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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>