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<?php session_start();
require_once("../patientmanager.php");
require_once("../DBManager.php");
include 'header.php';
include 'dashboarddocument.php';
if(isset($_POST['signup']))
{
PatientManager::admissionpatient("$_POST[patientid]","$_POST[Type_of_Admission]","$_POST[Reason_for_Admission]","$_POST[MLC]","$_POST[MLC_No]","$_POST[Upload_MLC_Slip]","$_POST[Information_Obtained_from]","$_POST[General_Consent_Signed]","$_POST[Upload_Consent]","$_POST[ID_Band_tied]","$_POST[Wt]","$_POST[SPo2]","$_POST[RBS]","$_POST[Temp]","$_POST[pulse]","$_POST[BP]","$_POST[Pain_Assessment]","$_POST[Chief_Complain]","$_POST[Admitted_Under]","$_POST[enteredby]");
}
?>
<!DOCTYPE html>
<html lang="en">
<head>
<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:;
}
</style>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="https://www.w3schools.com/w3css/4/w3.css">
<title>Eye | Request for Admission</title>
<script>
function myFunction() {
var checkBox = document.getElementById("myCheck");
var text = document.getElementById("text");
if (checkBox.checked == true){
text.style.display = "block";
} else {
text.style.display = "none";
}
}
function myFunction2() {
var checkBox = document.getElementById("myCheck2");
var text = document.getElementById("text2");
if (checkBox.checked == true){
text.style.display = "block";
} else {
text.style.display = "none";
}
}
function myFunction3() {
var checkBox = document.getElementById("myCheck3");
var text = document.getElementById("text3");
if (checkBox.checked == true){
text.style.display = "block";
} else {
text.style.display = "none";
}
}
function myFunction9() {
var checkBox = document.getElementById("myCheck9");
var text = document.getElementById("text9");
if (checkBox.checked == true){
text.style.display = "block";
} else {
text.style.display = "none";
}
}
function myFunction4() {
var checkBox = document.getElementById("myCheck4");
var text = document.getElementById("text4");
if (checkBox.checked == true){
text.style.display = "block";
} else {
text.style.display = "none";
}
}
function myFunction10() {
var checkBox = document.getElementById("myCheck10");
var text = document.getElementById("text10");
if (checkBox.checked == true){
text.style.display = "block";
} else {
text.style.display = "none";
}
}
</script>
</head>
<body>
<div class="content-wrapper">
<!-- Content Header (Page header) -->
<section class="content-header">
<form name="signup" method="post" >
<fieldset>
<h3 align="center">Request for Admission </h3>
<?php
$sql ="SELECT * FROM Request_for_Admission WHERE patient='patientid'";
$qsql = mysqli_query($con,$sql);
while($rs = mysqli_fetch_array($qsql))
{
echo "
<div><label for='item'>Hospital name<span></span></label><input type='text' value='rs[patientid]' name='patientid'>
</div>
";
}
?>
<div><label for="item">Type of Admission<span>*</span>
<select name='Type_of_Admission'>
<option value='' disabled selected>Type of Admission</option>
<option value='First Time '>First Time </option>
<option value='Continuation of Treatment'>Continuation of Treatment</option>
<option value='Supportive Therapy'>Supportive Therapy</option>
</select>
</div>
<div> <label for="item">Reason for Admission<span>*</span> <select name='Reason_for_Admission'>
<option value='' disabled selected>Reason for Admission</option>
<option value='Emergency'>Emergency </option>
<option value='Observation'>Observation</option>
</select>
</div>
<div class="checkbox">
<input type="checkbox" name="MLC" id="myCheck3" onclick="myFunction3()"><span>MLC </span>
</div>
<div id="text3" style="display:none" >
<div> <label for="item">MLC No<span>*</span><input name="MLC_No" type="text">
</div>
<div> <label for="item">Upload MLC Slip<span>*</span><input name="Upload_MLC_Slip" type="file">
</div>
</div>
<div class="checkbox">
