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updated the structure plus seperation of add and update pages
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<!DOCTYPE html> | ||
<html lang="en"> | ||
<head> | ||
<meta charset="UTF-8"> | ||
<meta name="viewport" content="width=device-width, initial-scale=1.0"> | ||
<title>Patient Information Form</title> | ||
<link href="../static/style-css-method.css" rel="stylesheet"> | ||
<style> | ||
/* General Styling */ | ||
.container { | ||
display: flex; | ||
flex-wrap: wrap; | ||
gap: 20px; | ||
width: 100%; | ||
max-width: 1200px; | ||
margin: auto; | ||
} | ||
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||
fieldset { | ||
border: 1px solid #ccc; | ||
border-radius: 8px; | ||
padding: 20px; | ||
flex: 0 1 calc(48% - 20px); | ||
box-sizing: border-box; | ||
} | ||
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legend { | ||
font-weight: bold; | ||
} | ||
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label { | ||
display: block; | ||
margin-bottom: 10px; | ||
font-size: 14px; | ||
} | ||
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input, select, textarea { | ||
width: 100%; | ||
padding: 8px; | ||
margin-bottom: 10px; | ||
border: 1px solid #ccc; | ||
border-radius: 4px; | ||
font-size: 14px; | ||
box-sizing: border-box; | ||
} | ||
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textarea { | ||
resize: none; | ||
} | ||
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.checkbox-group { | ||
display: flex; | ||
flex-direction: column; | ||
gap: 5px; | ||
} | ||
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/* Responsive Design */ | ||
@media (max-width: 768px) { | ||
fieldset { | ||
flex: 0 1 100%; | ||
} | ||
} | ||
</style> | ||
</head> | ||
<body> | ||
<div class="sidebar"> | ||
<a href="#" class="navbar-brand">Medical Portal</a> | ||
<ul class="navbar-nav"> | ||
<li class="nav-item"><a href="../" class="nav-link">Home</a></li> | ||
<li class="nav-item"><a href="../dashboard/view-patient" class="nav-link">Patients list</a></li> | ||
</ul> | ||
</div> | ||
|
||
<div class="main-content"> | ||
<section class="hero"> | ||
<h2>Add Patient</h2> | ||
<form action="{{ url_for('update_patient') }}" method="POST"> | ||
<div class="container"> | ||
<!-- Doctor Details --> | ||
<fieldset> | ||
<legend>Doctor Details</legend> | ||
<label for="doctor-email">Doctor E-mail:</label> | ||
<textarea id="doctor-email" name="doctor_email">{{doctor_email}}</textarea> | ||
|
||
<label for="admission-date">Admission Date:</label> | ||
<input type="date" id="admission-date" name="admission-date" value="{{ admission_date }}"> | ||
</fieldset> | ||
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||
<!-- Patient Basic Information --> | ||
<fieldset> | ||
<legend>Patient Basic Information</legend> | ||
<label for="first-name">First Name:</label> | ||
<input type="text" id="first-name" name="first-name" value="{{ firstname }}"> | ||
|
||
<label for="last-name">Last Name:</label> | ||
<input type="text" id="last-name" name="last-name" value="{{ lastname }}"> | ||
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||
<label for="insurance-number">Insurance Number:</label> | ||
<input type="text" id="insurance-number" name="insurance-number" value="{{ insurance_number }}"> | ||
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||
<label for="phone-number">Phone Number:</label> | ||
<input type="tel" id="phone-number" name="phone-number" value="{{ phone_number }}"> | ||
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||
<label for="address">Address:</label> | ||
<textarea id="address" name="address" rows="3">{{address}}</textarea> | ||
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||
