1044 lines
42 KiB
PHP
1044 lines
42 KiB
PHP
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<html>
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<head>
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<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script>
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<div id="opd_form_div" style="display:none">
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<form id="opd_form" name="opd_form">
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<?php
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//include autoloader;
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include('includes/config/config.php');
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include_once("includes/functions.php");
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?>
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<style>
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div b {
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text-transform: capitalize;
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}
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.tbl1 {
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width: 100%;
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}
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th {
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background-color: #e1e1e1;
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font-size: 12px;
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font-style: bold;
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vertical-align: top;
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}
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td {
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text-align: left;
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font-size: 12px;
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vertical-align: top;
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}
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h1 {
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text-align: left;
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font-size: 12px;
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vertical-align: top;
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}
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.page-break {
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page-break-before: always;
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/* or use page-break-after: always; */
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}
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/* .tbl_tbl {
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border: 1px solid black;
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border-collapse: collapse;
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} */
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</style>
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</head>
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<?php
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$queryc = "select * from company_profile ";
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$resultc = mysqli_query($conn, $queryc);
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$row_company = mysqli_fetch_array($resultc);
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@extract($row_company);
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?>
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<table width="100%" cellspacing="0">
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<tr>
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<td width="20%">
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<?php if (isset($row_company['company_logo']) && $row_company['company_logo'] != null) { ?>
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<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;">
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<?php } ?>
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</td>
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<td width="60%" align="center">
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<div style="margin-left: 20px; margin-top: 5px; line-height: 1;">
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<center style="font-size: 18px ; text-transform: capitalize;"><b>
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<?php echo ($row_company['company_name']) ?>
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<br>
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<br> <span style="font-size: 12px;"> <?php echo ($row_company['address']) ?>
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<br>MEDICAL CENTRE</span>
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</b>
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</center>
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</div>
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</td>
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<td width="20%" align="right">
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</td>
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</tr>
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<tr rowspan="2">
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<td colspan="1"></td>
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<td colspan="2"></td>
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</tr>
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<tr>
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<td colspan="1"></td>
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<td colspan="2"></td>
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</tr>
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<tr>
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<td colspan="1"></td>
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<td colspan="2"></td>
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</tr>
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</table>
