emp_health_assessment; foreach ($empHealthArr as $key => $value) { array_push($short_code,$value->short_code); array_push($status,$value->status); } $tuberculosisArr = $nurse->emp_tuberculosis_data; foreach ($tuberculosisArr as $key => $value) { array_push($short_code,$value->short_code); array_push($status,$value->status); } // _die($short_code); $new_health_array=array_combine($short_code,$status); $drugScreenJson = json_decode($nurse->drug_screen); $physcialAssesmentJson = json_decode($nurse->physical_assesment); $under_care_physicianJson = json_decode($nurse->under_care_physician); // _die($physcialAssesmentJson); foreach($new_health_array as $key=>$val){ $object->$key=$val; } foreach($drugScreenJson as $key=>$val){ $object->$key=$val; } foreach($under_care_physicianJson as $key=>$val){ $object->$key=$val; } foreach($physcialAssesmentJson as $key=>$val){ $object->$key=$val; } $emp_health_assesment = $object; // _die($emp_health_assesment); ?>

Health Assessment

Indicate if you are suffering from or have a history of the following conditions:

***If you answer “YES” to any question under this section then an Employment Clearance letter from your physician must be uploaded***

Condition	Yes	No
Diabetes	diabetes==1) { echo "checked"; } ?>/>	diabetes==0) { echo "checked"; } ?>/>
Kidney Disease	kidney_disease==1) { echo "checked"; } ?>/>	kidney_disease==0) { echo "checked"; } ?>/>
Heart Disease	heart_disease==1) { echo "checked"; } ?>/>	heart_disease==0) { echo "checked"; } ?>/>
High Blood Pressure	high_blood_pressure==1) { echo "checked"; } ?>/>	high_blood_pressure==0) { echo "checked"; } ?>/>
Arthritis	arthritis==1) { echo "checked"; } ?>/>	arthritis==0) { echo "checked"; } ?>/>
Mental Illness	mental_illness==1) { echo "checked"; } ?>/>	mental_illness==0) { echo "checked"; } ?>/>
Seizure/Convulsion	epilepsy==1) { echo "checked"; } ?>/>	epilepsy==0) { echo "checked"; } ?>/>
Swelling in the Extremities	swelling_extremities==1) { echo "checked"; } ?>/>	swelling_extremities==0) { echo "checked"; } ?>/>
Allergies	allergies==1) { echo "checked"; } ?>/>	allergies==0) { echo "checked"; } ?>/>

Condition	Yes	No
Back Pain	back_pain==1) { echo "checked"; } ?>/>	back_pain==0) { echo "checked"; } ?>/>
Pain on Urination	pain_urination==1) { echo "checked"; } ?>/>	pain_urination==0) { echo "checked"; } ?>/>
Change in Bowel Habits	change_bowel_habit==1) { echo "checked"; } ?>/>	change_bowel_habit==0) { echo "checked"; } ?>/>
Increased Thrust	increased_thirst==1) { echo "checked"; } ?>/>	increased_thirst==0) { echo "checked"; } ?>/>
Persistent Sores/Lumps	persistent_lumps==1) { echo "checked"; } ?>/>	persistent_lumps==0) { echo "checked"; } ?>/>
Infectious Disease	infectious_disease==1) { echo "checked"; } ?>/>	infectious_disease==0) { echo "checked"; } ?>/>
Cancer	cancer==1) { echo "checked"; } ?>/>	cancer==0) { echo "checked"; } ?>/>
Any Other Physical Disability	other_disability==1) { echo "checked"; } ?>/>	other_disability==0) { echo "checked"; } ?>/>

Tuberculosis Questionnaire

Indicate if you have been experiencing the following conditions:

Condition	Yes	No
Persistent Cough for < 3 Weeks	cough_3_weeks==1) { echo "checked"; } ?>/>	cough_3_weeks==0) { echo "checked"; } ?>/>
Blood in the Sputum	blood_sputum==1) { echo "checked"; } ?>/>	blood_sputum==0) { echo "checked"; } ?>/>
Shortness of Breath	shortness_breath==1) { echo "checked"; } ?>/>	shortness_breath==0) { echo "checked"; } ?>/>
Night Sweats	night_sweat==1) { echo "checked"; } ?>/>	night_sweat==0) { echo "checked"; } ?>/>
Chest Pain	chest_pain==1) { echo "checked"; } ?>/>	chest_pain==0) { echo "checked"; } ?>/>

