Lifestyle modules - edit revamp

app/Http/Controllers/NoteController.php

@@ -359,6 +359,15 @@ class NoteController extends Controller
         ]);
     }
 
+    public function moduleView(Request $request, Note $note, $segmentInternalName, $view) {
+        return view("app.patient.modules.{$segmentInternalName}.{$view}", [
+            'patient' => $note->client,
+            'note' => $note,
+            'segment' => $note->coreSegment,
+            'segmentInternalName' => $segmentInternalName
+        ]);
+    }
+
     public function rhsSidebar(Request $request, Client $patient, Note $note) {
         return view('app.patient.note.rhs-sidebar', compact('patient', 'note'));
     }

resources/views/app/patient/modules/lifestyle_general/edit.blade.php

@@ -0,0 +1,447 @@
+<?php
+use App\Models\Client;
+use App\Models\Note;
+use App\Models\Point;
+/** @var Client $patient */
+/** @var Note $note */
+/** @var Point $point */
+
+if(!@$sessionKey) {
+    $sessionKey = request()->cookie('sessionKey');
+}
+
+$point = Point::getOrCreateOnlyTopLevelPointOfCategory($note, 'LIFESTYLE_GENERAL', $sessionKey);
+
+$contentData = [
+    "current_overall_health_level" => '',
+    "sleep" => '',
+    "weight_management" => '',
+    "nutrition" => '',
+    "exercise" => '',
+    "purpose_and_connection" => '',
+    "mental_health" => '',
+    "substance_use" => '',
+    "how_important_rank_1_area" => '',
+    "how_confident_rank_1_area" => '',
+    "how_important_rank_2_area" => '',
+    "how_confident_rank_2_area" => '',
+    "how_important_rank_3_area" => '',
+    "how_confident_rank_3_area" => '',
+    "visit_gains" => [],
+    "gain_other_description" => '',
+];
+
+if ($point->lastChildReview && $point->lastChildReview->data) {
+    $point->lastChildReview->data = json_decode($point->lastChildReview->data, true);
+    $contentData = $point->lastChildReview->data;
+}
+?>
+<div class="p-3 mcp-theme-1">
+
+    <div visit-moe close-on-save close-on-cancel class="d-block">
+        <form show url="/api/visitPoint/upsertChildReview" class="mcp-theme-1">
+            <input type="hidden" name="uid" value="<?= $point->uid ?>">
+            <input type="hidden" name="noteUid" value="<?= $note->uid ?>">
+            <input type="hidden" name="segmentUid" value="<?= $note->coreSegment->uid ?>">
+            <input type="hidden" name="data" value="{{json_encode($contentData)}}">
+
+            <div id="edit-univ_sub_lifestyle_general-container">
+
+                <div class="row">
+                    <div class="col-md-12">
+                        <h5 class="bg-light p-1 font-weight-bold">GETTING STARTED</h5>
+                    </div>
+                </div>
+
+                <div class="row">
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        Please circle your current overall <b>LEVEL OF HEALTH</b>
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.current_overall_health_level">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                            <div class="flex-grow-1">
+                                <div class="row mb-2">
+                                    <div class="col-12">
+                                        Please rank the top <b>3 areas</b> you would like to improve with 1 being the most important and
+                                        3 the least important
+                                    </div>
+                                </div>
+                                <table class="table table-sm width-300px table-striped table-bordered m-0">
+                                    <tbody>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Sleep</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.sleep">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Weight Management</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.weight_management">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Nutrition</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.nutrition">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Exercise</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.exercise">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Purpose &amp; Connection</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.purpose_and_connection">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Mental Health</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.mental_health">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Substance Use</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.substance_use">
+                                        </td>
+                                    </tr>
+                                    </tbody>
+                                </table>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                                        the <b>#1</b> most motivated topic area to address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_important_rank_1_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>CONFIDENT</b> are you regarding your ability to make the
+                                        change you ranked as the <b>#1</b> most motivated topic area to
+                                        address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_confident_rank_1_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                                        the <b>#2</b> most motivated topic area to address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_important_rank_2_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>CONFIDENT</b> are you regarding your ability to make the
+                                        change you ranked as the <b>#2</b> most motivated topic area to
+                                        address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_confident_rank_2_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                                        the <b>#3</b> most motivated topic area to address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_important_rank_3_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>CONFIDENT</b> are you regarding your ability to make the
+                                        change you ranked as the <b>#3</b> most motivated topic area to
+                                        address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_confident_rank_3_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-12">
+                                        <div>
+                                            <b>What would you like to gain from this lifestyle visit?</b> Check all that apply
+                                        </div>
+                                        <div class="mt-2">
+                                            <div class="form-check form-check-inline">
+                                                <input class="form-check-input" type="checkbox"
+                                                       id="more_medical_scientific_knowledge"
+                                                       value="more_medical_scientific_knowledge" v-model="data.visit_gains">
+                                                <label class="form-check-label" for="more_medical_scientific_knowledge">More medical/scientific
+                                                    knowledge</label>
+                                            </div>
+                                            <div class="form-check form-check-inline">
+                                                <input class="form-check-input" type="checkbox"
+                                                       id="practical_health_tips"
+                                                       value="practical_health_tips" v-model="data.visit_gains">
+                                                <label class="form-check-label" for="practical_health_tips">Practical health tips</label>
+                                            </div>
+                                            <div class="form-check form-check-inline">
+                                                <input class="form-check-input" type="checkbox" id="accountability"
+                                                       value="accountability" v-model="data.visit_gains">
+                                                <label class="form-check-label" for="accountability">Accountability</label>
+                                            </div>
+                                            <div class="form-check form-check-inline">
+                                                <input class="form-check-input" type="checkbox"
+                                                       id="personalized_plan"
+                                                       value="personalized_plan" v-model="data.visit_gains">
+                                                <label class="form-check-label" for="personalized_plan">Personalized Plan</label>
+                                            </div>
+                                            <div class="form-check form-check-inline">
+                                                <input class="form-check-input" type="checkbox" id="other"
+                                                       value="other"
+                                                       v-model="data.visit_gains">
+                                                <label class="form-check-label" for="other">Other</label>
+                                            </div>
+
+                                            <div v-if="data.visit_gains.indexOf('other') !== -1" class="form-group mt-3">
+                                                <label>Other</label>
+                                                <input type="text" class="form-control" name="gain_other_description"
+                                                       v-model="data.gain_other_description" />
+                                            </div>
+
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                </div>
+
+                <div class="mt-3 pt-3 border-top text-center">
+                    <button type="button" v-on:click.prevent="saveForm()" class="btn btn-sm btn-primary mr-2">Submit</button>
+                    <button type="button" onclick="closeStagPopup()" class="btn btn-sm btn-default border">Cancel</button>
+                </div>
+
+            </div>
+
+            <div class="d-none">
+                <button submit class="btn btn-sm btn-primary mr-2">Submit</button>
+                <button cancel class="btn btn-sm btn-default border">Cancel</button>
+            </div>
+        </form>
+    </div>
+
+</div>
+<script>
+    (function() {
+        function init() {
+
+            runMCInitializer('hide-moes');
+
+            // any JS can come here
+            // will be run on page-load as well as whenever this segment is refreshed
+            new Vue({
+                el: '#edit-univ_sub_lifestyle_general-container',
+                delimiters: ["@{{","}}"],
+                data: {
+                    data: <?= json_encode($contentData) ?>
+                },
+                watch: {
+                    $data: {
+                        handler: function(val, oldVal) {
+                            let parent = $('#edit-univ_sub_lifestyle_general-container').closest('form');
+                            parent.find('[name="data"]').val(JSON.stringify(this.data));
+
+                            // autosave on change
+                            autoSaveSegment(parent.find('[submit]').first());
+                        },
+                        deep: true
+                    }
+                },
+                methods: {
+                    calculateTotal: function() {
+                        var days = !isNaN(parseInt(this.data.days_exercise)) ? parseInt(this.data.days_exercise) : 0;
+                        var min = !isNaN(parseInt(this.data.min_exercise)) ? parseInt(this.data.min_exercise) : 0;
+                        this.data.total_exercise = days * min;
+                    },
+                    saveForm: function() {
+                        let parent = $('#edit-univ_sub_lifestyle_general-container').closest('form');
+                        parent.find('[name="data"]').val(JSON.stringify(this.data));
+                        autoSaveSegmentAndClose(parent.find('[submit]').first());
+                    }
+                }
+            });
+        }
+
+        window.segmentInitializers.lifestyle_general = init;
+
+        addMCInitializer('edit-univ_sub_lifestyle_general-container-{{$note->id}}', init, '#edit-univ_sub_lifestyle_general-container');
+
+    })();
+</script>

resources/views/app/patient/modules/lifestyle_general/summary.blade.php

@@ -0,0 +1,272 @@
+<?php
+
+use App\Models\Client;
+use App\Models\Point;
+use App\Models\Note;
+/** @var Client $patient */
+/** @var Note $note */
+
+$point = Point::getGlobalSingletonOfCategory($patient, 'LIFESTYLE_GENERAL', false);
+
+if ($point && @$point->data) {
+    $contentData = $point->data;
+?>
+
+    <div id="v3_sleep_assessment_section" class="mt-3">
+
+        <div class="row">
+
+            <div class="col-md-12">
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Please circle your current overall <b>LEVEL OF HEALTH</b>
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->current_overall_health_level ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div class="col-md-12">
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row mb-2">
+                            <div class="col-12">
+                                Please rank the top <b>3 areas</b> you would like to improve with 1 being the most important and
+                                3 the least important
+                            </div>
+                        </div>
+                        <table class="table table-sm width-300px table-striped table-bordered m-0">
+                            <tbody>
+                            <tr>
+                                <td class="text-nowrap align-middle">Sleep</td>
+                                <td class="px-3">
+                                    <?= @$contentData->sleep ?>
+                                </td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle">Weight Management</td>
+                                <td class="px-3">
+                                    <?= @$contentData->weight_management ?>
+                                </td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle">Nutrition</td>
+                                <td class="px-3">
+                                    <?= @$contentData->nutrition ?>
+                                </td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle">Exercise</td>
+                                <td class="px-3">
+                                    <?= @$contentData->exercise ?>
+                                </td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle">Purpose &amp; Connection</td>
+                                <td class="px-3">
+                                    <?= @$contentData->purpose_and_connection ?>
+                                </td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle">Mental Health</td>
+                                <td class="px-3">
+                                    <?= @$contentData->mental_health ?>
+                                </td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle">Substance Use</td>
+                                <td class="px-3">
+                                    <?= @$contentData->substance_use ?>
+                                </td>
+                            </tr>
+                            </tbody>
+                        </table>
+                    </div>
+                </div>
+            </div>
+
+            <div class="col-md-12">
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                                the <b>#1</b> most motivated topic area to address?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->how_important_rank_1_area ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div class="col-md-12">
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How <b>CONFIDENT</b> are you regarding your ability to make the
+                                change you ranked as the <b>#1</b> most motivated topic area to
+                                address?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->how_confident_rank_1_area ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div class="col-md-12">
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                                the <b>#2</b> most motivated topic area to address?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->how_important_rank_2_area ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div class="col-md-12">
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How <b>CONFIDENT</b> are you regarding your ability to make the
+                                change you ranked as the <b>#2</b> most motivated topic area to
+                                address?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->how_confident_rank_2_area ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div class="col-md-12">
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                                the <b>#3</b> most motivated topic area to address?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->how_important_rank_3_area ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div class="col-md-12">
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How <b>CONFIDENT</b> are you regarding your ability to make the
+                                change you ranked as the <b>#3</b> most motivated topic area to
+                                address?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->how_confident_rank_3_area ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div class="col-md-12">
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                <div>
+                                    <b>What would you like to gain from this lifestyle visit?</b> Check all that apply
+                                </div>
+                                <div>
+
+                                    <div class="d-flex align-items-center">
+                                        <span class="width-22px">
+                                          <?php if (@$contentData->visit_gains && in_array('more_medical_scientific_knowledge', $contentData->visit_gains)) : ?>
+                                              <i class="fa fa-check"></i>
+                                          <?php endif; ?>
+                                        </span>
+                                        <span class="ml-2">More medical/scientific knowledge</span>
+                                    </div>
+
+                                    <div class="d-flex align-items-center">
+                                        <span class="width-22px">
+                                          <?php if (@$contentData->visit_gains && in_array('practical_health_tips', $contentData->visit_gains)) : ?>
+                                              <i class="fa fa-check"></i>
+                                          <?php endif; ?>
+                                        </span>
+                                        <span class="ml-2">Practical health tips</span>
+                                    </div>
+
+                                    <div class="d-flex align-items-center">
+                                        <span class="width-22px">
+                                          <?php if (@$contentData->visit_gains && in_array('accountability', $contentData->visit_gains)) : ?>
+                                              <i class="fa fa-check"></i>
+                                          <?php endif; ?>
+                                        </span>
+                                        <span class="ml-2">Accountability</span>
+                                    </div>
+
+                                    <div class="d-flex align-items-center">
+                                        <span class="width-22px">
+                                          <?php if (@$contentData->visit_gains && in_array('personalized_plan', $contentData->visit_gains)) : ?>
+                                              <i class="fa fa-check"></i>
+                                          <?php endif; ?>
+                                        </span>
+                                        <span class="ml-2">Personalized Plan</span>
+                                    </div>
+
+                                    <div class="d-flex align-items-center">
+                                        <span class="width-22px">
+                                          <?php if (@$contentData->visit_gains && in_array('other', $contentData->visit_gains)) : ?>
+                                              <i class="fa fa-check"></i>
+                                          <?php endif; ?>
+                                        </span>
+                                        <span class="ml-2">Other</span>
+                                        <span class="ml-2 font-italic text-secondary"><?= @$contentData->gain_other_description ?></span>
+                                    </div>
+
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+        </div>
+    </div>
+
+<?php
+} else {
+    echo '<div class="text-secondary">-</div>';
+}
+?>
+