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<h4>
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<center>PRE - EMPLOYMENT MEDICAL EXAMINATION FORM FOR DRIVER</center>
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</h4>
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<?php
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$checkup_id = $_REQUEST['checkup_id'];
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$sql_employee_key = "SELECT * FROM checkup_form_key_value WHERE checkup_form_id ='" . $checkup_id . "'";
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error_log("get_data_key:" . $sql_employee_key);
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$res_data_key = mysqli_query($conn, $sql_employee_key);
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while ($rows_exa_key = mysqli_fetch_array($res_data_key)) {
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if ($rows_exa_key['checkup_form_key'] == 'smoking_1') {
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$smoking_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'alcohol_7') {
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$alcohol_7 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'tobacco_chewing_1') {
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$tobacco_chewing_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'drugs') {
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$drugs = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'diabetes_1') {
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$diabetes_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'seizure_disorder_epilepsy') {
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$seizure_disorder_epilepsy = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'high_blood_pressure_1') {
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$high_blood_pressure_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'head_injury_causing_symptom') {
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$head_injury_causing_symptom = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'brain_tumor') {
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$brain_tumor = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'shoulder_injury') {
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$shoulder_injury = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'muscle_disease') {
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$muscle_disease = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'asthma_lung_disorder') {
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$asthma_lung_disorder = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'heart_disease') {
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$heart_disease = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'heart_disease_1') {
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$heart_disease_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'paralysis_of_any_type') {
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$paralysis_of_any_type = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'loss_of_vision') {
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$loss_of_vision = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'loss_of_hearing_deafness') {
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$loss_of_hearing_deafness = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'tuberculosis') {
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$tuberculosis = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'vertigo') {
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$vertigo = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'tinitus') {
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$tinitus = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'h_o_unconsciousness') {
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$h_o_unconsciousness = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'mental_illness') {
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$mental_illness = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'others_1') {
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$others_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'h_o_of_major_illness') {
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$h_o_of_major_illness = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'h_o_of_any_major_operation') {
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$h_o_of_any_major_operation = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'h_o_of_any_deformity') {
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$h_o_of_any_deformity = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'h_o_of_any_accident') {
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$h_o_of_any_accident = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'urine_abnormality_remarks') {
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$urine_abnormality_remarks = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'abnormality_remarks') {
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$abnormality_remarks = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'night_blindness_remarks') {
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$night_blindness_remarks = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'if_the_answer_is_yes_give_details_1') {
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$if_the_answer_is_yes_give_details_1 = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'if_the_answer_is_yes_give_details_2') {
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$if_the_answer_is_yes_give_details_2 = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'if_the_answer_is_yes_give_details_3 ') {
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$if_the_answer_is_yes_give_details_3 = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'height') {
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$height = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 's1_s2') {
