DEWATA [ login.easenup.in ]

Name	Size	Permission
FrontOffice	[ DIR ]	drwxr-xr-x
NewFrontOffice	[ DIR ]	drwxr-xr-x
Provider	[ DIR ]	drwxr-xr-x
RP	[ DIR ]	drwxr-xr-x
assets	[ DIR ]	drwxr-xr-x
easenup	[ DIR ]	drwxr-x---
laboratory	[ DIR ]	drwxr-xr-x
pateint	[ DIR ]	drwxr-xr-x
patients	[ DIR ]	drwxr-xr-x
patients.1	[ DIR ]	drwxr-xr-x
print	[ DIR ]	drwxr-xr-x
spc	[ DIR ]	drwxr-xr-x
test	[ DIR ]	drwxr-xr-x
vendor	[ DIR ]	drwxr-xr-x
.trash_restore	10.28 KB	-rw-------
AddNewPatient.php	25.98 KB	-rw-r--r--
AddPatient.php	22.15 KB	-rw-r--r--
Book1.xlsx	9.01 KB	-rw-r--r--
ConsultantFees.php	4.99 KB	-rw-r--r--
Create_Gate_pass.php	1.52 KB	-rw-r--r--
Dischargesummery.php	27.62 KB	-rw-r--r--
DoctorsList.php	18.62 KB	-rw-r--r--
DownloadLink.php	11.41 KB	-rw-r--r--
Edit_BasicInfo.php	14.39 KB	-rw-r--r--
Edit_GeneralTarifRate.php	19.32 KB	-rw-r--r--
Edit_SharedDecisionAid.php	1.63 KB	-rw-r--r--
Follow-up.php	14.79 KB	-rw-r--r--
Follow-up.php.1	14.79 KB	-rw-r--r--
Follow-up.php.2	14.79 KB	-rw-r--r--
GeneralTarifRate.php	19.98 KB	-rw-r--r--
HospitalCourse.php	6.56 KB	-rw-r--r--
InvestigationLab.php	17.51 KB	-rw-r--r--
ListLabDepartment.php	24.78 KB	-rw-r--r--
LoginManager2.php	57.18 KB	-rw-r--r--
PatientAppointments.php	26.99 KB	-rw-r--r--
PatientMenu.php	12.8 KB	-rw-r--r--
PriscriptionTimeline.php	9.5 KB	-rw-r--r--
PriscriptionVitals.php	9.2 KB	-rw-r--r--
ProcedureSurgery.php	39.37 KB	-rw-r--r--
RAJLALIT (1).jpg	40.72 KB	-rw-r--r--
RAJLALIT.jpg	146.52 KB	-rw-r--r--
Referral.php	18.63 KB	-rw-r--r--
Request_Transport.php	2.18 KB	-rw-r--r--
Treatment and Surgery - Unspec...	2.29 KB	-rw-r--r--
Treatment and Surgery.xlsx	125.27 KB	-rw-r--r--
VendorList.php	21.55 KB	-rw-r--r--
Workdesk.php	10.76 KB	-rw-r--r--
about.jpg	183.88 KB	-rw-r--r--
add-allergies.php	11.55 KB	-rw-r--r--
add-immunization.php	10.49 KB	-rw-r--r--
assets.zip	189.46 KB	-rw-r--r--
assets.zip.1	5.77 MB	-rw-r--r--
assets.zip.zip	189.63 KB	-rw-r--r--
clint-eastwood-signature-e5a46...	29.28 KB	-rw-r--r--
d41d8cd98f00b204e9800998ecf842...	31.98 KB	-rw-r--r--
d41d8cd98f00b204e9800998ecf842...	29.28 KB	-rw-r--r--
d41d8cd98f00b204e9800998ecf842...	29.94 KB	-rw-r--r--
