYSTEM:<?php ?> </b> <br>PULSE: <u><?php echo $pulse_3; ?> /min</u> <br>BLOOD PRESSURE: <u><?php echo $blood_pressure_4 ?> mm Hg</u> <br>HEART SOUNDS: <u><?php echo $heart_sound_3 ?></u> <br>MURMURS: <u><?php echo $murmurs_2 ?></u> <br>PERIPHERAL PULSATIONS: <u><?php echo $peripheral_pulsations ?></u></td>
<td style="width: 50%;"> <b>RESPIRATORY SYSTEM</b> <br>SHAPE OF CHEST: <u><?php echo $shape_of_chest ?></u> <br> CHEST MOVEMENTS: <u><?php echo $chest_of_movements ?></u> <br>TRACHEA: <u><?php echo $trachea ?></u> <br>BREATH SOUNDS: <u><?php echo $breath_sounds ?></u> <br>ABNORMAL SOUNDS: <u><?php echo $abnormal_sounds ?></u> </td>
</tr>
<!-- <tr>
<td style="width: 50%;"> <b>RESPIRATORY SYSTEM</b> <br>SHAPE OF CHEST: <u><?php echo $shape_of_chest ?></u> <br> CHEST MOVEMENTS: <u><?php echo $chest_of_movements ?></u> <br>TRACHEA: <u><?php echo $trachea ?></u> <br>BREATH SOUNDS: <u><?php echo $breath_sounds ?></u> <br>ABNORMAL SOUNDS: <u><?php echo $abnormal_sounds ?></u> </td>
<td style="width: 50%;"> <b>CENTRAL NERVOUS SYSTEM</b> <br> HIGHER FUNCTIONS: <u><?php echo $higher_functions ?></u> <br> CRANIAL NERVES: <u><?php echo $cranial_nerves ?></u> <br> SENSORY SYSTEM <u><?php echo $sensory_system ?></u><br> MOTOR FUNCTIONS: <u><?php echo $motor_functions ?></u> <br> REFLEXES: <u><?php echo $reflexes ?></u> </td>
</tr>
<tr>
<td style="width: 100%;" colspan="2"> <b>LOCOMOTOR SYSTEM</b> <br> POSTURE: <u><?php echo $posture_3 ?></u> <br> GAIT: <u><?php echo $gait ?></u> <br>SPINE: <u><?php echo $spine ?></u> </td>
</tr> -->
</table><br>
<h2 style="font-size: 12px;"><b>INVESTIGATIONS</b></h2>
<table border="1" width="92%" cellspacing="0">
<tr>
<td rowspan="2" style="width: 25%; padding: 15px;">URINE EXAM</td>
<td colspan="3" style="width: 25%; padding: 15px;">ALBUMIN: <?php echo $albumin ?></td>
<td colspan="3" style="width: 25%; padding: 15px;">SUGAR: <?php echo $sugar ?></td>
<td colspan="2" style="width: 25%; padding: 15px;">ACETONE: <?php echo $acetone ?></td>
</tr>
<tr>
<td colspan="3" style="width: 25%; padding: 15px;">BILE SALTS: <?php echo $bile_salts ?></td>
<td colspan="3" style="width: 25%; padding: 15px;">BILE PIGMENT: <?php echo $bile_pigments ?></td>
<td colspan="2" style="width: 25%; padding: 15px;">MICROSCOPY: <?php echo $microscopy ?></td>
</tr>
<tr>
<td rowspan="3" style="width: 25%; padding: 15px;">HAEMOGRAM</td>
<td colspan="2" style="width: 37%; padding: 15px;">Hb: <?php echo $haemoglobin_4 ?> g/dL</td>
<td colspan="6" style="width: 37%; padding: 15px;"></td>
</tr>
<tr>
<td colspan="2" rowspan="2" style="width: 37%; padding: 10px;">TLC: <?php echo $tlc_wbc_2 ?> cumm</td>
<td rowspan="2" style="width: 15%; padding: 10px;">DLC</td>
<td style="width: 4%;">P:</td>
<td style="width: 4%;">L</td>
<td style="width: 4%;">E</td>
<td style="width: 4%;">M</td>
<td style="width: 4%;">B</td>
</tr>
<tr>
<td style="width: 4%;"><?php echo $polymorphs_1 ?> %</td>
<td style="width: 4%;"><?php echo $lymphocytes_5 ?> %</td>
