PageRenderTime 47ms CodeModel.GetById 10ms RepoModel.GetById 1ms app.codeStats 0ms

/contrib/forms/routine_screening_record/new.php

https://github.com/md-tech/openemr
PHP | 233 lines | 230 code | 3 blank | 0 comment | 8 complexity | 68156100b66ef4586321a39eca9d7aa9 MD5 | raw file
    

  1. <?php
    2. 

  2. include_once("../../globals.php");
    3. 

  3. include_once("$srcdir/api.inc");
    4. 

  4. include_once("$srcdir/forms.inc");
    5. 

  5. include_once("$srcdir/calendar.inc");
    6. 

  6. $frmn = 'form_routine_screening_record';
    7. 

  7. $ftitle = 'Routine screening record';
    8. 

  8. $old = sqlStatement("select form_id, formdir from forms where (form_name='${ftitle}') and (pid=$pid) order by date desc limit 1");
    9. 

  9. if ($old) {
    10. 

  10.   $dt = sqlFetchArray($old);
    11. 

  11.   $fid = $dt{'form_id'};
    12. 

  12.   if ($fid && ($fid != 0) && ($fid != '')){
    13. 

  13.   $fdir = $dt{'formdir'};
    14. 

  14.   unset($dt);
    15. 

  15.   $dt = formFetch($frmn, $fid);
    16. 

  16.   $newid = formSubmit($frmn, array_slice($dt,7), $id, $userauthorized);
    17. 

  17.   addForm($encounter, $ftitle, $newid, $fdir, $pid, $userauthorized);
    18. 

  18.   $id = $newid;
    19. 

  19.   formJump("${rootdir}/patient_file/encounter/view_form.php?formname=${fdir}&id=${newid}");
    20. 

  20.   exit;
    21. 

  21.   }
    22. 

  22.   }
    23. 

  23. ?>
    24. 

  24. <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
    25. 

  25. "http://www.w3.org/TR/html4/loose.dtd">
    26. 

  26. 

  27. <html>
    28. 

  28. <head>
    29. 

  29. <?php html_header_show();?>
    30. 

  30. <title>Form: Routine screening record</title>
    31. 

  31. <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
    32. 

  32. <link rel="stylesheet" href="../../acog.css" type="text/css">
    33. 

  33. <script language="JavaScript" src="../../acog.js" type="text/JavaScript"></script>
    34. 

  34. <script language="JavaScript" type="text/JavaScript">
    35. 

  35. window.onload = initialize;
    36. 

  36. </script>
    37. 

  37. </head>
    38. 

  38. 

  39. <?php
    40. 

  40.    $fres=sqlStatement("select * from patient_data where pid='".$pid."'");
    41. 

  41.    if ($fres){
    42. 

  42.      $patient = sqlFetchArray($fres);
    43. 

  43.    }
    44. 

  44. ?>
    45. 

  45. <body class="body_top">
    46. 

  46. 

  47. <form action="<?php echo $rootdir;?>/forms/routine_screening_record/save.php?mode=new" method="post" enctype="multipart/form-data" name="my_form">
    48. 

  48. <?php include("../../acog_menu.inc"); ?>
    49. 

  49. <div class="srvChapter">Routine screening record <a href="#" onMouseOver="toolTip('The <strong>Routine Screening Record</strong> includes those screening tests recommended by ACOG for routine use and provides reminders for recommended frequency of services.', 300)" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></div>
    50. 

  50. <div style="border: solid 2px black; background-color:#FFFFFF;">
    51. 

  51.   <table  border="0" cellpadding="2" cellspacing="0">
    52. 

  52.     <tr align="left" valign="bottom">
    53. 

  53.       <td colspan="4" class="fibody2" id="bordR">patient name: 
    54. 

  54.         <input name="pname" type="text" class="fullin" id="pname" style="width: 74%" value="<?php
    55. 

  55.           echo $patient{'fname'}.' '.$patient{'mname'}.' '.$patient{'lname'};
    56. 

  56.           ?>"></td>
    57. 

  57.       <td colspan="4" class="fibody2" id="bordR">Birth date: 
    58. 

  58.         <input name="pbdate" type="text" class="fullin" id="pbdate" style="width: 65%" value="<?php
    59. 

  59.           echo $patient{'DOB'};
    60. 

  60.           ?>"></td>
    61. 

  61.       <td colspan="3" class="fibody2">ID No:
    62. 

  62.         <input name="rs_pid" type="text" class="fullin" id="rs_pid" style="width:80%" value="<?php
    63. 