d41d8cd98f00b204e9800998ecf842...	29.94 KB	-rw-r--r--
d41d8cd98f00b204e9800998ecf842...	146.52 KB	-rw-r--r--
d41d8cd98f00b204e9800998ecf842...	31.98 KB	-rw-r--r--
d41d8cd98f00b204e9800998ecf842...	23.24 KB	-rw-r--r--
d41d8cd98f00b204e9800998ecf842...	29.28 KB	-rw-r--r--
d41d8cd98f00b204e9800998ecf842...	23.6 KB	-rw-r--r--
dbconnection.php	319 B	-rw-r--r--
diagnosistimeline_discharge.ph...	2.65 KB	-rw-r--r--
discharge.php	15.68 KB	-rw-r--r--
discharge_medicine.php	10.63 KB	-rw-r--r--
dischargechecklist.php	17.7 KB	-rw-r--r--
dist.zip	2.61 MB	-rw-r--r--
doctors-1.jpg	23.6 KB	-rw-r--r--
doctors-2.jpg	23.6 KB	-rw-r--r--
doctors-3.jpg	23.6 KB	-rw-r--r--
doctors-4.jpg	23.6 KB	-rw-r--r--
edit_showpage_Medical_Assessme...	15.56 KB	-rw-r--r--
error_log	1.25 KB	-rw-r--r--
error_log.1	483.79 KB	-rw-r--r--
features.jpg	57.05 KB	-rw-r--r--
header2.php	4.74 KB	-rw-r--r--
header3.php	4.92 KB	-rw-r--r--
inhouse2.php	16.27 KB	-rw-r--r--
inputandoutput.php	2.31 KB	-rw-r--r--
instant-search-ajax-php-mysql....	10.54 KB	-rw-r--r--
investigationfee.php	2.58 KB	-rw-r--r--
list_tretment (1).xls	171 KB	-rw-r--r--
list_tretment.csv	96.65 KB	-rw-r--r--
list_tretment.xlsx	46.38 KB	-rw-r--r--
load_data.php	269 B	-rw-r--r--
loaddepartment.php	3.36 KB	-rw-r--r--
logo.png	180.58 KB	-rw-r--r--
mail.php	400 B	-rw-r--r--
medicineinvace.php	31.28 KB	-rw-r--r--
nursingAssessment.php	4.35 KB	-rw-r--r--
nursinginstruction.php	2.4 KB	-rw-r--r--
nursingset.php	12.06 KB	-rw-r--r--
pateint.zip	1.16 MB	-rw-r--r--
patient_referral.php	11.2 KB	-rw-r--r--
patients.easenup.in.zip	2.19 MB	-rw-r--r--
print.1	22.1 KB	-rw-r--r--
show_Create_Gate_pass.php	1.88 KB	-rw-r--r--
show_Follow_up.php	1.27 KB	-rw-r--r--
show_Request_Transport.php	1.37 KB	-rw-r--r--
show_discharge.php	1.18 KB	-rw-r--r--
show_discharge_summery.php	71.41 KB	-rw-r--r--
show_dischargechecklist.php	5.71 KB	-rw-r--r--
showpage_Create_Gate_pass.php	22.54 KB	-rw-r--r--
slide-1.jpeg	6.08 KB	-rw-r--r--
slide-2.jpg	71.27 KB	-rw-r--r--
slide-21.jpg	134.46 KB	-rw-r--r--
treatment_ONCOLOGY	3.78 KB	-rw-r--r--
upload_document.php	12.01 KB	-rw-r--r--
vital_nursing.php	8.78 KB	-rw-r--r--