resources/views/app/patient/modules/lifestyle_nutrition/edit.blade.php

@@ -0,0 +1,1301 @@
+<?php
+use App\Models\Client;
+use App\Models\Note;
+use App\Models\Point;
+/** @var Client $patient */
+/** @var Note $note */
+/** @var Point $point */
+
+if(!@$sessionKey) {
+    $sessionKey = request()->cookie('sessionKey');
+}
+
+$point = Point::getOrCreateOnlyTopLevelPointOfCategory($note, 'LIFESTYLE_NUTRITION', $sessionKey);
+
+$contentData = [
+    "four_leaf_fresh_fruit" => "",
+    "four_leaf_whole_vegetables" => "",
+    "four_leaf_whole_grains" => "",
+    "four_leaf_omega_3" => "",
+    "four_leaf_dairy_foods" => "",
+    "four_leaf_eggs" => "",
+    "four_leaf_cows_milk" => "",
+    "four_leaf_added_sugar" => "",
+    "four_leaf_white_flour" => "",
+    "four_leaf_sweets_salty_snacks" => "",
+    "four_leaf_meat_poultry_and_fish" => "",
+    "four_leaf_vegetable_oil" => "",
+    "nutrition_caffeinated" => "",
+    "nutrition_alcohol" => "",
+    "nutrition_junk_food" => "",
+    "nutrition_restaurant" => "",
+    "nutrition_sugary_drinks" => "",
+    "nutrition_8_glasses" => "",
+    "nutrition_nuts" => "",
+    "nutrition_artificial_sweeteners" => "",
+    "nutrition_salt" => "",
+    "nutrition_processed_meats" => "",
+    "nutrition_text_reactions" => "",
+    "nutrition_text_avoid_foods" => "",
+    "nutrition_text_crave_foods" => "",
+    "nutrition_text_diet_plan" => "",
+    "nutrition_text_overeating" => "",
+    "nutrition_text_food_choices" => "",
+    "nutrition_text_eating_disorder" => "",
+    "nutrition_supplements" => [],
+    "nutrition_oils" => [],
+    "food_recall_breakfast" => "",
+    "food_recall_breakfast_time" => "",
+    "food_recall_lunch" => "",
+    "food_recall_lunch_time" => "",
+    "food_recall_dinner" => "",
+    "food_recall_dinner_time" => "",
+    "food_recall_snacks" => "",
+    "food_recall_snacks_time" => "",
+    "food_recall_drinks" => "",
+    "food_recall_drinks_time" => "",
+    "wm_skip_meals" => "",
+    "wm_snacks" => "",
+    "wm_tv_while_eating" => "",
+    "wm_eating_in_bed" => "",
+    "wm_difficulty_sleeping" => "",
+    "wm_lack_exercise" => "",
+    "wm_lack_purpose" => "",
+    "wm_eating_habit_factors" => [],
+    "wm_eating_situations" => [],
+    "weight_loss_medications" => [],
+    "weight_loss_medications_other" => "",
+    "weight_loss_strategies" => [],
+    "weight_loss_strategies_other" => "",
+    "weight_loss_fad_diets" => [],
+    "weight_loss_fad_diets_other" => "",
+];
+
+if ($point->lastChildReview && $point->lastChildReview->data) {
+    $point->lastChildReview->data = json_decode($point->lastChildReview->data, true);
+    $contentData = $point->lastChildReview->data;
+}
+?>
+<div class="p-3 mcp-theme-1">
+    <div visit-moe close-on-save close-on-cancel class="d-block">
+        <form show url="/api/visitPoint/upsertChildReview" class="mcp-theme-1">
+            <input type="hidden" name="uid" value="<?= $point->uid ?>">
+            <input type="hidden" name="noteUid" value="<?= $note->uid ?>">
+            <input type="hidden" name="segmentUid" value="<?= $note->coreSegment->uid ?>">
+            <input type="hidden" name="data" value="{{json_encode($contentData)}}">
+
+            <div id="edit-univ_sub_nutrition_assessment-container">
+
+                <!-- 4-leaf survey -->
+                <p class="font-weight-bold my-3 font-size-14"><i>The 4Leaf Survey</i></p>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">1.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>FRESH FRUIT.</b> On average, how many daily servings of whole
+                                fresh fruit do you eat? (Fruit juice doesn't count; not a whole plant)
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_fresh_fruit">
+                                    <option value="0">0</option>
+                                    <option value="1-2">1-2</option>
+                                    <option value="3-5">3-5</option>
+                                    <option value="6+">6+</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">2.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>WHOLE VEGETABLES.</b> On average, how many daily servings of
+                                whole vegetables do you eat?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px"
+                                        v-model="data.four_leaf_whole_vegetables">
+                                    <option value="0">0</option>
+                                    <option value="1-2">1-2</option>
+                                    <option value="3-5">3-5</option>
+                                    <option value="6+">6+</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">3.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>WHOLE GRAINS, LEGUMES, POTATOES</b> or other starches. On average,
+                                how many daily servings of these foods do you eat?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_whole_grains">
+                                    <option value="0">0</option>
+                                    <option value="1-2">1-2</option>
+                                    <option value="3-5">3-5</option>
+                                    <option value="6+">6+</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">4.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>OMEGA-3s.</b> Are you getting all you need from whole, plant-based
+                                sources like flaxseeds, walnuts, hemp & chia seeds?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_omega_3">
+                                    <option value="No">No</option>
+                                    <option value="Maybe">Maybe</option>
+                                    <option value="Not Sure">Not Sure</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">5.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>DAIRY FOODS.</b> How many days per week do you eat dairy foods
+                                like cheese, yogurt and ice cream? (Soy does not count)
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_dairy_foods">
+                                    <option value="0">0</option>
+                                    <option value="1-2">1-2</option>
+                                    <option value="3-5">3-5</option>
+                                    <option value="6-7">6-7</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">6.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>EGGS.</b> How many days per week do you either eat eggs or add
+                                them as an ingredient when cooking?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_eggs">
+                                    <option value="0">0</option>
+                                    <option value="1-2">1-2</option>
+                                    <option value="3-5">3-5</option>
+                                    <option value="6-7">6-7</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">7.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>COW'S MILK OR CREAM.</b> How many days per week do you drink
+                                them or add to your food, like cereal, coffee, etc.?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_cows_milk">
+                                    <option value="0">0</option>
+                                    <option value="1-2">1-2</option>
+                                    <option value="3-5">3-5</option>
+                                    <option value="6-7">6-7</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">8.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>ADDED SUGAR.</b> Are you really serious about eliminating added
+                                sugar at home and in food products that you buy?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_added_sugar">
+                                    <option value="You bet">You bet</option>
+                                    <option value="Fairly">Fairly</option>
+                                    <option value="Not Very">Not Very</option>
+                                    <option value="No">No</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">9.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>WHITE FLOUR.</b> Bread, pasta, cakes, cookies, etc. How would you
+                                describe your consumption level of these foods.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_white_flour">
+                                    <option value="Zero">Zero</option>
+                                    <option value="Light">Light</option>
+                                    <option value="Medium">Medium</option>
+                                    <option value="Heavy">Heavy</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">10.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>SWEETS & SALTY SNACKS.</b> How would you best describe your
+                                consumption level of these unhealthy foods.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_sweets_salty_snacks">
+                                    <option value="Minimal">Minimal</option>
+                                    <option value="Light">Light</option>
+                                    <option value="Medium">Medium</option>
+                                    <option value="Heavy">Heavy</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">11.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>MEAT, POULTRY AND FISH.</b> How many of your meals per week
+                                include any animal flesh? (beef, pork, lamb, chicken, turkey or fish)
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_meat_poultry_and_fish">
+                                    <option value="0-1">0-1</option>
+                                    <option value="2-5">2-5</option>
+                                    <option value="6-11">6-11</option>
+                                    <option value="12+">12+</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">12.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                <b>VEGETABLE OIL.</b> How many of your meals per week include vegetable
+                                oil, like olive or canola? (All oil is 100% fat, not whole plant)
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.four_leaf_vegetable_oil">
+                                    <option value="0-1">0-1</option>
+                                    <option value="2-5">2-5</option>
+                                    <option value="6-11">6-11</option>
+                                    <option value="12+">12+</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <hr class="my-4">
+
+                <!-- nutrition -->
+                <p class="font-weight-bold my-3 font-size-14"><i>NUTRITION - Eating Patterns</i></p>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                On average, how many cups (8 oz.) of caffeinated beverages do you drink per day (tea, soda, coffee, or
+                                energy drinks)?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.nutrition_caffeinated">
+                                    <option value="0">0</option>
+                                    <option value="1">1</option>
+                                    <option value="2">2</option>
+                                    <option value="3">3</option>
+                                    <option value="4+">4+</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                On average, how many servings of alcohol do you drink per day?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.nutrition_alcohol">
+                                    <option value="0">0</option>
+                                    <option value="1">1</option>
+                                    <option value="2">2</option>
+                                    <option value="3">3</option>
+                                    <option value="4+">4+</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                On average, how often do you snack on convenience or “junk” food per day? (i.e. chips, candy, granola
+                                bars, crackers, cookies, etc.)
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.nutrition_junk_food">
+                                    <option value="0">0</option>
+                                    <option value="1">1</option>
+                                    <option value="2">2</option>
+                                    <option value="3">3</option>
+                                    <option value="4+">4+</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                On average, how many meals do you buy from a restaurant or fast food per week?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.nutrition_restaurant">
+                                    <option value="0">0</option>
+                                    <option value="1">1</option>
+                                    <option value="2">2</option>
+                                    <option value="3">3</option>
+                                    <option value="4+">4+</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                On average, how many cups (8 oz.) of sugary drinks (soda, sports drinks, juice) do you drink per day?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.nutrition_sugary_drinks">
+                                    <option value="0">0</option>
+                                    <option value="1">1</option>
+                                    <option value="2">2</option>
+                                    <option value="3">3</option>
+                                    <option value="4+">4+</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                On average, do you drink at least 8 glasses of water per day?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.nutrition_8_glasses">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                On average, do you eat at least 5 handfuls of nuts per week? No Yes
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.nutrition_nuts">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you use natural or artificial sweeteners? (i.e. Equal, Stevia, Splenda, Sweet & Low, honey, agave,
+                                etc.) No Yes
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.nutrition_artificial_sweeteners">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you add salt to most of your meals? No Yes
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.nutrition_salt">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">j.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you eat processed meats (i.e. sausage, hot dogs, salami, bacon)?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.nutrition_processed_meats">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">k.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                Do you have any bad reactions (sensitivities or allergies) to food? If yes, please list here:
+                            </div>
+                        </div>
+                        <div class="row">
+                            <div class="col-12">
+                                <input type="text" class="form-control form-control-sm"
+                                       v-model="data.nutrition_text_reactions">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">l.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                Do you avoid any particular foods? If yes, please list here:
+                            </div>
+                        </div>
+                        <div class="row">
+                            <div class="col-12">
+                                <input type="text" class="form-control form-control-sm"
+                                       v-model="data.nutrition_text_avoid_foods">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">m.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                Do you have foods that you crave? If yes, please list here:
+                            </div>
+                        </div>
+                        <div class="row">
+                            <div class="col-12">
+                                <input type="text" class="form-control form-control-sm"
+                                       v-model="data.nutrition_text_crave_foods">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">n.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                Are you currently following a particular diet or nutrition plan? If yes, please list here:
+                            </div>
+                        </div>
+                        <div class="row">
+                            <div class="col-12">
+                                <input type="text" class="form-control form-control-sm"
+                                       v-model="data.nutrition_text_diet_plan">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">o.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                During the last 3 months, did you have any episodes of excessive overeating? If yes please explain here:
+                            </div>
+                        </div>
+                        <div class="row">
+                            <div class="col-12">
+                                <input type="text" class="form-control form-control-sm"
+                                       v-model="data.nutrition_text_overeating">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">p.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                Are you concerned about making the wrong food choices? If yes, please explain here:
+                            </div>
+                        </div>
+                        <div class="row">
+                            <div class="col-12">
+                                <input type="text" class="form-control form-control-sm"
+                                       v-model="data.nutrition_text_food_choices">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">q.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                Have you ever had an eating disorder? If yes, please list here:
+                            </div>
+                        </div>
+                        <div class="row">
+                            <div class="col-12">
+                                <input type="text" class="form-control form-control-sm"
+                                       v-model="data.nutrition_text_eating_disorder">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="row">
+                    <div class="col-6">
+                        <div class="font-weight-bold mb-1">Do you use any of the following VITAMINS or SUPPLEMENTS? <i>Check all that apply</i></div>
+                        <table class="table table-sm table-striped table-bordered m-0">
+                            <tbody>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_supplements" value="Vitamin D"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Vitamin D</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_supplements" value="Calcium"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Calcium</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_supplements" value="Vitamin B12"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Vitamin B12</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_supplements" value="Probiotics"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Probiotics</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_supplements" value="Omega 3"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Omega 3</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_supplements" value="Multivitamin"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Multivitamin</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_supplements" value="Other"></td>
+                                <td class="text-nowrap align-middle">Other</td>
+                                <td class="p-0">
+                                    <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.nutrition_supplements_other">
+                                </td>
+                            </tr>
+                            </tbody>
+                        </table>
+                    </div>
+                    <div class="col-6">
+                        <div class="font-weight-bold mb-1">Do you use any of the following OILS with your meals or cooking? <i>Check all that apply</i></div>
+                        <table class="table table-sm table-striped table-bordered m-0">
+                            <tbody>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_oils" value="Olive Oil"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Olive Oil</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_oils" value="Canola Oil"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Canola Oil</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_oils" value="Vegetable Oil"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Vegetable Oil</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_oils" value="Coconut Oil"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Coconut Oil</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_oils" value="Butter"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Butter</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_oils" value="Lard"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Lard</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.nutrition_oils" value="Other"></td>
+                                <td class="text-nowrap align-middle">Other</td>
+                                <td class="p-0">
+                                    <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.nutrition_oils_other">
+                                </td>
+                            </tr>
+                            </tbody>
+                        </table>
+                    </div>
+                </div>
+                <p class="font-weight-bold my-3 font-size-14">FOOD RECALL: <i>Please record below what AND how much you ate and drank yesterday (or the last typical day)</i></p>
+                <table class="table table-sm table-striped table-bordered m-0">
+                    <tbody>
+                    <tr>
+                        <td class="text-nowrap align-middle">Breakfast:</td>
+                        <td class="p-0 w-50">
+                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.food_recall_breakfast">
+                        </td>
+                        <td class="text-nowrap align-middle">Time:</td>
+                        <td class="p-0">
+                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.food_recall_breakfast_time">
+                        </td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle">Lunch:</td>
+                        <td class="p-0 w-50">
+                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.food_recall_lunch">
+                        </td>
+                        <td class="text-nowrap align-middle">Time:</td>
+                        <td class="p-0">
+                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.food_recall_lunch_time">
+                        </td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle">Dinner:</td>
+                        <td class="p-0 w-50">
+                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.food_recall_dinner">
+                        </td>
+                        <td class="text-nowrap align-middle">Time:</td>
+                        <td class="p-0">
+                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.food_recall_dinner_time">
+                        </td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle">Snacks:</td>
+                        <td class="p-0 w-50">
+                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.food_recall_snacks">
+                        </td>
+                        <td class="text-nowrap align-middle">Time:</td>
+                        <td class="p-0">
+                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.food_recall_snacks_time">
+                        </td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle">Drinks/Beverages:</td>
+                        <td class="p-0 w-50">
+                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.food_recall_drinks">
+                        </td>
+                        <td class="text-nowrap align-middle">Time:</td>
+                        <td class="p-0">
+                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.food_recall_drinks_time">
+                        </td>
+                    </tr>
+                    </tbody>
+                </table>
+                <hr class="my-4">
+
+                <!-- WEIGHT MANAGEMENT -->
+                <p class="font-weight-bold my-3 font-size-14"><i>WEIGHT MANAGEMENT</i></p>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How often do you skip meals?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wm_skip_meals">
+                                    <option value="1">1 - Never</option>
+                                    <option value="2">2 - Seldom</option>
+                                    <option value="3">3 - Sometimes</option>
+                                    <option value="4">4 - Often</option>
+                                    <option value="5">5 - Always</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How often do you snack in between meals?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wm_snacks">
+                                    <option value="1">1 - Never</option>
+                                    <option value="2">2 - Seldom</option>
+                                    <option value="3">3 - Sometimes</option>
+                                    <option value="4">4 - Often</option>
+                                    <option value="5">5 - Always</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How often do you eat while watching TV?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wm_tv_while_eating">
+                                    <option value="1">1 - Never</option>
+                                    <option value="2">2 - Seldom</option>
+                                    <option value="3">3 - Sometimes</option>
+                                    <option value="4">4 - Often</option>
+                                    <option value="5">5 - Always</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How often do you eat while in bed?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wm_eating_in_bed">
+                                    <option value="1">1 - Never</option>
+                                    <option value="2">2 - Seldom</option>
+                                    <option value="3">3 - Sometimes</option>
+                                    <option value="4">4 - Often</option>
+                                    <option value="5">5 - Always</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How often do you have difficulty sleeping?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wm_difficulty_sleeping">
+                                    <option value="1">1 - Never</option>
+                                    <option value="2">2 - Seldom</option>
+                                    <option value="3">3 - Sometimes</option>
+                                    <option value="4">4 - Often</option>
+                                    <option value="5">5 - Always</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How often do you lack physical activity or exercise?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wm_lack_exercise">
+                                    <option value="1">1 - Never</option>
+                                    <option value="2">2 - Seldom</option>
+                                    <option value="3">3 - Sometimes</option>
+                                    <option value="4">4 - Often</option>
+                                    <option value="5">5 - Always</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How often do you feel a lack of purpose or meaning in your life?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wm_lack_purpose">
+                                    <option value="1">1 - Never</option>
+                                    <option value="2">2 - Seldom</option>
+                                    <option value="3">3 - Sometimes</option>
+                                    <option value="4">4 - Often</option>
+                                    <option value="5">5 - Always</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="font-weight-bold mb-1">Which of the following factors apply to your eating habits and current lifestyle? <i>Check all that apply</i></div>
+                <table class="table table-sm table-striped table-bordered mb-3">
+                    <tbody>
+                    <tr>
+
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Like healthy food"></td>
+                        <td class="text-nowrap align-middle">Like healthy food</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Don’t like healthy food"></td>
+                        <td class="text-nowrap align-middle">Don’t like healthy food</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Know how to cook healthy foods"></td>
+                        <td class="text-nowrap align-middle">Know how to cook healthy foods</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Fast eater"></td>
+                        <td class="text-nowrap align-middle">Fast eater</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Eat slowly"></td>
+                        <td class="text-nowrap align-middle">Eat slowly</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Read nutrition labels"></td>
+                        <td class="text-nowrap align-middle">Read nutrition labels</td>
+                    </tr>
+                    <tr>
+
+
+
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Rely on packaged or fast foods"></td>
+                        <td class="text-nowrap align-middle">Rely on packaged or fast foods</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Dislike cooking"></td>
+                        <td class="text-nowrap align-middle">Dislike cooking</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Prepare meals at home"></td>
+                        <td class="text-nowrap align-middle">Prepare meals at home</td>
+                    </tr>
+                    <tr>
+
+
+
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Do not plan meals"></td>
+                        <td class="text-nowrap align-middle">Do not plan meals</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Eat a variety of foods"></td>
+                        <td class="text-nowrap align-middle">Eat a variety of foods</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Always hungry"></td>
+                        <td class="text-nowrap align-middle">Always hungry</td>
+                    </tr>
+                    <tr>
+
+
+
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Late night eater"></td>
+                        <td class="text-nowrap align-middle">Late night eater</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Negative relationship to food"></td>
+                        <td class="text-nowrap align-middle">Negative relationship to food</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Erratic eater"></td>
+                        <td class="text-nowrap align-middle">Erratic eater</td>
+                    </tr>
+                    <tr>
+
+
+
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="No time to prepare healthy food choices"></td>
+                        <td class="text-nowrap align-middle">No time to prepare healthy food choices</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Don’t know how to cook"></td>
+                        <td class="text-nowrap align-middle">Don’t know how to cook</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_habit_factors" value="Live alone or eat alone often"></td>
+                        <td class="text-nowrap align-middle">Live alone or eat alone often</td>
+                    </tr>
+                    </tbody>
+                </table>
+                <div class="font-weight-bold mb-1">Do any of the following situations or emotions cause you to eat? <i>Check all that apply</i></div>
+                <table class="table table-sm table-striped table-bordered m-0">
+                    <tbody>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_situations" value="Sadness"></td>
+                        <td class="text-nowrap align-middle">Sadness</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_situations" value="Pain"></td>
+                        <td class="text-nowrap align-middle">Pain</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_situations" value="Insomnia"></td>
+                        <td class="text-nowrap align-middle">Insomnia</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_situations" value="Anxiety"></td>
+                        <td class="text-nowrap align-middle">Anxiety</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_situations" value="Fatigue"></td>
+                        <td class="text-nowrap align-middle">Fatigue</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_situations" value="Social or Family Situations"></td>
+                        <td class="text-nowrap align-middle">Social or Family Situations</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_situations" value="Boredom"></td>
+                        <td class="text-nowrap align-middle">Boredom</td>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.wm_eating_situations" value="Stress"></td>
+                        <td class="text-nowrap align-middle">Stress</td>
+                    </tr>
+                    </tbody>
+                </table>
+                <hr class="my-4">
+
+                <!-- WEIGHT HISTORY -->
+                <p class="font-weight-bold my-3 font-size-14"><i>WEIGHT HISTORY</i></p>
+                <div class="d-flex align-items-baseline mb-1">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Have you ever been overweight or obese? If yes, answer below:
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_obese">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-1">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Were you overweight as a child?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_obese_child">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-1">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Were you overweight as a teenager?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_obese_teenager">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-1">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Were you overweight between the ages of 20-29?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_obese_20_29">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-1">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Were you overweight between the ages of 30-39?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_obese_30_39">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Were you overweight above the age of 40?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_obese_40_plus">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-1">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Are you currently trying to lose or gain weight?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_looking_to_lose_or_gain">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                If yes, please circle your goal:
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_lose_or_gain">
+                                    <option value="Lose weight">Lose weight</option>
+                                    <option value="Gain weight">Gain weight</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-1">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Have you ever intentionally lost or reduced your weight by more than 5 lbs.?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_intentionally_lost_5_lbs">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                If yes, did you regain weight within 1 year?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_regained_within_a_year">
+                                    <option value="Lose weight">Lose weight</option>
+                                    <option value="Gain weight">Gain weight</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-1">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Have you had weight loss surgery?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.wh_weight_loss_surgery">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                If yes, please list the type of surgery you had:
+                            </div>
+                            <div class="col-6">
+                                <input class="form-control form-control-sm" v-model="data.wh_weight_loss_surgery_text">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="font-weight-bold mb-2">Have you ever used weight loss medications? <i>If yes, circle which ones you have used? If other, please list.</i></div>
+                <div class="d-flex flex-wrap">
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Acutrim" class="mr-2"><span>Acutrim</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Alli" class="mr-2"><span>Alli</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Amphetamines" class="mr-2"><span>Amphetamines</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Anorex" class="mr-2"><span>Anorex</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Belviq" class="mr-2"><span>Belviq</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Byetta" class="mr-2"><span>Byetta</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Contrave" class="mr-2"><span>Contrave</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Dexatrim" class="mr-2"><span>Dexatrim</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Didrex" class="mr-2"><span>Didrex</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Fastin" class="mr-2"><span>Fastin</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Fen-Phen" class="mr-2"><span>Fen-Phen</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Fenfluramine" class="mr-2"><span>Fenfluramine</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Mazanor" class="mr-2"><span>Mazanor</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Meridia" class="mr-2"><span>Meridia</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Obalan" class="mr-2"><span>Obalan</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Phendiet" class="mr-2"><span>Phendiet</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Phentermine" class="mr-2"><span>Phentermine</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Plegine" class="mr-2"><span>Plegine</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Pondimin" class="mr-2"><span>Pondimin</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Prozac" class="mr-2"><span>Prozac</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Qsymia" class="mr-2"><span>Qsymia</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Redux" class="mr-2"><span>Redux</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Sanorex" class="mr-2"><span>Sanorex</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Tenuate" class="mr-2"><span>Tenuate</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Tepanol" class="mr-2"><span>Tepanol</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Vyvanse" class="mr-2"><span>Vyvanse</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Wechless" class="mr-2"><span>Wechless</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Wellbutrin" class="mr-2"><span>Wellbutrin</span></div>
+                    <div class="d-inline-flex width-150px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="Xenical" class="mr-2"><span>Xenical</span></div>
+                    <div class="d-inline-flex text-nowrap align-items-baseline"><input type="checkbox" v-model="data.weight_loss_medications" value="i_dont_remember" class="mr-2"><span>I don't remember the name of the medication</span></div>
+                </div>
+                <div class="d-flex align-items-center mt-1 mb-3">
+                    <input type="checkbox" v-model="data.weight_loss_medications" value="other" class="mr-2">
+                    <span class="mr-2">Other</span>
+                    <input type="text" class="flex-grow-1 form-control form-control-sm" v-model="data.weight_loss_medications_other">
+                </div>
+                <p class="font-weight-bold font=size-14">WEIGHT LOSS STRATEGIES</p>
+                <div class="font-weight-bold mb-2">Have you tried any of the following alternative therapies or programs? <i>Check all that apply. If other, please list.</i></div>
+                <div class="d-flex flex-wrap">
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_strategies" value="Acupuncture" class="mr-2"><span>Acupuncture</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_strategies" value="Acupressure" class="mr-2"><span>Acupressure</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_strategies" value="Nutritionist/Registered Dietitian" class="mr-2"><span>Nutritionist/Registered Dietitian</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_strategies" value="Residential Programs" class="mr-2"><span>Residential Programs</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_strategies" value="Hypnosis" class="mr-2"><span>Hypnosis</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_strategies" value="Physical Activity/Exercises" class="mr-2"><span>Physical Activity/Exercises</span></div>
+                </div>
+                <div class="d-flex align-items-center mt-1 mb-3">
+                    <input type="checkbox" v-model="data.weight_loss_strategies" value="other" class="mr-2">
+                    <span class="mr-2">Other</span>
+                    <input type="text" class="flex-grow-1 form-control form-control-sm" v-model="data.weight_loss_strategies_other">
+                </div>
+                <div class="font-weight-bold mb-2">Which commercial or fad diets have you tried in the past? <i>Check all that apply. If other, please list.</i></div>
+                <div class="d-flex flex-wrap">
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Atkins Diet" class="mr-2"><span>Atkins Diet</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Calorie Counting" class="mr-2"><span>Calorie Counting</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="CHIP" class="mr-2"><span>CHIP</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="DASH" class="mr-2"><span>DASH</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Elimination Diet (Allergy)" class="mr-2"><span>Elimination Diet (Allergy)</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Gluten Free" class="mr-2"><span>Gluten Free</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Jenny Craig" class="mr-2"><span>Jenny Craig</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Low Carb" class="mr-2"><span>Low Carb</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Low Fat" class="mr-2"><span>Low Fat</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Mediterranean Diet" class="mr-2"><span>Mediterranean Diet</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Paleo" class="mr-2"><span>Paleo</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Slim Fast/Meal" class="mr-2"><span>Slim Fast/Meal</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="South Beach" class="mr-2"><span>South Beach</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Vegan" class="mr-2"><span>Vegan</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Vegetarian" class="mr-2"><span>Vegetarian</span></div>
+                    <div class="d-inline-flex width-300px align-items-baseline"><input type="checkbox" v-model="data.weight_loss_fad_diets" value="Weight Watchers" class="mr-2"><span>Weight Watchers</span></div>
+                </div>
+                <div class="d-flex align-items-center mt-1 mb-3">
+                    <input type="checkbox" v-model="data.weight_loss_fad_diets" value="other" class="mr-2">
+                    <span class="mr-2">Other</span>
+                    <input type="text" class="flex-grow-1 form-control form-control-sm" v-model="data.weight_loss_fad_diets_other">
+                </div>
+
+                <div class="mt-3 pt-3 border-top text-center">
+                    <button type="button" v-on:click.prevent="saveForm()" class="btn btn-sm btn-primary mr-2">Submit</button>
+                    <button type="button" onclick="closeStagPopup()" class="btn btn-sm btn-default border">Cancel</button>
+                </div>
+
+            </div>
+
+            <div class="d-none">
+                <button submit class="btn btn-sm btn-primary mr-2">Submit</button>
+                <button cancel class="btn btn-sm btn-default border">Cancel</button>
+            </div>
+        </form>
+    </div>
+</div>
+<script>
+    (function() {
+        function init() {
+
+            runMCInitializer('hide-moes');
+
+            // any JS can come here
+            // will be run on page-load as well as whenever this segment is refreshed
+            new Vue({
+                el: '#edit-univ_sub_nutrition_assessment-container',
+                delimiters: ["@{{","}}"],
+                data: {
+                    data: <?= json_encode($contentData) ?>
+                },
+                watch: {
+                    $data: {
+                        handler: function(val, oldVal) {
+                            let parent = $('#edit-univ_sub_nutrition_assessment-container').closest('form');
+                            parent.find('[name="data"]').val(JSON.stringify(this.data));
+
+                            // autosave on change
+                            autoSaveSegment(parent.find('[submit]').first());
+                        },
+                        deep: true
+                    }
+                },
+                methods: {
+                    saveForm: function() {
+                        let parent = $('#edit-univ_sub_nutrition_assessment-container').closest('form');
+                        parent.find('[name="data"]').val(JSON.stringify(this.data));
+                        autoSaveSegmentAndClose(parent.find('[submit]').first());
+                    }
+                }
+            });
+        }
+
+        window.segmentInitializers.lifestyle_nutrition = init;
+
+        addMCInitializer('edit-univ_sub_nutrition_assessment-container-{{$note->id}}', init, '#edit-univ_sub_nutrition_assessment-container');
+
+    })();
+</script>

