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<?php session_start();
include 'dbconnection.php';
require_once("../patientmanager.php");
require_once("../DBManager.php");
if(isset($_POST['Routine_Examination']))
{
PatientManager::preAssessmentSheet("$_GET[prescriptionid]","$_GET[patientid]","$_GET[surgeryid]","$_POST[Cough]","$_POST[Fever]","$_POST[Wheezing]","$_POST[Hypertension]","$_POST[Diabetes]","$_POST[Liverproblem]","$_POST[Previous_Operation]", "$_POST[Smoking]","$_POST[Migraine]","$_POST[Pregnancy]","$_POST[Bleeding_Disorder]","$_POST[SOB]","$_POST[Palpitation]","$_POST[Chest_Pain]","$_POST[Renal_Disease]","$_POST[Allergies]","$_POST[Alcohol]","$_POST[Anesthesia_Problem]","$_POST[Urination]","$_POST[Back_Neck_Pain]","$_POST[Arthritis]","$_POST[Blackouts]","$_POST[Muscie]","$_POST[Weight_Loss_Gain]","$_POST[hernia]","$_POST[Pacemaker]","$_POST[Artificial]","$_POST[Resp_System]","$_POST[Resp_System_note]","$_POST[CVS_status]","$_POST[CVS_status_note]","$_POST[Dentures_status]", "$_POST[Dentures_status_note]","$_POST[Dentures_status_lower]","$_POST[Dentures_lower_note]","$_POST[Mouth_Opening]","$_POST[Mouth_Opening_note]","$_POST[Neck_Mobility]","$_POST[Neck_Mobility_note]","$_POST[Venous_Access]","$_POST[Venous_Access_note]","$_POST[Nervous_System]","$_POST[Nervous_System_note]","$_POST[Abdomen_System]","$_POST[Intubation_Difficulty]","$_POST[Intubation_Difficulty_note]","$_POST[Special_Anesthesia_Problems]","$_POST[Special_Anesthesia_Problems_note]","$_POST[PALLOR]","$_POST[ICTERUS]","$_POST[CYANOSIS]","$_POST[LYMPHNODES]","$_POST[JVP_RAISED]","$_POST[TM_JOINT]","$_POST[DENTAL_REACTION]","$_POST[Abdomen_note]","$_POST[Neck]","$_POST[Neck_note]","$_POST[Asthama_Breathlesness]","$_POST[BloodTransfusion]","$_POST[Previous_Admission]","$_POST[Indigestion]","$_POST[Acid]","$_POST[Heartburn]","$_POST[Hiatus]","$_POST[ContactLens]","$_POST[HearingAid]","$_POST[entered_by]");
}
?>
<div style = "display:none;" id = "loaderImg"> <div class="loader"> </div> </div>
<form name="Routine_Examination" method="post" id="myForm" >
<h3 align="center">Checklist </h3>
<table id="example2" class="table table-bordered table-hover" border="1" width='100%'><tr>
<td>
<input type="checkbox" name="Cough"></td><td><span style="font-size: 17px;">Cough </span></td></tr><tr>
<td><input type="checkbox" name="Fever"></td><td><span style="font-size: 17px;">Fever </span></td></tr><tr>
<td><input type="checkbox" name="Wheezing"></td><td><span style="font-size: 17px;">Wheezing </span></td>
</tr>
<tr>
<td> <input type="checkbox" name="Hypertension"></td><td><span style="font-size: 17px;">Hypertension</span></td>
</tr>
<tr>
<td> <input type="checkbox" name="Diabetes"></td><td><span style="font-size: 17px;">Diabetes</span></td>
</tr>
<tr>
<td> <input type="checkbox" name="Asthama_Breathlesness"></td><td><span style="font-size: 17px;">Asthama OR Breathlesness</span></td>
</tr>
<td> <input type="checkbox" name="BloodTransfusion"></td><td><span style="font-size: 17px;">Blood Transfusion</span></td>
</tr>
<td> <input type="checkbox" name="Liverproblem"></td><td><span style="font-size: 17px;">Liver Problem/Jaundice </span></td></tr><tr>
<td> <input type="checkbox" name="Previous_Operation"></td><td><span style="font-size: 17px;">Tuberculosis </span></td>
</tr>
<tr>
<td> <input type="checkbox" name"Smoking"></td><td><span style="font-size: 17px;">Smoking / Alcohal</span></td></tr>
<tr>
<td> <input type="checkbox" name="Migraine"></td><td><span style="font-size: 17px;">Headache/Migraine</span></td>
</tr>
<tr>
<td> <input type="checkbox" name="Pregnancy"></td><td><span style="font-size: 17px;">Pregnancy</span></td></tr>
<tr>
<td> <input type="checkbox" name="Bleeding_Disorder"></td><td><span style="font-size: 17px;">Bleeding Disorder</span></td>
</tr>
<tr>
<td> <input type="checkbox" name="SOB"></td><td><span style="font-size: 17px;">SOB</span></td></tr><tr>
<td> <input type="checkbox" name="Palpitation"></td><td><span style="font-size: 17px;">Palpitation</span></td>
</tr>
<tr>
<td> <input type="checkbox" name="Chest_Pain"></td><td><span style="font-size: 17px;">CAD/PTCA/CABG/Chest Pain</span></td></tr><tr>
