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<?php session_start();
require_once('../DBManager.php');
require_once('../LoginManager.php');
include 'header.php';
include 'dashboarddocument.php';
//Code for Registration
if(isset($_POST['signup']))
{
$updated_at=date("F d, Y / h:i:s A");
$sql ="UPDATE trauma_checklist SET further='$_POST[further]', Pneumo_Haemothorax='$_POST[Pneumo_Haemothorax]',Fluids_Started='$_POST[Fluids_Started]',iv_fluids_started='$_POST[iv_fluids_started]',Full_Survey='$_POST[Full_Survey]',Perineum='$_POST[Perineum]',Back='$_POST[Back]',Pelvic_Fracture='$_POST[Pelvic_Fracture]',Internal_Bleeding='$_POST[Internal_Bleeding]',Ultrasound='$_POST[Ultrasound]',CT='$_POST[CT]',Peritoneal='$_POST[Peritoneal]',Spinal_Immobilization='$_POST[Spinal_Immobilization]',Neurovascular_Status='$_POST[Neurovascular_Status]',Hypothermic='$_POST[Hypothermic]',contraindication='$_POST[contraindication]',Nasogastric_Tube='$_POST[Nasogastric_Tube]',Chest_Drain='$_POST[Chest_Drain]',None_Indicated='$_POST[None_Indicated]',leaves_patient='$_POST[leaves_patient]',Analgesics='$_POST[Analgesics]',Antibiotics='$_POST[Antibiotics]',None_Indicated2='$_POST[None_Indicated2]',tests_imaging='$_POST[tests_imaging]',Examinations='$_POST[Examinations]',Abdominal='$_POST[Abdominal]',vascular='$_POST[vascular]',care_discussed='$_POST[care_discussed]',Receiving_Unit='$_POST[Receiving_Unit]',Primary_team='$_POST[Primary_team]',Other_Specialists='$_POST[Other_Specialists]',Trauma_Chart='$_POST[Trauma_Chart]',Trauma_Slip='$_POST[Trauma_Slip]',created_at='$_POST[created_at]',updated_at='$updated_at' WHERE prescriptionid='$_GET[prescriptionid]' AND patientid='$_GET[patientid]'";
$sql1 ="UPDATE save_activity SET created_at='$_POST[created_at]',updated_at='$updated_at' WHERE prescriptionid='$_GET[prescriptionid]' AND userno='$_GET[patientid]' AND discription='Intial Assessment<br>Trauma Checklist<br>Doc.no-'";
if($qsql = mysqli_query($con,$sql))
{
if($qsql = mysqli_query($con,$sql1))
{
echo "<script>alert('Update successfully');</script><script>window.history.go(-2)</script>;</script>";
}
}else {
echo "Sorry, there was an error uploading your file.";
}
}
?>
<style>
.center {
border: 1px solid grey;
text-align:;
}
.center2 {
border: 5px solid grey;
text-align:;
}
</style>
<div class='center'>
<div class='content-wrapper'>
<form name="signup" method="post" enctype="multipart/form-data">
<div class='center'>
<ol order='1'><div class="checkbox">
<h3 align="center">Trauma Care Checklist</h3>
<h4 align="center">Immediately after primary & secondary surveys</h4>
<?php
$sql ="SELECT * FROM trauma_checklist WHERE prescriptionid='$_GET[prescriptionid]' AND patientid='$_GET[patientid]'";
$qsql = mysqli_query($con,$sql);
while($rs = mysqli_fetch_array($qsql))
{
echo"<table id='example2' class='table table-bordered table-hover'>
<tr><td width='50%'> Date & Time</td><td width='50%'> <input id='party' value='$rs[created_at]' type='datetime-local' name='created_at'
pattern='[0-9]{4}-[0-9]{2}-[0-9]{2}T[0-9]{2}:[0-9]{2}'></td></tr>
</table>";
if($rs[further] == 'Yes'){
echo"
<label><b><li>Is Further Airway Intervention Needed?</b></li></label>
<div class='checkbox'><input type='radio' value= 'Yes' name='further' checked><span> Yes </span></div>
<p><input type='radio' value= 'No' name='further'><span> No </span></P>
</div>
";
}
elseif($rs[further] == 'No')
{
echo"
<label><b><li>Is Further Airway Intervention Needed?</b></li></label>