resources/views/app/patient/modules/lifestyle_nutrition/summary.blade.php

@@ -0,0 +1,1228 @@
+<?php
+
+use App\Models\Client;
+use App\Models\Point;
+use App\Models\Note;
+/** @var Client $patient */
+/** @var Note $note */
+
+$point = Point::getGlobalSingletonOfCategory($patient, 'LIFESTYLE_NUTRITION', false);
+
+if ($point && @$point->data) {
+    $contentData = $point->data;
+?>
+
+    <div class="mt-3">
+
+        <!-- 4-leaf survey -->
+        <p class="font-weight-bold my-3 font-size-14"><i>The 4Leaf Survey</i></p>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">1.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>FRESH FRUIT.</b> On average, how many daily servings of whole
+                        fresh fruit do you eat? (Fruit juice doesn't count; not a whole plant)
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_fresh_fruit ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">2.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>WHOLE VEGETABLES.</b> On average, how many daily servings of
+                        whole vegetables do you eat?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_whole_vegetables ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">3.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>WHOLE GRAINS, LEGUMES, POTATOES</b> or other starches. On average,
+                        how many daily servings of these foods do you eat?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_whole_grains ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">4.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>OMEGA-3s.</b> Are you getting all you need from whole, plant-based
+                        sources like flaxseeds, walnuts, hemp & chia seeds?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_omega_3 ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">5.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>DAIRY FOODS.</b> How many days per week do you eat dairy foods
+                        like cheese, yogurt and ice cream? (Soy does not count)
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_dairy_foods ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">6.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>EGGS.</b> How many days per week do you either eat eggs or add
+                        them as an ingredient when cooking?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_eggs ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">7.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>COW'S MILK OR CREAM.</b> How many days per week do you drink
+                        them or add to your food, like cereal, coffee, etc.?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_cows_milk ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">8.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>ADDED SUGAR.</b> Are you really serious about eliminating added
+                        sugar at home and in food products that you buy?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_added_sugar ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">9.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>WHITE FLOUR.</b> Bread, pasta, cakes, cookies, etc. How would you
+                        describe your consumption level of these foods.
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_white_flour ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">10.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>SWEETS & SALTY SNACKS.</b> How would you best describe your
+                        consumption level of these unhealthy foods.
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_sweets_salty_snacks ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">11.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>MEAT, POULTRY AND FISH.</b> How many of your meals per week
+                        include any animal flesh? (beef, pork, lamb, chicken, turkey or fish)
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_meat_poultry_and_fish ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">12.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        <b>VEGETABLE OIL.</b> How many of your meals per week include vegetable
+                        oil, like olive or canola? (All oil is 100% fat, not whole plant)
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->four_leaf_vegetable_oil ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <hr class="my-4">
+
+        <!-- nutrition -->
+        <p class="font-weight-bold my-3 font-size-14"><i>NUTRITION - Eating Patterns</i></p>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        On average, how many cups (8 oz.) of caffeinated beverages do you drink per day (tea, soda, coffee, or
+                        energy drinks)?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->nutrition_caffeinated ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        On average, how many servings of alcohol do you drink per day?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->nutrition_alcohol ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        On average, how often do you snack on convenience or “junk” food per day? (i.e. chips, candy, granola
+                        bars, crackers, cookies, etc.)
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->nutrition_junk_food ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        On average, how many meals do you buy from a restaurant or fast food per week?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->nutrition_restaurant ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        On average, how many cups (8 oz.) of sugary drinks (soda, sports drinks, juice) do you drink per day?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->nutrition_sugary_drinks ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        On average, do you drink at least 8 glasses of water per day?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->nutrition_8_glasses ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        On average, do you eat at least 5 handfuls of nuts per week? No Yes
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->nutrition_nuts ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Do you use natural or artificial sweeteners? (i.e. Equal, Stevia, Splenda, Sweet & Low, honey, agave,
+                        etc.) No Yes
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->nutrition_artificial_sweeteners ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Do you add salt to most of your meals? No Yes
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->nutrition_salt ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">j.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Do you eat processed meats (i.e. sausage, hot dogs, salami, bacon)?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->nutrition_processed_meats ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">k.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-12">
+                        Do you have any bad reactions (sensitivities or allergies) to food? If yes, please list here:
+                    </div>
+                </div>
+                <div class="row">
+                    <div class="col-12">
+                        <?= @$contentData->nutrition_text_reactions ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">l.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-12">
+                        Do you avoid any particular foods? If yes, please list here:
+                    </div>
+                </div>
+                <div class="row">
+                    <div class="col-12">
+                        <?= @$contentData->nutrition_text_avoid_foods ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">m.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-12">
+                        Do you have foods that you crave? If yes, please list here:
+                    </div>
+                </div>
+                <div class="row">
+                    <div class="col-12">
+                        <?= @$contentData->nutrition_text_crave_foods ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">n.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-12">
+                        Are you currently following a particular diet or nutrition plan? If yes, please list here:
+                    </div>
+                </div>
+                <div class="row">
+                    <div class="col-12">
+                        <?= @$contentData->nutrition_text_diet_plan ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">o.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-12">
+                        During the last 3 months, did you have any episodes of excessive overeating? If yes please explain here:
+                    </div>
+                </div>
+                <div class="row">
+                    <div class="col-12">
+                        <?= @$contentData->nutrition_text_overeating ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">p.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-12">
+                        Are you concerned about making the wrong food choices? If yes, please explain here:
+                    </div>
+                </div>
+                <div class="row">
+                    <div class="col-12">
+                        <?= @$contentData->nutrition_text_food_choices ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">q.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-12">
+                        Have you ever had an eating disorder? If yes, please list here:
+                    </div>
+                </div>
+                <div class="row">
+                    <div class="col-12">
+                        <?= @$contentData->nutrition_text_eating_disorder ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="row">
+            <div class="col-6">
+                <div class="font-weight-bold mb-1">Do you use any of the following VITAMINS or SUPPLEMENTS? <i>Check all that apply</i></div>
+                <table class="table table-sm table-striped table-bordered m-0">
+                    <tbody>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_supplements && in_array('Vitamin D', $contentData->nutrition_supplements)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Vitamin D</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_supplements && in_array('Calcium', $contentData->nutrition_supplements)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Calcium</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_supplements && in_array('Vitamin B12', $contentData->nutrition_supplements)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Vitamin B12</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_supplements && in_array('Probiotics', $contentData->nutrition_supplements)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Probiotics</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_supplements && in_array('Omega 3', $contentData->nutrition_supplements)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Omega 3</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_supplements && in_array('Multivitamin', $contentData->nutrition_supplements)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Multivitamin</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_supplements && in_array('Other', $contentData->nutrition_supplements)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle">Other</td>
+                        <td class="p-0">
+                            <?= @$contentData->nutrition_supplements_other ?>
+                        </td>
+                    </tr>
+                    </tbody>
+                </table>
+            </div>
+            <div class="col-6">
+                <div class="font-weight-bold mb-1">Do you use any of the following OILS with your meals or cooking? <i>Check all that apply</i></div>
+                <table class="table table-sm table-striped table-bordered m-0">
+                    <tbody>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_oils && in_array('Olive Oil', $contentData->nutrition_oils)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Olive Oil</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_oils && in_array('Canola Oil', $contentData->nutrition_oils)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Canola Oil</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_oils && in_array('Vegetable Oil', $contentData->nutrition_oils)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Vegetable Oil</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_oils && in_array('Coconut Oil', $contentData->nutrition_oils)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Coconut Oil</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_oils && in_array('Butter', $contentData->nutrition_oils)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Butter</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_oils && in_array('Lard', $contentData->nutrition_oils)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle" colspan="2">Lard</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center">
+                            <?php if (@$contentData->nutrition_oils && in_array('Other', $contentData->nutrition_oils)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                        </td>
+                        <td class="text-nowrap align-middle">Other</td>
+                        <td class="p-0">
+                            <?= @$contentData->nutrition_oils_other ?>
+                        </td>
+                    </tr>
+                    </tbody>
+                </table>
+            </div>
+        </div>
+        <p class="font-weight-bold my-3 font-size-14">FOOD RECALL: <i>Please record below what AND how much you ate and drank yesterday (or the last typical day)</i></p>
+        <table class="table table-sm table-striped table-bordered m-0">
+            <tbody>
+            <tr>
+                <td class="text-nowrap align-middle">Breakfast:</td>
+                <td class="p-0 w-50">
+                    <?= @$contentData->food_recall_breakfast ?>
+                </td>
+                <td class="text-nowrap align-middle">Time:</td>
+                <td class="p-0">
+                    <?= @$contentData->food_recall_breakfast_time ?>
+                </td>
+            </tr>
+            <tr>
+                <td class="text-nowrap align-middle">Lunch:</td>
+                <td class="p-0 w-50">
+                    <?= @$contentData->food_recall_lunch ?>
+                </td>
+                <td class="text-nowrap align-middle">Time:</td>
+                <td class="p-0">
+                    <?= @$contentData->food_recall_lunch_time ?>
+                </td>
+            </tr>
+            <tr>
+                <td class="text-nowrap align-middle">Dinner:</td>
+                <td class="p-0 w-50">
+                    <?= @$contentData->food_recall_dinner ?>
+                </td>
+                <td class="text-nowrap align-middle">Time:</td>
+                <td class="p-0">
+                    <?= @$contentData->food_recall_dinner_time ?>
+                </td>
+            </tr>
+            <tr>
+                <td class="text-nowrap align-middle">Snacks:</td>
+                <td class="p-0 w-50">
+                    <?= @$contentData->food_recall_snacks ?>
+                </td>
+                <td class="text-nowrap align-middle">Time:</td>
+                <td class="p-0">
+                    <?= @$contentData->food_recall_snacks_time ?>
+                </td>
+            </tr>
+            <tr>
+                <td class="text-nowrap align-middle">Drinks/Beverages:</td>
+                <td class="p-0 w-50">
+                    <?= @$contentData->food_recall_drinks ?>
+                </td>
+                <td class="text-nowrap align-middle">Time:</td>
+                <td class="p-0">
+                    <?= @$contentData->food_recall_drinks_time ?>
+                </td>
+            </tr>
+            </tbody>
+        </table>
+        <hr class="my-4">
+
+        <!-- WEIGHT MANAGEMENT -->
+        <p class="font-weight-bold my-3 font-size-14"><i>WEIGHT MANAGEMENT</i></p>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        How often do you skip meals?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wm_skip_meals ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        How often do you snack in between meals?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wm_snacks ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        How often do you eat while watching TV?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wm_tv_while_eating ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        How often do you eat while in bed?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wm_eating_in_bed ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        How often do you have difficulty sleeping?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wm_difficulty_sleeping ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        How often do you lack physical activity or exercise?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wm_lack_exercise ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        How often do you feel a lack of purpose or meaning in your life?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wm_lack_purpose ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="font-weight-bold mb-1">Which of the following factors apply to your eating habits and current lifestyle? <i>Check all that apply</i></div>
+        <table class="table table-sm table-striped table-bordered mb-3">
+            <tbody>
+            <tr>
+
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Like healthy food', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Like healthy food</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Don’t like healthy food', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Don’t like healthy food</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Know how to cook healthy foods', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Know how to cook healthy foods</td>
+            </tr>
+            <tr>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Fast eater', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Fast eater</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Eat slowly', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Eat slowly</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Read nutrition labels', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Read nutrition labels</td>
+            </tr>
+            <tr>
+
+
+
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Rely on packaged or fast foods', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Rely on packaged or fast foods</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Dislike cooking', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Dislike cooking</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Prepare meals at home', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Prepare meals at home</td>
+            </tr>
+            <tr>
+
+
+
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Do not plan meals', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Do not plan meals</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Eat a variety of foods', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Eat a variety of foods</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Always hungry', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Always hungry</td>
+            </tr>
+            <tr>
+
+
+
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Late night eater', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Late night eater</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Negative relationship to food', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Negative relationship to food</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Erratic eater', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Erratic eater</td>
+            </tr>
+            <tr>
+
+
+
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('No time to prepare healthy food choices', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">No time to prepare healthy food choices</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Don’t know how to cook', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Don’t know how to cook</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_habit_factors && in_array('Live alone or eat alone often', $contentData->wm_eating_habit_factors)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Live alone or eat alone often</td>
+            </tr>
+            </tbody>
+        </table>
+        <div class="font-weight-bold mb-1">Do any of the following situations or emotions cause you to eat? <i>Check all that apply</i></div>
+        <table class="table table-sm table-striped table-bordered m-0">
+            <tbody>
+            <tr>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_situations && in_array('Sadness', $contentData->wm_eating_situations)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Sadness</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_situations && in_array('Pain', $contentData->wm_eating_situations)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Pain</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_situations && in_array('Insomnia', $contentData->wm_eating_situations)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Insomnia</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_situations && in_array('Anxiety', $contentData->wm_eating_situations)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Anxiety</td>
+            </tr>
+            <tr>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_situations && in_array('Fatigue', $contentData->wm_eating_situations)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Fatigue</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_situations && in_array('Social or Family Situations', $contentData->wm_eating_situations)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Social or Family Situations</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_situations && in_array('Boredom', $contentData->wm_eating_situations)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Boredom</td>
+                <td class="text-nowrap align-middle width-40px text-center">
+                    <?php if (@$contentData->wm_eating_situations && in_array('Stress', $contentData->wm_eating_situations)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                </td>
+                <td class="text-nowrap align-middle">Stress</td>
+            </tr>
+            </tbody>
+        </table>
+        <hr class="my-4">
+
+        <!-- WEIGHT HISTORY -->
+        <p class="font-weight-bold my-3 font-size-14"><i>WEIGHT HISTORY</i></p>
+        <div class="d-flex align-items-baseline mb-1">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Have you ever been overweight or obese? If yes, answer below:
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_obese ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-1">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Were you overweight as a child?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_obese_child ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-1">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Were you overweight as a teenager?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_obese_teenager ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-1">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Were you overweight between the ages of 20-29?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_obese_20_29 ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-1">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Were you overweight between the ages of 30-39?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_obese_30_39 ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Were you overweight above the age of 40?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_obese_40_plus ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-1">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Are you currently trying to lose or gain weight?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_looking_to_lose_or_gain ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        If yes, please circle your goal:
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_lose_or_gain ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-1">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Have you ever intentionally lost or reduced your weight by more than 5 lbs.?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_intentionally_lost_5_lbs ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        If yes, did you regain weight within 1 year?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_regained_within_a_year ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-1">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        Have you had weight loss surgery?
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_weight_loss_surgery ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="d-flex align-items-baseline mb-3">
+            <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+            <div class="flex-grow-1">
+                <div class="row">
+                    <div class="col-6">
+                        If yes, please list the type of surgery you had:
+                    </div>
+                    <div class="col-6">
+                        <?= @$contentData->wh_weight_loss_surgery_text ?>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="font-weight-bold mb-2">Have you ever used weight loss medications? <i>If yes, circle which ones you have used? If other, please list.</i></div>
+        <div class="d-flex flex-wrap">
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Acutrim', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Acutrim</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Alli', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Alli</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Amphetamines', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Amphetamines</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Anorex', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Anorex</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Belviq', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Belviq</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Byetta', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Byetta</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Contrave', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Contrave</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Dexatrim', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Dexatrim</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Didrex', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Didrex</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Fastin', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Fastin</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Fen-Phen', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Fen-Phen</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Fenfluramine', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Fenfluramine</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Mazanor', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Mazanor</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Meridia', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Meridia</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Obalan', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Obalan</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Phendiet', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Phendiet</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Phentermine', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Phentermine</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Plegine', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Plegine</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Pondimin', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Pondimin</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Prozac', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Prozac</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Qsymia', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Qsymia</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Redux', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Redux</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Sanorex', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Sanorex</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Tenuate', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Tenuate</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Tepanol', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Tepanol</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Vyvanse', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Vyvanse</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Wechless', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Wechless</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Wellbutrin', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Wellbutrin</span>
+            </div>
+            <div class="d-inline-flex width-150px align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('Xenical', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Xenical</span>
+            </div>
+            <div class="d-inline-flex text-nowrap align-items-baseline">
+                <?php if (@$contentData->weight_loss_medications && in_array('i_dont_remember', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>I don't remember the name of the medication</span>
+            </div>
+        </div>
+        <div class="d-flex align-items-center mt-1 mb-3">
+            <?php if (@$contentData->weight_loss_medications && in_array('other', $contentData->weight_loss_medications)) : ?><i class="fa fa-check"></i><?php endif; ?>
+            <span class="mr-2">Other</span>
+            <?= @$contentData->weight_loss_medications_other ?>
+        </div>
+        <p class="font-weight-bold font=size-14">WEIGHT LOSS STRATEGIES</p>
+        <div class="font-weight-bold mb-2">Have you tried any of the following alternative therapies or programs? <i>Check all that apply. If other, please list.</i></div>
+        <div class="d-flex flex-wrap">
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_strategies && in_array('Acupuncture', $contentData->weight_loss_strategies)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Acupuncture</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_strategies && in_array('Acupressure', $contentData->weight_loss_strategies)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Acupressure</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_strategies && in_array('Nutritionist/Registered Dietitian', $contentData->weight_loss_strategies)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Nutritionist/Registered Dietitian</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_strategies && in_array('Residential Programs', $contentData->weight_loss_strategies)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Residential Programs</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_strategies && in_array('Hypnosis', $contentData->weight_loss_strategies)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Hypnosis</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_strategies && in_array('Physical Activity/Exercises', $contentData->weight_loss_strategies)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Physical Activity/Exercises</span>
+            </div>
+        </div>
+        <div class="d-flex align-items-center mt-1 mb-3">
+            <?php if (@$contentData->weight_loss_strategies && in_array('other', $contentData->weight_loss_strategies)) : ?><i class="fa fa-check"></i><?php endif; ?>
+            <span class="mr-2">Other</span>
+            <?= @$contentData->weight_loss_strategies_other ?>
+        </div>
+        <div class="font-weight-bold mb-2">Which commercial or fad diets have you tried in the past? <i>Check all that apply. If other, please list.</i></div>
+        <div class="d-flex flex-wrap">
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Atkins Diet', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Atkins Diet</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Calorie Counting', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Calorie Counting</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('CHIP', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>CHIP</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('DASH', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>DASH</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Elimination Diet (Allergy)', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Elimination Diet (Allergy)</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Gluten Free', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Gluten Free</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Jenny Craig', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Jenny Craig</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Low Carb', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Low Carb</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Low Fat', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Low Fat</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Mediterranean Diet', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Mediterranean Diet</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Paleo', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Paleo</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Slim Fast/Meal', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Slim Fast/Meal</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('South Beach', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>South Beach</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Vegan', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Vegan</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Vegetarian', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Vegetarian</span>
+            </div>
+            <div class="d-inline-flex width-300px align-items-baseline">
+                <?php if (@$contentData->weight_loss_fad_diets && in_array('Weight Watchers', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+                <span>Weight Watchers</span>
+            </div>
+        </div>
+        <div class="d-flex align-items-center mt-1 mb-3">
+            <?php if (@$contentData->weight_loss_fad_diets && in_array('other', $contentData->weight_loss_fad_diets)) : ?><i class="fa fa-check"></i><?php endif; ?>
+            <span class="mr-2">Other</span>
+            <?= @$contentData->weight_loss_fad_diets_other ?>
+        </div>
+    </div>
+
+<?php
+} else {
+    echo '<div class="text-secondary">-</div>';
+}
+?>
+