Code Editor : dischargechecklist.php

<?php

if(isset($_POST['signup'])) 
{
   PatientManager::dischargechecklist("$_GET[prescriptionid]","$_GET[patientid]","$_POST[Pharmacy_Replacement]","$_POST[Billing_Completed]","$_POST[summary_handed]","$_POST[Prescription_explained]","$_POST[Report_handed]","$_POST[iv_cannula_removed]","$_POST[Hospital_Dress_Changed]","$_POST[Hospital_belonging]","$_POST[Pending_report_informed]","$_POST[Admission_Consent]","$_POST[Transfusion_Consent]","$_POST[Cost_Consent]","$_POST[Procedure_Consent]","$_POST[High_Risk_Consent]","$_POST[Anesthesia_Consent]","$_POST[LAMA_DOR_Consent]","$_POST[Discharge_Consent]","$_POST[check_date]","$_POST[Nurse_Name]","$_POST[entered_by]");
}

<?php

$sql ="SELECT * FROM patient WHERE patientid='$_GET[patientid]'";
		$qsql = mysqli_query($con,$sql);
		while($rs = mysqli_fetch_array($qsql))
		{
		    echo "

<div class='center'>
    <table id='example2' class='table table-bordered table-hover' width='100%'>
<h3 align='center'>Discharge Checklist</h3>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; UHID: </td>
<td width='50%'>$rs[patientid]</td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Pt. Name: </td>
<td width='50%'>$rs[patientname]</td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp;  W/O,D/O,S/O. :  </td>
<td width='50%'>$rs[HusbandName]</td>
</tr>
<tr>
<td width='50%'> &nbsp;  &nbsp; &nbsp; &nbsp; DOB:  </td>
<td width='50%'>$rs[dob]</td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Sex : </td>
<td width='50%'>$rs[gendor]</td>
</tr>
 ";
	  echo "</td></tr>";	}
		?>
		<form name="signup" method="post">
		    	<?php
		$sql ="SELECT * FROM addaspatient WHERE prescriptionid='$_GET[prescriptionid]' AND patientid='$_GET[patientid]'";
		$qsql = mysqli_query($con,$sql);
		while($rs = mysqli_fetch_array($qsql))
		{
            echo "
            <input type='hidden' name='prescriptionid' value='$rs[prescriptionid]'>
                <input type='hidden' name='patientid' value='$rs[patientid]'>
            ";
		}
		?>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Date : </td>
<td width='50%'><input type='date' name='check_date'>
</td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Admission Consent : </td>
<td width='50%'><select name='Admission_Consent'>
    <option value='Admission Consent' disabled selected>Admission Consent</option>
       <option value='Present'>Present</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Blood Transfusion Consent : </td>
<td width='50%'><select name='Transfusion_Consent'>
    <option value='Blood Transfusion Consent' disabled selected>Blood Transfusion Consent</option>
      <option value='Not Applicable'>Not Applicable</option>
       <option value='Present'>Present</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Cost Consent : </td>
<td width='50%'><select name='Cost_Consent'>
    <option value='Cost Consent' disabled selected>Cost Consent</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Present'>Present</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Procedure Consent : </td>
<td width='50%'><select name='Procedure_Consent'>
    <option value='Procedure_Consent' disabled selected>Procedure Consent</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Present'>Present</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; High Risk Consent : </td>
<td width='50%'><select name='High_Risk_Consent'>
    <option value='High_Risk_Consent' disabled selected>High Risk Consent</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Present'>Present</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Anesthesia Consent : </td>
<td width='50%'><select name='Anesthesia_Consent'>
    <option value='Anesthesia_Consent' disabled selected>Anesthesia Consent</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Present'>Present</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; LAMA/DOR Consent : </td>
<td width='50%'><select name='LAMA_DOR_Consent'>
    <option value='LAMA_DOR_Consent' disabled selected>LAMA/DOR Consent:</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Present'>Present</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Discharge Consent : </td>
<td width='50%'><select name='Discharge_Consent'>
    <option value='LAMA_DOR_Consent' disabled selected>Discharge Consent</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Present'>Present</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
            <?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,$sql);
		while($rs = mysqli_fetch_array($qsql))
		{
if(Pregnancy==$rs[casetype])
{
?>  <div id="mmenu">
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Safe Childbirth Checklist Step 1 : </td>
<td width='50%'><select name='Safe_Childbirth_Checklist'>
    <option value='Safe_Childbirth_Checklist' disabled selected>Safe Childbirth Checklist</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Completed'>Completed</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>

