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@@ -23,6 +23,7 @@
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</label>
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</label>
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</div>
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</div>
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<div class="mb-2"><input type="text" class="form-control form-control-sm" name="Prognosis" value="" placeholder="Prognosis"></div>
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<div class="mb-2"><input type="text" class="form-control form-control-sm" name="Prognosis" value="" placeholder="Prognosis"></div>
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+ <div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="History" value="" placeholder="History"></textarea></div>
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<div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="Treatment Goal" value="" placeholder="Treatment Goal"></textarea></div>
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<div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="Treatment Goal" value="" placeholder="Treatment Goal"></textarea></div>
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<div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="Treatment Plan" value="" placeholder="Treatment Plan"></textarea></div>
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<div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="Treatment Plan" value="" placeholder="Treatment Plan"></textarea></div>
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<div class="d-flex align-items-center">
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<div class="d-flex align-items-center">
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@@ -37,11 +38,12 @@
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<tr>
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<tr>
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<th class="px-2 text-secondary">Title</th>
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<th class="px-2 text-secondary">Title</th>
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<th class="px-2 text-secondary">ICD</th>
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<th class="px-2 text-secondary">ICD</th>
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- <th class="px-2 text-secondary">Chronic or Acute</th>
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+ <th class="px-2 text-secondary">Chr/Act</th>
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<th class="px-2 text-secondary">Current?</th>
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<th class="px-2 text-secondary">Current?</th>
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<th class="px-2 text-secondary">Prognosis</th>
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<th class="px-2 text-secondary">Prognosis</th>
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- <th class="px-2 text-secondary">Treatment Goal</th>
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- <th class="px-2 text-secondary">Treatment Plan</th>
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+ <th class="px-2 text-secondary">History</th>
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+ <th class="px-2 text-secondary">Goal</th>
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+ <th class="px-2 text-secondary w-25">Plan</th>
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<th class="px-2 text-secondary delete-column"> </th>
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<th class="px-2 text-secondary delete-column"> </th>
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</tr>
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</tr>
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</thead>
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</thead>
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