/contrib/forms/progressnotes/view.php

https://github.com/md-tech/openemr · PHP · 1083 lines · 530 code · 549 blank · 4 comment · 38 complexity · 3766be01cc5edda888d90513fbd64562 MD5 · raw file 

    

  1. <?php
    2. 

  2. 

  3. #######################################################
    4. 

  4. 

  5. # Progress Notes Form created by Kam Sharifi	      #
    6. 

  6. 

  7. # kam@sharmen.com				      #
    8. 

  8. 

  9. #######################################################
    10. 

  10. 

  11. include_once("../../globals.php");
    12. 

  12. 

  13. ?>
    14. 

  14. 

  15. <html><head>
    16. 

  16. <?php html_header_show();?>
    17. 

  17. 

  18. <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
    19. 

  19. 

  20. </head>
    21. 

  21. 

  22. <body class="body_top">
    23. 

  23. 

  24. <?php
    25. 

  25. 

  26. include_once("$srcdir/api.inc");
    27. 

  27. 

  28. $obj = formFetch("form_progressnotes", $_GET["id"]);
    29. 

  29. 

  30. ?>
    31. 

  31. 

  32. <form method=post action="<?php echo $rootdir?>/forms/progressnotes/save.php?mode=update&id=<?php echo $_GET["id"];?>" name="my_form">
    33. 

  33. 

  34. <span class="title">Progress Notes</span><Br><br>
    35. 

  35. 

  36. 

  37. 

  38. <table width=100%>
    39. 

  39. 

  40. <b>
    41. 

  41. 

  42. <span class=text>P: </span><input size=3 type=entry name="prog_p" value="<?php echo $obj{"prog_p"};?>" >
    43. 

  43. 

  44. <span class=text>R: </span><input size=3 type=entry name="prog_r" value="<?php echo $obj{"prog_r"};?>" >
    45. 

  45. 

  46. <span class=text>BP: </span><input size=3 type=entry name="prog_bp" value="<?php echo $obj{"prog_bp"};?>" >
    47. 

  47. 

  48. <span class=text>HT: </span><input size=3 type=entry name="prog_ht" value="<?php echo $obj{"prog_ht"};?>" >
    49. 

  49. 

  50. <span class=text>WT: </span><input size=3 type=entry name="prog_wt" value="<?php echo $obj{"prog_wt"};?>" >
    51. 

  51. 

  52. <span class=text>TEMP: </span><input size=3 type=entry name="prog_temp" value="<?php echo $obj{"prog_temp"};?>" >
    53. 

  53. 

  54. <span class=text>LMP: </span><input size=3 type=entry name="prog_lmp" value="<?php echo $obj{"prog_lmp"};?>" >
    55. 

  55. 

  56. <br><span class=text>Last Pap Smear: </span><input size=3 type=entry name="prog_last_pap_smear" value="<?php echo $obj{"prog_last_pap_smear"};?>" >
    57. 

  57. 

  58. <span class=text>Last Td. Booster: </span><input size=3 type=entry name="prog_last_td_booster" value="<?php echo $obj{"prog_last_td_booster"};?>" >
    59. 

  59. 

  60. <span class=text>Allergies: </span><input size=3 type=entry name="prog_allergies" value="<?php echo $obj{"prog_allergies"};?>" >
    61. 

  61. 

  62. <span class=text>Last Mammogram: </span><input size=3 type=entry name="prog_last_mammogram" value="<?php echo $obj{"prog_last_mammogram"};?>" >
    63. 

  63. 

  64. </b>
    65. 

  65. 

  66. </table>
    67. 

  67. 

  68. <br>
    69. 

  69. 

  70. 

  71. 

  72. <span class=text><b>Present Complaint*:</b> </span><br><textarea cols=40 rows=8 wrap=virtual name="prog_present_complaint" ><?php echo $obj{"prog_present_complaint"};?></textarea>
    73. 

  73. 

  74. 

  75. 

  76. <br><br>
    77. 

  77. 

  78. <b>Past Medical History</b>
    79. 

  79. 

  80. 

  81. 

  82.     <TABLE ID="Table1" BORDER=1 CELLSPACING=2 CELLPADDING=1 WIDTH="100%" >
    83. 

  83. 

  84.         <TR>
    85. 

  85. 

  86.             <TD WIDTH=53>
    87. 

  87. 

  88.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    89. 

  89. 

  90.             </TD>
    91. 

  91. 

  92.             <TD WIDTH=40>
    93. 

  93. 

  94.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>ABN</B></FONT><B></B></P>
    95. 

  95. 

  96.             </TD>
    97. 

  97. 

  98.             <TD WIDTH=34>
    99. 

  99. 

  100.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>NE</B></FONT><B></B></P>
    101. 