  63.           echo $patient{'id'};
    64. 

  64.           ?>"></td>
    65. 

  65.       </tr>
    66. 

  66.     <tr align="center" valign="middle">
    67. 

  67.       <td class="ficaption2" id="bordR">age</td>
    68. 

  68.       <td width="9%" class="ficaption2" id="bordR">Cervical cytology </td>
    69. 

  69.       <td width="9%" class="ficaption2" id="bordR">Lipid profile assessment<a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></td>
    70. 

  70.       <td width="9%" class="ficaption2" id="bordR">Mammo-<br>
    71. 

  71.         graphy<a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></td>
    72. 

  72.       <td width="9%" class="ficaption2" id="bordR">Colorectal cancer screening <a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></td>
    73. 

  73.       <td width="9%" class="ficaption2" id="bordR">Bone density screening <a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"> <img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></td>
    74. 

  74.       <td width="9%" class="ficaption2" id="bordR">Chlamydia screening <a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a> </td>
    75. 

  75.       <td width="9%" class="ficaption2" id="bordR">Gonor-<br>
    76. 

  76.         rhea screening <a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a> </td>
    77. 

  77.       <td width="9%" class="ficaption2" id="bordR">Urinalysis</td>
    78. 

  78.       <td width="9%" class="ficaption2" id="bordR">Fasting glucose test <a href="#" onMouseOver="toolTip('This test may be appropriate for other patients based on risk (see High-Risk Laboratory Record and Table of High-Risk Factors)')" onMouseOut="toolTip();"><img src="../../pic/mark_q.png" width="13" height="13" border="0" align="texttop"></a></td>
    79. 

  79.       <td width="9%" class="ficaption2">Thyroid stimulating hormone screening </td>
    80. 

  80.     </tr>
    81. 

  81.     <tr align="center" valign="middle">
    82. 

  82.       <td class="fibody2" id="bordR">13-18</td>
    83. 

  83.       <td class="fibody2" id="bordR">ANNUALLY BEGINNING
    84. 

  84.         APPROXIMATELY 3 YEARS
    85. 

  85.         AFTER INITIATION OF
    86. 

  86.         SEXUAL INTERCOURSE</td>
    87. 

  87.       <td class="fibody2" id="bordR">&nbsp; </td>
    88. 

  88.       <td class="fibody2" id="bordR">&nbsp; </td>
    89. 

  89.       <td class="fibody2" id="bordR">&nbsp; </td>
    90. 

  90.       <td class="fibody2" id="bordR">&nbsp; </td>
    91. 

  91.       <td class="fibody2" id="bordR">        SEXUALLY ACTIVE WOMEN
    92. 

  92.         UNDER AGE 25</td>
    93. 

  93.       <td class="fibody2" id="bordR">SEXUALLY ACTIVE
    94. 

  94.         ADOLES-<br>
    95. 

  95.         CENTS</td>
    96. 

  96.       <td class="fibody2" id="bordR">&nbsp;</td>
    97. 

  97.       <td class="fibody2" id="bordR">&nbsp;</td>
    98. 

  98.       <td class="fibody2">&nbsp;</td>
    99. 

  99.     </tr>
    100. 

  100.     <tr align="center" valign="middle">
    101. 

  101.       <td class="fibody2" id="bordR">19-39</td>
    102. 

  102.       <td class="fibody2" id="bordR">ANNUALLY BEGINNING NO LATER THAN AGE 21 YEARS</td>
    103. 

  103.       <td class="fibody2" id="bordR">&nbsp; </td>
    104. 

  104.       <td class="fibody2" id="bordR">&nbsp; </td>
    105. 

  105.       <td class="fibody2" id="bordR">&nbsp; </td>
    106. 

  106.       <td class="fibody2" id="bordR">&nbsp; </td>
    107. 

  107.       <td class="fibody2" id="bordR"> SEXUALLY ACTIVE WOMEN<br>
    108. 

  108. UNDER AGE 25</td>
    109. 

  109.       <td class="fibody2" id="bordR">&nbsp; </td>
    110. 

  110.       <td class="fibody2" id="bordR">&nbsp;</td>
    111. 

  111.       <td class="fibody2" id="bordR">&nbsp;</td>
    112. 

  112.       <td class="fibody2">&nbsp;</td>
    113. 

  113.     </tr>
    114. 

  114.     <tr align="center" valign="middle">
    115. 