<input type="checkbox" name="Trauma" id="myCheck4" onclick="myFunction4()"><span>Trauma </span>
</div>
<div id="text4" style="display:none" >
<div class="checkbox">
<h3 align="center">Trauma Care Checklist</h3>
<p>
<h4 align="center">Immediately after primary & secondary surveys</h4>
<label>Is Further Airway Intervention Needed?</label>
<p><input type="radio" value= "yes" name="further"><span>Yes </span></P>
<p><input type="radio" value= "noo" name="further"><span>No </span></P>
</div><div class="checkbox">
<p>
<label>Is There A Tension Pneumo-Haemothorax ?</label>
<p><input type="radio" value= "yes" name="Pneumo_Haemothorax"><span>Yes, Chest Drain Placed</P>
<p><input type="radio" value= "noo" name="Pneumo_Haemothorax"><span>No </span></P>
</div>
<div class="checkbox">
<p>
<label>IS The Pulse and Fluids Started ?</label>
<p><input type="radio" value= "yes" name="Fluids_Started"><span>Yes</P>
<p><input type="radio" value= "noo" name="Fluids_Started"><span>Not Available </span></P>
</div>
<div class="checkbox">
<p>
<label>Large-bore IV placed and fluids started </label>
<p><input type="radio" value= "yes" name="fluids_started"><span>Yes</P>
<p><input type="radio" value= "yes" name="fluids_started"><span>Not indicated</P>
<p><input type="radio" value= "noo" name="fluids_started"><span>Not Available </span></P>
</div>
<div class="checkbox">
<p>
<label>Full Survey For (and control of)External bleeding, Including : </label>
<p><input type="radio" value= "yes" name="further"><span>Scalp</P>
<p><input type="radio" value= "Perineum" name="further"><span>Perineum</P>
<p><input type="radio" value= "Back" name="further"><span>Back </span></P>
</div>
<div class="checkbox">
<p>
<label>Assessed For Pelvic Fracture by: </label>
<p><input type="radio" value= "Exam" name="further"><span>Exam</P>
<p><input type="radio" value= "X-ray" name="further"><span>X-ray</P>
<p><input type="radio" value= "CT" name="further"><span>CT</span></P>
</div>
<div class="checkbox">
<p>
<label>Assessed For Internal Bleeding By: </label>
<p><input type="radio" value= "Exam" name="further"><span>Exam</P>
<p><input type="radio" value= "Ultrasound" name="further"><span>Ultrasound</P>
<p><input type="radio" value= "CT" name="further"><span>CT</span></P>
<p><input type="radio" value= "Peritoneal lavage" name="further"><span>Peritoneal lavage</span></P>
</div>
<div class="checkbox">
<p>
<label>Is Spinal Immobilization Needed? </label>
<p><input type="radio" value= "Yes,Done" name="further"><span>Yes,Done</P>
<p><input type="radio" value= "Not Indicated" name="further"><span>Not Indicated</P>
</div>
<div class="checkbox">
<p>
<label>Neurovascular Status of all 4 limbs Checked? </label>
<p><input type="radio" value= "Yes" name="further"><span>Yes</P>
<p><input type="radio" value= "Not Indicated" name="further"><span>Not Indicated</P>
</div>
</P>
<div class="checkbox">
<p>
<label>IS the patient Hypothermic? </label>
<p><input type="radio" value= "Yes Done" name="Hypothermic"><span>Yes, Warming </P>
<p><input type="radio" value= "Not Indicated" name="Hypothermic"><span>No</P>
</div>
</p>
<div class="checkbox">
<p>
<label>Does the Patient Need(if no contraindication) </label>
<p><input type="radio" value= "Yes,Done" name="contraindication3"><span>Urinary Catheter </P>
<p><input type="radio" value= "Nasogastric Tube" name="contraindication2"><span>Nasogastric Tube</P>
<p><input type="radio" value= "chest drain" name="contraindication1"><span>Chest Drain</P>
<p><input type="radio" value= "None Indicated" name="contraindication"><span>None Indicated</P>
</div>
<H3 align="center">Before team leaves patient</H3>
<div class="checkbox">
<p>
<label>Has the Patient been Given </label>
<p><input type="radio" value= "Tetanus Vaccine" name="contraindication"><span>Tetanus Vaccine </P>
<p><input type="radio" value= "Analgesics" name="contraindication"><span>Analgesics</P>
