<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script> <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css"> <head> <style> .tbl1 { border: 2px solid black; border-collapse: collapse; font-weight: 800; padding: 15px; } * { text-transform: capitalize !important; } </style> </head> <div id="checkup_form_form" style="display:none"> <?php include('includes/config/config.php'); include_once("includes/functions.php"); error_reporting(0); $query = "select * from company_profile where company_id =5 "; //echo $query; $result = mysqli_query($conn, $query); $row = mysqli_fetch_array($result); @extract($row); ?> <div style="margin-top:-20px"> <br> <br> <br> <div style="margin-top: 20px"> <table width="100%" class="tbl3" id="form_header"> <tr> <td colspan="2" align="center"><strong>(FORM - O)</strong></td> </tr> <tr> <td colspan="2" align="center"><b>(See rule 29F(2) and 29L)</b></td> </tr> <tr> <td colspan="2" align="center"><b>Report of medical examination under rule 29B</b></td> </tr> <tr> <td colspan="2" align="center"><b>(To be Issued In Triplicate)**</b></td> </tr> </table> <?php $sql_section = "select checkup_form_section_ids from checkup_type where checkup_type_id=(select checkup_type_id from checkup_form where checkup_id='" . $_REQUEST['checkup_id'] . "')"; error_log("section query :" . $sql_section); $result_section = mysqli_query($conn, $sql_section); $row_section = mysqli_fetch_assoc($result_section); $section_ids = explode(",", $row_section['checkup_form_section_ids']); error_log("section ids : " . print_r($section_ids, true)); $data = array(); foreach ($section_ids as $sec_ids) { $sql_value = "select cfk.checkup_form_key,cfk.checkup_form_value,cp.parameter_name,cp.checkup_form_section_id,cp.input_type from checkup_parameter cp left join checkup_form cf on cp.checkup_type_ids = cf.checkup_type_id left join checkup_form_key_value cfk on cfk.checkup_form_id=cf.checkup_id where cp.checkup_form_section_id='" . $sec_ids . "' and cf.checkup_id='" . $_REQUEST['checkup_id'] . "' and cfk.checkup_form_key=cp.`column_name`"; $result_val = mysqli_query($GLOBALS['conn'], $sql_value); while ($row_val = mysqli_fetch_assoc($result_val)) { if ($row_val['input_type'] == 'select') { $data[$row_val['checkup_form_key']] = getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $row_val['checkup_form_value']); } else if ($row_val['input_type'] == 'multiselect') { $data[$row_val['checkup_form_key']] = getCommaSeperatedValuesForInClause("select parameter_value_name from checkup_parameter_value", 'parameter_value_id', $row_val['checkup_form_value']); } else { $data[$row_val['checkup_form_key']] = $row_val['checkup_form_value']; } } // error_log("value query for form o :" . $sql_value); error_log("data array : " . print_r($data, true)); } $sql_form_type_data = "select a.*,b.*,c.patient_name,c.identity,c.emp_photo,c.emp_sign,c.image_type,c.emp_image_type from form_data a inner join checkup_form b on a.checkup_id=b.checkup_id left join patient_master c on c.id = b.emp_id where a.checkup_id='" . $_REQUEST['checkup_id'] . "'"; // echo $sql_form_type_data; $result_form_type_data = mysqli_query($conn, $sql_form_type_data); $row_form_type_data = mysqli_fetch_assoc($result_form_type_data); @extract($row_form_type_data); // $certificate_no = $row_form_type_data['ticket_no']; $patient_name = $row_form_type_data['patient_name']; $identification_mark = $row_form_type_data['identity']; ?