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@@ -0,0 +1,721 @@
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+<?php
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+
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+use App\Models\Point;
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+
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+$category = 'COVID_INTAKE';
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+$endPoint = 'upsertNoteSingleton';
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+
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+$point = Point::where('added_in_segment_id', $segment->id)->where('category', $category)->orderBy('id', 'DESC')->first();
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+$contentData = [
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+ "ans_how_are_you" => '',
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+ "ans_is_address_correct" => null, // yes/no
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+ "ans_corrected_address" => '',
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+ "ans_has_worked_with_an_np_before" => null, // yes/no
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+ "ans_has_worked_with_an_np_before_expl_feedback" => null, // yes/no
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+ "ans_goal_expl_feedback" => null, // yes/no
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+ "ans_quick_intake_expl_feedback" => null, // yes/no
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+ "ans_normal_temp_is_986" => null, // yes/no
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+ "ans_baseline_expl_feedback_1" => null, // yes/no
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+ "ans_baseline_expl_feedback_2" => null, // yes/no
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+
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+ "ans_baseline_temperature" => '',
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+ "ans_currently_running_high" => '',
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+
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+ "ans_baseline_blood_ox" => '',
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+ "ans_blood_ox_by_self" => '', // yes/no
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+ "ans_blood_ox_expl_feedback" => null, // yes/no
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+ "ans_blood_ox_condition_covid" => null, // yes/no
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+ "ans_condition_covid_how_now" => '',
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+ "ans_condition_covid_recovered" => '',
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+ "ans_condition_covid_lingering_symptoms" => '',
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+ "ans_blood_ox_condition_asthma" => null, // yes/no
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+ "ans_condition_asthma_how_now" => '',
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+ "ans_condition_asthma_recovered" => '',
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+ "ans_condition_asthma_lingering_symptoms" => '',
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+ "ans_blood_ox_condition_copd" => null, // yes/no
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+ "ans_condition_copd_how_now" => '',
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+ "ans_condition_copd_recovered" => '',
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+ "ans_condition_copd_lingering_symptoms" => '',
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+ "ans_blood_ox_condition_other" => '',
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+ "ans_condition_other_how_now" => '',
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+ "ans_condition_other_recovered" => '',
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+ "ans_condition_other_lingering_symptoms" => '',
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+
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+ "ans_baseline_heart_rate" => '',
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+ "ans_baseline_bp" => '',
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+ "ans_bp_by_self" => '', // yes/no
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+ "ans_high_bp_ever" => null, // yes/no
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+ "ans_bp_medicine" => null, // yes/no
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+ "ans_bp_medicine_1_type" => '',
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+ "ans_bp_medicine_1_dose" => '',
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+ "ans_bp_medicine_2_type" => '',
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+ "ans_bp_medicine_2_dose" => '',
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+ "ans_bp_medicine_3_type" => '',
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+ "ans_bp_medicine_3_dose" => '',
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+ "ans_cardiac_heart_ever_cad" => null, // yes/no
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+ "ans_cardiac_heart_ever_irr" => null, // yes/no
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+ "ans_cardiac_heart_ever_chf" => null, // yes/no
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+ "ans_cardiac_heart_ever_other" => '',
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+ "ans_chest_pain" => null, // yes/no
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+ "ans_shortness_of_breath" => null, // yes/no
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+ "ans_fatigue" => null, // yes/no
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+ "ans_headache" => null, // yes/no,
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+ "ans_increase_in_heart_rate" => null, // yes/no,
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+ "ans_increase_in_heart_rate_frequency" => '',
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+ "ans_monitor_bp_before_after_workouts" => null, // yes/no,
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+
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+ "ans_covid_vaccine" => null, // yes/no,
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+ "ans_covid_vaccine_no_long_term_safety" => '',
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+ "ans_covid_vaccine_no_short_term_side_effects" => '',
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+ "ans_covid_vaccine_no_logistic_issues" => '',
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+ "ans_covid_vaccine_no_covid19_doubts" => '',
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+ "ans_covid_vaccine_no_vaccine_efficacy_doubts" => '',
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+ "ans_covid_vaccine_no_other" => '',
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+ "ans_covid_vaccine_yes_which" => '',
