748 lines
33 KiB
PHP
748 lines
33 KiB
PHP
<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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body {
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text-transform: uppercase;
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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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<?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($res_data_key)) {
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$dataArray[$rows_exa_key['checkup_form_key']] = $rows_exa_key['checkup_form_value'];
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}
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$sql_employee_appointment = "SELECT * FROM checkup_form WHERE checkup_id = '" . $checkup_id . "' ";
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error_log("sql injury pres:" . $sql_employee_appointment);
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$res_emp_appoint = mysqli_query($conn, $sql_employee_appointment);
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while ($rows_emp_appoint = mysqli_fetch_array($res_emp_appoint)) {
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$emp_id = $rows_emp_appoint['emp_id'];
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$ticket_no = $rows_emp_appoint['ticket_no'];
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$date_a = $rows_emp_appoint['checkup_date'];
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$appointment_date = date("d-m-Y", strtotime($date_a));
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$patient_name = getFieldFromTable('patient_name', 'patient_master', 'id', $rows_emp_appoint['emp_id']);
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$primary_phone = getFieldFromTable('primary_phone', 'patient_master', 'id', $rows_emp_appoint['emp_id']);
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$dob = getFieldFromTable('dob', 'patient_master', 'id', $rows_emp_appoint['emp_id']);
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$gender = getFieldFromTable('gender', 'patient_master', 'id', $rows_emp_appoint['emp_id']);
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$c = date('Y');
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$y = date('Y', strtotime($dob));
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$age = $c - $y;
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}
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?>
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<table width="100%" cellspacing="0">
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<tr>
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<td width="20%">
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<?php if (isset($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>OCCUPATIONAL HEALTH CENTER (OHC)</span><br>
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<span style="font-size: 18px ; text-transform: capitalize;"></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 style="font-size: 12px;" width="20%" align="right">
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<span >
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Sr No: <?php echo $ticket_no ?> <br>
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Date: <?php echo $appointment_date ?>
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</span>
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</td> -->
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</tr>
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</table>
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<h4>
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<center>MEDICAL EXAMINATION FORM FOR DRIVERS</center>
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</h4>
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<table style="width: 100%;">
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<tr>
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<td style="width: 70%;"></td>
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<td style="width: 20%;"></td>
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</tr>
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<tr>
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<td style="width: 70%;"></td>
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<td style="width: 30%;"></td>
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</tr>
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</table>
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<br>
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<table style="width: 100%;">
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<tr>
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<td style="width: 80%;">Name: <u><?php echo $patient_name; ?></u> </td>
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<td style="width: 10%;">Age: <u><?php echo $age; ?></u></td>
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<td style="width: 10%;">Sex: <u><?php if ($gender == 'M') {
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echo 'MALE';
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} else if ($gender == 'F') {
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echo 'FEMALE';
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} ?></u></td>
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</tr>
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</table>
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<table style="width: 100%;">
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<tr>
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<td style="width: 50%;">Contact: <u><?php echo $primary_phone; ?></u></td>
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</tr>