  101. 

  102.             </TD>
    103. 

  103. 

  104.             <TD WIDTH=324>
    105. 

  105. 

  106.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>PHYSICAL EXAMINATION -Comments</B></FONT><B></B></P>
    107. 

  107. 

  108.             </TD>
    109. 

  109. 

  110.         </TR>
    111. 

  111. 

  112.         <TR>
    113. 

  113. 

  114.             <TD HEIGHT=14>
    115. 

  115. 

  116.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    117. 

  117. 

  118.             </TD>
    119. 

  119. 

  120.             <TD WIDTH=40>
    121. 

  121. 

  122.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    123. 

  123. 

  124.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    125. 

  125. 

  126.                         <TR>
    127. 

  127. 

  128.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox2" TYPE=CHECKBOX NAME="prog_skin_abn" <?if ($obj{"prog_skin_abn"} == "on") {echo "checked";};?>></TD>
    129. 

  129. 

  130.                         </TR>
    131. 

  131. 

  132.                     </TABLE>
    133. 

  133. 

  134.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    135. 

  135. 

  136.             <TD WIDTH=34>
    137. 

  137. 

  138.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    139. 

  139. 

  140.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    141. 

  141. 

  142.                         <TR>
    143. 

  143. 

  144.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox8" TYPE=CHECKBOX NAME="prog_skin_ne" <?if ($obj{"prog_skin_ne"} == "on") {echo "checked";};?>></TD>
    145. 

  145. 

  146.                         </TR>
    147. 

  147. 

  148.                     </TABLE>
    149. 

  149. 

  150.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    151. 

  151. 

  152.             <TD WIDTH=324>
    153. 

  153. 

  154.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>SKIN: no significant lesions</B></FONT><B></B></P>
    155. 

  155. 

  156.             </TD>
    157. 

  157. 

  158.         </TR>
    159. 

  159. 

  160.         <TR>
    161. 

  161. 

  162.             <TD HEIGHT=14>
    163. 

  163. 

  164.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    165. 

  165. 

  166.             </TD>
    167. 

  167. 

  168.             <TD WIDTH=40>
    169. 

  169. 

  170.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    171. 

  171. 

  172.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    173. 

  173. 

  174.                         <TR>
    175. 

  175. 

  176.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox7" TYPE=CHECKBOX NAME="prog_head_abn" <?if ($obj{"prog_head_abn"} == "on") {echo "checked";};?>></TD>
    177. 

  177. 

  178.                         </TR>
    179. 

  179. 

  180.                     </TABLE>
    181. 

  181. 

  182.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    183. 

  183. 

  184.             <TD WIDTH=34>
    185. 

  185. 

  186.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    187. 

  187. 

  188.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    189. 

  189. 

  190.                         <TR>
    191. 

  191. 

  192.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox9" TYPE=CHECKBOX NAME="prog_head_ne" <?if ($obj{"prog_head_ne"} == "on") {echo "checked";};?>></TD>
    193. 

  193. 

  194.                         </TR>
    195. 

  195. 

  196.                     </TABLE>
    197. 

  197. 

  198.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    199. 

  199. 

  200.             <TD WIDTH=324>
    201. 

  201. 

  202.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>HEAD: normocephalic. no headache</B></FONT><B></B></P>
    203. 

  203. 

  204.             </TD>
    205. 

  205. 

  206.         </TR>
    207. 

  207. 

  208.         <TR>
    209. 

  209. 

  210.             <TD HEIGHT=11>
    211. 

  211. 

  212.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    213. 

  213. 

  214.             </TD>
    215. 

  215. 

  216.             <TD WIDTH=40>
    217. 

  217. 

  218.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    219. 

  219. 

  220.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    221. 

  221. 

  222.                         <TR>
    223. 

  223. 

  224.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox10" TYPE=CHECKBOX NAME="prog_eyes_abn" <?if ($obj{"prog_eyes_abn"} == "on") {echo "checked";};?>></TD>
    225. 

  225. 

  226.                         </TR>
    227. 

  227. 

  228.                     </TABLE>
    229. 

  229. 

  230.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    231. 

  231. 

  232.             <TD WIDTH=34>
    233. 

  233. 

  234.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    235. 

  235. 

  236.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    237. 

  237. 

  238.                         <TR>
    239. 

  239. 

  240.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox11" TYPE=CHECKBOX NAME="prog_eyes_ne" <?if ($obj{"prog_eyes_ne"} == "on") {echo "checked";};?>></TD>
    241. 

  241. 

  242.                         </TR>
    243. 

  243. 

  244.                     </TABLE>
    245. 

  245. 

  246.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    247. 

  247. 

  248.             <TD WIDTH=324>
    249. 

  249. 