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+ "ans_covid_vaccine_yes_dose1_date" => '',
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+ "ans_covid_vaccine_yes_dose2_date" => '',
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+ "ans_covid_vaccine_dose1_symptoms" => '',
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+ "ans_covid_vaccine_dose1_symptoms_start" => '',
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+ "ans_covid_vaccine_dose1_symptoms_duration" => '',
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+ "ans_covid_vaccine_dose1_symptoms_medications" => '',
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+ "ans_covid_vaccine_dose1_symptoms_any_from_list" => '',
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+ "ans_covid_vaccine_dose2_symptoms" => '',
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+ "ans_covid_vaccine_dose2_symptoms_start" => '',
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+ "ans_covid_vaccine_dose2_symptoms_duration" => '',
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+ "ans_covid_vaccine_dose2_symptoms_medications" => '',
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+ "ans_covid_vaccine_dose2_symptoms_any_from_list" => '',
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+ "ans_covid_help_for_vaccination" => '',
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+ "ans_covid_cdc_checklist_vaccinated_social_gatherings" => null, // yes/no
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+ "ans_covid_cdc_checklist_vaccinated_social_distancing" => null, // yes/no
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+ "ans_covid_cdc_checklist_vaccinated_mask_wearing" => null, // yes/no
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+ "ans_covid_cdc_checklist_vaccinated_hand_washing" => null, // yes/no
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+ "ans_covid_cdc_checklist_vaccinated_face_rubbing" => null, // yes/no
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+ "ans_covid_cdc_checklist_not_vaccinated_social_gatherings" => null, // yes/no
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+ "ans_covid_cdc_checklist_not_vaccinated_social_distancing" => null, // yes/no
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+ "ans_covid_cdc_checklist_not_vaccinated_mask_wearing" => null, // yes/no
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+ "ans_covid_cdc_checklist_not_vaccinated_hand_washing" => null, // yes/no
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+ "ans_covid_cdc_checklist_not_vaccinated_face_rubbing" => null, // yes/no
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+
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+ "ans_plan_reported_only_baseline_vitals" => null, // checkbox
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+ "ans_plan_instructed_cdc_guidelines" => null, // checkbox
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+ "ans_plan_not_vaccinated_advised_to_get_vaccinated" => null, // checkbox
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+ "ans_plan_not_vaccinated_advised_vaccine_safety" => null, // checkbox
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+ "ans_plan_not_vaccinated_stressed_vaccine_benefits" => null, // checkbox
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+ "ans_plan_not_vaccinated_discussed_barriers_to_vaccination" => null, // checkbox
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+ "ans_plan_not_vaccinated_all_qns_answered" => null, // checkbox
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+ "ans_plan_1_dose_encouraged_to_get_2nd_dose" => null, // checkbox
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+ "ans_plan_1_dose_explained_antibody_development" => null, // checkbox
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+ "ans_plan_1_dose_discussed_barriers_to_vaccination" => null, // checkbox
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+ "ans_plan_1_dose_all_qns_answered" => null, // checkbox
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+ "ans_plan_ls_patient_confirms_understanding_ls_mods" => null, // checkbox
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+ "ans_plan_ls_patient_elects_supervised_ls_mods" => null, // checkbox
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+ "ans_plan_ls_explained_exercise_risks" => null, // checkbox
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+ "ans_plan_ls_instructed_bp_random_times_daily" => null, // checkbox
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+
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+];
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+if (!!@$point->data) {
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+ $contentData = json_decode($point->data, true);
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+}
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+?>
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+<div visit-moe close-on-save close-on-cancel class="d-block p-3">
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+ <form show url="/api/visitPoint/<?= $endPoint ?>" class="mcp-theme-1">
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+ <input type="hidden" name="segmentUid" value="<?= $segment->uid ?>">
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+ <input type="hidden" name="category" value="<?= $category ?>">
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+ <input type="hidden" name="data" value="{{json_encode($contentData)}}">
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+
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+ <p class="mb-2">Hi {{strtolower($patient->sex) === 'M' ? 'Mr.' : 'Mrs.'}} {{$patient->displayName()}}, My name is {{$pro->displayName()}}. I'm a board-certified nurse practitioner.</p>
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+
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+ <div class="mb-2">
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+ <label class="mb-1">How are you?</label>
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+ <textarea data-name="ans_how_are_you" class="form-control form-control-sm" rows="2">{{ @$contentData['ans_how_are_you'] }}</textarea>
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+ </div>
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+
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+ <hr class="my-3">
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+
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+ <div class="mb-2">
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+ <?php
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+ $mailingAddress = implode(' ', [$patient->mailing_address_line1, $patient->mailing_address_line2, $patient->mailing_address_city, $patient->mailing_address_state, $patient->mailing_address_zip]);
