1174 lines
82 KiB
PHP
Executable File
1174 lines
82 KiB
PHP
Executable File
<!--sidebar end-->
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<!--main content start-->
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<style>
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.required-field:before {content: "*";color: red;}
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</style>
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<div class="app-content content">
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<section class="content-wrapper">
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<div class="row">
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<div class="col-12">
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<div class="card">
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<div class="card-header">
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<div class="row">
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<div class="col-12">
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<h3 class="font-weight-bold">
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<?php
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// print_r($patient);exit;
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if (!empty($discharge->id))
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echo lang('edit').' '.lang('patient discharge');
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else
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echo lang('add').' '.lang('patient discharge');
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?>
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</h3>
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</div>
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</div>
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</div>
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<hr class="mt-0 mb-0" />
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<div class="card-body">
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<div class="row">
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<div class="col-md-12">
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<form role="form" id="patientDischargeForm" action="<?php echo base_url(); ?>patient_discharge/addNew" method="post" enctype="multipart/form-data" onsubmit="return validateForm()">
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<input type="hidden" name="patient_id" value='<?php if (!empty($patient->id)) { echo $patient->id; } ?>'>
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<input type="hidden" name="<?php echo $this->security->get_csrf_token_name();?>" value="<?php echo $this->security->get_csrf_hash();?>">
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<div class="row">
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<div class="form-group col-md-4">
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<label ><?php echo lang('name'); ?></label>
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<?php $name = $patient->first_name.' '.$patient->last_name; ?>
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<input type="text" class="form-control" name="name" id="exampleInputEmail1" value='<?php
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if (!empty($name)) {
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echo $name;
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}
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?>' placeholder="" disabled>
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('gender'); ?></label>
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<input type="gender" class="form-control" name="gender" id="exampleInputEmail1" value='<?php
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if (!empty($patient->gender)) {
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echo $patient->gender;
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}
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?>' placeholder="" disabled>
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('Dob'); ?></label>
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<input type="date" class="form-control futDateNonAccept" name="dob"id="ptdob" value='<?php
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if (!empty($setval)) {
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echo set_value('dob');
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}
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if (!empty($patient->dob)) {
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echo $patient->dob;
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}
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?>' placeholder="" disabled>
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</div>
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<?php
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$HtFI = explode(',', $patient->height);
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$Htf = $HtFI[0];
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$Hti = $HtFI[1];
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$height= $Htf."'".$Hti."'' ";
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?>
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<div class="form-group col-md-4">
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<label ><?php echo lang('height'); ?></label>
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<input class="form-control" name="height" value=<?=$height?> placeholder="" disabled>
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('weight'); ?></label>
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<input type="text" class="form-control" name="weight" value='<?php
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if (!empty($setval)) {
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echo set_value('weight');
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}
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if (!empty($patient->weight)) {
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echo $patient->weight;
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}
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?>' placeholder="" disabled>
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('allergies'); ?></label>
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<input type="text" class="form-control" name="allergy" value='<?php
