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<?php session_start(); include 'dbconnection.php'; require_once("../patientmanager.php"); require_once("../DBManager.php"); if(isset($_POST['Vulnerability'])) { PatientManager::Vulnerability("$_GET[prescriptionid]","$_GET[patientid]","$_POST[Insulin_dependent]","$_POST[Insulin_specify]","$_POST[Last_menstrual_period]","$_POST[Gravida]","$_POST[Para]","$_POST[Abortion]","$_POST[Cesarean]","$_POST[Child_alive]","$_POST[Death]","$_POST[Level_Consciousness]","$_POST[Eye_Opening_Response]","$_POST[Best_Verbal_Response]","$_POST[Best_Motor_Response]","$_POST[Dependency]","$_POST[Modn]","$_POST[Vulnevilty_Assessment]","$_POST[Pain_Assessment]","$_POST[Pain_Location]","$_POST[Pain_Location1]","$_POST[Pain_Location2]","$_POST[Pain_Location3]","$_POST[Pain_Location4]","$_POST[Pain_Location5]","$_POST[other_pain_location]","$_POST[fall_risk]","$_POST[low_fall_risk]","$_POST[high_fall_risk]","$_POST[implement_low]","$_POST[Complete_paralysis]","$_POST[History_more]","$_POST[Patient_experienced]","$_POST[deemed_high]","$_POST[entered_by]"); } ?> <!DOCTYPE html> <html lang="en"> <head><meta charset="euc-kr"> <link rel="stylesheet" href="../plugins/select2/css/select2.min.css"> <link rel="stylesheet" href="../plugins/select2-bootstrap4-theme/select2-bootstrap4.min.css"> <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.1.1/jquery.min.js"></script> <script type="text/javascript"> </script> <style> #loaderImg { position: absolute; top: 0; bottom: 0; left: 0; right: 0; margin: auto; border: 10px solid grey; border-radius: 50%; border-top: 10px solid black; width: 100px; height: 100px; animation: spin 1s linear infinite; } @keyframes spin { 0% { -webkit-transform: rotate(0deg); transform: rotate(0deg); } 100% { -webkit-transform: rotate(360deg); transform: rotate(360deg); } } </style> <style> .box{ display: none; } .box2{ display: none; } .hide{ display:none; } .show{ display:block; } .center { border: 1px solid grey; text-align:; } .center2 { border: 5px solid grey; text-align:; } </style> <link rel="stylesheet" href="https://www.w3schools.com/w3css/4/w3.css"> <script src="https://code.jquery.com/jquery-3.5.1.min.js"></script> <script> function onButtonClick(){ document.getElementById('textInput').className="show"; } $(document).ready(function(){ $("select").change(function(){ $(this).find("option:selected").each(function(){ var optionValue = $(this).attr("value"); if(optionValue){ $(".box").not("." + optionValue).hide(); $("." + optionValue).show(); } else{ $(".box").hide(); } }); }).change(); }); </script> <script> $(document).ready(function(){ $("select").change(function(){ $(this).find("option:selected").each(function(){ var optionValue = $(this).attr("value"); if(optionValue){ $(".box2").not("." + optionValue).hide(); $("." + optionValue).show(); } else{ $(".box2").hide(); } }); }).change(); }); function myFunction103() { var checkBox = document.getElementById("myCheck103"); var text = document.getElementById("text103"); if (checkBox.checked == true){ text.style.display = "block"; } else { text.style.display = "none"; } }function myFunction201() { var checkBox = document.getElementById("myCheck201"); var text = document.getElementById("text201"); if (checkBox.checked == true){ text.style.display = "block"; } else { text.style.display = "none"; } } function myFunction202() { var checkBox = document.getElementById("myCheck202"); var text = document.getElementById("text202"); if (checkBox.checked == true){ text.style.display = "block"; } else { text.style.display = "none"; } } function myFunction1030() { var checkBox = document.getElementById("myCheck1030"); var text = document.getElementById("text1030"); if (checkBox.checked == true){ text.style.display = "block"; } else { text.style.display = "none"; } } function myFunction10301() { var checkBox = document.getElementById("myCheck10301"); var text = document.getElementById("text10301"); if (checkBox.checked == true){ text.style.display = "block"; } else { text.style.display = "none"; } } function myFunction103010() { var checkBox = document.getElementById("myCheck103010"); var text = document.getElementById("text103010"); if (checkBox.checked == true){ text.style.display = "block"; } else { text.style.display = "none"; } } function myFunction1031() { var checkBox = document.getElementById("myCheck1031"); var text = document.getElementById("text1031"); if (checkBox.checked == true){ text.style.display = "block"; } else { text.style.display = "none"; } } function myFunction1032() { var checkBox = document.getElementById("myCheck1032"); var text = document.getElementById("text1032"); if (checkBox.checked == true){ text.style.display = "block"; } else { text.style.display = "none"; } } function myFunction21jul(id) { var x = document.getElementById(id); if (x.className.indexOf("w3-show") == -1) { x.className += " w3-show"; } else { x.className = x.className.replace(" w3-show", ""); } } $(document).ready(function(){ $('#VulnerabilityForm').submit(function() { $('#loaderImg').show(); return true; }); }); </script> <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script> </script> <style> .switch { position: relative; display: inline-block; width: 90px; height: 34px; } .switch input {display:none;} .slider { position: absolute; cursor: pointer; top: 0; left: 0; right: 0; bottom: 0; background-color: #ca2222; -webkit-transition: .4s; transition: .4s; border-radius: 34px; } .slider:before { position: absolute; content: ""; height: 26px; width: 26px; left: 4px; bottom: 4px; background-color: white; -webkit-transition: .4s; transition: .4s; border-radius: 50%; } input:checked + .slider { background-color: #2ab934; } input:focus + .slider { box-shadow: 0 0 1px #2196F3; } input:checked + .slider:before { -webkit-transform: translateX(26px); -ms-transform: translateX(26px); transform: translateX(55px); } /*------ ADDED CSS ---------*/ .slider:after { content:'No'; color: white; display: block; position: absolute; transform: translate(-50%,-50%); top: 50%; left: 50%; font-size: 10px; font-family: Verdana, sans-serif; } input:checked + .slider:after { content:'Yes'; } .center { border: 1px solid grey; text-align:; } .btn { display: inline-block; padding: 10px 15px; font-size: 20px; border-radius: 0; -webkit-appearance: none; border: 1px solid transparent; } </style> <div class='center'> <div style = "display:none;" id = "loaderImg"> <div class="loader"> </div> </div> <form name="signup" method="post" id="VulnerabilityForm" > <?php include 'dbconnection.php'; $sql ="SELECT * FROM addaspatient WHERE prescriptionid='$_GET[prescriptionid]' AND patientid='$_GET[patientid]'"; $qsql = mysqli_query($con,$sql); while($rs = mysqli_fetch_array($qsql)) { $usertype=$rs['typevisit']; if($usertype == 'OPD'){ echo " <h3 align='center'>Vulnerability Assessment</h3> "; } else{ echo " <h3 align='center'>Vulnerability Assessment </h3>"; } } ?> <script src="https://cdnjs.cloudflare.com/ajax/libs/jquery/2.2.3/jquery.min.js"></script> </head> <h4>Level of Consciousness </h4> <div class="checkbox"> <input value="Conscious" name="Level_Consciousness" class="product-list" type="checkbox"><span>Conscious</span></div> <div class="checkbox"> <input value="Semi Conscious" id="myCheck201" onclick="myFunction201()" name="Level_Consciousness" class="product-list" type="checkbox"><span>Semi Conscious</span></div> <div class="checkbox"> <input value="Un-conscious" id="myCheck202" onclick="myFunction202()" name="Level_Consciousness" class="product-list" type="checkbox"><span>Un-conscious </span></div> <script type="text/javascript"> $('.product-list').on('change', function() { $('.product-list').not(this).prop('checked', false); }); </script> <div id="text201" style="display:none" > <h4 align='center'>Glasgow Coma Scale</h4> <label>Eye Opening Response</label><select name='Eye_Opening_Response'> <option value='' disabled selected>Eye Opening Response </option> <option value='1'>No Response</option> <option value='2'>To Pain</option> <option value='3'>To Speech and Pain</option> <option value='4'>Spontaneously</option> </select> <label>Best Verbal Response </label> <select name='Best_Verbal_Response'> <option value='' disabled selected>Best Verbal Response </option> <option value='1'>No Response</option> <option value='2'>Incomprehensive Sound</option> <option value='3'>Inappropriate Words</option> <option value='4'>Confused</option> <option value='5'>Oriented to time, place and person</option> </select> <label>Best Motor Response</label> <select name='Best_Motor_Response'> <option value='' disabled selected>Best Motor Response </option> <option value='1'>No Response</option> <option