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+ ?>
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+ <label class="mb-1">Let me confirm your mailing address for delivery of the self-monitoring kit: {{$mailingAddress}}</label>
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+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_is_address_correct" name="ans_is_address_correct" {{@$contentData['ans_is_address_correct'] && @$contentData['ans_is_address_correct'] === 'yes' ? 'checked' : ''}} value="yes">
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+ <span class="ml-1">Yes</span>
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+ </label>
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_is_address_correct" name="ans_is_address_correct" {{@$contentData['ans_is_address_correct'] && @$contentData['ans_is_address_correct'] === 'no' ? 'checked' : ''}} value="no">
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+ <span class="ml-1">No</span>
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+ </label>
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+ </div>
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+ </div>
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+
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+ <div class="mb-2">
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+ <label class="mb-1">If different from above:</label>
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+ <textarea data-name="ans_corrected_address" class="form-control form-control-sm" rows="1">{{ @$contentData['ans_corrected_address'] }}</textarea>
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+ </div>
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+
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+ <hr class="my-3">
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+
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+ <div class="mb-2">
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+ So it'll be my responsibility to ensure that you know exactly how to use the kit once you get it.
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+ </div>
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+
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+ <div class="mb-2">
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+ <label class="mb-1">Have you ever worked with a nurse practitioner before?</label>
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+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_has_worked_with_an_np_before" name="ans_has_worked_with_an_np_before" {{@$contentData['ans_has_worked_with_an_np_before'] && @$contentData['ans_has_worked_with_an_np_before'] === 'yes' ? 'checked' : ''}} value="yes">
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+ <span class="ml-1">Yes</span>
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+ </label>
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_has_worked_with_an_np_before" name="ans_has_worked_with_an_np_before" {{@$contentData['ans_has_worked_with_an_np_before'] && @$contentData['ans_has_worked_with_an_np_before'] === 'no' ? 'checked' : ''}} value="no">
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+ <span class="ml-1">No</span>
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+ </label>
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+ </div>
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+ </div>
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+
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+ <div class="mb-2 ml-3">
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+ <ul>
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+ <li>Like medical doctors, we have the authority to write prescriptions and order labs.</li>
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+ <li>So if you ever need anything (medical advice, prescriptions, labs, etc.), you can always call me via phone.</li>
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+ <li>Or we can do video calls over Zoom if that's ever helpful.</li>
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+ <li>And because telemedicine is now covered by Medicare and we're allowed to waive co-pays, it's free of charge for patients.</li>
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+ <li>You'll never get a bill or anything.</li>
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+ <li>
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+ <label class="mb-1"><b>Ok?</b></label>
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+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_has_worked_with_an_np_before_expl_feedback" name="ans_has_worked_with_an_np_before_expl_feedback" {{@$contentData['ans_has_worked_with_an_np_before_expl_feedback'] && @$contentData['ans_has_worked_with_an_np_before_expl_feedback'] === 'yes' ? 'checked' : ''}} value="yes">
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+ <span class="ml-1">Yes</span>
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+ </label>
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_has_worked_with_an_np_before_expl_feedback" name="ans_has_worked_with_an_np_before_expl_feedback" {{@$contentData['ans_has_worked_with_an_np_before_expl_feedback'] && @$contentData['ans_has_worked_with_an_np_before_expl_feedback'] === 'no' ? 'checked' : ''}} value="no">
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+ <span class="ml-1">No</span>
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+ </label>
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+ </div>
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+ </li>
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+ </ul>
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+ </div>
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+
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+ <div class="mb-2">
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+ Our goal right now is to help you stay healthy and monitor your most important vital signs at home during this pandemic.
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+ </div>
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+ <div class="mb-2 ml-3">
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+ <ul>
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+ <li>So as you might know, last week Governor Hogan declared a state of emergency.</li>
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+ <li>Right now, there are more individuals hospitalized in Maryland due to COVID-19 than at any previous point in the entire pandemic.</li>
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+ <li>
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+ So self-monitoring your vitals is more important than ever these days because even though vaccines are really effective, there’s an ongoing risk of getting COVID even after vaccination.