<div class='checkbox'><input type='radio' value= 'yes' name='further'><span> Yes </span></div>
<p><input type='radio' value= 'NO' name='further' checked><span> No </span></P>
</div>
";
}
else
{
echo"
<label><b><li>Is Further Airway Intervention Needed?</b></li></label>
<div class='checkbox'><input type='radio' value= 'yes' name='further'><span> Yes </span></div>
<p><input type='radio' value= 'NO' name='further'><span> No </span></P>
</div>";
}
if($rs[Pneumo_Haemothorax] == 'Yes, Chest Drain Placed'){
echo"
<p>
<label><b><li>Is There A Tension Pneumo-Haemothorax ?</li></b></label>
<div class='checkbox'><input type='radio' value= 'Yes, Chest Drain Placed' name='Pneumo_Haemothorax' checked><span> Yes, Chest Drain Placed</P>
<p><input type='radio' value= 'No' name='Pneumo_Haemothorax'><span> No </span></P>
</div>
";
}
elseif($rs[Pneumo_Haemothorax] == 'No'){
echo"
<p>
<label><b><li>Is There A Tension Pneumo-Haemothorax ?</li></b></label>
<div class='checkbox'><input type='radio' value= 'Yes, Chest Drain Placed' name='Pneumo_Haemothorax' ><span> Yes, Chest Drain Placed</P>
<p><input type='radio' value= 'No' name='Pneumo_Haemothorax' checked><span> No </span></P>
</div>
";
}
else{
echo"
<p>
<label><b><li>Is There A Tension Pneumo-Haemothorax ?</li></b></label>
<div class='checkbox'><input type='radio' value= 'Yes, Chest Drain Placed' name='Pneumo_Haemothorax' ><span> Yes, Chest Drain Placed</P>
<p><input type='radio' value= 'No' name='Pneumo_Haemothorax'><span> No </span></P>
</div>
";
}
if($rs[Fluids_Started] == 'Yes'){
echo"
<div class='checkbox'>
<p>
<label><b><li>IS The Pulse and Fluids Started ?</label></b></li>
<p><input type='radio' value= 'Yes' name='Fluids_Started' checked><span> Yes</P>
<p><input type='radio' value= 'Not Available' name='Fluids_Started'><span> Not Available </span></P>
</div>
";
}
elseif($rs[Fluids_Started] == 'Not Available'){
echo"
<div class='checkbox'>
<p>
<label><b><li>IS The Pulse and Fluids Started ?</label></b></li>
<p><input type='radio' value= 'Yes' name='Fluids_Started' ><span> Yes</P>
<p><input type='radio' value= 'Not Available' name='Fluids_Started' checked><span> Not Available </span></P>
</div>
";
}
else{
echo"
<div class='checkbox'>
<p>
<label><b><li>IS The Pulse and Fluids Started ?</label></b></li>
<p><input type='radio' value= 'Yes' name='Fluids_Started'><span> Yes</P>
<p><input type='radio' value= 'Not Available' name='Fluids_Started'><span> Not Available </span></P>
</div>
";
}
if($rs[iv_fluids_started] == 'Yes'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Large-bore IV placed and fluids started </label></b></li>
<p><input type='radio' value= 'Yes' name='iv_fluids_started' checked><span> Yes</P>
<p><input type='radio' value= 'Not indicated' name='iv_fluids_started'><span> Not indicated</P>
<p><input type='radio' value= 'Not Available' name='iv_fluids_started'><span> Not Available </span></P>
</div>
";
}
elseif($rs[iv_fluids_started] == 'Not indicated'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Large-bore IV placed and fluids started </label></b></li>
<p><input type='radio' value= 'Yes' name='iv_fluids_started'><span> Yes</P>
<p><input type='radio' value= 'Not indicated' name='iv_fluids_started' checked><span> Not indicated</P>
<p><input type='radio' value= 'Not Available' name='iv_fluids_started'><span> Not Available </span></P>
</div>
";
}
elseif($rs[iv_fluids_started] == 'Not Available'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Large-bore IV placed and fluids started </label></b></li>
