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<?php session_start(); require_once('../DBManager.php'); require_once('../LoginManager.php'); include 'dbconnection.php'; include 'header.php'; include 'dashboarddocument.php'; if(isset($_POST['signup'])) { $sql ="UPDATE Vulnerability SET Insulin_dependent='$_POST[Insulin_dependent]',Insulin_specify='$_POST[Insulin_specify]',Last_menstrual_period='$_POST[Last_menstrual_period]',Gravida='$_POST[Gravida]',Para='$_POST[Para]',Abortion='$_POST[Abortion]',Cesarean='$_POST[Cesarean]',Child_alive='$_POST[Child_alive]',Death='$_POST[Death]',Level_Consciousness='$_POST[Level_Consciousness]',Eye_Opening_Response='$_POST[Eye_Opening_Response]',Best_Verbal_Response='$_POST[Best_Verbal_Response]',Best_Motor_Response='$_POST[Best_Motor_Response]',Dependency='$_POST[Dependency]',Modn='$_POST[Modn]',Vulnevilty_Assessment='$_POST[Vulnevilty_Assessment]',Pain_Assessment='$_POST[Pain_Assessment]',Pain_Location='$_POST[Pain_Location]',Pain_Location1='$_POST[Pain_Location1]',Pain_Location2='$_POST[Pain_Location2]',Pain_Location3='$_POST[Pain_Location3]',Pain_Location4='$_POST[Pain_Location4]',Pain_Location5='$_POST[Pain_Location5]',other_pain_location='$_POST[other_pain_location]',fall_risk='$_POST[fall_risk]',low_fall_risk='$_POST[low_fall_risk]',high_fall_risk='$_POST[high_fall_risk]',implement_low='$_POST[implement_low]',Complete_paralysis='$_POST[Complete_paralysis]',History_more='$_POST[History_more]',Patient_experienced='$_POST[Patient_experienced]',deemed_high='$_POST[deemed_high]' WHERE prescriptionid='$_GET[prescriptionid]' AND patientid='$_GET[patientid]'"; if($qsql = mysqli_query($con,$sql)) { 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:; } input.largerCheckbox { width: 20px; height: 20px; } </style> <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.1.1/jquery.min.js"></script> <script type="text/javascript"> $(document).ready(function(){ $('#myForm').submit(function() { $('#loaderImg').show(); return true; }); }); </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> .switch { position: relative; display: inline-block; width: 90px; height: 34px; } .switch input {display:none;} .slider5 { position: absolute; cursor: pointer; top: 0; left: 0; right: 0; bottom: 0; background-color: #ca2222; -webkit-transition: .4s; transition: .4s; border-radius: 34px; } .slider5: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 + .slider5 { background-color: #2ab934; } input:focus + .slider5 { box-shadow: 0 0 1px #2196F3; } input:checked + .slider5:before { -webkit-transform: translateX(26px); -ms-transform: translateX(26px); transform: translateX(55px); } /*------ ADDED CSS ---------*/ .slider5:after { content:'Undone'; color: white; display: block; position: absolute; transform: translate(-50%,-50%); top: 50%; left: 50%; font-size: 10px; font-family: Verdana, sans-serif; } input:checked + .slider5:after { content:'Done'; } .center { border: 1px solid grey; text-align:; } .box2{ display: none; } .center { border: 1px solid grey; text-align:; } .center2 { border: 5px solid grey; text-align:; } </style> <div class="content-wrapper"> <!-- Content Header (Page header) --> <section class="content-header"> <div class='center'> <div style = "display:none;" id = "loaderImg"> <div class="loader"> </div> </div> <form name="signup" id='myForm' enctype="multipart/form-data" method="post" > <?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>"; } } ?> <table id="example2" class="table table-bordered table-hover"> <?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]) { ?