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+ <ul>
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+ <li>It’s likely that COVID is going to become ‘endemic’ like the flu, where the virus is here to stay and change season to season.</li>
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+ <li>So you do need a long-term strategy to protect yourself in addition to vaccines.</li>
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+ <li>Small changes in your temperature or oxygen levels are extremely helpful in detecting COVID early, and early treatment is extremely effective at preventing hospitalization.</li>
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+ <li>
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+ <label class="mb-1"><b>Does that make sense?</b></label>
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+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_goal_expl_feedback" name="ans_goal_expl_feedback" {{@$contentData['ans_goal_expl_feedback'] && @$contentData['ans_goal_expl_feedback'] === 'yes' ? 'checked' : ''}} value="yes">
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+ <span class="ml-1">Yes</span>
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+ </label>
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_goal_expl_feedback" name="ans_goal_expl_feedback" {{@$contentData['ans_goal_expl_feedback'] && @$contentData['ans_goal_expl_feedback'] === 'no' ? 'checked' : ''}} value="no">
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+ <span class="ml-1">No</span>
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+ </label>
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+ </div>
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+ </li>
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+ </ul>
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+ </li>
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+ </ul>
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+ </div>
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+
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+ <div class="mb-2">
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+ <label class="mb-1">So today we’re going to conduct a quick intake, I’m going to give you some important information, and then we’ll get you all set up. <b>Ok?</b></label>
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+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_quick_intake_expl_feedback" name="ans_quick_intake_expl_feedback" {{@$contentData['ans_quick_intake_expl_feedback'] && @$contentData['ans_quick_intake_expl_feedback'] === 'yes' ? 'checked' : ''}} value="yes">
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+ <span class="ml-1">Yes</span>
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+ </label>
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_quick_intake_expl_feedback" name="ans_quick_intake_expl_feedback" {{@$contentData['ans_quick_intake_expl_feedback'] && @$contentData['ans_quick_intake_expl_feedback'] === 'no' ? 'checked' : ''}} value="no">
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+ <span class="ml-1">No</span>
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+ </label>
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+ </div>
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+ </div>
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+
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+ <hr class="my-3">
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+
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+ <div class="mb-1">
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+ So first we’re going to talk a little bit about the <b>baseline</b> numbers of your vital signs.
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+ </div>
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+
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+ <div class="mb-1">
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+ Baseline means what is normal for <b>you</b>.
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+ </div>
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+
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+ <div class="mb-2">
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+ <label class="mb-1">For example, have you heard that normal body temperature is 98.6 F?.</label>
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+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_normal_temp_is_986" name="ans_normal_temp_is_986" {{@$contentData['ans_normal_temp_is_986'] && @$contentData['ans_normal_temp_is_986'] === 'yes' ? 'checked' : ''}} value="yes">
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+ <span class="ml-1">Yes</span>
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+ </label>
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+ <label class="my-0 mr-3 d-flex align-items-center">
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+ <input type="radio" data-name="ans_normal_temp_is_986" name="ans_normal_temp_is_986" {{@$contentData['ans_normal_temp_is_986'] && @$contentData['ans_normal_temp_is_986'] === 'no' ? 'checked' : ''}} value="no">
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+ <span class="ml-1">No</span>
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+ </label>
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+ </div>
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+ </div>
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+
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+ <div class="mb-2 ml-3">
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+ <ul>
