3299 lines
372 KiB
PHP
Executable File
3299 lines
372 KiB
PHP
Executable File
<?php
|
||
//closed for url id hidden
|
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if(isset($_GET['scheduleId'])) { $scheduleId = $_GET['scheduleId']; }
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if(isset($_GET['id'])) { $patient_id=$_GET['id']; }
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//closed for url id hidden
|
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// if(isset($scheduleId)) { $scheduleId = $scheduleId; }
|
||
// if(isset($id)) { $patient_id=$id; }
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||
//if(isset($type)) { $type=$_GET['type']; }
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||
// echo 'PID:'.$patient_id;
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||
// echo 'SID:'.$scheduleId;
|
||
// echo 'TYPE:'.$type;
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||
// die;
|
||
|
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$nutrition=isset($reportData->nutrition)?json_decode($reportData->nutrition):(object)[];
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$visit_info=isset($reportData->visit_info)?json_decode($reportData->visit_info):(object)[];
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||
?>
|
||
|
||
<!--main content start-->
|
||
<style type="text/css">
|
||
.required:after {
|
||
content:"*";
|
||
color:red;
|
||
}
|
||
.card-header.collapse-card-header {
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||
border: 1px solid #1e9ff2;
|
||
border-radius: 0px !important;
|
||
padding: 5px;
|
||
position: relative;
|
||
border-bottom: none;
|
||
}
|
||
#headingTwentyFive {
|
||
border-bottom: 1px solid #1e9ff2;
|
||
}
|
||
.card.card-section {
|
||
margin: 0;
|
||
}
|
||
.card-header.collapse-card-header button.collapse-button-view h3{
|
||
font-size:18px;
|
||
}
|
||
.clock_hide{display:none;}
|
||
</style>
|
||
|
||
<style type="text/css">
|
||
.fstfdt6tsrt + :where(.col-sm-8,.col-sm-4){
|
||
padding-top: 11px;
|
||
}
|
||
.risk_field{
|
||
display: flex;
|
||
}
|
||
.risk_label{
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||
margin-right: 5px;
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||
}
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||
.risk-input-field{
|
||
width: 200px;
|
||
}
|
||
.right_align{
|
||
float: right;
|
||
}
|
||
/*.img_fixed_sizexx{
|
||
max-width: 350px;
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||
max-height: 300px;
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||
height: 100%;
|
||
width: 100%;
|
||
object-fit: cover;
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||
}*/
|
||
.image-container-hjvhjsdtd6tchgds {
|
||
max-width: 100%;
|
||
max-height: 100%;
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||
display: flex;
|
||
justify-content: flex-start;
|
||
align-items: center;
|
||
}
|
||
|
||
.image-container-hjvhjsdtd6tchgds img {
|
||
max-width: 100%;
|
||
max-height: 100%;
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||
width: auto;
|
||
height: auto;
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||
}
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||
@media screen and (min-width: 577px) {
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||
.image-container-hjvhjsdtd6tchgds img {
|
||
min-width: 475px;
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||
min-height: 400px;
|
||
}
|
||
}
|
||
.hgfdyevfhjgvshgdv6:hover a{
|
||
text-decoration: underline;
|
||
}
|
||
.truncatebyline{
|
||
overflow: hidden;
|
||
text-overflow: ellipsis;
|
||
word-break: break-all;
|
||
}
|
||
.truncatebyline.by1{
|
||
-webkit-line-clamp: 1;
|
||
}
|
||
.truncatebyline.by2{
|
||
-webkit-line-clamp: 2;
|
||
}
|
||
.truncatebyline.by3{
|
||
-webkit-line-clamp: 3;
|
||
}
|
||
.ml-0{
|
||
margin-left: 0px !important;
|
||
}
|
||
</style>
|
||
|
||
<!-- <link href="https://cdnjs.cloudflare.com/ajax/libs/select2/4.0.6-rc.0/css/select2.min.css" rel="stylesheet" />
|
||
<script src="https://cdnjs.cloudflare.com/ajax/libs/select2/4.0.6-rc.0/js/select2.min.js"></script> -->
|
||
<link href="https://www.jqueryscript.net/css/jquerysctipttop.css" rel="stylesheet" type="text/css">
|
||
<link rel="stylesheet" href="<?php echo base_url(); ?>common/signature/drawing-table.css" type="text/css" media="screen" charset="utf-8" />
|
||
<div class="app-content content">
|
||
<section class="content-wrapper">
|
||
<!-- page start-->
|
||
<section class="row">
|
||
<div class="col-md-12">
|
||
<div class="card">
|
||
<!-- <div class="card-header card-header-title-part">
|
||
<h3 class="font-weight-bold text-uppercase"><?php echo $heading; ?></h3>
|
||
</div> -->
|
||
<div class="card-content">
|
||
<div class="card-body card-body_assessment">
|
||
<div class="col-lg-3"></div>
|
||
<div class="col-md-12">
|
||
<input type="hidden" id="patientId" value="<?php echo $patient_id; ?>">
|
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<input type="hidden" id="mainId" value="<?php echo $reportData->id; ?>" >
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||
<div class="accordion" id="accordionExample">
|
||
<!-- patient Details record start -->
|
||
<div class="card card-section">
|
||
<div class="card-header collapse-card-header" id="PatientDtl">
|
||
<h2 class="mb-0">
|
||
<button class="btn btn-link collapse-button-view" type="button" data-toggle="collapse" data-target="#collapsePatientDtl" aria-expanded="true" aria-controls="collapseOne">
|
||
<h3 class="font-weight-bold text-uppercase truncatebyline by1 ml-0">PATIENT DEMOGRAPHICS</h3>
|
||
<i class="la la-angle-down"></i>
|
||
</button>
|
||
</h2>
|
||
</div>
|
||
<div id="collapsePatientDtl" class="collapse show" aria-labelledby="PatientDtl" data-parent="#accordionExample">
|
||
<div class="card-body">
|
||
<ul class="nav nav-pills" id="myTab2" role="tablist">
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link active" id="patient_basic_info_tab" data-toggle="tab" href="#patient_basic_info" role="tab" aria-controls="patient_basic_info" aria-selected="true">Basic Info
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Basic Info</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="intake_sheet_tab" data-toggle="tab" href="#intake_sheet" role="tab" aria-controls="intake_sheet" aria-selected="false">Intake Sheet
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Intake Sheet</h6> -->
|
||
</a>
|
||
</li>
|
||
</ul>
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||
<div class="tab-content">
|
||
<div class="tab-pane fade show active" id="patient_basic_info" role="tabpanel" aria-labelledby="patient_basic_info_tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Basic-info</h5>
|
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<div class="form-group">
|
||
<div class="row">
|
||
<div class="col-lg-3">
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<label><?php echo lang('Patient ID'); ?></label>
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<input type="text" class="form-control" value="<?php echo $patient_data->patient_id; ?>" Readonly>
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</div>
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<div class="col-lg-3">
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<label><?php echo lang('Patient Name'); ?></label>
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||
<input type="text" class="form-control" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>" Readonly>
|
||
</div>
|
||
<div class="col-lg-3">
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<label><?php echo lang('DOB'); ?></label>
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||
<input type="text" class="form-control" value="<?php echo $patient_data->dob; ?>" Readonly>
|
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</div>
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<div class="col-lg-3">
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<label><?php echo lang('Gender'); ?></label>
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<input type="text" class="form-control" value="<?php echo $patient_data->gender; ?>" Readonly>
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</div>
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<?php
|
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if($type=='initial_assessment')
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{ $ass_type="Initial Assessment"; }
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else{ $ass_type="Re Assmessment"; }
|
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?>
|
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<div class="col-lg-3">
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<label><?php echo lang('Type of Document/Visit'); ?></label>
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<!-- <input type="text" class="form-control" value="<?php echo $ass_type; ?>" Readonly> -->
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<select class="form-control" id="assessment_type">
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<option value="Initial Assessment" <?=$ass_type=='Initial Assessment'?'selected':''?>>
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Initial Assessment
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</option>
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<option value="Re Assmessment" <?=$ass_type=='Re Assmessment'?'selected':''?>>
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Re Assessment
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</option>
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</select>
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</div>
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<div class="col-lg-3">
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<label><?php echo lang("Document Status"); ?></label>
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<input type="text" class="form-control" value="" Readonly>
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</div>
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<div class="col-lg-3">
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<label><?php echo lang("Primary Physician's Name"); ?></label>
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<input type="text" class="form-control" value="" Readonly>
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</div>
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<div class="col-lg-3">
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<label><?php echo lang("Diagnosis"); ?></label>
|
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<input type="text" class="form-control" value="" Readonly>
|
||
</div>
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||
</div>
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</div>
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||
</div>
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<div class="tab-pane fade" id="intake_sheet" role="tabpanel" aria-labelledby="intake_sheet_tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Intake-sheet</h5>
|
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<form method="POST" class="form_class" id="intakeSheetRecord">
|
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<input type="hidden" name="<?=$this->security->get_csrf_token_name()?>" value="<?=$this->security->get_csrf_hash()?>" />
|
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<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?=$type?>">
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<input type="hidden" name="scheduleId" id="scheduleId" value="<?=$scheduleId?>">
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<input type="hidden" name="caregiver_id" value="<?=$caregiver['id']?>">
|
||
<input type="hidden" name="patientName" value="<?=$patient_data->first_name.' '.$patient_data->last_name?>">
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||
<input type="hidden" name="dob" value="<?=$patient_data->dob?>">
|
||
<?php viewDynamincForm('intake-sheet-form'); ?>
|
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<button type="submit" name="submit" class="btn btn-info"><?=lang('submit')?></button>
|
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</form>
|
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</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
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<!-- patient Details record end -->
|
||
|
||
<!-- patient visit record start -->
|
||
<div class="card card-section">
|
||
<div class="card-header collapse-card-header" id="headingOne">
|
||
<h2 class="mb-0">
|
||
<button class="btn btn-link collapse-button-view" type="button" data-toggle="collapse" data-target="#collapseOne" aria-expanded="true" aria-controls="collapseOne">
|
||
<h3 class="font-weight-bold text-uppercase truncatebyline by1 ml-0" id="assessment_tab">Assessment</h3>
|
||
<i class="la la-angle-down"></i>
|
||
</button>
|
||
</h2>
|
||
</div>
|
||
<div id="collapseOne" class="collapse" aria-labelledby="headingOne" data-parent="#accordionExample">
|
||
<div class="card-body">
|
||
<ul class="nav nav-pills" id="myTab" role="tablist">
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link active" id="visit-info-tab" data-toggle="tab" href="#visit-info" role="tab" aria-controls="visit-info" aria-selected="true">Visit Info
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Visit Info</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="psycho-social-tab" data-toggle="tab" href="#psycho-social" role="tab" aria-controls="psycho-social" aria-selected="false">Psychosocial
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Psychosocial</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Vital-Signs-tab" data-toggle="tab" href="#Vital-Signs" role="tab" aria-controls="Vital-Signs" aria-selected="false">Vital Signs
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Vital Signs</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Neuro-EENT-Psych-tab" data-toggle="tab" href="#Neuro-EENT-Psych" role="tab" aria-controls="Neuro-EENT-Psych" aria-selected="false">Neuro/EENT/Psych
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Neuro/EENT/Psych</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Cardiovascular-Pulmonary-tab" data-toggle="tab" href="#Cardiovascular-Pulmonary" role="tab" aria-controls="Cardiovascular-Pulmonary" aria-selected="false">Cardiovascular/Pulmonary
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Cardiovascular/Pulmonary</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="GI-GU-Reproductive-tab" data-toggle="tab" href="#GI-GU-Reproductive" role="tab" aria-controls="GI-GU-Reproductive" aria-selected="false">GI/GU/Reproductive
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">GI/GU/Reproductive</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Musculoskeletal-PV-Pain-tab" data-toggle="tab" href="#Musculoskeletal-PV-Pain" role="tab" aria-controls="Musculoskeletal-PV-Pain" aria-selected="false">Musculoskeletal/PV/Pain
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Musculoskeletal/PV/Pain</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Endrocrine-Hemotopoietic-tab" data-toggle="tab" href="#Endrocrine-Hemotopoietic" role="tab" aria-controls="Endrocrine-Hemotopoietic" aria-selected="false">Endrocrine Hemotopoietic
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Endrocrine Hemotopoietic</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Nutrition-tab" data-toggle="tab" href="#Nutrition" role="tab" aria-controls="Nutrition" aria-selected="false">Nutrition
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Nutrition</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Integument-tab" data-toggle="tab" href="#Integument" role="tab" aria-controls="Integument" aria-selected="false">Integument
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Integument</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Medication-tab" data-toggle="tab" href="#Medication" role="tab" aria-controls="Medication" aria-selected="false">Medication
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Medication</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="DME-Supplies-tab" data-toggle="tab" href="#DME-Supplies" role="tab" aria-controls="DME-Supplies" aria-selected="false">DME/Supplies
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">DME/Supplies</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Paraprofessional-Supervission-tab" data-toggle="tab" href="#Paraprofessional-Supervission" role="tab" aria-controls="Paraprofessional-Supervission" aria-selected="false">Paraprofessional Supervission
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Paraprofessional Supervission</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Narrative-tab" data-toggle="tab" href="#Narrative" role="tab" aria-controls="Narrative" aria-selected="false">Narrative
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Narrative</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Home-Health-Certification-POC-tab" data-toggle="tab" href="#Home-Health-Certification-POC" role="tab" aria-controls="Home-Health-Certification-POC" aria-selected="false">Home Health Certification & POC
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Narrative</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="Covid-19-Screening-tab" data-toggle="tab" href="#Covid-19-Screening" role="tab" aria-controls="Covid-19-Screening" aria-selected="false">Patient Covid-19 Screening
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Narrative</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="home-safety-assessments-tab" data-toggle="tab" href="#home-safety-assessments" role="tab" aria-controls="Covid-19-Screening" aria-selected="false">Home Safety Assessments
|
||
<!-- <h6 class="font-weight-bold text-uppercase ord-heading">Narrative</h6> -->
|
||
</a>
|
||
</li>
|
||
<li class="nav-item hgfdyevfhjgvshgdv6">
|
||
<a class="nav-link" id="patient-authorization-tab" data-toggle="tab" href="#patient-authorization" role="tab" aria-controls="Patient Authorization" aria-selected="false">Patient Authorization & Consents
|
||
</a>
|
||
</li>
|
||
</ul>
|
||
<div class="tab-content">
|
||
<div class="tab-pane fade show active" id="visit-info" role="tabpanel" aria-labelledby="visit-info-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">visit-info</h5>
|
||
<form method="POST" class="form_class" id="patientVisitRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<input type="hidden" id="visit_date_val" value="<?=isset($visit_info->visit_date)?$visit_info->visit_date:''?>">
|
||
<input type="hidden" id="start_time_val" value="<?=isset($visit_info->Start_Time)?$visit_info->Start_Time:''?>">
|
||
<input type="hidden" id="end_time_val" value="<?=isset($visit_info->End_Time)?$visit_info->End_Time:''?>">
|
||
<?php viewDynamincForm('order'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="psycho-social" role="tabpanel" aria-labelledby="psycho-social-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Psychosocial</h5>
|
||
<form method="POST" class="form_class" id="patientPsychosocialRecord">
|
||
<input type="hidden" name="<?=$this->security->get_csrf_token_name()?>" value="<?=$this->security->get_csrf_hash()?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?=$type?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?=$scheduleId?>">
|
||
<input type="hidden" name="caregiver_id" value="<?=$caregiver['id']?>">
|
||
<input type="hidden" name="patientName" value="<?=$patient_data->first_name.' '.$patient_data->last_name?>">
|
||
<input type="hidden" name="dob" value="<?=$patient_data->dob?>">
|
||
<?php viewDynamincForm('psycho-social'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info">
|
||
<?=lang('submit')?>
|
||
</button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="Vital-Signs" role="tabpanel" aria-labelledby="Vital-Signs-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Vital-Signs</h5>
|
||
<form method="POST" class="form_class" id="patientVitalSignRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php viewDynamincForm('vitalSign'); ?>
|
||
<img src="https://www.disabled-world.com/pics/1/pain-scale-chart-3.gif" width="500">
|
||
<?php viewDynamincForm('vitalSign-pain'); ?>
|
||
<!-- Teaching for vital sign pain measurment -->
|
||
<div class="form-horizontal">
|
||
<div><input name="if-infusion-teaching-provided-form-741-token" type="hidden" value="3380897495fc5e9d42887f4.24139932"><input name="if-infusion-teaching-provided-form-741" type="hidden" value="1"></div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Teaching Provided</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_0" name="Teaching_Provided" value="Yes" class="conditional_opt form-check-input" attr_to_open="pain_condition_depending_field" attr_open_for="Yes"><label for="Teaching_Provided_To_0" class="form-check-label">Yes</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_4" name="Teaching_Provided" value="No" class="conditional_opt form-check-input" attr_to_open="pain_condition_depending_field" attr_open_for="Yes"><label for="Teaching_Provided_To_4" class="form-check-label">No</label></div>
|
||
</div>
|
||
</div>
|
||
<div id="pain_condition_depending_field" style="display: none">