> <?php $sql ="SELECT * FROM Vulnerability WHERE prescriptionid='$_GET[prescriptionid]' AND patientid='$_GET[patientid]'"; $qsql = mysqli_query($con,$sql); while($rs = mysqli_fetch_array($qsql)) { if($rs[Insulin_dependent] == 'Yes'){ echo"<tr><td width='50%'>Insulin dependent</td><td width='50%'> <div class='checkbox'> <h4><input type='checkbox' name='Insulin_dependent' value='Yes' id='myCheck103' onclick='myFunction103()'>Insulin dependent diabetes mellitus</h4> </div></td></tr> "; } echo"<tr><td width='50%'>Specify</td> <td width='50%'> <select name='Insulin_specify'> <option value='$rs[Insulin_specify]'>$rs[Insulin_specify]</option> <option value='Type 1'>Type 1</option> <option value='Type 2'>Type 2</option> </select></td></tr><tr><td width='50%'>Last menstrual period </td> <td width='50%'> <input type='date' value='$rs[Last_menstrual_date]' name='Last_menstrual_date' placeholder='Last menstrual period'> <input type='text' value='$rs[Last_menstrual_period]' name='Last_menstrual_period' placeholder='Last menstrual period'> <select class='form-control' name='durationselect' class='form-control'> <option value='$rs[durationselect]'>$rs[durationselect]</option> <option value='Week'>Week </option> <option value='Month'>Month </option> </select> </div> </td></tr> <tr><td width='50%'>Obstetric History</td><td width='50%'> <p>Gravida <input type='Number' value= '$rs[Gravida_Para]' name='Gravida_Para'></P> <p>Para <input type='Number' value='Gravida_Para' name='Gravida_Para'></P> <p>Abortion <input type='number' value= '$rs[Abortion]' name='Abortion'></P> <p>Cesarean <input type='number' value= '$rs[Cesarean]' name='Cesarean'></P> <p>Child alive <input type='number' value= '$rs[Child_alive]' name='Child_alive'></P> <p>Death <input type='number' value= '$rs[Death]' name='Death'></P> </td></tr> <tr><td width='50%'>Detail of complication in last pregnancy</td><td width='50%'> <textarea value='$rs[last_pregnancy]' name='last_pregnancy' rows='3' cols='100'> </textarea> </td></tr> "; } ?> <?php } } ?> <script src='https://cdnjs.cloudflare.com/ajax/libs/jquery/2.2.3/jquery.min.js'></script> </head> <tr> <td width='50%'> <span>Level of Consciousness </span></td> <td width='50%'> <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> </td> </tr> </table> <div id='text201' style='display:none' > <h4 align='center'>Glasgow Coma Scale</h4> <table id="example2" class="table table-bordered table-hover"> <tr><td width='50%'>Eye Opening Response </td><td width='50%'><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> </td></tr> <tr> <td width='50%'>Best Verbal Response </td> <td width='50%'> <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> </td></tr> <tr><td width='50%'> Best Motor Response</td><td width='50%'> <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> </td></tr> </table> </div> <div id='text202' style='display:none' > <h4 align='center'>Glasgow Coma Scale</h4> <table id="example2" class="table table-bordered table-hover"> <tr><td width='50%'>Eye Opening Response </td><td width='50%'><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> </td></tr> <tr> <td width='50%'>Best Verbal Response </td> <td width='50%'> <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> </td></tr> <tr><td width='50%'> Best Motor Response</td><td width='50%'> <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> </td></tr> </table></div> <br> <table id="example2" class="table table-bordered table-hover"> <tr><td width='50%'>Dependency</td> <td width='50%'> <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> </td></tr> <?php $sql ="SELECT * FROM Vulnerability WHERE patientid='$_GET[patientid]' AND prescriptionid='$_GET[prescriptionid]' "; $qsql = mysqli_query($con,$sql); while($rpm = mysqli_fetch_array($qsql)) { echo " <tr><td width='50%'>Mode of Movement </td> <td width='50%'> <select name='Modn'> <option value='$rpm[Modn]'>$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> </td></tr></select> "; } ?> <tr> <td width='50%'>Pain Assessment</td> <td width='50%'> <select name='Pain_Assessment'> <?php $sql ="SELECT * FROM Vulnerability WHERE patientid='$_GET[patientid]' AND prescriptionid='$_GET[prescriptionid]' "; $qsql = mysqli_query($con,$sql); while($rpm = mysqli_fetch_array($qsql)) { echo " <option value='$rpm[Pain_Assessment]'>$rpm[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> </td></tr>"; } ?