224 lines
8.1 KiB
PHP
224 lines
8.1 KiB
PHP
<?php include('techsyn_header.php'); ?>
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<!-- Main Content Container for side bar and body-->
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<style>
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input{
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margin-left: 20px;
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}
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</style>
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<div class="main-container ace-save-state" id="main-container">
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<script type="text/javascript">
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try{ace.settings.loadState('main-container')}catch(e){}
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</script>
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<?php include('techsyn_sidebar.php'); ?>
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<div class="main-content">
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<div class="main-content-inner">
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<div class="breadcrumbs ace-save-state" id="breadcrumbs">
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<ul class="breadcrumb">
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<li><i class="ace-icon fa fa-home home-icon"></i> <a href="#">Home</a>
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</li>
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<li class="#">Patient Visit</li>
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<li class="active">Health Surveillance</li>
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</ul>
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<?php $sql_parameter_master="select * from physical_parameter_master";
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$result_param_master= mysqli_query($conn,$sql_parameter_master);
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$data=array();
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while ($row_checkup_param_master= mysqli_fetch_assoc($result_param_master)) {
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$data[]=$row_checkup_param_master;
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}
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?>
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</div>
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<div class="page-content">
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<div class="box box-primary"
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style="padding: 10px; margin: 2px 0px 50px 5px; width: 99.5%;">
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<div class="box-header with-border">
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<h3 class="box-title">Initial Medical Examination Card (Short Term)</h3>
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</div>
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<div id="user-profile-2">
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<form class="form-horizontal" id="employee_form"
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name="employee_form" enctype="multipart/form-data" action="#"
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method="post">
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<div class="box-body">
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<div class="row">
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<div class="col-sm-12">
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<table class="table table-bordered">
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<tr>
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<td><b> Height(cms)</b></td>
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<td><input style="margin-left:20px" type="number" name="asthma" id="asthma" /></td>
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<td colspan="2"><b style="margin-left: 188px ">CLINICAL EXAMINATION</</b></td>
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</tr>
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<tr>
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<td><b> Weight(kgs)</b></td>
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<td><input style="margin-left:20px" type="number" name="asthma" id="asthma" /></td>
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<td colspan="2"><b > PALLOR</b> <input style="margin-left:171px;width:46%" type="text" name="pallor" id="pallor" /></td>
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</tr>
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<tr>
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<td colspan="2"><b style="margin-left: 330px ">Vision</b></td>
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<td colspan="2"><b >PULSE</</b><input style="margin-left:181px;width:46%" type="number" name="pulse" id="pulse" /></td>
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</tr>
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<tr>
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<td ></td>
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<td ><b style="margin-left:100px">RT.EYE</b><b style="margin-left:134px">LT.EYE</b></td>
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<td colspan="2"><b >BP</</b><input style="margin-left:202px;width:151px" type="number" name="bp" id="bp" /> mm of Hg</td>
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</tr>
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<tr>
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<td > <b>Distant Vision</b> <b style="margin-left:134px">Without Glasses</b></td>
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<td ><input style="" type="number" name="asthma" id="asthma" /><input style="margin-left:35px" type="number" name="asthma" id="asthma" /></td>
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<td colspan="2" ><b>MUSCULO SKELETAL</b><input style="margin-left:115px;width:46%" type="text" name="asthma" id="asthma" /></td>
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</tr>
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<tr>
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<td align="right"><b >With Glasses</b></td>
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<td ><input style="" type="number" name="asthma" id="asthma" /><input style="margin-left:35px" type="number" name="asthma" id="asthma" /></td>
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<td colspan="2" rowspan="2" > <b>RS</b><input style="margin-left: 205px;width: 46%;" type="text" name="asthma" id="asthma" /></td>
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</tr>
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<tr>
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<td > <b>Near Vision</b> <b style="margin-left:134px">Without Glasses</b></td>
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<td ><input style="" type="number" name="asthma" id="asthma" /><input style="margin-left:35px" type="number" name="asthma" id="asthma" /></td>
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</tr>
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<tr>
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<td align="right"><b >With Glasses</b></td>
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<td ><input style="" type="number" name="asthma" id="asthma" /><input style="margin-left:35px" type="number" name="asthma" id="asthma" /></td>
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<td colspan="2" rowspan="2"><b>ANY OTHER RELEVANT FINDING</b><br><br><textarea rows="3" cols="80" name="asthma" id="asthma" ></textarea></td>
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</tr>
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<tr>
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<td colspan="2" ><b >COLOR VISION</b>
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<input style="margin-left: 214px" type="radio" name="pink" id="pink" /> Normal <input type="radio" style="margin-left:75px" name="epilepsy" id="epilepsy" /> DEFECTIVE
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</td>
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</tr>
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<tr>
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<td colspan="2" rowspan="2" ><b >IDENTIFICATION OF INDIVIDUAL COLOURS</b>
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<input style="margin-left: 80px" type="radio" name="pink" id="pink" /> Normal <input type="radio" style="margin-left:75px" name="epilepsy" id="epilepsy" /> DEFECTIVE
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</td>
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<td>
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</td>
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</tr>
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<tr>
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</tr>
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<tr>
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<td colspan="2" rowspan="2" ><b >CVS</b><b style="margin-left:134px">S1</b><input style="" type="text" name="s1" id="s1" />
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<b style="margin-left:134px">S2</b><input style="" type="text" name="s2" id="s2" /><br>
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<div style="padding-top: 10px;padding-left: 69px"><b >Any other Sound</b><input style="" type="text" name="any_other_sound" id="any_other_sound" />
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<b style="margin-left: 24px;">ECG (12 Lead) findings</b><input style="" type="text" name="ecg_findings" id="ecg_findings" /></div>
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<div style="padding-top: 10px;padding-left: 49px">
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<b >2D Echo/TMT Findings</b><input style="width:62%;" type="text" name="tmt_findings" id="tmt_findings" />
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</div>
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<!-- <select style="margin-left: 169px;width:212px" name="cvs" id="cvs" >
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<option value="">Please Select Option</option>
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<?php
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$param_values=$data[0]['parameter_value'];
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$parameter_values_array = explode(",", $param_values);
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for ($p = 0; $p < count($parameter_values_array); $p ++) {?>
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<option value="<?php echo $parameter_values_array[$p]; ?>"><?php echo getTableFieldValue('medical_parameter_value', 'med_param_value', 'med_param_val_id',$parameter_values_array[$p])?></option>
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<?php }
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?>
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</select> -->
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</td>
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<td colspan="2" rowspan="2" ><b >Status</b>
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<input style="margin-left: 214px" type="radio" name="status" id="status" /> FIT <input type="radio" style="margin-left:75px" name="epilepsy" id="epilepsy" /> UNFIT
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</td>
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</tr>
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</table>
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</div>
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</div>
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</div>
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<div class="box-footer" style="text-align: center">
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<button class="btn btn-primary" type="button" id="save_button"
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onclick="save_employee()">
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<i class="ace-icon fa fa-save"></i> Save
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</button>
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<button class="btn btn-primary" type="button" id="update_button" style="display:none"
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onclick="save_employee()">
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<i class="ace-icon fa fa-floppy"></i> Update
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</button>
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<button class="btn btn-warning" type="reset">
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<i class="ace-icon fa fa-undo"></i> Reset
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</button>
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<button class="btn btn-success" onclick='navigateReceptionist()'>
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<i class="ace-icon fa fa-forward"></i> Next
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</button>
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</div>
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</form>
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</div>
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</div>
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</div>
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</div>
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</div>
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<?php include('techsyn_footer.php'); ?>
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