<td> <input type="checkbox" name="Renal_Disease"></td><td><span style="font-size: 17px;">Renal Disease</span></td>
</tr>
<tr>
<td> <input type="checkbox" name="Allergies"></td><td><span style="font-size: 17px;">Allergies: Drug/Food</span></td></tr><tr>
<td> <input type="checkbox" name="Previous_Admission"></td> <td><span style="font-size: 17px;">Previous Admission</span></td>
</tr>
<!-- <tr>-->
<!--<td> <input type="checkbox" name="Alcohol"></td><td><span style="font-size: 17px;">Alcohol</span></td></tr>-->
<tr>
<td> <input type="checkbox" name="Seizures"></td><td><span style="font-size: 17px;">Seizures/Fainting/Syncope</span></td>
</tr>
<tr>
<td><input type="checkbox" name="Fever"></td><td><span style="font-size: 17px;">Recent URI/Fever </span></td></tr><tr>
<td> <input type="checkbox" name="Anesthesia_Problem"></td> <td> <span style="font-size: 17px;">Previous Anesthesia& Problem</span></td>
</tr>
<tr>
<td> <input type="checkbox" name="Urination"></td><td><span style="font-size: 17px;">Frequent Urination </span></td></tr><tr>
<td> <input type="checkbox" name="Back_Neck_Pain"></td><td><span style="font-size: 17px;">Back/Neck Pain</span></td>
</tr>
<tr>
<td><input type="checkbox" name="Arthritis"></td><td><span style="font-size: 17px;">Arthritis/Painful/Swollen Join </span></td></tr><tr>
<td> <input type="checkbox" name="Blackouts"></td><td><span style="font-size: 17px;">Blackouts/Loss of Consciousness</span></td>
</tr>
<tr>
<td> <input type="checkbox" name="Muscie"></td><td><span style="font-size: 17px;">Abnormality of Nerve of Muscie </span></td></tr><tr>
<td><input type="checkbox" name="Weight_Loss_Gain"></td><td><span style="font-size: 17px;"> Weight Loss/Gain </span></td>
</tr>
<tr>
<td><input type="checkbox" name="Indigestion"></td><td><span style="font-size: 17px;">Indigestion </span></td></tr>
<tr>
<td><input type="checkbox" name="Acid"></td><td><span style="font-size: 17px;">Acid </span></td></tr>
<tr>
<td><input type="checkbox" name="Heartburn"></td><td><span style="font-size: 17px;">Heartburn </span></td></tr>
<tr>
<td><input type="checkbox" name="Hiatus"></td><td><span style="font-size: 17px;">Hiatus hernia </span></td></tr>
<tr>
<td><input type="checkbox" name="ContactLens"></td><td><span style="font-size: 17px;">Contact Lens </span></td></tr><tr>
<tr>
<td><input type="checkbox" name="Pacemaker"></td><td><span style="font-size: 17px;">Pacemaker </span></td></tr><tr>
<tr>
<td><input type="checkbox" name="HearingAid"></td><td><span style="font-size: 17px;">Hearing Aid </span></td></tr><tr>
<td> <input type="checkbox" name="Artificial"></td><td><span style="font-size: 17px;"> Artificial Joint/Plates </span></td>
</tr>
</table>
<table id="example2" class="table table-bordered table-hover" border="1" width='100%'>
<th></th>
<th></th>
<!-- <tr>-->
<!-- <td width='20%'>Resp. System</td>-->
<!-- <td width='20%'><select name='Resp_System'>-->
<!-- <option value='' >Unknown</option>-->
<!-- <option value='Normal'>Normal</option>-->
<!--<option value='Attention Needed'>Attention Needed</option>-->
<!-- </select></td>-->
<!-- <td width='60%'><input name="Resp_System_note" type="text"></td>-->
<!-- </tr>-->
<!-- <tr>-->
<!-- <td width='20%'>CVS (cardiovascular system)</td>-->
<!-- <td width='20%'><select name='CVS_status'>-->
<!-- <option value='' >Unknown</option>-->
<!-- <option value='Normal'>Normal</option>-->
<!--<option value='Attention Needed'>Attention Needed</option>-->
<!-- </select></td>-->
<!-- <td width='60%'><input name="CVS_status_note" type="text"></td>-->
<!-- </tr>-->
<tr>
<td width='20%'>Loose Tooth/Dentures
Upper
</td>
<td width='20%'><select name='Dentures_status'>
<option value='Unknown' >Unknown</option>
<option value='Present'>Present</option>
<option value='None'>None</option>
</select></td>
<!--<td width='60%'><input name="Dentures_status_note" type="text"></td>-->
</tr>
<tr>
<td width='20%'>Loose Tooth/Dentures
lower
</td>
<td width='20%'><select name='Dentures_status_lower'>
<option value='Unknown' >Unknown</option>
<option value='Present'>Present</option>
<option value='None'>None</option>
</select></td>
<!--<td width='60%'><input name="Dentures_lower_note"type="text"></td>-->