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Teaching Provided To</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_0" name="Teaching_Provided_To" value="Patient" class="form-check-input"><label for="Teaching_Provided_To_0" class="form-check-label">Patient</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_1" name="Teaching_Provided_To" value="Caregiver" class="form-check-input"><label for="Teaching_Provided_To_1" class="form-check-label">Caregiver</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_2" name="Teaching_Provided_To" value="Spouse" class="form-check-input"><label for="Teaching_Provided_To_2" class="form-check-label">Spouse</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_3" name="Teaching_Provided_To" value="Parent" class="form-check-input"><label for="Teaching_Provided_To_3" class="form-check-label">Parent</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_4" name="Teaching_Provided_To" value="Other" class="form-check-input"><label for="Teaching_Provided_To_4" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Instruct Patient on </label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _0" name="Instruct_Patient_on []" value="S/S of IV Site Complications" class="form-check-input"><label for="Instruct_Patient_on _0" class="form-check-label">S/S of IV Site Complications</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _1" name="Instruct_Patient_on []" value="S/S of Adverse Reactions" class="form-check-input"><label for="Instruct_Patient_on _1" class="form-check-label">S/S of Adverse Reactions</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _2" name="Instruct_Patient_on []" value="Disease Process" class="form-check-input"><label for="Instruct_Patient_on _2" class="form-check-label">Disease Process</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _3" name="Instruct_Patient_on []" value="Sign & Symptoms" class="form-check-input"><label for="Instruct_Patient_on _3" class="form-check-label">Sign & Symptoms</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _4" name="Instruct_Patient_on []" value="Medication Therapy" class="form-check-input"><label for="Instruct_Patient_on _4" class="form-check-label">Medication Therapy</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _5" name="Instruct_Patient_on []" value="Medication Purpose" class="form-check-input"><label for="Instruct_Patient_on _5" class="form-check-label">Medication Purpose</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _6" name="Instruct_Patient_on []" value="Medication Actions" class="form-check-input"><label for="Instruct_Patient_on _6" class="form-check-label">Medication Actions</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _7" name="Instruct_Patient_on []" value="Medication Storage" class="form-check-input"><label for="Instruct_Patient_on _7" class="form-check-label">Medication Storage</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _8" name="Instruct_Patient_on []" value="Supply Storage" class="form-check-input"><label for="Instruct_Patient_on _8" class="form-check-label">Supply Storage</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _9" name="Instruct_Patient_on []" value="Universal Precautions" class="form-check-input"><label for="Instruct_Patient_on _9" class="form-check-label">Universal Precautions</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Response To Teaching</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_0" name="Response_To_Teaching[]" value="Agreement to Comply" class="form-check-input"><label for="Response_To_Teaching_0" class="form-check-label">Agreement to Comply</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_1" name="Response_To_Teaching[]" value="Understood" class="form-check-input"><label for="Response_To_Teaching_1" class="form-check-label">Understood</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_2" name="Response_To_Teaching[]" value="Need Further Teaching" class="form-check-input"><label for="Response_To_Teaching_2" class="form-check-label">Need Further Teaching</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_3" name="Response_To_Teaching[]" value="Other" class="form-check-input"><label for="Response_To_Teaching_3" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label for="Notes" class="col-sm-4 col-form-label">Notes</label>
|
||
<div class="col-sm-8"><textarea id="Notes" name="Notes" class="form-control"></textarea></div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!-- Teaching for vital sign pain measurment -->
|
||
<?php viewDynamincForm('vital-sign-form-92'); ?>
|
||
<!-- Teaching for vital sign pain measurment -->
|
||
<div class="form-horizontal">
|
||
<div><input name="if-infusion-teaching-provided-form-741-token" type="hidden" value="3380897495fc5e9d42887f4.24139932"><input name="if-infusion-teaching-provided-form-741" type="hidden" value="1"></div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Teaching Provided</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_0" name="Teaching_Provided_oxymeter" value="Yes" class="conditional_opt form-check-input" attr_to_open="oxymeter_condition_depending_field" attr_open_for="Yes"><label for="Teaching_Provided_To_0" class="form-check-label">Yes</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_4" name="Teaching_Provided_oxymeter" value="No" class="conditional_opt form-check-input" attr_to_open="oxymeter_condition_depending_field" attr_open_for="Yes"><label for="Teaching_Provided_To_4" class="form-check-label">No</label></div>
|
||
</div>
|
||
</div>
|
||
<div id="oxymeter_condition_depending_field" style="display: none">
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Teaching Provided To</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_0" name="Teaching_Provided_To" value="Patient" class="form-check-input"><label for="Teaching_Provided_To_0" class="form-check-label">Patient</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_1" name="Teaching_Provided_To" value="Caregiver" class="form-check-input"><label for="Teaching_Provided_To_1" class="form-check-label">Caregiver</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_2" name="Teaching_Provided_To" value="Spouse" class="form-check-input"><label for="Teaching_Provided_To_2" class="form-check-label">Spouse</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_3" name="Teaching_Provided_To" value="Parent" class="form-check-input"><label for="Teaching_Provided_To_3" class="form-check-label">Parent</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_4" name="Teaching_Provided_To" value="Other" class="form-check-input"><label for="Teaching_Provided_To_4" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Instruct Patient on </label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _0" name="Instruct_Patient_on []" value="S/S of IV Site Complications" class="form-check-input"><label for="Instruct_Patient_on _0" class="form-check-label">S/S of IV Site Complications</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _1" name="Instruct_Patient_on []" value="S/S of Adverse Reactions" class="form-check-input"><label for="Instruct_Patient_on _1" class="form-check-label">S/S of Adverse Reactions</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _2" name="Instruct_Patient_on []" value="Disease Process" class="form-check-input"><label for="Instruct_Patient_on _2" class="form-check-label">Disease Process</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _3" name="Instruct_Patient_on []" value="Sign & Symptoms" class="form-check-input"><label for="Instruct_Patient_on _3" class="form-check-label">Sign & Symptoms</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _4" name="Instruct_Patient_on []" value="Medication Therapy" class="form-check-input"><label for="Instruct_Patient_on _4" class="form-check-label">Medication Therapy</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _5" name="Instruct_Patient_on []" value="Medication Purpose" class="form-check-input"><label for="Instruct_Patient_on _5" class="form-check-label">Medication Purpose</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _6" name="Instruct_Patient_on []" value="Medication Actions" class="form-check-input"><label for="Instruct_Patient_on _6" class="form-check-label">Medication Actions</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _7" name="Instruct_Patient_on []" value="Medication Storage" class="form-check-input"><label for="Instruct_Patient_on _7" class="form-check-label">Medication Storage</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _8" name="Instruct_Patient_on []" value="Supply Storage" class="form-check-input"><label for="Instruct_Patient_on _8" class="form-check-label">Supply Storage</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _9" name="Instruct_Patient_on []" value="Universal Precautions" class="form-check-input"><label for="Instruct_Patient_on _9" class="form-check-label">Universal Precautions</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Response To Teaching</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_0" name="Response_To_Teaching[]" value="Agreement to Comply" class="form-check-input"><label for="Response_To_Teaching_0" class="form-check-label">Agreement to Comply</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_1" name="Response_To_Teaching[]" value="Understood" class="form-check-input"><label for="Response_To_Teaching_1" class="form-check-label">Understood</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_2" name="Response_To_Teaching[]" value="Need Further Teaching" class="form-check-input"><label for="Response_To_Teaching_2" class="form-check-label">Need Further Teaching</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_3" name="Response_To_Teaching[]" value="Other" class="form-check-input"><label for="Response_To_Teaching_3" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label for="Notes" class="col-sm-4 col-form-label">Notes</label>
|
||
<div class="col-sm-8"><textarea id="Notes" name="Notes" class="form-control"></textarea></div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$(".conditional_opt").click(function(){
|
||
var val = $(this).val();
|
||
var to_open = $(this).attr('attr_to_open');
|
||
var open_for = $(this).attr('attr_open_for');
|
||
// alert(val+' '+to_open+' '+open_for);
|
||
if(val == open_for)
|
||
{
|
||
$("#"+to_open).show();
|
||
}
|
||
else
|
||
{
|
||
$("#"+to_open).hide();
|
||
}
|
||
});
|
||
})
|
||
</script>
|
||
<!-- Teaching for vital sign pain measurment -->
|
||
|
||
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="Neuro-EENT-Psych" role="tabpanel" aria-labelledby="Neuro-EENT-Psych-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Neuro-EENT-Psych</h5>
|
||
<form method="POST" class="form_class" id="patientNeuroRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php viewDynamincForm('neurological'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="Cardiovascular-Pulmonary" role="tabpanel" aria-labelledby="Cardiovascular-Pulmonary-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Cardiovascular-Pulmonary</h5>
|
||
<form method="POST" class="form_class" id="patientCardiovascularRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">RESPIRATORY</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_0" name="RESPIRATORY[]" value="WNL" class="form-check-input">
|
||
<label for="RESPIRATORY_0" class="form-check-label">WNL</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Clubbing" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Clubbing</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Dyspnea at Rest" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Dyspnea at Rest</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Dyspnea on Exertion (DOE)" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Dyspnea on Exertion (DOE)</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Tachypnea" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Tachypnea</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Vocal Fremitus" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Vocal Fremitus</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Tactile Fremitus" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Tactile Fremitus</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="JVD" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">JVD</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Paroxysmal Nocturnal Dyspnea (PND)" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Paroxysmal Nocturnal Dyspnea (PND), Other</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Other" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Other</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php viewDynamincForm('respiratory-form'); ?>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">TOOLS</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_TOOLS_0" name="RESPIRATORY_TOOLS[]" value="COUGH" class="form-check-input">
|
||
<label for="RESPIRATORY_TOOLS_0" class="form-check-label">COUGH</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_TOOLS_1" name="RESPIRATORY_TOOLS[]" value="BIPAP" class="form-check-input">
|
||
<label for="RESPIRATORY_TOOLS_1" class="form-check-label">BIPAP</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_TOOLS_3" name="RESPIRATORY_TOOLS[]" value="CPAP" class="form-check-input">
|
||
<label for="RESPIRATORY_TOOLS_3" class="form-check-label">CPAP</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_TOOLS_4" name="RESPIRATORY_TOOLS[]" value="TRACHEOSTOMY" class="form-check-input">
|
||
<label for="RESPIRATORY_TOOLS_4" class="form-check-label">TRACHEOSTOMY</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_TOOLS_5" name="RESPIRATORY_TOOLS[]" value="OXYGEN" class="form-check-input">
|
||
<label for="RESPIRATORY_TOOLS_5" class="form-check-label">OXYGEN</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_TOOLS_6" name="RESPIRATORY_TOOLS[]" value="VENTILATION" class="form-check-input">
|
||
<label for="RESPIRATORY_TOOLS_6" class="form-check-label">VENTILATION</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$("input:checkbox[name='RESPIRATORY_TOOLS[]']").click(function(){
|
||
$("#RESPIRATORY_COUGH").hide();
|
||
$("#BIPAP_COUGH").hide();
|
||
$("#CPAP_COUGH").hide();
|
||
$("#RESPIRATORY_COUGH_TRACHEOSTOMY").hide();
|
||
$("#RESPIRATORY_COUGH_OXYGEN").hide();
|
||
$("#RESPIRATORY_COUGH_VENTILATION").hide();
|
||
var list = $("input[name='RESPIRATORY_TOOLS[]']:checked").map(function () {
|
||
|
||
if(this.value == 'COUGH') { $("#RESPIRATORY_COUGH").show(); }
|
||
if(this.value == 'BIPAP') { $("#BIPAP_COUGH").show(); }
|
||
if(this.value == 'CPAP') { $("#CPAP_COUGH").show(); }
|
||
if(this.value == 'TRACHEOSTOMY') { $("#RESPIRATORY_COUGH_TRACHEOSTOMY").show(); }
|
||
if(this.value == 'OXYGEN') { $("#RESPIRATORY_COUGH_OXYGEN").show(); }
|
||
if(this.value == 'VENTILATION') { $("#RESPIRATORY_COUGH_VENTILATION").show(); }
|
||
}).get();
|
||
|
||
});
|
||
|
||
$("input:checkbox[name='RESPIRATORY_Cough_type[]']").click(function(){
|
||
$(".respCndDsply").hide();
|
||
var list = $("input[name='RESPIRATORY_Cough_type[]']:checked").map(function () {
|
||
|
||
if(this.value == 'PRODUCTIVE') { $("#PRODUCTIVE_respCndDsply_1").show(); }
|
||
if(this.value == 'PRODUCTIVE') { $("#PRODUCTIVE_respCndDsply_2").show(); }
|
||
if(this.value == 'PRODUCTIVE') { $("#PRODUCTIVE_respCndDsply_3").show(); }
|
||
|
||
}).get();
|
||
|
||
});
|
||
|
||
|
||
|
||
})
|
||
</script>
|
||
|
||
<!--IF Cough Selected-->
|
||
<div class="form-group row justify-content-end" class="respCndDsply" id="RESPIRATORY_COUGH" style="display: none;">
|
||
<?php viewDynamincForm('if-cough-selected-form'); ?>
|
||
<label class="main-label col-sm-4 col-form-label">Cough Description</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_Cough_type_0" name="RESPIRATORY_Cough_type[]" value="DRY" class="form-check-input">
|
||
<label for="RESPIRATORY_Cough_type_0" class="form-check-label">DRY</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_Cough_type_1" name="RESPIRATORY_Cough_type[]" value="PRODUCTIVE" class="form-check-input">
|
||
<label for="RESPIRATORY_Cough_type_1" class="form-check-label">PRODUCTIVE</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
|
||
|
||
<!--IF PRODUCTIVE Selected-->
|
||
<div class="form-group row justify-content-end" class="respCndDsply" id="PRODUCTIVE_respCndDsply_1" style="display: none;">
|
||
<label class="main-label col-sm-4 col-form-label">PRODUCTIVE COLOR</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_0" name="RESPIRATORY[]" value="Clear" class="form-check-input">
|
||
<label for="RESPIRATORY_0" class="form-check-label">Clear</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Yellow" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Yellow</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Green" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Green</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Brown" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Brown</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="White" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">White</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Other" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Other</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end" class="respCndDsply" id="PRODUCTIVE_respCndDsply_2" style="display: none;">
|
||
<label class="main-label col-sm-4 col-form-label">Consistency</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_0" name="RESPIRATORY[]" value="Thin" class="form-check-input">
|
||
<label for="RESPIRATORY_0" class="form-check-label">Thin</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Tenacious" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Tenacious</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Thick" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Thick</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Other" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Other</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end" class="respCndDsply" id="PRODUCTIVE_respCndDsply_3" style="display: none;">
|
||
<label class="main-label col-sm-4 col-form-label">Amount</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_0" name="RESPIRATORY[]" value="Scant" class="form-check-input">
|
||
<label for="RESPIRATORY_0" class="form-check-label">Scant</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Copious" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Copious</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Moderate" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Moderate</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input type="checkbox" id="RESPIRATORY_1" name="RESPIRATORY[]" value="Other" class="form-check-input">
|
||
<label for="RESPIRATORY_1" class="form-check-label">Other</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!--END IF PRODUCTIVE Selected-->
|
||
<!--if-cough-selected-form-->
|
||
<!--END IF Cough Selected-->
|
||
|
||
<!--IF BIPAP Selected-->
|
||
<div class="form-group row justify-content-end" class="respCndDsply" id="BIPAP_COUGH" style="display: none;">
|
||
<label for="input-1" class="col-sm-2 col-form-label">IPAP</label>
|
||
<div class="col-sm-4">
|
||
<input id="input-1" name="BIPAP_IPAP" type="text" value="" class="form-control">
|
||
</div>
|
||
<label for="input-1" class="col-sm-2 col-form-label">EPAP</label>
|
||
<div class="col-sm-4">
|
||
<input id="input-1" name="BIPAP_EPAP" type="text" value="" class="form-control">
|
||
</div>
|
||
<label for="input-1" class="col-sm-2 col-form-label">FiO2</label>
|
||
<div class="col-sm-4">
|
||
<input id="input-1" name="BIPAP_FiO2" type="text" value="" class="form-control">
|
||
</div>
|
||
<label for="input-1" class="col-sm-2 col-form-label">RATE</label>
|
||
<div class="col-sm-4">
|
||
<input id="input-1" name="BIPAP_RATE" type="text" value="" class="form-control">
|
||
</div>
|
||
</div>
|
||
<!--END IF BIPAP Selected-->
|
||
<!--IF CPAP Selected-->
|
||
<div class="form-group row justify-content-end" class="respCndDsply" id="CPAP_COUGH" style="display: none;">
|
||
<label for="input-1" class="col-sm-2 col-form-label">CPAP</label>
|
||
<div class="col-sm-4">
|
||
<input id="input-1" name="CPAP" type="text" value="" class="form-control">
|
||
</div>
|
||
<label for="input-1" class="col-sm-2 col-form-label">PEEP</label>
|
||
<div class="col-sm-4">
|
||
<input id="input-1" name="CPAP_EPAP" type="text" value="" class="form-control">
|
||
</div>
|
||
<label for="input-1" class="col-sm-2 col-form-label">FiO2</label>
|
||
<div class="col-sm-4">
|
||
<input id="input-1" name="CPAP_FiO2" type="text" value="" class="form-control">
|
||
</div>
|
||
</div>
|
||
<!--END IF CPAP Selected-->
|
||
<!--IF TRACHEOSTOMY Selected-->
|
||
<div id="RESPIRATORY_COUGH_TRACHEOSTOMY">
|
||
<?php viewDynamincForm('if-TRACHEOSTOMY-selected-form'); ?>
|
||
</div>
|
||
<!--END IF TRACHEOSTOMY Selected-->
|
||
<!--IF OXYGEN Selected-->
|
||
<div id="RESPIRATORY_COUGH_OXYGEN">
|
||
<?php
|
||
//viewDynamincForm('if-OXYGEN-selected-form');
|
||
viewDynamincForm('if-OXYGEN-is-selected');
|
||
?>
|
||
</div>
|
||
<!--if-OXYGEN-selected-form-->
|
||
<!--END IF OXYGEN Selected-->
|
||
<!--IF VENTILATION Selected-->
|
||
<div id="RESPIRATORY_COUGH_VENTILATION">
|
||
<?php viewDynamincForm('if-VENTILATION-selected-form'); ?>
|
||
</div>
|
||
<!--if-VENTILATION-selected-form-->
|
||
<!--END IF VENTILATION Selected-->
|
||
<?php viewDynamincForm('cardiovascular'); ?>
|
||
|
||
|
||
<!-- Cardiovascular Edema form -->
|
||
<?php viewDynamincForm('cardiovascular-edema'); ?>
|
||
<!-- Cardiovascular Edema form -->
|
||
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$(".conditional_opt_edema").click(function(){
|
||
var val = $(this).val();
|
||
var to_open = $(this).attr('attr_to_open');
|
||
var open_for = $(this).attr('attr_open_for');
|
||
$(".edema_sub_forms").hide();
|
||
if(val == open_for)
|
||
{
|
||
$("#"+to_open).show();