<p><input type='radio' value= 'Yes' name='iv_fluids_started'><span> Yes</P>
<p><input type='radio' value= 'Not indicated' name='iv_fluids_started' checked><span> Not indicated</P>
<p><input type='radio' value= 'Not Available' name='iv_fluids_started'><span> Not Available </span></P>
</div>
";
}
else{
echo"
<div class='checkbox'>
<p>
<label><b><li>Large-bore IV placed and fluids started </label></b></li>
<p><input type='radio' value= 'Yes' name='iv_fluids_started'><span> Yes</P>
<p><input type='radio' value= 'Not indicated' name='iv_fluids_started' ><span> Not indicated</P>
<p><input type='radio' value= 'Not Available' name='iv_fluids_started' checked><span> Not Available </span></P>
</div>
";
}
echo"<div class='checkbox'>
<p>
<label><b><li>Full Survey For (and control of)External bleeding, Including : </label></b></li>";
if($rs[Full_Survey] == 'Scalp'){
echo"
<p> <input type='checkbox' value= 'Scalp' name='Full_Survey' checked><span>Scalp</P>
";
}
else{
echo"
<p> <input type='checkbox' value= 'Scalp' name='Full_Survey' ><span>Scalp</P>
";
}
if($rs[Perineum] == 'Perineum'){
echo"
<p> <input type='checkbox' value= 'Perineum' name='Perineum' checked><span>Perineum</P>
";
}
else
{
echo" <p> <input type='checkbox' value= 'Perineum' name='Perineum' ><span>Perineum</P>
";
}
if($rs[Back] == 'Back'){
echo"
<p> <input type='checkbox' value= 'Back' name='Back' checked><span>Back </span></P>
";
}
else{
echo"
<p> <input type='checkbox' value= 'Back' name='Back'><span>Back </span></P>";
}
echo"
</div>
";
if($rs[Pelvic_Fracture] == 'Exam'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Assessed For Pelvic Fracture by: </label></b></li>
<p><input type='radio' value= 'Exam' name='Pelvic_Fracture' checked><span> Exam</P>
<p><input type='radio' value= 'X-ray' name='Pelvic_Fracture'><span> X-ray</P>
<p><input type='radio' value= 'CT' name='Pelvic_Fracture'><span> CT</span></P>
</div>
";
}
elseif($rs[Pelvic_Fracture] == 'X-ray'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Assessed For Pelvic Fracture by: </label></b></li>
<p><input type='radio' value= 'Exam' name='Pelvic_Fracture'><span> Exam</P>
<p><input type='radio' value= 'X-ray' name='Pelvic_Fracture' checked><span> X-ray</P>
<p><input type='radio' value= 'CT' name='Pelvic_Fracture'><span> CT</span></P>
</div>
";
}
elseif($rs[Pelvic_Fracture] == 'CT'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Assessed For Pelvic Fracture by: </label></b></li>
<p><input type='radio' value= 'Exam' name='Pelvic_Fracture'><span> Exam</P>
<p><input type='radio' value= 'X-ray' name='Pelvic_Fracture' checked><span> X-ray</P>
<p><input type='radio' value= 'CT' name='Pelvic_Fracture'><span> CT</span></P>
</div>
";
}
else
{
echo"
<div class='checkbox'>
<p>
<label><b><li>Assessed For Pelvic Fracture by: </label></b></li>
<p><input type='radio' value= 'Exam' name='Pelvic_Fracture'><span> Exam</P>
<p><input type='radio' value= 'X-ray' name='Pelvic_Fracture'><span> X-ray</P>
<p><input type='radio' value= 'CT' name='Pelvic_Fracture' checked><span> CT</span></P>
</div>
";
}
echo"<div class='checkbox'>
<p>
<label><b><li>Assessed For Internal Bleeding By: </label></b></li>";
if($rs[Internal_Bleeding] == 'Exam'){
echo"<p> <input type='checkbox' value= 'Exam' name='Internal_Bleeding'checked><span>Exam</P>
";
}
else{
echo"<p> <input type='checkbox' value= 'Exam' name='Internal_Bleeding' ><span>Exam</P>";
}
if($rs[Ultrasound] == 'Ultrasound'){
echo"