resources/views/app/patient/modules/lifestyle_physical_activity/edit.blade.php

@@ -0,0 +1,412 @@
+<?php
+use App\Models\Client;
+use App\Models\Note;
+use App\Models\Point;
+/** @var Client $patient */
+/** @var Note $note */
+/** @var Point $point */
+
+if(!@$sessionKey) {
+    $sessionKey = request()->cookie('sessionKey');
+}
+
+$point = Point::getOrCreateOnlyTopLevelPointOfCategory($note, 'LIFESTYLE_PHYSICAL_ACTIVITY', $sessionKey);
+
+$contentData = [
+    "total_exercise" => 0,
+    "days_exercise" => "",
+    "min_exercise" => "",
+    "completing_activities_difficult" => "",
+    "completing_activities_difficult_yes" => "",
+    "health_problems" => [],
+    "activities_done" => "",
+    "exercise_motivation" => [],
+    "barriers_exercise" => [],
+    "injuries_difficult" => "",
+    "injuries_difficult_yes" => "",
+    "bone_problems" => "",
+    "bone_problems_yes" => "",
+    "breathing_problems" => "",
+    "breathing_problems_yes" => "",
+    "balance_problems" => "",
+    "balance_problems_yes" => ""
+];
+
+if ($point->lastChildReview && $point->lastChildReview->data) {
+    $point->lastChildReview->data = json_decode($point->lastChildReview->data, true);
+    $contentData = $point->lastChildReview->data;
+}
+?>
+<div class="p-3 mcp-theme-1">
+    <div visit-moe close-on-save close-on-cancel class="d-block">
+        <form show url="/api/visitPoint/upsertChildReview" class="mcp-theme-1">
+            <input type="hidden" name="uid" value="<?= $point->uid ?>">
+            <input type="hidden" name="noteUid" value="<?= $note->uid ?>">
+            <input type="hidden" name="segmentUid" value="<?= $note->coreSegment->uid ?>">
+            <input type="hidden" name="data" value="{{json_encode($contentData)}}">
+
+            <div id="edit-univ_sub_physical_activity_assessment-container">
+                <p class="font-weight-bold my-3 font-size-14"><i>Exercise</i></p>
+                <p><b>EXERCISE HABITS: AEROBIC/CARDIO TRAINING</b></p>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-8">
+                                During the average week, how many <b>days</b> do you exercise at a moderate to strenuous intensity (i.e. brisk walking or enough to break a light sweat)?
+                            </div>
+                            <div class="col-4">
+                                <div class="d-flex">
+                                    <input type="number" @change="calculateTotal" min="1" max="7" class="form-control mr-1 form-control-sm width-200px" v-model="data.days_exercise" value="">days
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-8">
+                                During an average session, how many <b>minutes</b> do you exercise at a moderate to strenuous intensity (i.e. brisk walking or enough movement to break a light sweat)?
+                            </div>
+                            <div class="col-4">
+                                <div class="d-flex">
+                                    <input type="number" @change="calculateTotal" min="1" class="form-control mr-1 form-control-sm width-200px" v-model="data.min_exercise" value="">min
+                                </div>
+                                <span><b>@{{data.total_exercise}}</b> Total min/week (days x min)</span>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-8">
+                                List types of activities you do (i.e. weightlifting, Pilates, kettle ball, resistance machines, exercise bands, etc.):
+                            </div>
+                            <div class="col-4">
+                                <input type="text" class="form-control form-control-sm width-200px" v-model="data.activities_done" value="">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="row mb-3">
+                    <div class="col-6">
+                        <p><b>What MOTIVATES you or would motivate you to exercise?</b> <em>Check top three</em></p>
+                        <table class="table table-sm table-striped table-bordered m-0">
+                            <tbody>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Nothing would motivate me"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Nothing would motivate me</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Control Blood glucose"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Control Blood glucose</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Decrease stress"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Decrease stress</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Increase self-esteem"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Increase self-esteem</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Family or partner"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Family or partner</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Body Image"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Body Image</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Prevent heart disease"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Prevent heart disease</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Improve mood"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Improve mood</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Increase Energy"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Increase Energy</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Prevent Bone loss"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Prevent Bone loss</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Weight reduction"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Weight reduction</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Reduce blood pressure"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Reduce blood pressure</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Improve sleep"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Improve sleep</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.exercise_motivation" value="Other"></td>
+                                <td class="text-nowrap align-middle">Other</td>
+                                <td class="p-0">
+                                    <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none" type="text" v-model="data.exercise_motivation_other">
+                                </td>
+                            </tr>
+                            </tbody>
+                        </table>
+                    </div>
+                    <div class="col-6">
+                        <p><b>Are there any BARRIERS or PROBLEMS that limit exercise?</b> <em>Check all that apply</em></p>
+                        <table class="table table-sm table-striped table-bordered m-0">
+                            <tbody>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="No barriers"></td>
+                                <td class="text-nowrap align-middle" colspan="2">No barriers</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="Life Transition Period"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Life Transition Period </td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="Family Responsibility"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Family Responsibility</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="Depression"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Depression </td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="Time"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Time</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="Apparel"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Apparel</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="Work Responsibility"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Work Responsibility </td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="Fear"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Fear</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="Energy"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Energy</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="Cost"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Cost</td>
+                            </tr>
+                            <tr>
+                                <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.barriers_exercise" value="Other"></td>
+                                <td class="text-nowrap align-middle" colspan="2">Other</td>
+                            </tr>
+                            </tbody>
+                        </table>
+                    </div>
+                </div>
+
+                <p><b>EXERCISE SAFETY</b></p>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you have any injuries that would make it difficult to exercise?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.injuries_difficult">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                                <label v-if="data.injuries_difficult == 'Yes'" class="mt-2">If yes, please explain:</label>
+                                <input type="text" class="form-control form-control-sm width-200px" v-if="data.injuries_difficult == 'Yes'" v-model="data.injuries_difficult_yes" value="">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you have any joint, muscle, or bone problems that might get worse with exercise?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.bone_problems">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                                <label v-if="data.bone_problems == 'Yes'" class="mt-2">If yes, please explain:</label>
+                                <input type="text" class="form-control form-control-sm width-200px" v-if="data.bone_problems == 'Yes'" v-model="data.bone_problems_yes" value="">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you have any breathing problems while exercising?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.breathing_problems">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                                <label v-if="data.breathing_problems == 'Yes'" class="mt-2">If yes, please explain:</label>
+                                <input type="text" class="form-control form-control-sm width-200px" v-if="data.breathing_problems == 'Yes'" v-model="data.breathing_problems_yes" value="">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you have any balance problems or have had a fall in the last 6 months?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.balance_problems">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                                <label v-if="data.balance_problems == 'Yes'" class="mt-2">If yes, please explain:</label>
+                                <input type="text" class="form-control form-control-sm width-200px" v-if="data.balance_problems == 'Yes'" v-model="data.balance_problems_yes" value="">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you have any difficulty completing your activities of daily living (i.e. showering, dressing, toileting)?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.completing_activities_difficult">
+                                    <option value="No">No</option>
+                                    <option value="Yes">Yes</option>
+                                </select>
+                                <label v-if="data.completing_activities_difficult == 'Yes'" class="mt-2">If yes, please explain:</label>
+                                <input type="text" class="form-control form-control-sm width-200px" v-if="data.completing_activities_difficult == 'Yes'" v-model="data.completing_activities_difficult_yes" value="">
+                            </div>
+                        </div>
+                    </div>
+                </div>
+
+                <p><b>Do you have any of the following health problems? Check all that apply</b></p>
+                <table class="table table-sm table-striped table-bordered m-0">
+                    <tbody>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.health_problems" value="Arrhythmia or irregular heartbeat"></td>
+                        <td class="text-nowrap align-middle" colspan="2">Arrhythmia or irregular heartbeat </td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.health_problems" value="Arthritis or significant joint pain"></td>
+                        <td class="text-nowrap align-middle" colspan="2">Arthritis or significant joint pain </td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.health_problems" value="Chest pain/angina"></td>
+                        <td class="text-nowrap align-middle" colspan="2">Chest pain/angina</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.health_problems" value="Uncontrolled diabetes"></td>
+                        <td class="text-nowrap align-middle" colspan="2">Uncontrolled diabetes</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.health_problems" value="Severe or uncontrolled heart failure"></td>
+                        <td class="text-nowrap align-middle" colspan="2">Severe or uncontrolled heart failure</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.health_problems" value="Uncontrolled asthma"></td>
+                        <td class="text-nowrap align-middle" colspan="2">Uncontrolled asthma</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.health_problems" value="Recent heart attack"></td>
+                        <td class="text-nowrap align-middle" colspan="2">Recent heart attack</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.health_problems" value="Chronic or unusual fatigue/tiredness"></td>
+                        <td class="text-nowrap align-middle" colspan="2">Chronic or unusual fatigue/tiredness </td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.health_problems" value="Difficulty breathing with activity"></td>
+                        <td class="text-nowrap align-middle" colspan="2">Difficulty breathing with activity</td>
+                    </tr>
+                    <tr>
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.health_problems" value="Other"></td>
+                        <td class="text-nowrap align-middle" colspan="2">Other</td>
+                    </tr>
+                    </tbody>
+                </table>
+
+                <div class="mt-3 pt-3 border-top text-center">
+                    <button type="button" v-on:click.prevent="saveForm()" class="btn btn-sm btn-primary mr-2">Submit</button>
+                    <button type="button" onclick="closeStagPopup()" class="btn btn-sm btn-default border">Cancel</button>
+                </div>
+
+            </div>
+
+            <div class="d-none">
+                <button submit class="btn btn-sm btn-primary mr-2">Submit</button>
+                <button cancel class="btn btn-sm btn-default border">Cancel</button>
+            </div>
+        </form>
+    </div>
+</div>
+<script>
+    (function() {
+        function init() {
+
+            runMCInitializer('hide-moes');
+            // any JS can come here
+            // will be run on page-load as well as whenever this segment is refreshed
+            new Vue({
+                el: '#edit-univ_sub_physical_activity_assessment-container',
+                delimiters: ["@{{","}}"],
+                data: {
+                    data: <?= json_encode($contentData) ?>
+                },
+                watch: {
+                    $data: {
+                        handler: function(val, oldVal) {
+                            let parent = $('#edit-univ_sub_physical_activity_assessment-container').closest('form');
+                            parent.find('[name="data"]').val(JSON.stringify(this.data));
+
+                            // autosave on change
+                            autoSaveSegment(parent.find('[submit]').first());
+                        },
+                        deep: true
+                    }
+                },
+                methods: {
+                    calculateTotal: function() {
+                        var days = !isNaN(parseInt(this.data.days_exercise)) ? parseInt(this.data.days_exercise) : 0;
+                        var min = !isNaN(parseInt(this.data.min_exercise)) ? parseInt(this.data.min_exercise) : 0;
+                        this.data.total_exercise = days * min;
+                    },
+                    saveForm: function() {
+                        let parent = $('#edit-univ_sub_physical_activity_assessment-container').closest('form');
+                        parent.find('[name="data"]').val(JSON.stringify(this.data));
+                        autoSaveSegmentAndClose(parent.find('[submit]').first());
+                    }
+                }
+            });
+        }
+
+        window.segmentInitializers.lifestyle_physical_activity = init;
+
+        addMCInitializer('edit-univ_sub_physical_activity_assessment-container-{{$note->id}}', init, '#edit-univ_sub_physical_activity_assessment-container');
+
+    })();
+</script>

resources/views/app/patient/modules/lifestyle_physical_activity/summary.blade.php

@@ -0,0 +1,455 @@
+<?php
+
+use App\Models\Client;
+use App\Models\Point;
+use App\Models\Note;
+/** @var Client $patient */
+/** @var Note $note */
+
+$point = Point::getGlobalSingletonOfCategory($patient, 'LIFESTYLE_PHYSICAL_ACTIVITY', false);
+
+if ($point && @$point->data) {
+    $contentData = $point->data;
+?>
+
+<div id="v2_physical_assessment_Section" class="mt-3">
+
+    <p class="font-weight-bold my-3 font-size-14"><i>Exercise</i></p>
+    <p><b>EXERCISE HABITS: AEROBIC/CARDIO TRAINING</b></p>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-8">
+                    During the average week, how many <b>days</b> do you exercise at a moderate to strenuous
+                    intensity
+                    (i.e. brisk walking or enough to break a light sweat)?
+                </div>
+                <div class="col-4">
+                    <div class="d-flex">
+                        <?= @$contentData->days_exercise ?> days
+                    </div>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-8">
+                    During an average session, how many <b>minutes</b> do you exercise at a moderate to
+                    strenuous
+                    intensity (i.e. brisk walking or enough movement to break a light sweat)?
+                </div>
+                <div class="col-4">
+                    <div class="d-flex">
+                        <?= @$contentData->min_exercise ?> mins
+                    </div>
+                    <span><b><?= @$contentData->total_exercise ?></b> Total min/week (days x min)</span>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-8">
+                    List types of activities you do (i.e. weightlifting, Pilates, kettle ball, resistance
+                    machines,
+                    exercise bands, etc.):
+                </div>
+                <div class="col-4">
+                    <?= @$contentData->activities_done ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="row mb-3">
+        <div class="col-6">
+            <p><b>What MOTIVATES you or would motivate you to exercise?</b> <em>Check top three</em></p>
+            <table class="table table-sm table-striped table-bordered m-0">
+                <tbody>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Nothing would motivate me', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Nothing would motivate me</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Control Blood glucose', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Control Blood glucose</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Decrease stress', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Decrease stress</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Increase self-esteem', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Increase self-esteem</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Family or partner', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Family or partner</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Body Image', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Body Image</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Prevent heart disease', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Prevent heart disease</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Improve mood', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Improve mood</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Increase Energy', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Increase Energy</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Prevent Bone loss', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Prevent Bone loss</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Weight reduction', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Weight reduction</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Reduce blood pressure', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Reduce blood pressure</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Improve sleep', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Improve sleep</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->exercise_motivation && in_array('Other', $contentData->exercise_motivation)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle">Other</td>
+                    <td class="p-0">
+                        <?= @$contentData->exercise_motivation_other ?>
+                    </td>
+                </tr>
+                </tbody>
+            </table>
+        </div>
+        <div class="col-6">
+            <p><b>Are there any BARRIERS or PROBLEMS that limit exercise?</b> <em>Check all that apply</em></p>
+            <table class="table table-sm table-striped table-bordered m-0">
+                <tbody>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('No barriers', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">No barriers</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('Life Transition Period', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Life Transition Period</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('Family Responsibility', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Family Responsibility</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('Depression', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Depression</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('Time', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Time</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('Apparel', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Apparel</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('Work Responsibility', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Work Responsibility</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('Fear', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Fear</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('Energy', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Energy</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('Cost', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Cost</td>
+                </tr>
+                <tr>
+                    <td class="text-nowrap align-middle width-40px text-center">
+                        <?php if (@$contentData->barriers_exercise && in_array('Other', $contentData->barriers_exercise)): ?>
+                        <i class="fa fa-check"></i>
+                        <?php endif; ?>
+                    </td>
+                    <td class="text-nowrap align-middle" colspan="2">Other</td>
+                </tr>
+                </tbody>
+            </table>
+        </div>
+    </div>
+
+    <p><b>EXERCISE SAFETY</b></p>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Do you have any injuries that would make it difficult to exercise?
+                </div>
+                <div class="col-6">
+                    <b><?= @$contentData->injuries_difficult ?></b>
+                    <div><?= @$contentData->injuries_difficult_yes ?></div>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Do you have any joint, muscle, or bone problems that might get worse with exercise?
+                </div>
+                <div class="col-6">
+                    <b><?= @$contentData->bone_problems ?></b>
+                    <div><?= @$contentData->bone_problems_yes ?></div>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Do you have any breathing problems while exercising?
+                </div>
+                <div class="col-6">
+                    <b><?= @$contentData->breathing_problems ?></b>
+                    <div><?= @$contentData->breathing_problems_yes ?></div>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Do you have any balance problems or have had a fall in the last 6 months?
+                </div>
+                <div class="col-6">
+                    <b><?= @$contentData->balance_problems ?></b>
+                    <div><?= @$contentData->balance_problems_yes ?></div>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Do you have any difficulty completing your activities of daily living (i.e. showering,
+                    dressing,
+                    toileting)?
+                </div>
+                <div class="col-6">
+                    <b><?= @$contentData->completing_activities_difficult ?></b>
+                    <div><?= @$contentData->completing_activities_difficult_yes ?></div>
+                </div>
+            </div>
+        </div>
+    </div>
+
+    <p><b>Do you have any of the following health problems? Check all that apply</b></p>
+    <table class="table table-sm table-striped table-bordered m-0">
+        <tbody>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->health_problems && in_array('Arrhythmia or irregular heartbeat', $contentData->health_problems)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>
+            </td>
+            <td class="text-nowrap align-middle" colspan="2">Arrhythmia or irregular heartbeat</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->health_problems && in_array('Arthritis or significant joint pain', $contentData->health_problems)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>
+            </td>
+            <td class="text-nowrap align-middle" colspan="2">Arthritis or significant joint pain</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->health_problems && in_array('Chest pain/angina', $contentData->health_problems)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>
+            </td>
+            <td class="text-nowrap align-middle" colspan="2">Chest pain/angina</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->health_problems && in_array('Uncontrolled diabetes', $contentData->health_problems)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>
+            </td>
+            <td class="text-nowrap align-middle" colspan="2">Uncontrolled diabetes</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->health_problems && in_array('Severe or uncontrolled heart failure', $contentData->health_problems)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>
+            </td>
+            <td class="text-nowrap align-middle" colspan="2">Severe or uncontrolled heart failure</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->health_problems && in_array('Uncontrolled asthma', $contentData->health_problems)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>
+            </td>
+            <td class="text-nowrap align-middle" colspan="2">Uncontrolled asthma</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->health_problems && in_array('Recent heart attack', $contentData->health_problems)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>
+            </td>
+            <td class="text-nowrap align-middle" colspan="2">Recent heart attack</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->health_problems && in_array('Chronic or unusual fatigue/tiredness', $contentData->health_problems)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>
+            </td>
+            <td class="text-nowrap align-middle" colspan="2">Chronic or unusual fatigue/tiredness</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->health_problems && in_array('Difficulty breathing with activity', $contentData->health_problems)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>
+            </td>
+            <td class="text-nowrap align-middle" colspan="2">Difficulty breathing with activity</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->health_problems && in_array('Other', $contentData->health_problems)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>
+            </td>
+            <td class="text-nowrap align-middle" colspan="2">Other</td>
+        </tr>
+        </tbody>
+    </table>
+</div>
+
+<?php
+} else {
+    echo '<div class="text-secondary">-</div>';
+}
+?>
+