> <div style="margin-top: 20px"> <table width="100%" class="tbl3" style="border-spacing: 10px;"> <tr> <td> <p><?= $para_one ?> </p> </td> </tr> <tr> <td><?= $para_one_1 ?> </td> </tr> <tr> <td> <p><?= $para_one_2 ?> </p> </td> </tr> <tr> <td> <p><?= $para_one_3 ?> </p> </td> </tr> <tr> <td><?= $para_one_4 ?> </td> </tr> <tr> <td><?= $para_one_5 ?> </td> </tr> <tr> <td><?= $para_one_6 ?> </td> </tr> <tr> <td> <p><?= $para_one_7 ?> </p> </td> </tr> </table> <table class="tbl3" width="100%"> <tr> <td> <?php $sql_image = "select * from patient_master where id='" . $row_form_type_data['emp_id'] . "'"; $result_image = mysqli_query($conn, $sql_image); $row_image = mysqli_fetch_assoc($result_image); @extract($row_image); error_log("image query " . $sql_image); ?> <img class="img-responsive" src="data:<?php echo $row_image['emp_image_type'] ?>;base64,<?php echo base64_encode($row_image['emp_photo']) ?>" style="display: block; width: 180px; height: 150px;" /> </td> </tr> </table> <table width="100%" class="tbl3"> <?php $doc_emp_id = $row_form_type_data['doc_attend']; $doctor_name = getFieldfromTable('patient_name', 'patient_master', 'id', $doc_emp_id); $sql_sign = "select * from employee_signature where emp_id='" . $doc_emp_id . "'"; $result_sign = mysqli_query($conn, $sql_sign); $row_sign = mysqli_fetch_assoc($result_sign); @extract($row_sign); error_log("sign query " . $sql_sign); ?> <tr> <td colspan="3" align="right"><span class="profile-picture" id="profile-picture1"> <img src="data:<?php echo $row_sign['image_type'] ?>;base64,<?php echo base64_encode($row_sign['emp_sign']) ?>" style="width: 120px; height: 40px;" /></span></td> </tr> <tr> <td align="left">Place:</span> SUTRAPADA</td> <td colspan="3" align="right">Signature of examining authority</td> </tr> <tr> <td align="left">Date: <?= date_format(date_create($row_form_type_data['approval_date']), "d-M-Y") ?></td> <td colspan="3" align="right">Name and designation in block letter:</td> </tr> </table> <table width="100%" style="margin-right: 20px"> <tr> <td width="70%"> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ </td> </tr> </table> <table width="100%" id="id_table" class="tbl3" style=" page-break-after: always;"> <tr> <td align="left">* Delete whatever is not applicable</td> </tr> <tr> <td> **One copy of the certificate shall be handed over to the person concerned and another copy shall be send to the manager of the mine concerned by registered post; and the third copy shall be retained by the examining authority. </td> </tr> <tr> <td align="center"> <p><?= $para_two ?></p> </td> </tr> <tr> <td> <p><?= $para_three ?></p> </td> </tr> <tr> <td> <p><?= $para_four ?></p> </td> </tr> </table> <?php $sql_med = "select b.patient_name,b.identity ,a.doc_attend from checkup_form a left join patient_master b on a.emp_id = b.id where a.checkup_id = '" . $_REQUEST['checkup_id'] . "'"; error_log("DATA:" . $sql_med); $result_med = mysqli_query($conn, $sql_med); $row_med = mysqli_fetch_array($result_med); @extract($row_med); ?> <table width="100%" class="tbl3" style="page-break-after:always;"> <tr> <td colspan="2" align="center"><b>Report of The Examining Authority</b></td> </tr> <tr> <td colspan="2" align="center"><b>(To be filled in for every medical examination whether initial or periodical or re -examination or after cure/control of disability).</b></td> </tr> <tr> <td align="left">Annexure to <?= $para_one ?