  250.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>EYES: perla. eom satisfactory</B></FONT><B></B></P>
    251. 

  251. 

  252.             </TD>
    253. 

  253. 

  254.         </TR>
    255. 

  255. 

  256.         <TR>
    257. 

  257. 

  258.             <TD>
    259. 

  259. 

  260.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    261. 

  261. 

  262.             </TD>
    263. 

  263. 

  264.             <TD WIDTH=40>
    265. 

  265. 

  266.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    267. 

  267. 

  268.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    269. 

  269. 

  270.                         <TR>
    271. 

  271. 

  272.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox12" TYPE=CHECKBOX NAME="prog_ears_abn" <?if ($obj{"prog_ears_abn"} == "on") {echo "checked";};?>></TD>
    273. 

  273. 

  274.                         </TR>
    275. 

  275. 

  276.                     </TABLE>
    277. 

  277. 

  278.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    279. 

  279. 

  280.             <TD WIDTH=34>
    281. 

  281. 

  282.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    283. 

  283. 

  284.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    285. 

  285. 

  286.                         <TR>
    287. 

  287. 

  288.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox13" TYPE=CHECKBOX NAME="prog_ears_ne" <?if ($obj{"prog_ears_ne"} == "on") {echo "checked";};?>></TD>
    289. 

  289. 

  290.                         </TR>
    291. 

  291. 

  292.                     </TABLE>
    293. 

  293. 

  294.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    295. 

  295. 

  296.             <TD WIDTH=324>
    297. 

  297. 

  298.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>EARS: drums intact</B></FONT><B></B></P>
    299. 

  299. 

  300.             </TD>
    301. 

  301. 

  302.         </TR>
    303. 

  303. 

  304.         <TR>
    305. 

  305. 

  306.             <TD HEIGHT=19>
    307. 

  307. 

  308.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    309. 

  309. 

  310.             </TD>
    311. 

  311. 

  312.             <TD WIDTH=40>
    313. 

  313. 

  314.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    315. 

  315. 

  316.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    317. 

  317. 

  318.                         <TR>
    319. 

  319. 

  320.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox14" TYPE=CHECKBOX NAME="prog_nose_abn" <?if ($obj{"prog_nose_abn"} == "on") {echo "checked";};?>></TD>
    321. 

  321. 

  322.                         </TR>
    323. 

  323. 

  324.                     </TABLE>
    325. 

  325. 

  326.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    327. 

  327. 

  328.             <TD WIDTH=34>
    329. 

  329. 

  330.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    331. 

  331. 

  332.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    333. 

  333. 

  334.                         <TR>
    335. 

  335. 

  336.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox16" TYPE=CHECKBOX NAME="prog_nose_ne" <?if ($obj{"prog_nose_ne"} == "on") {echo "checked";};?>></TD>
    337. 

  337. 

  338.                         </TR>
    339. 

  339. 

  340.                     </TABLE>
    341. 

  341. 

  342.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    343. 

  343. 

  344.             <TD WIDTH=324>
    345. 

  345. 

  346.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>NOSE: no abnormality</B></FONT><B></B></P>
    347. 

  347. 

  348.             </TD>
    349. 

  349. 

  350.         </TR>
    351. 

  351. 

  352.         <TR>
    353. 

  353. 

  354.             <TD>
    355. 

  355. 

  356.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    357. 

  357. 

  358.             </TD>
    359. 

  359. 

  360.             <TD WIDTH=40>
    361. 

  361. 

  362.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    363. 

  363. 

  364.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    365. 

  365. 

  366.                         <TR>
    367. 

  367. 

  368.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox17" TYPE=CHECKBOX NAME="prog_throat_abn" <?if ($obj{"prog_throat_abn"} == "on") {echo "checked";};?>></TD>
    369. 

  369. 

  370.                         </TR>
    371. 

  371. 

  372.                     </TABLE>
    373. 

  373. 

  374.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    375. 

  375. 

  376.             <TD WIDTH=34>
    377. 

  377. 

  378.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    379. 

  379. 

  380.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    381. 

  381. 

  382.                         <TR>
    383. 

  383. 

  384.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox15" TYPE=CHECKBOX NAME="prog_throat_ne" <?if ($obj{"prog_throat_ne"} == "on") {echo "checked";};?>></TD>
    385. 

  385. 

  386.                         </TR>
    387. 

  387. 

  388.                     </TABLE>
    389. 

  389. 

  390.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    391. 

  391. 

  392.             <TD WIDTH=324>
    393. 

  393. 

  394.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>THROAT: dear, no infection</B></FONT><B></B></P>
    395. 

  395. 

  396.             </TD>
    397. 

  397. 

  398.         </TR>
    399. 

  399. 

  400.         <TR>
    401. 