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$s1_s2 = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'murmurs_1') {
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$murmurs_1 = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'resp_sys') {
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$resp_sys = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'weight_9') {
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$weight_9 = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'spo2') {
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$spo2 = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'blood_pressure_1') {
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$blood_pressure_1 = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'disadvantage_for_driving') {
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$disadvantage_for_driving = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'posture_deformity') {
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$posture_deformity = $rows_exa_key['checkup_form_value'];
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}
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if ($rows_exa_key['checkup_form_key'] == 'ent_1') {
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$ent_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'hearing_test') {
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$ent_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
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}
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if ($rows_exa_key['checkup_form_key'] == 'teeth_1') {
|
||
|
|
|
||
|
|
$teeth_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'tongue_1') {
|
||
|
|
|
||
|
|
$tongue_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'nails_1') {
|
||
|
|
|
||
|
|
$nails_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'skin_1') {
|
||
|
|
|
||
|
|
$skin_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'conversational_hearing_1') {
|
||
|
|
|
||
|
|
$conversational_hearing_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'night_blindness') {
|
||
|
|
|
||
|
|
$night_blindness = 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_1') {
|
||
|
|
|
||
|
|
$distant_lt_uncorrected_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_1') {
|
||
|
|
|
||
|
|
$distant_rt_uncorrected_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_corrected_1') {
|
||
|
|
|
||
|
|
$distant_rt_corrected_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_lt_corrected_1') {
|
||
|
|
|
||
|
|
$distant_lt_corrected_1 = 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_1') {
|
||
|
|
|
||
|
|
$near_lt_corrected_1 = 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_1') {
|
||
|
|
|
||
|
|
$near_lt_corrected_1 = 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_1') {
|
||
|
|
|
||
|
|
$near_rt_uncorrected_1 = 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_1') {
|
||
|
|
|
||
|
|
$near_lt_uncorrected_1 = 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_1') {
|
||
|
|
|
||
|
|
$near_rt_corrected_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'colour_vision_by_ishihara_chart') {
|
||
|
|
|
||
|
|
$colour_vision_by_ishihara_chart = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'pulse_9') {
|
||
|
|
|
||
|
|
$pulse_9 = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'abdomen') {
|
||
|
|
|
||
|
|
$abdomen = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'hernia') {
|
||
|
|
|
||
|
|
$hernia = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'hydrocele') {
|
||
|
|
|
||
|
|
$hydrocele = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'varicocele_1') {
|
||
|
|
|
||
|
|
$varicocele_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'tandem_walking') {
|
||
|
|
|
||
|
|
$tandem_walking = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'finger_nose_test') {
|
||
|
|
|
||
|
|
$finger_nose_test = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'extremities') {
|
||
|
|
|
||
|
|
$extremities = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'rom_at_limb_joints') {
|
||
|
|
|
||
|
|
$rom_at_limb_joints = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'muscle_power') {
|
||
|
|
|
||
|
|
$muscle_power = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'gait_1') {
|
||
|
|
|
||
|
|
$gait_1 = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'spine_1') {
|
||
|
|
|
||
|
|
$spine_1 = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'blood_gr') {
|
||
|
|
|
||
|
|
$blood_gr = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'serum_creatinine') {
|
||
|
|
|
||
|
|
$serum_creatinine = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'sgpt') {
|
||
|
|
|
||
|
|
$sgpt = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'hb_2') {
|
||
|
|
|
||
|
|
$hb_2 = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'urine_report') {
|
||
|
|
|
||
|
|
$urine_report = 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_1') {
|
||
|
|
|
||
|
|
$marital_status_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $rows_exa_key['checkup_form_value']);
|
||
|
|
}
|
||
|
|
|
||
|
|
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'ppbs') {
|
||
|
|
|
||
|
|
$ppbs = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'fasting') {
|
||
|
|
|
||
|
|
$fasting = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'rbs') {
|
||
|
|
|
||
|
|
$rbs = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'x_ray_chest_pa_view_1') {
|
||
|
|
|
||
|
|
$x_ray_chest_pa_view_1 = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'no_of_children_male') {
|
||
|
|
|
||
|
|
$no_of_children_male = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'no_of_children_female') {
|
||
|
|
|
||
|
|
$no_of_children_female = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($rows_exa_key['checkup_form_key'] == 'field_of_vision') {
|
||
|
|
|
||
|
|
$field_of_vision = $rows_exa_key['checkup_form_value'];
|
||
|
|
}
|
||
|
|
if ($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'];
|
||
|
|
}
|
||
|
|
}
|
||
|
|
|
||
|
|
|
||
|
|