></td> <td align="center" style="margin-left: 10px;">as result of medical examination on <?= date_format(date_create($row_form_type_data['approval_date']), "d-M-Y") ?></td> </tr> <tr> <td height="1%">Identification Mark: <?= $row_med['identity'] ?></td> </tr> <tr> <td height="1%">1.General Development: <?= $data['general_development'] ?></td> <td align="right"><span class="profile-picture" id="profile-picture1"> <img src="data:<?php echo $row_form_type_data['image_type'] ?>;base64,<?php echo base64_encode($row_form_type_data['emp_sign']) ?>" style="width: 120px; height: 40px;" /></span> <br> Left Thumb Impression of the Candidate </td> </tr> <tr> <td height="1%">2.Height: <?= $data['height'] ?>cms</td> </tr> <tr> <td height="1%">3.Weight: <?= $data['weight'] ?>kgs</td> </tr> <tr> <td align="left">4. Eyes: (i) Visual Activity-Distant Vision (with or without glasses,)</td> </tr> <tr> <td align="left"><span style="margin-left: 50px">Right Eye: <?= $data['visual_acuity_distant_vision_rt_eye'] ?></span></td> <td align="center">Left Eye: <?= $data['visual_acuity_distant_vision_lt_eye'] ?></td> </tr> <tr> <td align="left"><span style="margin-left: 50px">(ii) Any Organic Disease Of Eyes: </span><?= $data['any_organic_disease_of_eyes'] ?></span></td> <td align="center"> (iii) Night Blindness: </span><?= $data['night_blindness'] ?></span> </td> </tr> <tr> <td align="left"><span style="margin-left: 50px">(iv) Colour Blindness: </span><?= $data['colour_blindness'] ?></span></td> <td align="center">(v) Squint: </span><?= $data['squint'] ?></td> </tr> <tr> <td height="1%">5. Ears: (i) Hearing: </td> </tr> <tr> <?php error_log("ear : " . $data['hearing_condition_rt_ear']); ?> <td align="left"><span style="margin-left: 50px">Right Ear: <?= $data['hearing_condition_rt_ear'] ?> </span></td> <td align="center">Left Ear: <?= $data['hearing_condition_lt_ear'] ?></td> </tr> <tr> <td height="1%"><span style="margin-left: 50px">(ii) Any Organic Diseases: </span><?= $data['any_organic_disease'] ?></td> </tr> <tr> <td height="1%">6. Respiratory System: </td> </tr> <tr> <td align="left"><span style="margin-left: 50px">(i) After Full Inspiration: <?= $data['after_full_inspiration'] ?> cms </span></td> <td align="center">(ii) After Full Expiration: </span><?= $data['after_full_expiration'] ?> cms</td> </tr> <tr> <td height="1%">7. Circulatory System:</td> </tr> <tr> <td align="left"><span style="margin-left: 50px">Blood Pressure: <?= $data['systolic_blood_pressure'] . "/" . $data['diastolic_blood_pressure'] ?> mm/Hg</span></td> <td align="center">Pulse: <?= $data['pulse'] ?>/Min</td> </tr> <tr> <td height="1%">8. Abdomen:</td> </tr> <tr> <td align="left"><span style="margin-left: 50px">Tenderness: <?= $data['tenderness'] ?></span></td> <td align="center">Liver: <?= $data['liver'] ?></td> </tr> <tr> <td align="left"><span style="margin-left: 50px">Speen: <?= $data['spleen'] ?></span></td> <td align="center">Tumour: <?= $data['tumour'] ?></td> </tr> <tr> <td height="1%">9. Nervous System:</td> </tr> <tr> <td align="left"><span style="margin-left: 100px">History Of Fits or Epilepsy: </span><?= $data['history_of_fits_or_epilepsy'] ?></td> <td align="center">Paralysis: </span><?= $data['paralysis'] ?></td> </tr> <tr> <td align="left"><span style="margin-left: 100px">Mental Health: </span><?= $data['mental_health'] ?></td> </tr> <tr> <td height="1%">10. Locomotory System: <?= $data['locomotory_system'] ?></td> </tr> <tr> <td height="1%">11. Skin: <?