value='2'>Abnormal Extension (Decerebrate)</option> <option value='3'>Abnormal Flexion (Decorticate)</option> <option value='4'>Flexion withdrawal from pain</option> <option value='5'>Moves to localized pain</option> <option value='6'>Obeys Commands</option> </select> </div> <div id="text202" style="display:none" > <h4 align='center'>Glasgow Coma Scale</h4> <label>Eye Opening Response</label><select name='Eye_Opening_Response'> <option value='' disabled selected>Eye Opening Response </option> <option value='1'>No Response</option> <option value='2'>To Pain</option> <option value='3'>To Speech and Pain</option> <option value='4'>Spontaneously</option> </select> <label>Best Verbal Response </label> <select name='Best_Verbal_Response'> <option value='' disabled selected>Best Verbal Response </option> <option value='1'>No Response</option> <option value='2'>Incomprehensive Sound</option> <option value='3'>Inappropriate Words</option> <option value='4'>Confused</option> <option value='5'>Oriented to time, place and person</option> </select> <label>Best Motor Response</label> <select name='Best_Motor_Response'> <option value='' disabled selected>Best Motor Response </option> <option value='1'>No Response</option> <option value='2'>Abnormal Extension (Decerebrate)</option> <option value='3'>Abnormal Flexion (Decorticate)</option> <option value='4'>Flexion withdrawal from pain</option> <option value='5'>Moves to localized pain</option> <option value='6'>Obeys Commands</option> </select> </div> <br> <div><label>Dependency</label> <select name="Dependency"> <option value='' disabled selected>Dependency </option> <option value='Independent'>Independent</option> <option value='Partially Dependent'>Partially Dependent</option> <option value='Completely Dependent'>Completely Dependent </option> </select> </div> <div> <label>Mode of Movement </label> <select name="Modn"> <?php $sql ="SELECT * FROM patient WHERE patientid='$_GET[patientid]'"; $qsql = mysqli_query($con,$sql); while($rpm = mysqli_fetch_array($qsql)) { $a =$rpm['Modn']; if(is_null($a)) { echo " <option value='' disabled selected>Mode of Movement </option> <option value='Self'>Self</option> <option value='Ambulatory'>Ambulatory</option> <option value='Wheel chair'>Wheel chair</option> <option value='Stretcher'>Stretcher </option> <option value='Physical Support'>Physical Support </option> "; } else{ echo " <option value='$rpm[Modn]' disabled selected> $rpm[Modn] </option> <option value='Self'>Self</option> <option value='Ambulatory'>Ambulatory</option> <option value='Wheel chair'>Wheel chair</option> <option value='Stretcher'>Stretcher </option> <option value='Physical Support'>Physical Support </option> "; } } ?> </select> </div><div> <label for="item">Pain Assessment<span>*</span> <select name='Pain_Assessment'> <option value='' disabled selected>Pain Assessment</option> <option value='1'>1</option> <option value='2'>2</option> <option value='3'>3</option> <option value='4'>4</option> <option value='5'>5</option> <option value='6'>6</option> <option value='7'>7</option> <option value='8'>8</option> <option value='9'>9</option> <option value='10'>10</option> </select> </div> <label>Location</label><select name="Pain_Location"> <option value='' disabled selected>Pain Location</option> <option value="Head">Head</option> <option value="forehead">forehead</option> <option value="Eyes">Eyes</option> <option value="Ear">Ear</option> <option value="Mouth">Mouth</option> <option value="cheek">cheek</option> <option value="chin">chin</option> <option value="Neck">Neck</option> <option value="Adam apple">Adam apple</option> <option value="Face">Face</option> <option value="Shoulder">Shoulder</option> <option value="Arm">Arm</option> <option value="elbow">elbow</option> <option value="forearm">forearm</option> <option value="wrist">wrist</option> <option value="palm">palm</option> <option value="fingers">fingers</option> <option value="Back">Back</option> <option value="Chest">Chest</option> <option value="Stomach">Stomach</option> <option value="umbilicus">umbilicus</option> <option value="abdomen">abdomen</option> <option value="groin">groin</option> <option value="hips">hips</option> <option value="penis-vagina">penis-vagina</option> <option value="leg">leg</option> <option value="thigh">thigh</option> <option