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<tr>
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<td style="width: 50%;">Emergency Contact No : </td>
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</tr>
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</table>
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<h2 style="font-size: 12px;">MEDICAL EXAMINATION PAST HISTORY</h2>
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<table border="1" width="100%" cellspacing="0">
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<tr>
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<td style="width: 80px;" colspan="1">Personal History</td>
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<td style="width: 15px;" colspan="1">Yes</td>
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<td style="width: 15px;" colspan="1">No</td>
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<td style="width: 80px;" colspan="3">Personal History</td>
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<td style="width: 15px;" colspan="1">Yes</td>
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<td style="width: 15px;" colspan="1">No</td>
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</tr>
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<tr>
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<?php $smoking_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['smoking_1']); ?>
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<td style="width: 80px;" colspan="1">Smoking</td>
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<td style="width: 15px;" colspan="1"><?php if ($smoking_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($smoking_1 == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<?php $marital_status_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['marital_status_1']); ?>
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<td style="width: 80px;" colspan="1">Married</td>
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<td style="width: 15px;" colspan="1"></td>
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<td style="width: 15px;" colspan="1"></td>
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<td style="width: 15px;" colspan="1"><?php if ($marital_status_1 == 'Married') { ?> <input type="checkbox" checked name="" id=""> <?php } ?></td>
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<td style="width: 15px;" colspan="1"></td>
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</tr>
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<tr>
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<?php $alcohol_7 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['alcohol_7']); ?>
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<td style="width: 80px;" colspan="1">Alcohol</td>
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<td style="width: 15px;" colspan="1"><?php if ($alcohol_7 == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($alcohol_7 == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 80px;" colspan="1">Unmarried</td>
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<td style="width: 15px;" colspan="1"></td>
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<td style="width: 15px;" colspan="1"></td>
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<td style="width: 15px;" colspan="1"><?php if ($marital_status_1 == 'Unmarried') { ?> <input type="checkbox" checked name="" id=""> <?php } ?></td>
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<td style="width: 15px;" colspan="1"></td>
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</tr>
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<tr>
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<?php $tobacco_chewing_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['tobacco_chewing_1']); ?>
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<td style="width: 80px;" colspan="1">Tobacco Chewing</td>
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<td style="width: 15px;" colspan="1"><?php if ($tobacco_chewing_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($tobacco_chewing_1 == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 80px;" colspan="5">No Of Childrens</td>
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</tr>
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<tr>
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<?php $drugs = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['drugs']); ?>
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<td style="width: 80px;" colspan="1">Drugs</td>
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<td style="width: 15px;" colspan="1"><?php if ($drugs == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($drugs == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 80px;" colspan="1">M: <?php echo $dataArray['no_of_children_male'] ?></td>
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<td style="width: 15px;" colspan="4">F: <?php echo $dataArray['no_of_children_female'] ?></td>
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</tr>
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<tr>
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<td colspan="8"> Remarks: <?php echo $dataArray['if_the_answer_is_yes_give_details']?></td>
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</tr>
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</table>
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<br>
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<h2 style="font-size: 12px;">MEDICAL HISTORY OF KNOWN ILLNESS AS SELF DECLARATION FOR PHYSICAL FITNESS</h2>
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<table border="1" width="100%" cellspacing="0">
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<tr>