<p><input type="radio" value= "Antibiotics" name="contraindication"><span>Antibiotics</P>
<p><input type="radio" value= "None Indicated" name="contraindication"><span>None Indicated</P>
</div>
<div class="checkbox">
<p>
<label>Have All tests and imaging been Reviewed </label>
<p><input type="radio" value= "Yes" name="contraindication"><span>Yes</P>
<p><input type="radio" value= "No, Follow-up Plan in Place" name="contraindication"><span>No, Follow-up Plan in Place</P>
</div>
<div class="checkbox">
<p>
<label>Which serial Examinations Are Needed </label>
<p><input type="radio" value= "Neurological" name="Examinations"><span>Neurological</P>
<p><input type="radio" value= "Abdominal" name="Examinations"><span>Abdominal</P>
<p><input type="radio" value= "vascular" name="Examinations"><span>Vascular</P>
<p><input type="radio" value= "None" name="Examinations"><span>None</P>
</div>
<div class="checkbox">
<p>
<label>Plan of care discussed with: </label>
<p><input type="radio" value= "Patient/Family" name="Examinations"><span>Patient/Family</P>
<p><input type="radio" value= "Receiving Unit" name="Examinations"><span>Receiving Unit</P>
<p><input type="radio" value= "Primary team" name="Examinations"><span>Primary team</P>
<p><input type="radio" value= "None" name="Examinations"><span>Other Specialists</P>
</div>
<div class="checkbox">
<p>
<label>Relevant Trauma Chart or Form Comleted? </label>
<p><input type="radio" value= "Patient/Family" name="Examinations"><span>Patient/Family</P>
<p><input type="radio" value= "Not Available" name="Examinations"><span>Not Available</P>
</div>
<div> <label for="item">Trauma MLC Slip<span>*</span><input name="Upload_MLC_Slip" type="file">
</div>
</div>
<div class="checkbox">
<input type="checkbox" name="Covid" id="myCheck10" onclick="myFunction10()"><span>Covid 19 Checklist </span>
</div>
<div id="text10" style="display:none" >
<table id="example2" class="table table-bordered table-hover">
<tr><td>
<span style="font-size: 20px">Fever </span></h3></td><td><label class="switch">
<input name="Fever" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td><span style="font-size: 20px">Loss of Smell</span></h3></td><td><label class="switch">
<input name="smell" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td><span style="font-size: 20px">Diarrhoea </span></h3></td><td><label class="switch">
<input name="Diarrhoea" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td><span style="font-size: 20px">Facial Deformity</span></h3></td><td><label class="switch">
<input name="Deformity" type="checkbox">
<span class="slider"></span>
</label>
</td>
</tr>
<tr><td>
<span style="font-size: 20px">Cough </span></h3></td><td><label class="switch">
<input name="Cough" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td><span style="font-size: 20px">Loss of Taste</span></h3></td><td><label class="switch">
<input name="Taste" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td><span style="font-size: 20px">Weakness </span></h3></td><td><label class="switch">
<input name="Weakness" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td>
</td>
<td>
</td>
</tr>
<tr><td>
<span style="font-size: 20px">Breathlessness </span></h3></td><td><label class="switch">
<input name="Breathlessness" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td><span style="font-size: 20px">Loss of Appetite</span></h3></td><td><label class="switch">
<input name="Appetite" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td><span style="font-size: 20px">Power Loss in Limbs </span></h3></td><td><label class="switch">
<input name="Limbs" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td>
</td>
<td>
</td>
</tr>
<tr><td>
<span style="font-size: 20px">Sore Throat </span></h3></td><td><label class="switch">