resources/views/app/patient/modules/lifestyle_sleep/edit.blade.php

@@ -0,0 +1,808 @@
+<?php
+use App\Models\Client;
+use App\Models\Note;
+use App\Models\Point;
+/** @var Client $patient */
+/** @var Note $note */
+/** @var Point $point */
+
+if(!@$sessionKey) {
+    $sessionKey = request()->cookie('sessionKey');
+}
+
+$point = Point::getOrCreateOnlyTopLevelPointOfCategory($note, 'LIFESTYLE_SLEEP', $sessionKey);
+
+// replace content data
+$contentData = [
+    "current_overall_health_level" => '',
+    "sleep" => '',
+    "weight_management" => '',
+    "nutrition" => '',
+    "exercise" => '',
+    "purpose_and_connection" => '',
+    "mental_health" => '',
+    "substance_use" => '',
+    "how_important_rank_1_area" => '',
+    "how_confident_rank_1_area" => '',
+    "how_important_rank_2_area" => '',
+    "how_confident_rank_2_area" => '',
+    "how_important_rank_3_area" => '',
+    "how_confident_rank_3_area" => '',
+    "visit_gains" => [],
+    "gain_other_description" => '',
+    "sleep_difficulty_staying_awake_routine_tasks" => '',
+    "sleep_difficulty_staying_awake_driving" => '',
+    "sleep_need_to_nap_during_the_day" => '',
+    "sleep_taken_you_more_than_30_mins_to_sleep" => '',
+    "sleep_woken_up_at_night" => '',
+    "sleep_unintentionally_woken_up_in_morning" => '',
+    "sleep_look_at_screen_within_2_hours_of_sleep" => '',
+    "sleep_legs_or_arms_jerked_during_sleep" => '',
+    "sleep_experienced_creeping_crawling_in_legs" => '',
+    "sleep_snored_loudly_gasped_choked_during_sleep" => '',
+    "sleep_used_sleeping_aids_to_sleep" => '',
+    "sleep_have_a_job_that_requires_shifts" => '',
+    "sleep_have_medical_condition_affecting_sleep" => '',
+    "sleep_do_you_get_at_least_7_8_hours_sleep_weekday" => '',
+    "sleep_do_you_get_at_least_7_8_hours_sleep_weekend" => ''
+];
+
+if ($point->lastChildReview && $point->lastChildReview->data) {
+    $point->lastChildReview->data = json_decode($point->lastChildReview->data, true);
+    $contentData = $point->lastChildReview->data;
+}
+?>
+<div class="p-3 mcp-theme-1">
+    <div visit-moe close-on-save close-on-cancel class="d-block">
+        <form show url="/api/visitPoint/upsertChildReview" class="mcp-theme-1">
+            <input type="hidden" name="uid" value="<?= $point->uid ?>">
+            <input type="hidden" name="noteUid" value="<?= $note->uid ?>">
+            <input type="hidden" name="segmentUid" value="<?= $note->coreSegment->uid ?>">
+            <input type="hidden" name="data" value="{{json_encode($contentData)}}">
+
+            <div id="edit-univ_sub_sleep_assessment-container">
+                <div class="row">
+                    <div class="col-md-12">
+                        <h5 class="bg-light p-1 font-weight-bold">GETTING STARTED</h5>
+                    </div>
+                </div>
+
+                <div class="row">
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        Please circle your current overall <b>LEVEL OF HEALTH</b>
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.current_overall_health_level">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                            <div class="flex-grow-1">
+                                <div class="row mb-2">
+                                    <div class="col-12">
+                                        Please rank the top <b>3 areas</b> you would like to improve with 1 being the most important and
+                                        3 the least important
+                                    </div>
+                                </div>
+                                <table class="table table-sm width-300px table-striped table-bordered m-0">
+                                    <tbody>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Sleep</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.sleep">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Weight Management</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.weight_management">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Nutrition</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.nutrition">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Exercise</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.exercise">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Purpose &amp; Connection</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.purpose_and_connection">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Mental Health</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.mental_health">
+                                        </td>
+                                    </tr>
+                                    <tr>
+                                        <td class="text-nowrap align-middle">Substance Use</td>
+                                        <td class="p-0">
+                                            <input class="form-control form-control-sm min-width-unset border-0 rounded-0 shadow-none"
+                                                   type="number" min="1" max="3" v-model="data.substance_use">
+                                        </td>
+                                    </tr>
+                                    </tbody>
+                                </table>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                                        the <b>#1</b> most motivated topic area to address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_important_rank_1_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>CONFIDENT</b> are you regarding your ability to make the
+                                        change you ranked as the <b>#1</b> most motivated topic area to
+                                        address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_confident_rank_1_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                                        the <b>#2</b> most motivated topic area to address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_important_rank_2_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>CONFIDENT</b> are you regarding your ability to make the
+                                        change you ranked as the <b>#2</b> most motivated topic area to
+                                        address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_confident_rank_2_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                                        the <b>#3</b> most motivated topic area to address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_important_rank_3_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How <b>CONFIDENT</b> are you regarding your ability to make the
+                                        change you ranked as the <b>#3</b> most motivated topic area to
+                                        address?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.how_confident_rank_3_area">
+                                            <option value="0">0 - Very poor health</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5</option>
+                                            <option value="6">6</option>
+                                            <option value="7">7</option>
+                                            <option value="8">8</option>
+                                            <option value="9">9</option>
+                                            <option value="10">10 - Excellent health</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-12">
+                                        <div>
+                                            <b>What would you like to gain from this lifestyle visit?</b> Check all that apply
+                                        </div>
+                                        <div>
+                                            <div class="form-check form-check-inline">
+                                                <input class="form-check-input" type="checkbox" id="more_medical_scientific_knowledge"
+                                                       name="visit_gains" value="more_medical_scientific_knowledge" v-model="data.visit_gains">
+                                                <label class="form-check-label" for="more_medical_scientific_knowledge">More medical/scientific
+                                                    knowledge</label>
+                                            </div>
+                                            <div class="form-check form-check-inline">
+                                                <input class="form-check-input" type="checkbox"
+                                                       name="visit_gains" value="practical_health_tips" v-model="data.visit_gains">
+                                                <label class="form-check-label" for="practical_health_tips">Practical health tips</label>
+                                            </div>
+                                            <div class="form-check form-check-inline">
+                                                <input class="form-check-input" type="checkbox" name="visit_gains"
+                                                       value="accountability" v-model="data.visit_gains">
+                                                <label class="form-check-label" for="accountability">Accountability</label>
+                                            </div>
+                                            <div class="form-check form-check-inline">
+                                                <input class="form-check-input" type="checkbox"
+                                                       name="visit_gains" value="personalized_plan" v-model="data.visit_gains">
+                                                <label class="form-check-label" for="personalized_plan">Personalized Plan</label>
+                                            </div>
+                                            <div class="form-check form-check-inline">
+                                                <input class="form-check-input" type="checkbox" name="visit_gains" value="other"
+                                                       v-model="data.visit_gains">
+                                                <label class="form-check-label" for="other">Other</label>
+                                            </div>
+
+                                            <div v-if="data.visit_gains.indexOf('other') !== -1" class="form-group mt-3">
+                                                <label>Other</label>
+                                                <input type="text" class="form-control" name="gain_other_description"
+                                                       v-model="data.gain_other_description" />
+                                            </div>
+
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                </div>
+
+                <hr>
+
+                <div class="row">
+                    <div class="col-md-12">
+                        <h5 class="bg-light p-1 font-weight-bold">SLEEP</h5>
+                        <p><b>Please answer based on your sleeping patterns OVER the LAST TWO WEEKS</b></p>
+                    </div>
+                </div>
+
+                <div class="row mb-1">
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often have you had difficulty staying awake during routine tasks?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_difficulty_staying_awake_routine_tasks">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often have you had difficulty staying awake while driving?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_difficulty_staying_awake_driving">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often have you felt fatigued or needed to nap during the day?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_need_to_nap_during_the_day">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often has it taken you more than 30 minutes to fall asleep at night?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_taken_you_more_than_30_mins_to_sleep">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often have you woken up at night?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.sleep_woken_up_at_night">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often have you unintentionally woken up early in the morning?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_unintentionally_woken_up_in_morning">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often do you look at a screen within 2 hours of sleeping (i.e. TV, computer, iPad, or Phone)?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_look_at_screen_within_2_hours_of_sleep">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often have your legs or arms jerked during sleep?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_legs_or_arms_jerked_during_sleep">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often have you experienced “creeping” or “crawling” feelings in your legs?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_experienced_creeping_crawling_in_legs">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">j.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often have you snored loudly, gasped, choked, or stopped breathing during sleep?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_snored_loudly_gasped_choked_during_sleep">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">k.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        How often have you used sleeping aids (i.e. tobacco, alcohol, over-the-counter medications, or
+                                        prescription medications) to help you fall asleep?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_used_sleeping_aids_to_sleep">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">l.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        Do you have a job that requires night shifts?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_have_a_job_that_requires_shifts">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">m.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        Do you have a medical condition or chronic pain that interferes with your sleep?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_have_medical_condition_affecting_sleep">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">n.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        On an average weekday do you get at least 7-8 hours of sleep in a 24-hour period?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_do_you_get_at_least_7_8_hours_sleep_weekday">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">o.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        On an average weekend do you get at least 7-8 hours of sleep in a 24-hour period?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.sleep_do_you_get_at_least_7_8_hours_sleep_weekend">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+
+                </div>
+
+                <div class="mt-3 pt-3 border-top text-center">
+                    <button type="button" v-on:click.prevent="saveForm()" class="btn btn-sm btn-primary mr-2">Submit</button>
+                    <button type="button" onclick="closeStagPopup()" class="btn btn-sm btn-default border">Cancel</button>
+                </div>
+
+            </div>
+
+            <div class="d-none">
+                <button submit class="btn btn-sm btn-primary mr-2">Submit</button>
+                <button cancel class="btn btn-sm btn-default border">Cancel</button>
+            </div>
+        </form>
+    </div>
+</div>
+<script>
+    (function() {
+        function init() {
+
+            runMCInitializer('hide-moes');
+            // any JS can come here
+            // will be run on page-load as well as whenever this segment is refreshed
+            new Vue({
+                el: '#edit-univ_sub_sleep_assessment-container',
+                delimiters: ["@{{","}}"],
+                data: {
+                    data: <?= json_encode($contentData) ?>
+                },
+                watch: {
+                    $data: {
+                        handler: function(val, oldVal) {
+                            let parent = $('#edit-univ_sub_sleep_assessment-container').closest('form');
+                            parent.find('[name="data"]').val(JSON.stringify(this.data));
+
+                            // autosave on change
+                            autoSaveSegment(parent.find('[submit]').first());
+                        },
+                        deep: true
+                    }
+                },
+                methods: {
+                    saveForm: function() {
+                        let parent = $('#edit-univ_sub_sleep_assessment-container').closest('form');
+                        parent.find('[name="data"]').val(JSON.stringify(this.data));
+                        autoSaveSegmentAndClose(parent.find('[submit]').first());
+                    }
+                }
+            });
+        }
+
+        window.segmentInitializers.lifestyle_sleep = init;
+
+        addMCInitializer('edit-univ_sub_sleep_assessment-container-{{$note->id}}', init, '#edit-univ_sub_sleep_assessment-container');
+
+    })();
+</script>

resources/views/app/patient/modules/lifestyle_sleep/summary.blade.php

@@ -0,0 +1,534 @@
+<?php
+
+use App\Models\Client;
+use App\Models\Point;
+use App\Models\Note;
+/** @var Client $patient */
+/** @var Note $note */
+
+$point = Point::getGlobalSingletonOfCategory($patient, 'LIFESTYLE_SLEEP', false);
+
+if ($point && @$point->data) {
+$contentData = $point->data;
+?>
+
+<div id="v2_sleep_assessment_section" class="mt-3">
+    <div class="row">
+        <div class="col-md-12">
+            <h5 class="bg-light p-1 font-weight-bold">GETTING STARTED</h5>
+        </div>
+    </div>
+
+    <div class="row">
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            Please circle your current overall <b>LEVEL OF HEALTH</b>
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->current_overall_health_level ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                <div class="flex-grow-1">
+                    <div class="row mb-2">
+                        <div class="col-12">
+                            Please rank the top <b>3 areas</b> you would like to improve with 1 being the most important and
+                            3 the least important
+                        </div>
+                    </div>
+                    <table class="table table-sm width-300px table-striped table-bordered m-0">
+                        <tbody>
+                        <tr>
+                            <td class="text-nowrap align-middle">Sleep</td>
+                            <td class="p-0">
+                                <?= @$contentData->sleep ?>
+                            </td>
+                        </tr>
+                        <tr>
+                            <td class="text-nowrap align-middle">Weight Management</td>
+                            <td class="p-0">
+                                <?= @$contentData->weight_management ?>
+                            </td>
+                        </tr>
+                        <tr>
+                            <td class="text-nowrap align-middle">Nutrition</td>
+                            <td class="p-0">
+                                <?= @$contentData->nutrition ?>
+                            </td>
+                        </tr>
+                        <tr>
+                            <td class="text-nowrap align-middle">Exercise</td>
+                            <td class="p-0">
+                                <?= @$contentData->exercise ?>
+                            </td>
+                        </tr>
+                        <tr>
+                            <td class="text-nowrap align-middle">Purpose &amp; Connection</td>
+                            <td class="p-0">
+                                <?= @$contentData->purpose_and_connection ?>
+                            </td>
+                        </tr>
+                        <tr>
+                            <td class="text-nowrap align-middle">Mental Health</td>
+                            <td class="p-0">
+                                <?= @$contentData->mental_health ?>
+                            </td>
+                        </tr>
+                        <tr>
+                            <td class="text-nowrap align-middle">Substance Use</td>
+                            <td class="p-0">
+                                <?= @$contentData->substance_use ?>
+                            </td>
+                        </tr>
+                        </tbody>
+                    </table>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                            the <b>#1</b> most motivated topic area to address?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->how_important_rank_1_area ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How <b>CONFIDENT</b> are you regarding your ability to make the
+                            change you ranked as the <b>#1</b> most motivated topic area to
+                            address?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->how_confident_rank_1_area ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                            the <b>#2</b> most motivated topic area to address?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->how_important_rank_2_area ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How <b>CONFIDENT</b> are you regarding your ability to make the
+                            change you ranked as the <b>#2</b> most motivated topic area to
+                            address?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->how_confident_rank_2_area ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How <b>IMPORTANT</b> is it for you to make the change you ranked as
+                            the <b>#3</b> most motivated topic area to address?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->how_important_rank_3_area ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How <b>CONFIDENT</b> are you regarding your ability to make the
+                            change you ranked as the <b>#3</b> most motivated topic area to
+                            address?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->how_confident_rank_3_area ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-12">
+                            <div>
+                                <b>What would you like to gain from this lifestyle visit?</b> Check all that apply
+                            </div>
+                            <div>
+
+                                <div class="d-flex align-items-center">
+                    <span>
+                      <?php if (@$contentData->visit_gains && in_array('more_medical_scientific_knowledge', $contentData->visit_gains)) : ?>
+                          <i class="fa fa-check"></i>
+                      <?php endif; ?>
+                    </span>
+                                    <span class="ml-3">More medical/scientific knowledge</span>
+                                </div>
+
+                                <div class="d-flex align-items-center">
+                    <span>
+                      <?php if (@$contentData->visit_gains && in_array('practical_health_tips', $contentData->visit_gains)) : ?>
+                          <i class="fa fa-check"></i>
+                      <?php endif; ?>
+                    </span>
+                                    <span class="ml-3">Practical health tips</span>
+                                </div>
+
+                                <div class="d-flex align-items-center">
+                    <span>
+                      <?php if (@$contentData->visit_gains && in_array('accountability', $contentData->visit_gains)) : ?>
+                          <i class="fa fa-check"></i>
+                      <?php endif; ?>
+                    </span>
+                                    <span class="ml-3">Accountability</span>
+                                </div>
+
+                                <div class="d-flex align-items-center">
+                    <span>
+                      <?php if (@$contentData->visit_gains && in_array('personalized_plan', $contentData->visit_gains)) : ?>
+                          <i class="fa fa-check"></i>
+                      <?php endif; ?>
+                    </span>
+                                    <span class="ml-3">Personalized Plan</span>
+                                </div>
+
+                                <div class="d-flex align-items-center">
+                    <span>
+                      <?php if (@$contentData->visit_gains && in_array('other', $contentData->visit_gains)) : ?>
+                          <i class="fa fa-check"></i>
+                      <?php endif; ?>
+                    </span>
+                                    <span class="ml-3">Other</span>
+                                </div>
+
+                                <div class="form-group mt-3">
+                                    <label>Other</label>
+                                    <?= @$contentData->gain_other_description ?>
+                                </div>
+
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+    </div>
+
+    <hr>
+
+    <div class="row">
+        <div class="col-md-12">
+            <h5 class="bg-light p-1 font-weight-bold">SLEEP</h5>
+            <p><b>Please answer based on your sleeping patterns OVER the LAST TWO WEEKS</b></p>
+        </div>
+    </div>
+
+    <div class="row mb-1">
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often have you had difficulty staying awake during routine tasks?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_difficulty_staying_awake_routine_tasks ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often have you had difficulty staying awake while driving?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_difficulty_staying_awake_driving ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often have you felt fatigued or needed to nap during the day?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_need_to_nap_during_the_day ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often has it taken you more than 30 minutes to fall asleep at night?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_taken_you_more_than_30_mins_to_sleep ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often have you woken up at night?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_woken_up_at_night ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often have you unintentionally woken up early in the morning?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_unintentionally_woken_up_in_morning ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often do you look at a screen within 2 hours of sleeping (i.e. TV, computer, iPad, or Phone)?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_look_at_screen_within_2_hours_of_sleep ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often have your legs or arms jerked during sleep?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_legs_or_arms_jerked_during_sleep ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often have you experienced “creeping” or “crawling” feelings in your legs?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_experienced_creeping_crawling_in_legs ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">j.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often have you snored loudly, gasped, choked, or stopped breathing during sleep?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_snored_loudly_gasped_choked_during_sleep ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">k.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            How often have you used sleeping aids (i.e. tobacco, alcohol, over-the-counter medications, or
+                            prescription medications) to help you fall asleep?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_used_sleeping_aids_to_sleep ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">l.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            Do you have a job that requires night shifts?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_have_a_job_that_requires_shifts ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">m.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            Do you have a medical condition or chronic pain that interferes with your sleep?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_have_medical_condition_affecting_sleep ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">n.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            On an average weekday do you get at least 7-8 hours of sleep in a 24-hour period?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_do_you_get_at_least_7_8_hours_sleep_weekday ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">o.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            On an average weekend do you get at least 7-8 hours of sleep in a 24-hour period?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->sleep_do_you_get_at_least_7_8_hours_sleep_weekend ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+    </div>
+</div>
+
+<?php
+} else {
+    echo '<div class="text-secondary">-</div>';
+}
+?>
+