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+ <li>So, that’s the <b>average</b> for all humans.</li>
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+ <li>But everyone is unique. Some people run hotter and some run colder.</li>
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+ <li>Also, normal body temperature number goes <b>down</b> with age</li>
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+ <li>As we get older our bodies run on a colder temperature.</li>
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+ <li>So when you were 18, your baseline body temperature might have been 98.6, but today it might in fact be 97!</li>
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+ <li>So, what’s normal for one person could be signs of a fever in another person!</li>
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+ <li>So if someone with a baseline temperature of 97.7 measures in at 98.6, it could mean that <b>they’re not actually normal</b> - in fact they are starting to run a fever!</li>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1"><b>Does that make sense?</b></label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_baseline_expl_feedback_1" name="ans_baseline_expl_feedback_1" {{@$contentData['ans_baseline_expl_feedback_1'] && @$contentData['ans_baseline_expl_feedback_1'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_baseline_expl_feedback_1" name="ans_baseline_expl_feedback_1" {{@$contentData['ans_baseline_expl_feedback_1'] && @$contentData['ans_baseline_expl_feedback_1'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </li>
|
|
|
+ </ul>
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1"><b>So the numbers you read on self-monitoring equipment mean different things to different people.</b> So we’re going to go through your vital signs and each meter one by one, and I’m going to ask you some questions about each of them. <b>OK?</b></label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
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|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_baseline_expl_feedback_2" name="ans_baseline_expl_feedback_2" {{@$contentData['ans_baseline_expl_feedback_2'] && @$contentData['ans_baseline_expl_feedback_2'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_baseline_expl_feedback_2" name="ans_baseline_expl_feedback_2" {{@$contentData['ans_baseline_expl_feedback_2'] && @$contentData['ans_baseline_expl_feedback_2'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <hr class="my-3">
|
|
|
+
|
|
|
+ <p><b>Temperature</b></p>
|
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|
+
|
|
|
+ <div class="ml-3">
|
|
|
+
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1">Do you know what your baseline temperature usually reads in at?</label>
|
|
|
+ <input type="text" data-name="ans_baseline_temperature" value="{{@$contentData['ans_baseline_temperature']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <div class="mb-2 ml-3">
|
|
|
+ If you don't, don’t worry, we can measure that once you get the thermometer.
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1">Do you currently feel like you may be running high?</label>
|
|
|
+ <input type="text" data-name="ans_currently_running_high" value="{{@$contentData['ans_currently_running_high']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </div>
|
|
|
+
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <hr class="my-3">
|
|
|
+
|
|
|
+ <p><b>Blood Oxygen / Pulmonary</b></p>
|
|
|
+
|
|
|
+ <div class="ml-3">
|
|
|
+
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1">And what about your baseline blood oxygen, do you know what that usually reads in at?</label>
|
|
|
+ <input type="text" data-name="ans_baseline_blood_ox" value="{{@$contentData['ans_baseline_blood_ox']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <div class="mb-2 ml-3">
|
|
|
+ <ul>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">Have you ever operated a fingertip pulse oxygen meter by yourself?</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_blood_ox_by_self" name="ans_blood_ox_by_self" {{@$contentData['ans_blood_ox_by_self'] && @$contentData['ans_blood_ox_by_self'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_blood_ox_by_self" name="ans_blood_ox_by_self" {{@$contentData['ans_blood_ox_by_self'] && @$contentData['ans_blood_ox_by_self'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ Blood oxygen is particularly important to know about these days.
|
|
|
+ <ul>
|
|
|
+ <li>There are many causes of fever.</li>
|
|
|
+ <li>Most of them, like the normal flu, don’t affect your oxygen level.</li>
|
|
|
+ <li>COVID, however, almost always causes a drop in your oxygen level!</li>
|
|
|
+ <li>So, if you ever have a fever, and notice a drop in your blood oxygen level as well, it’s more likely to be COVID and you can help you seek appropriate medical attention sooner.</li>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">Does that make sense?</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_blood_ox_expl_feedback" name="ans_blood_ox_expl_feedback" {{@$contentData['ans_blood_ox_expl_feedback'] && @$contentData['ans_blood_ox_expl_feedback'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_blood_ox_expl_feedback" name="ans_blood_ox_expl_feedback" {{@$contentData['ans_blood_ox_expl_feedback'] && @$contentData['ans_blood_ox_expl_feedback'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ Have you ever been diagnosed with any condition that affects the lungs and may possibly affect your blood oxygen readings, such as COVID, asthma, or COPD?