= $data['skin'] ?></td> </tr> <tr> <td height="1%">12. Hydrocele: <?= $data['hydrocele'] ?></td> </tr> <tr> <td height="1%">13. Hernia: <?= $data['hernea'] ?></td> </tr> <tr> <td height="1%">14. Any Other Abnormality: <?= $data['any_other_abnormality'] ?></td> </tr> <tr> <td height="1%">15. Urine: Reaction: <?= $data['reaction'] ?></td> </tr> <tr> <td height="1%"><span style="margin-left: 60px">Albumin: </span><?= $data['albumin'] ?></td> <td align="center"> Sugar: </span><?= $data['sugar'] ?></td> </tr> <tr> <td align="left">16. Skiagram Of Chest:</td> <td align="center"><?= $data['skiagram_of_chest'] ?></td> </tr> <tr> <td align="left">17. Any other test considered necessary by the examining authority.</td> <td align="center"><?= $data['any_other_test_considered_necessary_by_the_examining_authority'] ?></td> </tr> <tr height="2%"> <td align="left">18. Any opinion of specialist considered necessary. </td> <td align="center"><?= $data['any_opinion_of_specialist_considered_necessary'] ?></td> </tr> <br> <tr> <td colspan="2" align="right"> <span class="profile-picture" id="profile-picture1"> <img src="data:<?php echo $row_sign['image_type'] ?>;base64,<?php echo base64_encode($row_sign['emp_sign']) ?>" style="width: 120px; height: 40px;" /></span></td> </tr> <tr> <td>PLACE: GHCL LTD SUTRAPADA</td> <td colspan="2" align="right">Signature of the examining authority</td> </tr> <tr> <td align="left">NAME:<?= getFieldFromTable('patient_name', 'patient_master', 'id', $row_med['doc_attend']); ?> <td align="right"> DESIGNATION :<?= getFieldFromTable('designation_name', 'designation', 'designation_id', getFieldFromTable('designation_id', 'patient_master', 'id', $row_med['doc_attend'])); ?> </td> </td> </tr> <tr> <td align="left"> CITY / TOWN : <?= getFieldFromTable('village', 'patient_master', 'id', $row_med['doc_attend']); ?> </td> <td align="right"> DISTRICT : <?= getFieldFromTable('district', 'patient_master', 'id', $row_med['doc_attend']); ?> </td> </tr> <tr> <td align="left"> PH / MOB: <?= getFieldFromTable('primary_phone', 'patient_master', 'id', $row_med['doc_attend']); ?> </td> <td align="right"> EMAIL ADDRESS: <?= getFieldFromTable('offial_email_id', 'patient_master', 'id', $row_med['doc_attend']); ?> </td> </tr> <tr> <td align="left">PLACE OF POSTING : <?= getFieldFromTable('post', 'patient_master', 'id', $row_med['doc_attend']); ?> </td> <td align="right">PO. : SUTRAPADA STATE: <?= getFieldFromTable('state', 'patient_master', 'id', $row_med['doc_attend']); ?></td> </tr> </table> <table width="100%" class="tbl3"> <tr> <td colspan="2" align="center"><b>Report of medical examination under mines rule 29-B</b></td> </tr> <tr> <td colspan="2" align="center"><b>(To be issued in continuation with Form O)</b></td> </tr> </table> <table width="100%" class="tbl3"> <tr> <td> <p><?= $para_one ?> </p> </td> </tr> <tr> <td> Name: <?= $patient_name ?> </td> </tr> <tr> <td> Identifiction Mark: <?= $identification_mark ?> </td> </tr> <tr> <td align="center"> <b>Result of Lung Function Test (Spirometry)</b> </td> </tr> </table> <br> <br> <table width="100%" cellspacing="0" class="tbl3" border="1"> <tr> <th>Parameters</th> <th>Predicted Value</th> <th>Performed Value</th> <th>% Of Predicted</th> </tr> <tr> <td>Forced Vital Capacity (FEV)</td> <td><?= $data['forced_vital_capacity_fev_predicted_value'] ?></td> <td><?= $data['forced_vital_capacity_fev_parformed_value'] ?></td> <td><?