resources/views/app/patient/modules/lifestyle_social/edit.blade.php

@@ -0,0 +1,293 @@
+<?php
+use App\Models\Client;
+use App\Models\Note;
+use App\Models\Point;
+/** @var Client $patient */
+/** @var Note $note */
+/** @var Point $point */
+
+if(!@$sessionKey) {
+    $sessionKey = request()->cookie('sessionKey');
+}
+
+$point = Point::getOrCreateOnlyTopLevelPointOfCategory($note, 'LIFESTYLE_SOCIAL_RELATIONSHIPS', $sessionKey);
+
+// replace content data
+$contentData = [
+    "social_i_live_purposeful_life" => '',
+    "social_i_have_spiritual_community" => '',
+    "social_i_have_source_of_inner_strength" => '',
+    "social_i_am_satisfied_with_current_belief_system" => '',
+    "social_i_have_people_who_care" => '',
+    "social_i_have_people_who_accept_me_at_my_worst_and_best" => '',
+    "social_i_have_people_i_trust_at_home_or_work" => '',
+    "social_i_get_help_when_i_am_sick" => ''
+];
+
+if ($point->lastChildReview && $point->lastChildReview->data) {
+    $point->lastChildReview->data = json_decode($point->lastChildReview->data, true);
+    $contentData = $point->lastChildReview->data;
+}
+?>
+<div class="p-3 mcp-theme-1">
+    <div visit-moe close-on-save close-on-cancel class="d-block">
+        <form show url="/api/visitPoint/upsertChildReview" class="mcp-theme-1">
+            <input type="hidden" name="uid" value="<?= $point->uid ?>">
+            <input type="hidden" name="noteUid" value="<?= $note->uid ?>">
+            <input type="hidden" name="segmentUid" value="<?= $note->coreSegment->uid ?>">
+            <input type="hidden" name="data" value="{{json_encode($contentData)}}">
+
+            <div id="edit-univ_sub_social_relationships_assessment-container">
+
+                <div class="row">
+                    <div class="col-md-12">
+                        <h5 class="bg-light p-1 font-weight-bold">PURPOSE AND CONNECTION</h5>
+                        <p><b>How often do you agree with the following:</b></p>
+                    </div>
+                </div>
+
+                <div class="row mb-1">
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        I live a purposeful and meaningful life
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm "
+                                                v-model="data.social_i_live_purposeful_life">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        I have a spiritual community that I can turn to in times of need
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm "
+                                                v-model="data.social_i_have_spiritual_community">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        I have a source of inner strength and meaning
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm "
+                                                v-model="data.social_i_have_source_of_inner_strength">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        I am satisfied with my current belief system
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm "
+                                                v-model="data.social_i_am_satisfied_with_current_belief_system">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        I have people who care about what happens to me
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm "
+                                                v-model="data.social_i_have_people_who_care">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        I have people who accept me at my worst and best
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm "
+                                                v-model="data.social_i_have_people_who_accept_me_at_my_worst_and_best">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        I have people I trust at home or work who I can talk to about my problems
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm "
+                                                v-model="data.social_i_have_people_i_trust_at_home_or_work">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        I get help when I’m sick
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm "
+                                                v-model="data.social_i_get_help_when_i_am_sick">
+                                            <option value="1">1 - Never</option>
+                                            <option value="2">2 - Seldom</option>
+                                            <option value="3">3 - Sometimes</option>
+                                            <option value="4">4 - Often</option>
+                                            <option value="5">5 - Always</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+
+
+                </div>
+
+                <div class="mt-3 pt-3 border-top text-center">
+                    <button type="button" v-on:click.prevent="saveForm()" class="btn btn-sm btn-primary mr-2">Submit</button>
+                    <button type="button" onclick="closeStagPopup()" class="btn btn-sm btn-default border">Cancel</button>
+                </div>
+
+            </div>
+
+            <div class="d-none">
+                <button submit class="btn btn-sm btn-primary mr-2">Submit</button>
+                <button cancel class="btn btn-sm btn-default border">Cancel</button>
+            </div>
+        </form>
+    </div>
+</div>
+<script>
+    (function() {
+        function init() {
+
+            runMCInitializer('hide-moes');
+            // any JS can come here
+            // will be run on page-load as well as whenever this segment is refreshed
+            new Vue({
+                el: '#edit-univ_sub_social_relationships_assessment-container',
+                delimiters: ["@{{","}}"],
+                data: {
+                    data: <?= json_encode($contentData) ?>
+                },
+                watch: {
+                    $data: {
+                        handler: function(val, oldVal) {
+                            let parent = $('#edit-univ_sub_social_relationships_assessment-container').closest('form');
+                            parent.find('[name="data"]').val(JSON.stringify(this.data));
+
+                            // autosave on change
+                            autoSaveSegment(parent.find('[submit]').first());
+                        },
+                        deep: true
+                    }
+                },
+                methods: {
+                    saveForm: function() {
+                        let parent = $('#edit-univ_sub_social_relationships_assessment-container').closest('form');
+                        parent.find('[name="data"]').val(JSON.stringify(this.data));
+                        autoSaveSegmentAndClose(parent.find('[submit]').first());
+                    }
+                }
+            });
+        }
+
+        window.segmentInitializers.lifestyle_social = init;
+
+        addMCInitializer('edit-univ_sub_social_relationships_assessment-container-{{$note->id}}', init, '#edit-univ_sub_social_relationships_assessment-container');
+
+    })();
+</script>

resources/views/app/patient/modules/lifestyle_social/summary.blade.php

@@ -0,0 +1,167 @@
+<?php
+
+use App\Models\Client;
+use App\Models\Point;
+use App\Models\Note;
+/** @var Client $patient */
+/** @var Note $note */
+
+$point = Point::getGlobalSingletonOfCategory($patient, 'LIFESTYLE_SOCIAL_RELATIONSHIPS', false);
+
+if ($point && @$point->data) {
+$contentData = $point->data;
+?>
+
+<div id="v2_social_assessment_section" class="mt-3">
+
+    <div class="row">
+        <div class="col-md-12">
+            <h5 class="bg-light p-1 font-weight-bold">PURPOSE AND CONNECTION</h5>
+            <p><b>How often do you agree with the following:</b></p>
+        </div>
+    </div>
+
+    <div class="row mb-1">
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            I live a purposeful and meaningful life
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->social_i_live_purposeful_life ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            I have a spiritual community that I can turn to in times of need
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->social_i_have_spiritual_community ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            I have a source of inner strength and meaning
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->social_i_have_source_of_inner_strength ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            I am satisfied with my current belief system
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->social_i_am_satisfied_with_current_belief_system ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            I have people who care about what happens to me
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->social_i_have_people_who_care ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            I have people who accept me at my worst and best
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->social_i_have_people_who_accept_me_at_my_worst_and_best ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            I have people I trust at home or work who I can talk to about my problems
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->social_i_have_people_i_trust_at_home_or_work ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            I get help when I’m sick
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->social_i_get_help_when_i_am_sick ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+
+
+    </div>
+
+
+
+</div>
+
+<?php
+} else {
+    echo '<div class="text-secondary">-</div>';
+}
+?>
+

resources/views/app/patient/modules/lifestyle_stress/edit.blade.php

@@ -0,0 +1,697 @@
+<?php
+use App\Models\Client;
+use App\Models\Note;
+use App\Models\Point;
+/** @var Client $patient */
+/** @var Note $note */
+/** @var Point $point */
+
+if(!@$sessionKey) {
+    $sessionKey = request()->cookie('sessionKey');
+}
+
+$point = Point::getOrCreateOnlyTopLevelPointOfCategory($note, 'LIFESTYLE_STRESS', $sessionKey);
+
+// replace content data
+$contentData = [
+    "uncontrollable_things_life" => "",
+    "lack_confidence" => "",
+    "things_not_going_well" => "",
+    "let_things_go_hard" => "",
+    "cope_stress" => [],
+    "extreme_stress_learn_from_experience" => "",
+    "extreme_stress_take_action" => "",
+    "extreme_stress_prioritize_importance" => "",
+    "extreme_stress_opportunity_to_grow" => "",
+    "extreme_stress_set_goals" => "",
+    "extreme_stress_ways_around_problem" => "",
+    "extreme_stress_motivated_to_pursue_goals" => "",
+    "extreme_stress_know_can_get_through_it" => "",
+    "body_connect_set_goals" => "",
+    "body_connect_feelings_affect" => "",
+    "body_connect_emotion_experience" => "",
+    "body_connect_tension_aware" => "",
+    "body_connect_angry" => "",
+    "body_connect_stress" => "",
+    "body_connect_emotion_react" => "",
+    "depression_little_interest" => "",
+    "depression_feeling_depressed" => "",
+    "depression_trouble_sleeping" => "",
+    "depression_feeling_tired" => "",
+    "depression_poor_appetite" => "",
+    "depression_feeling_bad_self" => "",
+    "depression_trouble_concentrating" => "",
+    "depression_moving_slow" => "",
+    "depression_hurting_self" => "",
+    "anxiety_feeling_nervous" => "",
+    "anxiety_uncontrollable_worry" => "",
+    "anxiety_worry_different_things" => "",
+    "anxiety_trouble_relaxing" => "",
+    "anxiety_restless" => "",
+    "anxiety_easily_annoyed" => ""
+];
+
+if ($point->lastChildReview && $point->lastChildReview->data) {
+    $point->lastChildReview->data = json_decode($point->lastChildReview->data, true);
+    $contentData = $point->lastChildReview->data;
+}
+?>
+<div class="p-3 mcp-theme-1">
+    <div visit-moe close-on-save close-on-cancel class="d-block">
+        <form show url="/api/visitPoint/upsertChildReview" class="mcp-theme-1">
+            <input type="hidden" name="uid" value="<?= $point->uid ?>">
+            <input type="hidden" name="noteUid" value="<?= $note->uid ?>">
+            <input type="hidden" name="segmentUid" value="<?= $note->coreSegment->uid ?>">
+            <input type="hidden" name="data" value="{{json_encode($contentData)}}">
+
+            <div id="edit-univ_sub_stress_assessment-container">
+                <p class="font-weight-bold my-3 font-size-14"><i>Mental Health</i></p>
+                <p><b>PERCEIVED STRESS</b></p>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How often have you felt that you were unable to control the important things in your life?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.uncontrollable_things_life">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How often have you felt <b>lack of</b> confidence about your ability to handle your personal problems?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.lack_confidence">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How often have you felt that things were <b>not</b> going your way?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.things_not_going_well">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Have often have you found it hard to let go of things that upset you?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.let_things_go_hard">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+
+                <p><b>How do you COPE with stress? <em>Check all that apply</em></b></p>
+                <table class="table table-sm table-striped table-bordered m-0">
+                    <tbody>
+                    <tr v-for="cope in stress_cope">
+                        <td class="text-nowrap align-middle width-40px text-center"><input type="checkbox" class="m-0" v-model="data.cope_stress" :value="cope"></td>
+                        <td class="text-nowrap align-middle" colspan="2">@{{cope}}</td>
+                    </tr>
+                    </tbody>
+                </table>
+
+                <p class="mt-2"><b>RESILIENCE</b></p>
+                <p><b>When I am under extreme stress</b></p>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                I find a way to learn from my experience.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.extreme_stress_learn_from_experience">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                I find a way to take action.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.extreme_stress_take_action">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                I find it easy to prioritize what is important in my life.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.extreme_stress_prioritize_importance">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                I look at a stressful situation as an opportunity to grow.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.extreme_stress_opportunity_to_grow">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                I meet the goals I set for myself.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.extreme_stress_set_goals">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                I believe that there are a lot of ways around a problem.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.extreme_stress_ways_around_problem">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                I feel motivated to pursue my goals.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.extreme_stress_motivated_to_pursue_goals">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                I know I can get through it.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.extreme_stress_know_can_get_through_it">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+
+                <p class="mt-2"><b>MIND-BODY CONNECTION</b></p>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                I meet the goals I set for myself.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.body_connect_set_goals">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do thoughts or feelings affect your physical health?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.body_connect_feelings_affect">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Could you be experiencing some emotion and not be aware of it?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.body_connect_emotion_experience">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Are you aware of tension in your body?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.body_connect_tension_aware">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you notice how your body changes when angry?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.body_connect_angry">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you notice stress in your body?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.body_connect_stress">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you notice how your body reacts to emotions?
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.body_connect_emotion_react">
+                                    <option v-for="(opt, i) in options_a" :value="i+1">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+
+                <p class="mt-2"><b>DEPRESSION</b></p>
+                <p><b>Over the last 2 weeks, how often have you been bothered by the following?</b></p>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Little interest or pleasure in doing things.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.depression_little_interest">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Feeling down, depressed or hopeless.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.depression_feeling_depressed">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Trouble falling asleep, staying asleep, or sleeping too much.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.depression_trouble_sleeping">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Feeling tired or having little energy.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.depression_feeling_tired">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Poor appetite or overeating.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.depression_poor_appetite">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Feeling bad about yourself or that you’re a failure or have let yourself or your family down.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.depression_feeling_bad_self">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Trouble concentrating on things, such as reading the newspaper or watching television.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.depression_trouble_concentrating">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Moving or speaking so slowly that other people could have noticed. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.depression_moving_slow">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Thoughts that you would be better off dead or of hurting yourself in some way.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.depression_hurting_self">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+
+                <p class="mt-2"><b>ANXIETY</b></p>
+                <p><b>Over the last 2 weeks, how often have you been bothered by the following?</b></p>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Feeling nervous, anxious, or on edge.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.anxiety_feeling_nervous">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Not being able to stop or control worrying.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.anxiety_uncontrollable_worry">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Worrying too much about different things.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.anxiety_worry_different_things">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Trouble relaxing.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.anxiety_trouble_relaxing">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Being so restless that it’s hard to sit still.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.anxiety_restless">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Becoming easily annoyed or irritable.
+                            </div>
+                            <div class="col-6">
+                                <select class="form-control form-control-sm width-200px" v-model="data.anxiety_easily_annoyed">
+                                    <option v-for="(opt, i) in options_b" :value="i">@{{opt}}</option>
+                                </select>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+
+                <div class="mt-3 pt-3 border-top text-center">
+                    <button type="button" v-on:click.prevent="saveForm()" class="btn btn-sm btn-primary mr-2">Submit</button>
+                    <button type="button" onclick="closeStagPopup()" class="btn btn-sm btn-default border">Cancel</button>
+                </div>
+
+            </div>
+
+            <div class="d-none">
+                <button submit class="btn btn-sm btn-primary mr-2">Submit</button>
+                <button cancel class="btn btn-sm btn-default border">Cancel</button>
+            </div>
+        </form>
+    </div>
+</div>
+<script>
+    (function() {
+        function init() {
+
+            runMCInitializer('hide-moes');
+            // any JS can come here
+            // will be run on page-load as well as whenever this segment is refreshed
+            new Vue({
+                el: '#edit-univ_sub_stress_assessment-container',
+                delimiters: ["@{{","}}"],
+                data: {
+                    data: <?= json_encode($contentData) ?>,
+                    options_a: [
+                        "1 - Never",
+                        "2 - Seldom",
+                        "3 - Sometimes",
+                        "4 - Often",
+                        "5 - Always"
+                    ],
+                    options_b: [
+                        "0 - Not at all",
+                        "1 - Several days",
+                        "2 - Most days",
+                        "3 - Daily"
+                    ],
+                    stress_cope: [
+                        "Meditation",
+                        "Exercise/Physical Activity",
+                        "Counseling/Psychotherapy ",
+                        "Socializing with friends or",
+                        "family ",
+                        "Art",
+                        "Food (too much, too little) ",
+                        "Spirituality/Faith",
+                        "Sex",
+                        "Recreational drugs (i.e.",
+                        "marijuana, cocaine, etc.)",
+                        "Television and/or video games",
+                        "Gambling ",
+                        "Journaling",
+                        "Massage/Body work ",
+                        "Prayer",
+                        "Substance (tobacco, alcohol)",
+                        "Distraction",
+                        "Hurting yourself (i.e. cutting, etc.)",
+                        "Pet therapy",
+                        "Other"
+                    ]
+                },
+                watch: {
+                    $data: {
+                        handler: function(val, oldVal) {
+                            let parent = $('#edit-univ_sub_stress_assessment-container').closest('form');
+                            parent.find('[name="data"]').val(JSON.stringify(this.data));
+
+                            // autosave on change
+                            autoSaveSegment(parent.find('[submit]').first());
+                        },
+                        deep: true
+                    }
+                },
+                methods: {
+                    calculateTotal: function() {
+                        var days = !isNaN(parseInt(this.data.days_exercise)) ? parseInt(this.data.days_exercise) : 0;
+                        var min = !isNaN(parseInt(this.data.min_exercise)) ? parseInt(this.data.min_exercise) : 0;
+                        this.data.total_exercise = days * min;
+                    },
+                    saveForm: function() {
+                        let parent = $('#edit-univ_sub_stress_assessment-container').closest('form');
+                        parent.find('[name="data"]').val(JSON.stringify(this.data));
+                        autoSaveSegmentAndClose(parent.find('[submit]').first());
+                    }
+                }
+            });
+        }
+
+        window.segmentInitializers.lifestyle_stress = init;
+
+        addMCInitializer('edit-univ_sub_stress_assessment-container-{{$note->id}}', init, '#edit-univ_sub_stress_assessment-container');
+
+    })();
+</script>

resources/views/app/patient/modules/lifestyle_stress/summary.blade.php

@@ -0,0 +1,642 @@
+<?php
+
+use App\Models\Client;
+use App\Models\Point;
+use App\Models\Note;
+/** @var Client $patient */
+/** @var Note $note */
+
+$point = Point::getGlobalSingletonOfCategory($patient, 'LIFESTYLE_STRESS', false);
+
+if ($point && @$point->data) {
+$contentData = $point->data;
+?>
+
+<div id="v2_stress_assessment_Section" class="mt-3">
+    <p class="font-weight-bold my-3 font-size-14"><i>Mental Health</i></p>
+    <p><b>PERCEIVED STRESS</b></p>
+    <p>(1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Often, 5 = Always)</p>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    How often have you felt that you were unable to control the important things in your life?
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->uncontrollable_things_life ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    How often have you felt <b>lack of</b> confidence about your ability to handle your personal problems?
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->lack_confidence ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    How often have you felt that things were <b>not</b> going your way?
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->things_not_going_well ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Have often have you found it hard to let go of things that upset you?
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->let_things_go_hard ?>
+                </div>
+            </div>
+        </div>
+    </div>
+
+    <p><b>How do you COPE with stress? <em>Check all that apply</em></b></p>
+    <table class="table table-sm table-striped table-bordered m-0">
+        <tbody>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Meditation', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Meditation</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Exercise/Physical Activity', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Exercise/Physical Activity</td>
+        </tr>
+        <tr>
+
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Counseling/Psychotherapy ', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Counseling/Psychotherapy </td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Socializing with friends or', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Socializing with friends or</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('family ', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Family </td>
+        </tr>
+        <tr>
+
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Art', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Art</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Food (too much, too little) ', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Food (too much, too little)</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Spirituality/Faith', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Spirituality/Faith</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Sex', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Sex</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Recreational drugs (i.e.', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Recreational drugs (i.e.</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('marijuana, cocaine, etc.)', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">marijuana, cocaine, etc.)</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Television and/or video games', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Television and/or video games</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Gambling ', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Gambling </td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Journaling', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Journaling</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Massage/Body work ', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Massage/Body work </td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Prayer', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Prayer</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Substance (tobacco, alcohol)', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Substance (tobacco, alcohol)</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Distraction', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?>&nbsp;</td>
+            <td class="text-nowrap align-middle" colspan="2">Distraction</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Hurting yourself (i.e. cutting, etc.)', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Hurting yourself (i.e. cutting, etc.)</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Pet therapy', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Pet therapy</td>
+        </tr>
+        <tr>
+            <td class="text-nowrap align-middle width-40px text-center">
+                <?php if (@$contentData->cope_stress && in_array('Other', $contentData->cope_stress)): ?>
+                <i class="fa fa-check"></i>
+                <?php endif; ?></td>
+            <td class="text-nowrap align-middle" colspan="2">Other</td>
+        </tr>
+        </tbody>
+    </table>
+
+    <p class="mt-2"><b>RESILIENCE</b></p>
+    <p><b>When I am under extreme stress</b></p>
+    <p>(1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Often, 5 = Always)</p>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    I find a way to learn from my experience.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->extreme_stress_learn_from_experience ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    I find a way to take action.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->extreme_stress_take_action ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    I find it easy to prioritize what is important in my life.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->extreme_stress_prioritize_importance ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    I look at a stressful situation as an opportunity to grow.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->extreme_stress_opportunity_to_grow ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    I meet the goals I set for myself.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->extreme_stress_set_goals ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    I believe that there are a lot of ways around a problem.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->extreme_stress_ways_around_problem ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    I feel motivated to pursue my goals.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->extreme_stress_motivated_to_pursue_goals ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    I know I can get through it.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->extreme_stress_know_can_get_through_it ?>
+                </div>
+            </div>
+        </div>
+    </div>
+
+    <p class="mt-2"><b>MIND-BODY CONNECTION</b></p>
+    <p>(1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Often, 5 = Always)</p>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    I meet the goals I set for myself.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->body_connect_set_goals ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Do thoughts or feelings affect your physical health?
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->body_connect_feelings_affect ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Could you be experiencing some emotion and not be aware of it?
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->body_connect_emotion_experience ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Are you aware of tension in your body?
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->body_connect_tension_aware ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Do you notice how your body changes when angry?
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->body_connect_angry ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Do you notice stress in your body?
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->body_connect_stress ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Do you notice how your body reacts to emotions?
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->body_connect_emotion_react ?>
+                </div>
+            </div>
+        </div>
+    </div>
+
+    <p class="mt-2"><b>DEPRESSION</b></p>
+    <p><b>Over the last 2 weeks, how often have you been bothered by the following?</b></p>
+    <p>
+        (0 = Not at all, 1 = Several days, 2 = Most days, 3 = Daily)
+    </p>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Little interest or pleasure in doing things.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->depression_little_interest ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Feeling down, depressed or hopeless.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->depression_feeling_depressed ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Trouble falling asleep, staying asleep, or sleeping too much.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->depression_trouble_sleeping ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Feeling tired or having little energy.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->depression_feeling_tired ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Poor appetite or overeating.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->depression_poor_appetite ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Feeling bad about yourself or that you’re a failure or have let yourself or your family down.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->depression_feeling_bad_self ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Trouble concentrating on things, such as reading the newspaper or watching television.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->depression_trouble_concentrating ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Moving or speaking so slowly that other people could have noticed. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->depression_moving_slow ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Thoughts that you would be better off dead or of hurting yourself in some way.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->depression_hurting_self ?>
+                </div>
+            </div>
+        </div>
+    </div>
+
+    <p class="mt-2"><b>ANXIETY</b></p>
+    <p><b>Over the last 2 weeks, how often have you been bothered by the following?</b></p>
+    <p>
+        (0 = Not at all, 1 = Several days, 2 = Most days, 3 = Daily)
+    </p>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Feeling nervous, anxious, or on edge.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->anxiety_feeling_nervous ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Not being able to stop or control worrying.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->anxiety_uncontrollable_worry ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Worrying too much about different things.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->anxiety_worry_different_things ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Trouble relaxing.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->anxiety_trouble_relaxing ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Being so restless that it’s hard to sit still.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->anxiety_restless ?>
+                </div>
+            </div>
+        </div>
+    </div>
+    <div class="d-flex align-items-baseline mb-3">
+        <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+        <div class="flex-grow-1">
+            <div class="row">
+                <div class="col-6">
+                    Becoming easily annoyed or irritable.
+                </div>
+                <div class="col-6">
+                    <?= @$contentData->anxiety_easily_annoyed ?>
+                </div>
+            </div>
+        </div>
+    </div>
+</div>
+
+<?php
+} else {
+    echo '<div class="text-secondary">-</div>';
+}
+?>
+