|
||
}
|
||
|
||
});
|
||
})
|
||
</script>
|
||
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Edema Position</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="edema_Position_0" name="edema_Position" value="Right Lower Extremely" attr_open_for="Right Lower Extremely" class="form-check-input conditional_opt_edema" attr_to_open="Edema-Right-Lower-Extremity"><label for="edema_Position_0" class="form-check-label" >Right Lower Extremely</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="edema_Position_1" name="edema_Position" value="Right Upper Extremely" attr_open_for="Right Upper Extremely" class="form-check-input conditional_opt_edema" attr_to_open="Edema-Right-upper-Extremity"><label for="edema_Position_1" class="form-check-label" >Right Upper Extremely</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="edema_Position_2" name="edema_Position" value="Left Lower Extremely" attr_open_for="Left Lower Extremely" class="form-check-input conditional_opt_edema" attr_to_open="Edema-left-Lower-Extremity"><label for="edema_Position_2" class="form-check-label" >Left Lower Extremely</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="edema_Position_3" name="edema_Position" value="Left Upper Extremely" attr_open_for="Left Upper Extremely" class="form-check-input conditional_opt_edema" attr_to_open="Edema-left-upper-Extremity"><label for="edema_Position_3" class="form-check-label" >Left Upper Extremely</label></div>
|
||
</div>
|
||
</div>
|
||
<?php viewDynamincForm('cardiovascular-heart'); ?>
|
||
<div id="Edema-Right-Lower-Extremity" class="edema_sub_forms" style="display: none">
|
||
<!-- Cardiovascular Edema Right-Lower form -->
|
||
<?php viewDynamincForm('Edema-Right-Lower-Extremity'); ?>
|
||
</div>
|
||
<div id="Edema-Right-upper-Extremity" class="edema_sub_forms" style="display: none">
|
||
<!-- Cardiovascular Edema Right-upper form -->
|
||
<?php viewDynamincForm('Edema-Right-upper-Extremity'); ?>
|
||
</div>
|
||
|
||
<div id="Edema-left-Lower-Extremity" class="edema_sub_forms" style="display: none">
|
||
<!-- Cardiovascular Edema left-Lower form -->
|
||
<?php viewDynamincForm('Edema-left-Lower-Extremity'); ?>
|
||
</div>
|
||
<div id="Edema-left-upper-Extremity" class="edema_sub_forms" style="display: none">
|
||
<!-- Cardiovascular Edema left-upper form -->
|
||
<?php viewDynamincForm('Edema-left-upper-Extremity'); ?>
|
||
</div>
|
||
|
||
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="GI-GU-Reproductive" role="tabpanel" aria-labelledby="GI-GU-Reproductive-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">GI-GU-Reproductive</h5>
|
||
<form method="POST" class="form_class" id="patientGIGURecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$("input:checkbox[name='Gi_Signs_Symptoms[]']").click(function(){
|
||
$("#Gi_Signs_Diarrhea").hide();
|
||
$("#Gi_Signs_Vomiting").hide();
|
||
var list = $("input[name='Gi_Signs_Symptoms[]']:checked").map(function () {
|
||
|
||
if(this.value == 'Diarrhea') { $("#Gi_Signs_Diarrhea").show(); }
|
||
if(this.value == 'Vomiting') { $("#Gi_Signs_Vomiting").show(); }
|
||
|
||
}).get();
|
||
|
||
});
|
||
});
|
||
</script>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label fstfdt6tsrt">Signs & Symptoms</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_0" name="Gi_Signs_Symptoms[]" value="WNL" class="form-check-input"><label for="Gi_Signs_Symptoms_0" class="form-check-label">WNL</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_1" name="Gi_Signs_Symptoms[]" value="Nausea" class="form-check-input"><label for="Gi_Signs_Symptoms_1" class="form-check-label">Nausea</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_2" name="Gi_Signs_Symptoms[]" value="Vomiting" class="form-check-input"><label for="Gi_Signs_Symptoms_2" class="form-check-label">Vomiting</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_3" name="Gi_Signs_Symptoms[]" value="Constipation" class="form-check-input"><label for="Gi_Signs_Symptoms_3" class="form-check-label">Constipation</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_4" name="Gi_Signs_Symptoms[]" value="Diarrhea" class="form-check-input"><label for="Gi_Signs_Symptoms_4" class="form-check-label">Diarrhea</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_5" name="Gi_Signs_Symptoms[]" value="GRD" class="form-check-input"><label for="Gi_Signs_Symptoms_5" class="form-check-label">GRD</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_6" name="Gi_Signs_Symptoms[]" value="Abdominal Distention" class="form-check-input"><label for="Gi_Signs_Symptoms_6" class="form-check-label">Abdominal Distention</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_7" name="Gi_Signs_Symptoms[]" value="Ascites" class="form-check-input"><label for="Gi_Signs_Symptoms_7" class="form-check-label">Ascites</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_8" name="Gi_Signs_Symptoms[]" value="Cramping" class="form-check-input"><label for="Gi_Signs_Symptoms_8" class="form-check-label">Cramping</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_9" name="Gi_Signs_Symptoms[]" value="Flatulence" class="form-check-input"><label for="Gi_Signs_Symptoms_9" class="form-check-label">Flatulence</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_10" name="Gi_Signs_Symptoms[]" value="Gastritis" class="form-check-input"><label for="Gi_Signs_Symptoms_10" class="form-check-label">Gastritis</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_11" name="Gi_Signs_Symptoms[]" value="Heatburn" class="form-check-input"><label for="Gi_Signs_Symptoms_11" class="form-check-label">Heatburn</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_12" name="Gi_Signs_Symptoms[]" value="Indigestion" class="form-check-input"><label for="Gi_Signs_Symptoms_12" class="form-check-label">Indigestion</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_13" name="Gi_Signs_Symptoms[]" value="Jaundice" class="form-check-input"><label for="Gi_Signs_Symptoms_13" class="form-check-label">Jaundice</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_14" name="Gi_Signs_Symptoms[]" value="Malaise" class="form-check-input"><label for="Gi_Signs_Symptoms_14" class="form-check-label">Malaise</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_15" name="Gi_Signs_Symptoms[]" value="Melena" class="form-check-input"><label for="Gi_Signs_Symptoms_15" class="form-check-label">Melena</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_16" name="Gi_Signs_Symptoms[]" value="Impaction" class="form-check-input"><label for="Gi_Signs_Symptoms_16" class="form-check-label">Impaction</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_17" name="Gi_Signs_Symptoms[]" value="Incontinence" class="form-check-input"><label for="Gi_Signs_Symptoms_17" class="form-check-label">Incontinence</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Gi_Signs_Symptoms_18" name="Gi_Signs_Symptoms[]" value="Other" class="form-check-input"><label for="Gi_Signs_Symptoms_18" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
|
||
<div class="form-group row justify-content-end" id="Gi_Signs_Diarrhea" style="display: none">
|
||
|
||
<label for="Diarrhea_Frequency" class="col-sm-2 col-form-label">Diarrhea Frequency</label>
|
||
<div class="col-sm-4">
|
||
<select id="Diarrhea_Frequency" name="Diarrhea_Frequency" class="form-control">
|
||
<option value="3 x Daily">3 x Daily</option>
|
||
<option value="4 x Daily">4 x Daily</option>
|
||
<option value="5 x Daily">5 x Daily</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end" id="Gi_Signs_Vomiting" style="display: none">
|
||
<label for="Vomiting_Frequency" class="col-sm-2 col-form-label">Vomiting Frequency</label>
|
||
<div class="col-sm-4">
|
||
<select id="Vomiting_Frequency" name="Vomiting_Frequency" class="form-control">
|
||
<option value="3 x Daily">3 x Daily</option>
|
||
<option value="4 x Daily">4 x Daily</option>
|
||
<option value="5 x Daily">5 x Daily</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label fstfdt6tsrt">BOWEL SOUNDS</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="BOWEL_SOUNDS_0" name="BOWEL_SOUNDS" value="Absent" class="form-check-input"><label for="BOWEL_SOUNDS_0" class="form-check-label">Absent</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="BOWEL_SOUNDS_1" name="BOWEL_SOUNDS" value="Normal" class="form-check-input"><label for="BOWEL_SOUNDS_1" class="form-check-label">Normal</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="BOWEL_SOUNDS_2" name="BOWEL_SOUNDS" value="Active In 4 Quads" class="form-check-input"><label for="BOWEL_SOUNDS_2" class="form-check-label">Active In 4 Quads</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="BOWEL_SOUNDS_3" name="BOWEL_SOUNDS" value="Hyperactive" class="form-check-input"><label for="BOWEL_SOUNDS_3" class="form-check-label">Hyperactive</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="BOWEL_SOUNDS_4" name="BOWEL_SOUNDS" value="Hypotactive" class="form-check-input"><label for="BOWEL_SOUNDS_4" class="form-check-label">Hypotactive</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="BOWEL_SOUNDS_5" name="BOWEL_SOUNDS" value="No Assessment" class="form-check-input"><label for="BOWEL_SOUNDS_5" class="form-check-label">No Assessment</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="BOWEL_SOUNDS_6" name="BOWEL_SOUNDS" value="WNL" class="form-check-input"><label for="BOWEL_SOUNDS_6" class="form-check-label">WNL</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label for="Date_of_Last_Bowel_Movement" class="col-sm-4 col-form-label">Date of Last Bowel Movemet</label>
|
||
<div class="col-sm-8"><input id="Date_of_Last_Bowel_Movement" name="Date_of_Last_Bowel_Movement" type="date" value="" class="form-control"></div>
|
||
</div>
|
||
<?php viewDynamincForm('Gu-form-3'); ?>
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$(".conditional_opt_OSTOMY").click(function(){
|
||
var val = $(this).val();
|
||
var to_open = $(this).attr('attr_to_open');
|
||
var open_for = $(this).attr('attr_open_for');
|
||
// alert(val+' '+to_open+' '+open_for);
|
||
if(val == open_for)
|
||
{
|
||
$("#"+to_open).show();
|
||
}
|
||
else
|
||
{
|
||
$("#"+to_open).hide();
|
||
}
|
||
});
|
||
});
|
||
</script>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">OSTOMY</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="OSTOMY_0" name="OSTOMY" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_0" class="form-check-label">Yes</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="OSTOMY_1" name="OSTOMY" value="No" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_1" class="form-check-label">No</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end" id="OSTOMY_TYPE" style="display: none">
|
||
<label class="main-label col-sm-4 col-form-label">Type</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="OSTOMY_type_0" name="OSTOMY_type" value="Colostomy" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_form" attr_open_for="Colostomy"><label for="OSTOMY_type_0" class="form-check-label">Colostomy</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="OSTOMY_type_1" name="OSTOMY_type" value="Ileostomy" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_form" attr_open_for="Ileostomy"><label for="OSTOMY_type_1" class="form-check-label">Ileostomy</label></div>
|
||
</div>
|
||
</div>
|
||
|
||
<div id="OSTOMY_form" style="display: none">
|
||
<?php viewDynamincForm('Gi-form'); ?>
|
||
</div>
|
||
<?php viewDynamincForm('Gu-form-1'); ?>
|
||
<?php viewDynamincForm('Gu-form-2'); ?>
|
||
<?php viewDynamincForm('reproductive-form'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
<!-- <button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button> -->
|
||
</form>
|
||
|
||
<!-- <form method="POST" class="form_class" id="patientGIGURecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php //viewDynamincForm('Gu-form-1'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button> -->
|
||
<!-- </form> -->
|
||
<!-- <form method="POST" class="form_class" id="patientGIGURecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php //viewDynamincForm('Gu-form-2'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button> -->
|
||
<!-- </form> -->
|
||
<!-- <form method="POST" class="form_class" id="patientGIGURecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php viewDynamincForm('reproductive-form'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form> -->
|
||
</div>
|
||
<div class="tab-pane fade" id="Musculoskeletal-PV-Pain" role="tabpanel" aria-labelledby="Musculoskeletal-PV-Pain-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Musculoskeletal-PV-Pain</h5>
|
||
<form method="POST" class="form_class" id="patientMusculoskeletalRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
|
||
<?php viewDynamincForm('musculoskeletal'); ?>
|
||
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">ROM</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="ROM_0" name="ROM" value="WNL" class="form-check-input conditional_opt_OSTOMY" attr_to_open="Musculoskeletal-form-2" attr_open_for="Limited"><label for="ROM_0" class="form-check-label">WNL</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="ROM_1" name="ROM" value="Limited" class="form-check-input conditional_opt_OSTOMY" attr_to_open="Musculoskeletal-form-2" attr_open_for="Limited"><label for="ROM_1" class="form-check-label">Limited</label></div>
|
||
</div>
|
||
</div>
|
||
|
||
<div id="Musculoskeletal-form-2" style="display: none">
|
||
<?php viewDynamincForm('Musculoskeletal-form-2'); ?>
|
||
</div>
|
||
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$(".conditional_opt_MUSCULOSKELETAL").click(function(){
|
||
$(".opt_MUSCULOSKELETAL").hide();
|
||
var val = $(this).val();
|
||
var to_open = $(this).attr('attr_to_open');
|
||
var open_for = $(this).attr('attr_open_for');
|
||
// alert(val+' '+to_open+' '+open_for);
|
||
if(val == open_for)
|
||
{
|
||
$("#"+to_open).show();
|
||
}
|
||
else
|
||
{
|
||
$("#"+to_open).hide();
|
||
}
|
||
});
|
||
});
|
||
</script>
|
||
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Device</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Device_ROM_0" name="ROM" value="Device" class="form-check-input conditional_opt_MUSCULOSKELETAL" attr_to_open="MUSCULOSKELETAL_device_form" attr_open_for="Device"><label for="Device_ROM_0" class="form-check-label">Device</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Device_ROM_1" name="ROM" value="No Device" class="form-check-input conditional_opt_MUSCULOSKELETAL" attr_to_open="MUSCULOSKELETAL-no-device-form" attr_open_for="No Device"><label for="Device_ROM_1" class="form-check-label">No device</label></div>
|
||
</div>
|
||
</div>
|
||
|
||
<div id="MUSCULOSKELETAL_device_form" class="opt_MUSCULOSKELETAL" style="display: none">
|
||
<?php viewDynamincForm('MUSCULOSKELETAL_device_form'); ?>
|
||
</div>
|
||
|
||
<div id="MUSCULOSKELETAL-no-device-form" class="opt_MUSCULOSKELETAL" style="display: none">
|
||
<?php viewDynamincForm('MUSCULOSKELETAL-no-device-form'); ?>
|
||
</div>
|
||
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$("input:checkbox[name='nonAmbulatory']").click(function(){
|
||
if($("input:checkbox[name='nonAmbulatory']").prop('checked')){
|
||
var to_open = $(this).attr('attr_to_open');
|
||
$("#"+to_open).show();
|
||
}
|
||
else
|
||
{
|
||
var to_open = $(this).attr('attr_to_open');
|
||
$("#"+to_open).hide();
|
||
}
|
||
});
|
||
});
|
||
|
||
|
||
$(function(){
|
||
$(".conditional_opt_nonamb").click(function(){
|
||
var val = $(this).val();
|
||
var to_open = $(this).attr('attr_to_open');
|
||
var open_for = $(this).attr('attr_open_for');
|
||
// alert(val+' '+to_open+' '+open_for);
|
||
if(val == open_for)
|
||
{
|
||
$("#"+to_open).show();
|
||
}
|
||
else
|
||
{
|
||
$("#"+to_open).hide();
|
||
}
|
||
});
|
||
});
|
||
</script>
|
||
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Device_nonAmb_0" name="nonAmbulatory" value="Device" class="form-check-input" attr_to_open="non_ambs_forms" ><label for="Device_nonAmb_0" class="form-check-label">Non Ambulatory</label></div>
|
||
</div>
|
||
</div>
|
||
<div id="non_ambs_forms" style="display: none;">
|
||
|
||
<div class="form-group row justify-content-end">
|
||
<div class=" col-sm-12">
|
||
<div class="form-check form-check-inline"><input type="radio" id="non_ambulatory_options_0" name="non_ambulatory_options" value="Bed Bound" class="form-check-input conditional_opt_nonamb" attr_to_open="non_ambs_nonChair" attr_open_for="Chair Bound"><label for="non_ambulatory_options_0" class="form-check-label">Bed Bound</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="non_ambulatory_options_1" name="non_ambulatory_options" value="Chair Bound" class="form-check-input conditional_opt_nonamb" attr_to_open="non_ambs_nonChair" attr_open_for="Chair Bound"><label for="non_ambulatory_options_1" class="form-check-label">Chair Bound</label></div>
|
||
</div>
|
||
</div>
|
||
<div id="non_ambs_nonChair" style="display: none;">
|
||
<?php viewDynamincForm('MUSCULOSKELETAL-Non-Ambulatory-chairbound'); ?>
|
||
</div>
|
||
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Gait</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Gait_0" name="Gait" value="WNL" class="form-check-input conditional_opt_nonamb" attr_to_open="nb_gait_opt" attr_open_for="Abnormality"><label for="Gait_0" class="form-check-label">WNL</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Gait_1" name="Gait" value="Abnormality" class="form-check-input conditional_opt_nonamb" attr_to_open="nb_gait_opt" attr_open_for="Abnormality"><label for="Gait_1" class="form-check-label">Abnormality</label></div>
|
||
</div>
|
||
</div>
|
||
|
||
<div class="form-group row justify-content-end" id="nb_gait_opt" style="display: none;">
|
||
<div class=" col-sm-12">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_0" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Parkinsonian" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_0" class="form-check-label">Parkinsonian</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_1" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Spastic" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_1" class="form-check-label">Spastic</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_2" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Hemiplegic" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_2" class="form-check-label">Hemiplegic</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_3" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Antalgic" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_3" class="form-check-label">Antalgic</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_4" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Arthrogenic" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_4" class="form-check-label">Arthrogenic</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_5" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Lurching" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_5" class="form-check-label">Lurching</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_6" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Scissors" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_6" class="form-check-label">Scissors</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_7" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Steppage" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_7" class="form-check-label">Steppage</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_8" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Trendelenburg" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_8" class="form-check-label">Trendelenburg</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_9" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Waddling" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_9" class="form-check-label">Waddling</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="MUSCULOSKELETAL-Non-Ambulatory-gait-options_10" name="MUSCULOSKELETAL-Non-Ambulatory-gait-options[]" value="Other" class="form-check-input"><label for="MUSCULOSKELETAL-Non-Ambulatory-gait-options_10" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
|
||
<?php viewDynamincForm('MUSCULOSKELETAL-Non-Ambulatory-gait'); ?>
|
||
</div>
|
||
<?php viewDynamincForm('MUSCULOSKELETAL-Activity-mobility'); ?>
|
||
|
||
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="Endrocrine-Hemotopoietic" role="tabpanel" aria-labelledby="Endrocrine-Hemotopoietic-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Endrocrine-Hemotopoietic</h5>
|
||
<form method="POST" class="form_class" id="patientEndrocrineRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php viewDynamincForm('endocrine'); ?>
|
||
<?php viewDynamincForm('HEMATOPOIETIC-form'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
<!-- <form method="POST" class="form_class" id="patientEndrocrineRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<div class="form-group row justify-content-end"><label class="main-label col-sm-4 col-form-label">Patient Taking/Receiving Medication As Prescribed</label><div class="col-sm-8"><div class="form-check form-check-inline"><input type="checkbox" id="Patient_Taking/Receiving_Medication_As_Prescribed_0" name="Teaching_Provided[]" value="Yes" class="form-check-input"><label for="Teaching_Provided_0" class="form-check-label">Yes</label></div><div class="form-check form-check-inline"><input type="checkbox" id="Teaching_Provided_1" name="Teaching_Provided[]" value="No" class="form-check-input"><label for="Teaching_Provided_1" class="form-check-label">No</label></div></div></div>
|
||