<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Safe Childbirth Checklist Step 1 : </td>
<td width='50%'><select name='Step_1'>
    <option value='Safe_Childbirth_Checklist' disabled selected>Safe Childbirth Checklist</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Completed'>Completed</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Safe Childbirth Checklist Step 2 : </td>
<td width='50%'><select name='Step_2'>
    <option value='Safe_Childbirth_Checklist' disabled selected>Safe Childbirth Checklist</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Completed'>Completed</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Safe Childbirth Checklist Step 3 : </td>
<td width='50%'><select name='Step_3'>
    <option value='Safe_Childbirth_Checklist' disabled selected>Safe Childbirth Checklist</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Completed'>Completed</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Safe Childbirth Checklist Step 4 : </td>
<td width='50%'><select name='Step_4'>
    <option value='Safe_Childbirth_Checklist' disabled selected>Safe Childbirth Checklist</option> 
      <option value='Not Applicable'>Not Applicable</option>
      <option value='Completed'>Completed</option>
          <option value='Missing'>Missing </option>
</select></td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Safe Childbirth Checklist (Step 4) : </td>
<td width='50%'><label class='switch'>
  <input name='Safe_Childbirth_Checklist4' id="myCheck102" onclick="myFunction102()" type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
</table>

<div id="text102" style="display:none" >
     <h3 align="center">Safe Childbirth Checklist 
Before Discharge (Step 4)
</h3>
              <div class="checkbox">
          <table id='example2' class='table table-bordered table-hover' width='100%'>   <tr> <td> 
    <p>
       <h4>Confirm stay at facility for 24 hours after delivery</h4>
</td>
<td>
<select name='Confirm_stay'>
    <option value='Safe_Childbirth_Checklist' disabled selected>Confirm stay at facility for 24 hours</option> 
      <option value='Yes'>Yes</option>
      <option value='Not Needed'>Not Needed </option>
    
</select>
    </td>  </tr>
    <tr> <td> 
    <p>
       <h4>Does mother need to start antibiotics? </h4>
</td>
<td>
<select name='Confirm_stay'>
    <option value='start_antibiotics' disabled selected>start antibiotics? </option> 
      <option value='No'>No</option>
      <option value='Yes given and delay discharge'>Yes, given and delay discharge </option>
    
</select>
    </td>  </tr>
        <tr> <td> 
    <p>
       <h4>Is mother’s blood pressure normal?</h4>
</td>
<td>
<select name='blood_pressure_normal'>
    <option value='start_antibiotics' disabled selected>Is mother’s blood pressure normal?</option> 
      <option value='No treat and delay discharge '>No, treat and delay discharge </option>
      <option value='Yes'>Yes </option>
    
</select>
    </td>  </tr>
    
           <tr> <td> 
    <p>
       <h4>Is mother bleeding abnormally?</h4>
</td>
<td>
<select name='blood_pressure_normal'>
    <option value='start_antibiotics' disabled selected>Is mother bleeding abnormally?</option> 
      <option value='No'>No</option>
      <option value='Yes, treat and delay discharge'>Yes, treat and delay discharge </option>
    
</select>
    </td>  </tr>
    
             <tr> <td> 
    <p>
       <h4>Does baby need to start antibiotics?</h4>
</td>
<td>
<select name='blood_pressure_normal'>
    <option value='start_antibiotics' disabled selected>Does baby need to start antibiotics?</option> 
      <option value='No'>No</option>
      <option value='Yes, give antibiotics, delay discharge, give special care'>Yes, give antibiotics, delay discharge, give special care</option>
    
</select>
    </td>  </tr>
    
         <tr> <td> 
    <p>
       <h4>Is baby feeding well?</h4>
</td>
<td>
<select name='blood_pressure_normal'>
    <option value='start_antibiotics' disabled selected>Is baby feeding well?</option> 
      <option value='No, establish good breastfeeding practices and delay discharge '>No, establish good breastfeeding practices and delay discharge </option>
      <option value='Yes'>Yes</option>
    
