@extends('master')


@section('content')
	
	<script type="text/javascript">

	function priorWork(){
    	//alert('hola');
    	element = document.getElementById("injury_impairment");
    	textArea = document.getElementById("injury_impairment_text_area");
    	if(element.checked){
    		textArea.style.display='block';
    	}else{
    		textArea.style.display='none';
    	}
    }

	$(document).ready(function(){
		$(document).foundation({
		    abide: {
		        validators: {
		            systolicLimits: function(el, required, parent) {
		            	systolic    = el.value;
		               	valid = ((systolic >= 20 ) && (systolic<= 250));
		               	parent.closest( 'small.error').css({display:'block'});
			  			return valid;
		            },
		            diastolicLimits: function(el, required, parent) {
		            	systolic    = el.value;
		               	valid = ((systolic > 0 ) && (systolic<= 140));
		               	parent.closest( 'small.error').css({display:'block'});
			  			return valid;
		            },
		            respiratoryRateLimits: function(el, required, parent) {
		            	systolic    = el.value;
		               	valid = ((systolic > 0 ) && (systolic<= 40));
		               	parent.closest( 'small.error').css({display:'block'});
			  			return valid;
		            },
		            heartRateLimits: function(el, required, parent) {
		            	systolic    = el.value;
		               	valid = ((systolic > 0 ) && (systolic<= 300));
		               	parent.closest( 'small.error').css({display:'block'});
			  			return valid;
		            },
		            temperatureLimits: function(el, required, parent) {
		            	systolic    = el.value;
		               	valid = ((systolic > 0 ) && (systolic<= 140));
		               	parent.closest( 'small.error').css({display:'block'});
			  			return valid;
		            },
		            heightLimits: function(el, required, parent) {
		            	systolic    = el.value;
		               	valid = ((systolic >= 48 ) && (systolic<= 86));
		               	parent.closest( 'small.error').css({display:'block'});
			  			return valid;
		            },
		            weightLimits: function(el, required, parent) {
		            	systolic    = el.value;
		               	valid = ((systolic >= 50 ) && (systolic<= 400));
		               	parent.closest( 'small.error').css({display:'block'});
			  			return valid;
		            }
		        }
		    }
		});
	});

	function BMI(){
		
		var height, weight, bmi, heighttSquared;

		height = document.getElementById("height").value;
		weight = document.getElementById("weight").value;

		height = height * 0.0254;
		weight = weight / 2.2;

		heightSquared = height * height;

		bmi = weight / heightSquared;
		bmi = bmi.toFixed(2);

		document.getElementById("bmi").value = bmi;

	}

	
		function uncheckedDrugAllergyHistory(){

			$("#penicillin").removeAttr("checked");
			$("#sulfa").removeAttr("checked");
			$("#tetracycline").removeAttr("checked");
			$("#fluoroquinolone").removeAttr("checked");
			$("#other_DAH").removeAttr("checked");

			element = document.getElementById("content_DAH");
			element.style.display='none';

		}

		function uncheckedNone(other){
			if (typeof(other)==='undefined') other = false;
			if(other){
			
				$("#none").removeAttr("checked");	
				element = document.getElementById("content_DAH");
		        check = document.getElementById("other_DAH");
		        if (check.checked) {
		            element.style.display='block';
		        }
		        else {
		            element.style.display='none';
		        }

			}else{
				$("#none").removeAttr("checked");	
			}
			
		}

	</script>

	 <div class="row">
        <div class="large-12 columns">
            <div class="row">
                <div class="small-12 medium-12 large-12 columns">
                    <h4>Illness Exam</h4>
                </div>
            </div>

            <div class="row">
                <div class="small-6 medium-6 large-6 columns">
                    <h5>{{{ $patientData->fname . " " . $patientData->lname }}}</h5>
                </div>
            </div>

            <div class="row">
                <div class="small-4 medium-4 large-4 columns">
                    <h5>Employer: {{{ $employer->name }}}</h5>
                </div>
            </div>

            <div class="row">
                <div class="small-12 medium-12 large-12 columns">
                    <p>This screen for evaluation of illness following accidental exposure known at the time of the examination.</p>
                </div>
            </div>
        </div>
    </div>

  	<form action="{{{ URL::to('patients/' . $patientData->pid . '/illness-exam') }}}" method="post" data-abide>
    <div class="row">
    	<div class="small-12 medium-12 large-12  columns">
    		<div class="row">
    			<div class="small-12 medium-3 large-3  columns">
    				<hr>
    				<h5>Physical Exam Findings</h5>
			        <h6>Vital Signs</h6>