<?php viewDynamincForm('HEMATOPOIETIC-form'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form> -->
|
||
</div>
|
||
<div class="tab-pane fade" id="Nutrition" role="tabpanel" aria-labelledby="Nutrition-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Nutrition</h5>
|
||
<form method="POST" class="form_class" id="patientNutritionRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php viewDynamincForm('nutrition'); ?>
|
||
|
||
<table class="table table-bordered">
|
||
<tbody>
|
||
<tr>
|
||
<th colspan="2" class="text-center">Fall Risk Assessments</th>
|
||
</tr>
|
||
<tr>
|
||
<th class="text-center">Patient Risk Factors</th>
|
||
<th class="text-center">Environmental Risk Factors</th>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_0" name="FULL_RISK_0" value="Yes" class="form-check-input conditional_opt_OSTOMY"
|
||
<?=isset($nutrition->FULL_RISK_0)&&$nutrition->FULL_RISK_0=='Yes'?'checked':''?>
|
||
><label for="FULL_RISK_0" class="form-check-label">History of falls</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_1" name="FULL_RISK_1" value="Yes" class="form-check-input conditional_opt_OSTOMY"
|
||
<?=isset($nutrition->FULL_RISK_1)&&$nutrition->FULL_RISK_1=='Yes'?'checked':''?>
|
||
><label for="FULL_RISK_1" class="form-check-label">Unsafe stairs</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_2" name="FULL_RISK_2" value="Yes" class="form-check-input conditional_opt_OSTOMY"
|
||
<?=isset($nutrition->FULL_RISK_2)&&$nutrition->FULL_RISK_2=='Yes'?'checked':''?>
|
||
><label for="FULL_RISK_2" class="form-check-label">Confusion</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_3" name="FULL_RISK_3" value="Yes" class="form-check-input conditional_opt_OSTOMY"
|
||
<?=isset($nutrition->FULL_RISK_3)&&$nutrition->FULL_RISK_3=='Yes'?'checked':''?>
|
||
><label for="FULL_RISK_3" class="form-check-label">Irregular floor surfaces/slippery floor </label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_4" name="FULL_RISK_4" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_4)&&$nutrition->FULL_RISK_4=='Yes'?'checked':''?>
|
||
><label for="FULL_RISK_4" class="form-check-label">Age (over 65)</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_5" name="FULL_RISK_5" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_5)&&$nutrition->FULL_RISK_5=='Yes'?'checked':''?>
|
||
><label for="FULL_RISK_5" class="form-check-label">Scatter rugs</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_6" name="FULL_RISK_6" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_6)&&$nutrition->FULL_RISK_6=='Yes'?'checked':''?>><label for="FULL_RISK_6" class="form-check-label">Impaired Judgment</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_7" name="FULL_RISK_7" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_7)&&$nutrition->FULL_RISK_7=='Yes'?'checked':''?>><label for="FULL_RISK_7" class="form-check-label">Poor lighting/glare</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_8" name="FULL_RISK_8" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_8)&&$nutrition->FULL_RISK_8=='Yes'?'checked':''?>><label for="FULL_RISK_8" class="form-check-label">Sensory deficit/pain</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_9" name="FULL_RISK_9" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_9)&&$nutrition->FULL_RISK_9=='Yes'?'checked':''?>><label for="FULL_RISK_9" class="form-check-label">Clutter/obstacles electrical wires furniture</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_10" name="FULL_RISK_10" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_10)&&$nutrition->FULL_RISK_10=='Yes'?'checked':''?>><label for="FULL_RISK_10" class="form-check-label">Decreased level of cooperation</label></div></td>
|
||
<td></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_11" name="FULL_RISK_11" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_11)&&$nutrition->FULL_RISK_11=='Yes'?'checked':''?>><label for="FULL_RISK_11" class="form-check-label">Increased anxiety</label></div></td>
|
||
<td></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_12" name="FULL_RISK_12" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_12)&&$nutrition->FULL_RISK_12=='Yes'?'checked':''?>><label for="FULL_RISK_12" class="form-check-label">Incontinence/Urgency</label></div></td>
|
||
<td></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_13" name="FULL_RISK_13" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_13)&&$nutrition->FULL_RISK_13=='Yes'?'checked':''?>><label for="FULL_RISK_13" class="form-check-label">Cardiovascular/respiratory disease affecting perfusion and oxygenation</label></div></td>
|
||
<td></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_14" name="FULL_RISK_14" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_14)&&$nutrition->FULL_RISK_14=='Yes'?'checked':''?>><label for="FULL_RISK_14" class="form-check-label">Medications affecting blood pressure or level of consciousness</label></div></td>
|
||
<td></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_15" name="FULL_RISK_15" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_15)&&$nutrition->FULL_RISK_15=='Yes'?'checked':''?>><label for="FULL_RISK_15" class="form-check-label">Polypharmacy 4 or more medications</label></div></td>
|
||
<td></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="FULL_RISK_16" name="FULL_RISK_16" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->FULL_RISK_16)&&$nutrition->FULL_RISK_16=='Yes'?'checked':''?>><label for="FULL_RISK_16" class="form-check-label">Postural hypotension dizziness</label></div></td>
|
||
<td></td>
|
||
</tr>
|
||
<tr>
|
||
<td colspan="2"><div class="risk_field"><label for="FULL_RISK_17" class="risk_label">Total Score</label><input type="text" id="FULL_RISK_17" name="FULL_RISK_17" value="" class="form-control risk-input-field"></td>
|
||
</tr>
|
||
|
||
</tbody>
|
||
</table>
|
||
|
||
<table class="table table-bordered">
|
||
<tbody>
|
||
<tr>
|
||
<th><div class="form-check form-check-inline"><input type="radio" id="RISK_LEVEL_0" name="risk_level" value="Low Risk Level(0-1 Factor)" class="form-check-input"><label for="RISK_LEVEL_0" class="form-check-label">Low Risk Level(0-1 Factor)</label></div></th>
|
||
<th><div class="form-check form-check-inline"><input type="radio" id="RISK_LEVEL_1" name="risk_level" value="Moderate Risk Level(2-3 Factors)" class="form-check-input"><label for="RISK_LEVEL_1" class="form-check-label">Moderate Risk Level(2-3 Factors)</label></div></th>
|
||
<th><div class="form-check form-check-inline"><input type="radio" id="RISK_LEVEL_2" name="risk_level" value="High Risk Level(4 or more Factors)" class="form-check-input"><label for="RISK_LEVEL_2" class="form-check-label">High Risk Level(4 or more Factors)</label></div></th>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_0_0" name="risk_level_0_0" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_0_0)&&$nutrition->risk_level_0_0=='Yes'?'checked':''?>><label for="RISK_LEVEL_0_0" class="form-check-label">Routine assessment and care</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_1_0" name="risk_level_1_0" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_1_0)&&$nutrition->risk_level_1_0=='Yes'?'checked':''?>><label for="RISK_LEVEL_1_0" class="form-check-label">Refer to MD for potential rehabilitation services</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_2_0" name="risk_level_2_0" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_2_0)&&$nutrition->risk_level_2_0=='Yes'?'checked':''?>><label for="RISK_LEVEL_2_0" class="form-check-label">Care conference (MD, Supervisory, Family)</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_0_1" name="risk_level_0_1" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_0_1)&&$nutrition->risk_level_0_1=='Yes'?'checked':''?>><label for="RISK_LEVEL_0_1" class="form-check-label">Patients given fall prevention handout</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_1_1" name="risk_level_1_1" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_1_1)&&$nutrition->risk_level_1_1=='Yes'?'checked':''?>><label for="RISK_LEVEL_1_1" class="form-check-label">Patients given fall prevention handout</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_2_1" name="risk_level_2_1" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_2_1)&&$nutrition->risk_level_2_1=='Yes'?'checked':''?>><label for="RISK_LEVEL_2_1" class="form-check-label">Refer to MD for evaluation rehabilitation services</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<td></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_1_2" name="risk_level_1_2" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_1_2)&&$nutrition->risk_level_1_2=='Yes'?'checked':''?>><label for="RISK_LEVEL_1_2" class="form-check-label">Review medication with patient/caregiver for falls risk</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_2_2" name="risk_level_2_2" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_2_2)&&$nutrition->risk_level_2_2=='Yes'?'checked':''?>><label for="RISK_LEVEL_2_2" class="form-check-label">Patients given fall prevention handout</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<td></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_1_3" name="risk_level_1_3" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_1_3)&&$nutrition->risk_level_1_3=='Yes'?'checked':''?>><label for="RISK_LEVEL_1_3" class="form-check-label">Assess proper lighting at home</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_2_3" name="risk_level_2_3" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_2_3)&&$nutrition->risk_level_2_3=='Yes'?'checked':''?>><label for="RISK_LEVEL_2_3" class="form-check-label">Review medication with physician patient/caregiver falls risk</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<td></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_1_4" name="risk_level_1_4" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_1_4)&&$nutrition->risk_level_1_4=='Yes'?'checked':''?>><label for="RISK_LEVEL_1_4" class="form-check-label">Assess proper use and availability of assistive devices</label></div></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_2_4" name="risk_level_2_4" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_2_4)&&$nutrition->risk_level_2_4=='Yes'?'checked':''?>><label for="RISK_LEVEL_2_4" class="form-check-label">Assess patient home for good lighting</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<td></td>
|
||
<td></td>
|
||
<td><div class="form-check form-check-inline"><input type="checkbox" id="RISK_LEVEL_2_5" name="risk_level_2_5" value="Yes" class="form-check-input conditional_opt_OSTOMY" <?=isset($nutrition->risk_level_2_5)&&$nutrition->risk_level_2_5=='Yes'?'checked':''?>><label for="RISK_LEVEL_2_5" class="form-check-label">Assess proper use and availability of assistive devices</label></div></td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
|
||
<table class="table table-bordered">
|
||
|
||
<tbody>
|
||
<tr>
|
||
<th scope="row">Patient Has an illness or conditio that makes him/her the kind of amount of food he/she eats.</th>
|
||
<td><div class="form-check form-check-inline"><input type="radio" id="OSTOMY_0" name="Nutrition_screening_assessment_1" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_0" class="form-check-label">Yes</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<th scope="row">Patient eats less than 2meals per day</th>
|
||
<td><div class="form-check form-check-inline"><input type="radio" id="OSTOMY_2" name="Nutrition_screening_assessment_2" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_2" class="form-check-label">Yes</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<th scope="row">Patient eates few fruits or vegtables, milk or protein.</th>
|
||
<td><div class="form-check form-check-inline"><input type="radio" id="OSTOMY_3" name="Nutrition_screening_assessment_3" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_3" class="form-check-label">Yes</label></div></td>
|
||
|
||
</tr>
|
||
<tr>
|
||
<th scope="row">Patient has tooth or mouth problems that make him/her diffucult to eat.</th>
|
||
<td><div class="form-check form-check-inline"><input type="radio" id="OSTOMY_4" name="Nutrition_screening_assessment_4" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_4" class="form-check-label">Yes</label></div></td>
|
||
|
||
</tr>
|
||
<tr>
|
||
<th scope="row">Patient does not have enough money to buy the food he/she needs.</th>
|
||
<td><div class="form-check form-check-inline"><input type="radio" id="OSTOMY_5" name="Nutrition_screening_assessment_5" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_5" class="form-check-label">Yes</label></div></td>
|
||
|
||
</tr>
|
||
<tr>
|
||
<th scope="row">Patient eats alone most of the time.</th>
|
||
<td><div class="form-check form-check-inline"><input type="radio" id="OSTOMY_6" name="Nutrition_screening_assessment_6" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_6" class="form-check-label">Yes</label></div></td>
|
||
|
||
</tr>
|
||
|
||
<tr>
|
||
<th scope="row">Without waiting to, Patient has loose or gained 10lbs, in the last 6 months.</th>
|
||
<td><div class="form-check form-check-inline"><input type="radio" id="OSTOMY_7" name="Nutrition_screening_assessment_7" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_7" class="form-check-label">Yes</label></div><div class="risk_field"><label for="OSTOMY_7_input" class="col-form-label risk_label">Changes</label><input type="text" id="OSTOMY_7_input" name="Nutrition_screening_assessment_7_input" value="" class="form-control"></div></td>
|
||
|
||
</tr>
|
||
<tr>
|
||
<th scope="row">Patient is not always physically able to shop, cook fed him/her self</th>
|
||
<td><div class="form-check form-check-inline"><input type="radio" id="OSTOMY_8" name="Nutrition_screening_assessment_8" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_8" class="form-check-label">Yes</label></div><div class="risk_field"><label for="OSTOMY_8_input" class="col-form-label risk_label">Which</label><input type="text" id="OSTOMY_8_input" name="Nutrition_screening_assessment_8_input" value="" class="form-control"></div></td>
|
||
|
||
</tr>
|
||
<tr>
|
||
<th scope="row">Patient takes 3 or more prescription or over-the-counter drugs per day.</th>
|
||
<td><div class="form-check form-check-inline"><input type="radio" id="OSTOMY_9" name="Nutrition_screening_assessment_9" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_9" class="form-check-label">Yes</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<th scope="row">Patient takes 3 or more beer, liquor or wine almost every day</th>
|
||
<td><div class="form-check form-check-inline"><input type="radio" id="OSTOMY_10" name="Nutrition_screening_assessment_10" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_3" class="form-check-label">Yes</label></div></td>
|
||
</tr>
|
||
<tr>
|
||
<th scope="row"></th>
|
||
<td><label>Total :</label>0</td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<?php viewDynamincForm('risk_level-oderate_high_utritional'); ?>
|
||
<!-- <div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">OSTOMY</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="OSTOMY_0" name="OSTOMY" value="Yes" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_0" class="form-check-label">Yes</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="OSTOMY_1" name="OSTOMY" value="No" class="form-check-input conditional_opt_OSTOMY" attr_to_open="OSTOMY_TYPE" attr_open_for="Yes"><label for="OSTOMY_1" class="form-check-label">No</label></div>
|
||
</div>
|
||
</div> -->
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="Integument" role="tabpanel" aria-labelledby="Integument-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Integument</h5>
|
||
<form method="POST" class="form_class" id="patientIntegumentRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<table class="table table-bordered table-responsive">
|
||
<tbody>
|
||
<tr>
|
||
<td scope="row"><b>* Sensory Reception</b><br>Ability to response meaningful To preassure related discomfort</td>
|
||
<td><b>1) Completely Limited</b><input type="radio" name="Sensory_Reception" value="Completely Limited"><br>Unresponsive (Does not Moan, Flinch, or Grasp) To pain full stimull, Due to diminesed level of con-Sciousness or sedation. Or Limited Ability to feel pain over most of Body</td>
|
||
<td><b>2) Very Limited</b><input type="radio" name="Sensory_Reception" value="Very Limited"><br>Response only to painfull stimull, Cannot communicate discomfort or the need to be turned. Or Have some sensory impairment which limits ability to feel pain or discomfort over 2 of body.</td>
|
||
<td><b>3) Slightly Limited</b><input type="radio" name="Sensory_Reception" value="Slightly Limited"><br>Response to verval commands, But cannot Always communicate discomfort or the need to be turned. Or Have some sensory impairment which limits ability to feel pain or discomfort in 1 or extreamities.</td>
|
||
<td><b>4) No Impairment</b><input type="radio" name="Sensory_Reception" value="No Impairment"><br>Response to verval commands has no sensory deflicts which would Limit ability to feel or Voice pain or Discomfort.</td>
|
||
<td>0</td>
|
||
</tr>
|
||
<tr>
|
||
<td scope="row"><b>* Moister</b><br>Degree to which skin is exposed to moister</td>
|
||
<td><b>1) Constantly Moist</b><input type="radio" name="Moister" value="Constantly Moist"><br>Skin is kept moidt almost constantly prespiration , urine etc. Dampness is detected every time patient is moved or turned.</td>
|
||
<td><b>2) Very Moist</b><input type="radio" name="Moister" value="Very Moist"><br>Skin is often bu not always moist. Limence must be changed at least once a week</td>
|
||
<td><b>3) Occasionally Moist</b><input type="radio" name="Moister" value="Occasionally Moist"><br>Skin is occasionally moist. Require a extra limen change approximatly once a day.</td>
|
||
<td><b>4) Rearly Moist</b><input type="radio" name="Moister" value="Rearly Moist"><br>Skin is usually dry. Limens only requires changing at routine intervals</td>
|
||
<td>0</td>
|
||
</tr>
|
||
<tr>
|
||
<td scope="row"><b>* Activity</b><br>Degree of Physical Activity</td>
|
||
<td><b>1) Bedfast</b><input type="radio" name="Activity" value="Bedfast"><br>Confined to bed</td>
|
||
<td><b>2) Chainfast</b><input type="radio" name="Activity" value="Chainfast"><br>Ability to walk severaly limited or not existent. Cannot bear own weight And/Or must be assisted into chair or wheelchair</td>
|
||
<td><b>3) Walks Occasionally</b><input type="radio" name="Activity" value="Walks Occasionally"><br>Walks occationaly during day but for very short distance, With or Without assistance. Spends majority of each shift in Bed Or Chair.</td>
|
||
<td><b>4) Walks Freqently</b><input type="radio" name="Activity" value="Walks Freqently"><br>Walks out side the room atleast twice a day and inside the room atleast once in every two hours During walking hours.</td>
|
||
<td>0</td>
|
||
</tr>
|
||
<tr>
|
||
<td scope="row"><b>* Mobility</b><br>Ability to change and contorol body Position</td>
|
||
<td><b>1) Completely Immobile</b><input type="radio" name="Mobility" value="Completely Immobile"><br>Does not make even slight changes in Body or Extreamly position Assistance</td>
|
||
<td><b>2) Very Limited</b><input type="radio" name="Mobility" value="Very Limited"><br>Make occetionally slight changes in body or Etrmity position But unable to make frequent or significant changes independently.</td>
|
||
<td><b>3) Slightly Limited</b><input type="radio" name="Mobility" value="Slightly Limited"><br>Make Frequent through slight changes in body or extremity position independently.</td>
|
||
<td><b>4) No Limitation</b><input type="radio" name="Mobility" value="No Limitation"><br>Makes major and frequent changes in position without assist</td>
|
||
<td>0</td>
|
||
</tr>
|
||
<tr>
|
||
<td scope="row"><b>* Nutrition</b>Usual Food Intake Pattern</td>
|
||
<td><b>1) Very poor</b><input type="radio" name="Nutrition" value="Very poor"><br>REarly eats a complete meal and generally eats only about 2 of any food offered. protein intake includes only 3 serving of meal or dairy products per day. Ocationallity will take diatry suppliment.</td>
|
||
<td><b>2) Probably Inadequate</b><input type="radio" name="Nutrition" value="Probably Inadequate"><br>Rearly eats a complete meal and generally eats only about 2 of any food offered.protein intake includes only 3 serving of meal or dairy products per day. Ocationallity will take diatry suppliment.</td>
|
||
<td><b>3) Adequate</b><input type="radio" name="Nutrition" value="Adequate"><br>Eat over half of most meal. Eats a total of 4 serving of protine meat, dairy product per day. Ocationnaly will refuse a meal but will take a suppliment when offered.</td>
|
||
<td><b>4) Excellent</b><input type="radio" name="Nutrition" value="Excellent"><br>Eats most of every meal, Never refuses Never refuse a mealusually eats a total of 4 or more serving of meat and dairy products. ocationallity eats between meals. Does not require suppliment.</td>
|
||
<td>0</td>
|
||
</tr>
|
||
<tr>
|
||
<td scope="row"><b>* Friction and Shear</b></td>
|
||
<td><b>1) Problem</b><input type="radio" name="Friction_and_Shear" value="Problem"><br>Requires moderate maximum assistance in moving. complite lifting without sliding against sheet is impossible. Frequently slides down in bed or chair. Require frequent repositioning with maximum assistance, Spasicity contracture or agitation leads to almost constant friction.</td>
|
||