value="knee">knee</option> <option value="calf">calf</option> <option value="ankle">ankle</option> <option value="foot">foot</option> <option value="toes">toes</option> <option value="Other">Other</option> </select> <p align='right'><input type="button" style='height:40px;width:100px' onclick="myFunction21jul('Demo1')" value="Add Row"></p> <p1 id="Demo1" class="w3-container w3-hide"> <label>Location</label><select name="Pain_Location1"> <option value='' disabled selected>Pain Location</option> <option value="Head">Head</option> <option value="forehead">forehead</option> <option value="Eyes">Eyes</option> <option value="Ear">Ear</option> <option value="Mouth">Mouth</option> <option value="cheek">cheek</option> <option value="chin">chin</option> <option value="Neck">Neck</option> <option value="Adam apple">Adam apple</option> <option value="Face">Face</option> <option value="Shoulder">Shoulder</option> <option value="Arm">Arm</option> <option value="elbow">elbow</option> <option value="forearm">forearm</option> <option value="wrist">wrist</option> <option value="palm">palm</option> <option value="fingers">fingers</option> <option value="Back">Back</option> <option value="Chest">Chest</option> <option value="Stomach">Stomach</option> <option value="umbilicus">umbilicus</option> <option value="abdomen">abdomen</option> <option value="groin">groin</option> <option value="hips">hips</option> <option value="penis-vagina">penis-vagina</option> <option value="leg">leg</option> <option value="thigh">thigh</option> <option value="knee">knee</option> <option value="calf">calf</option> <option value="ankle">ankle</option> <option value="foot">foot</option> <option value="toes">toes</option> <option value="Other">Other</option> </select> <p align='right'><input type="button" style='height:40px;width:100px' onclick="myFunction21jul('Demo2')" value="Add Row"></p> </p1> <p2 id="Demo2" class="w3-container w3-hide"> <label>Location</label><select name="Pain_Location2"> <option value='' disabled selected>Pain Location</option> <option value="Head">Head</option> <option value="forehead">forehead</option> <option value="Eyes">Eyes</option> <option value="Ear">Ear</option> <option value="Mouth">Mouth</option> <option value="cheek">cheek</option> <option value="chin">chin</option> <option value="Neck">Neck</option> <option value="Adam apple">Adam apple</option> <option value="Face">Face</option> <option value="Shoulder">Shoulder</option> <option value="Arm">Arm</option> <option value="elbow">elbow</option> <option value="forearm">forearm</option> <option value="wrist">wrist</option> <option value="palm">palm</option> <option value="fingers">fingers</option> <option value="Back">Back</option> <option value="Chest">Chest</option> <option value="Stomach">Stomach</option> <option value="umbilicus">umbilicus</option> <option value="abdomen">abdomen</option> <option value="groin">groin</option> <option value="hips">hips</option> <option value="penis-vagina">penis-vagina</option> <option value="leg">leg</option> <option value="thigh">thigh</option> <option value="knee">knee</option> <option value="calf">calf</option> <option value="ankle">ankle</option> <option value="foot">foot</option> <option value="toes">toes</option> <option value="Other">Other</option> </select> <p align='right'><input type="button" style='height:40px;width:100px' onclick="myFunction21jul('Demo3')" value="Add Row"></p> </p2> <p3 id="Demo3" class="w3-container w3-hide"> <label>Location</label><select name="Pain_Location3"> <option value='' disabled selected>Pain Location</option> <option value="Head">Head</option> <option value="forehead">forehead</option> <option value="Eyes">Eyes</option> <option value="Ear">Ear</option> <option value="Mouth">Mouth</option> <option value="cheek">cheek</option> <option value="chin">chin</option> <option value="Neck">Neck</option> <option value="Adam apple">Adam apple</option> <option value="Face">Face</option> <option value="Shoulder">Shoulder</option> <option value="Arm">Arm</option> <option value="elbow">elbow</option> <option value="forearm">forearm</option> <option value="wrist">wrist</option> <option value="palm">palm</option> <option value="fingers">fingers</option> <option value="Back">Back</option> <option value="Chest">Chest</option> <option value="Stomach">Stomach</option> <option