<p> <input type='checkbox' value= 'Ultrasound' name='Ultrasound' checked><span>Ultrasound</P>
";
}
else{
echo" <p> <input type='checkbox' value= 'Ultrasound' name='Ultrasound'><span>Ultrasound</P>";
}
if($rs[CT] == 'CT'){
echo"
<p> <input type='checkbox' value= 'CT' name='CT' checked><span>CT</span></P>
";
}
else{
echo" <p> <input type='checkbox' value= 'CT' name='CT'><span>CT</span></P>";
}
if($rs[Peritoneal] == 'Peritoneal lavage'){
echo"
<p> <input type='checkbox' value= 'Peritoneal lavage' name='Peritoneal' checked><span>Peritoneal lavage</span></P>
";
}
else{
echo"<p> <input type='checkbox' value= 'Peritoneal lavage' name='Peritoneal'><span>Peritoneal lavage</span></P>";
}
echo"
</div>
";
if($rs[Spinal_Immobilization] == 'Yes,Done'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Is Spinal Immobilization Needed? </label></b></li>
<p><input type='radio' value='Yes,Done' name='Spinal_Immobilization' checked><span> Yes,Done</P>
<p><input type='radio' value='Not Indicated' name='Spinal_Immobilization'><span> Not Indicated</P>
</div>";
}
elseif($rs[Spinal_Immobilization] == 'Not Indicated'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Is Spinal Immobilization Needed? </label></b></li>
<p><input type='radio' value='Yes,Done' name='Spinal_Immobilization' ><span> Yes,Done</P>
<p><input type='radio' value='Not Indicated' name='Spinal_Immobilization'checked><span> Not Indicated</P>
</div>
";
}
else
{
echo"
<div class='checkbox'>
<p>
<label><b><li>Is Spinal Immobilization Needed? </label></b></li>
<p><input type='radio' value='Yes,Done' name='Spinal_Immobilization' ><span> Yes,Done</P>
<p><input type='radio' value='Not Indicated' name='Spinal_Immobilization'><span> Not Indicated</P>
</div>
";
}
if($rs[Neurovascular_Status] == 'Yes'){
echo"<div class='checkbox'>
<p>
<label><b><li>Neurovascular Status of all 4 limbs Checked? </label></b></li>
<p><input type='radio' value='Yes' name='Neurovascular_Status' checked><span> Yes</P>
<p><input type='radio' value= 'Not Indicated' name='Neurovascular_Status'><span> Not Indicated</P>
</div>
";
}
elseif($rs[Neurovascular_Status] == 'Not Indicated'){
echo"<div class='checkbox'>
<p>
<label><b><li>Neurovascular Status of all 4 limbs Checked? </label></b></li>
<p><input type='radio' value='Yes' name='Neurovascular_Status' ><span> Yes</P>
<p><input type='radio' value= 'Not Indicated' name='Neurovascular_Status' checked><span> Not Indicated</P>
</div>
";
}
else{
echo"
<div class='checkbox'>
<p>
<label><b><li>Neurovascular Status of all 4 limbs Checked? </label></b></li>
<p><input type='radio' value='Yes' name='Neurovascular_Status' ><span> Yes</P>
<p><input type='radio' value= 'Not Indicated' name='Neurovascular_Status' ><span> Not Indicated</P>
</div>
";
}
if($rs[Hypothermic] == 'Yes, Warming'){
echo"
<div class='checkbox'>
<p>
<label><b><li>IS the patient Hypothermic? </label></b></li>
<p><input type='radio' value= 'Yes, Warming' name='Hypothermic' checked><span> Yes, Warming </P>
<p><input type='radio' value= 'Not Indicated' name='Hypothermic'><span> No</P>
</div>
";
}
elseif($rs[Hypothermic] == 'Not Indicated'){
echo"
<div class='checkbox'>
<p>
<label><b><li>IS the patient Hypothermic? </label></b></li>
<p><input type='radio' value= 'Yes Done' name='Hypothermic'><span> Yes, Warming </P>
<p><input type='radio' value= 'Not Indicated' name='Hypothermic' checked><span> No</P>
</div>
";
}
else
{
echo"
<div class='checkbox'>
<p>
<label><b><li>IS the patient Hypothermic? </label></b></li>