			        <input type="hidden" id="check_in" name="check_in" value="{{{$checkIn}}}" readonly/>

			         <div class="row">
				            <div class="large-12 columns">
					            <label>Systolic BP</label>
					            <input type="number" id="systolic" name="systolic" data-abide-validator="systolicLimits"/>
					            <small class="error" data-error-message>The Systolic value is not in the valid limits</small>
				            </div>
				        </div>

				        <div class="row">
				            <div class="large-12 columns">
					            <label>Diastolic BP</label>
					            <input type="text"  id="diastolic" name="diastolic" data-abide-validator="diastolicLimits"/>
					            <small class="error" data-error-message>The Diastolic value is not in the valid limits</small>
				            </div>
				        </div>

				        <div class="row">
				            <div class="large-12 columns">
					            <label>Respiratory rate</label>
					            <input type="number"  id="respiratory" name="respiratory" placeholder="" data-abide-validator="respiratoryRateLimits"/>
					            <small class="error" data-error-message>The respiratory rate value is not in the valid limits</small>
				            </div>
				        </div>

				        <div class="row">
				        	<div class="row collapse">
						        <label>Heart rate</label>
						        <div class="small-9 columns">
						          <input type="number"  id="heart_rate" name="heart_rate" placeholder="Beats per minute" data-abide-validator="heartRateLimits"/>
						          <small class="error" data-error-message>The heart rate value is not in the valid limits</small>
						        </div>
						        <div class="small-3 columns">
						          <span class="postfix">bpm</span>
						        </div>
						    </div>
				        </div>

				        <div class="row">
				        	<div class="row collapse">
				        		<label>Temperature</label>
					            <div class="small-9 columns">
						            <input type="number" id="temperature" name="temperature" placeholder="Temperature" data-abide-validator="temperatureLimits"/>
						            <small class="error" data-error-message>The respiratory rate value is not in the valid limits</small>
					            </div>
					            <div class="small-3 columns">
						          <span class="postfix">
						          	<select>
										<option value="F">ºF</option>
										<option value="C">ºC</option>
									</select>
						          </span>
							          
						        </div>
				        	</div>
				        </div>

				        <div class="row">
					        <div class="row collapse">
				        		<label>Height Inches</label>
					            <div class="small-9 columns">
						            <input type="number" id="height" name="height" onkeyup="BMI();" placeholder="Height"  data-abide-validator="heightLimits"/>
						            <small class="error" data-error-message>The height value is not in the valid limits</small>
					            </div>
					            <div class="small-3 columns">
						          <span class="postfix">Inches</span>
						        </div>
				        	</div>
				        </div>

				        <div class="row">
					        <div class="row collapse">
				        		<label>Weight</label>
					            <div class="small-9 columns">
						            <input type="number" id="weight" name="weight" onkeyup="BMI();" placeholder="Weight" data-abide-validator="weightLimits"/>
						            <small class="error" data-error-message>The weight value is not in the valid limits</small>
					            </div>
					            <div class="small-3 columns">
						          <span class="postfix">lbs</span>
						        </div>
				        	</div>
				        </div>

			        <div class="row">
				        <div class="row collapse">
			        		<label>BMI</label>
				            <div class="small-9 columns">
					            <input type="text" id="bmi" name="bmi" placeholder="BMI" readonly/>
				            </div>
				            
			        	</div>
			        </div>

			        <div class="row">
			            <div class="large-12 columns">
			            	<p>
			            		<label>
			            		<input type="checkbox" placeholder="" id="injury_impairment" name="injury_impairment" value="1" onclick="priorWork();"/>
			            			History of work related injury or impairment (if yes, please specify)
					            </label>
			            	</p>
			            </div>
			            <div class="small-12 medium-12 large-12 end columns" id="injury_impairment_text_area" style="display:none;">
				            <textarea cols="20" rows="4" placeholder="Specify details of the impairment" id="injury_impairment_text" name="injury_impairment_text"></textarea>
			            </div>
			        </div>
    			</div>
    			<div class="small-12 medium-8 large-8  columns">
    				<div class="row">
    					
    					<div class="small-12 medium-6 large-6  columns">
	    					<hr>
							<h5>Drug Allergy History</h5>

					        <div class="row">
					            <div class="large-12 columns">
					            	<p>
						            	<label>
								            <input type="checkbox" placeholder="" id="penicillin" name="penicillin" value="1" onclick="uncheckedNone();"/>
								            Penicillin
						            	</label>
						            </p>
					            </div>
					        </div>