<input name="Throat" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td><span style="font-size: 20px">Vomitting</span></h3></td><td><label class="switch">
<input name="Vomitting" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td><span style="font-size: 20px">Slurred Voice </span></h3></td><td><label class="switch">
<input name="Limbs" type="checkbox">
<span class="slider"></span>
</label>
</td>
<td>
</td>
<td>
</td>
</tr>
</table>
</div>
<div> <label for="item">Information Obtained from <span>*</span><select name='Information_Obtained_from'>
<option value='' disabled selected>Information Obtained from</option>
<option value='Patient'>Patient</option>
<option value='Family'>Family</option>
<option value='Old Chart'>Old Chart</option>
<option value='Other'>Other</option>
</select>
</div>
<div class="checkbox">
<input type="checkbox" name="Trauma" id="myCheck4" onclick="myFunction4()"><span>General Consent Signed </span>
</div>
<div id="text4" style="display:none">
<label>Upload Consent</label>
<input type="file" name='uploadconsent'>
<label>Download consent format </label>
<button value="Download consent format">Download consent format </button>
</div>
<div class="checkbox"> <input name="ID_Band_tied" type="checkbox"><span>Patient Identification Band tied</span>
</div>
<div class="checkbox"> <input name="ID_Band_tied" type="checkbox"><span>Patient Rights & Responsibilities explained </span>
</div>
<div class="checkbox"> <input name="ID_Band_tied" type="checkbox"><span>Patient Made aware of surroundings and safety measures</span>
</div>
<div><input type="button" onclick="myFunction('Demo1')" value="Medical Condition"></div>
<div id="Demo1" class="w3-container w3-hide">
<table id="example2" class="table table-bordered table-hover">
<thead>
<tr>
<div class='card-header d-flex p-0'>
<ul class='nav nav-pills ml-auto p-2'>
<th><strong>Medical Condition</strong></th>
<th><strong>Status</strong></th>
<th><strong>Edit</strong></th>
</tr>
</thead>
<?php
$sql ="SELECT * FROM medi_condition_final WHERE patientid='patientid]'";
$qsql = mysqli_query($con,$sql);
while($rs = mysqli_fetch_array($qsql))
{
echo " <tbody>
<tr> <td> $rs[medicalcon]</td>
<td> $rs[Status]</td>
<td><a href='edit_medicalcon.php?patientid=$rs[patientid]&medicalcoid=$rs[medicalcoid]'>Edit</a></td>
</tr>
";
}
?> </tr>
</thead>
</tbody>
<tfoot>
</tfoot>
</table>
<script>
function myFunction(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", "");
}
}
</script>
<button style="height:40px;width:100px"><a href="medicalcon_nurse.php">Add More</a></button> <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">
<option value="" disabled selected>Mode of Movement </option>
<option value="Independent">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>Level of Consciousness </label>
<select name="Level">
<option value="" disabled selected>Level of Consciousness </option>
<option value="Conscious">Conscious</option>
<option value="Semi Conscious">Semi Conscious</option>
<option value="Un-conscious ">Un-conscious </option>
</select>
</div></div><br>
<div><input type="button" onclick="harila('Demo')" value="Known Allergies"></div>
<div id="Demo" class="w3-container w3-hide">
<table id="example2" class="table table-bordered table-hover">
<thead>
<tr>
<div class='card-header d-flex p-0'>
<ul class='nav nav-pills ml-auto p-2'>
<th><strong>Allergies</strong></th>
<th><strong>Category</strong></th>
<th><strong>Edit</strong></th>
</tr>
</thead>
<?php
$sql ="SELECT * FROM allergy WHERE patientid='GET[patientid]'";
$qsql = mysqli_query($con,$sql);
while($rs = mysqli_fetch_array($qsql))
{
echo " <tbody>
<tr> <td> $rs[Allergen]</td>
<td> $rs[Category]</td>
<td><a href='edit_alg.php?patientid=$rs[patientid]&medicalcoid=$rs[medicalcoid]'>Edit</a></td>
</tr>
";
}
?> </tr>
</thead>
</tbody>
<tfoot>
</tfoot>