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<td style="width: 80px;" colspan="1">Disease</td>
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<td style="width: 15px;" colspan="1">Yes</td>
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<td style="width: 15px;" colspan="1">No</td>
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<td style="width: 80px;" colspan="1">Disease</td>
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<td style="width: 15px;" colspan="1">Yes</td>
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<td style="width: 15px;" colspan="1">No</td>
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</tr>
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<tr>
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<td style="width: 80px;" colspan="1">Diabetes</td>
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<?php $diabetes_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['diabetes_1']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($diabetes_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($diabetes_1 == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 80px;" colspan="1">Heart Disease </td>
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<?php $heart_disease = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['heart_disease']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($heart_disease == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($heart_disease == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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</tr>
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<tr>
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<td style="width: 80px;" colspan="1">Seizure Disorder / Epilepsy</td>
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<?php $seizure_disorder_epilepsy = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['seizure_disorder_epilepsy']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($seizure_disorder_epilepsy == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($seizure_disorder_epilepsy == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 80px;" colspan="1">High Blood Pressure</td>
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<?php $high_blood_pressure_1 = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['high_blood_pressure_1']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($high_blood_pressure_1 == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($high_blood_pressure_1 == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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</tr>
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<tr>
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<td style="width: 80px;" colspan="1">Head Injury Causing Symptom</td>
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<?php $head_injury_causing_symptom = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['head_injury_causing_symptom']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($head_injury_causing_symptom == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($head_injury_causing_symptom == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 80px;" colspan="1">Paralysis Of Any Type</td>
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<?php $paralysis_of_any_type = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['paralysis_of_any_type']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($paralysis_of_any_type == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($paralysis_of_any_type == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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</tr>
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<tr>
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<td style="width: 80px;" colspan="1">Brain Tumor </td>
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<?php $brain_tumor = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['brain_tumor']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($brain_tumor == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($brain_tumor == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 80px;" colspan="1">Loss Of Vision</td>
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<?php $loss_of_vision = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['loss_of_vision']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($loss_of_vision == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($loss_of_vision == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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</tr>
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<tr>
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<td style="width: 80px;" colspan="1"> Shoulder Injury </td>
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<?php $shoulder_injury = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['shoulder_injury']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($shoulder_injury == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($shoulder_injury == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 80px;" colspan="1">Loss Of Hearing / Deafness</td>
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<?php $loss_of_hearing_deafness = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['loss_of_hearing_deafness']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($loss_of_hearing_deafness == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($loss_of_hearing_deafness == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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</tr>
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<tr>
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<td style="width: 80px;" colspan="1"> Muscle Disease </td>