|
|
|
+ <ul>
|
|
|
+ <li>
|
|
|
+ <div>
|
|
|
+ <label class="mb-1">COVID</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_blood_ox_condition_covid" name="ans_blood_ox_condition_covid" {{@$contentData['ans_blood_ox_condition_covid'] && @$contentData['ans_blood_ox_condition_covid'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_blood_ox_condition_covid" name="ans_blood_ox_condition_covid" {{@$contentData['ans_blood_ox_condition_covid'] && @$contentData['ans_blood_ox_condition_covid'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ <ul>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">How are you feeling now?</label>
|
|
|
+ <input type="text" data-name="ans_condition_covid_how_now" value="{{@$contentData['ans_condition_covid_how_now']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">Have you recovered completely?</label>
|
|
|
+ <input type="text" data-name="ans_condition_covid_recovered" value="{{@$contentData['ans_condition_covid_recovered']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">Do you have any lingering symptoms like Shortness of breath, weakness, or brain fog?</label>
|
|
|
+ <input type="text" data-name="ans_condition_covid_lingering_symptoms" value="{{@$contentData['ans_condition_covid_lingering_symptoms']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ </ul>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ <div>
|
|
|
+ <label class="mb-1">Asthma</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_blood_ox_condition_asthma" name="ans_blood_ox_condition_asthma" {{@$contentData['ans_blood_ox_condition_asthma'] && @$contentData['ans_blood_ox_condition_asthma'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_blood_ox_condition_asthma" name="ans_blood_ox_condition_asthma" {{@$contentData['ans_blood_ox_condition_asthma'] && @$contentData['ans_blood_ox_condition_asthma'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ <ul>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">How are you feeling now?</label>
|
|
|
+ <input type="text" data-name="ans_condition_asthma_how_now" value="{{@$contentData['ans_condition_asthma_how_now']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">Have you recovered completely?</label>
|
|
|
+ <input type="text" data-name="ans_condition_asthma_recovered" value="{{@$contentData['ans_condition_asthma_recovered']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">Do you have any lingering symptoms like Shortness of breath, weakness, or brain fog?</label>
|
|
|
+ <input type="text" data-name="ans_condition_asthma_lingering_symptoms" value="{{@$contentData['ans_condition_asthma_lingering_symptoms']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ </ul>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ <div>
|
|
|
+ <label class="mb-1">COPD</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_blood_ox_condition_copd" name="ans_blood_ox_condition_copd" {{@$contentData['ans_blood_ox_condition_copd'] && @$contentData['ans_blood_ox_condition_copd'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_blood_ox_condition_copd" name="ans_blood_ox_condition_copd" {{@$contentData['ans_blood_ox_condition_copd'] && @$contentData['ans_blood_ox_condition_copd'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ <ul>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">How are you feeling now?</label>
|
|
|
+ <input type="text" data-name="ans_condition_copd_how_now" value="{{@$contentData['ans_condition_copd_how_now']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">Have you recovered completely?</label>
|
|
|
+ <input type="text" data-name="ans_condition_copd_recovered" value="{{@$contentData['ans_condition_copd_recovered']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">Do you have any lingering symptoms like Shortness of breath, weakness, or brain fog?</label>
|
|
|
+ <input type="text" data-name="ans_condition_copd_lingering_symptoms" value="{{@$contentData['ans_condition_copd_lingering_symptoms']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ </ul>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ <div>
|
|
|
+ <label class="mb-1">Other</label>
|
|
|
+ <input type="text" data-name="ans_blood_ox_condition_other" value="{{@$contentData['ans_blood_ox_condition_other']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </div>
|
|
|
+ <ul>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">How are you feeling now?</label>
|
|
|
+ <input type="text" data-name="ans_condition_other_how_now" value="{{@$contentData['ans_condition_other_how_now']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">Have you recovered completely?</label>
|
|
|
+ <input type="text" data-name="ans_condition_other_recovered" value="{{@$contentData['ans_condition_other_recovered']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ <li class="mb-2">
|
|
|
+ <label class="mb-1">Do you have any lingering symptoms like Shortness of breath, weakness, or brain fog?</label>
|
|
|
+ <input type="text" data-name="ans_condition_other_lingering_symptoms" value="{{@$contentData['ans_condition_other_lingering_symptoms']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ </ul>
|
|
|
+ </li>
|
|
|
+ </ul>
|
|
|
+ </li>
|
|
|
+
|
|
|
+ </ul>
|
|
|
+ </li>
|
|
|
+ </ul>
|
|
|
+ </div>
|
|
|
+
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <hr class="my-3">
|
|
|
+
|
|
|
+ <p><b>Blood Oxygen / Pulmonary</b></p>
|
|
|
+
|
|
|
+ <div class="ml-3">
|
|
|
+