  401. 

  402.             <TD HEIGHT=18>
    403. 

  403. 

  404.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    405. 

  405. 

  406.             </TD>
    407. 

  407. 

  408.             <TD WIDTH=40>
    409. 

  409. 

  410.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    411. 

  411. 

  412.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    413. 

  413. 

  414.                         <TR>
    415. 

  415. 

  416.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox19" TYPE=CHECKBOX NAME="prog_teeth_abn" <?if ($obj{"prog_teeth_abn"} == "on") {echo "checked";};?>></TD>
    417. 

  417. 

  418.                         </TR>
    419. 

  419. 

  420.                     </TABLE>
    421. 

  421. 

  422.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    423. 

  423. 

  424.             <TD WIDTH=34>
    425. 

  425. 

  426.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    427. 

  427. 

  428.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    429. 

  429. 

  430.                         <TR>
    431. 

  431. 

  432.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox20" TYPE=CHECKBOX NAME="prog_teeth_ne" <?if ($obj{"prog_teeth_ne"} == "on") {echo "checked";};?>></TD>
    433. 

  433. 

  434.                         </TR>
    435. 

  435. 

  436.                     </TABLE>
    437. 

  437. 

  438.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    439. 

  439. 

  440.             <TD WIDTH=324>
    441. 

  441. 

  442.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>TEETH: good repair, no dentures</B></FONT><B></B></P>
    443. 

  443. 

  444.             </TD>
    445. 

  445. 

  446.         </TR>
    447. 

  447. 

  448.         <TR>
    449. 

  449. 

  450.             <TD>
    451. 

  451. 

  452.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    453. 

  453. 

  454.             </TD>
    455. 

  455. 

  456.             <TD WIDTH=40>
    457. 

  457. 

  458.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    459. 

  459. 

  460.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    461. 

  461. 

  462.                         <TR>
    463. 

  463. 

  464.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox18" TYPE=CHECKBOX NAME="prog_neck_abn" <?if ($obj{"prog_neck_abn"} == "on") {echo "checked";};?>></TD>
    465. 

  465. 

  466.                         </TR>
    467. 

  467. 

  468.                     </TABLE>
    469. 

  469. 

  470.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    471. 

  471. 

  472.             <TD WIDTH=34>
    473. 

  473. 

  474.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    475. 

  475. 

  476.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    477. 

  477. 

  478.                         <TR>
    479. 

  479. 

  480.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox21" TYPE=CHECKBOX NAME="prog_neck_ne" <?if ($obj{"prog_neck_ne"} == "on") {echo "checked";};?>></TD>
    481. 

  481. 

  482.                         </TR>
    483. 

  483. 

  484.                     </TABLE>
    485. 

  485. 

  486.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    487. 

  487. 

  488.             <TD WIDTH=324>
    489. 

  489. 

  490.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>NECK: supple, no adenopathy</B></FONT><B></B></P>
    491. 

  491. 

  492.             </TD>
    493. 

  493. 

  494.         </TR>
    495. 

  495. 

  496.         <TR>
    497. 

  497. 

  498.             <TD>
    499. 

  499. 

  500.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    501. 

  501. 

  502.             </TD>
    503. 

  503. 

  504.             <TD WIDTH=40>
    505. 

  505. 

  506.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    507. 

  507. 

  508.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    509. 

  509. 

  510.                         <TR>
    511. 

  511. 

  512.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox22" TYPE=CHECKBOX NAME="prog_chest_abn" <?if ($obj{"prog_chest_abn"} == "on") {echo "checked";};?>></TD>
    513. 

  513. 

  514.                         </TR>
    515. 

  515. 

  516.                     </TABLE>
    517. 

  517. 

  518.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    519. 

  519. 

  520.             <TD WIDTH=34>
    521. 

  521. 

  522.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    523. 

  523. 

  524.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    525. 

  525. 

  526.                         <TR>
    527. 

  527. 

  528.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox23" TYPE=CHECKBOX NAME="prog_chest_ne" <?if ($obj{"prog_chest_ne"} == "on") {echo "checked";};?>></TD>
    529. 

  529. 

  530.                         </TR>
    531. 

  531. 

  532.                     </TABLE>
    533. 

  533. 

  534.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    535. 

  535. 

  536.             <TD WIDTH=324>
    537. 

  537. 

  538.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>CHEST: symmetrical, no pain</B></FONT><B></B></P>
    539. 

  539. 

  540.             </TD>
    541. 

  541. 

  542.         </TR>
    543. 

  543. 

  544.         <TR>
    545. 

  545. 

  546.             <TD>
    547. 

  547. 

  548.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    549. 

  549. 

  550.             </TD>
    551. 

  551. 

  552.             <TD WIDTH=40>
    553. 