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if (!empty($assessment->allergy)) {
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echo $assessment->allergy;
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}
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?>' placeholder="" disabled>
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('Marital status'); ?></label>
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<input type="text" class="form-control" name="marital_stat" value='<?php
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if (!empty($patient->marital_stat)) {
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echo $patient->marital_stat;
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}
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?>' placeholder="" disabled>
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('Language'); ?></label>
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<input type="text" class="form-control" name=" primary_language" value='<?php
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if (!empty($patient->primary_language)) {
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echo $patient->language_name;
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}
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?>' placeholder="" disabled>
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('Address'); ?></label>
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<input type="text" class="form-control" name="address" value='<?php
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$address = json_decode($patient->address);
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if (!empty($address)) {
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echo($address->address.",".$address->Apartment.",".$address->City.",".$address->State.",".$address->Zipcode.",".$address->County);
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}
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?>' placeholder="" disabled>
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('Admitted Date'); ?></label>
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<input type="date" class="form-control futDateNonAccept" name="entry_date" value='<?php
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if (!empty($patient->entry_date)) {
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echo $patient->entry_date;
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}
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?>' placeholder="" disabled>
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('CHCS Discharge Date'); ?></label>
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<input type="date" class="form-control futDateNonAccept" name="chcs_discharge_date" value="<?php
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if (!empty($setval)) {
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echo set_value('chcs_discharge_date');
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}
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if (!empty($discharge->chcs_discharge_date)) {
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echo $discharge->chcs_discharge_date;
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}
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?>" placeholder="">
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<section class="col-md-12 chcs_discharge_date">
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</section>
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</div>
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<div class="form-group col-md-4">
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<label class="required-field"><?php echo lang('Primary Diagnosis'); ?></label>
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<input type="text" class="form-control" name="primary_diagnosis" value="<?php
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if (!empty($setval)) {
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echo set_value('primary_diagnosis');
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}
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if (!empty($discharge->primary_diagnosis)) {
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echo $discharge->primary_diagnosis;
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}
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?>" placeholder="" required>
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<section class="col-md-12 primary_diagnosis">
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</section>
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</div>
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</div>
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<div class="row">
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<div class="form-group col-md-4">
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<label ><?php echo lang('Secondary Diagnosis'); ?></label>
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<input type="text" class="form-control" name="secondary_diagnosis" value="<?php
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if (!empty($discharge->secondary_diagnosis)) {
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echo $discharge->secondary_diagnosis;
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}
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?>" placeholder="">
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('Service provided'); ?></label>
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<select id="service_provided" class="form-control" name="service_provided" value="<?= $discharge->service_provided ?>">
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<option value="1" <?php if (!empty($discharge->service_provided)) {
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if($discharge->service_provided == 1) {
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echo "selected";
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}
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}
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?> >Nursing Assessment</option>
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<option value="2"<?php if (!empty($discharge->service_provided)) {
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if($discharge->service_provided == 2) {
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echo "selected";