					        <div class="row">
					            <div class="large-12 columns">
					            	<p>
					            		<label>
								            <input type="checkbox" placeholder="" id="sulfa" name="sulfa" value="1" onclick="uncheckedNone();"/>
								            Sulfa
						            	</label>
						            </p>
					            </div>
					        </div>

					        <div class="row">
					            <div class="large-12 columns">
					            	<p>
						            	<label>
								            <input type="checkbox" placeholder="" id="tetracycline" name="tetracycline" value="1" onclick="uncheckedNone();"/>
								            Tetracycline
						            </label>
						            </p>
					            </div>
					        </div>

					        <div class="row">
					            <div class="large-12 columns">
					            	<p>
						            	<label>
								            <input type="checkbox" placeholder="" id="fluoroquinolone" name="fluoroquinolone" value="1" onclick="uncheckedNone();" />
								            Fluoroquinolone
						            	</label>
						            </p>
					            </div>
					        </div>

					        <div class="row">
					            <div class="large-12 columns">
					            	<p>
					            		<label>
								            <input type="checkbox" placeholder="" id="other_DAH" name="other_DAH" value="1" onclick="uncheckedNone(true);"/>
								            Other Medication (Please specify)
						            	</label>
						            </p>
						            <div class="row">
						            	<div class="small-12 medium-10 large-10 end columns" id="content_DAH" style="display:none;">
								            <textarea cols="20" rows="4" placeholder="Please specify" id="text_other_medication_DAH" name="text_other_medication_DAH"></textarea>
							            </div>
						            </div>
					            </div>
					        </div>

					        <div class="row">
					            <div class="large-12 columns">
					            	<p>
					            		<label>
								            <input type="checkbox" placeholder="" id="none" name="none" value="1" onclick="uncheckedDrugAllergyHistory();" />
								            None
						            	</label>
						            </p>
					            </div>
					        </div>
					    </div>


					    <div class="small-12 medium-6 large-6  columns">
					    	<hr>
					        <h6>Head and Neck</h6>

					        <div class="row">
					            <div class="large-12 columns">
					            	<p>
							            <label>
								            <input type="checkbox" placeholder="" id="normal_conjunctiva" name="normal_conjunctiva" value="1" />
								           	Normal conjunctiva and EOM
							            </label>
						            </p>
					            </div>
					        </div>

					        <div class="row">
					            <div class="large-12 columns">
					            	<p>
					            		<label>
								            <input type="checkbox" placeholder="" id="pupils_midrange" name="pupils_midrange" value="1" />
								            	Pupils midrange, reactive to light and accommodation
							            </label>
						            </p>
					            </div>
					        </div>

					        <div class="row">
					            <div class="large-12 columns">
					            	<p>
					            		<label>
								            <input type="checkbox" placeholder="" id="neck_normal" name="neck_normal" value="1"/>
								            	Neck show normal range of motion, no adenopathy, 
								            	thyromegaly or jugular venous distension or carotid bruit
						            </label>
						            </p>
					            </div>
					        </div>

					        <div class="row">
					            <div class="large-12 columns">
						            <textarea rows="4" cols="20" placeholder="Please note abnormal findings" id="abnormal_findings" name="abnormal_findings"></textarea>
					            </div>
					        </div>
					    </div>
					    <div class="row">
    							<div class="small-12 medium-6 large-6  columns">
			    					<hr>
									<h5>Review of Systems Related to ChE Inhibition</h5>
									<p>Positive answers suggest possible illness related to ChE inhibitor</p>

