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