> <?php $sql ="SELECT * FROM Vulnerability WHERE patientid='$_GET[patientid]' AND prescriptionid='$_GET[prescriptionid]' "; $qsql = mysqli_query($con,$sql); while($rpm = mysqli_fetch_array($qsql)) { echo " <tr> <td width='50%'> Pain Location</td><td width='50%'><select name='Pain_Location'> <option value='$rpm[Pain_Location]'>$rpm[Pain_Location]</option> <option value='Head'>Head</option> <option value='forehead'>forehead</option> <option value='Eyes'>Eyes</option> <option value='Ear'>Ear</option> <option value='Mouth'>Mouth</option> <option value='cheek'>cheek</option> <option value='chin'>chin</option> <option value='Neck'>Neck</option> <option value='Adam apple'>Adam apple</option> <option value='Face'>Face</option> <option value='Shoulder'>Shoulder</option> <option value='Arm'>Arm</option> <option value='elbow'>elbow</option> <option value='forearm'>forearm</option> <option value='wrist'>wrist</option> <option value='palm'>palm</option> <option value='fingers'>fingers</option> <option value='Back'>Back</option> <option value='Chest'>Chest</option> <option value='Stomach'>Stomach</option> <option value='umbilicus'>umbilicus</option> <option value='abdomen'>abdomen</option> <option value='groin'>groin</option> <option value='hips'>hips</option> <option value='penis-vagina'>penis-vagina</option> <option value='leg'>leg</option> <option value='thigh'>thigh</option> <option value='knee'>knee</option> <option value='calf'>calf</option> <option value='ankle'>ankle</option> <option value='foot'>foot</option> <option value='toes'>toes</option> <option value='Other'>Other</option> </select><br> </td></tr><tr><td width='50%'>Other Pain Location</td><td width='50%'> <input type='text' name='other_pain_location' VALUE='$rpm[other_pain_location]' placeholder='Other Pain Location'> </td> </tr> <tr> <td width='50%'> Pain Location</td><td width='50%'><select name='Pain_Location1'> <option value='$rpm[Pain_Location1]'>$rpm[Pain_Location1]</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><br> </td> </tr> <tr> <td width='50%'> Pain Location</td><td width='50%'><select name='Pain_Location2'> <option value='$rpm[Pain_Location2]'>$rpm[Pain_Location2]</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><br> </td> </tr> <tr> <td width='50%'> Pain Location</td><td width='50%'><select name='Pain_Location3'> <option value='$rpm[Pain_Location3]'>$rpm[Pain_Location3]</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><br> </td> </tr> <tr> <td width='50%'> Pain Location</td><td width='50%'><select name='Pain_Location4'> <option value='$rpm[Pain_Location4]'>$rpm[Pain_Location4]</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><br> </td> </tr> <tr> <td width='50%'> Pain Location</td><td width='50%'><select name='Pain_Location5'> <option value='$rpm[Pain_Location5]'>$rpm[Pain_Location5]</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><br> </td> </tr>"; } ?> <?php $sql ="SELECT * FROM Vulnerability WHERE patientid='$_GET[patientid]' AND prescriptionid='$_GET[prescriptionid]' "; $qsql = mysqli_query($con,$sql); while($rpm = mysqli_fetch_array($qsql)) { if($rpm[fall_risk]=='on') { ?> <?php $sql ="SELECT * FROM Vulnerability WHERE patientid='$_GET[patientid]' AND prescriptionid='$_GET[prescriptionid]' "; $qsql = mysqli_query($con,$sql); while($rpm = mysqli_fetch_array($qsql)) { if($rpm[low_fall_risk]=='on') { echo" <tr> <td width='50%'><span style='font-size: 20px'> Low fall risk </span></h3></td><td width='50%'> <input name='low_fall_risk' type='checkbox' checked> </td></tr>"; } if($rpm[implement_low]='on'){ echo"<tr><td width='50%'> <span style='font-size: 20px'> implement low fall risk interventions per protocol </span></h3></td><td width='50%'> <input name='implement_low' type='checkbox' checked></td></tr> "; } else { echo"<tr><td width='50%><span style='font-size: 20px'> implement low fall risk interventions per protocol </span></h3></td><td width='50%'> <input name='implement_low' type='checkbox'> </td>"; } } } ?> <?php } ?> </table> <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> <input name='History_more' type='checkbox'> </td> </tr> <tr><td> <span style='font-size: 20px'>Patient has experienced a fall during the hospitalization </span></h3></td><td> <input name='Patient_experienced' type='checkbox'> </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> <input name='deemed_high' type='checkbox'> </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 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> <?php } } ?> <input type='submit' name='signup' value='Update'> </form> </div>