							        <div class="row">
							            <div class="large-12 columns">
								            <p>
									            <label>
									            	<input type="checkbox" placeholder="" id="headache" name="headache" value="1"/>
									            	Headache
									            </label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
							            		<label>
								            		<input type="checkbox" placeholder="" id="trouble_concentrating" name="trouble_concentrating" value="1"/>
								            		Trouble concentrating
								            	</label>	
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
								            <p>
								            	<label>
										            <input type="checkbox" placeholder="" id="blurry_vision" name="blurry_vision" value="1" />
										            Blurry vision
								            	</label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
								            	<label>
										            <input type="checkbox" placeholder="" id="wheezing" name="wheezing" value="1" />
										            Wheezing
									            </label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
							            		<label>
										            <input type="checkbox" placeholder="" id="salivation" name="salivation" value="1" />
										            Salivation
										        </label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
							            		<label>
										            <input type="checkbox" placeholder="" id="abdominal_pain" name="abdominal_pain" value="1" />
										            Abdominal pain
								            	</label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
								            	<label>
										            <input type="checkbox" placeholder="" id="diarrhea" name="diarrhea" value="1" />
										            Diarrhea
								            	</label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
							            		<label>
										            <input type="checkbox" placeholder="" id="muscle_twitching" name="muscle_twitching" value="1" />
										            Muscle twitching
								            	</label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
							            		<label>
										            <input type="checkbox" placeholder="" id="loss_control" name="loss_control" value="1" />
										            Loss of control of urine or excessive urination
								            	</label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
							            		<label>
										            <input type="checkbox" placeholder="" id="excessive_sweating" name="excessive_sweating" value="1" />
										            Excessive sweating
								            	</label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
							            		<label>
										            <input type="checkbox" placeholder="" id="nausea" name="nausea" value="1" />
										            Nausea
								            	</label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
							            		<label>
										            <input type="checkbox" placeholder="" id="vomiting" name="vomiting" value="1" />
										            Vomiting
								            	</label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
							            		<label>
										            <input type="checkbox" placeholder="" id="dizziness" name="dizziness" value="1" />
										            Dizziness
								            	</label>
								            </p>
							            </div>
							        </div>

    							</div>
    							<div class="small-12 medium-6 large-6  columns">
    								<hr>
							        <h6>Chest</h6>

							        <div class="row">
							            <div class="large-12 columns">
							            	<p>
								            	<label>
										            <input type="checkbox" placeholder="" id="no_abnormal_breath_sounds" name="no_abnormal_breath_sounds" value="1"/>
										            
										            	No rales, wheezes or abnormal breath sounds
									            </label>
								            </p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
								            <p>
									            <label>
										            <input type="checkbox" placeholder="" id="normal_cardiac" name="normal_cardiac" value="1" />
										            
										            	Normal cardiac rhythm, no murmurs, or abnormal
										            	heart sounds
									            </label>
								        	</p>
							            </div>
							        </div>

							        <div class="row">
							            <div class="large-12 columns">
								            <textarea rows="4" cols="20" placeholder="Please note abnormal findings" id="chest_abnormal_findings" name="chest_abnormal_findings"></textarea>
							            </div>
							        </div>
    							</div>
    						</div>
    					</div>
    				</div>
    			</div>
    		</div>
    	</div>
    </div>

    <div class="row">
    	<div class="row">
    		<div class="small-12 large-12 columns">
    			<hr>
    			<h5>Poisoning</h5>
    		</div>
    	</div>
    	<fieldset>
    		<div class="small-12 large-4 columns">
    			<p>
    		        		<label class="text-center">
    				            <input type="radio" placeholder="" id="" name="poisoning_option" value="Posible Poisoning"/>
    				            Possible Poisoning
    		            	</label>
    		            </p>
    		</div>
    		<div class="small-12 large-4 columns">
    			<p>
    		        		<label class="text-center">
    				            <input type="radio" placeholder="" id="" name="poisoning_option" value="Probable Poisoning"/>
    				            Probable Poisoning
    		            	</label>
    		            </p>
    		</div>
    		<div class="small-12 large-4 columns">
    			<p>
    		        		<label class="text-center">
    				            <input type="radio" placeholder="" id="" name="poisoning_option" value="Definite Poisoning"/>
    				            Definite Poisoning
    		            	</label>
    		            </p>
    		</div>
    	</fieldset>
    </div>
    <div class="row">

    	<div class="small-12 medium-6 large-6  columns">
    		<hr>
	        <h5>Exposures</h5>

	         <div class="row">
	            <div class="large-12 columns">
		            <textarea rows="4" cols="20" placeholder="record unusual exposure events – broken hose lines, spills, etc" id="resent_exposures" name="resent_exposures"></textarea>
	            </div>
	        </div>
    	</div>
    	<div class="small-12 medium-6 large-6  end columns">
    		<hr>
			<h5>illnesses</h5>

	         <div class="row">
	            <div class="large-12 columns">
		            <textarea rows="4" cols="20" placeholder="History of work related injury or impairment (if yes, please specify)  " id="recent_illnes" name="recent_illnes"></textarea>
	            </div>
	        </div>
    	</div>
    </div>
    <div class="row">
    </div>

    

    <div class="row">
        <div class="small-6 medium-6 large-6 columns">
            <button class="expand">Save</button>
        </div>
        <div class="small-6 medium-6 large-6 end columns">
            <a href="{{{ URL::to('patients/'.$patientData->pid) }}}" class="button expand">Cancel</a>
        </div>
    </div>

    </form>
    
@stop