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@@ -55,25 +55,70 @@
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<div class="form-group">
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<div class="form-group">
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<label class="m-0">Symptoms</label>
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<label class="m-0">Symptoms</label>
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<div class="d-flex align-items-end">
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<div class="d-flex align-items-end">
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- <select name="HPI_symptoms" multiple="multiple" class="select2" v-model="data.HPI_symptoms"></select>
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+ <select name="HPI_symptoms" multiple="multiple" class="select2" v-model="data.HPI_symptoms">
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+ <option value=""></option>
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+ <option>change in bowels</option>
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+ <option>chronic or persistent cough</option>
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+ <option>clumsiness</option>
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+ <option>edema of lower extremities</option>
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+ <option>episodes of chest tightness</option>
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+ <option>episodes of wheezing</option>
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+ <option>excessive phlegm</option>
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+ <option>excessively dry skin</option>
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+ <option>High blood pressure</option>
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+ <option>impotency</option>
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+ <option>loss of muscle strength</option>
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+ <option>loss of sensation</option>
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+ <option>occasional sleep disturbance</option>
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+ <option>persistent joint pain</option>
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+ <option>problems breathing through nose</option>
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+ <option>shortness of breath with exercise</option>
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+ <option>urinary discomfort</option>
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+ <option>weight gain</option>
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+ <option>weight loss</option>
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+ </select>
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</div>
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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<label class="m-0">Severity</label>
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<label class="m-0">Severity</label>
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<div class="d-flex align-items-end">
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<div class="d-flex align-items-end">
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- <select name="HPI_severity" multiple="multiple" class="select2" v-model="data.HPI_severity"></select>
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+ <select name="HPI_severity" multiple="multiple" class="select2" v-model="data.HPI_severity">
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+ <option value=""></option>
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+ <option>Mild</option>
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+ <option>Moderate</option>
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+ <option>Severe</option>
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+ </select>
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</div>
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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<label class="m-0">Duration</label>
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<label class="m-0">Duration</label>
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<div class="d-flex align-items-end">
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<div class="d-flex align-items-end">
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- <select name="HPI_duration" multiple="multiple" class="select2" v-model="data.HPI_duration"></select>
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+ <select name="HPI_duration" multiple="multiple" class="select2" v-model="data.HPI_duration">
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+ <option value=""></option>
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+ <option>Less than 1 week</option>
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+ <option>1 week</option>
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+ <option>2 weeks</option>
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+ <option>3 weeks</option>
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+ <option>1 month</option>
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+ <option>2 months</option>
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+ <option>3 months</option>
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+ <option>4 months</option>
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+ <option>5 months</option>
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+ <option>6 months</option>
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+ <option>1 year</option>
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+ <option>Unknown</option>
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+ <option>2-3 years</option>
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+ </select>
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</div>
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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<label class="m-0">Timing</label>
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<label class="m-0">Timing</label>
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<div class="d-flex align-items-end">
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<div class="d-flex align-items-end">
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- <select name="HPI_timing" multiple="multiple" class="select2" v-model="data.HPI_timing"></select>
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+ <select name="HPI_timing" multiple="multiple" class="select2" v-model="data.HPI_timing">
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+ <option value=""></option>
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+ <option>constant</option>
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+ <option>intermittent</option>
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+ </select>
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</div>
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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@@ -85,31 +130,83 @@
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<div class="form-group">
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<div class="form-group">
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<label class="m-0">Aggravating Factors:</label>
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<label class="m-0">Aggravating Factors:</label>
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<div class="d-flex align-items-end">
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<div class="d-flex align-items-end">
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- <select name="HPI_aggravating_factors" multiple="multiple" class="select2" v-model="data.HPI_aggravating_factors"></select>
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+ <select name="HPI_aggravating_factors" multiple="multiple" class="select2" v-model="data.HPI_aggravating_factors">
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+ <option value=""></option>
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+ <option>exercise</option>
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+ <option>exertion</option>
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+ <option>rest</option>
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+ <option>stress</option>
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+ </select>
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</div>