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1">Do you know what your baseline heart rate and blood pressure usually read in at?</label>
|
|
|
+ <div class="row">
|
|
|
+ <input type="text" data-name="ans_baseline_heart_rate" value="{{@$contentData['ans_baseline_heart_rate']}}" placeholder="Heart Rate" class="form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ <input type="text" data-name="ans_baseline_bp" value="{{@$contentData['ans_baseline_bp']}}" placeholder="BP" class="ml-3 form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1">Have you ever operated a digital blood pressure and pulse meter by yourself?</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_bp_by_self" name="ans_bp_by_self" {{@$contentData['ans_bp_by_self'] && @$contentData['ans_bp_by_self'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_bp_by_self" name="ans_bp_by_self" {{@$contentData['ans_bp_by_self'] && @$contentData['ans_bp_by_self'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1">Have you ever been diagnosed with high blood pressure?</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_high_bp_ever" name="ans_high_bp_ever" {{@$contentData['ans_high_bp_ever'] && @$contentData['ans_high_bp_ever'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_high_bp_ever" name="ans_high_bp_ever" {{@$contentData['ans_high_bp_ever'] && @$contentData['ans_high_bp_ever'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1">Do you take BP medicine?</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_bp_medicine" name="ans_bp_medicine" {{@$contentData['ans_bp_medicine'] && @$contentData['ans_bp_medicine'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_bp_medicine" name="ans_bp_medicine" {{@$contentData['ans_bp_medicine'] && @$contentData['ans_bp_medicine'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </div>
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+
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+ <div class="mb-3 ml-3">
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+ <label class="mb-2">If taking BP medication:</label>
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+ <div class="mb-2">
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+ <input type="text" data-name="ans_bp_medicine_1_type" value="{{@$contentData['ans_bp_medicine_1_type']}}" placeholder="Type" class="ml-3 form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ <input type="text" data-name="ans_bp_medicine_1_dose" value="{{@$contentData['ans_bp_medicine_1_dose']}}" placeholder="Dose" class="ml-3 form-control form-control-sm d-inline-block w-auto ml-2">
|
|
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+ </div>
|
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+ <div class="mb-2">
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+ <input type="text" data-name="ans_bp_medicine_2_type" value="{{@$contentData['ans_bp_medicine_2_type']}}" placeholder="Type" class="ml-3 form-control form-control-sm d-inline-block w-auto ml-2">
|
|
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+ <input type="text" data-name="ans_bp_medicine_2_dose" value="{{@$contentData['ans_bp_medicine_2_dose']}}" placeholder="Dose" class="ml-3 form-control form-control-sm d-inline-block w-auto ml-2">
|
|
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+ </div>
|
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+ <div class="mb-2">
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+ <input type="text" data-name="ans_bp_medicine_3_type" value="{{@$contentData['ans_bp_medicine_3_type']}}" placeholder="Type" class="ml-3 form-control form-control-sm d-inline-block w-auto ml-2">
|
|
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+ <input type="text" data-name="ans_bp_medicine_3_dose" value="{{@$contentData['ans_bp_medicine_3_dose']}}" placeholder="Dose" class="ml-3 form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </div>
|
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+ </div>
|
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+
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+ <div class="mb-2">
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+ <label class="mb-1">Have you ever been diagnosed with any cardiac or heart condition that may affect your heart rate or blood pressure, such as....?</label>
|
|
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+ <ul>
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+ <li>
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+ <label class="mb-1">CAD or other atherosclerosis</label>
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+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
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|
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+ <label class="my-0 mr-3 d-flex align-items-center">
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|
|
+ <input type="radio" data-name="ans_cardiac_heart_ever_cad" name="ans_cardiac_heart_ever_cad" {{@$contentData['ans_cardiac_heart_ever_cad'] && @$contentData['ans_cardiac_heart_ever_cad'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
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+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_cardiac_heart_ever_cad" name="ans_cardiac_heart_ever_cad" {{@$contentData['ans_cardiac_heart_ever_cad'] && @$contentData['ans_cardiac_heart_ever_cad'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