value="umbilicus">umbilicus</option> <option value="abdomen">abdomen</option> <option value="groin">groin</option> <option value="hips">hips</option> <option value="penis-vagina">penis-vagina</option> <option value="leg">leg</option> <option value="thigh">thigh</option> <option value="knee">knee</option> <option value="calf">calf</option> <option value="ankle">ankle</option> <option value="foot">foot</option> <option value="toes">toes</option> <option value="Other">Other</option> </select> <p align='right'><input type="button" style='height:40px;width:100px' onclick="myFunction21jul('Demo4')" value="Add Row"></p> </p3> <p3 id="Demo4" class="w3-container w3-hide"> <label>Location</label><select name="Pain_Location4"> <option value='' disabled selected>Pain Location</option> <option value="Head">Head</option> <option value="forehead">forehead</option> <option value="Eyes">Eyes</option> <option value="Ear">Ear</option> <option value="Mouth">Mouth</option> <option value="cheek">cheek</option> <option value="chin">chin</option> <option value="Neck">Neck</option> <option value="Adam apple">Adam apple</option> <option value="Face">Face</option> <option value="Shoulder">Shoulder</option> <option value="Arm">Arm</option> <option value="elbow">elbow</option> <option value="forearm">forearm</option> <option value="wrist">wrist</option> <option value="palm">palm</option> <option value="fingers">fingers</option> <option value="Back">Back</option> <option value="Chest">Chest</option> <option value="Stomach">Stomach</option> <option value="umbilicus">umbilicus</option> <option value="abdomen">abdomen</option> <option value="groin">groin</option> <option value="hips">hips</option> <option value="penis-vagina">penis-vagina</option> <option value="leg">leg</option> <option value="thigh">thigh</option> <option value="knee">knee</option> <option value="calf">calf</option> <option value="ankle">ankle</option> <option value="foot">foot</option> <option value="toes">toes</option> <option value="Other">Other</option> </select> <p align='right'><input type="button" style='height:40px;width:100px' onclick="myFunction21jul('Demo5')" value="Add Row"></p> </p3> <p3 id="Demo5" class="w3-container w3-hide"> <label>Location</label><select name="Pain_Location5"> <option value='' disabled selected>Pain Location</option> <option value="Head">Head</option> <option value="forehead">forehead</option> <option value="Eyes">Eyes</option> <option value="Ear">Ear</option> <option value="Mouth">Mouth</option> <option value="cheek">cheek</option> <option value="chin">chin</option> <option value="Neck">Neck</option> <option value="Adam apple">Adam apple</option> <option value="Face">Face</option> <option value="Shoulder">Shoulder</option> <option value="Arm">Arm</option> <option value="elbow">elbow</option> <option value="forearm">forearm</option> <option value="wrist">wrist</option> <option value="palm">palm</option> <option value="fingers">fingers</option> <option value="Back">Back</option> <option value="Chest">Chest</option> <option value="Stomach">Stomach</option> <option value="umbilicus">umbilicus</option> <option value="abdomen">abdomen</option> <option value="groin">groin</option> <option value="hips">hips</option> <option value="penis-vagina">penis-vagina</option> <option value="leg">leg</option> <option value="thigh">thigh</option> <option value="knee">knee</option> <option value="calf">calf</option> <option value="ankle">ankle</option> <option value="foot">foot</option> <option value="toes">toes</option> <option value="Other">Other</option> </select> </p3> <br> <div class='Other box'> <input type='text' name='other_pain_location' placeholder='Other Pain Location'> </div> <br> <div class="checkbox"> <input name="fall_risk" type="checkbox" id="myCheck1030" onclick="myFunction1030()"><span>Fall Risk </span> </div> <div id="text1030" style="display:none"> <table id="example2" class="table table-bordered table-hover"> <tr><td> <span style="font-size: 20px"> Low fall risk </span></h3></td><td><label class="switch"> <input name="low_fall_risk" id="myCheck1031" onclick="myFunction1031()" type="checkbox"> <span class="slider"></span> </label> </td> </tr> <tr><td> <span style="font-size: 20px">High fall risk</span></h3></td><td><label class="switch"> <input