<td><b>2) Potential Problem</b><input type="radio" name="Friction_and_Shear" value="Potential Problem"><br>Moves feebly or requires minimum assistance. Durig a move skin probally slides to some extends agains sheets, Chair, retains or other devices. Maintain relatively good position in chair or bed most of the time but ocationally slides down. </td>
|
||
<td></td>
|
||
<td><b>3) No apparent Problem </b><input type="radio" name="Friction_and_Shear" value="No apparent Problem"><br>Moves in bed and chair independently and has sufficient muschel strength to lift up completely during move. Maintains good position in bed or chair</td>
|
||
<td>0</td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<?php viewDynamincForm('integument'); ?>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Wound</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Wound_0" name="Wound" value="Yes" class="form-check-input conditional_opt_nonamb" attr_to_open="wound_care_form" attr_open_for="Yes"><label for="Wound_0" class="form-check-label">Yes</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Wound_1" name="Wound" value="No" class="form-check-input conditional_opt_nonamb" attr_to_open="wound_care_form" attr_open_for="Yes"><label for="Wound_1" class="form-check-label">No</label></div>
|
||
</div>
|
||
</div>
|
||
<div id="wound_care_form" style="display: none">
|
||
<?php viewDynamincForm('wound-care-form'); ?>
|
||
</div>
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Skin Potency</h5>
|
||
<?php viewDynamincForm('skin-potency'); ?>
|
||
<h6 class="font-weight-bold text-uppercase ord-heading mt-1">If abnormal, mark X on the Image below & comment</h6>
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="body_mark_image" id="body_mark_image" value="">
|
||
<input type="hidden" name="feet_mark_image" id="feet_mark_image" value="">
|
||
<div class="row">
|
||
<div class="col-sm-12">
|
||
<div class="image-container-hjvhjsdtd6tchgds">
|
||
<?php
|
||
if($reportData->body_mark_base64!=''){
|
||
?>
|
||
<img id="body_img_view" class="img_fixed_sizexx" src="<?=$reportData->body_mark_base64?>">
|
||
<input type="hidden" id="updated_body_img" value="<?=$reportData->body_mark_base64?>">
|
||
<?php
|
||
}else{
|
||
?>
|
||
<img id="body_img_view" class="img_fixed_sizexx" src="<?=base_url()?>systemfiles/medias/nurse-assessment-body.png">
|
||
<input type="hidden" id="updated_body_img" value="<?=base_url()?>systemfiles/medias/nurse-assessment-body.png">
|
||
<?php
|
||
}
|
||
?>
|
||
</div>
|
||
<button type="button" name="mark_body" onclick="body_mark_modal()" class="btn btn-info">Mark on body</button>
|
||
</div>
|
||
<div class="col-sm-12" style="margin-bottom:10px;">
|
||
<div class="image-container-hjvhjsdtd6tchgds">
|
||
<?php
|
||
if($reportData->feet_mark_base64!=''){
|
||
?>
|
||
<img id="feet_img_view" class="img_fixed_sizexx" src="<?=$reportData->feet_mark_base64?>">
|
||
<input type="hidden" id="updated_feet_img" value="<?=$reportData->feet_mark_base64?>">
|
||
<?php
|
||
}else{
|
||
?>
|
||
<img id="feet_img_view" class="img_fixed_sizexx" src="<?=base_url()?>systemfiles/medias/nurse-assessment-feet.png">
|
||
<input type="hidden" id="updated_feet_img" value="<?=base_url()?>systemfiles/medias/nurse-assessment-feet.png">
|
||
<?php
|
||
}
|
||
?>
|
||
</div>
|
||
<button type="button" name="mark_feet" onclick="feet_mark_modal()" class="btn btn-info">Mark on feet</button>
|
||
</div>
|
||
</div>
|
||
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="Medication" role="tabpanel" aria-labelledby="Medication-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Medication</h5>
|
||
<form method="POST" class="form_class" id="patientMedicationRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<!-- <div class="form-group row justify-content-end"><label class="main-label col-sm-4 col-form-label">Patient Taking/Receiving Medication As Prescribed</label><div class="col-sm-8"><div class="form-check form-check-inline"><input type="checkbox" id="Patient_Taking/Receiving_Medication_As_Prescribed_0" name="Teaching_Provided[]" value="Yes" class="form-check-input"><label for="Teaching_Provided_0" class="form-check-label">Yes</label></div><div class="form-check form-check-inline"><input type="checkbox" id="Teaching_Provided_1" name="Teaching_Provided[]" value="No" class="form-check-input"><label for="Teaching_Provided_1" class="form-check-label">No</label></div></div></div> -->
|
||
<?php viewDynamincForm('MEDICATION-PROFILE-form'); ?>
|
||
|
||
<!-- If dosage change -->
|
||
<?php viewDynamincForm('MEDICATION-PROFILE-form-2'); ?>
|
||
|
||
<!-- If medication profile -->
|
||
<?php viewDynamincForm('MEDICATION-PROFILE-form-patient_medication_info'); ?>
|
||
|
||
<!-- <script type="text/javascript">
|
||
$(function(){
|
||
$(". conditional_opt").click(function(){
|
||
var val = $(this).val();
|
||
var to_open = $(this).attr('attr_to_open');
|
||
var open_for = $(this).attr('attr_open_for');
|
||
// alert(val+' '+to_open+' '+open_for);
|
||
if(val == open_for)
|
||
{
|
||
$("#"+to_open).show();
|
||
}
|
||
else
|
||
{
|
||
$("#"+to_open).hide();
|
||
}
|
||
});
|
||
})
|
||
</script> -->
|
||
<!-- infusion first part -->
|
||
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">INFUSION THERAPIES</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="INFUSION_THERAPIES_0" name="INFUSION_THERAPIES" value="Yes" class="form-check-input conditional_opt" attr_to_open="infusion_therapy_block" attr_open_for="Yes"><label for="INFUSION_THERAPIES_0" class="form-check-label">Yes</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="INFUSION_THERAPIES_1" name="INFUSION_THERAPIES" value="No" class="form-check-input conditional_opt" attr_to_open="infusion_therapy_block" attr_open_for="Yes"><label for="INFUSION_THERAPIES_1" class="form-check-label">No</label></div>
|
||
</div>
|
||
</div>
|
||
<div id="infusion_therapy_block" style="display: none;">
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">IV Therapy</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="IV_Therapy_0" name="IV_Therapy[]" value="Peripheral IV" class="form-check-input"><label for="IV_Therapy_0" class="form-check-label">Peripheral IV</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="IV_Therapy_1" name="IV_Therapy[]" value="Subcustaneous Port (SQ)" class="form-check-input"><label for="IV_Therapy_1" class="form-check-label">Subcustaneous Port (SQ)</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="IV_Therapy_2" name="IV_Therapy[]" value="Peripheral Inserted Central Catheter(PICC)" class="form-check-input"><label for="IV_Therapy_2" class="form-check-label">Peripheral Inserted Central Catheter(PICC)</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="IV_Therapy_3" name="IV_Therapy[]" value="Central Catheter" class="form-check-input"><label for="IV_Therapy_3" class="form-check-label">Central Catheter</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="IV_Therapy_4" name="IV_Therapy[]" value="Parenteral Route" class="form-check-input"><label for="IV_Therapy_4" class="form-check-label">Parenteral Route</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Method Of Infusion</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Method_Of_Infusion_0" name="Method_Of_Infusion" value="Gravity" class="form-check-input"><label for="Method_Of_Infusion_0" class="form-check-label">Gravity</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Method_Of_Infusion_1" name="Method_Of_Infusion" value="IV Push" class="form-check-input"><label for="Method_Of_Infusion_1" class="form-check-label">IV Push</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Method_Of_Infusion_2" name="Method_Of_Infusion" value="Dial A Flow" class="form-check-input"><label for="Method_Of_Infusion_2" class="form-check-label">Dial A Flow</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Method_Of_Infusion_3" name="Method_Of_Infusion" value="Pump" class="form-check-input"><label for="Method_Of_Infusion_3" class="form-check-label">Pump</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Did Nurse Establish IV Access</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Did_Nurse_Establish_IV_Access_0" name="Did_Nurse_Establish_IV_Access" value="Yes" class="form-check-input conditional_opt" attr_to_open="infusion_therapy_block_2" attr_open_for="Yes"><label for="Did_Nurse_Establish_IV_Access_0" class="form-check-label">Yes</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Did_Nurse_Establish_IV_Access_1" name="Did_Nurse_Establish_IV_Access" value="No" class="form-check-input conditional_opt" attr_to_open="infusion_therapy_block_2" attr_open_for="Yes"><label for="Did_Nurse_Establish_IV_Access_1" class="form-check-label">No</label></div>
|
||
</div>
|
||
</div>
|
||
<div id="infusion_therapy_block_2" style="display: none;">
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Venous Access</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Venous_Access_0" name="Venous_Access" value="PICC" class="form-check-input conditional_opt" attr_to_open="infusion_therapy_block_3" attr_open_for="Peripheral IV"><label for="Venous_Access_0" class="form-check-label">PICC</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Venous_Access_1" name="Venous_Access" value="Peripheral IV" class="form-check-input conditional_opt" attr_to_open="infusion_therapy_block_3" attr_open_for="Peripheral IV"><label for="Venous_Access_1" class="form-check-label">Peripheral IV</label></div>
|
||
</div>
|
||
</div>
|
||
<div id="infusion_therapy_block_3" style="display: none;">
|
||
<!-- infusion first part -->
|
||
<?php viewDynamincForm('medication-infusion-therapy-form'); ?>
|
||
</div>
|
||
<!-- infusion first part 2nd-->
|
||
<?php viewDynamincForm('medication-infusion-therapy-form-2'); ?>
|
||
<!-- infusion 1 -->
|
||
<?php //viewDynamincForm('if-infusion-teaching-provided-form-741'); ?>
|
||
|
||
<!-- infusion 1 -->
|
||
<?php viewDynamincForm('if-infusion-teaching-provided-form'); ?>
|
||
|
||
<!-- Teaching -->
|
||
<?php viewDynamincForm('MEDICATION-PROFILE-form-4-teaching'); ?>
|
||
</div>
|
||
</div>
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Medication Management</h5>
|
||
<?php viewDynamincForm('medication-management'); ?>
|
||
|
||
|
||
<!-- Medication profile Medication/Supplies In Home Adequate is yes -->
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="DME-Supplies" role="tabpanel" aria-labelledby="DME-Supplies-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">DME-Supplies</h5>
|
||
<form method="POST" class="form_class" id="patientDMESuppliesRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$(".dme_Chain").click(function(){
|
||
var val = $(this).val();
|
||
// alert("#"+val+"_"+select);
|
||
if($(this).prop("checked"))
|
||
{
|
||
$("#"+val+"_select").prop('disabled', false);
|
||
}
|
||
else
|
||
{
|
||
$("#"+val+"_select").prop('disabled', true);
|
||
}
|
||
});
|
||
})
|
||
</script>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="cane" value="cane" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Cane</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="cane_select" name="cane_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="bed_pan" value="bed_pan" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Bed Pan</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="bed_pan_select" name="bed_pan_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Chair_cusion" value="Chair_cusion" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Chair cusion</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Chair_cusion_select" name="Chair_cusion_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Catheter" value="Catheter" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Catheter</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Catheter_select" name="Catheter_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Gastromy_Tube" value="Gastromy_Tube" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Gastromy Tube</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Gastromy_Tube_select" name="Gastromy_Tube_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Chux" value="Chux" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Chux</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Chux_select" name="Chux_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Hospital_Bed" value="Hospital_Bed" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Hospital Bed</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Hospital_Bed_select" name="Hospital_Bed_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Glucometer" value="Glucometer" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Glucometer / Strips</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Glucometer_select" name="Glucometer_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="IV_supplies_Bed" value="IV_supplies_Bed" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">IV supplies</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="IV_supplies_select" name="IV_supplies_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Injection_supplies" value="Injection_supplies" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Injection supplies</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Injection_supplies_select" name="Injection_supplies_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="NON_sterial_Gloves" value="NON_sterial_Gloves" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">NON sterial Gloves</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="NON_sterial_Gloves_select" name="NON_sterial_Gloves_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Low_air_loss_mattress" value="Low_air_loss_mattress" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Low air loss mattress</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Low_air_loss_mattress_select" name="Low_air_loss_mattress_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Shower_Rails" value="Shower_Rails" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Shower Rails</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Shower_Rails_select" name="Shower_Rails_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Ostomy_Supplies" value="Ostomy_Supplies" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Ostomy Supplies</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Ostomy_Supplies_select" name="Ostomy_Supplies_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Trapeze" value="Trapeze" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Trapeze</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Trapeze_select" name="Trapeze_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Side_Rails" value="Side_Rails" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Side Rails</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Side_Rails_select" name="Side_Rails_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Walker" value="Walker" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Walker</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Walker_select" name="Walker_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Urinalysis_supplies" value="Urinalysis_supplies" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Urinalysis supplies</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Urinalysis_supplies_select" name="Urinalysis_supplies_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Diapers" value="Diapers" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Diapers</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Diapers_select" name="Diapers_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Wheelchair" value="Wheelchair" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Wheelchair</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Wheelchair_select" name="Wheelchair_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Enema" value="Enema" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Enema</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Enema_select" name="Enema_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Bedside_Commodes" value="Bedside_Commodes" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Bedside Commodes</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Bedside_Commodes_select" name="Bedside_Commodes_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Central_line_supplies" value="Central_line_supplies" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Central line supplies</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Central_line_supplies_select" name="Central_line_supplies_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Crutches" value="Crutches" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Crutches</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Crutches_select" name="Crutches_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Hand_Rail" value="Hand_Rail" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Hand Rail</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Hand_Rail_select" name="Hand_Rail_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Irrigation_Set" value="Irrigation_Set" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Irrigation Set</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Irrigation_Set_select" name="Irrigation_Set_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="NG_Tube" value="NG_Tube" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">NG Tube</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="NG_Tube_select" name="NG_Tube_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Prosthesis" value="Prosthesis" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Prosthesis</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Prosthesis_select" name="Prosthesis_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Sterial_Gluves" value="Sterial_Gluves" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Sterial Gluves</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Sterial_Gluves_select" name="Sterial_Gluves_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Venipuncture_Supplies" value="Venipuncture_Supplies" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Venipuncture Supplies</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Venipuncture_Supplies_select" name="Venipuncture_Supplies_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="Wound_Care_Supply" value="Wound_Care_Supply" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Wound Care Supply</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Wound_Care_Supply_select" name="Wound_Care_Supply_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="Others" value="Others" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Others</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<select id="Others_select" name="Others_select" class="form-control" disabled>
|
||
<option value="" selected>Select</option>
|
||
<option value="Apical">Apical</option>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
|
||
<h4>Equipmemt In Home</h4>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="equipmemt_in_home[]" value="Cane" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Cane</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="equipmemt_in_home[]" value="Grab_bar" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Grab Bar</label></div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="equipmemt_in_home[]" value="Hospital_bed" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Hospital Bed</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="equipmemt_in_home[]" value="Shower_chair" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Shower chair</label></div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="equipmemt_in_home[]" value="Walker" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Walker</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="equipmemt_in_home[]" value="WC" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">W/C</label></div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="equipmemt_in_home[]" value="Others" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<h4>Condition of equipment in home</h4>
|
||
<div class="form-group row justify-content-end">
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="condition_of_equipment[]" value="Good" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Good</label></div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_0" name="condition_of_equipment[]" value="Repair" class="form-check-input dme_Chain"><label for="dme_0" class="form-check-label">Repair</label></div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-sm-6">
|
||
<div class="form-group row">
|
||
<div class="col-sm-6">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="dme_1" name="condition_of_equipment[]" value="Use_safely" class="form-check-input dme_Chain"><label for="dme_1" class="form-check-label">Use safely</label></div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
|
||
|
||
|
||
<?php viewDynamincForm('dme-supplies'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="Paraprofessional-Supervission" role="tabpanel" aria-labelledby="Paraprofessional-Supervission-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Paraprofessional-Supervission</h5>
|
||
<form method="POST" class="form_class" id="patientParaprofessionalRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php viewDynamincForm('Paraprofessional_Supervision_Required-form'); ?>
|
||
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$("input:checkbox[name='Performance_observation[]']").click(function(){
|
||
$("#Performance_Obserbation_Bathing").hide();
|
||
$("#Performance_Obserbation_Grooming").hide();
|
||
$("#Performance_Obserbation_Toileting").hide();
|
||
