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@@ -5,21 +5,21 @@
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<div class="col-md-12 section bg-light pt-2 mb-3">
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<div class="mb-4 d-flex align-items-start">
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<label class="mb-0 mr-3">
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- <input type="checkbox" data-name="functional_status" v-model="data.functional_status" />
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+ <input type="checkbox" data-name="functional_status" name="functional_status" v-model="data.functional_status" />
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<b>Functional Status Assessed</b>
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</label>
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<div class="border p-1">
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<div>
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<label class="mb-0 mr-3">
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- <input type="radio" data-name="functional_impairments" value="NO" v-model="data.functional_impairments" />
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+ <input type="radio" data-name="functional_impairments" name="functional_impairments" value="NO" v-model="data.functional_impairments" />
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<span>No Impairments</span>
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</label>
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<label class="mb-0 mr-3">
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- <input type="radio" data-name="functional_impairments" value="YES" v-model="data.functional_impairments" />
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+ <input type="radio" data-name="functional_impairments" name="functional_impairments" value="YES" v-model="data.functional_impairments" />
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<span>Functional Impairments Present</span>
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</label>
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<label class="mb-0 mr-3">
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- <input type="radio" data-name="functional_impairments" value="" v-model="data.functional_impairments" />
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+ <input type="radio" data-name="functional_impairments" name="functional_impairments" value="" v-model="data.functional_impairments" />
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<span>--</span>
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</label>
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</div>
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@@ -28,21 +28,21 @@
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</div>
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<div class="mb-4 d-flex align-items-start">
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<label class="mb-0 mr-3">
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- <input type="checkbox" data-name="cognitive_status" v-model="data.cognitive_status" />
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+ <input type="checkbox" data-name="cognitive_status" name="cognitive_status" v-model="data.cognitive_status" />
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<b>Cognitive Status Assessed</b>
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</label>
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<div class="border p-1">
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<div>
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<label class="mb-0 mr-3">
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- <input type="radio" data-name="cognitive_impairments" value="NO" v-model="data.cognitive_impairments" />
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+ <input type="radio" data-name="cognitive_impairments" name="cognitive_impairments" value="NO" v-model="data.cognitive_impairments" />
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<span>No Impairments</span>
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</label>
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<label class="mb-0 mr-3">
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- <input type="radio" data-name="cognitive_impairments" value="YES" v-model="data.cognitive_impairments" />
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+ <input type="radio" data-name="cognitive_impairments" name="cognitive_impairments" value="YES" v-model="data.cognitive_impairments" />
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<span>Functional Impairments Present</span>
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</label>
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<label class="mb-0 mr-3">
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- <input type="radio" data-name="cognitive_impairments" value="" v-model="data.cognitive_impairments" />
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+ <input type="radio" data-name="cognitive_impairments" name="cognitive_impairments" value="" v-model="data.cognitive_impairments" />
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<span>--</span>
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</label>
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</div>
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@@ -52,7 +52,7 @@
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<div class="form-group textarea">
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<label class="m-0">History of Present Illness:</label>
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<div class="d-flex align-items-end">
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- <select data-name="HPI_description" name="HPI_description[]" select2 multiple="multiple" class="form-control form-control-sm" v-model="data.HPI_description">
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+ <select data-name="HPI_description" name="HPI_description[]" multiple="multiple" class="select2" v-model="data.HPI_description">
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</select>
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</div>
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</div>
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