|
|
@@ -20,21 +20,21 @@ $formID = rand(0, 100000);
|
|
|
|
|
|
<div class="form-group mb-2">
|
|
|
<label class="d-flex align-items-center">
|
|
|
- <input type="checkbox" class="my-0 mr-2" name="no_known_allergies" <?= $contentData['no_known_allergies'] ? 'checked' : '' ?>>
|
|
|
+ <input type="checkbox" class="my-0 mr-2" name="no_known_allergies" <?= @$contentData['no_known_allergies'] ? 'checked' : '' ?>>
|
|
|
<span>No known allergies</span>
|
|
|
</label>
|
|
|
<label class="d-flex align-items-center">
|
|
|
- <input type="checkbox" class="my-0 mr-2" name="no_known_medication_allergies" <?= $contentData['no_known_medication_allergies'] ? 'checked' : '' ?>>
|
|
|
+ <input type="checkbox" class="my-0 mr-2" name="no_known_medication_allergies" <?= @$contentData['no_known_medication_allergies'] ? 'checked' : '' ?>>
|
|
|
<span>No known medication allergies</span>
|
|
|
</label>
|
|
|
<label class="d-flex align-items-center">
|
|
|
- <input type="checkbox" class="my-0 mr-2" name="allergy_reconciliation_performed" <?= $contentData['allergy_reconciliation_performed'] ? 'checked' : '' ?>>
|
|
|
+ <input type="checkbox" class="my-0 mr-2" name="allergy_reconciliation_performed" <?= @$contentData['allergy_reconciliation_performed'] ? 'checked' : '' ?>>
|
|
|
<span>Allergy reconciliation performed</span>
|
|
|
</label>
|
|
|
</div>
|
|
|
|
|
|
<div class="form-group mb-2">
|
|
|
- <textarea rte type="text" class="form-control form-control-sm p-2" name="value" placeholder="Value"><?= $contentData['value'] ?></textarea>
|
|
|
+ <textarea rte type="text" class="form-control form-control-sm p-2" name="value" placeholder="Value"><?= @$contentData['value'] ?></textarea>
|
|
|
</div>
|
|
|
<div class="form-group m-0 d-flex">
|
|
|
<button class="btn btn-sm btn-primary mr-2">Submit</button>
|