</tr>
<tr>
<td width='20%'>Mouth Opening
</td>
<td width='20%'><select name='Mouth_Opening_note'>
<option value='Unknown' >Unknown</option>
<option value='Normal'>Normal</option>
<option value='Attention Needed'>Attention Needed</option>
</select></td>
<!--<td width='60%'><input name="Mouth_Opening_note"type="text"></td>-->
</tr>
<tr>
<td width='20%'>Neck
</td>
<td width='20%'><select name='Neck'>
<option value='Unknown' >Unknown</option>
<option value='SHORT'>SHORT</option>
<option value='LONG'>LONG</option>
<option value='NORMAL'>NORMAL</option>
</select></td>
<!--<td width='60%'><input name="Neck_note" type="text"></td>-->
</tr>
<tr>
<td width='20%'>Neck Mobility
</td>
<td width='20%'><select name='Neck_Mobility'>
<option value='Unknown' >Unknown</option>
<option value='Normal'>Normal</option>
<option value='Attention Needed'>Attention Needed</option>
</select></td>
<!--<td width='60%'><input name="Neck_Mobility_note"type="text"></td>-->
</tr>
<tr>
<td width='20%'>Venous Access
</td>
<td width='20%'><select name='Venous_Access'>
<option value='Unknown' >Unknown</option>
<option value='Normal'>Normal</option>
<option value='Attention Needed'>Attention Needed</option>
</select></td>
<!--<td width='60%'><input name="Venous_Access_note"type="text"></td>-->
</tr>
<tr>
<td width='20%'>Nervous System
</td>
<td width='20%'><select name='Nervous_System'>
<option value='Unknown' >Unknown</option>
<option value='Normal'>Normal</option>
<option value='Attention Needed'>Attention Needed</option>
</select></td>
<!--<td width='60%'><input name="Nervous_System_note"type="text"></td>-->
</tr>
<tr>
<td width='20%'>Abdomen
</td>
<td width='20%'><select name='Abdomen_System'>
<option value='Unknown' >Unknown</option>
<option value='Normal'>Normal</option>
<option value='Attention Needed'>Attention Needed</option>
</select></td>
<!--<td width='60%'><input name="Abdomen_note"type="text"></td>-->
</tr>
<tr>
<td width='20%'>Intubation Difficulty
</td>
<td width='20%'><select name='Intubation_Difficulty'>
<option value='Unknown' >Unknown</option>
<option value='Normal'>Normal</option>
<option value='Attention Needed'>Attention Needed</option>
</select></td>
<!--<td width='60%'><input name="Intubation_Difficulty_note"type="text"></td>-->
</tr>
<tr>
<td width='20%'>Special Anesthesia Problems
</td>
<td width='20%'><select name='Special_Anesthesia_Problems'>
<option value='Unknown' >Unknown</option>
<option value='Normal'>Normal </option>
<option value='Attention Needed'>Attention Needed</option>
</select></td>
<!--<td width='60%'><input name="Special_Anesthesia_Problems_note" type="text"></td>-->
</tr>
</table>
<table id="example2" class="table table-bordered table-hover" border="1" width='100%'>
</table>
<table id="example2" class="table table-bordered table-hover">
<tr><td><span style="font-size: 20px">PALLOR </span></h3></td><td><label class="switch">
<input type="checkbox" name='PALLOR'>
<span class="slider"></span>
</label>
</td>
</tr>
<tr>
<td><span style="font-size: 20px">ICTERUS</span></h3></td><td><label class="switch">
<input type="checkbox" name='ICTERUS'>
<span class="slider"></span>
</label>
</td>
</tr>
<tr><td><span style="font-size: 20px">CYANOSIS </span></h3></td><td><label class="switch">
<input type="checkbox" name='CYANOSIS'>
<span class="slider"></span>
</label>
</td>
</tr>
<tr><td><span style="font-size: 20px">LYMPHNODES </span></h3></td><td><label class="switch">
<input type="checkbox" name='LYMPHNODES'>
<span class="slider"></span>
</label>
</td>
</tr>
<tr>
<td><span style="font-size: 20px">JVP RAISED </span></h3></td><td><label class="switch">
<input type="checkbox" name='JVP_RAISED'>
<span class="slider"></span>
</label>
</td>
</tr>
<tr>
<td><span style="font-size: 20px">T.M.JOINT</span></h3></td><td><label class="switch">
<input type="checkbox" name='TM_JOINT'>
<span class="slider"></span>
</label>
</td>
</tr>
<tr>
<td><span style="font-size: 20px">DENTAL ABOUT REACTION </span></h3></td><td><label class="switch">
<input type="checkbox" name='DENTAL_REACTION'>
<span class="slider"></span>
</label>
</td>
</tr>
</table>
<input type='submit' name='Routine_Examination' value='Submit'>
</form>