$sql_employee_appointment = "SELECT * FROM checkup_form WHERE checkup_id = '" . $checkup_id . "' ";
|
||
|
|
|
||
|
|
|
||
|
|
error_log("sql injury pres:" . $sql_employee_appointment);
|
||
|
|
|
||
|
|
$res_emp_appoint = mysqli_query($conn, $sql_employee_appointment);
|
||
|
|
|
||
|
|
while ($rows_emp_appoint = mysqli_fetch_array($res_emp_appoint)) {
|
||
|
|
$emp_id = $rows_emp_appoint['emp_id'];
|
||
|
|
$ticket_no = $rows_emp_appoint['ticket_no'];
|
||
|
|
|
||
|
|
$date_a = $rows_emp_appoint['checkup_date'];
|
||
|
|
|
||
|
|
|
||
|
|
$appointment_date = date("d-m-Y", strtotime($date_a));
|
||
|
|
|
||
|
|
$patient_name = getFieldFromTable('patient_name', 'patient_master', 'id', $rows_emp_appoint['emp_id']);
|
||
|
|
$primary_phone = getFieldFromTable('primary_phone', 'patient_master', 'id', $rows_emp_appoint['emp_id']);
|
||
|
|
$dob = getFieldFromTable('dob', 'patient_master', 'id', $rows_emp_appoint['emp_id']);
|
||
|
|
$gender = getFieldFromTable('gender', 'patient_master', 'id', $rows_emp_appoint['emp_id']);
|
||
|
|
|
||
|
|
$c = date('Y');
|
||
|
|
$y = date('Y', strtotime($dob));
|
||
|
|
$age = $c - $y;
|
||
|
|
}
|
||
|
|
|
||
|
|
?>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
<tr>
|
||
|
|
<td style="width: 70%;"></td>
|
||
|
|
<td style="width: 20%;">Sr No : <?php echo $ticket_no ?></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td style="width: 70%;"></td>
|
||
|
|
<td style="width: 30%;">Date : <?php echo $appointment_date ?></td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
<br>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80%;">Name: <u><?php echo $patient_name; ?></u> </td>
|
||
|
|
<td style="width: 10%;">Age: <u><?php echo $age; ?></u></td>
|
||
|
|
<td style="width: 10%;">Sex: <u><?php if ($gender == 'M') {
|
||
|
|
echo 'MALE';
|
||
|
|
} else if ($gender == 'F') {
|
||
|
|
echo 'FEMALE';
|
||
|
|
} ?></u></td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Contact: <u><?php echo $primary_phone; ?></u></td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Emergency Contact No : </td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
<br><br>
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
<h2 style="font-size: 12px;">MEDICAL EXAMINATION PAST HISTORY</h2>
|
||
|
|
<table border="1" width="100%" cellspacing="0">
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Personal History</td>
|
||
|
|
<td style="width: 15px;" colspan="1">Yes</td>
|
||
|
|
<td style="width: 15px;" colspan="1">No</td>
|
||
|
|
<td style="width: 80px;" colspan="3">Personal History</td>
|
||
|
|
<td style="width: 15px;" colspan="1">Yes</td>
|
||
|
|
<td style="width: 15px;" colspan="1">No</td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Smoking</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($smoking_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($smoking_1 == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">Married</td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($marital_status_1 == 'Married') { ?> <input type="checkbox" checked name="" id=""> <?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Alcohol</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($alcohol_7 == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($alcohol_7 == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">Unmarried</td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($marital_status_1 == 'Unmarried') { ?> <input type="checkbox" checked name="" id=""> <?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Tobacco Chewing</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($tobacco_chewing_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($tobacco_chewing_1 == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="5">No Of Childrens</td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Drugs</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($drugs == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($drugs == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">M: <?php echo $no_of_children_male ?></td>
|
||
|
|
<td style="width: 15px;" colspan="4">F: <?php echo $no_of_children_female ?></td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td colspan="8">Remarks : <?php echo $if_the_answer_is_yes_give_details_2?> </td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
<br>
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
<h2 style="font-size: 12px;">MEDICAL HISTORY OF KNOWN ILLNESS AS SELF DECLARATION FOR PHYSICAL FITNESS</h2>
|
||
|
|
<table border="1" width="100%" cellspacing="0">
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Disease</td>
|
||
|
|
<td style="width: 15px;" colspan="1">Yes</td>
|
||
|
|
<td style="width: 15px;" colspan="1">No</td>
|
||
|
|
<td style="width: 80px;" colspan="1">Disease</td>
|
||
|
|
<td style="width: 15px;" colspan="1">Yes</td>
|
||
|
|
<td style="width: 15px;" colspan="1">No</td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Diabetes</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($diabetes_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($diabetes_1 == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">Heart Disease </td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($heart_disease == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($heart_disease == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Seizure Disorder / Epilepsy</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($seizure_disorder_epilepsy == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($seizure_disorder_epilepsy == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">High Blood Pressure</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($high_blood_pressure_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($high_blood_pressure_1 == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Head Injury Causing Symptom</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($head_injury_causing_symptom == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($head_injury_causing_symptom == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">Paralysis Of Any