<p><input type='radio' value= 'Yes Done' name='Hypothermic'><span> Yes, Warming </P>
<p><input type='radio' value= 'Not Indicated' name='Hypothermic'><span> No</P>
</div>
";
}
echo"
<div class='checkbox'>
<p>
<label><b><li>Does the Patient Need(if no contraindication) </label></b></li>";
if($rs[contraindication] == 'Yes,Done'){
echo"
<p> <input type='checkbox' value= 'Yes,Done' name='contraindication' checked><span>Urinary Catheter </P>
";
}
else
{
echo"
<p> <input type='checkbox' value= 'Yes,Done' name='contraindication'><span>Urinary Catheter </P>";
}
if($rs[Nasogastric_Tube] == 'Nasogastric Tube'){
echo"
<p> <input type='checkbox' value= 'Nasogastric Tube' name='Nasogastric_Tube' checked><span>Nasogastric Tube</P>
";
}
else{
echo"<p> <input type='checkbox' value= 'Nasogastric Tube' name='Nasogastric_Tube' checked><span>Nasogastric Tube</P>";
}
if($rs[Chest_Drain] == 'chest drain'){
echo"<p> <input type='checkbox' value= 'chest drain' name='Chest_Drain' checked><span>Chest Drain</P>
";
}
else{
echo"<p> <input type='checkbox' value= 'chest drain' name='Chest_Drain'><span>Chest Drain</P>";
}
if($rs[None_Indicated] == 'None Indicated'){
echo"
<p> <input type='checkbox' value= 'None Indicated' name='None_Indicated' checked><span>None Indicated</P>
";
}
else{
echo"
<p> <input type='checkbox' value= 'None Indicated' name='None_Indicated' ><span>None Indicated</P>";
}
echo"</div>";
echo"
<div class='checkbox'>
<p>
<label><b><li>Has the Patient been Given </label></b></li>
";
if($rs[leaves_patient] == 'Tetanus Vaccine'){
echo"
<p> <input type='checkbox' value= 'Tetanus Vaccine' name='leaves_patient' checked><span>Tetanus Vaccine </P>
";
}
else{
echo"
<p> <input type='checkbox' value= 'Tetanus Vaccine' name='leaves_patient' ><span>Tetanus Vaccine </P>
";
}
if($rs[Analgesics] == 'Analgesics'){
echo"
<p> <input type='checkbox' value= 'Analgesics' name='Analgesics' checked><span>Analgesics</P>
";
}
else{
echo"
<p> <input type='checkbox' value= 'Analgesics' name='Analgesics'><span>Analgesics</P>
";
}
if($rs[Antibiotics] == 'Antibiotics'){
echo"
<p> <input type='checkbox' value= 'Antibiotics' name='Antibiotics' checked><span>Antibiotics</P>
";
}
else{
echo"
<p> <input type='checkbox' value= 'Antibiotics' name='Antibiotics'><span>Antibiotics</P>
";
}
if($rs[None_Indicated] == 'None Indicated'){
echo"
<p> <input type='checkbox' value= 'None Indicated' name='None_Indicated' checked><span>None Indicated</P>
";
}
else{
echo" <p> <input type='checkbox' value= 'None Indicated' name='None_Indicated'><span>None Indicated</P>
";
}
echo"
</div>
";
if($rs[tests_imaging] == 'Yes'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Have All tests and imaging been Reviewed </label></b></li>
<p><input type='radio' value= 'Yes' name='tests_imaging' checked><span> Yes</P>
<p><input type='radio' value= 'No, Follow-up Plan in Place' name='tests_imaging'><span> No, Follow-up Plan in Place</P>
</div>
";
}
elseif($rs[tests_imaging] == 'No, Follow-up Plan in Place'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Have All tests and imaging been Reviewed </label></b></li>
<p><input type='radio' value= 'Yes' name='tests_imaging'><span> Yes</P>
<p><input type='radio' value= 'No, Follow-up Plan in Place' name='tests_imaging' checked><span> No, Follow-up Plan in Place</P>
</div>
";
}
else
{
echo"
<div class='checkbox'>
<p>
<label><b><li>Have All tests and imaging been Reviewed </label></b></li>
<p><input type='radio' value= 'Yes' name='tests_imaging'><span> Yes</P>