resources/views/app/patient/modules/lifestyle_substances/edit.blade.php

@@ -0,0 +1,967 @@
+<?php
+use App\Models\Client;
+use App\Models\Note;
+use App\Models\Point;
+/** @var Client $patient */
+/** @var Note $note */
+/** @var Point $point */
+
+if(!@$sessionKey) {
+    $sessionKey = request()->cookie('sessionKey');
+}
+
+$point = Point::getOrCreateOnlyTopLevelPointOfCategory($note, 'LIFESTYLE_SUBSTANCE_USE', $sessionKey);
+
+// replace content data
+$contentData = [
+    "nicotine_i_use_any_of_listed_items_above" => '',
+    "nicotine_do_you_want_to_quit_nicotine" => '',
+    "nicotine_how_soon_in_mins" => '',
+    "nicotine_how_many_cigarettes_per_day" => '',
+    "nicotine_age_started_smoking" => '',
+    "nicotine_longest_time_stayed_quit" => '',
+    "nicotine_why_started_smoking_again" => '',
+    "smokes_around_me" => [],
+    "nicotine_other_smoke_around_me_description" => '',
+    "nicotine_times_seriously_tried_to_quit" => '',
+    "nicotine_recent_quit_duration" => '',
+    "nicotine_who_is_supporting_you_to_quit" => '',
+    "nicotine_most_important_reason_to_quit" => '',
+    "nicotine_ever_used_medication_to_quit" => '',
+    "nicotine_medication_used" => [],
+    "nicotine_medication_used_other_description" => '',
+    "nicotine_medication_did_they_help" => '',
+    "nicotine_medication_list_helpful_ones" => '',
+    "nicotine_used_any_other_methods_to_quit" => '',
+    "nicotine_other_methods_used" => [],
+    "nicotine_other_methods_other_description" => '',
+    "alcohol_do_you_drink_alcohol" => '',
+    "alcohol_prefered_type_of_alcohol" => '',
+    "alcohol_how_many_servings_per_day" => '',
+    "alcohol_felt_like_cutting_down" => '',
+    "alcohol_have_people_criticized_you" => '',
+    "alcohol_felt_guilty" => '',
+    "alcohol_drank_in_morning_to_get_rid_of_hangover" => '',
+    "alcohol_do_you_binge_drink" => '',
+    "recreational_have_you_ever_used_any" => '',
+    "recreational_level_of_concern" => '',
+    "recreational_how_much_used" => '',
+    "marijuana_have_you_ever_used_marijuana" => '',
+    "marijuana_level_of_concern" => '',
+    "marijuana_how_much_used" => '',
+    "mental_health_ever_received_treatment" => '',
+    "drug_or_alcohol_have_you_ever_received_treatment" => ''
+];
+
+if ($point->lastChildReview && $point->lastChildReview->data) {
+    $point->lastChildReview->data = json_decode($point->lastChildReview->data, true);
+    $contentData = $point->lastChildReview->data;
+}
+?>
+<div class="p-3 mcp-theme-1">
+    <div visit-moe close-on-save close-on-cancel class="d-block">
+        <form show url="/api/visitPoint/upsertChildReview" class="mcp-theme-1">
+            <input type="hidden" name="uid" value="<?= $point->uid ?>">
+            <input type="hidden" name="noteUid" value="<?= $note->uid ?>">
+            <input type="hidden" name="segmentUid" value="<?= $note->coreSegment->uid ?>">
+            <input type="hidden" name="data" value="{{json_encode($contentData)}}">
+
+            <div id="edit-univ_sub_substance_use_assessment-container">
+
+                <div class="row">
+                    <div class="col-md-12">
+                        <h5 class="bg-light p-1 font-weight-bold">SMOKING AND SUBSTANCE HISTORY</h5>
+                        <p><b>NICOTINE/TOBACCO</b> (i.e. cigarettes, e-cigarettes, e-cigarettes/vaping, cigars, chew, snuff)</p>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        Do you use any of the nicotine products listed above?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.nicotine_i_use_any_of_listed_items_above">
+                                            <option value="No">No</option>
+                                            <option value="Yes">Yes</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+                    <div v-if="data.nicotine_i_use_any_of_listed_items_above == 'Yes'" class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        If yes, do you want to quit using the nicotine/tobacco products?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.nicotine_do_you_want_to_quit_nicotine">
+                                            <option value="No">No</option>
+                                            <option value="Yes">Yes</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div v-if="data.nicotine_do_you_want_to_quit_nicotine == 'Yes'" class="col-md-12">
+                        <p class="pl-2 font-weight-bold">If yes, answer the questions below:</p>
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-12">
+                                            <label>How soon after you wake up do you use nicotine/tobacco? </label>
+                                            <div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="radio" name="nicotine_how_soon_in_mins"
+                                                           id="nicotine_how_soon_60_min" value="after_60_mins" v-model="data.nicotine_how_soon_in_mins">
+                                                    <label class="form-check-label" for="nicotine_how_soon_60_min">After 60 minutes</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="radio" name="nicotine_how_soon_in_mins"
+                                                           id="nicotine_how_soon_31_60_min" value="31_60_mins" v-model="data.nicotine_how_soon_in_mins">
+                                                    <label class="form-check-label" for="nicotine_how_soon_31_60_min">31-60 minutes</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="radio" name="nicotine_how_soon_in_mins"
+                                                           id="nicotine_how_soon_6_30_min" value="6_30_mins" v-model="data.nicotine_how_soon_in_mins">
+                                                    <label class="form-check-label" for="nicotine_how_soon_6_30_min">6-30 minutes</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="radio" name="nicotine_how_soon_in_mins"
+                                                           id="nicotine_how_soon_within_5_min" value="within_5_mins"
+                                                           v-model="data.nicotine_how_soon_in_mins">
+                                                    <label class="form-check-label" for="nicotine_how_soon_within_5_min">Within 5 minutes</label>
+                                                </div>
+                                            </div>
+
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-12">
+                                            <label>How many cigarettes do you smoke per day?</label>
+                                            <div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="radio" name="nicotine_how_many_cigarettes_per_day"
+                                                           id="nicotine_how_many_10_or_less" value="after_60_mins"
+                                                           v-model="data.nicotine_how_many_cigarettes_per_day">
+                                                    <label class="form-check-label" for="nicotine_how_many_10_or_less">10 or less</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="radio" name="nicotine_how_many_cigarettes_per_day"
+                                                           id="nicotine_how_many_11_20" value="31_60_mins"
+                                                           v-model="data.nicotine_how_many_cigarettes_per_day">
+                                                    <label class="form-check-label" for="nicotine_how_many_11_20">11-20</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="radio" name="nicotine_how_many_cigarettes_per_day"
+                                                           id="nicotine_how_many_21_30" value="6_30_mins"
+                                                           v-model="data.nicotine_how_many_cigarettes_per_day">
+                                                    <label class="form-check-label" for="nicotine_how_many_21_30">21-30</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="radio" name="nicotine_how_many_cigarettes_per_day"
+                                                           id="nicotine_how_many_31_plus" value="within_5_mins"
+                                                           v-model="data.nicotine_how_many_cigarettes_per_day">
+                                                    <label class="form-check-label" for="nicotine_how_many_31_plus">31+</label>
+                                                </div>
+                                            </div>
+
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <hr />
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            What age did you start smoking?
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control" name="nicotine_age_started_smoking"
+                                                   v-model="data.nicotine_age_started_smoking" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            What is the longest time period you have stayed quit?
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control" name="nicotine_longest_time_stayed_quit"
+                                                   v-model="data.nicotine_longest_time_stayed_quit" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            What made you start smoking again?
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control" name="nicotine_why_started_smoking_again"
+                                                   v-model="data.nicotine_why_started_smoking_again" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-12">
+                                            <div>
+                                                Which of the following people smoke around you? <small class="text-muted">Check all that
+                                                    apply</small>
+                                            </div>
+                                            <div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_friends_smoke_around_me"
+                                                           name="smokes_around_me" value="Friends"
+                                                           v-model="data.smokes_around_me">
+                                                    <label class="form-check-label" for="nicotine_friends_smoke_around_me">Friends</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_family_smoke_around_me"
+                                                           name="smokes_around_me" value="Family" v-model="data.smokes_around_me">
+                                                    <label class="form-check-label" for="nicotine_family_smoke_around_me">Family</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_partner_smoke_around_me"
+                                                           name="smokes_around_me" value="Partner"
+                                                           v-model="data.smokes_around_me">
+                                                    <label class="form-check-label" for="nicotine_partner_smoke_around_me">Partner</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_co_workers_smoke_around_me"
+                                                           name="smokes_around_me" value="Co-Workers"
+                                                           v-model="data.smokes_around_me">
+                                                    <label class="form-check-label" for="nicotine_co_workers_smoke_around_me">Co-Workers</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_other_smoke_around_me"
+                                                           name="smokes_around_me" value="Other" v-model="data.smokes_around_me">
+                                                    <label class="form-check-label" for="nicotine_other_smoke_around_me">Other</label>
+                                                </div>
+                                                <div v-if="data.smokes_around_me.indexOf('Other') !== -1" class="form-group mt-3">
+                                                    <label>Other</label>
+                                                    <input type="text" class="form-control" name="nicotine_other_smoke_around_me_description"
+                                                           v-model="data.nicotine_other_smoke_around_me_description" />
+                                                </div>
+                                            </div>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <hr>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            How many times have you seriously tried to quit?
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control" name="nicotine_times_seriously_tried_to_quit"
+                                                   v-model="data.nicotine_times_seriously_tried_to_quit" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            For your most recent quit attempt, how long did it last?
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control" name="nicotine_recent_quit_duration"
+                                                   v-model="data.nicotine_recent_quit_duration" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">j.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            Who is supporting you to quit smoking?
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control" name="nicotine_who_is_supporting_you_to_quit"
+                                                   v-model="data.nicotine_who_is_supporting_you_to_quit" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">k.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            What is your most important reason to quit smoking?
+                                        </div>
+                                        <div class="col-6">
+                  <textarea type="text" class="form-control" name="nicotine_most_important_reason_to_quit"
+                            v-model="data.nicotine_most_important_reason_to_quit"></textarea>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <hr>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">l.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            Are you currently using or have used any medications to help you quit smoking?
+                                        </div>
+                                        <div class="col-6">
+                                            <select class="form-control" name="nicotine_ever_used_medication_to_quit"
+                                                    v-model="data.nicotine_ever_used_medication_to_quit">
+                                                <option value="No">No</option>
+                                                <option value="Yes">Yes</option>
+                                            </select>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-12">
+                                            If yes, check with of the following medications you have used:
+                                            <div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_medication_used_nicotine_patch"
+                                                           name="nicotine_medication_used" value="Nicotine Patch"
+                                                           v-model="data.nicotine_medication_used">
+                                                    <label class="form-check-label" for="nicotine_medication_used_nicotine_patch">
+                                                        Nicotine Patch
+                                                    </label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_medication_used_nicotine_gum"
+                                                           name="nicotine_medication_used" value="Nicotine Gum"
+                                                           v-model="data.nicotine_medication_used">
+                                                    <label class="form-check-label" for="nicotine_medication_used_nicotine_gum">
+                                                        Nicotine Gum
+                                                    </label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_medication_used_nicotine_lozenge"
+                                                           name="nicotine_medication_used" value="Nicotine Lozenge"
+                                                           v-model="data.nicotine_medication_used">
+                                                    <label class="form-check-label" for="nicotine_medication_used_nicotine_lozenge">
+                                                        Nicotine Lozenge
+                                                    </label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_medication_used_wellbutrin"
+                                                           name="nicotine_medication_used" value="Wellbutrin/Bupropion Pill"
+                                                           v-model="data.nicotine_medication_used">
+                                                    <label class="form-check-label" for="nicotine_medication_used_wellbutrin">
+                                                        Wellbutrin/Bupropion Pill
+                                                    </label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_medication_used_chantix"
+                                                           name="nicotine_medication_used" value="Chantix/Varenicline Pill"
+                                                           v-model="data.nicotine_medication_used">
+                                                    <label class="form-check-label" for="nicotine_medication_used_chantix">
+                                                        Chantix/ Varenicline Pill
+                                                    </label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_medication_used_other"
+                                                           name="nicotine_medication_used" value="Other" v-model="data.nicotine_medication_used">
+                                                    <label class="form-check-label" for="nicotine_medication_used_other">
+                                                        Other
+                                                    </label>
+                                                </div>
+                                                <div class="form-group mt-3">
+                                                    <label>Other:</label>
+                                                    <input type="text" class="form-control" name="nicotine_medication_used_other_description"
+                                                           v-model="data.nicotine_medication_used_other_description" />
+                                                </div>
+                                            </div>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">m.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            If you used any of the medication listed above, did they help?
+                                        </div>
+                                        <div class="col-6">
+                                            <select class="form-control" name="nicotine_medication_did_they_help"
+                                                    v-model="data.nicotine_medication_did_they_help">
+                                                <option value="No">No</option>
+                                                <option value="Yes">Yes</option>
+                                            </select>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div v-if="data.nicotine_medication_did_they_help == 'Yes'">
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">l.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            If yes, list which ones helped:
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control" name="nicotine_medication_list_helpful_ones"
+                                                   v-model="data.nicotine_medication_list_helpful_ones" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">n.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            Have you used any methods in the past other than medications to try to quit?
+                                        </div>
+                                        <div class="col-6">
+                                            <select class="form-control" name="nicotine_used_any_other_methods_to_quit"
+                                                    v-model="data.nicotine_used_any_other_methods_to_quit">
+                                                <option value="No">No</option>
+                                                <option value="Yes">Yes</option>
+                                            </select>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div v-if="data.nicotine_used_any_other_methods_to_quit == 'Yes'">
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">l.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-12">
+                                            If yes, check which of the following methods you have used:
+                                            <div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_other_methods_self_help"
+                                                           name="nicotine_other_methods_used" value="Self-help"
+                                                           v-model="data.nicotine_other_methods_used">
+                                                    <label class="form-check-label" for="nicotine_other_methods_self_help">Self-help</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_other_methods_gradual_reduction"
+                                                           name="nicotine_other_methods_used" value="Gradual reduction"
+                                                           v-model="data.nicotine_other_methods_used">
+                                                    <label class="form-check-label" for="nicotine_other_methods_gradual_reduction">Gradual reduction</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_other_methods_cold_turkey"
+                                                           name="nicotine_other_methods_used" value="Cold turkey"
+                                                           v-model="data.nicotine_other_methods_used">
+                                                    <label class="form-check-label" for="nicotine_other_methods_cold_turkey">Cold turkey</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_other_methods_hypnosis"
+                                                           name="nicotine_other_methods_used" value="Hypnosis" v-model="data.nicotine_other_methods_used">
+                                                    <label class="form-check-label" for="nicotine_other_methods_hypnosis">Hypnosis</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_other_methods_acupuncture"
+                                                           name="nicotine_other_methods_used" value="Acupuncture"
+                                                           v-model="data.nicotine_other_methods_used">
+                                                    <label class="form-check-label" for="nicotine_other_methods_acupuncture">Acupuncture</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_other_methods_special_filters"
+                                                           name="nicotine_other_methods_used" value="Special filters"
+                                                           v-model="data.nicotine_other_methods_used">
+                                                    <label class="form-check-label" for="nicotine_other_methods_special_filters">Special filters</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_other_methods_vapinge"
+                                                           name="nicotine_other_methods_used" value="Vaping/e-cigarettes" v-model="data.nicotine_other_methods_used">
+                                                    <label class="form-check-label" for="nicotine_other_methods_vapinge">Vaping/e-cigarettes</label>
+                                                </div>
+                                                <div class="form-check form-check-inline">
+                                                    <input class="form-check-input" type="checkbox" id="nicotine_other_methods_other"
+                                                           name="nicotine_other_methods_used" value="Other" v-model="data.nicotine_other_methods_used">
+                                                    <label class="form-check-label" for="nicotine_other_methods_other">Other</label>
+                                                </div>
+
+                                                <div v-if="data.nicotine_other_methods_used.indexOf('Other') !== -1" class="form-group mt-3">
+                                                    <label>Other:</label>
+                                                    <input type="text" class="form-control" name="nicotine_other_methods_other_description"
+                                                           v-model="data.nicotine_other_methods_other_description">
+                                                </div>
+
+                                            </div>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+
+
+                    </div>
+
+                    <div class="col-md-12">
+                        <h6 class="font-weight-bold">ALCOHOL</h6>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        Do you drink alcohol?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm" v-model="data.alcohol_do_you_drink_alcohol">
+                                            <option value="No">No</option>
+                                            <option value="Yes">Yes</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div v-if="data.alcohol_do_you_drink_alcohol == 'Yes'" class="col-md-12">
+                        <p class="pl-2 font-weight-bold">If yes, please answer the questions below:</p>
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            What type of alcohol do you prefer?
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control form-control-sm"
+                                                   v-model="data.alcohol_prefered_type_of_alcohol" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            On average, how many servings do you drink per day/week/month/year on average?
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control form-control-sm"
+                                                   v-model="data.alcohol_how_many_servings_per_day" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            Have you ever felt you should <b>“Cut down”</b> on your drinking?
+                                        </div>
+                                        <div class="col-6">
+                                            <select class="form-control form-control-sm"
+                                                    v-model="data.alcohol_felt_like_cutting_down">
+                                                <option value="No">No</option>
+                                                <option value="Yes">Yes</option>
+                                            </select>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            Have people <b>Annoyed</b> you by criticizing your drinking?
+                                        </div>
+                                        <div class="col-6">
+                                            <select class="form-control form-control-sm"
+                                                    v-model="data.alcohol_have_people_criticized_you">
+                                                <option value="No">No</option>
+                                                <option value="Yes">Yes</option>
+                                            </select>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            Have you ever felt <b>Guilty</b> about your drinking?
+                                        </div>
+                                        <div class="col-6">
+                                            <select class="form-control form-control-sm" v-model="data.alcohol_felt_guilty">
+                                                <option value="No">No</option>
+                                                <option value="Yes">Yes</option>
+                                            </select>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            Have you ever had a drink in the morning to steady your nerves or to get rid of a hangover (<b>eye
+                                                opener</b>)?
+                                        </div>
+                                        <div class="col-6">
+                                            <select class="form-control form-control-sm"
+                                                    v-model="data.alcohol_drank_in_morning_to_get_rid_of_hangover">
+                                                <option value="No">No</option>
+                                                <option value="Yes">Yes</option>
+                                            </select>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            Do you binge drink (more than 5 drinks for men or 4 drinks for women within 2 hours)?
+                                        </div>
+                                        <div class="col-6">
+                                            <select class="form-control form-control-sm" v-model="data.alcohol_do_you_binge_drink">
+                                                <option value="No">No</option>
+                                                <option value="Yes">Yes</option>
+                                            </select>
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+
+
+                    </div>
+
+                    <hr>
+
+                    <div class="col-md-12">
+                        <h6 class="font-weight-bold">Have you used any of the following substances in the past year?</h6>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        Recreational drugs (cocaine, heroin, meth, etc.)
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.recreational_have_you_ever_used_any">
+                                            <option value="No">No</option>
+                                            <option value="Yes">Yes</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div v-if="data.recreational_have_you_ever_used_any == 'Yes'" class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        If yes, what level of concern do you have regarding use of the substances
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.recreational_level_of_concern">
+                                            <option value="0">0 - No concern</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5 - High concern</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            If yes, how much substance do you usually use?
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control form-control-sm"
+                                                   v-model="data.recreational_how_much_used" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        <b>Marijuana</b>
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.marijuana_have_you_ever_used_marijuana">
+                                            <option value="No">No</option>
+                                            <option value="Yes">Yes</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                    <div v-if="data.marijuana_have_you_ever_used_marijuana == 'Yes'" class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        If yes, what level of concern do you have regarding use of the substances
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.marijuana_level_of_concern">
+                                            <option value="0">0 - No concern</option>
+                                            <option value="1">1</option>
+                                            <option value="2">2</option>
+                                            <option value="3">3</option>
+                                            <option value="4">4</option>
+                                            <option value="5">5 - High concern</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                        <div>
+                            <div class="d-flex align-items-baseline mb-3">
+                                <div class="flex-grow-1">
+                                    <div class="row">
+                                        <div class="col-6">
+                                            If yes, how much substance do you usually use?
+                                        </div>
+                                        <div class="col-6">
+                                            <input type="text" class="form-control form-control-sm"
+                                                   v-model="data.marijuana_how_much_used" />
+                                        </div>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+
+                </div>
+
+                <hr>
+
+                <div class="row">
+                    <div class="col-md-12">
+                        <h5 class="bg-light p-1 font-weight-bold">TREATMENT HISTORY</h5>
+                    </div>
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        Have you ever received treatment for a mental health problem?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.mental_health_ever_received_treatment">
+                                            <option value="No">No</option>
+                                            <option value="Yes">Yes</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+                    <div class="col-md-12">
+                        <div class="d-flex align-items-baseline mb-3">
+                            <div class="flex-grow-1">
+                                <div class="row">
+                                    <div class="col-6">
+                                        Have you ever received treatment for drug or alcohol use?
+                                    </div>
+                                    <div class="col-6">
+                                        <select class="form-control form-control-sm"
+                                                v-model="data.drug_or_alcohol_have_you_ever_received_treatment">
+                                            <option value="No">No</option>
+                                            <option value="Yes">Yes</option>
+                                        </select>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+
+                <div class="mt-3 pt-3 border-top text-center">
+                    <button type="button" v-on:click.prevent="saveForm()" class="btn btn-sm btn-primary mr-2">Submit</button>
+                    <button type="button" onclick="closeStagPopup()" class="btn btn-sm btn-default border">Cancel</button>
+                </div>
+
+            </div>
+
+            <div class="d-none">
+                <button submit class="btn btn-sm btn-primary mr-2">Submit</button>
+                <button cancel class="btn btn-sm btn-default border">Cancel</button>
+            </div>
+        </form>
+    </div>
+</div>
+<script>
+    (function() {
+        function init() {
+
+            runMCInitializer('hide-moes');
+            // any JS can come here
+            // will be run on page-load as well as whenever this segment is refreshed
+            new Vue({
+                el: '#edit-univ_sub_substance_use_assessment-container',
+                delimiters: ["@{{","}}"],
+                data: {
+                    data: <?= json_encode($contentData) ?>
+                },
+                watch: {
+                    $data: {
+                        handler: function(val, oldVal) {
+                            let parent = $('#edit-univ_sub_substance_use_assessment-container').closest('form');
+                            parent.find('[name="data"]').val(JSON.stringify(this.data));
+
+                            // autosave on change
+                            autoSaveSegment(parent.find('[submit]').first());
+                        },
+                        deep: true
+                    }
+                },
+                methods: {
+                    saveForm: function() {
+                        let parent = $('#edit-univ_sub_substance_use_assessment-container').closest('form');
+                        parent.find('[name="data"]').val(JSON.stringify(this.data));
+                        autoSaveSegmentAndClose(parent.find('[submit]').first());
+                    }
+                }
+            });
+        }
+
+        window.segmentInitializers.lifestyle_substances = init;
+
+        addMCInitializer('edit-univ_sub_substance_use_assessment-container-{{$note->id}}', init, '#edit-univ_sub_substance_use_assessment-container');
+
+    })();
+</script>