Type</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($paralysis_of_any_type == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($paralysis_of_any_type == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Brain Tumor </td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($brain_tumor == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($brain_tumor == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">Loss Of Vision</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($loss_of_vision == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($loss_of_vision == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1"> Shoulder Injury </td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($shoulder_injury == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($shoulder_injury == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">Loss Of Hearing / Deafness</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($loss_of_hearing_deafness == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($loss_of_hearing_deafness == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1"> Muscle Disease </td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($muscle_disease == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($muscle_disease == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">Tuberculosis</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($tuberculosis == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($tuberculosis == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1"> Asthma / Lung Disorder </td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($asthma_lung_disorder == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($asthma_lung_disorder == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">Vertigo</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($vertigo == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($vertigo == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Tinitus</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($tinitus == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($tinitus == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">H/o Unconsciousness</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($h_o_unconsciousness == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($h_o_unconsciousness == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">Mental Illness</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($mental_illness == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($mental_illness == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">Others</td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1"><b>Past History Of Illness</b></td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
<td style="width: 80px;" colspan="1"><b>Past History Of Illness</b></td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
<td style="width: 15px;" colspan="1"></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">H/o Major Illness</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($h_o_of_major_illness == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($h_o_of_major_illness == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">H/o Any Deformity</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($h_o_of_any_deformity == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($h_o_of_any_deformity == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 80px;" colspan="1">H/o Any Accident</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($h_o_of_any_accident == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($h_o_of_any_accident == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 80px;" colspan="1">H/o Any Major Operation</td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($h_o_of_any_major_operation == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
<td style="width: 15px;" colspan="1"><?php if ($h_o_of_any_major_operation == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td colspan="6">Remarks : <?php echo $if_the_answer_is_yes_give_details_1?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
|
||
|
|
</table>
|
||
|
|
<div class="page-break"></div>
|
||
|
|
|
||
|
|
|
||
|
|
<h2 style="font-size: 12px;">GENERAL EXAMINATION:</h2>
|
||
|
|
|
||
|
|
<table style="width: 100%;">
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;">Height: <u><?php echo $height; ?></u> Csm</td>
|
||
|
|
<td style="width: 20%; text-align: center;">weight_9: <u><?php echo $weight_9; ?></u> Kg</td>
|
||
|
|
<td style="width: 20%; text-align: right;">SP02: <u><?php echo $spo2; ?></u> </td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Disadvantages For Driving: <u><?php echo $disadvantage_for_driving; ?></u> </td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Posture / Deformity: <u><?php echo $posture_deformity; ?></u> </td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;">ENT: <u><?php echo $ent_1; ?></u></td>
|
||
|
|
<td style="width: 20%; text-align: center;">Teeth: <u><?php echo $teeth_1; ?></u></td>
|
||
|
|
<td style="width: 20%; text-align: right;">Tongue: <u><?php echo $tongue_1; ?></u></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;">Nails: <u><?php echo $nails_1; ?></u></td>
|
||
|
|
<td style="width: 20%; text-align: center;">Skin: <u><?php echo $skin_1; ?></u></td>
|
||
|
|
<td style="width: 20%; text-align: right;">Hearing Test: <u><?php echo $hearing_test ?></u></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;">Remarks: <u><?php echo $abnormality_remarks; ?></u></td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
<h2 style="font-size: 12px;">MEDICAL HISTORY OF KNOWN ILLNESS AS SELF DECLARATION FOR PHYSICAL FITNESS</h2>
|
||
|
|
<table border="1" width="100%" cellspacing="0">
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;" colspan="1" rowspan="2">Eyes</td>
|
||
|
|
<td style="width: 20%;" colspan="2">Distant</td>
|
||
|
|
<td style="width: 20%;" colspan="2">Near</td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
|
||
|
|
<td style="width: 20%; padding: 10px;" colspan="1">R</td>
|
||
|
|