= $data['forced_vital_capacity_of_predicted'] ?></td> </tr> <tr> <td>Forced Vital Capacity FEV1</td> <td><?= $data['forced_vital_capacity1_predicted_value'] ?></td> <td><?= $data['forced_vital_capacity1_fev1_parformed_value'] ?></td> <td><?= $data['forced_vital_capacity1_fev1_of_predicted'] ?></td> </tr> <tr> <td>FEV1/FVC</td> <td><?= $data['fev_fvc_predicted_value'] ?></td> <td><?= $data['fev_fvc_parformed_value'] ?></td> <td><?= $data['fev_fvc_of_predicted'] ?></td> </tr> <tr> <td>Peak expiratory flow</td> <td><?= $data['peak_expiratory_flow_predicted_value'] ?></td> <td><?= $data['peak_expiratory_flow_parformed_value'] ?></td> <td><?= $data['peak_expiratory_flow_of_predicted'] ?></td> </tr> </table> <table width="100%" class="tbl3" style="page-break-after: always;"> <tr> <td>Spirometry Report Enclosed</td> </tr> <tr> <td colspan="2" align="right"><span class="profile-picture" id="profile-picture1"> <img src="data:<?php echo $row_sign['image_type'] ?>;base64,<?php echo base64_encode($row_sign['emp_sign']) ?>" style="width: 120px; height: 40px;" /></span></td> </tr> <tr> <td align="right">Signature of examination authority</td> </tr> </table> <br> <br> <table width="100%" class="tbl3"> <tr> <td colspan="2" align="center"><b>Report of Medical Examination as per the recommendations of National Safety Conferences in Mines</b></td> </tr> <tr> <td colspan="2" align="center"><b>(To be issued in continuation with Form O)</b></td> </tr> </table> <br> <br> <table width="100%" class="tbl3"> <tr> <td> <p><?= $para_one ?> </p> </td> </tr> <tr> <td> Name: <?= $patient_name ?> </td> </tr> <tr> <td> Identifiction Mark: <?= $identification_mark ?> </td> </tr> <tr> <td> <b>1. Cardiological Assessment</b> </td> </tr> </table> <br> <br> <table width="100%" cellspacing="0" border="1" class="tbl3"> <tr> <td rowspan="3" width="30%"> Ausculation </td> <td width="30%"> S1 </td> <td width="40%"> <?= $data['auscultation_s1'] ?> </td> </tr> <tr> <td width="30%"> S2 </td> <td width="40%"> <?= $data['auscultation_s2'] ?> </td> </tr> <tr> <td width="30%"> Additional Sould </td> <td width="40%"> <?= $data['auscultation_additional_sould'] ?> </td> </tr> <tr> <td colspan="2"> Electrocardiogram (12 leads) findings: </td> <td> <?= $data['electrocardiogram_12_leads_findings'] ?> </td> </tr> </table> <br> <table width="100%" class="tbl3"> <tr> <td>Enclosed ECG</td> </tr> </table> <br> <table width="100%" class="tbl3"> <tr> <td><b>2. Neurological assessment</b></td> </tr> </table> <br> <table width="100%" cellspacing="0" border="1" class="tbl3"> <tr> <th>Findings</th> <th>Normal/abnormal</th> </tr> <tr> <td>Superficial reflexes</td> <td><?= $data['superficial_reflexes'] ?></td> </tr> <tr> <td>Deep Reflexes</td> <td><?= $data['deep_reflexes'] ?></td> </tr> <tr> <td>Peripheral Circulation</td> <td><?= $data['peripheral_circulation'] ?></td> </tr> <tr> <td>Vibrational Syndromes</td> <td><?= $data['vibrational_syndromes'] ?></td> </tr> </table> <br> <br> <br> <table width="100%" class="tbl3"> <tr> <td><b>3. ILO Classification Of Chest Rediograph:</b></td> </tr> </table> <br> <table width="100%" cellspacing="0" border="1" class="tbl3"> <tr> <th>Profusion Of Pneumoconiotic Opacities</th> <th>Grades</th> <th>Types</th> </tr> <tr> <td><?= $data['profusional_of_pneumoconiotic_opacities'] ?></td> <td><?= $data['grades'] ?></td> <td><?= $data['types'] ?