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+ </div>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">Irregular heart rhythm</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_cardiac_heart_ever_irr" name="ans_cardiac_heart_ever_irr" {{@$contentData['ans_cardiac_heart_ever_irr'] && @$contentData['ans_cardiac_heart_ever_irr'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_cardiac_heart_ever_irr" name="ans_cardiac_heart_ever_irr" {{@$contentData['ans_cardiac_heart_ever_irr'] && @$contentData['ans_cardiac_heart_ever_irr'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">CHF</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_cardiac_heart_ever_chf" name="ans_cardiac_heart_ever_chf" {{@$contentData['ans_cardiac_heart_ever_chf'] && @$contentData['ans_cardiac_heart_ever_chf'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_cardiac_heart_ever_chf" name="ans_cardiac_heart_ever_chf" {{@$contentData['ans_cardiac_heart_ever_chf'] && @$contentData['ans_cardiac_heart_ever_chf'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">Other</label>
|
|
|
+ <input type="text" data-name="ans_cardiac_heart_ever_other" value="{{@$contentData['ans_cardiac_heart_ever_other']}}" class="ml-3 form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ </ul>
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1">Do you have any:</label>
|
|
|
+ <ul>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">Chest pain</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_chest_pain" name="ans_chest_pain" {{@$contentData['ans_chest_pain'] && @$contentData['ans_chest_pain'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_chest_pain" name="ans_chest_pain" {{@$contentData['ans_chest_pain'] && @$contentData['ans_chest_pain'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">Shortness of breath?</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_shortness_of_breath" name="ans_shortness_of_breath" {{@$contentData['ans_shortness_of_breath'] && @$contentData['ans_shortness_of_breath'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_shortness_of_breath" name="ans_shortness_of_breath" {{@$contentData['ans_shortness_of_breath'] && @$contentData['ans_shortness_of_breath'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">Fatigue or light-headedness?</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_fatigue" name="ans_fatigue" {{@$contentData['ans_fatigue'] && @$contentData['ans_fatigue'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_fatigue" name="ans_fatigue" {{@$contentData['ans_fatigue'] && @$contentData['ans_fatigue'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">Headache?</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_headache" name="ans_headache" {{@$contentData['ans_headache'] && @$contentData['ans_headache'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_headache" name="ans_headache" {{@$contentData['ans_headache'] && @$contentData['ans_headache'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </li>
|
|
|
+ </ul>
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <div class="mb-2">
|
|
|
+ <label class="mb-1">Do you ever notice an increase in your heart rate?</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_increase_in_heart_rate" name="ans_increase_in_heart_rate" {{@$contentData['ans_increase_in_heart_rate'] && @$contentData['ans_increase_in_heart_rate'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_increase_in_heart_rate" name="ans_increase_in_heart_rate" {{@$contentData['ans_increase_in_heart_rate'] && @$contentData['ans_increase_in_heart_rate'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ <ul>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">How ofter?</label>
|
|
|
+ <input type="text" data-name="ans_increase_in_heart_rate_frequency" value="{{@$contentData['ans_increase_in_heart_rate_frequency']}}" class="ml-3 form-control form-control-sm d-inline-block w-auto ml-2">
|
|
|
+ </li>
|
|
|
+ <li>
|
|
|
+ <label class="mb-1">Do you monitor your BP before / after workouts?</label>
|
|
|
+ <div class="d-inline-flex ml-2 align-items-baseline pt-1">
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_monitor_bp_before_after_workouts" name="ans_monitor_bp_before_after_workouts" {{@$contentData['ans_monitor_bp_before_after_workouts'] && @$contentData['ans_monitor_bp_before_after_workouts'] === 'yes' ? 'checked' : ''}} value="yes">
|
|
|
+ <span class="ml-1">Yes</span>
|
|
|
+ </label>
|
|
|
+ <label class="my-0 mr-3 d-flex align-items-center">
|
|
|
+ <input type="radio" data-name="ans_monitor_bp_before_after_workouts" name="ans_monitor_bp_before_after_workouts" {{@$contentData['ans_monitor_bp_before_after_workouts'] && @$contentData['ans_monitor_bp_before_after_workouts'] === 'no' ? 'checked' : ''}} value="no">
|
|
|
+ <span class="ml-1">No</span>
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ </li>
|
|
|
+ </ul>
|
|
|
+ </div>
|
|
|
+
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <div class="pt-2">
|
|
|
+ <button submit class="btn btn-sm btn-primary mr-2"><i class="fa fa-save"></i></button>
|
|
|
+ <div class="d-inline-flex align-self-stretch align-items-center">
|
|
|
+ <span class="autosave-indicator saving text-sm text-secondary">Saving changes …</span>
|
|
|
+ <span class="autosave-indicator saved text-sm text-secondary">
|
|
|
+ <i class="fa fa-check"></i>
|
|
|
+ Saved
|
|
|
+ </span>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ </form>
|
|
|
+</div>
|