$("#Performance_Obserbation_Ambulation").hide();
|
||
$("#Performance_Obserbation_Transfersh").hide();
|
||
$("#Performance_Obserbation_other").hide();
|
||
var list = $("input[name='Performance_observation[]']:checked").map(function () {
|
||
|
||
if(this.value == 'Bathing') { $("#Performance_Obserbation_Bathing").show(); }
|
||
if(this.value == 'Grooming') { $("#Performance_Obserbation_Grooming").show(); }
|
||
if(this.value == 'Toileting') { $("#Performance_Obserbation_Toileting").show(); }
|
||
if(this.value == 'Ambulation') { $("#Performance_Obserbation_Ambulation").show(); }
|
||
if(this.value == 'Transfers') { $("#Performance_Obserbation_Transfersh").show(); }
|
||
if(this.value == 'Other task') { $("#Performance_Obserbation_other").show(); }
|
||
|
||
}).get();
|
||
|
||
});
|
||
});
|
||
</script>
|
||
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Performance Obserbation </label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Performance_observation_0" name="Performance_observation[]" value="Bathing" class="form-check-input"><label for="Performance_observation_0" class="form-check-label">Bathing</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Performance_observation_1" name="Performance_observation[]" value="Grooming" class="form-check-input"><label for="Performance_observation_1" class="form-check-label">Grooming</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Performance_observation_2" name="Performance_observation[]" value="Toileting" class="form-check-input"><label for="Performance_observation_2" class="form-check-label">Toileting</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Performance_observation_3" name="Performance_observation[]" value="Ambulation" class="form-check-input"><label for="Performance_observation_3" class="form-check-label">Ambulation</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Performance_observation_4" name="Performance_observation[]" value="Transfers" class="form-check-input"><label for="Performance_observation_4" class="form-check-label">Transfers</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Performance_observation_5" name="Performance_observation[]" value="Vital Sign Reads and Record" class="form-check-input"><label for="Performance_observation_5" class="form-check-label">Vital Sign Reads and Record</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Performance_observation_6" name="Performance_observation[]" value="Other task" class="form-check-input"><label for="Performance_observation_6" class="form-check-label">Other task</label></div>
|
||
</div>
|
||
</div>
|
||
|
||
<div class="form-group row justify-content-end" id="Performance_Obserbation_Bathing" style="display: none;">
|
||
<label class="main-label col-sm-4 col-form-label">Bathing</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Bathing_0" name="Bathing" value="Bed Sponge" class="form-check-input"><label for="Bathing_0" class="form-check-label">Bed Sponge</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Bathing_1" name="Bathing" value="Tub" class="form-check-input"><label for="Bathing_1" class="form-check-label">Tub</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Bathing_2" name="Bathing" value="Shower" class="form-check-input"><label for="Bathing_2" class="form-check-label">Shower</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end" id="Performance_Obserbation_Grooming" style="display: none;">
|
||
<label class="main-label col-sm-4 col-form-label">Grooming</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Grooming_0" name="Grooming" value="Comb hair" class="form-check-input"><label for="Grooming_0" class="form-check-label">Comb hair</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Grooming_1" name="Grooming" value="Shave" class="form-check-input"><label for="Grooming_1" class="form-check-label">Shave</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Grooming_2" name="Grooming" value="Oral Hygiene" class="form-check-input"><label for="Grooming_2" class="form-check-label">Oral Hygiene</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Grooming_3" name="Grooming" value="Denture care" class="form-check-input"><label for="Grooming_3" class="form-check-label">Denture care</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Grooming_4" name="Grooming" value="Dressing" class="form-check-input"><label for="Grooming_4" class="form-check-label">Dressing</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Grooming_5" name="Grooming" value="Nail Care" class="form-check-input"><label for="Grooming_5" class="form-check-label">Nail Care</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Grooming_6" name="Grooming" value="Foot Care" class="form-check-input"><label for="Grooming_6" class="form-check-label">Foot Care</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Grooming_7" name="Grooming" value="Skin Care" class="form-check-input"><label for="Grooming_7" class="form-check-label">Skin Care</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Grooming_8" name="Grooming" value="Other" class="form-check-input"><label for="Grooming_8" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end" id="Performance_Obserbation_Toileting" style="display: none;">
|
||
<label class="main-label col-sm-4 col-form-label">Toileting</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Toileting_0" name="Toileting" value="Bedpan/Urinal" class="form-check-input"><label for="Toileting_0" class="form-check-label">Bedpan/Urinal</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Toileting_1" name="Toileting" value="Commode/Toilet" class="form-check-input"><label for="Toileting_1" class="form-check-label">Commode/Toilet</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Toileting_2" name="Toileting" value="Incontinence Care" class="form-check-input"><label for="Toileting_2" class="form-check-label">Incontinence Care</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Toileting_3" name="Toileting" value="Assiste PT with OSTOMY" class="form-check-input"><label for="Toileting_3" class="form-check-label">Assiste PT with OSTOMY</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Toileting_4" name="Toileting" value="Other" class="form-check-input"><label for="Toileting_4" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end" id="Performance_Obserbation_Ambulation" style="display: none;">
|
||
<label class="main-label col-sm-4 col-form-label">Ambulating</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_0" name="Ambulating" value="Device" class="form-check-input"><label for="Ambulating_0" class="form-check-label">Device</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_1" name="Ambulating" value="Walker" class="form-check-input"><label for="Ambulating_1" class="form-check-label">Walker</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_2" name="Ambulating" value="Cane" class="form-check-input"><label for="Ambulating_2" class="form-check-label">Cane</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_3" name="Ambulating" value="Crutches" class="form-check-input"><label for="Ambulating_3" class="form-check-label">Crutches</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_4" name="Ambulating" value="W/C" class="form-check-input"><label for="Ambulating_4" class="form-check-label">W/C</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_5" name="Ambulating" value="Other" class="form-check-input"><label for="Ambulating_5" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end" id="Performance_Obserbation_Transfersh" style="display: none;">
|
||
<label class="main-label col-sm-4 col-form-label">Transfer</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_0" name="Ambulating" value="Device" class="form-check-input"><label for="Ambulating_0" class="form-check-label">Device</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_1" name="Ambulating" value="Walker" class="form-check-input"><label for="Ambulating_1" class="form-check-label">Walker</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_2" name="Ambulating" value="Cane" class="form-check-input"><label for="Ambulating_2" class="form-check-label">Cane</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_3" name="Ambulating" value="Crutches" class="form-check-input"><label for="Ambulating_3" class="form-check-label">Crutches</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_4" name="Ambulating" value="W/C" class="form-check-input"><label for="Ambulating_4" class="form-check-label">W/C</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_5" name="Ambulating" value="Other" class="form-check-input"><label for="Ambulating_5" class="form-check-label">Other</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_6" name="Ambulating" value="Bed to Chair" class="form-check-input"><label for="Ambulating_6" class="form-check-label">Bed to Chair</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_7" name="Ambulating" value="Chair to Bed" class="form-check-input"><label for="Ambulating_7" class="form-check-label">Chair to Bed</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_8" name="Ambulating" value="Hoyer Lift" class="form-check-input"><label for="Ambulating_8" class="form-check-label">Hoyer Lift</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_9" name="Ambulating" value="Sitting To Standing" class="form-check-input"><label for="Ambulating_9" class="form-check-label">Sitting To Standing</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Ambulating_10" name="Ambulating" value="Other" class="form-check-input"><label for="Ambulating_10" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end" id="Performance_Obserbation_other" style="display: none;">
|
||
<label class="main-label col-sm-4 col-form-label">Other Task</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Other_Task_0" name="Other_Task" value="Meal Preparation" class="form-check-input"><label for="Other_Task_0" class="form-check-label">Meal Preparation</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Other_Task_1" name="Other_Task" value="value-2" class="form-check-input"><label for="Other_Task_1" class="form-check-label">Assist With Feeding</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Other_Task_2" name="Other_Task" value="value-3" class="form-check-input"><label for="Other_Task_2" class="form-check-label">Escort to Appointment/Outdoor</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Other_Task_3" name="Other_Task" value="value-4" class="form-check-input"><label for="Other_Task_3" class="form-check-label">Range of motion</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Other_Task_4" name="Other_Task" value="value-5" class="form-check-input"><label for="Other_Task_4" class="form-check-label">Turn & position</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Other_Task_5" name="Other_Task" value="value-6" class="form-check-input"><label for="Other_Task_5" class="form-check-label">other</label></div>
|
||
</div>
|
||
</div>
|
||
|
||
<div class="form-horizontal">
|
||
<div><input name="if-infusion-teaching-provided-form-741-token" type="hidden" value="3380897495fc5e9d42887f4.24139932"><input name="if-infusion-teaching-provided-form-741" type="hidden" value="1"></div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Teaching Provided</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_0" name="Teaching_Provided" value="Yes" class="conditional_opt_para form-check-input" attr_to_open="para_condition_depending_field" attr_open_for="Yes"><label for="Teaching_Provided_To_0" class="form-check-label">Yes</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_4" name="Teaching_Provided" value="No" class="conditional_opt_para form-check-input" attr_to_open="para_condition_depending_field" attr_open_for="Yes"><label for="Teaching_Provided_To_4" class="form-check-label">No</label></div>
|
||
</div>
|
||
</div>
|
||
<div id="para_condition_depending_field" style="display: none">
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Teaching Provided To</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_0" name="Teaching_Provided_To" value="Patient" class="form-check-input"><label for="Teaching_Provided_To_0" class="form-check-label">Patient</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_1" name="Teaching_Provided_To" value="Caregiver" class="form-check-input"><label for="Teaching_Provided_To_1" class="form-check-label">Caregiver</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_2" name="Teaching_Provided_To" value="Spouse" class="form-check-input"><label for="Teaching_Provided_To_2" class="form-check-label">Spouse</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_3" name="Teaching_Provided_To" value="Parent" class="form-check-input"><label for="Teaching_Provided_To_3" class="form-check-label">Parent</label></div>
|
||
<div class="form-check form-check-inline"><input type="radio" id="Teaching_Provided_To_4" name="Teaching_Provided_To" value="Other" class="form-check-input"><label for="Teaching_Provided_To_4" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Instruct Patient on </label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _0" name="Instruct_Patient_on []" value="S/S of IV Site Complications" class="form-check-input"><label for="Instruct_Patient_on _0" class="form-check-label">S/S of IV Site Complications</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _1" name="Instruct_Patient_on []" value="S/S of Adverse Reactions" class="form-check-input"><label for="Instruct_Patient_on _1" class="form-check-label">S/S of Adverse Reactions</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _2" name="Instruct_Patient_on []" value="Disease Process" class="form-check-input"><label for="Instruct_Patient_on _2" class="form-check-label">Disease Process</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _3" name="Instruct_Patient_on []" value="Sign & Symptoms" class="form-check-input"><label for="Instruct_Patient_on _3" class="form-check-label">Sign & Symptoms</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _4" name="Instruct_Patient_on []" value="Medication Therapy" class="form-check-input"><label for="Instruct_Patient_on _4" class="form-check-label">Medication Therapy</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _5" name="Instruct_Patient_on []" value="Medication Purpose" class="form-check-input"><label for="Instruct_Patient_on _5" class="form-check-label">Medication Purpose</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _6" name="Instruct_Patient_on []" value="Medication Actions" class="form-check-input"><label for="Instruct_Patient_on _6" class="form-check-label">Medication Actions</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _7" name="Instruct_Patient_on []" value="Medication Storage" class="form-check-input"><label for="Instruct_Patient_on _7" class="form-check-label">Medication Storage</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _8" name="Instruct_Patient_on []" value="Supply Storage" class="form-check-input"><label for="Instruct_Patient_on _8" class="form-check-label">Supply Storage</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Instruct_Patient_on _9" name="Instruct_Patient_on []" value="Universal Precautions" class="form-check-input"><label for="Instruct_Patient_on _9" class="form-check-label">Universal Precautions</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label class="main-label col-sm-4 col-form-label">Response To Teaching</label>
|
||
<div class="col-sm-8">
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_0" name="Response_To_Teaching[]" value="Agreement to Comply" class="form-check-input"><label for="Response_To_Teaching_0" class="form-check-label">Agreement to Comply</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_1" name="Response_To_Teaching[]" value="Understood" class="form-check-input"><label for="Response_To_Teaching_1" class="form-check-label">Understood</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_2" name="Response_To_Teaching[]" value="Need Further Teaching" class="form-check-input"><label for="Response_To_Teaching_2" class="form-check-label">Need Further Teaching</label></div>
|
||
<div class="form-check form-check-inline"><input type="checkbox" id="Response_To_Teaching_3" name="Response_To_Teaching[]" value="Other" class="form-check-input"><label for="Response_To_Teaching_3" class="form-check-label">Other</label></div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group row justify-content-end">
|
||
<label for="Notes" class="col-sm-4 col-form-label">Notes</label>
|
||
<div class="col-sm-8"><textarea id="Notes" name="Notes" class="form-control"></textarea></div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$(".conditional_opt_para").click(function(){
|
||
var val = $(this).val();
|
||
var to_open = $(this).attr('attr_to_open');
|
||
var open_for = $(this).attr('attr_open_for');
|
||
// alert(val+' '+to_open+' '+open_for);
|
||
if(val == open_for)
|
||
{
|
||
$("#"+to_open).show();
|
||
}
|
||
else
|
||
{
|
||
$("#"+to_open).hide();
|
||
}
|
||
});
|
||
})
|
||
</script>
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">ADIs/IADLs</h5>
|
||
<?php viewDynamincForm('adis_iadls'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="Narrative" role="tabpanel" aria-labelledby="Narrative-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Narrative</h5>
|
||
<form method="POST" class="form_class" id="patientNarrativeRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php viewDynamincForm('narrative-form'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="Home-Health-Certification-POC" role="tabpanel" aria-labelledby="Home-Health-Certification-POC-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Home Health Certification & POC</h5>
|
||
<form method="POST" class="form_class" id="patientHHC_POCRecord">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php viewDynamincForm('hhc-poc-form'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="Covid-19-Screening" role="tabpanel" aria-labelledby="Covid-19-Screening-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Patient Covid-19 Screening</h5>
|
||
<form method="POST" class="form_class" id="patientCovid19Screening">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php viewDynamincForm('covid_19_screening'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="home-safety-assessments" role="tabpanel" aria-labelledby="home-safety-assessments-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Home Safety Assessments</h5>
|
||
<form method="POST" class="form_class" id="home_safety_assessments">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<h6 class="font-weight-bold text-uppercase ord-heading mt-1">ENVIRONMENTAL/MOBILITY</h6>
|
||
<?php viewDynamincForm('home-safety-environmental'); ?>
|
||
<h6 class="font-weight-bold text-uppercase ord-heading mt-1">BATHROOM</h6>
|
||
<?php viewDynamincForm('home-safety-bathroom'); ?>
|
||
<h6 class="font-weight-bold text-uppercase ord-heading mt-1">MEDICATIONS</h6>
|
||
<?php viewDynamincForm('home-safety-medications'); ?>
|
||
<h6 class="font-weight-bold text-uppercase ord-heading mt-1">SUPPLIES/EQUIPMENT/ELECTRICAL</h6>
|
||
<?php viewDynamincForm('home-safety-supplies'); ?>
|
||
<h6 class="font-weight-bold text-uppercase ord-heading mt-1">FIRE/EMERGENCY</h6>
|
||
<?php viewDynamincForm('home-safety-fire'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
<div class="tab-pane fade" id="patient-authorization" role="tabpanel" aria-labelledby="patient-authorization-tab">
|
||
<h5 class="font-weight-bold text-uppercase ord-heading mt-1">Patient Authorization & Consents</h5>
|
||
<span class="">
|
||
<hr class="my-2">
|
||
<h4 class="font-weight-bold">Privacy Act Statement</h4>
|
||
<br>
|
||
Sections 1812, 1814, 1815, 1816, 1861, and 1862 of the Social Security Act authorize collection of this information. The primary use of this Information is to process and pay Medicare benefits to or on behalf of eligible individuals. Disclosure of this information may be made to : Peer Review Organizations and Quality Review Organizations in connection with their review of claims, or in connection with studies or other review activities, conducted pursuant to Part B of Title XI of the Social Security Act; State Licensing Boards for review of unethical practices or nonprofessional conduct; A congressional office from the record of an individual in response to an inquiry from the congressional office at the request of that individual.<br><br>
|
||
Where the individual's identification number is his/her Social Security Number (SSN), collection of this information is authorized by Executive Order 9397. Furnishing the information on this form, including the SSN, is voluntary, but failure to do so may result in disapproval of the request for payment of Medicare benefits.
|
||
<br><br>
|
||
<h4 class="font-weight-bold">Paper Work Burden Statement</h4>
|
||
<br>
|
||
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid 0MB control number. The valid 0MB control number for this information collection is 0938-0357. The time required to complete this information collection is estimated to aver age 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, Mailstop N2-14-26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
|
||
</span>
|
||
<span class="">
|
||
<hr class="my-2">
|
||
<h4 class="font-weight-bold">COVID-19 Liability Release Waiver for Clients</h4><br>
|
||
Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), our Agency is taking extra precautions with the care of every client to include health history review and encourage enhanced sanitation/disinfecting procedures in compliance with CDC and Dept. of Health guidance.