Condition	Yes	No
Unexplained Weight Loss	unexplained_weight_loss==1) { echo "checked"; } ?>/>	unexplained_weight_loss==0) { echo "checked"; } ?>/>
Loss of Appetite	appetite_loss==1) { echo "checked"; } ?>/>	appetite_loss==0) { echo "checked"; } ?>/>
Hoarseness	hoarseness==1) { echo "checked"; } ?>/>	hoarseness==0) { echo "checked"; } ?>/>
Increased Thirst	thirst_increase==1) { echo "checked"; } ?>/>	thirst_increase==0) { echo "checked"; } ?>/>
Fatigue	fatigue==1) { echo "checked"; } ?>/>	fatigue==0) { echo "checked"; } ?>/>
Fever	fever==1) { echo "checked"; } ?>/>	fever==0) { echo "checked"; } ?>/>

hepatatis_vaccine) && $nurse->hepatatis_vaccine==1){echo "checked"; } ?>/> Yes

hepatatis_vaccine) && $nurse->hepatatis_vaccine==0){echo "checked"; } ?>/> No

positive_ppd) && $nurse->positive_ppd==1){echo "checked"; } ?>/> Yes

positive_ppd) && $nurse->positive_ppd==0){echo "checked"; } ?>/> No

under_care==1){echo "checked"; } ?>> Yes

under_care==0){echo "checked"; } ?>> No

under_care==0){$under_care_hide="style='display:none'";} ?>

> under_care_explain)){echo $emp_health_assesment->under_care_explain;} ?>' placeholder="">

> name_of_physician)){echo $emp_health_assesment->name_of_physician;} ?>' placeholder="">

> tel_of_physician)){echo $emp_health_assesment->tel_of_physician;} ?>' placeholder="">

change_behaviour==1){echo "checked";}?>> Yes

change_behaviour==0){echo "checked"; } ?>> No

change_behaviour ==0 ) {?> style="display:none" > change_behaviour_explain)){echo $emp_health_assesment->change_behaviour_explain;}?>' placeholder="">

prescription_medications==1){echo "checked"; } ?>> Yes

prescription_medications==0){echo "checked"; } ?>> No

prescription_medications ==0 ) {?> style="display:none" > prescription_medications_explain)){echo $emp_phy_data->prescription_medications_explain;}?>' placeholder="">

screening_test=="1" || $emp_phy_data->screening_test==""){echo "checked";}?>> Yes

screening_test=="0"){echo "checked";}?>> No

screening_test !=0 ) {?> style="display:none" > screening_test_explain)) { echo $emp_phy_data->screening_test_explain; } ?>' placeholder="">

past_illness==1){echo "checked"; } ?>> Yes

past_illness==0) {echo "checked"; } ?>> No

past_illness ==0 ){?> style="display:none" > past_illness_explain)){echo $emp_phy_data->past_illness_explain;}?>' placeholder="">

physicaldefects==1){ echo "checked"; } ?>> Yes

physicaldefects==0) { echo "checked"; } ?>> No

physicaldefects ==0 ){?> style="display:none" > physicaldefects_explain)){echo $emp_phy_data->physicaldefects_explain;}?>' placeholder="">

injured==1) {echo "checked"; }?>> Yes

injured==0) { echo "checked"; } ?>> No

injured ==0 ) {?> style="display:none" > injured_explain)){echo $emp_phy_data->injured_explain;}?>' placeholder="">

defects==1){echo "checked"; } ?>> Yes

defects==0){echo "checked"; } ?>> No

defects ==0 ) {?> style="display:none" > defects_explain)){echo $emp_phy_data->defects_explain;}?>' placeholder="">

inVision==1){echo "checked"; } ?>> Yes

inVision==0){echo "checked"; } ?>> No

inVision ==0 ) {?> style="display:none" > inVision_explain)){echo $emp_phy_data->inVision_explain;}?>' placeholder="">

speach==1){echo "checked"; } ?>> Yes

speach==0){echo "checked"; } ?>> No

speach ==0 ) {?> style="display:none" > speach_explain)){echo $emp_phy_data->speach_explain;}?>' placeholder="">

physical_exam_form); ?>

" min="1" required>