<td style="width: 20%;" colspan="1">L</td>
|
||
|
|
<td style="width: 20%;" colspan="1">R</td>
|
||
|
|
<td style="width: 20%;" colspan="1">L</td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;" colspan="1">Uncorrected</td>
|
||
|
|
<td style="width: 20%;" colspan="1"><?php echo $distant_rt_uncorrected_1 ?></td>
|
||
|
|
<td style="width: 20%;" colspan="1"><?php echo $distant_lt_uncorrected_1; ?></td>
|
||
|
|
<td style="width: 20%;" colspan="1"><?php echo $near_rt_uncorrected_1 ?></td>
|
||
|
|
<td style="width: 20%;" colspan="1"><?php echo $near_lt_uncorrected_1 ?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;" colspan="1">Corrected</td>
|
||
|
|
<td style="width: 20%;" colspan="1"><?php echo $distant_rt_corrected_1 ?></td>
|
||
|
|
<td style="width: 20%;" colspan="1"><?php echo $distant_lt_corrected_1 ?></td>
|
||
|
|
<td style="width: 20%;" colspan="1"><?php echo $near_rt_corrected_1 ?></td>
|
||
|
|
<td style="width: 20%;" colspan="1"><?php echo $near_lt_corrected_1 ?></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
|
||
|
|
</table>
|
||
|
|
|
||
|
|
<table style="width: 100%;">
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Colour Vision: <u> <?php echo $colour_vision_by_ishihara_chart ?></u></td>
|
||
|
|
<td style="width: 50%;">Field Of Vision: <u> <?php echo $field_of_vision ?> </u></td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Night Blindness: <u> <?php echo $night_blindness ?> </u></td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td>Remarks : <?php echo $night_blindness_remarks ?></td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
|
||
|
|
|
||
|
|
<h2 style="font-size: 12px;">Systemic Examination</h2>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;"> <b> cvs </b></td>
|
||
|
|
<td style="width: 20%; text-align: center;">Pulse: <u> <?php echo $pulse_9; ?> </u></td>
|
||
|
|
<td style="width: 20%; text-align: right;">B.P.: <u><?php echo $blood_pressure_1 ?></u> mm of Hg</td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;"></td>
|
||
|
|
<td style="width: 20%; text-align: center;">SIS2: <u> <?php echo $s1_s2 ?></u></td>
|
||
|
|
<td style="width: 20%; text-align: right;">Murmur: <u> <?php echo $murmurs_1 ?></u></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td>Remarks : <?php echo $if_the_answer_is_yes_give_details_3?></td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">RESP. SYS. <u>:<?php echo $resp_sys ?></u></td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Abdomen: <u> <?php echo $abdomen ?></u></td>
|
||
|
|
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
</table>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;">Genito-Urinary System :</td>
|
||
|
|
<td style="width: 20%;">Hernia: <u> <?php echo $hernia; ?></u></td>
|
||
|
|
<td style="width: 20%;">Hydrocele:<u> <?php echo $hydrocele ?></u></td>
|
||
|
|
<td style="width: 20%;">Vericocele:<u> <?php echo $varicocele_1 ?></u></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
|
||
|
|
</table>
|
||
|
|
|
||
|
|
<h2 style="font-size: 12px;">CNS:</h2>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Tandem Walking: <u><?php echo $tandem_walking ?></u> </td>
|
||
|
|
<td style="width: 50%;">Finger Nose Test: <u><?php echo $finger_nose_test ?></u> </td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Extremities: <u><?php echo $extremities ?></u></td>
|
||
|
|
<td style="width: 50%;">Rom At Limb Joints: <u><?php echo $rom_at_limb_joints ?></u></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Muscle Power: <u><?php echo $muscle_power ?></u></td>
|
||
|
|
<td style="width: 50%;">Higher Function: <u><?php echo $tandem_walking ?></u></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Gait: <u><?php echo $gait_1 ?></u></td>
|
||
|
|
<td style="width: 50%;">Spine: <u><?php echo $spine_1 ?></u></td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
|
||
|
|
</table>
|
||
|
|
|
||
|
|
<h2 style="font-size: 12px;">BLOOD EXAMINATION</h2>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;">Blood Gr: <u><?php echo $blood_gr ?></u> </td>
|
||
|
|
<td style="width: 20%; text-align: center;">CREAT: <u><?php echo $serum_creatinine ?></u></td>
|
||
|
|
<td style="width: 20%; text-align: right;">SGPT:<u><?php echo $sgpt ?></u></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;">Hb% :<u><?php echo $hb_2 ?></u></td>
|
||
|
|
<td style="width: 20%; text-align: center;">URINE R & M: <u><?php echo $urine_report ?></u></td>
|
||
|
|
<td style="width: 20%; text-align: right;"></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td style="width: 20%;">FBS/PPBS/R :<u><?php echo $fasting."/".$ppbs."/".$rbs ?></u></td>
|
||
|
|
<td style="width: 20%; text-align: center;">X-RAY CHEST: <u><?php echo $x_ray_chest_pa_view_once_in_year ?></u></td>
|
||
|
|
<td style="width: 20%; text-align: right;"></td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td colspan="3">Remarks : <?php echo $urine_abnormality_remarks?></td>
|
||
|
|
</tr>
|
||
|
|
</table>
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
<h2 style="font-size: 12px;">Certificate</h2>
|
||
|
|
<table style="width: 100%;">
|
||
|
|
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">I Certify That Mr <u> <?php if($patient_name){ echo $patient_name;}else{?></u>____________________ <?php } ?>is Examined</td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">For Distant/near/colour Vision/field Of Vision & For Hearing Ability,</td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Hands /arms / Legs Deformity & Found.</td>
|
||
|
|
</tr>
|
||
|
|
|
||
|
|
</table>
|
||
|
|
|
||
|
|
|
||
|
|
<br>
|
||
|
|
|
||
|
|
<table style="width: 100%;">
|
||
|
|
|
||
|
|
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Medicaly Fit In Regards Of Bodily Heath , Eye Sight, Mental And Health & Hearing</td>
|
||
|
|
</tr>
|
||
|
|
<tr>
|
||
|
|
<td style="width: 50%;">Medicaly Unfit For Following Reasons</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: 95%;">
|
||
|
|
<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="width: 50%; 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>
|