</table> <button style="height:40px;width:100px"><a href="Allergies.php">Add More</a></button>
</div>
<script>
function harila(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", "");
}
}
</script>
<br><div>
<input type="button" onclick="vitals('Demo3')" value="Vitals"></div>
<div id="Demo3" class="w3-container w3-hide">
<table id="example2" class="table table-bordered table-hover">
<thead>
<tr>
<div class='account-details'>
<tr>
<tr><td style="width:50%"><label><h4 align="center">Vitals</h2></label></td><td style="width:50%"><label><h4 align="center">Range</h2></label></td></tr>
<tr><td style="width:29%"><div><h5>Weight : </h5> </td></div><td style="width:46%"><div><input name="Wt" placeholder="In KG" type="text"></div></td></tr>
<td><div><h5>SPo2 : </h5> </td></div><td><div><input name="SPo2" placeholder="Oxygen saturation" type="text"></div></td></tr>
<tr><td><div><h5>RBS : </h5> </td></div><td><div><input placeholder="mg/dl" name="RBS" type="text"></div></td></tr>
<tr><td><div><h5>Temperature: </h5> </td></div><td><div><input placeholder="째C" name="Temp" type="text"></div></td></tr>
<tr><td><div><h5>Blood Pressure: </h5> </td></div><td><div><input placeholder="mmHg" name="BP" type="text"></div></td></tr>
</div>
</tr>
</tr>
</thead>
</tbody>
<tfoot>
</tfoot>
</table>
</div> <script>
function vitals(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", "");
}
}
</script>
<br>
<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>
<h4 align="center">Chief Complain</h4>
<table id="example2" class="table table-bordered table-hover">
<tr><td>
<span style="font-size: 20px">Ocular Alignment & motility </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
<td>
<span style="font-size: 20px">Lid/Adenexae </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
</tr>
<tr><td>
<span style="font-size: 20px">Sciera </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
<td>
<span style="font-size: 20px">Conjunctiva </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
</tr>
<tr><td>
<span style="font-size: 20px">Cornea </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
<td>
<span style="font-size: 20px">Anterior Chamber </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
</tr>
<tr><td>
<span style="font-size: 20px">IRS/NVI/PXF </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
<td>
<span style="font-size: 20px">Pupil </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
</tr>
<tr><td>
<span style="font-size: 20px">Lens/IOL </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
<td>
<span style="font-size: 20px">Cataract </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
</tr>
<tr><td>
<span style="font-size: 20px">Subluxated </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
<td>
<span style="font-size: 20px">Dislocated </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
</tr>
<tr><td>
<span style="font-size: 20px">Posterior Capsule </span></h3></td><td><label class="switch">
<input type="checkbox">
<span class="slider"></span>
</label>
</td>
</tr>
</table>
<label>Note </label>
<textarea id="w3review" name="w3review" rows="2" cols="100"></textarea><div> <label for="item">Admitted Under<span>*</span><input name="Admitted_Under" type="text">
</div>
<div> <label for="item">Attending Nurse<span>*</span>
<select " name="Attending_Nurse" id="select2">
<option value="">Attending Nurse</option>
<?php
$sqldoctor= "SELECT * FROM Nurse WHERE Nurseid='$_GET[Nurseid]'";
$qsqldoctor = mysqli_query($con,$sqldoctor);
while($rsdoctor = mysqli_fetch_array($qsqldoctor))
{
if($rsdoctor[Nurseid] == $rsedit[Nurseid])
{
echo "<option value='$rsdoctor[Nurseid]' selected>$rsdoctor[Nurseid]-$rsdoctor[Name]</option>";
}
else
{
echo "<option value='rsdoctor[Nurseid]'>$rsdoctor[Name]</option>";
}
}
?>
</select>
</div>
<input type="submit" name="signup" value="Submit">
</div>
</form>
</body>
</html>