|
||
<br>
|
||
<p class="font-weight-bold">Symptoms of COVID-19 may include:</p>
|
||
<ul>
|
||
<li>Fever</li>
|
||
<li>Fatigue</li>
|
||
<li>Dry Cough</li>
|
||
<li>Difficulty Breathing</li>
|
||
</ul>
|
||
<p class="font-weight-bold">I agree to the following:</p>
|
||
<ul>
|
||
<li>I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.</li>
|
||
<li>I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 30 days.</li>
|
||
<li>I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30days,</li>
|
||
<li>I affirm that I, as well as all household members, have not traveled outside of the country or to any city considered to be a "hot spot" for COVID-19 infections within the past 30-days,</li>
|
||
<li>I understand that CareGiver Pro Homecare cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.</li>
|
||
</ul>
|
||
<br>
|
||
<p class="font-weight-bold">Care Giver Pro Homecare is following these enhanced procedures to prevent the spread ofCOVID-19:</p>
|
||
<ul>
|
||
<li>CareGiver Pro Homecare is enhancing protection for clients amid COVID-19 by.</li>
|
||
<li>Requiring Clients to immediately report to the Agency any of the symptoms noted above,</li>
|
||
<li>Requiring Personal Protective Equipment (PPE) to be worn by both Caregiver and Client when contact is in 6-feet range of each other.</li>
|
||
<li>Require both Caregiver and Client follows all the CDC infection control measures, including but not limited to: proper and frequent hand washing and enhanced cleaning of high-contact surfaces,</li>
|
||
<li>Wellness Checks for Caregiver: measure and record temperature daily before start of each shift.</li>
|
||
<li>Aides with elevated temperature must immediately report this finding to the agency.</li>
|
||
<li>Caregiver mandatory use of gloves and face coverings,</li>
|
||
<li>Require Caregivers to immediately report to the Agency any of the noted symptoms above.</li>
|
||
</ul>
|
||
</span>
|
||
<a href="<?=base_url()?>referral/ReferralActivation/<?=base64_enc($patient_id)?>" aria-selected="false">Go to Patient Authorization & Consents
|
||
</a>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!-- patient visit record end -->
|
||
|
||
<!-- EMERGENCY PREPAREDNESS PLAN section -->
|
||
<div class="card card-section">
|
||
<div class="card-header collapse-card-header" id="headingTwentySix">
|
||
<h2 class="mb-0">
|
||
<button class="btn btn-link collapsed collapse-button-view" type="button" data-toggle="collapse" data-target="#collapseTwentySix" aria-expanded="false" aria-controls="collapseTwentySix">
|
||
<h3 class="font-weight-bold text-uppercase truncatebyline by1 ml-0">EMERGENCY PREPAREDNESS PLAN</h3>
|
||
<i class="la la-angle-down"></i>
|
||
</button>
|
||
</h2>
|
||
</div>
|
||
<div id="collapseTwentySix" class="collapse" aria-labelledby="headingTwentySix" data-parent="#accordionExample">
|
||
<div class="card-body">
|
||
<form method="POST" class="form_class" id="emergency_preparedness_plan">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="AssessmentType" id="AssessmentType" value="<?php echo $type; ?>">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<input type="hidden" name="caregiver_id" value="<?= $caregiver['id'] ?>">
|
||
<input type="hidden" name="patientName" value="<?php echo $patient_data->first_name.' '.$patient_data->last_name; ?>">
|
||
<input type="hidden" name="dob" value="<?php echo $patient_data->dob; ?>">
|
||
<?php viewDynamincForm('emergency_preparedness_plan'); ?>
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!-- EMERGENCY PREPAREDNESS PLAN section -->
|
||
|
||
<!-- authorities section -->
|
||
<div class="card card-section">
|
||
<div class="card-header collapse-card-header" id="headingTwentyFive">
|
||
<h2 class="mb-0">
|
||
<button class="btn btn-link collapsed collapse-button-view" type="button" data-toggle="collapse" data-target="#collapseTwentyFive" aria-expanded="false" aria-controls="collapseTwentyFive">
|
||
<h3 class="font-weight-bold text-uppercase truncatebyline by1 ml-0">Authorities</h3>
|
||
<i class="la la-angle-down"></i>
|
||
</button>
|
||
</h2>
|
||
</div>
|
||
<div id="collapseTwentyFive" class="collapse" aria-labelledby="headingTwentyFive" data-parent="#accordionExample">
|
||
<div class="card-body">
|
||
<!-- this is for clock in & out -->
|
||
<!-- <div class="form-group">
|
||
<div class="row">
|
||
<div class="col-lg-12">
|
||
<input type="text" id="cg_id" value="<?php echo $schedule_data['caregiver_id'];?>" hidden readonly>
|
||
<input type="text" id="pt_id" value="<?php echo $patient_data->id;?>" hidden readonly>
|
||
<input type="text" id="sch_id" value="<?php echo $schedule_id;?>" hidden readonly>
|
||
</div>
|
||
</div>
|
||
</div> -->
|
||
<!-- this is for clock in & out -->
|
||
|
||
<form method="POST" class="form_class" id="Authorities" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<div class="form-group">
|
||
<input type="hidden" name="scheduleId" id="scheduleId" value="<?php echo $scheduleId; ?>">
|
||
<div class="row">
|
||
<div class="col-lg-4">
|
||
<label for="exampleInputEmail1" ><?php echo lang('PRINT NAME'); ?></label>
|
||
<input type="text" class="form-control" name="caregiverPrintName" value="<?= $caregiver['name'] ?>" readonly>
|
||
</div>
|
||
<div class="col-lg-4">
|
||
<label for="exampleInputEmail1" ><?php echo lang('TITLE'); ?></label>
|
||
<input type="text" class="form-control" name="caregiverPrintTitle" value="<?= $caregiver['skill'] ?>" readonly>
|
||
</div>
|
||
<?php $authoritiesData = json_decode($reportData->authorities);?>
|
||
|
||
<div class="col-lg-4">
|
||
<label for="exampleInputEmail1" ><?php echo lang('Date'); ?></label>
|
||
<?php //if($authoritiesData->clinicalSignatureDate!=""){ ?>
|
||
<!-- <label></label> -->
|
||
<?php //echo $authoritiesData->clinicalSignatureDate; ?>
|
||
<?php //} else{ ?>
|
||
<input type="datetime" class='form-control' value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" name='clinicalSignatureDate' id='' readonly>
|
||
<?php //} ?>
|
||
</div>
|
||
<div class="col-lg-5 mb-3 mt-2">
|
||
<label for="exampleInputEmail1" ><?php echo lang('SIGNATURE'); ?></label>
|
||
<?php if($authoritiesData->signature!=""){ ?>
|
||
<img class="form-control" width="200" height="200" src="<?php echo $authoritiesData->signature; ?>" />
|
||
|
||
<?php }else{ ?>
|
||
<label class="pull-right"><span style="cursor: pointer;margin-top: 4px;" onclick="clearCanvas('authorities_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas id="signature" width="400" height="200"></canvas>
|
||
<?php } ?>
|
||
<!-- <img src="" width="400" height="200" id="signature2"> -->
|
||
</div>
|
||
|
||
<!-- this is for clock in & out -->
|
||
<!-- <div class="col-lg-7 mt-2 mb-1 center">
|
||
<button type="button" class="btn btn-info btn-lg mx-1
|
||
<?php if($clock_InOut!=0){if($clock_InOut->clock_status==0 || $clock_InOut->clock_status==1){echo "clock_hide";}}?>" id="clock_in">
|
||
<span class="center">
|
||
<i class="fa fa-clock-o fa-2x"></i> 
|
||
<?php echo lang('Clock In');?>
|
||
</span>
|
||
</button>
|
||
<button type="button" class="btn btn-danger btn-lg mx-1
|
||
<?php if($clock_InOut==0 || $clock_InOut->clock_status==1){echo "clock_hide";}?>" id="clock_out">
|
||
<span class="center">
|
||
<i class="fa fa-clock-o fa-2x"></i> 
|
||
<?php echo lang('Clock Out');?>
|
||
</span>
|
||
</button>
|
||
<h4 class="badge badge-success
|
||
<?php if($clock_InOut==0 || $clock_InOut->clock_status==0){echo "clock_hide";}?>" id="clock_success">
|
||
Clock Has been Set
|
||
</h4>
|
||
</div> -->
|
||
|
||
<!-- this is old -->
|
||
<!-- <div class="col-lg-7 mt-2 mb-1 center">
|
||
<button type="button" class="btn btn-info btn-lg mx-1" id="clock_in"
|
||
<?php if($clock_InOut!=0){if($clock_InOut->clock_status==0 || $clock_InOut->clock_status==1){echo "disabled";}}?>>
|
||
<span class="center">
|
||
<i class="fa fa-clock-o fa-2x"></i> 
|
||
<?php echo lang('Clock In');?>
|
||
</span>
|
||
</button>
|
||
<button type="button" class="btn btn-danger btn-lg mx-1" id="clock_out"
|
||
<?php if($clock_InOut==0 || $clock_InOut->clock_status==1){echo "disabled";}?>>
|
||
<span class="center">
|
||
<i class="fa fa-clock-o fa-2x"></i> 
|
||
<?php echo lang('Clock Out');?>
|
||
</span>
|
||
</button>
|
||
</div> -->
|
||
<!-- this is for clock in & out -->
|
||
</div>
|
||
</div>
|
||
<div class="form-group">
|
||
<div class="row">
|
||
<div class="col-lg-4">
|
||
<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!-- authorities section -->
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</section>
|
||
<!-- page end-->
|
||
</section>
|
||
</div>
|
||
|
||
|
||
|
||
<!-- body mark modal -->
|
||
<div class="modal fade" id="body_mark_modal" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true">
|
||
<div class="modal-dialog width-larger" role="document">
|
||
<div class="modal-content">
|
||
<div class="modal-header">
|
||
<h5 class="modal-title" id="exampleModalLabel">Mark On Body</h5>
|
||
<div class="bg-lg m-auto">
|
||
<button type="button" class="close" data-dismiss="modal">×</button>
|
||
</div>
|
||
</div>
|
||
<div class="modal-body fix-height-body">
|
||
<div id="card_1">
|
||
<form role="form" action="" method="post" enctype="multipart/form-data" name="newGenInfo">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<label class="pull-right"><span style="cursor: pointer;margin-top: 4px;" onclick="eraseCanvas('body_mark_canvas')" class="badge badge-info">Erasess</span></label>
|
||
<canvas id="body_mark_canvas" width="475" height="400"></canvas>
|
||
<div class="form-group mt-2 center-y right_align">
|
||
<button type="button" class="btn btn-primary" name="button" onclick="save_body_image()" class="btn btn-info">
|
||
Save
|
||
</button>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!-- body mark modal -->
|
||
|
||
|
||
<!-- feet mark modal -->
|
||
<div class="modal fade" id="feet_mark_modal" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true">
|
||
<div class="modal-dialog width-larger" role="document">
|
||
<div class="modal-content">
|
||
<div class="modal-header">
|
||
<h5 class="modal-title" id="exampleModalLabel">Mark On Feet</h5>
|
||
<div class="bg-lg m-auto">
|
||
<button type="button" class="close" data-dismiss="modal">×</button>
|
||
</div>
|
||
</div>
|
||
<div class="modal-body fix-height-body">
|
||
<div id="card_1">
|
||
<form role="form" action="" method="post" enctype="multipart/form-data" name="newGenInfo">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<label class="pull-right"><span style="cursor: pointer;margin-top: 4px;" onclick="eraseCanvas('feet_mark_canvas')" class="badge badge-info">Erasess</span></label>
|
||
<canvas id="feet_mark_canvas" width="475" height="400"></canvas>
|
||
<div class="form-group mt-2 center-y right_align">
|
||
<button type="button" class="btn btn-primary" name="button" onclick="save_feet_image()" class="btn btn-info">
|
||
Save
|
||
</button>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!-- feet mark modal -->
|
||
|
||
|
||
<!-- Footer Script-->
|
||
<!-- <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script> -->
|
||
<script type="text/javascript" src="https://pagead2.googlesyndication.com/pagead/show_ads.js"></script>
|
||
<script src="https://code.jquery.com/jquery-3.4.1.min.js" integrity="sha384-vk5WoKIaW/vJyUAd9n/wmopsmNhiy+L2Z+SBxGYnUkunIxVxAv/UtMOhba/xskxh" crossorigin="anonymous"></script>
|
||
<!-- <script src="<?php echo base_url(); ?>common/signature/drawing-table.js" type="text/javascript"></script> -->
|
||
|
||
<!-- for clock in and out of caregiver -->
|
||
<!-- <script>
|
||
$(document).ready(function(){
|
||
$("#clock_in").click(function(){
|
||
var cg_id=$("#cg_id").val();
|
||
var pt_id=$("#pt_id").val();
|
||
var sch_id=$("#sch_id").val();
|
||
$.ajax({
|
||
url:"<?php echo base_url()?>Assessment/ajax_clock_in",
|
||
type:"GET",
|
||
data:{cg_id:cg_id,pt_id:pt_id,sch_id:sch_id},
|
||
dataType: "json",
|
||
success:function(data){
|
||
// console.log(data);
|
||
if(data==0){
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'error',
|
||
title: 'Something Went Wrong! or already clocked In! Try Again later',
|
||
showConfirmButton: false,
|
||
timer: 3500
|
||
});
|
||
}
|
||
if(data==1){
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'success',
|
||
title: 'Clocked in successfully',
|
||
showConfirmButton: false,
|
||
timer: 3500
|
||
});
|
||
// $("#clock_in").attr("disabled","");
|
||
// $("#clock_out").removeAttr("disabled");
|
||
$("#clock_in").addClass("clock_hide");
|
||
$("#clock_out").removeClass("clock_hide");
|
||
}
|
||
}
|
||
});
|
||
});
|
||
$("#clock_out").click(function(){
|
||
var sch_id=$("#sch_id").val();
|
||
$.ajax({
|
||
url:"<?php echo base_url()?>Assessment/ajax_clock_out",
|
||
type:"GET",
|
||
data:{sch_id:sch_id},
|
||
dataType: "json",
|
||
success:function(data){
|
||
// console.log(data);
|
||
if(data==0){
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'error',
|
||
title: 'Something Went Wrong! Try Again later',
|
||
showConfirmButton: false,
|
||
timer: 3500
|
||
});
|
||
}
|
||
if(data==1){
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'success',
|
||
title: 'Clocked out successfully',
|
||
showConfirmButton: false,
|
||
timer: 3500
|
||
});
|
||
// $("#clock_out").attr("disabled","");
|
||
$("#clock_out").addClass("clock_hide");
|
||
$("#clock_success").removeClass("clock_hide");
|
||
}
|
||
}
|
||
});
|
||
});
|
||
});
|
||
</script> -->
|
||
<!-- for clock in and out of caregiver ending here -->
|
||
|
||
|
||
<script>
|
||
try {
|
||
fetch(new Request("https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js", { method: 'HEAD', mode: 'no-cors' })).then(function(response) {
|
||
return true;
|
||
}).catch(function(e) {
|
||
var carbonScript = document.createElement("script");
|
||
carbonScript.src = "//cdn.carbonads.com/carbon.js?serve=CK7DKKQU&placement=wwwjqueryscriptnet";
|
||
carbonScript.id = "_carbonads_js";
|
||
document.getElementById("carbon-block").appendChild(carbonScript);
|
||
});
|
||
} catch (error) {
|
||
console.log(error);
|
||
}
|
||
</script>
|
||
<script type="text/javascript">
|
||
var _gaq = _gaq || [];
|
||
_gaq.push(['_setAccount', 'UA-36251023-1']);
|
||
_gaq.push(['_setDomainName', 'jqueryscript.net']);
|
||
_gaq.push(['_trackPageview']);
|
||
|
||
(function() {
|
||
var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true;
|
||
ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js';
|
||
var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s);
|
||
})();
|
||
|
||
</script>
|
||
|
||
<script type="text/javascript">
|
||
|
||
function clearCanvas(id)
|
||
{
|
||
var cnvid = "signature";
|
||
var c = document.getElementById(cnvid);
|
||
var ctx = c.getContext("2d");
|
||
ctx.fillStyle = "red";
|
||
ctx.clearRect(0, 0, 400, 200);
|
||
}
|
||
$(".form_class").submit(function(e){
|
||
e.preventDefault();
|
||
console.log(document.getElementById('signature'));
|
||
if(document.getElementById('signature')!=='undefined' && document.getElementById('signature')!==null){
|
||
var canvas = document.getElementById('signature');
|
||
var signature=canvas.toDataURL("image/png");
|
||
}else{
|
||
var signature="";
|
||
}
|
||
|
||
// $("#signature2").attr("src",signature);
|
||
//console.log(signature);
|
||
|
||
var fromId = $(this).attr('id');
|
||
var pid = $("#patientId").val();
|
||
var mainId = $("#mainId").val();
|
||
// console.log(">>>>>>>>>>>>",fromId);
|
||
//alert(mainId);
|
||
var asmType = $("#AssessmentType").val();
|
||
|
||
// alert(fromId);
|
||
var fd = new FormData();
|
||
var other_data = $('#'+fromId).serializeArray();
|
||
$.each(other_data,function(key,input){
|
||
fd.append('fId', fromId);
|
||
fd.append('pid', pid);
|
||
fd.append('mainId', mainId);
|
||
fd.append('asmType', asmType);
|
||
fd.append('signature', signature);
|
||
fd.append(input.name,input.value);
|
||
});
|
||
// console.log(fd);
|
||
|
||
$.ajax({
|
||
url: '<?=base_url()?>assessment/saveReportData',
|
||
data: fd,
|
||
contentType: false,
|
||
processData: false,
|
||
type: 'POST',
|
||
//dataType:'JOSN',
|
||
success: function(data){
|
||
console.log(data);
|
||
data=JSON.parse(data);
|
||
if(data.mainId){
|
||
$("#mainId").val(data.mainId);
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'success',
|
||
title: data.msg,
|
||
showConfirmButton: false,
|
||
timer: 3500
|
||
});
|
||
}else{
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'error',
|
||
title: data.msg,
|
||
showConfirmButton: false,
|
||
timer: 3500
|
||
});
|
||
}
|
||
|
||
//alert(data.msg);
|
||
}
|
||
});
|
||
|
||
});
|
||
</script>
|
||
|
||
<script type="text/javascript">
|
||
/* future date dob not accept */
|