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<?php $muscle_disease = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['muscle_disease']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($muscle_disease == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($muscle_disease == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 80px;" colspan="1">Tuberculosis</td>
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<?php $tuberculosis = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['tuberculosis']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($tuberculosis == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($tuberculosis == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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</tr>
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<tr>
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<td style="width: 80px;" colspan="1"> Asthma / Lung Disorder </td>
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<?php $asthma_lung_disorder = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['asthma_lung_disorder']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($asthma_lung_disorder == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($asthma_lung_disorder == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 80px;" colspan="1">Vertigo</td>
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<?php $vertigo = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['vertigo']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($vertigo == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($vertigo == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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</tr>
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<tr>
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<td style="width: 80px;" colspan="1">Tinitus</td>
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<?php $tinitus = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['tinitus']); ?>
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<td style="width: 15px;" colspan="1"><?php if ($tinitus == 'Yes') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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<td style="width: 15px;" colspan="1"><?php if ($tinitus == 'No') { ?> <input checked type="checkbox" name="" id=""><?php } ?></td>
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|
<td style="width: 80px;" colspan="1">H/o Unconsciousness</td>
|
|
|
|
<?php $h_o_unconsciousness = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['h_o_unconsciousness']); ?>
|
|
|
|
<td style="width: 15px;" colspan="1"><?php if ($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>
|
|
|
|
<?php $mental_illness = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['mental_illness']); ?>
|
|
|
|
<td style="width: 15px;" colspan="1"><?php if ($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 colspan="6" > Remaeks : <?php echo $dataArray['if_the_answer_is_yes_give_details_1']?></td>
|
|
</tr>
|
|
</table>
|
|
<h2 style="font-size: 12px;">SIGN OF CANDIDATE _____________________</h2>
|
|
<table border="1" width="100%" cellspacing="0">
|
|
<tr>
|
|
<td style="width: 80px;" colspan="1"><b>Past History Of Illness</b></td>
|
|
<td style="width: 15px;" colspan="1">Yes</td>
|
|
<td style="width: 15px;" colspan="1">No</td>
|
|
<td style="width: 80px;" colspan="1"><b>Past History Of Illness</b></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">H/o Major Illness</td>
|
|
|
|
<?php $h_o_of_major_illness = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['h_o_of_major_illness']); ?>
|
|
|
|
<td style="width: 15px;" colspan="1"><?php if ($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>
|
|
|
|
<?php $h_o_of_any_deformity = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['h_o_of_any_deformity']); ?>
|
|
|
|
<td style="width: 15px;" colspan="1"><?php if ($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>
|
|
|
|
<?php $h_o_of_any_accident = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['h_o_of_any_accident']); ?>
|
|
|
|
<td style="width: 15px;" colspan="1"><?php if ($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>
|
|
|
|
<?php $h_o_of_any_major_operation = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['h_o_of_any_major_operation']); ?>
|
|
|
|
<td style="width: 15px;" colspan="1"><?php if ($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>
|
|
|
|
|
|
</table>
|
|
|
|
|
|
<h2 style="font-size: 12px;">GENERAL EXAMINATION:</h2>
|
|
|
|
<table style="width: 100%;">
|
|
<tr>
|
|
<td style="width: 20%;">Height: <u><?php echo $dataArray['height'] ; ?></u> Csm</td>
|
|
<td style="width: 20%; text-align: center;">weight: <u><?php echo $dataArray['weight_9'] ?></u> Kg</td>
|
|
<td style="width: 20%; text-align: right;">SP02: <u><?php echo $dataArray['spo2'] ; ?></u> </td>
|
|
</tr>
|
|
</table>
|
|
<table style="width: 100%;">
|
|
|
|
<tr>
|
|
<td style="width: 50%;">Disadvantages For Driving: <u><?php echo $dataArray['disadvantage_for_driving'] ; ?></u> </td>
|
|
|
|
</tr>
|
|
|
|
<tr>
|
|
<td style="width: 50%;">Posture / Deformity: <u><?php echo $dataArray['posture_deformity']; ?></u> </td>
|
|
|
|
</tr>
|
|
</table>
|
|
<table style="width: 100%;">
|
|
|
|
<tr>
|
|
<td style="width: 20%;">ENT: <u><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['ent_1']); ?></u></td>
|
|
<td style="width: 20%; text-align: center;">Teeth: <u><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['teeth_1']) ?></u></td>
|
|
<td style="width: 20%; text-align: right;">Tongue: <u><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['tongue_1']) ; ?></u></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td style="width: 20%;">Nails: <u><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['nails_1']); ?></u></td>