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}
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}
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?>>Patient Education</option>
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<option value="3" <?php if (!empty($discharge->service_provided)) {
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if($discharge->service_provided == 3) {
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echo "selected";
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}
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}
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?>>Infusion Therapy</option>
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</select>
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</div>
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<div class="form-group col-md-4" id="infusion_therapy" style="<?php if($discharge->service_provided == 3){
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echo "display: block";
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}else{
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echo "display: none";
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} ?>"
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>
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<label ><?php echo lang('Infusion Therapy Method'); ?></label>
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<select class="form-control" name="infusion_therapy">
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Dropdown with Midline Cath, S/L PICC
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<option value="1" <?php if (!empty($discharge->infusion_therapy)) {
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if($discharge->service_provided == 1) {
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echo "selected";
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}
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}
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?>>Midline Cath</option>
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<option value="2" <?php if (!empty($discharge->infusion_therapy)) {
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if($discharge->service_provided == 2) {
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echo "selected";
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}
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}
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?>>S/L PICC</option>
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</select>
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</div>
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</div>
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<div class="row">
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<div class="form-group col-md-4">
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<label ><?php echo lang('Comments'); ?></label>
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<input type="text" class="form-control" name="comments" value="<?php
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if (!empty($discharge->comments)) {
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echo $discharge->comments;
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}
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?>
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" placeholder="">
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('Other'); ?></label>
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<input type="text" class="form-control" name="other" value="<?php
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if (!empty($discharge->other)) {
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echo $discharge->other;
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}
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?>" placeholder="">
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</div>
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<div class="form-group col-md-4">
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<label ><?php echo lang('Level Of Care'); ?></label>
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<select class="form-control" name="level_of_care">
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<?php foreach($services as $service) {?>
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<option value="<?= $service->id?>" <?php if (!empty($discharge->level_of_care)) {
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if($discharge->level_of_care == $service->id) {
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echo "selected";
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}
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}
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?>><?= $service->name?></option>
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<?php } ?>
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</select>
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</div>
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<div class="form-group col-md-4">
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<label class="required-field"><?php echo lang('Specify'); ?></label>
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<input type="text" class="form-control" name="specify" value="<?php
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if (!empty($setval)) {
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echo set_value('specify');
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}
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if (!empty($discharge->specify)) {
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echo $discharge->specify;
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}
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?>" placeholder="" required>
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<section class="col-md-12 specify"></section>
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</div>
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</div>
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<div class="row">
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<div class="form-group col-md-12">
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<label><?php echo lang('Patient will have more knowledge about disease ?'); ?></label>