<label for="email">E-mail:</label> | ||
<textarea id="email" name="email">{{patient_email}}</textarea> | ||
</fieldset> | ||
|
||
<!-- Demographic Information --> | ||
<fieldset> | ||
<legend>Demographic Information</legend> | ||
<label for="gender">Gender:</label> | ||
<select id="gender" name="gender"> | ||
<option value="male" {% if gender == 'male' %}selected{% endif %}>Male</option> | ||
<option value="female" {% if gender == 'female' %}selected{% endif %}>Female</option> | ||
<option value="other" {% if gender == 'other' %}selected{% endif %}>Other</option> | ||
</select> | ||
|
||
<label for="age">Age:</label> | ||
<input type="number" id="age" name="age" value="{{ age }}"> | ||
|
||
<label for="race">Race:</label> | ||
<input type="text" id="race" name="race" value="{{ race }}"> | ||
|
||
<label for="family-status">Family Status:</label> | ||
<input type="text" id="family-status" name="family-status" value="{{ family_status }}"> | ||
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||
<label for="occupation">Occupation:</label> | ||
<input type="text" id="occupation" name="occupation" value="{{ occupation }}"> | ||
|
||
<label for="height">Height:</label> | ||
<input type="text" id="height" name="height" value="{{ height }}"> | ||
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||
<label for="weight">Weight:</label> | ||
<input type="text" id="weight" name="weight" value="{{ weight }}"> | ||
</fieldset> | ||
|
||
<!-- Vital Signs --> | ||
<fieldset> | ||
<legend>Vital Signs</legend> | ||
<label for="core-temp">Core Temperature:</label> | ||
<input type="text" id="core-temp" name="core-temp" value="{{ core_temp }}"> | ||
|
||
<label for="heart-rate">Heart Rate:</label> | ||
<input type="text" id="heart-rate" name="heart-rate" value="{{ heart_rate }}"> | ||
|
||
<label for="respiratory-rate">Respiratory Rate:</label> | ||
<input type="text" id="respiratory-rate" name="respiratory-rate" value="{{ respiratory_rate }}"> | ||
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||
<label for="blood-oxygen">Blood Oxygen:</label> | ||
<input type="text" id="blood-oxygen" name="blood-oxygen" value="{{ blood_oxygen }}"> | ||
|
||
<label for="blood-pressure">Blood Pressure:</label> | ||
<input type="text" id="blood-pressure" name="blood-pressure" value="{{ blood_pressure }}"> | ||
</fieldset> | ||
|
||
<!-- Immunization Status --> | ||
<fieldset> | ||
<legend>Immunization Status</legend> | ||
<div class="checkbox-group"> | ||
<label><input type="checkbox" name="immunization-status" value="Hepatitis A" {% if 'Hepatitis A' in immunization_status %}checked{% endif %}> Hepatitis A</label> | ||
<label><input type="checkbox" name="immunization-status" value="Hepatitis B" {% if 'Hepatitis B' in immunization_status %}checked{% endif %}> Hepatitis B</label> | ||
<label><input type="checkbox" name="immunization-status" value="HPV" {% if 'HPV' in immunization_status %}checked{% endif %}> HPV</label> | ||
<label><input type="checkbox" name="immunization-status" value="Flu" {% if 'Flu' in immunization_status %}checked{% endif %}> Flu</label> | ||
<label><input type="checkbox" name="immunization-status" value="Yellow Fever" {% if 'Yellow Fever' in immunization_status %}checked{% endif %}> Yellow Fever</label> | ||
</div> | ||
</fieldset> | ||
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||
<!-- Medical History --> | ||
<fieldset> | ||
<legend>Medical History</legend> | ||
<label for="disease-history">Disease History:</label> | ||
<textarea id="disease-history" name="disease-history" rows="4">{{disease_history}}</textarea> | ||
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||
<label for="family-history">Family History:</label> | ||