<td style="width: 4%;"><?php echo $eosinophil_4 ?> %</td>
<td style="width: 4%;"><?php echo $monocyte_3 ?> %</td>
<td style="width: 4%;"><?php echo $basophils_5 ?> %</td>
</tr>
<tr>
<td colspan="9" style="width: 37%; padding: 20px;">CRP: <?php echo $crp_1 ?> mg/dL</td>
</tr>
<tr>
<td style="width: 25%;">BLOOD GROUP</td>
<td colspan="8" style="width: 75%;"><?php echo $blood_group ?></td>
</tr>
<tr>
<td rowspan="4" style="width: 25%;">BIOCHEMICAL</td>
<td colspan="8" style="width: 25%;">BLOOD SUGAR</td>
</tr>
<tr>
<td colspan="2" style="width: 25%;">F : <?php echo $fasting_1 ?> mg/dL</td>
<td colspan="2" style="width: 25%;">PP/PG: <?php echo $ppbs_1 ?> mg/dL</td>
<td colspan="4" style="width: 25%;">RANDOM: <?php echo $rbs_1 ?> mg/dL</td>
</tr>
<tr>
<td colspan="3" style="width: 25%;">SGPT: <?php echo $sgpt_3 ?> U/L</td>
<td colspan="5" style="width: 25%;">SERUM CREATININE: <?php echo $serum_creatinine_3 ?> mg/dL</td>
</tr>
<tr>
<td colspan="3" style="width: 25%;">SERUM CHOLESTEROL: <?php echo $total_cholesterol_2 ?> mg/dL</td>
<td colspan="5" style="width: 75%;">OTHERS: <?php echo $others_8 ?></td>
</tr>
<tr>
<td style="width: 25%; padding: 20px;">STOOL EXAM</td>
<td colspan="2" style="width: 25%; padding: 20px;">OVA: <?php echo $stool_r_m ?></td>
<td colspan="3" style="width: 25%; padding: 20px;">CYST: <?php echo $cyst_3 ?></td>
<td colspan="3" style="width: 25%; padding: 20px;">OTHERS: <?php echo $others_4 ?></td>
</tr>
<tr>
<td style="width: 25%; padding: 10px;">X-RAY CHEST</td>
<td colspan="4" style="width: 75%; padding: 10px;"><?php echo $x_ray_chest_pa_view_once_in_year ?></td>
<td colspan="4" style="width: 75%; padding: 10px;"><?php echo $advice_remarks ?></td>
</tr>
<tr>
<td style="width: 25%; padding: 10px;">ECG</td>
<td colspan="4" style="width: 75%; padding: 10px;"><?php echo $ecg_1 ?></td>
<td colspan="4" style="width: 75%; padding: 10px;"><?php echo $advice_remarks_2 ?></td>
</tr>
<tr>
<td rowspan="6" style="width: 25%; padding: 10px;">PULMONARY FUNCTION TEST</td>
<td style="width: 25%; padding: 10px;"></td>
<td style="width: 25%; padding: 10px;">MEASURED</td>
<td colspan="6" style="width: 25%; padding: 10px;">% OF PREDICTED</td>
</tr>
<tr>
<td style="width: 25%; padding: 10px;">FVC</td>
<td style="width: 25%; padding: 10px;"><?php echo $fvc ?></td>
<td colspan="6" style="width: 25%; padding: 10px;"><?php echo $fvc_1 ?></td>
</tr>
<tr>
<td style="width: 25%; padding: 10px;">FEV1</td>
<td style="width: 25%; padding: 10px;"><?php echo $fev_1 ?></td>
<td colspan="6" style="width: 25%; padding: 10px;"><?php echo $fev_1_2 ?></td>
</tr>
<tr>
<td style="width: 25%; padding: 10px;">FEV1/FVC</td>
<td style="width: 25%; padding: 10px;"><?php echo $fev_1_fvc ?></td>
<td colspan="6" style="width: 25%; padding: 10px;"><?php echo $fev_1_fvc_1 ?></td>
</tr>
<tr>
<td style="width: 25%; padding: 10px;">MMF (FEF 25% -75%)</td>
<td style="width: 25%; padding: 10px;"><?php echo $mmf_fef_25_75 ?></td>