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<div class="row col-md-6">
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<div class="form-check col-md-6">
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<input class="form-check-input" type="radio" name="about_disease" id="radio" value="1" <?php if (!empty($discharge->about_disease)) {
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if($discharge->about_disease == 1) {
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echo "checked";
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}
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}
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?>>
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<label class="form-check-label" for="YES">
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YES
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</label>
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</div>
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<div class="form-check col-md-6">
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<input class="form-check-input" type="radio" name="about_disease" id="radio" value="0" <?php
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if($discharge->about_disease == 0) {
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echo "checked";
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}
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?>>
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<label class="form-check-label" for="NO">
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NO
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</label>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="form-group col-md-12">
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<label ><?php echo lang('Patient will be knowledgeable about health behaviors needed to manage condition ?'); ?></label>
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<div class="row col-md-6">
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<div class="form-check col-md-6">
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<input class="form-check-input" type="radio" name="about_health_behaviors" id="radio" value="1" <?php if (!empty($discharge->about_health_behaviors)) {
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if($discharge->about_health_behaviors == 1) {
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echo "checked";
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}
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}
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?>>
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<label class="form-check-label" for="YES">
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YES
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</label>
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</div>
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<div class="form-check col-md-6">
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<input class="form-check-input" type="radio" name="about_health_behaviors" id="radio" value="0" <?php
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if($discharge->about_health_behaviors == 0) {
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echo "checked";
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}
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?>>
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<label class="form-check-label" for="NO">
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NO
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</label>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="form-group col-md-12">
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<label ><?php echo lang('Patient will be knowledgeable about signs and symptoms of complicaitons of therapy ?'); ?></label>
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<div class="row col-md-6">
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<div class="form-check col-md-6">
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<input class="form-check-input" type="radio" name="patient_about_signs" id="radio" value="1" <?php if (!empty($discharge->patient_about_signs)) {
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if($discharge->patient_about_signs == 1) {
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echo "checked";
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}
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}
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?>>
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<label class="form-check-label" for="YES">
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YES
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</label>
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</div>
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<div class="form-check col-md-6">
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<input class="form-check-input" type="radio" name="patient_about_signs" id="radio" value="0" <?php
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if($discharge->patient_about_signs == 0) {
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echo "checked";
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}
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?>>
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<label class="form-check-label" for="NO">
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NO
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</label>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="form-group col-md-12">
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<label ><?php echo lang('Patient will identify action to take if signs and symptoms of complications occur ?'); ?></label>
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<div class="row col-md-6">
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<div class="form-check col-md-6">
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<input class="form-check-input" type="radio" name="patient_identify_action" id="radio" value="1" <?php if (!empty($discharge->patient_identify_action)) {
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if($discharge->patient_identify_action == 1) {
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echo "checked";
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}
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}
