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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>