resources/views/app/patient/modules/lifestyle_substances/summary.blade.php

@@ -0,0 +1,803 @@
+<?php
+
+use App\Models\Client;
+use App\Models\Point;
+use App\Models\Note;
+/** @var Client $patient */
+/** @var Note $note */
+
+$point = Point::getGlobalSingletonOfCategory($patient, 'LIFESTYLE_SUBSTANCE_USE', false);
+
+if ($point && @$point->data) {
+$contentData = $point->data;
+?>
+
+<div id="v2_substance_use_assessment_section" class="mt-3">
+
+    <div class="row">
+        <div class="col-md-12">
+            <h5 class="bg-light p-1 font-weight-bold">SMOKING AND SUBSTANCE HISTORY</h5>
+            <p><b>NICOTINE/TOBACCO</b> (i.e. cigarettes, e-cigarettes, e-cigarettes/vaping, cigars, chew, snuff)</p>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            Do you use any of the nicotine products listed above?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->nicotine_i_use_any_of_listed_items_above ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <?php if (@$contentData->nicotine_i_use_any_of_listed_items_above == 'Yes') : ?>
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            If yes, do you want to quit using the nicotine/tobacco products?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->nicotine_do_you_want_to_quit_nicotine ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <?php endif; ?>
+
+        <?php if (@$contentData->nicotine_do_you_want_to_quit_nicotine == 'Yes') : ?>
+        <div class="col-md-12">
+            <p class="pl-2 font-weight-bold">If yes, answer the questions below:</p>
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                <label>How soon after you wake up do you use nicotine/tobacco? </label>
+                                <div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_how_soon_in_mins === 'after_60_mins') : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_how_soon_60_min">After 60 minutes</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_how_soon_in_mins === '31_60_mins') : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_how_soon_31_60_min">31-60 minutes</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_how_soon_in_mins === '6_30_mins') : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_how_soon_6_30_min">6-30 minutes</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_how_soon_in_mins === 'within_5_mins') : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_how_soon_within_5_min">Within 5 minutes</label>
+                                    </div>
+                                </div>
+
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                <label>How many cigarettes do you smoke per day?</label>
+                                <div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_how_many_cigarettes_per_day === 'after_60_mins') : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_how_many_10_or_less">10 or less</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_how_many_cigarettes_per_day === '31_60_mins') : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_how_many_11_20">11-20</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_how_many_cigarettes_per_day === '6_30_mins') : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_how_many_21_30">21-30</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_how_many_cigarettes_per_day === 'within_5_mins') : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_how_many_31_plus">31+</label>
+                                    </div>
+                                </div>
+
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <hr />
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                What age did you start smoking?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_age_started_smoking ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                What is the longest time period you have stayed quit?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_longest_time_stayed_quit ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                What made you start smoking again?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_why_started_smoking_again ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                <div>
+                                    Which of the following people smoke around you? <small class="text-muted">Check all that
+                                        apply</small>
+                                </div>
+                                <div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->smokes_around_me && in_array('Friends', $contentData->smokes_around_me)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_friends_smoke_around_me">Friends</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->smokes_around_me && in_array('Family', $contentData->smokes_around_me)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_family_smoke_around_me">Family</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->smokes_around_me && in_array('Partner', $contentData->smokes_around_me)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_partner_smoke_around_me">Partner</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->smokes_around_me && in_array('Co-Workers', $contentData->smokes_around_me)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_co_workers_smoke_around_me">Co-Workers</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->smokes_around_me && in_array('Other', $contentData->smokes_around_me)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_other_smoke_around_me">Other</label>
+                                    </div>
+                                    <div class="form-group mt-3">
+                                        <label>Other</label>
+                                        <?= @$contentData->nicotine_other_smoke_around_me_description ?>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <hr>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                How many times have you seriously tried to quit?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_times_seriously_tried_to_quit ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">i.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                For your most recent quit attempt, how long did it last?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_recent_quit_duration ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">j.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Who is supporting you to quit smoking?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_who_is_supporting_you_to_quit ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">k.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                What is your most important reason to quit smoking?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_most_important_reason_to_quit ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <hr>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">l.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Are you currently using or have used any medications to help you quit smoking?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_ever_used_medication_to_quit ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">&nbsp;</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                If yes, check with of the following medications you have used:
+                                <div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_medication_used && in_array('Nicotine Patch', $contentData->nicotine_medication_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_medication_used_nicotine_patch">
+                                            Nicotine Patch
+                                        </label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_medication_used && in_array('Nicotine Gum', $contentData->nicotine_medication_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_medication_used_nicotine_gum">
+                                            Nicotine Gum
+                                        </label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_medication_used && in_array('Nicotine Lozenge', $contentData->nicotine_medication_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_medication_used_nicotine_lozenge">
+                                            Nicotine Lozenge
+                                        </label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_medication_used && in_array('Wellbutrin/Bupropion Pill', $contentData->nicotine_medication_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_medication_used_wellbutrin">
+                                            Wellbutrin/Bupropion Pill
+                                        </label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_medication_used && in_array('Chantix/Varenicline Pill', $contentData->nicotine_medication_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_medication_used_chantix">
+                                            Chantix/ Varenicline Pill
+                                        </label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_medication_used && in_array('Other', $contentData->nicotine_medication_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_medication_used_other">
+                                            Other
+                                        </label>
+                                    </div>
+                                    <div class="form-group mt-3">
+                                        <label>Other:</label>
+                                        <?= @$contentData->nicotine_medication_used_other_description ?>
+                                    </div>
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">m.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                If you used any of the medication listed above, did they help?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_medication_did_they_help ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <?php if(@$contentData->nicotine_medication_did_they_help === 'Yes'): ?>
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">l.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                If yes, list which ones helped:
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_medication_list_helpful_ones ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+            <?php endif; ?>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">n.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Have you used any methods in the past other than medications to try to quit?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->nicotine_used_any_other_methods_to_quit ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <?php if(@$contentData->nicotine_used_any_other_methods_to_quit === 'Yes'): ?>
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">l.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-12">
+                                If yes, check which of the following methods you have used:
+                                <div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_other_methods_used && in_array('Self-help', $contentData->nicotine_other_methods_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_other_methods_self_help">Self-help</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_other_methods_used && in_array('Gradual reduction', $contentData->nicotine_other_methods_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_other_methods_gradual_reduction">Gradual reduction</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_other_methods_used && in_array('Cold turkey', $contentData->nicotine_other_methods_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_other_methods_cold_turkey">Cold turkey</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_other_methods_used && in_array('Hypnosis', $contentData->nicotine_other_methods_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_other_methods_hypnosis">Hypnosis</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_other_methods_used && in_array('Acupuncture', $contentData->nicotine_other_methods_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_other_methods_acupuncture">Acupuncture</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_other_methods_used && in_array('Acupuncture', $contentData->nicotine_other_methods_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_other_methods_special_filters">Special filters</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_other_methods_used && in_array('Vaping/e-cigarettes', $contentData->nicotine_other_methods_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_other_methods_vapinge">Vaping/e-cigarettes</label>
+                                    </div>
+                                    <div class="form-check form-check-inline">
+                                        <?php if (@$contentData->nicotine_other_methods_used && in_array('Other', $contentData->nicotine_other_methods_used)) : ?>
+                                        <i class="fa fa-check"></i>
+                                        <?php endif; ?>
+                                        <label class="form-check-label" for="nicotine_other_methods_other">Other</label>
+                                    </div>
+
+                                    <div class="form-group mt-3">
+                                        <label>Other:</label>
+                                        <?= @$contentData->nicotine_other_methods_other_description ?>
+                                    </div>
+
+                                </div>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+            <?php endif; ?>
+
+
+
+        </div>
+        <?php endif; ?>
+
+        <div class="col-md-12">
+            <h6 class="font-weight-bold">ALCOHOL</h6>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="pr-2 text-secondary font-weight-bold width-30px">a.</div>
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            Do you drink alcohol?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->alcohol_do_you_drink_alcohol ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <?php if(@$contentData->alcohol_do_you_drink_alcohol === 'Yes'): ?>
+        <div class="col-md-12">
+            <p class="pl-2 font-weight-bold">If yes, please answer the questions below:</p>
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">b.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                What type of alcohol do you prefer?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->alcohol_prefered_type_of_alcohol ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">c.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                On average, how many servings do you drink per day/week/month/year on average?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->alcohol_how_many_servings_per_day ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">d.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Have you ever felt you should <b>“Cut down”</b> on your drinking?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->alcohol_felt_like_cutting_down ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">e.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Have people <b>Annoyed</b> you by criticizing your drinking?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->alcohol_have_people_criticized_you ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">f.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Have you ever felt <b>Guilty</b> about your drinking?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->alcohol_felt_guilty ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">g.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Have you ever had a drink in the morning to steady your nerves or to get rid of a hangover (<b>eye
+                                    opener</b>)?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->alcohol_drank_in_morning_to_get_rid_of_hangover ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="pr-2 text-secondary font-weight-bold width-30px">h.</div>
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                Do you binge drink (more than 5 drinks for men or 4 drinks for women within 2 hours)?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->alcohol_do_you_binge_drink ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+
+
+        </div>
+        <?php endif; ?>
+
+        <hr>
+
+        <div class="col-md-12">
+            <h6 class="font-weight-bold">Have you used any of the following substances in the past year?</h6>
+        </div>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            Recreational drugs (cocaine, heroin, meth, etc.)
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->recreational_have_you_ever_used_any ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <?php if(@$contentData->recreational_have_you_ever_used_any === 'Yes'): ?>
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            If yes, what level of concern do you have regarding use of the substances
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->recreational_level_of_concern ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                If yes, how much substance do you usually use?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->recreational_how_much_used ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <?php endif; ?>
+
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            <b>Marijuana</b>
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->marijuana_have_you_ever_used_marijuana ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+
+        <?php if(@$contentData->marijuana_have_you_ever_used_marijuana === 'Yes'): ?>
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            If yes, what level of concern do you have regarding use of the substances
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->marijuana_level_of_concern ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+            <div>
+                <div class="d-flex align-items-baseline mb-3">
+                    <div class="flex-grow-1">
+                        <div class="row">
+                            <div class="col-6">
+                                If yes, how much substance do you usually use?
+                            </div>
+                            <div class="col-6">
+                                <?= @$contentData->marijuana_how_much_used ?>
+                            </div>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <?php endif; ?>
+
+    </div>
+
+    <hr>
+
+    <div class="row">
+        <div class="col-md-12">
+            <h5 class="bg-light p-1 font-weight-bold">TREATMENT HISTORY</h5>
+        </div>
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            Have you ever received treatment for a mental health problem?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->mental_health_ever_received_treatment ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+        <div class="col-md-12">
+            <div class="d-flex align-items-baseline mb-3">
+                <div class="flex-grow-1">
+                    <div class="row">
+                        <div class="col-6">
+                            Have you ever received treatment for drug or alcohol use?
+                        </div>
+                        <div class="col-6">
+                            <?= @$contentData->drug_or_alcohol_have_you_ever_received_treatment ?>
+                        </div>
+                    </div>
+                </div>
+            </div>
+        </div>
+    </div>
+
+
+</div>
+
+<?php
+} else {
+    echo '<div class="text-secondary">-</div>';
+}
+?>
+

resources/views/app/patient/note/dashboard.blade.php

@@ -457,7 +457,57 @@
                     "title" => 'COVID-19 Follow-up',
                     "href" => "/note-segment-view-by-name/{$note->uid}/covid_follow-up/edit",
                     "initer" => "covid-follow-up-{$note->id}"
-                ]
+                ],
+                [], // for separator
+                [
+                    "name" => 'Lifestyle General',
+                    "title" => 'Lifestyle General',
+                    "style" => 'stag-popup-md',
+                    "href" => "/module-view/{$note->uid}/lifestyle_general/edit",
+                    "initer" => "edit-univ_sub_lifestyle_general-container-{$note->id}"
+                ],
+                [
+                    "name" => 'Lifestyle Nutrition',
+                    "title" => 'Lifestyle Nutrition',
+                    "style" => 'stag-popup-md',
+                    "href" => "/module-view/{$note->uid}/lifestyle_nutrition/edit",
+                    "initer" => "edit-univ_sub_nutrition_assessment-container-{$note->id}"
+                ],
+                [
+                    "name" => 'Lifestyle Physical Activity',
+                    "title" => 'Lifestyle Physical Activity',
+                    "style" => 'stag-popup-md',
+                    "href" => "/module-view/{$note->uid}/lifestyle_physical_activity/edit",
+                    "initer" => "edit-univ_sub_physical_activity_assessment-container-{$note->id}"
+                ],
+                [
+                    "name" => 'Lifestyle Sleep',
+                    "title" => 'Lifestyle Sleep',
+                    "style" => 'stag-popup-md',
+                    "href" => "/module-view/{$note->uid}/lifestyle_sleep/edit",
+                    "initer" => "edit-univ_sub_sleep_assessment-container-{$note->id}"
+                ],
+                [
+                    "name" => 'Lifestyle Social',
+                    "title" => 'Lifestyle Social',
+                    "style" => 'stag-popup-md',
+                    "href" => "/module-view/{$note->uid}/lifestyle_social/edit",
+                    "initer" => "edit-univ_sub_social_relationships_assessment-container-{$note->id}"
+                ],
+                [
+                    "name" => 'Lifestyle Stress',
+                    "title" => 'Lifestyle Stress',
+                    "style" => 'stag-popup-md',
+                    "href" => "/module-view/{$note->uid}/lifestyle_stress/edit",
+                    "initer" => "edit-univ_sub_stress_assessment-container-{$note->id}"
+                ],
+                [
+                    "name" => 'Lifestyle Substances',
+                    "title" => 'Lifestyle Substances',
+                    "style" => 'stag-popup-md',
+                    "href" => "/module-view/{$note->uid}/lifestyle_substances/edit",
+                    "initer" => "edit-univ_sub_substance_use_assessment-container-{$note->id}"
+                ],
             ];
             ?>
             <div moe relative class="px-2 border-left screen-only">
@@ -468,7 +518,7 @@
                         @if(@$module['name'])
                             <a href="{{$module['href']}}"
                                open-in-stag-popup
-                               popup-style="overflow-visible"
+                               popup-style="overflow-visible {{@$module['style']}}"
                                title="{!! $module['title'] !!}"
                                mc-initer="{{ @$module['initer']  }}"
                                class="d-block mb-1 text-nowrap">{!! $module['name'] !!}</a>

routes/web.php

@@ -550,6 +550,7 @@ Route::middleware('pro.auth')->group(function () {
     Route::get('/mrv-summary/{note}', 'NoteController@mrvSummary')->name('mrv-summary');
     Route::get('/note-segment-view/{patient}/{note}/{segment}/{segmentInternalName}/{view}', 'NoteController@noteSegmentView')->name('note-segment-view');
     Route::get('/note-segment-view-by-name/{note}/{segmentInternalName}/{view}', 'NoteController@noteSegmentViewByName')->name('note-segment-view-by-name');
+    Route::get('/module-view/{note}/{segmentInternalName}/{view}', 'NoteController@moduleView')->name('module-view');
     Route::get('/chart-segment-view/{patient}/{segmentInternalName}/{view}', 'NoteController@chartSegmentView')->name('chart-segment-view');
     Route::get('/note-rhs-sidebar/{patient}/{note}', 'NoteController@rhsSidebar')->name('note-rhs-sidebar');
     Route::get('/medications-center/{patient}/{note}', 'NoteController@medicationsCenter')->name('medications-center');