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?>>
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<label class="form-check-label" for="YES">
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YES
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</label>
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</div>
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<div class="form-check col-md-6">
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<input class="form-check-input" type="radio" name="patient_identify_action" id="radio" value="0" <?php
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if($discharge->patient_identify_action == 0) {
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echo "checked";
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}
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?>>
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<label class="form-check-label" for="NO">
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NO
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</label>
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="form-group col-md-12">
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<label ><?php echo lang('Patient will denonstrate correct techniques and schedule fo adminsrtation of medications ?'); ?></label>
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<div class="row col-md-6">
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<div class="form-check col-md-6">
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<input class="form-check-input" type="radio" name="patient_adminstration_of_medication" id="radio" value="1" <?php if (!empty($discharge->patient_adminstration_of_medication)) {
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if($discharge->patient_adminstration_of_medication == 1) {
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echo "checked";
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}
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}
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?>>
|
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<label class="form-check-label" for="YES">
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|
YES
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</label>
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</div>
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<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="patient_adminstration_of_medication" id="radio" value="0" <?php
|
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if($discharge->patient_adminstration_of_medication == 0) {
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echo "checked";
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}
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|
?>>
|
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<label class="form-check-label" for="NO">
|
|
NO
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</label>
|
|
</div>
|
|
</div>
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|
</div>
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|
</div>
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<div class="row">
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<div class="form-group col-md-12">
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<label ><?php echo lang('Patient will be aware of complete and recorded list of medication ?'); ?></label>
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|
<div class="row col-md-6">
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|
<div class="form-check col-md-6">
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<input class="form-check-input" type="radio" name="patient_list_of_medications" id="radio" value="1" <?php if (!empty($discharge->patient_list_of_medications)) {
|
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if($discharge->patient_list_of_medications == 1) {
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echo "checked";
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|
}
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}
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|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
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|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="patient_list_of_medications" id="radio" value="0" <?php
|
|
if($discharge->patient_list_of_medications == 0) {
|
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echo "checked";
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}
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|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
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|
</label>
|
|
</div>
|
|
</div>
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|
</div>
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|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-12">
|
|
<label ><?php echo lang('Patient wound will heal without incident of infection ?'); ?></label>
|
|
<div class="row col-md-6">
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="patient_infection" id="radio" value="1" <?php if (!empty($discharge->patient_infection)) {
|
|
if($discharge->patient_infection == 1) {
|
|
echo "checked";
|
|
}
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
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|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="patient_infection" id="radio" value="0" <?php
|
|
if($discharge->patient_infection == 0) {
|
|
echo "checked";
|
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}
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|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
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|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-12">
|
|
<label ><?php echo lang('Patient willl maintain optimal level fo Assisted Daily Living (ADL) ?'); ?></label>
|
|
<div class="row col-md-6">
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="patient_adl" id="radio" value="1" <?php if (!empty($discharge->patient_adl)) {
|
|
if($discharge->patient_adl == 1) {
|
|
echo "checked";
|
|
}
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="patient_adl" id="radio" value="0" <?php
|
|
if($discharge->patient_adl == 0) {
|
|
echo "checked";
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-12">
|
|
<label ><?php echo lang("Patient's safety will be mainatined ?"); ?></label>
|
|
<div class="row col-md-6">
