frm_22.php
231 lines
| 9.8 KiB
| text/x-php
|
XmlPhpLexer
|
r0 | <?php | ||
?> | ||||
<script> | ||||
$(function() { | ||||
//alert('hola'); | ||||
$( "#date_exam" ).datepicker({ | ||||
showWeek: true, | ||||
dateFormat: 'dd/M/yy', | ||||
firstDay: 1 | ||||
}); | ||||
}); | ||||
</script> | ||||
<div style="width:650px; margin:0 auto;"> | ||||
<h1>28 Day Cycle, Cycle 1, Day 1</h1> | ||||
<table id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Date</td> | ||||
<td style="text-align:right;"><input type="text" id="date_exam" name="datos[date_exam]" value="" /></td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blood Pressure <br>before Dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_30" name="datos[blod_presure_v1_30]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_30" name="datos[blod_presure_v2_30]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_30" name="datos[pulse_rate_30]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_30" name="datos[respirations_30]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_30" name="datos[oral_temperatutre_30]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blood Pressure 30<br>min post dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_30" name="datos[blod_presure_v1_30]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_30" name="datos[blod_presure_v2_30]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_30" name="datos[pulse_rate_30]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_30" name="datos[respirations_30]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_30" name="datos[oral_temperatutre_30]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blod Pressure 60<br>min post dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_60" name="datos[blod_presure_v1_60]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_60" name="datos[blod_presure_v2_60]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_60" name="datos[pulse_rate_60]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_60" name="datos[respirations_60]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_60" name="datos[oral_temperatutre_60]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blod Pressure 120<br>min post dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_120" name="datos[blod_presure_v1_120]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_120" name="datos[blod_presure_v2_120]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_120" name="datos[pulse_rate_120]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_120" name="datos[respirations_120]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_120" name="datos[oral_temperatutre_120]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blood Pressure 3.75<br>hrs post Dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_30" name="datos[blod_presure_v1_30]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_30" name="datos[blod_presure_v2_30]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_30" name="datos[pulse_rate_30]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_30" name="datos[respirations_30]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_30" name="datos[oral_temperatutre_30]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blood Pressure 4.083<br>hrs post dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_30" name="datos[blod_presure_v1_30]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_30" name="datos[blod_presure_v2_30]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_30" name="datos[pulse_rate_30]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_30" name="datos[respirations_30]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_30" name="datos[oral_temperatutre_30]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blood Pressure 4.5<br>hrs post dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_30" name="datos[blod_presure_v1_30]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_30" name="datos[blod_presure_v2_30]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_30" name="datos[pulse_rate_30]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_30" name="datos[respirations_30]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_30" name="datos[oral_temperatutre_30]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blod Pressure 6<br>hrs post dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_180" name="datos[blod_presure_v1_180]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_180" name="datos[blod_presure_v2_180]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_180" name="datos[pulse_rate_180]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_180" name="datos[respirations_180]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_180" name="datos[oral_temperatutre_180]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blood Pressure 8<br>hrs post dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_30" name="datos[blod_presure_v1_30]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_30" name="datos[blod_presure_v2_30]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_30" name="datos[pulse_rate_30]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_30" name="datos[respirations_30]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_30" name="datos[oral_temperatutre_30]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blood Pressure 10<br>hrs post dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_30" name="datos[blod_presure_v1_30]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_30" name="datos[blod_presure_v2_30]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_30" name="datos[pulse_rate_30]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_30" name="datos[respirations_30]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_30" name="datos[oral_temperatutre_30]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td>Blood Pressure 24<br>hrs post dose</td> | ||||
<td>Pulse Rate</td> | ||||
<td>Respirations</td> | ||||
<td>Oral Temperature</td> | ||||
</tr> | ||||
<tr> | ||||
<td><input type="text" id="blod_presure_v1_30" name="datos[blod_presure_v1_30]" value="" style="width:35px;" />/<input type="text" id="blod_presure_v2_30" name="datos[blod_presure_v2_30]" value="" style="width:35px;" /> mmHg</td> | ||||
<td><input type="text" id="pulse_rate_30" name="datos[pulse_rate_30]" value="" style="width:55px;" /> bpm</td> | ||||
<td><input type="text" id="respirations_30" name="datos[respirations_30]" value="" style="width:55px;" /> rpm</td> | ||||
<td><input type="text" id="oral_temperatutre_30" name="datos[oral_temperatutre_30]" value="" style="width:55px;" /> C</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<div> | ||||
<input type="submit" value="save" id="btn_save" name="btn_save"><input type="reset" value="clear" id="btn_clear" name="btn_clear"> | ||||
</div> | ||||
</div> | ||||