<p><input type='radio' value='No, Follow-up Plan in Place' name='tests_imaging'><span> No, Follow-up Plan in Place</P>
</div>
";
}
echo"
<div class='checkbox'>
<p>
<label><b><li>Which serial Examinations Are Needed </label></b></li>
";
if($rs[Examinations] == 'Neurological'){
echo"
<p> <input type='checkbox' value= 'Neurological' name='Examinations' checked><span>Neurological</P>
";
}
else
{
echo"
<p> <input type='checkbox' value= 'Neurological' name='Examinations'><span>Neurological</P>
";
}
if($rs[Abdominal] == 'Abdominal'){
echo"
<p> <input type='checkbox' value= 'Abdominal' name='Abdominal' checked><span>Abdominal</P>
";
}
else{
echo"
<p> <input type='checkbox' value= 'Abdominal' name='Abdominal'><span>Abdominal</P>
";
}
if($rs[vascular] == 'vascular'){
echo"
<p> <input type='checkbox' value= 'vascular' name='vascular' checked><span>Vascular</P>
";
}
else{
echo"
<p> <input type='checkbox' value= 'vascular' name='vascular'><span>Vascular</P>
";
}
if($rs[Examinations] == 'None'){
echo"
<p> <input type='checkbox' value= 'None' name='Examinations' checked><span>None</P>";
}
else{
echo"
<p> <input type='checkbox' value= 'None' name='Examinations'><span>None</P>";
}
echo"
</div>
";
echo"<div class='checkbox'>
<p>
<label><b><li>Plan of care discussed with: </label></b></li>";
if($rs[care_discussed] == 'Patient/Family'){
echo"
<p> <input type='checkbox' value='Patient/Family' name='care_discussed' checked><span>Patient/Family</P>
";
}
else
{
echo"
<p> <input type='checkbox' value='Patient/Family' name='care_discussed'><span>Patient/Family</P>
";
}
if($rs[Receiving_Unit] == 'Receiving Unit'){
echo"
<p> <input type='checkbox' value= 'Receiving Unit' name='Receiving_Unit' checked><span>Receiving Unit</P>
";
}
else
{
echo"
<p> <input type='checkbox' value= 'Receiving Unit' name='Receiving_Unit'><span>Receiving Unit</P>
";
}
if($rs[Primary_team] == 'Primary team'){
echo"
<p> <input type='checkbox' value= 'Primary team' name='Primary_team' checked><span>Primary team</P>
";
}
else{
echo"
<p> <input type='checkbox' value= 'Primary team' name='Primary_team'><span>Primary team</P>
";
}
if($rs[Other_Specialists] == 'None'){
echo"
<p> <input type='checkbox' value= 'None' name='Other_Specialists' checked><span>Other Specialists</P>
";
}
else{
echo"
<p> <input type='checkbox' value= 'None' name='Other_Specialists'><span>Other Specialists</P>
";
}
echo"
</div>
";
if($rs[Trauma_Chart] == 'Patient/Family'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Relevant Trauma Chart or Form Comleted? </label></b></li>
<p><input type='radio' value= 'Patient/Family' name='Trauma_Chart' checked><span> Patient/Family</P>
<p><input type='radio' value= 'Not Available' name='Trauma_Chart'><span> Not Available</P>
</div></div>
";
}
elseif($rs[Trauma_Chart] == 'Not Available'){
echo"
<div class='checkbox'>
<p>
<label><b><li>Relevant Trauma Chart or Form Comleted? </label></b></li>
<p><input type='radio' value= 'Patient/Family' name='Trauma_Chart'><span> Patient/Family</P>
<p><input type='radio' value= 'Not Available' name='Trauma_Chart' checked><span> Not Available</P>
</div></div>
";
}
else{
echo"
<div class='checkbox'>
<p>
<label><b><li>Relevant Trauma Chart or Form Comleted? </label></b></li>
<p><input type='radio' value= 'Patient/Family' name='Trauma_Chart'><span> Patient/Family</P>
<p><input type='radio' value= 'Not Available' name='Trauma_Chart'><span> Not Available</P>
</div></div>
";
}
}
?>
<input type='submit' name='signup' value='Update'>
</form>
</div>