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="patient_safety" id="radio" value="1" <?php if (!empty($discharge->patient_safety)) {
|
|
if($discharge->patient_safety == 1) {
|
|
echo "checked";
|
|
}
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="patient_safety" id="radio" value="0" <?php
|
|
if($discharge->patient_safety == 0) {
|
|
echo "checked";
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-12">
|
|
<label ><?php echo lang("Caregiver will have more knowledge about disease ?"); ?></label>
|
|
<div class="row col-md-6">
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_about_disease" id="radio" value="1" <?php if (!empty($discharge->caregiver_about_disease)) {
|
|
if($discharge->caregiver_about_disease == 1) {
|
|
echo "checked";
|
|
}
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_about_disease" id="radio" value="0" <?php
|
|
if($discharge->caregiver_about_disease == 0) {
|
|
echo "checked";
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-12">
|
|
<label ><?php echo lang("Caregiver will be knowledge about health behaviors needed to manage condition ?"); ?></label>
|
|
<div class="row col-md-6">
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_about_health_behaviors" id="radio" value="1" <?php if (!empty($discharge->caregiver_about_health_behaviors)) {
|
|
if($discharge->caregiver_about_health_behaviors == 1) {
|
|
echo "checked";
|
|
}
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_about_health_behaviors" id="radio" value="0" <?php
|
|
if($discharge->caregiver_about_health_behaviors == 0) {
|
|
echo "checked";
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-12">
|
|
<label ><?php echo lang("Caregiver will be knowledgeable about signs and symptoms of complicaitons of therapy ?"); ?></label>
|
|
<div class="row col-md-6">
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_about_signs" id="radio" value="1" <?php if (!empty($discharge->caregiver_about_signs)) {
|
|
if($discharge->caregiver_about_signs == 1) {
|
|
echo "checked";
|
|
}
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_about_signs" id="radio" value="0" <?php
|
|
if($discharge->caregiver_about_signs == 0) {
|
|
echo "checked";
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-12">
|
|
<label ><?php echo lang("Caregiver will identify action to take if signs and symptoms of complications occur ?"); ?></label>
|
|
<div class="row col-md-6">
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_identify_action" id="radio" value="1" <?php if (!empty($discharge->caregiver_identify_action)) {
|
|
if($discharge->caregiver_identify_action == 1) {
|
|
echo "checked";
|
|
}
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_identify_action" id="radio" value="0" <?php
|
|
if($discharge->caregiver_identify_action == 0) {
|
|
echo "checked";
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-12">
|
|
<label ><?php echo lang("Caregiver will denonstrate correct techniques and schedule fo adminsrtation of medications ?"); ?></label>
|
|
<div class="row col-md-6">
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_adminstration_of_medication" id="radio" value="1" <?php if (!empty($discharge->caregiver_adminstration_of_medication)) {
|
|
if($discharge->caregiver_adminstration_of_medication == 1) {
|
|
echo "checked";
|
|
}
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_adminstration_of_medication" id="radio" value="0" <?php
|
|
if($discharge->caregiver_adminstration_of_medication == 0) {
|
|
echo "checked";
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-12">
|
|
<label ><?php echo lang("Caregiver will be aware of complete and recorded list of medication ?"); ?></label>
|
|
<div class="row col-md-6">
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_list_of_medications" id="radio" value="1" <?php if (!empty($discharge->caregiver_adminstration_of_medication)) {
|
|
if($discharge->caregiver_list_of_medications == 1) {
|
|
echo "checked";
|
|
}
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="caregiver_list_of_medications" id="radio" value="0" <?php
|
|
if($discharge->caregiver_list_of_medications == 0) {
|
|
echo "checked";
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('Reasons For Discharge'); ?></label>
|
|
<select class="form-control" name="reasons_for_discharge">
|
|
<option value="1"<?php if (!empty($discharge->reasons_for_discharge)) {
|
|
if($discharge->reasons_for_discharge == 1) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Complete Course Of Prescribe Care</option>
|
|
<option value="2" <?php if (!empty($discharge->reasons_for_discharge)) {
|
|
if($discharge->reasons_for_discharge == 2) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Wound Healed</option>
|
|
<option value="3" <?php if (!empty($discharge->reasons_for_discharge)) {
|
|
if($discharge->reasons_for_discharge == 3) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Transferred</option>
|
|
<option value="4" <?php if (!empty($discharge->reasons_for_discharge)) {
|
|
if($discharge->reasons_for_discharge == 4) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Hospitalized</option>
|
|
<option value="5" <?php if (!empty($discharge->reasons_for_discharge)) {
|
|
if($discharge->reasons_for_discharge == 5) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Moved</option>
|
|
<option value="6" <?php if (!empty($discharge->reasons_for_discharge)) {
|
|
if($discharge->reasons_for_discharge == 6) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Expired</option>
|
|
<option value="7" <?php if (!empty($discharge->reasons_for_discharge)) {
|
|
if($discharge->reasons_for_discharge == 7) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Unable To Complete Course of Therapy</option>
|
|
<option value="8" <?php if (!empty($discharge->reasons_for_discharge)) {
|
|
if($discharge->reasons_for_discharge == 8) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Stabilized</option>
|
|
</select>
|
|
</div>
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('Skilled Care Provided'); ?></label>
|
|
<select class="form-control" name="skilled_care">
|
|
<option value="1" <?php if (!empty($discharge->skilled_care)) {
|
|
if($discharge->skilled_care == 1) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Final Visit</option>
|
|
<option value="2" <?php if (!empty($discharge->skilled_care)) {
|
|
if($discharge->skilled_care == 2) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>No Visit Made</option>
|
|
<option value="3" <?php if (!empty($discharge->skilled_care)) {