  553. 

  554.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    555. 

  555. 

  556.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    557. 

  557. 

  558.                         <TR>
    559. 

  559. 

  560.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox24" TYPE=CHECKBOX NAME="prog_breast_abn" <?if ($obj{"prog_breast_abn"} == "on") {echo "checked";};?>></TD>
    561. 

  561. 

  562.                         </TR>
    563. 

  563. 

  564.                     </TABLE>
    565. 

  565. 

  566.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    567. 

  567. 

  568.             <TD WIDTH=34>
    569. 

  569. 

  570.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    571. 

  571. 

  572.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    573. 

  573. 

  574.                         <TR>
    575. 

  575. 

  576.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox25" TYPE=CHECKBOX NAME="prog_breast_ne" <?if ($obj{"prog_breast_ne"} == "on") {echo "checked";};?>></TD>
    577. 

  577. 

  578.                         </TR>
    579. 

  579. 

  580.                     </TABLE>
    581. 

  581. 

  582.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    583. 

  583. 

  584.             <TD WIDTH=324>
    585. 

  585. 

  586.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>BREAST: no masses</B></FONT><B></B></P>
    587. 

  587. 

  588.             </TD>
    589. 

  589. 

  590.         </TR>
    591. 

  591. 

  592.         <TR>
    593. 

  593. 

  594.             <TD>
    595. 

  595. 

  596.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    597. 

  597. 

  598.             </TD>
    599. 

  599. 

  600.             <TD WIDTH=40>
    601. 

  601. 

  602.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    603. 

  603. 

  604.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    605. 

  605. 

  606.                         <TR>
    607. 

  607. 

  608.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox26" TYPE=CHECKBOX NAME="prog_lungs_abn" <?if ($obj{"prog_lungs_abn"} == "on") {echo "checked";};?>></TD>
    609. 

  609. 

  610.                         </TR>
    611. 

  611. 

  612.                     </TABLE>
    613. 

  613. 

  614.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    615. 

  615. 

  616.             <TD WIDTH=34>
    617. 

  617. 

  618.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    619. 

  619. 

  620.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    621. 

  621. 

  622.                         <TR>
    623. 

  623. 

  624.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox27" TYPE=CHECKBOX NAME="prog_lungs_ne" <?if ($obj{"prog_lungs_ne"} == "on") {echo "checked";};?>></TD>
    625. 

  625. 

  626.                         </TR>
    627. 

  627. 

  628.                     </TABLE>
    629. 

  629. 

  630.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    631. 

  631. 

  632.             <TD WIDTH=324>
    633. 

  633. 

  634.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>LUNGS: dear to P&amp;a. no mono, no rales</B></FONT><B></B></P>
    635. 

  635. 

  636.             </TD>
    637. 

  637. 

  638.         </TR>
    639. 

  639. 

  640.         <TR>
    641. 

  641. 

  642.             <TD>
    643. 

  643. 

  644.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    645. 

  645. 

  646.             </TD>
    647. 

  647. 

  648.             <TD WIDTH=40>
    649. 

  649. 

  650.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    651. 

  651. 

  652.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    653. 

  653. 

  654.                         <TR>
    655. 

  655. 

  656.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox28" TYPE=CHECKBOX NAME="prog_heart_abn" <?if ($obj{"prog_heart_abn"} == "on") {echo "checked";};?>></TD>
    657. 

  657. 

  658.                         </TR>
    659. 

  659. 

  660.                     </TABLE>
    661. 

  661. 

  662.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    663. 

  663. 

  664.             <TD WIDTH=34>
    665. 

  665. 

  666.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    667. 

  667. 

  668.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    669. 

  669. 

  670.                         <TR>
    671. 

  671. 

  672.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox29" TYPE=CHECKBOX NAME="prog_heart_ne" <?if ($obj{"prog_heart_ne"} == "on") {echo "checked";};?>></TD>
    673. 

  673. 

  674.                         </TR>
    675. 

  675. 

  676.                     </TABLE>
    677. 

  677. 

  678.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    679. 

  679. 

  680.             <TD WIDTH=324>
    681. 

  681. 

  682.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>HEART: rsr. no cardiomegaly</B></FONT><B></B></P>
    683. 

  683. 

  684.             </TD>
    685. 

  685. 

  686.         </TR>
    687. 

  687. 

  688.         <TR>
    689. 

  689. 

  690.             <TD>
    691. 

  691. 

  692.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    693. 

  693. 

  694.             </TD>
    695. 

  695. 

  696.             <TD WIDTH=40>
    697. 

  697. 

  698.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    699. 

  699. 

  700.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    701. 

  701. 

  702.                         <TR>
    703. 

  703. 