||
|
||
$(document).ready(function () {
|
||
// alert("dateSec");
|
||
var todaysDate = new Date(); // Gets today's date
|
||
|
||
// Max date attribute is in "YYYY-MM-DD". Need to format today's date accordingly
|
||
|
||
var year = todaysDate.getFullYear(); // YYYY
|
||
var month = ("0" + (todaysDate.getMonth() + 1)).slice(-2); // MM
|
||
var day = ("0" + todaysDate.getDate()).slice(-2); // DD
|
||
|
||
var maxDate = (year +"-"+ month +"-"+ day); // Results in "YYYY-MM-DD" for today's date
|
||
|
||
// Now to set the max date value for the calendar to be today's date
|
||
$('.futDateNonAccept').attr('max',maxDate);
|
||
});
|
||
|
||
</script>
|
||
<script type="text/javascript">
|
||
$('#respiratory').change(function(){
|
||
var respType = $(this).val();
|
||
if(respType == 'Breath Sounds')
|
||
{
|
||
document.getElementById("respBreathSound").style.display = "block";
|
||
}
|
||
else
|
||
{
|
||
document.getElementById("respBreathSound").style.display = "none";
|
||
}
|
||
});
|
||
$('#cardiovascular').change(function(){
|
||
var cvacType = $(this).val();
|
||
if(cvacType == 'Rhythm')
|
||
{
|
||
document.getElementById("CvacRhythm").style.display = "block";
|
||
document.getElementById("cvacEdema").style.display = "none";
|
||
}
|
||
if(cvacType == 'Edema')
|
||
{
|
||
document.getElementById("CvacRhythm").style.display = "none";
|
||
document.getElementById("cvacEdema").style.display = "block";
|
||
}
|
||
});
|
||
$('#therapy_type').change(function(){
|
||
var therapy_type = $(this).val();
|
||
$.ajax('assessment/ajax_type_therapy', {
|
||
type: 'POST', // http method
|
||
data: { val: therapy_type,'<?php echo $this->security->get_csrf_token_name(); ?>' : '<?php echo $this->security->get_csrf_hash(); ?>' }, // data to submit
|
||
async: false,
|
||
success: function (data, status, xhr) {
|
||
// $('p').append('status: ' + status + ', data: ' + data);
|
||
// alert(data);
|
||
// msgs = data;
|
||
$("#typeAccValInp").html(data);
|
||
},
|
||
error: function (jqXhr, textStatus, errorMessage) {
|
||
// $('p').append('Error' + errorMessage);
|
||
alert("error duc");
|
||
}
|
||
});
|
||
});
|
||
$('#deviceAccessType').change(function(){
|
||
var dAccesType = $(this).val();
|
||
$.ajax('assessment/ajax_type_device_access', {
|
||
type: 'POST', // http method
|
||
data: { val: dAccesType,'<?php echo $this->security->get_csrf_token_name(); ?>' : '<?php echo $this->security->get_csrf_hash(); ?>' }, // data to submit
|
||
async: false,
|
||
success: function (data, status, xhr) {
|
||
// $('p').append('status: ' + status + ', data: ' + data);
|
||
// alert(data);
|
||
// msgs = data;
|
||
$("#deviceAccessTypeDiv").html(data);
|
||
},
|
||
error: function (jqXhr, textStatus, errorMessage) {
|
||
// $('p').append('Error' + errorMessage);
|
||
alert("error duc");
|
||
}
|
||
});
|
||
});
|
||
$('#accessAssessmentDD').change(function(){
|
||
var accessAssessment = $(this).val();
|
||
$.ajax('assessment/ajax_type_access_assessment', {
|
||
type: 'POST', // http method
|
||
data: { val: accessAssessment,'<?php echo $this->security->get_csrf_token_name(); ?>' : '<?php echo $this->security->get_csrf_hash(); ?>' }, // data to submit
|
||
async: false,
|
||
success: function (data, status, xhr) {
|
||
// $('p').append('status: ' + status + ', data: ' + data);
|
||
// alert(data);
|
||
// msgs = data;
|
||
$("#accessAssessmentDiv").html(data);
|
||
},
|
||
error: function (jqXhr, textStatus, errorMessage) {
|
||
// $('p').append('Error' + errorMessage);
|
||
alert("error duc");
|
||
}
|
||
});
|
||
});
|
||
$('#action').change(function(){
|
||
var accessAssessment = $(this).val();
|
||
$.ajax('assessment/ajax_action_box', {
|
||
type: 'POST', // http method
|
||
data: { val: accessAssessment,'<?php echo $this->security->get_csrf_token_name(); ?>' : '<?php echo $this->security->get_csrf_hash(); ?>' }, // data to submit
|
||
async: false,
|
||
success: function (data, status, xhr) {
|
||
// $('p').append('status: ' + status + ', data: ' + data);
|
||
// alert(data);
|
||
// msgs = data;
|
||
$("#actionDiv").html(data);
|
||
},
|
||
error: function (jqXhr, textStatus, errorMessage) {
|
||
// $('p').append('Error' + errorMessage);
|
||
alert("error duc");
|
||
}
|
||
});
|
||
});
|
||
$('#pumpRate').change(function(){
|
||
var accessAssessment = $(this).val();
|
||
$.ajax('assessment/ajax_pump_rate', {
|
||
type: 'POST', // http method
|
||
data: { val: accessAssessment,'<?php echo $this->security->get_csrf_token_name(); ?>' : '<?php echo $this->security->get_csrf_hash(); ?>' }, // data to submit
|
||
async: false,
|
||
success: function (data, status, xhr) {
|
||
// $('p').append('status: ' + status + ', data: ' + data);
|
||
// alert(data);
|
||
// msgs = data;
|
||
$("#pumpRateDiv").html(data);
|
||
},
|
||
error: function (jqXhr, textStatus, errorMessage) {
|
||
// $('p').append('Error' + errorMessage);
|
||
alert("error duc");
|
||
}
|
||
});
|
||
});
|
||
</script>
|
||
<script type="text/javascript">
|
||
function ifInweldingFun(_this){
|
||
var val = _this.value;
|
||
if(val == 'Indwelling')
|
||
{
|
||
document.getElementById("cathBalOrfr").style.display = "block";
|
||
|
||
}
|
||
if(val == 'Staight Catheter')
|
||
{
|
||
document.getElementById("cathBalOrfr").style.display = "none";
|
||
|
||
}
|
||
}
|
||
</script>
|
||
<script>
|
||
/*tool tip section*/
|
||
$(document).ready(function(){
|
||
$('[data-toggle="tooltip"]').tooltip();
|
||
});
|
||
</script>
|
||
|
||
<script type="text/javascript">
|
||
function isNumberKey(evt){
|
||
var charCode = (evt.which) ? evt.which : evt.keyCode
|
||
if (charCode > 31 && (charCode < 48 || charCode > 57)){
|
||
return false;
|
||
}
|
||
return true;
|
||
}
|
||
</script>
|
||
|
||
<script type="text/javascript">
|
||
function isCharKey(inputtxt){
|
||
var letters = /^[A-Za-z]+$/;
|
||
if(inputtxt.value.match(letters))
|
||
{
|
||
return true;
|
||
}
|
||
else
|
||
{
|
||
// alert("message");
|
||
return false;
|
||
}
|
||
}
|
||
</script>
|
||
|
||
<!-- psycho-social -->
|
||
<script type="text/javascript">
|
||
$(document).on('click','#psycho-social-tab',function(){
|
||
var patient_smoke=$('[name="patient_smoke"]:checked').val();
|
||
var trgt1=$("#smoke_frequency_per_day").closest(".justify-content-end");
|
||
toggleSmokeContainer(patient_smoke,trgt1);
|
||
|
||
var patient_alcoholic=$('[name="patient_alcoholic"]:checked').val();
|
||
var trgt2=$("#drink_frequency_per_day").closest(".justify-content-end");
|
||
var trgt3=$("#drink_frequency_per_week").closest(".justify-content-end");
|
||
toggleAlcoholContainer(patient_alcoholic,trgt2,trgt3);
|
||
});
|
||
$(document).on('click','[name="patient_smoke"]',function(){
|
||
var patient_smoke=$(this).val();
|
||
var trgt=$("#smoke_frequency_per_day").closest(".justify-content-end");
|
||
toggleSmokeContainer(patient_smoke,trgt);
|
||
});
|
||
$(document).on('click','[name="patient_alcoholic"]',function(){
|
||
var patient_alcoholic=$(this).val();
|
||
var trgt=$("#drink_frequency_per_day").closest(".justify-content-end");
|
||
var trgt2=$("#drink_frequency_per_week").closest(".justify-content-end");
|
||
toggleAlcoholContainer(patient_alcoholic,trgt,trgt2);
|
||
});
|
||
function toggleSmokeContainer(stat,trgt){
|
||
stat=stat!=undefined&&stat.trim()!=''?stat:'';
|
||
if(stat=="yes"){ trgt.show('slow'); }
|
||
else if(stat=="no" || stat==""){ trgt.hide('slow'); }
|
||
}
|
||
function toggleAlcoholContainer(stat,trgt,trgt2){
|
||
stat=stat!=undefined&&stat.trim()!=''?stat:'';
|
||
if(stat=="yes"){ trgt.show('slow'); trgt2.show('slow'); }
|
||
else if(stat=="no" || stat==""){ trgt.hide('slow'); trgt2.hide('slow'); }
|
||
}
|
||
</script>
|
||
<!-- psycho-social -->
|
||
|
||
<!-- cardiovascular chest-pain-->
|
||
<script type="text/javascript">
|
||
$(document).on('click','#Cardiovascular-Pulmonary-tab',function(){
|
||
var chest_pain=$('[name="chest_pain"]:checked').val();
|
||
var trgt1=$("#chest_pain_location").closest(".justify-content-end");
|
||
var trgt2=$("#chest_pain_frequency").closest(".justify-content-end");
|
||
var trgt3=$("#chest_pain_duration").closest(".justify-content-end");
|
||
toggleChestPainContainer(chest_pain,trgt1,trgt2,trgt3);
|
||
|
||
var associated_with_activity=$('[name="associated_with_activity"]:checked').val();
|
||
var trgt4=$("#measures_to_relieve").closest(".justify-content-end");
|
||
toggleRelieveContainer(associated_with_activity,trgt4);
|
||
|
||
var fluid_restriction=$('[name="fluid_restriction"]:checked').val();
|
||
var trgt5=$("#fluid_restricted_to").closest(".justify-content-end");
|
||
toggleFluidRestrictedContainer(fluid_restriction,trgt5);
|
||
});
|
||
|
||
$(document).on('click','[name="chest_pain"]',function(){
|
||
var chest_pain=$(this).val();
|
||
var trgt1=$("#chest_pain_location").closest(".justify-content-end");
|
||
var trgt2=$("#chest_pain_frequency").closest(".justify-content-end");
|
||
var trgt3=$("#chest_pain_duration").closest(".justify-content-end");
|
||
toggleChestPainContainer(chest_pain,trgt1,trgt2,trgt3);
|
||
});
|
||
$(document).on('click','[name="associated_with_activity"]',function(){
|
||
var associated_with_activity=$(this).val();
|
||
var trgt4=$("#measures_to_relieve").closest(".justify-content-end");
|
||
toggleRelieveContainer(associated_with_activity,trgt4);
|
||
});
|
||
$(document).on('click','[name="fluid_restriction"]',function(){
|
||
var fluid_restriction=$(this).val();
|
||
var trgt5=$("#fluid_restricted_to").closest(".justify-content-end");
|
||
toggleFluidRestrictedContainer(fluid_restriction,trgt5);
|
||
});
|
||
|
||
function toggleChestPainContainer(stat,trgt1,trgt2,trgt3){
|
||
stat=stat!=undefined&&stat.trim()!=''?stat:'';
|
||
if(stat=="yes"){ trgt1.show('slow'); trgt2.show('slow'); trgt3.show('slow'); }
|
||
else if(stat=="no" || stat==""){ trgt1.hide('slow'); trgt2.hide('slow'); trgt3.hide('slow'); }
|
||
}
|
||
function toggleRelieveContainer(stat,trgt){
|
||
stat=stat!=undefined&&stat.trim()!=''?stat:'';
|
||
if(stat=="yes"){ trgt.show('slow'); }
|
||
else if(stat=="no" || stat==""){ trgt.hide('slow'); }
|
||
}
|
||
function toggleFluidRestrictedContainer(stat,trgt5){
|
||
stat=stat!=undefined&&stat.trim()!=''?stat:'';
|
||
if(stat=="restricted"){ trgt5.show('slow'); }
|
||
else if(stat=="no" || stat==""){ trgt5.hide('slow'); }
|
||
}
|
||
</script>
|
||
<!-- cardiovascular chest-pain-->
|
||
<!-- mark image -->
|
||
<script src="https://cdnjs.cloudflare.com/ajax/libs/signature_pad/1.5.3/signature_pad.min.js"></script>
|
||
<script type="text/javascript">
|
||
$('document').ready(function(){
|
||
setCanvasDimension();
|
||
var signaturePad = new SignaturePad(document.getElementById('signature'), {
|
||
backgroundColor: 'white',
|
||
minWidth: 0.8,
|
||
maxWidth: 1.0,
|
||
penColor: 'black'
|
||
});
|
||
})
|
||
$(window).resize(function(){
|
||
setCanvasDimension();
|
||
});
|
||
function body_mark_modal()
|
||
{
|
||
drawCanvasBackgroundImage('body_mark_canvas');
|
||
var signaturePad = new SignaturePad(document.getElementById('body_mark_canvas'), {
|
||
backgroundColor: 'white',
|
||
minWidth: 0.8,
|
||
maxWidth: 1.0,
|
||
penColor: 'blue'
|
||
});
|
||
|
||
$('#body_mark_modal').modal('show');
|
||
}
|
||
function feet_mark_modal()
|
||
{
|
||
drawCanvasBackgroundImage('feet_mark_canvas');
|
||
var signaturePad = new SignaturePad(document.getElementById('feet_mark_canvas'), {
|
||
backgroundColor: 'white',
|
||
minWidth: 0.8,
|
||
maxWidth: 1.0,
|
||
penColor: 'blue'
|
||
});
|
||
|
||
$('#feet_mark_modal').modal('show');
|
||
}
|
||
function eraseCanvas(of){
|
||
var ctx = new SignaturePad(document.getElementById(of), {
|
||
backgroundColor: 'white',
|
||
minWidth: 0.8,
|
||
maxWidth: 1.0,
|
||
penColor: 'blue'
|
||
});
|
||
// var ctx = new SignaturePad(document.getElementById(of));
|
||
ctx.clear();
|
||
defaultCanvasBackgroundImage(of);
|
||
}
|
||
function defaultCanvasBackgroundImage(of){
|
||
var canvas=document.getElementById(of);
|
||
var ctx=canvas.getContext("2d");
|
||
var background=new Image();
|
||
if(of == 'body_mark_canvas'){
|
||
background.src="<?php echo base_url(); ?>systemfiles/medias/nurse-assessment-body.png";
|
||
}else if(of == 'feet_mark_canvas'){
|
||
background.src="<?php echo base_url(); ?>systemfiles/medias/nurse-assessment-feet.png";
|
||
}
|
||
var w=(window.innerWidth*0.8)>475?475:window.innerWidth*0.8;
|
||
var h=w*(400/475);
|
||
background.onload=function() {
|
||
ctx.drawImage(background, 0, 0,w,h);
|
||
};
|
||
}
|
||
function drawCanvasBackgroundImage(of){
|
||
var canvas=document.getElementById(of);
|
||
var ctx=canvas.getContext("2d");
|
||
var background=new Image();
|
||
if(of == 'body_mark_canvas'){
|
||
var updated_body_img = $('#updated_body_img').val();
|
||
background.src=updated_body_img;
|
||
}else if(of == 'feet_mark_canvas'){
|
||
var updated_feet_img = $('#updated_feet_img').val();
|
||
background.src=updated_feet_img;
|
||
}
|
||
var w=(window.innerWidth*0.8)>475?475:window.innerWidth*0.8;
|
||
var h=w*(400/475);
|
||
background.onload=function() {
|
||
ctx.drawImage(background, 0, 0,w,h);
|
||
};
|
||
}
|
||
function save_body_image()
|
||
{
|
||
var canvas=document.getElementById('body_mark_canvas');
|
||
if(canvas){
|
||
var body_image=canvas.toDataURL("image/png");
|
||
$("#body_mark_image").val(body_image);
|
||
$("#body_img_view").attr("src",body_image);
|
||
$("#updated_body_img").val(body_image);
|
||
}
|
||
$('#body_mark_modal').modal('hide');
|
||
}
|
||
function save_feet_image()
|
||
{
|
||
var canvas=document.getElementById('feet_mark_canvas');
|
||
if(canvas){
|
||
var feet_image=canvas.toDataURL("image/png");
|
||
$("#feet_mark_image").val(feet_image);
|
||
$("#feet_img_view").attr("src",feet_image);
|
||
$("#updated_feet_img").val(feet_image);
|
||
}
|
||
$('#feet_mark_modal').modal('hide');
|
||
}
|
||
function setCanvasDimension(){
|
||
/*Set canvas dimensions based on the window size*/
|
||
//for body_mark_canvas
|
||
var bm_canvas=document.getElementById('body_mark_canvas');
|
||
var ctx=bm_canvas.getContext('2d');
|
||
var w=(window.innerWidth*0.8)>475?475:window.innerWidth*0.8;
|
||
var h=w*(400/475);
|
||
// var w=window.innerWidth*0.8;
|
||
// var h=window.innerHeight*0.6;
|
||
// bm_canvas.width=w>475?475:w;
|
||
// bm_canvas.height=h>400?400:h;
|
||
var w=(window.innerWidth*0.8)>475?475:window.innerWidth*0.8;
|
||
var h=w*(400/475);
|
||
bm_canvas.width=w;
|
||
bm_canvas.height=h;
|
||
|
||
//for feet_mark_canvas
|
||
var ft_canvas=document.getElementById('feet_mark_canvas');
|
||
var ctx=ft_canvas.getContext('2d');
|
||
// var w=window.innerWidth*0.8;
|
||
// var h=window.innerHeight*0.6;
|
||
// ft_canvas.width=w>475?475:w;
|
||
// ft_canvas.height=h>400?400:h;
|
||
var w=(window.innerWidth*0.8)>475?475:window.innerWidth*0.8;
|
||
var h=w*(400/475);
|
||
ft_canvas.width=w;
|
||
ft_canvas.height=h;
|
||
|
||
//RN signature panel
|
||
var ft_canvas=document.getElementById('signature');
|
||
var ctx=ft_canvas.getContext('2d');
|
||
// var w=window.innerWidth*0.8;
|
||
// var h=window.innerHeight*0.6;
|
||
// ft_canvas.width=w>475?475:w;
|
||
// ft_canvas.height=h>400?400:h;
|
||
var w=(window.innerWidth*0.8)>400?400:window.innerWidth*0.8;
|
||
var h=w*(200/400);
|
||
ft_canvas.width=w;
|
||
ft_canvas.height=h;
|
||
/*Set canvas dimensions based on the window size*/
|
||
}
|
||
// NARRATIVE comments max length set
|
||
$(document).on('click','.narrative_comments',function(){
|
||
$(".narrative_comments").prop('maxlength', 200);
|
||
})
|
||
// assment type change
|
||
$(document).ready(function(){
|
||
var assessment_type=$('#assessment_type').val();
|
||
if(assessment_type == 'Re Assmessment'){
|
||
$('#assessment_tab').text('Re Assessment');
|
||
}else{
|
||
$('#assessment_tab').text('Assessment');
|
||
}
|
||
})
|
||
$(document).on('click','#assessment_type',function(){
|
||
var assessment_type=$('#assessment_type').val();
|
||
if(assessment_type == 'Re Assmessment'){
|
||
$('#assessment_tab').text('Re Assessment');
|
||
}else{
|
||
$('#assessment_tab').text('Assessment');
|
||
}
|
||
})
|
||
$(document).on('click','#headingOne',function(){
|
||
var assessment_type=$('#assessment_type').val();
|
||
var visit_date_val=$('#visit_date_val').val();
|
||
var start_time_val=$('#start_time_val').val();
|
||
var end_time_val=$('#end_time_val').val();
|
||
|
||
if(assessment_type == 'Re Assmessment'){
|
||
$('#visit_date').val('');
|
||
$('#Start_Time').val('');
|
||
$('#End_Time').val('');
|
||
}else{
|
||
$('#visit_date').val(visit_date_val);
|
||
$('#Start_Time').val(start_time_val);
|
||
$('#End_Time').val(end_time_val);
|
||
}
|
||
})
|
||
</script>
|
||
<!-- mark image -->
|
||
<!--main content end-->
|
||
<!--footer start
|