|
|
if($discharge->skilled_care == 3) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Telephone Contact</option>
|
|
</select>
|
|
</div>
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('Summary of progress To Date'); ?></label>
|
|
<input type="text" class="form-control" name="summary_of_progress" value="<?php if (!empty($discharge->summary_of_progress)) {
|
|
if($discharge->summary_of_progress == 1) {
|
|
echo $discharge->summary_of_progress;
|
|
}
|
|
}
|
|
?>" placeholder="">
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('Incident'); ?></label>
|
|
<div class="row col-md-6">
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="incident" id="radio" value="1" <?php if (!empty($discharge->incident)) {
|
|
if($discharge->incident == 1) {
|
|
echo "checked";
|
|
}
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check col-md-6">
|
|
<input class="form-check-input" type="radio" name="incident" id="radio" value="0" <?php
|
|
if($discharge->incident == 0) {
|
|
echo "checked";
|
|
}
|
|
?>>
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('Pressure Ulcer Location'); ?></label>
|
|
<input type="text" class="form-control" name="pressure_ulcer_location" value="<?php if (!empty($discharge->summary_of_progress)) {
|
|
if($discharge->pressure_ulcer_location == 1) {
|
|
echo $discharge->pressure_ulcer_location;
|
|
}
|
|
}
|
|
?>" placeholder="" >
|
|
</div>
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('Pressure Ulcer Stage'); ?></label>
|
|
<input type="text" class="form-control" name="pressure_ulcer_stage" value="<?php if (!empty($discharge->summary_of_progress)) {
|
|
if($discharge->pressure_ulcer_stage == 1) {
|
|
echo $discharge->pressure_ulcer_stage;
|
|
}
|
|
}
|
|
?>" placeholder="" >
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('Disscharge Status'); ?></label>
|
|
<select class="form-control" name="disscharge_status">
|
|
<option value="1" <?php if (!empty($discharge->disscharge_status)) {
|
|
if($discharge->disscharge_status == 1) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Stable</option>
|
|
<option value="2" <?php if (!empty($discharge->disscharge_status)) {
|
|
if($discharge->disscharge_status == 2) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Improved Noted</option>
|
|
<option value="3" <?php if (!empty($discharge->disscharge_status)) {
|
|
if($discharge->disscharge_status == 3) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Expired</option>
|
|
<option value="4" <?php if (!empty($discharge->disscharge_status)) {
|
|
if($discharge->disscharge_status == 4) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Oriented</option>
|
|
<option value="5" <?php if (!empty($discharge->disscharge_status)) {
|
|
if($discharge->disscharge_status == 5) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Agitated</option>
|
|
<option value="6" <?php if (!empty($discharge->disscharge_status)) {
|
|
if($discharge->disscharge_status == 6) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Disoriented</option>
|
|
<option value="7" <?php if (!empty($discharge->disscharge_status)) {
|
|
if($discharge->disscharge_status == 7) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Forgetful</option>
|
|
<option value="8" <?php if (!empty($discharge->disscharge_status)) {
|
|
if($discharge->disscharge_status == 8) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Lethargic</option>
|
|
</select>
|
|
</div>
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('Functional Status - ADL'); ?></label>
|
|
<select class="form-control" name="functional_status">
|
|
<option value="1" <?php if (!empty($discharge->functional_status)) {
|
|
if($discharge->functional_status == 1) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Independent</option>
|
|
<option value="2" <?php if (!empty($discharge->functional_status)) {
|
|
if($discharge->functional_status == 2) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Assistance</option>
|
|
<option value="3" <?php if (!empty($discharge->functional_status)) {
|
|
if($discharge->functional_status == 3) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Supervision</option>
|
|
<option value="4" <?php if (!empty($discharge->functional_status)) {
|
|
if($discharge->functional_status == 4) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Dependent</option>
|
|
</select>
|
|
</div>
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('Mobility'); ?></label>
|
|
<select class="form-control" name="mobility">
|
|
<option value="1" <?php if (!empty($discharge->mobility)) {
|
|
if($discharge->mobility == 1) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Independent</option>
|
|
<option value="2" <?php if (!empty($discharge->mobility)) {
|
|
if($discharge->mobility == 2) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Assistance</option>
|
|
<option value="3" <?php if (!empty($discharge->mobility)) {
|
|
if($discharge->mobility == 3) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Supervision</option>
|
|
<option value="4" <?php if (!empty($discharge->mobility)) {
|
|
if($discharge->mobility == 4) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Dependent</option>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-6">
|
|
<label ><?php echo lang('Medication List'); ?></label>
|
|
<select class="form-control" name="medication_list">
|
|
<option value="1" <?php if (!empty($discharge->medication_list)) {
|
|
if($discharge->medication_list == 1) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Patient</option>
|
|
<option value="2" <?php if (!empty($discharge->medication_list)) {
|
|
if($discharge->medication_list == 2) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Caregiver</option>
|
|
<option value="3" <?php if (!empty($discharge->medication_list)) {
|
|
if($discharge->medication_list == 3) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Next Provider</option>
|
|
</select>
|
|
</div>
|
|
<div class="form-group col-md-6">
|
|
<label ><?php echo lang('Instrucitions To Patient/Family'); ?></label>
|
|
<select class="form-control" name="instrucitions_to_patient_family">
|
|
<option value="1" <?php if (!empty($discharge->instrucitions_to_patient_family)) {
|
|
if($discharge->instrucitions_to_patient_family == 1) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Follow Up Visit With Physician</option>
|
|
<option value="2" <?php if (!empty($discharge->instrucitions_to_patient_family)) {
|
|