|
|
<td style="width: 20%; text-align: center;">Skin: <u><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['skin_1']); ?></u></td>
|
|
<td style="width: 20%; text-align: right;">Hearing Test: <u><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['hearing_test']) ?></u></td>
|
|
</tr>
|
|
<tr>
|
|
<td>Remarks : <?php echo $dataArray['abnormality_remarks']?></td>
|
|
</tr>
|
|
</table>
|
|
<br>
|
|
<div class="page-break"></div>
|
|
|
|
<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 getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['distant_rt_uncorrected_1']) ?></td>
|
|
<td style="width: 20%;" colspan="1"><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['distant_lt_uncorrected_1']) ; ?></td>
|
|
<td style="width: 20%;" colspan="1"><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['near_rt_uncorrected_1']) ?></td>
|
|
<td style="width: 20%;" colspan="1"><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['near_lt_uncorrected_1']) ?></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td style="width: 20%;" colspan="1">Corrected</td>
|
|
<td style="width: 20%;" colspan="1"><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['distant_rt_corrected_1']) ?></td>
|
|
<td style="width: 20%;" colspan="1"><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['distant_lt_corrected_1']) ?></td>
|
|
<td style="width: 20%;" colspan="1"><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['near_rt_corrected_1']) ?></td>
|
|
<td style="width: 20%;" colspan="1"><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['near_lt_corrected_1']) ?></td>
|
|
</tr>
|
|
|
|
</table>
|
|
|
|
<table style="width: 100%;">
|
|
|
|
<tr>
|
|
<td style="width: 50%;">Colour Vision: <u> <?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['colour_vision_by_ishihara_chart']) ?></u></td>
|
|
|
|
</tr>
|
|
|
|
<tr>
|
|
<td style="width: 50%;">Field Of Vision: <u> <?php echo $dataArray['field_of_vision'] ?> </u></td>
|
|
|
|
</tr>
|
|
<tr>
|
|
<td style="width: 50%;">Night Blindness: <u> <?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['night_blindness']) ?> </u></td>
|
|
|
|
</tr>
|
|
<tr>
|
|
<td style="width: 50%;">Night Blindness: <?php echo $dataArray['if_the_answer_is_yes_give_details_2']?></td>
|
|
|
|
</tr>
|
|
</table>
|
|
<br><br>
|
|
|
|
<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 $dataArray['pulse_9'] ; ?> </u></td>
|
|
<td style="width: 20%; text-align: right;">B.P.: <u><?php echo $dataArray['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 $dataArray['s1_s2'] ?></u></td>
|
|
<td style="width: 20%; text-align: right;">Murmur: <u> <?php echo $dataArray['murmurs_1'] ?></u></td>
|
|
</tr>
|
|
</table>
|
|
<table style="width: 100%;">
|
|
|
|
<tr>
|
|
<td style="width: 50%;">RESP. SYS. <u>:<?php echo $dataArray['resp_sys'] ?></u></td>
|
|
|
|
</tr>
|
|
|
|
<tr>
|
|
<td style="width: 50%;">Abdomen: <u> <?php echo $dataArray['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 getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['hernia']) ; ?></u></td>
|
|
<td style="width: 20%;">Hydrocele:<u> <?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['hydrocele']) ?></u></td>
|
|
<td style="width: 20%;">Vericocele:<u> <?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['varicocele_1']) ?></u></td>
|
|
</tr>
|
|
<tr>
|
|
<td>Remarks : <?php echo $dataArray['if_the_answer_is_yes_give_details_3']?></td>
|
|
</tr>
|
|
|
|
|
|
</table>
|
|
|
|
<h2 style="font-size: 12px;">CNS:</h2>
|
|
<table style="width: 100%;">
|
|
|
|
|
|
<tr>
|
|
<td style="width: 50%;">Tandem Walking: <u><?php echo $dataArray['tandem_walking'] ?></u> </td>
|
|
</tr>
|
|
<tr>
|
|
<td style="width: 50%;">Finger Nose Test: <u><?php echo $dataArray['finger_nose_test_1'] ?></u> </td>
|
|
</tr>
|
|
<tr>
|
|
<td style="width: 50%;">Extremities: <u><?php echo $dataArray['extremities'] ?></u></td>
|
|
</tr>
|
|
<tr>
|
|
<td style="width: 50%;">Rom At Limb Joints: <u><?php echo $dataArray['rom_at_limb_joints'] ?></u></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td style="width: 50%;">Muscle Power: <u><?php echo $dataArray['muscle_power'] ?></u></td>
|
|
</tr>
|
|
<tr>
|
|
<td style="width: 50%;">Higher Function: <u><?php echo $dataArray['tandem_walking'] ?></u></td>
|
|
</tr>
|
|
<tr>
|
|
<td style="width: 50%;">Gait: <u><?php echo $dataArray['gait_1'] ?></u></td>
|
|
</tr>
|
|
<tr>
|
|
<td style="width: 50%;">Spine: <u><?php echo $dataArray['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 $dataArray['blood_gr'] ?></u> </td>
|
|
<td style="width: 20%; text-align: center;">CREAT: <u><?php echo $dataArray['serum_creatinine'] ?></u></td>
|
|
<td style="width: 20%; text-align: right;">SGPT:<u><?php echo $dataArray['sgpt'] ?></u></td>
|
|
</tr>
|
|
<tr>
|
|
<td style="width: 20%;">Hb% :<u><?php echo $dataArray['hb_2'] ?></u></td>
|
|
<td style="width: 20%; text-align: center;">URINE R & M: <u><?php echo getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $dataArray['urine_report'])?></u></td>
|
|
<td style="width: 20%; text-align: right;"></td>
|
|
</tr>
|
|
<tr>
|
|
<td style="width: 20%;">FBS/PPBS/R :<u><?php echo $dataArray['fasting']."/".$dataArray['ppbs']."/".$dataArray['rbs'] ?></u></td>
|
|
<td style="width: 20%; text-align: center;">X-RAY CHEST: <u><?php echo $dataArray['x_ray_chest_pa_view_once_in_year'] ?></u></td>
|
|
<td style="width: 20%; text-align: right;"></td>
|
|
</tr>
|
|
</table>
|
|
|
|
<h2 style="font-size: 12px;"><b>Remarks : </b></h2>
|
|
|
|
|
|
<h2 style="font-size: 12px;">Certificate</h2>
|
|
<table style="width: 100%;">
|
|
|
|
|
|
<tr>
|
|
<td style="width: 50%;">I Certify That Mr <u> <?php if($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><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>
|