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="form-group">
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<label class="m-0">Alleviating Factors:</label>
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<label class="m-0">Alleviating Factors:</label>
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<div class="d-flex align-items-end">
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<div class="d-flex align-items-end">
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- <select name="HPI_alleviating_factors" multiple="multiple" class="select2" v-model="data.HPI_alleviating_factors"></select>
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+ <select name="HPI_alleviating_factors" multiple="multiple" class="select2" v-model="data.HPI_alleviating_factors">
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+ <option value=""></option>
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+ <option>cold</option>
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+ <option>heat</option>
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+ <option>rest</option>
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+ </select>
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</div>
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</div>
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</div>
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</div>
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<div class="form-group textarea">
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<div class="form-group textarea">
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<label class="m-0">Sleep Summary:</label>
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<label class="m-0">Sleep Summary:</label>
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<div class="d-flex align-items-end">
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<div class="d-flex align-items-end">
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- <select data-name="sleep_exam_sleep_summary" name="sleep_exam_sleep_summary" multiple="multiple" class="select2" v-model="data.sleep_exam_sleep_summary"></select>
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+ <select data-name="sleep_exam_sleep_summary" name="sleep_exam_sleep_summary" multiple="multiple" class="select2" v-model="data.sleep_exam_sleep_summary">
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+ <option value=""></option>
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+ <option>awakens due to extremity jerks</option>
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+ <option>awakens due to snoring</option>
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+ <option>awakens with chest pain or palpitations</option>
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+ <option>awakens with dry throat</option>
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+ <option>delayed sleep due to pain</option>
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+ <option>disturbed sleep</option>
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+ <option>fatigued from lack of sleep</option>
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+ <option>leg restlessness with aching or twitching</option>
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+ <option>sleep walks</option>
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+ <option>sleeps primarily on back</option>
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+ <option>sleeps primarily on side</option>
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+ <option>sleeps primarily on stomach</option>
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+ <option>takes over 45 mintues to fall asleep</option>
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+ <option>talks in sleep</option>
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+ <option>wakes gasping</option>
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+ </select>
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</div>
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</div>
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</div>
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</div>
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<div class="form-group textarea">
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<div class="form-group textarea">
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<label class="m-0">Previous Treatments:</label>
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<label class="m-0">Previous Treatments:</label>
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<div class="d-flex align-items-end">
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<div class="d-flex align-items-end">
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- <select data-name="PH_previous_treatment" name="PH_previous_treatment" multiple="multiple" class="select2" v-model="data.PH_previous_treatment"></select>
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+ <select data-name="PH_previous_treatment" name="PH_previous_treatment" multiple="multiple" class="select2" v-model="data.PH_previous_treatment">
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+ <option value=""></option>
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+ <option>BiPAP</option>
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+ <option>CPAP</option>
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+ <option>elevating head of bed</option>
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+ <option>oxygen therapy</option>
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+ <option>sleep aids</option>
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+ <option>soft pallet injection</option>
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+ <option>stimulants for daytime sleepiness</option>
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+ <option>tonsils and adeniod surgery</option>
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+ <option>Uvulopalatopharyngoplasty</option>
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+ <option>weight loss</option>
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+ </select>
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</div>
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</div>
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</div>
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</div>
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<div class="form-group textarea">
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<div class="form-group textarea">
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<label class="m-0">Current Treatments:</label>
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<label class="m-0">Current Treatments:</label>
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<div class="d-flex align-items-end">
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<div class="d-flex align-items-end">
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- <select data-name="PH_current_treatment" name="PH_current_treatment" multiple="multiple" class="select2" v-model="data.PH_current_treatment"></select>
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+ <select data-name="PH_current_treatment" name="PH_current_treatment" multiple="multiple" class="select2" v-model="data.PH_current_treatment">
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+ <option value=""></option>
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+ <option>BiPAP</option>
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+ <option>CPAP</option>
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+ <option>elevating head of bed</option>
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+ <option>oxygen therapy</option>
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+ <option>sleep aids</option>
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+ <option>soft pallet injection</option>
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+ <option>stimulants for daytime sleepiness</option>
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+ <option>tonsils and adeniod surgery</option>
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+ <option>Uvulopalatopharyngoplasty</option>
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+ <option>weight loss</option>
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+ </select>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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