if($discharge->instrucitions_to_patient_family == 2) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Discard Old Medication List and Update Other Providers Of Current Medication List</option>
|
|
<option value="3" <?php if (!empty($discharge->instrucitions_to_patient_family)) {
|
|
if($discharge->instrucitions_to_patient_family == 3) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Appropiate Disposal Of Medical Waste</option>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-6">
|
|
<label ><?php echo lang('Community'); ?></label>
|
|
<input type="text" name="instrucitions_to_patient_community" class="form-control" value="<?php if (!empty($discharge->instrucitions_to_patient_community)) {
|
|
if($discharge->instrucitions_to_patient_community) {
|
|
echo $discharge->instrucitions_to_patient_community;
|
|
}
|
|
}
|
|
?>">
|
|
</div>
|
|
<div class="form-group col-md-6">
|
|
<label ><?php echo lang('Other'); ?></label>
|
|
<input type="text" name="instrucitions_to_patient_other" class="form-control" value="<?php if (!empty($discharge->instrucitions_to_patient_other)) {
|
|
if($discharge->instrucitions_to_patient_other) {
|
|
echo $discharge->instrucitions_to_patient_other;
|
|
}
|
|
}
|
|
?>">
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-6">
|
|
<label ><?php echo lang('Notification Of Discharge'); ?></label>
|
|
<select class="form-control" name="notification_of_discharge">
|
|
<option value="1" <?php if (!empty($discharge->notification_of_discharge)) {
|
|
if($discharge->notification_of_discharge == 1) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>MD</option>
|
|
<option value="2" <?php if (!empty($discharge->notification_of_discharge)) {
|
|
if($discharge->notification_of_discharge == 2) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Patient</option>
|
|
<option value="3" <?php if (!empty($discharge->notification_of_discharge)) {
|
|
if($discharge->notification_of_discharge == 3) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Caregiver</option>
|
|
<option value="4" <?php if (!empty($discharge->notification_of_discharge)) {
|
|
if($discharge->notification_of_discharge == 4) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>>Referral Sources</option>
|
|
</select>
|
|
</div>
|
|
<div class="form-group col-md-6">
|
|
<label ><?php echo lang('Other'); ?></label>
|
|
<input type="text" name="notification_of_discharge_other" class="form-control" value="<?php if (!empty($discharge->notification_of_discharge_other)) {
|
|
if($discharge->notification_of_discharge_other) {
|
|
echo $discharge->notification_of_discharge_other;
|
|
}
|
|
}
|
|
?>">
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('name'); ?></label>
|
|
<?php $name = $patient->first_name.' '.$patient->last_name; ?>
|
|
<input type="text" class="form-control" name="name" id="exampleInputEmail1" value='<?php
|
|
|
|
if (!empty($name)) {
|
|
echo $name;
|
|
}
|
|
?>' placeholder="" disabled>
|
|
</div>
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('Title'); ?></label>
|
|
<select class="form-control" name="title">
|
|
<?php foreach($services as $service) {?>
|
|
<option value="<?= $service->id?>" <?php if (!empty($discharge->level_of_care)) {
|
|
if($discharge->title == $service->id) {
|
|
echo "selected";
|
|
}
|
|
}
|
|
?>><?= $service->name?></option>
|
|
<?php } ?>
|
|
</select>
|
|
</div>
|
|
<div class="form-group col-md-4">
|
|
<label ><?php echo lang('date'); ?></label>
|
|
<input type="date" class="form-control futDateNonAccept" name="date"id="ptdob" value='<?php
|
|
if (!empty($discharge->date)) {
|
|
echo $discharge->date;
|
|
}
|
|
?>' placeholder="">
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="btn-group">
|
|
<a class="btn btn-info btn-min-width" title="<?php echo lang('Back'); ?>" href="<?php echo base_url(); ?>patient">
|
|
<i class="fa fa-undo" aria-hidden="true"></i> <?php echo lang('Back'); ?>
|
|
</a>
|
|
</div>
|
|
<div class="btn-group">
|
|
<button type="submit" name="save" value="save" class="btn btn-default"><?php echo lang('Save as draft'); ?></button>
|
|
</div>
|
|
<div class="btn-group">
|
|
<button type="submit" name="submit" value="submit" class="btn btn-default"><?php echo lang('submit'); ?></button>
|
|
|
|
</div>
|
|
</form>
|
|
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
</section>
|
|
</div>
|
|
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
|
|
<script type="text/javascript"> /* future date dob not accept */
|
|
function validateForm() {
|
|
//var chcs_discharge_date = document.forms["patientDischargeForm"]["chcs_discharge_date"].value;
|
|
var primary_diagnosis = document.forms["patientDischargeForm"]["primary_diagnosis"].value;
|
|
var specify = document.forms["patientDischargeForm"]["specify"].value;
|
|
if (primary_diagnosis == "" || specify == "") {
|
|
// if (chcs_discharge_date == "") {
|
|
// $(".chcs_discharge_date").html("<div class='alert alert-danger' role='alert'> Please enter a value</div>");
|
|
// }
|
|
// if (primary_diagnosis == "") {
|
|
// $(".primary_diagnosis").html("<div class='alert alert-danger' role='alert'> Please enter a value</div>");
|
|
// //return false;
|
|
// }
|
|
// if (specify == "") {
|
|
// $(".specify").html("<div class='alert alert-danger' role='alert'> Please enter a value</div>");
|
|
|
|
// }
|
|
return false;
|
|
}
|
|
else{
|
|
return true;
|
|
}
|
|
}
|
|
$("#service_provided").on("change", function () {
|
|
|
|
var service_provided = this.value;
|
|
if (service_provided == 3) {
|
|
$('#infusion_therapy').show();
|
|
|
|
} else {
|
|
$("#infusion_therapy").hide();
|
|
}
|
|
//alert(jobRole);
|
|
})
|
|
$(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
|
|
$('.futDateNonAccept').attr('max',maxDate);
|
|
|
|
});
|
|
|
|
function isNumberKey(evt){
|
|
var charCode = (evt.which) ? evt.which : evt.keyCode
|
|
if (charCode > 31 && (charCode < 48 || charCode > 57))
|
|
return false;
|
|
return true;
|
|
}
|
|
</script>
|
|
<script>
|
|
function formatPhoneNumber(phoneNumberString,_this) {
|
|
|
|
var cleaned = ('' + phoneNumberString).replace(/\D/g, '')
|
|
if(cleaned.length > 10){
|
|
cleaned = cleaned.substr(0, 10);
|
|
}
|
|
var match = cleaned.match(/^(1|)?(\d{3})(\d{3})(\d{4})$/)
|
|
if (cleaned.length == 10 && match) {
|
|
var intlCode = (match[1] ? '+1 ' : '')
|
|
var fres = [intlCode, '(', match[2], ') ', match[3], '-', match[4]].join('')
|
|
_this.value = fres;
|
|
}else{
|
|
_this.value = cleaned
|
|
}
|
|
return null
|
|
}
|
|
</script>
|
|
<!--main content end-->
|
|
<!--footer start-->
|