  115.       <td class="fibody2" id="bordR">40-64</td>
    116. 

  116.       <td class="fibody2" id="bordR">EVERY 23 YEARS AFTER 3
    117. 

  117.         CONSECuTIVE NEGATIVE TEST
    118. 

  118.         RESULTS IF NO HISTORY OF
    119. 

  119.         CIN 2 OR 3,
    120. 

  120.         IMMUNOSUP-<br>
    121. 

  121.         PRESSION,
    122. 

  122.         HIV INFECTION, OR DES
    123. 

  123.         EXPOSURE IN UTERO</td>
    124. 

  124.       <td class="fibody2" id="bordR">EVERY 5 YEARS
    125. 

  125.         BEGINNING
    126. 

  126.         AT AGE 45</td>
    127. 

  127.       <td class="fibody2" id="bordR">EVERY 12 YEARS UNTIL
    128. 

  128.         AGE 50; YEARLY
    129. 

  129.         BEGINNING AT AGE 50</td>
    130. 

  130.       <td class="fibody2" id="bordR">        BEGINNING AT AGE 50
    131. 

  131.         YEARLY FOBT OR FLEXIBLE
    132. 

  132.         SIGMOIDOSCOPY EVERY
    133. 

  133.         5 YEARS OR YEARLY FOBT
    134. 

  134.         PLUS FLEXIBLE
    135. 

  135.         SIGMOIDOSCOPY EVERY 5
    136. 

  136.         YEARS OR DCBE EVERY 5
    137. 

  137.         YEARS OR COLONOSCOPY
    138. 

  138.         EVERY 10 YEARS</td>
    139. 

  139.       <td class="fibody2" id="bordR">&nbsp; </td>
    140. 

  140.       <td class="fibody2" id="bordR">&nbsp; </td>
    141. 

  141.       <td class="fibody2" id="bordR">&nbsp; </td>
    142. 

  142.       <td class="fibody2" id="bordR">&nbsp;</td>
    143. 

  143.       <td class="fibody2" id="bordR">EVERY 3 YEARS
    144. 

  144.         AFTER AGE 45</td>
    145. 

  145.       <td class="fibody2">EVERY 5 YEARS
    146. 

  146.         BEGINNING AT AGE 50</td>
    147. 

  147.     </tr>
    148. 

  148.     <tr align="center" valign="middle">
    149. 

  149.       <td class="fibody2" id="bordR">65 and older </td>
    150. 

  150.       <td class="fibody2" id="bordR">EVERY 23 YEARS AFTER 3<br>
    151. 

  151.         CONSECUTIVE NEGATIVE TEST
    152. 

  152.         RESULTS IF NO HISTORY OF
    153. 

  153.         CIN 2 OR 3,
    154. 

  154.         IMMUNOSUP-<br>
    155. 

  155.         PRESSION,
    156. 

  156.         HIV INFECTION, OR DES
    157. 

  157.         EXPOSURE IN UTERO</td>
    158. 

  158.       <td class="fibody2" id="bordR">EVERY 5 YEARS</td>
    159. 

  159.       <td class="fibody2" id="bordR">YEARLY OR AS
    160. 

  160.         APPROPRIATE</td>
    161. 

  161.       <td class="fibody2" id="bordR">        YEARLY FOBT OR FLEXIBLE
    162. 

  162.         SIGMOIDOSCOPY EVERY
    163. 

  163.         5 YEARS OR YEARLY FOBT
    164. 

  164.         PLUS FLEXIBLE
    165. 

  165.         SIGMOIDOSCOPY EVERY
    166. 

  166.         YEARS OR DCBE EVERY
    167. 

  167.         YEARS OR COLONOSCOPY
    168. 

  168.         EVERY 10 YEARS</td>
    169. 

  169.       <td class="fibody2" id="bordR">        IN THE ABSENCE OF
    170. 

  170.         NEW RISK FACTORS,
    171. 

  171.         SUBSEQUENT SCREENING
    172. 

  172.         NOT MORE FREQUENTLY
    173. 

  173.         THAN EVERY 2 YEARS</td>
    174. 

  174.       <td class="fibody2" id="bordR">&nbsp; </td>
    175. 

  175.       <td class="fibody2" id="bordR">&nbsp; </td>
    176. 

  176.       <td class="fibody2" id="bordR">YEARLY OR AS
    177. 

  177.         APPROPRIATE</td>
    178. 

  178.       <td class="fibody2" id="bordR">EVERY 3 YEARS</td>
    179. 