<td colspan="6" style="width: 25%; padding: 10px;"><?php echo $mmf_fef_25_75_1 ?></td>
</tr>
<tr>
<td style="width: 25%; padding: 10px;">PEFR</td>
<td style="width: 25%; padding: 10px;"><?php echo $pefr ?></td>
<td colspan="6" style="width: 25%; padding: 10px;"><?php echo $pefr_1 ?></td>
</tr>
<tr>
<td rowspan="3" style="width: 25%;">AUDIOMETRY TEST</td>
<td rowspan="3" style="width: 25%;">RESULT</td>
<td style="width: 25%;">FREQUENCY</td>
<td style="width: 25%;">250</td>
<td style="width: 25%;">500</td>
<td style="width: 25%;">1K</td>
<td style="width: 25%;">2K</td>
<td style="width: 25%;">3K</td>
<td style="width: 25%;">4K</td>
</tr>
<tr>
<td style="width: 25%;">LEFT EAR</td>
<td style="width: 25%;"><?php echo $frequency_250 ?> </td>
<td style="width: 25%;"><?php echo $frequency_500 ?> </td>
<td style="width: 25%;"><?php echo $frequency_1k_1 ?></td>
<td style="width: 25%;"><?php echo $frequency_2k_1 ?></td>
<td style="width: 25%;"><?php echo $frequency_4k_1 ?></td>
<td style="width: 25%;"><?php echo $frequency_8k_1 ?></td>
</tr>
<td style="width: 25%;">RIGHT EAR</td>
<td style="width: 25%;"><?php echo $frequency_250_1 ?> </td>
<td style="width: 25%;"><?php echo $frequency_500_1 ?> </td>
<td style="width: 25%;"><?php echo $frequency_1k_2 ?></td>
<td style="width: 25%;"><?php echo $frequency_2k_2 ?></td>
<td style="width: 25%;"><?php echo $frequency_4k_2 ?></td>
<td style="width: 25%;"><?php echo $frequency_8k_2 ?></td>
</tr>
<tr>
<td style="width: 25%; padding: 30px;"><b>REMARKS</b></td>
<?php if ($fit_unfit_status == 'fit') {
$status = 'Fit';
} else if ($fit_unfit_status == 'ufit') {
$status = 'Unfit';
} ?>
<td colspan="8" style="width: 75%; padding: 30px;">Medically <?php echo $status; ?></td>
</tr>
</table>
<?php
$query = "select e.emp_sign,e.image_type from employee_signature e left join checkup_form b on e.emp_id = b.doc_attend where b.checkup_id ='" . $checkup_id . "'";
// error_log("Signatures :" . $query);
$result1 = mysqli_query($conn, $query);
$sign_row = mysqli_fetch_array($result1);
extract($sign_row);
?>
<table style="width: 100%;">
<tr>
<td style="width: 80%;"></td>
<td style="width: 20%; align-items: end;"><img id='sign' style="text-align:center; width:150px; height:80px;" class="card-img-bottm" src="data:<?= $sign_row['image_type']; ?>;base64,<?= base64_encode($sign_row['emp_sign']) ?>"><br></td>
</tr>
</table>
<table style="width: 100%;">
<tr>
<td style="text-align: right;">Factory Medical Officer
</td>
</tr>
</table>
</form>
<form id="employeeDetailsFormPdf" action="" method="POST">
<input type="hidden" name="htmlText" id="htmlText" />
</form>
</div>
<script>
formSubmit();
function formSubmit() {
$("#htmlText").val($("#opd_form").html());
document.forms['employeeDetailsFormPdf'].action = "pdf_dynamic.php";
document.forms['employeeDetailsFormPdf'].method = "post";
document.forms['employeeDetailsFormPdf'].submit();
}
</script>
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