  704.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox30" TYPE=CHECKBOX NAME="prog_abdomen_abn" <?if ($obj{"prog_abdomen_abn"} == "on") {echo "checked";};?>></TD>
    705. 

  705. 

  706.                         </TR>
    707. 

  707. 

  708.                     </TABLE>
    709. 

  709. 

  710.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    711. 

  711. 

  712.             <TD WIDTH=34>
    713. 

  713. 

  714.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    715. 

  715. 

  716.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    717. 

  717. 

  718.                         <TR>
    719. 

  719. 

  720.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox31" TYPE=CHECKBOX NAME="prog_abdomen_ne" <?if ($obj{"prog_abdomen_ne"} == "on") {echo "checked";};?>></TD>
    721. 

  721. 

  722.                         </TR>
    723. 

  723. 

  724.                     </TABLE>
    725. 

  725. 

  726.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    727. 

  727. 

  728.             <TD WIDTH=324>
    729. 

  729. 

  730.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>ABDOMEN: non-tender, soft, no masses</B></FONT><B></B></P>
    731. 

  731. 

  732.             </TD>
    733. 

  733. 

  734.         </TR>
    735. 

  735. 

  736.         <TR>
    737. 

  737. 

  738.             <TD>
    739. 

  739. 

  740.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    741. 

  741. 

  742.             </TD>
    743. 

  743. 

  744.             <TD WIDTH=40>
    745. 

  745. 

  746.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    747. 

  747. 

  748.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    749. 

  749. 

  750.                         <TR>
    751. 

  751. 

  752.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox32" TYPE=CHECKBOX NAME="prog_spine_abn" <?if ($obj{"prog_spine_abn"} == "on") {echo "checked";};?>></TD>
    753. 

  753. 

  754.                         </TR>
    755. 

  755. 

  756.                     </TABLE>
    757. 

  757. 

  758.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    759. 

  759. 

  760.             <TD WIDTH=34>
    761. 

  761. 

  762.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    763. 

  763. 

  764.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    765. 

  765. 

  766.                         <TR>
    767. 

  767. 

  768.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox33" TYPE=CHECKBOX NAME="prog_spine_ne" <?if ($obj{"prog_spine_ne"} == "on") {echo "checked";};?>></TD>
    769. 

  769. 

  770.                         </TR>
    771. 

  771. 

  772.                     </TABLE>
    773. 

  773. 

  774.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    775. 

  775. 

  776.             <TD WIDTH=324>
    777. 

  777. 

  778.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>SPINE: no abnormalities</B></FONT><B></B></P>
    779. 

  779. 

  780.             </TD>
    781. 

  781. 

  782.         </TR>
    783. 

  783. 

  784.         <TR>
    785. 

  785. 

  786.             <TD>
    787. 

  787. 

  788.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    789. 

  789. 

  790.             </TD>
    791. 

  791. 

  792.             <TD WIDTH=40>
    793. 

  793. 

  794.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    795. 

  795. 

  796.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    797. 

  797. 

  798.                         <TR>
    799. 

  799. 

  800.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox34" TYPE=CHECKBOX NAME="prog_extremeities_abn" <?if ($obj{"prog_extremeities_abn"} == "on") {echo "checked";};?>></TD>
    801. 

  801. 

  802.                         </TR>
    803. 

  803. 

  804.                     </TABLE>
    805. 

  805. 

  806.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    807. 

  807. 

  808.             <TD WIDTH=34>
    809. 

  809. 

  810.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    811. 

  811. 

  812.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    813. 

  813. 

  814.                         <TR>
    815. 

  815. 

  816.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox35" TYPE=CHECKBOX NAME="prog_extremeities_ne" <?if ($obj{"prog_extremeities_ne"} == "on") {echo "checked";};?>></TD>
    817. 

  817. 

  818.                         </TR>
    819. 

  819. 

  820.                     </TABLE>
    821. 

  821. 

  822.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    823. 

  823. 

  824.             <TD WIDTH=324>
    825. 

  825. 

  826.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>EXTREMEITIES: no abnormalities</B></FONT><B></B></P>
    827. 

  827. 

  828.             </TD>
    829. 

  829. 

  830.         </TR>
    831. 

  831. 

  832.         <TR>
    833. 

  833. 

  834.             <TD>
    835. 

  835. 

  836.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    837. 

  837. 

  838.             </TD>
    839. 

  839. 

  840.             <TD WIDTH=40>
    841. 

  841. 

  842.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    843. 

  843. 

  844.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    845. 

  845. 

  846.                         <TR>
    847. 

  847. 

  848.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox36" TYPE=CHECKBOX NAME="prog_lowback_abn" <?if ($obj{"prog_lowback_abn"} == "on") {echo "checked";};?>></TD>
    849. 