<textarea id="family-history" name="family-history" rows="3">{{family_history}}</textarea> | ||
</fieldset> | ||
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||
<!-- Laboratory Test Results --> | ||
<fieldset> | ||
<legend>Laboratory Test Results</legend> | ||
<label for="wbc">WBC K/μl:</label> | ||
<input type="text" id="wbc" name="wbc" value="{{ wbc }}"> | ||
<label for="rbc">RBC million/mm3:</label> | ||
<input type="text" id="rbc" name="rbc" value="{{ rbc }}"> | ||
<label for="hco3">HCO3 mEq/L:</label> | ||
<input type="text" id="hco3" name="hco3" value="{{ hco3 }}"> | ||
<label for="glucose">Glucose mg/dL:</label> | ||
<input type="text" id="glucose" name="glucose" value="{{ glucose }}"> | ||
</fieldset> | ||
|
||
<!-- Allergies and Habits --> | ||
<fieldset> | ||
<legend>Allergies and Habits</legend> | ||
<label for="food-allergy">Food Allergy:</label> | ||
<textarea id="food-allergy" name="food-allergy" rows="3">{{food_allergy}}</textarea> | ||
<label for="medication-allergy">Medication Allergy:</label> | ||
<textarea id="medication-allergy" name="medication-allergy" rows="3">{{medication_allergy}}</textarea> | ||
<label for="other-allergy">Other Allergy:</label> | ||
<textarea id="other-allergy" name="other-allergy" rows="3">{{other_allergies}}</textarea> | ||
|
||
<label>Smoking History:</label> | ||
<div> | ||
<label><input type="radio" name="smoking-history" value="yes" {% if smoking_history == 'yes' %}checked{% endif %}> Yes</label> | ||
<label><input type="radio" name="smoking-history" value="no" {% if smoking_history == 'no' %}checked{% endif %}> No</label> | ||
</div> | ||
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||
<label>Alcohol History:</label> | ||
<div> | ||
<label><input type="radio" name="alcohol-history" value="yes" {% if alcohol_history == 'yes' %}checked{% endif %}> Yes</label> | ||
<label><input type="radio" name="alcohol-history" value="no" {% if alcohol_history == 'no' %}checked{% endif %}> No</label> | ||
</div> | ||
</fieldset> | ||
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||
<!-- Review of Systems (ROS) --> | ||
<fieldset> | ||
<legend>Review of Systems (ROS)</legend> | ||
<textarea id="general" name="ros" rows="3">{{ros}}</textarea> | ||
</fieldset> | ||
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||
<!-- Medication History --> | ||
<fieldset> | ||
<legend>Medication History</legend> | ||
<label for="current_med_name">Current Medication:</label> | ||
<textarea id="current_med_name" name="current_med_name" rows="3">{{current_med_name}}</textarea> | ||
<label for="current_med_frequency">Medication Frequency:</label> | ||
<textarea id="current_med_frequency" name="current_med_frequency" rows="3">{{current_med_frequency}}</textarea> | ||
<label for="current_med_dosage">Medication Dosage:</label> | ||
<textarea id="current_med_dosage" name="current_med_dosage" rows="3">{{current_med_dosage}}</textarea> | ||
<label for="past-medication">Past Medication:</label> | ||
<textarea id="past-medication" name="past-medication" rows="3">{{past_medication}}</textarea> | ||
</fieldset> | ||
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||
<!-- History of Present Illness --> | ||
<fieldset> | ||
<legend>History Of Present Illness</legend> | ||
<label for="chief-complaint">Chief Complaint:</label> | ||
<textarea id="chief-complaint" name="chief-complaint" rows="3">{{cc}}</textarea> | ||
<label for="soap-notes">SOAP Notes:</label> | ||
<textarea id="soap-notes" name="soap-notes" rows="3">{{soap}}</textarea> | ||
</fieldset> | ||
</div> | ||
<div style="display: flex; justify-content: flex-end; margin-top: 20px;"> | ||
<button type="submit" onclick="submitForm('update')">Update</button> | ||
</div> | ||
</form> | ||
</section> | ||
</div> | ||
</body> | ||
</html> |