</select>
    </td>  </tr>
    
    <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Discuss and offer family planning options to mother </td>
<td width='50%'><label class='switch'>
  <input name='family_planning'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp;  Arrange follow-up and confirm mother  </td>
<td width='50%'><label class='switch'>
  <input name='Arrange_follow_up'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>

</table>
<h3 align='center'>Danger Signs</h3>
<h5>Mother has any of</h3>
 <table id='example2' class='table table-bordered table-hover' width='100%'> 
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp;  Bleeding </td>
<td width='50%'><label class='switch'>
  <input name='Bleeding'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Severe abdominal pain </td>
<td width='50%'><label class='switch'>
  <input name='Severe_abdominal_pain'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp;  Severe headache or visual disturbance</td>
<td width='50%'><label class='switch'>
  <input name='visual_disturbance'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp;  Breathing difficulty</td>
<td width='50%'><label class='switch'>
  <input name='Breathing_difficulty'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp;  Fever or chills</td>
<td width='50%'><label class='switch'>
  <input name='Fever_chills'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Difficulty emptying bladder</td>
<td width='50%'><label class='switch'>
  <input name='Difficulty_emptying_bladder'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Epigastric pain</td>
<td width='50%'><label class='switch'>
  <input name='Epigastric_pain'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
<tr><td><h5 align='left'>Baby has any of:</h5></td></tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Fast/difficult breathing</td>
<td width='50%'><label class='switch'>
  <input name='Fast_difficult_breathing'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Fever</td>
<td width='50%'><label class='switch'>
  <input name='Fever'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Unusually cold</td>
<td width='50%'><label class='switch'>
  <input name='Unusually_cold'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Stops feeding well</td>
<td width='50%'><label class='switch'>
  <input name='Stops_feeding_well'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Less activity than normal</td>
<td width='50%'><label class='switch'>
  <input name='Less_activity'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
  <tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Whole body becomes yellow</td>
<td width='50%'><label class='switch'>
  <input name='becomes_yellow'  type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
</table></div></div>
<?php
}
}
?>
<table id='example2' class='table table-bordered table-hover' width='100%'>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Pharmacy Replacement  : </td>
<td width='50%'><label class='switch'>
  <input name='Pharmacy_Replacement' type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Billing Completed : </td>
<td width='50%'><label class='switch'>
  <input name='Billing_Completed' type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Discharge summary explained and handed over : </td>
<td width='50%'><label class='switch'>
  <input name='summary_handed' type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Prescription explained and handed over : </td>
<td width='50%'><label class='switch'>
  <input name='Prescription_explained' type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Report handed over : </td>
<td width='50%'><label class='switch'>
  <input name='Report_handed' type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Iv Cannula Removed : </td>
<td width='50%'><label class='switch'>
  <input name='iv_cannula_removed' type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr><tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Hospital Dress Changed : </td>
<td width='50%'><label class='switch'>
  <input name='Hospital_Dress_Changed' type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>
<tr>
<td width='50%'>&nbsp;  &nbsp; &nbsp; &nbsp; Hospital belonging checked and taken back : </td>
<td width='50%'><label class='switch'>
  <input name='Hospital_belonging' type='checkbox'>
  <span class='slider'></span>
</label>
</td>
</tr>

<tr><td width='50%'><label>&nbsp;  &nbsp; &nbsp; &nbsp; Pending report informed:</label></td><td width='50%'> <label class='switch'>
  <input name='Pending_report_informed' type='checkbox'>
  <span class='slider'></span>
</label></td></tr>

<tr><td width='50%'><label>&nbsp;  &nbsp; &nbsp; &nbsp;Attending Nursing Staff:</label></td><td width='50%'><input type="text" name='Nurse_Name' placeholder='Attending Nursing Staff:'> </td></tr>

</table>
</fieldset>

<br>

</form>
	<script>
n =  new Date();
y = n.getFullYear();
m = n.getMonth() + 1;
d = n.getDate();
document.getElementById("date").innerHTML = m + "/" + d + "/" + y;
</script>

</div>

${this.title}

Code Editor : dischargechecklist.php