  179.       <td class="fibody2">EVERY 5 YEARS</td>
    180. 

  180.     </tr>
    181. 

  181.     <tr align="left" valign="bottom">
    182. 

  182.       <td colspan="11" class="fibody2" style="border-bottom: 2px solid black;">&nbsp;</td>
    183. 

  183.       </tr>
    184. 

  184. <?php
    185. 

  185. $rsi = 1;
    186. 

  186. while ($rsi <  9){
    187. 

  187. print <<<EOL
    188. 

  188.     <tr align="left" valign="bottom">
    189. 

  189.       <td class="fibody2" id="bordR">Date</td>
    190. 

  190.       <td class="fibody3" id="bordR"><input name="cervical_date_${rsi}" type="text" class="fullin2"></td>
    191. 

  191.       <td class="fibody3" id="bordR"><input name="lipid_date_${rsi}" type="text" class="fullin2"></td>
    192. 

  192.       <td class="fibody3" id="bordR"><input name="mammo_date_${rsi}" type="text" class="fullin2"></td>
    193. 

  193.       <td class="fibody3" id="bordR"><input name="colorectal_date_${rsi}" type="text" class="fullin2"></td>
    194. 

  194.       <td class="fibody3" id="bordR"><input name="bone_date_${rsi}" type="text" class="fullin2"></td>
    195. 

  195.       <td class="fibody3" id="bordR"><input name="chlamyd_date_${rsi}" type="text" class="fullin2"></td>
    196. 

  196.       <td class="fibody3" id="bordR"><input name="gonor_date_${rsi}" type="text" class="fullin2"></td>
    197. 

  197.       <td class="fibody3" id="bordR"><input name="urinal_date_${rsi}" type="text" class="fullin2"></td>
    198. 

  198.       <td class="fibody3" id="bordR"><input name="glucose_date_${rsi}" type="text" class="fullin2"></td>
    199. 

  199.       <td class="fibody3"><input name="thyroid_date_${rsi}" type="text" class="fullin2"></td>
    200. 

  200.     </tr>
    201. 

  201.     <tr align="left" valign="bottom">
    202. 

  202.       <td class="fibody2" id="bordR">result</td>
    203. 

  203.       <td class="fibody5" id="bordR"><input name="cervical_res_${rsi}" type="text" class="fullin2"></td>
    204. 

  204.       <td class="fibody5" id="bordR"><input name="lipid_res_${rsi}" type="text" class="fullin2"></td>
    205. 

  205.       <td class="fibody5" id="bordR"><input name="mammo_res_${rsi}" type="text" class="fullin2"></td>
    206. 

  206.       <td class="fibody5" id="bordR"><input name="colorectal_res_${rsi}" type="text" class="fullin2"></td>
    207. 

  207.       <td class="fibody5" id="bordR"><input name="bone_res_${rsi}" type="text" class="fullin2"></td>
    208. 

  208.       <td class="fibody5" id="bordR"><input name="chlamyd_res_${rsi}" type="text" class="fullin2"></td>
    209. 

  209.       <td class="fibody5" id="bordR"><input name="gonor_res_${rsi}" type="text" class="fullin2"></td>
    210. 

  210.       <td class="fibody5" id="bordR"><input name="urinal_res_${rsi}" type="text" class="fullin2"></td>
    211. 

  211.       <td class="fibody5" id="bordR"><input name="glucose_res_${rsi}" type="text" class="fullin2"></td>
    212. 

  212.       <td class="fibody5"><input name="thyroid_res_${rsi}" type="text" class="fullin2"></td>
    213. 

  213.     </tr>
    214. 

  214. EOL;
    215. 

  215. $rsi++;
    216. 

  216. }
    217. 

  217. ?>
    218. 

  218.   </table>
    219. 

  219. </div>
    220. 

  220. <p>&nbsp;</p>
    221. 

  221. <table width="100%" border="0">
    222. 

  222.   <tr>
    223. 

  223.     <td align="left"> <a href="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save Data]</a> </td>
    224. 

  224.     <td align="right"> <a href="<?php echo $GLOBALS['form_exit_url']; ?>" class="link_submit"
    225. 

  225.      onclick="top.restoreSession()">[Don't Save]</a> </td>
    226. 

  226.   </tr>
    227. 

  227. </table>
    228. 

  228. </form>
    229. 

  229. <?php
    230. 

  230. formFooter();
    231. 

  231. ?>
    232. 

  232. </body>
    233. 

  233. </html>
    234. 

  234.