  849. 

  850.                         </TR>
    851. 

  851. 

  852.                     </TABLE>
    853. 

  853. 

  854.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    855. 

  855. 

  856.             <TD WIDTH=34>
    857. 

  857. 

  858.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    859. 

  859. 

  860.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    861. 

  861. 

  862.                         <TR>
    863. 

  863. 

  864.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox37" TYPE=CHECKBOX NAME="prog_lowback_ne" <?if ($obj{"prog_lowback_ne"} == "on") {echo "checked";};?>></TD>
    865. 

  865. 

  866.                         </TR>
    867. 

  867. 

  868.                     </TABLE>
    869. 

  869. 

  870.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    871. 

  871. 

  872.             <TD WIDTH=324>
    873. 

  873. 

  874.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>LOW BACK: rom normal</B></FONT><B></B></P>
    875. 

  875. 

  876.             </TD>
    877. 

  877. 

  878.         </TR>
    879. 

  879. 

  880.         <TR>
    881. 

  881. 

  882.             <TD>
    883. 

  883. 

  884.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    885. 

  885. 

  886.             </TD>
    887. 

  887. 

  888.             <TD WIDTH=40>
    889. 

  889. 

  890.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    891. 

  891. 

  892.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    893. 

  893. 

  894.                         <TR>
    895. 

  895. 

  896.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox38" TYPE=CHECKBOX NAME="prog_neuro_abn" <?if ($obj{"prog_neuro_abn"} == "on") {echo "checked";};?>></TD>
    897. 

  897. 

  898.                         </TR>
    899. 

  899. 

  900.                     </TABLE>
    901. 

  901. 

  902.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    903. 

  903. 

  904.             <TD WIDTH=34>
    905. 

  905. 

  906.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    907. 

  907. 

  908.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    909. 

  909. 

  910.                         <TR>
    911. 

  911. 

  912.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox39" TYPE=CHECKBOX NAME="prog_neuro_ne" <?if ($obj{"prog_neuro_ne"} == "on") {echo "checked";};?>></TD>
    913. 

  913. 

  914.                         </TR>
    915. 

  915. 

  916.                     </TABLE>
    917. 

  917. 

  918.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    919. 

  919. 

  920.             <TD WIDTH=324>
    921. 

  921. 

  922.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>NEURO: d(r&gt;&gt;2&gt;&gt;. no abnormal findings</B></FONT><B></B></P>
    923. 

  923. 

  924.             </TD>
    925. 

  925. 

  926.         </TR>
    927. 

  927. 

  928.         <TR>
    929. 

  929. 

  930.             <TD>
    931. 

  931. 

  932.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    933. 

  933. 

  934.             </TD>
    935. 

  935. 

  936.             <TD WIDTH=40>
    937. 

  937. 

  938.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    939. 

  939. 

  940.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    941. 

  941. 

  942.                         <TR>
    943. 

  943. 

  944.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox40" TYPE=CHECKBOX NAME="prog_rectal_abn" <?if ($obj{"prog_rectal_abn"} == "on") {echo "checked";};?>></TD>
    945. 

  945. 

  946.                         </TR>
    947. 

  947. 

  948.                     </TABLE>
    949. 

  949. 

  950.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    951. 

  951. 

  952.             <TD WIDTH=34>
    953. 

  953. 

  954.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    955. 

  955. 

  956.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    957. 

  957. 

  958.                         <TR>
    959. 

  959. 

  960.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox41" TYPE=CHECKBOX NAME="prog_rectal_ne" <?if ($obj{"prog_rectal_ne"} == "on") {echo "checked";};?>></TD>
    961. 

  961. 

  962.                         </TR>
    963. 

  963. 

  964.                     </TABLE>
    965. 

  965. 

  966.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    967. 

  967. 

  968.             <TD WIDTH=324>
    969. 

  969. 

  970.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>RECTAL: no abnormalities</B></FONT><B></B></P>
    971. 

  971. 

  972.             </TD>
    973. 

  973. 

  974.         </TR>
    975. 

  975. 

  976.         <TR>
    977. 

  977. 

  978.             <TD>
    979. 

  979. 

  980.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif">&nbsp;</FONT></P>
    981. 

  981. 

  982.             </TD>
    983. 

  983. 

  984.             <TD WIDTH=40>
    985. 

  985. 

  986.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    987. 

  987. 

  988.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    989. 

  989. 

  990.                         <TR>
    991. 

  991. 

  992.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox42" TYPE=CHECKBOX NAME="prog_pelvic_abn" <?if ($obj{"prog_pelvic_abn"} == "on") {echo "checked";};?>></TD>
    993. 

  993. 

  994.                         </TR>
    995. 

  995. 