></td> </tr> </table> <table width="100%" class="tbl3"> <tr> <td>Enclosed chest radiograph</td> </tr> </table> <br> <table width="100%" class="tbl3"> <tr> <td><b>4. Audiometry Findings</b></td> </tr> </table> <br> <table width="100%" cellspacing="0" border="1" class="tbl3"> <tr> <th>Conduction type</th> <th>Left Ear</th> <th>Right Ear</th> </tr> <tr> <td>Air Conduction</td> <?php error_log("air cond ear : " . $data['left_ear_1']); ?> <td><?= $data['left_ear_1'] ?></td> <td><?= $data['right_ear_1'] ?></td> </tr> <tr> <td>Bone Conduction</td> <?php error_log("air cond ear : " . $data['left_ear']); ?> <td><?= $data['left_ear'] ?></td> <td><?= $data['right_ear'] ?></td> </tr> </table> <table width="100%" class="tbl3"> <tr> <td>Enclosed audiometry report</td> </tr> </table> <br> <table width="100%" class="tbl3"> <tr> <td><b>5. Pathological/Microbiological Investigations</b></td> </tr> </table> <br> <table width="100%" cellspacing="0" border="1" class="tbl3"> <tr> <th>S.No.</th> <th>Tests</th> <th>Findings</th> </tr> <tr> <td>1.</td> <td>Blood-TLC,DLC,Hb,ESR,Platelets</td> <td><?= $data['blood_tc_dc_hb_esr_platelets'] ?></td> </tr> <tr> <td>2.</td> <td>Blood sugar - fasting & P.P.</td> <td><?= $data['blood_sugar_fasting_pp'] ?></td> </tr> <tr> <td>3.</td> <td>Lipid profile</td> <td><?= $data['lipid_profile'] ?></td> </tr> <tr> <td>4.</td> <td>Blood Urea,Creatinine</td> <td><?= $data['blood_urea_creatinine'] ?></td> </tr> <tr> <td>5.</td> <td>Urine routine</td> <td><?= $data['urine_routine'] ?></td> </tr> <tr> <td>6.</td> <td>Stool routine</td> <td><?= $data['stool_routine'] ?></td> </tr> </table> <table width="100%" class="tbl3"> <tr> <td>Enclosed investigation report</td> </tr> </table> <br><br> <table width="100%" class="tbl3"> <tr> <td><b>6. Special Test For M<span style="text-transform: lowercase;"></span>n exposure</b></td> </tr> </table> <br> <table width="100%" cellspacing="0" border="1" class="tbl3"> <tr> <th>Behavioural Disturbances</th> <th colspan="2">Present/Not present</th> </tr> <tr> <td rowspan="4">Neurological Disturbances</td> <td>Speech Defect</td> <td><?= $data['neurological_disturbances_speech_defect'] ?></td> </tr> <tr> <td>Tremor</td> <td><?= $data['neurological_disturbances_tremor'] ?></td> </tr> <tr> <td>Adiadocskinesia</td> <td><?= $data['neurological_disturbances_adiadocokinesia'] ?></td> </tr> <tr> <td>Emotional Changes</td> <td><?= $data['neurological_disturbances_emotional_change'] ?></td> </tr> </table> <table width="100%" class="tbl3"> <tr> <td>Enclosed report</td> </tr> </table> <br> <table width="100%" class="tbl3"> <tr> <td><b>7. Any Other Special Tests Required :</b> <?= $data['any_other_tests_required'] ?></td> </tr> </table> <br> <table width="100%" class="tbl3"> <tr> <td align="right"><span class="profile-picture" id="profile-picture1"> <img src="data:<?php echo $row_sign['image_type'] ?>;base64,<?php echo base64_encode($row_sign['emp_sign']) ?>" style="width: 120px; height: 40px;" /></span></td> </tr> <tr> <td align="right">Signature of examination authority</td> </tr> </table> </div> </div> </div> <form id="checkup_form_form_pdf" action="" method="POST"> <input type="hidden" name="htmlText" id="htmlText" /> </form> </div> <script> formSubmit(); function formSubmit() { $("#htmlText").val($("#checkup_form_form").html()); document.forms['checkup_form_form_pdf'].action = "pdf_dynamic.php"; document.forms['checkup_form_form_pdf'].method = "post"; document.forms['checkup_form_form_pdf'].submit(); } </script>