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<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>
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<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">RECORD OF MEDICAL EXAMINATION</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><input style="margin-left:20px" type="number" name="asthma" id="asthma" /></td>
<td><b> Waist(cms)</b><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><input style="margin-left:20px" type="number" name="asthma" id="asthma" /></td>
<td><b> Hip(cms)</b><input style="margin-left:35px" type="number" name="asthma" id="asthma" /></td>
<td colspan="2"><b > NAILS</b> <input style="margin-left: 114px" type="checkbox" name="pink" id="pink" /> Pink <input type="checkbox" style="margin-left:75px" name="epilepsy" id="epilepsy" /> Pale <input type="checkbox" style="margin-left:75px" name="epilepsy" id="epilepsy" /> Clubbing</td>
</tr>
<tr>
<td><b> BMI(cms)</b><input style="margin-left:40px" type="number" name="asthma" id="asthma" /></td>
<td></td>
<td colspan="2"><b >PULSE</</b><input style="margin-left:115px" type="number" name="pulse" id="pulse" /></td>
</tr>
<tr>
<td colspan="2"><b style="margin-left: 188px ">Vision</</b></td>
<td colspan="2"><b >BP</</b><input style="margin-left:134px" type="number" name="bp" id="bp" /> mm of Hg</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" rowspan="4"><b>ABDOMEN</b><select style="margin-left: 169px;width:212px" name="cvs" id="cvs" >
<option value="">Please Select Option</option>
<?php
$param_values=$data[3]['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>
</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>
</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>
</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" > <b>SKIN</b></td>
</tr>
<tr>
<td colspan="2" rowspan="2"><b >Any other eye disease</b><input style="" type="text" name="asthma" id="asthma" /></td>
<td colspan="2" > <b>RS</b><input style="margin-left:143px" type="text" name="asthma" id="asthma" /></td>
</tr>
<tr>
<td colspan="2" rowspan="2"> <b>MUSCULO SKELETAL</b><input style="margin-left:143px" type="text" name="asthma" id="asthma" /></td>
</tr>
<tr>
<td colspan="2" align="center" > <b style="font-weight: 800">IDENTIFICATION OF INDIVIDUAL COLOURS</b></td>
</tr>
<tr>
<td ><input style="margin-left: 114px" type="radio" name="individual_colors" id="individual_colors" /> Normal
<td ><input type="radio" style="margin-left:75px" name="individual_colors" id="individual_colors" /> DEFECTIVE
<td colspan="2"><b>ANY OTHER</b></td>
</tr>
<tr>
<td colspan="2" ><b>NYSTAGMUS</b></td>
<td rowspan="3" > <b>GENITO - URINARY</b><input type="text" name="asthma" id="asthma" /></td>
<td rowspan="3" > <b>CNS</b><input type="text" name="asthma" id="asthma" /></td>
</tr>
<tr>
<td colspan="2" ><b >COLOR VISION</b>
<input style="margin-left: 114px" type="radio" name="color_vision" id="color_vision" /> Normal <input type="radio" style="margin-left:75px" name="color_vision" id="color_vision" /> DEFECTIVE
</tr>
<tr>
<td colspan="2" ><b >Signature of Medical Assistant</b>
</tr>
<tr>
<td colspan="2" ><b >ENT</b>
<select style="margin-left: 10px" name="ent" id="ent" >
<option value="">Please Select Option</option>
<?php
$param_values=$data[1]['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" ><b >CVS</b><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>
</tr>
<tr>
<td colspan="4" align="center" > <b style="font-weight: 800">14. ILO CLASSIFICATION OF CHEST RADIOGRAPH (Enclosed Chest Radiograph)</b></td>
</tr>
<tr>
<td colspan="2" ><b> Profusion of Pneumoconiotic opacities</b></td>
<td ><b>Grades</b></td>
<td ><b>Types</b></td>
</tr>
<tr>
<td colspan="2" ><input style="margin-left: 114px" type="radio" name="color_vision" id="color_vision" /> Present <input type="radio" style="margin-left:75px" name="color_vision" id="color_vision" /> Absent
</td>
<td><textarea style="margin-left: 10px" rows="3" cols="50" name="asthma" id="asthma" ></textarea></td>
<td><textarea style="margin-left: 10px" rows="3" cols="50" name="asthma" id="asthma" ></textarea></td>
</tr>
<tr>
<td colspan="4" align="center" > <b style="font-weight: 800">15. RESULT OF SPIROMETRY (Report Enclosed)</b></td>
</tr>
<tr>
<td ><b>Parameters</b></td>
<td ><b>Predicted Value</b></td>
<td ><b>Performed Value</b></td>
<td ><b>% of Predicted</b></td>
</tr>
<tr>
<td ><b>Forced Vital Capacity (FVC)</b></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
</tr>
<tr>
<td ><b>Forced Expiratory Volume in 1 sec (FEV1)</b></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
</tr>
<tr>
<td ><b>FEV1/FVC</b></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
</tr>
<tr>
<td ><b>Peak Expiratory Flow</b></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
<td ><input type="text" name="asthma" id="asthma" /></td>
<td ><input type="text" name="asthma" id="asthma" /></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>
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