  996.                     </TABLE>
    997. 

  997. 

  998.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    999. 

  999. 

  1000.             <TD WIDTH=34>
    1001. 

  1001. 

  1002.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT>
    1003. 

  1003. 

  1004.                     <TABLE WIDTH="100%" BORDER=0 CELLSPACING=0 CELLPADDING=0 NOF=TE>
    1005. 

  1005. 

  1006.                         <TR>
    1007. 

  1007. 

  1008.                             <TD ALIGN="CENTER"><INPUT ID="Forms Checkbox43" TYPE=CHECKBOX NAME="prog_pelvic_ne" <?if ($obj{"prog_pelvic_ne"} == "on") {echo "checked";};?>></TD>
    1009. 

  1009. 

  1010.                         </TR>
    1011. 

  1011. 

  1012.                     </TABLE>
    1013. 

  1013. 

  1014.                     <FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"></FONT></TD>
    1015. 

  1015. 

  1016.             <TD WIDTH=324>
    1017. 

  1017. 

  1018.                 <P><FONT FACE="Arial,Helvetica,Geneva,Sans-serif,sans-serif"><B>PELVIC:</B></FONT><B></B></P>
    1019. 

  1019. 

  1020.             </TD>
    1021. 

  1021. 

  1022.         </TR>
    1023. 

  1023. 

  1024.     </TABLE> 
    1025. 

  1025. 

  1026. 

  1027. 

  1028. <br>
    1029. 

  1029. 

  1030. 

  1031. 

  1032. 

  1033. 

  1034. <span class=text><b>HEALTH EDUCATION PROVIDED<br>ASSESSMENT:</b></span><br><textarea cols=40 rows=8 wrap=virtual name="prog_assessment" ><?php echo $obj{"prog_assessment"};?></textarea>
    1035. 

  1035. 

  1036. 

  1037. 

  1038. <br><br>
    1039. 

  1039. 

  1040. 

  1041. 

  1042. <span class=text><b>Plan:</b></span><br><textarea cols=40 rows=8 wrap=virtual name="prog_plan" ><?php echo $obj{"prog_plan"};?></textarea>
    1043. 

  1043. 

  1044. 

  1045. 

  1046. <br><br>
    1047. 

  1047. 

  1048. <td><input size=3 type=entry name="prog_breast_se" value="<?php echo $obj{"prog_breast_se"};?>" >&nbsp;<span class=text><b>Breast Self Examination </span></td><br></b>
    1049. 

  1049. 

  1050. <td><input size=3 type=entry name="prog_dental_h" value="<?php echo $obj{"prog_dental_h"};?>" >&nbsp;<span class=text><b>Dental Health </span></td><br></b>
    1051. 

  1051. 

  1052. <td><input size=3 type=entry name="prog_diagnosis" value="<?php echo $obj{"prog_diagnosis"};?>" >&nbsp;<span class=text><b>Diagnosis/Prognosis </span></td><br></b>
    1053. 

  1053. 

  1054. <td><input size=3 type:entry name="prog_injur_p" value="<?php echo $obj{"prog_injur_p"};?>" >&nbsp;<span class=text><b>Injury Prevention </span></td><br></b>
    1055. 

  1055. 

  1056. <td><input size=3 type=entry name="prog_new_treat" value="<?php echo $obj{"prog_new_treat"};?>" >&nbsp;<span class=text><b>New Treatment/Medication </span></td><br></b>
    1057. 

  1057. 

  1058. <td><input size=3 type=entry name="prog_nutrition_e" value="<?php echo $obj{"prog_nutrition_e"};?>" >&nbsp;<span class=text><b>Nutrition/Exercise </span></td><br></b>
    1059. 

  1059. 

  1060. <td><input size=3 type=entry name="prog_sexual_p" value="<?php echo $obj{"prog_sexual_p"};?>" >&nbsp;<span class=text><b>Sexual Practice </span></td><br></b>
    1061. 

  1061. 

  1062. <td><input size=3 type=entry name="prog_substance_a" value="<?php echo $obj{"prog_substance_a"};?>" >&nbsp;<span class=text><b>Substance Abuse </span></td><br></b>
    1063. 

  1063. 

  1064. 

  1065. 

  1066. 

  1067. 

  1068. 

  1069. 

  1070. <a href="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save]</a>
    1071. 

  1071. 

  1072. <br>
    1073. 

  1073. 

  1074. <a href="<?php echo $GLOBALS['form_exit_url']; ?>" class="link" onclick="top.restoreSession()">[Don't Save]</a>
    1075. 

    1076. 

  1076. </form>
    1077. 

  1077. 

  1078. <?php
    1079. 

  1079. 

  1080. formFooter();
    1081. 

  1081. 

  1082. ?>
    1083.