name="high_fall_risk" type="checkbox" id="myCheck1032" onclick="myFunction1032()" type="checkbox"> <span class="slider"></span> </label> </td> </tr> </table> </div> <div id="text1031" style="display:none"> <table id="example2" class="table table-bordered table-hover"> <tr><td> <span style="font-size: 20px"> Implement low fall risk interventions as per protocol</span></h3></td><td><label class="switch"> <input name="implement_low" type="checkbox"> <span class="slider"></span> </label> </td> </tr> <tr><td> <span style="font-size: 20px">Complete paralysis or completely immobilized </span></h3></td><td><label class="switch"> <input name="Complete_paralysis" type="checkbox"> <span class="slider"></span> </label> </td> </tr> </table> </div> <div id="text1032" style="display:none"> <table id="example2" class="table table-bordered table-hover"> <tr><td> <span style="font-size: 20px">History of more than one fall within 6 months before admission </span></h3></td><td><label class="switch"> <input name="History_more" type="checkbox"> <span class="slider"></span> </label> </td> </tr> <tr><td> <span style="font-size: 20px">Patient has experienced a fall during the hospitalization </span></h3></td><td><label class="switch"> <input name="Patient_experienced" type="checkbox"> <span class="slider"></span> </label> </td> </tr> <tr><td> <span style="font-size: 20px">Patient is deemed high fall-risk per protocol such as seizure precaution </span></h3></td><td><label class="switch"> <input name="deemed_high" type="checkbox"> <span class="slider"></span> </label> </td> </tr> </table> </div> <?php session_start(); require_once('../LoginManager.php'); require_once('../DBManager.php'); $sql ="SELECT * FROM addaspatient WHERE prescriptionid='$_GET[prescriptionid]' AND patientid='$_GET[patientid]'"; $qsql = mysqli_query($con,$sql); if($rs = mysqli_fetch_array($qsql)) { if(Pregnancy==$rs[casetype]) { ?> <div id="mmenu"> <div class="checkbox"> <input type="checkbox" name="Safe_childbirth_checklist" id="myCheck102" onclick="myFunction102()"><span>Safe Childbirth Checklist </span> </div> <div id="text102" style="display:none" > <div class="checkbox"> <h3 align="center">Safe Childbirth Checklist </h3> <p> <h4>Does mother need referral</h4> <p><input type="radio" value= "NO" name="mother_need_referral"><span>No </span></P> <p><input type="radio" value= "Yes, organized" name="mother_need_referral"><span>Yes, organized </span></P> </div> <div class="checkbox"> <h4>Partograph started? </h4> <p><input type="radio" value= "No will start when greater than 4cm" name="Partograph_started"><span>No, will start when ≥4cm </span></P> <p><input type="radio" value= "yes" name="Partograph_started"><span>Yes</span></P> </div> <div class="checkbox"> <h4>Does mother need to start: Antibiotics? </h4> <p><input type="radio" value= "No" name="start_Antibiotics"><span>No</span></P> <p><input type="radio" value= "Yes given" name="start_Antibiotics"><span>Yes Given</span></P> </div> <div class="checkbox"> <h4>Magnesium sulfate and antihypertensive treatment?</h4> <p><input type="radio" value= "No" name="antihypertensive_treatment"><span>No</span></P> <p><input type="radio" value="Yes, magnesium sulfate given" name="antihypertensive_treatment"><span>Yes, magnesium sulfate given</span></P> <p><input type="radio" value="Yes, antihypertensive medication given" name="antihypertensive_treatment"><span>Yes, antihypertensive medication given</span></P> </div> <div class="checkbox"> <h4>Confirm supplies are available to clean hands and wear gloves for each vaginal exam </h4> <p><input type="radio" value= "Available" name="vaginal_exam"><span>Available </span></P> <p><input type="radio" value= "Unavailable" name="vaginal_exam"><span>Unavailable </span></P> </div> <div class="checkbox"> <h4>Encourage birth companion to be present at birth</h4> <p><input type="radio" value= "Yes" name="present_at_birth"><span>Yes</span></P> <p><input type="radio" value= "No" name="present_at_birth"><span>No </span></P> </div> <div class="checkbox"> <h4>Confirm that mother or companion will call for help during labour if needed </h4> <p><input type="radio" value= "Yes" name="labour_needed"><span>Yes</span></P> <p><input type="radio" value= "No" name="labour_needed"><span>No </span></P> </div> </div> </div> <?php } } ?> <input type="submit" name="Vulnerability" value="Submit"> </form> </div>