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@@ -36,7 +36,10 @@ $contentData = [
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"cdc_stress_emphasis_physical_reactions" => null,
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"cdc_stress_emphasis_physical_reactions" => null,
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"cdc_stress_emphasis_coping_with_stress" => null,
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"cdc_stress_emphasis_coping_with_stress" => null,
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"ans_hypertension_rpm_education" => null,
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"ans_hypertension_rpm_education" => null,
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-
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+ "top_wish_1" => null,
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+ "top_wish_2" => null,
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+ "top_wish_3" => null,
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+ "follow_up_for" => null
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];
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];
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if (!!@$point->data) {
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if (!!@$point->data) {
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@@ -50,6 +53,7 @@ if (!!@$point->data) {
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<input type="hidden" name="category" value="<?= $category ?>">
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<input type="hidden" name="category" value="<?= $category ?>">
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<input id="mainData" type="hidden" name="data" value="{{json_encode($contentData)}}">
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<input id="mainData" type="hidden" name="data" value="{{json_encode($contentData)}}">
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+ <h2>Note to provider: please begin visit asking vital signs using supplied equipment, and resolve any technical questions.</h2>
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<div class="mb-2">
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<div class="mb-2">
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<label class="mb-1">Have you received printed materials from CDC, “<b>How to Protect Yourself & Others</b>”?</label>
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<label class="mb-1">Have you received printed materials from CDC, “<b>How to Protect Yourself & Others</b>”?</label>
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@@ -204,7 +208,7 @@ if (!!@$point->data) {
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<hr class="my-3">
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<hr class="my-3">
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<div class="mb-2">
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<div class="mb-2">
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- <label class="mb-1">Answered all questions relating to COVID-19</label>
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+ <label class="mb-1">Answered all questions relating to COVID-19; patient verbalizes understanding.</label>
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<div class="d-inline-flex ml-2 align-items-baseline pt-1">
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<div class="d-inline-flex ml-2 align-items-baseline pt-1">
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<label class="my-0 mr-3 d-flex align-items-center">
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<label class="my-0 mr-3 d-flex align-items-center">
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<input type="radio" data-name="ans_has_answered_all_covid_19_questions" name="ans_has_answered_all_covid_19_questions" {{@$contentData['ans_has_answered_all_covid_19_questions'] && @$contentData['ans_has_answered_all_covid_19_questions'] === 'yes' ? 'checked' : ''}} value="yes">
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<input type="radio" data-name="ans_has_answered_all_covid_19_questions" name="ans_has_answered_all_covid_19_questions" {{@$contentData['ans_has_answered_all_covid_19_questions'] && @$contentData['ans_has_answered_all_covid_19_questions'] === 'yes' ? 'checked' : ''}} value="yes">
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@@ -392,6 +396,22 @@ if (!!@$point->data) {
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</div>
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</div>
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<hr class="my-3">
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<hr class="my-3">
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+
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+ <div class="mb-2">
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+ <label class="mb-1">What are your top three wishes for your health? <i class="fa fa-info-circle"></i> (Note to provider: sometimes patients need help to identify goals; <strong>"if you could wave a magic wand and have any three health wishes granted, what would they be?"</strong> common issues are fatigue, weight, joint pain, blood sugar, BP, etc.)</label>
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+ <div class="mt-1">1. <input type="text" data-name="top_wish_1" value="{{@$contentData ['top_wish_1']}}" class="form-control form-control-sm d-inline-block w-auto ml-2"></div>
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+ <div class="mt-1">2. <input type="text" data-name="top_wish_2" value="{{@$contentData ['top_wish_2']}}" class="form-control form-control-sm d-inline-block w-auto ml-2"></div>
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+ <div class="mt-1">3. <input type="text" data-name="top_wish_3" value="{{@$contentData ['top_wish_3']}}" class="form-control form-control-sm d-inline-block w-auto ml-2"></div>
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+ </div>
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+ <hr class="my-3">
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+
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+ <div class="mb-2">
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+ <label class="mb-1">Next follow-up for:</label>
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+ <input type="text" data-name="follow_up_for" value="{{@$contentData ['follow_up_for']}}" class="form-control form-control-sm d-inline-block w-auto ml-2">
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+ </div>
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+
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+ <hr class="my-3">
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+
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<div class="pt-2">
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<div class="pt-2">
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<button submit class="btn btn-sm btn-primary mr-2"><i class="fa fa-save"></i></button>
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<button submit class="btn btn-sm btn-primary mr-2"><i class="fa fa-save"></i></button>
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<div class="d-inline-flex align-self-stretch align-items-center">
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<div class="d-inline-flex align-self-stretch align-items-center">
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@@ -496,4 +516,4 @@ if (!!@$point->data) {
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covidFollowUp.init();
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covidFollowUp.init();
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};
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};
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}).call(window);
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}).call(window);
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-</script>
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+</script>
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