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@@ -17,6 +17,22 @@ $formID = rand(0, 100000);
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<input type="hidden" name="note_uid" value="<?= $note->uid?>">
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<input type="hidden" name="section_template_uid" value="<?= $sectionTemplate->uid ?>">
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<?php endif; ?>
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+
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+ <div class="form-group mb-2">
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+ <label class="d-flex align-items-center">
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+ <input type="checkbox" class="my-0 mr-2" name="no_known_allergies" <?= $contentData['no_known_allergies'] ? 'checked' : '' ?>>
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+ <span>No known allergies</span>
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+ </label>
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+ <label class="d-flex align-items-center">
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+ <input type="checkbox" class="my-0 mr-2" name="no_known_medication_allergies" <?= $contentData['no_known_medication_allergies'] ? 'checked' : '' ?>>
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+ <span>No known medication allergies</span>
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+ </label>
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+ <label class="d-flex align-items-center">
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+ <input type="checkbox" class="my-0 mr-2" name="allergy_reconciliation_performed" <?= $contentData['allergy_reconciliation_performed'] ? 'checked' : '' ?>>
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+ <span>Allergy reconciliation performed</span>
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+ </label>
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+ </div>
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+
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<div class="form-group mb-2">
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<textarea rte type="text" class="form-control form-control-sm p-2" name="value" placeholder="Value"><?= $contentData['value'] ?></textarea>
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</div>
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