<cfwindow
    name="pain"
    title=""
    height="500"
    width="800"
    resizable="false"
    center="true"
    closable="false"
    draggable="false"
    modal="true"
    bodystyle="background-color:white;" initshow="false">
	<cfform name="pain" id="pain">
        <div id="DivPainAssessmentd" style="margin:0 15px;">
            <img name="imgbtnClose" onClick="UpdateSoc('pain')" title="Close" style="cursor:pointer;float:right" id="imgbtnClose" src="../../../images/icon_back.gif" width="33" height="35" />
            <h4>Pain Assessment
            
            <cfif #AssForm.Psy_Nursing_M0630# nEQ '' OR #AssForm.Grooming_M0640# nEQ '' OR #AssForm.Grooming_M0640p
									# nEQ '' OR  #AssForm.Dress_Upper_M0650# neq '' OR #AssForm.Dress_Upper_M0650p# neq ''>
                <span style="color:blue">Pain assessment complete</span>
             <cfelse>
                <span style="color:red">Pain assessment incomplete</span>	
             </cfif>
             </h4>  
             
            <div class="row">
            	<div class="col-md-6">
            		<div class="form-group">
                <div class="label-stable">
                    <label>Pain Level</label>
                    <div class="radio-list">
                        <label>
                        <input type="radio" name="painlevel" value="pain level 0 (low)" /> <span>pain level 0 (low)</span></label>
                        <label>
                        <input type="radio" name="painlevel" value="pain level 1 (low)" <cfif #AssForm.Psy_Nursing_M0630# contains 'pain level 1 (low)'>checked</cfif>/> <span>pain level 1 (low)</span></label>
                        <label>
                        <input type="radio" name="painlevel" value="pain level 2 (low)" <cfif #AssForm.Psy_Nursing_M0630# contains 'pain level 2 (low)'>checked</cfif>/> <span>pain level 2 (low)</span></label>
                        <label>
                        <input type="radio" name="painlevel" value="pain level 3 (med)" <cfif #AssForm.Psy_Nursing_M0630# contains 'pain level 3 (med)'>checked</cfif>/> <span>pain level 3 (med)</span></label>
                        <label>
                        <input type="radio" name="painlevel" value="pain level 4 (med)" <cfif #AssForm.Psy_Nursing_M0630# contains 'pain level 4 (med)'>checked</cfif>/> <span>pain level 4 (med)</span></label>
                        <label>
                        <input type="radio" name="painlevel" value="pain level 5 (med)" <cfif #AssForm.Psy_Nursing_M0630# contains 'pain level 5 (med)'>checked</cfif>/> <span>pain level 5 (med)</span></label>
                        <label>
                        <input type="radio" name="painlevel" value="pain level 6 (med)" <cfif #AssForm.Psy_Nursing_M0630# contains 'pain level 6 (med)'>checked</cfif>/> <span>pain level 6 (med)</span></label>
                        <label>
                        <input type="radio" name="painlevel" value="pain level 7 (high)" <cfif #AssForm.Psy_Nursing_M0630# contains 'pain level 7 (high)'>checked</cfif>/> <span>pain level 7 (high)</span></label>
                        <label>
                        <input type="radio" name="painlevel" value="pain level 8 (high)" <cfif #AssForm.Psy_Nursing_M0630# contains 'pain level 8 (high)'>checked</cfif>/> <span>pain level 8 (high)</span></label>
                        <label>
                        <input type="radio" name="painlevel" value="pain level 9 (high)" <cfif #AssForm.Psy_Nursing_M0630# contains 'pain level 9 (high)'>checked</cfif>/> <span>pain level 9 (high)</span></label>
                        <label>
                        <input type="radio" name="painlevel" value="pain level 10 (high)" <cfif #AssForm.Psy_Nursing_M0630# contains 'pain level 10 (high)'>checked</cfif>/> <span>pain level 10 (high)</span></label>
                    </div>
                </div>
            </div>
            	</div>
                <div class="col-md-6">
                	<div class="form-group">
                <div class="label-stable">
                    <label> Rate Current Pain Treament Effectiveness on a scale or 1 to 10 (1= low effectiveness)</label>
                    <div class="radio-list">
                        <label>
                        <input type="radio" name="currentpain" value="pain level 0 (low)"  <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 0 (low)'>checked</cfif>/>  <span>pain level 0 (low)</span></label>
                        <label>
                        <input type="radio" name="currentpain" value="pain level 6 (med)" <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 6 (med)'>checked</cfif>/> <span>pain level 6 (med)</span></label>
                        <label>
                        <input type="radio" name="currentpain" value="pain level 1 (low)"  <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 1 (low)'>checked</cfif>/> <span>pain level 1 (low)</span></label>
                        <label>
                        <input type="radio" name="currentpain" value="pain level 7 (high)" <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 7 (high)'>checked</cfif>/> <span>pain level 7 (high)</span></label>
                        <label>
                        <input type="radio" name="currentpain" value="pain level 2 (low)"  <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 2 (low)'>checked</cfif>/> <span>pain level 2 (low)</span></label>
                        <label>
                        <input type="radio" name="currentpain" value="pain level 8 (high)" <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 8 (high)'>checked</cfif>/> <span>pain level 8 (high)</span></label>
                        <label>
                        <input type="radio" name="currentpain" value="pain level 3 (med)"  <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 3 (med)'>checked</cfif>/> <span>pain level 3 (med)</span></label>
                        <label>
                        <input type="radio" name="currentpain" value="pain level 9 (high)" <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 9 (high)'>checked</cfif>/> <span>pain level 9 (high)</span></label>
                        <label>
                        <input type="radio" name="currentpain" value="pain level 4 (med)" <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 4 (med)'>checked</cfif>/> <span>pain level 4 (med)</span></label>
                        <label>
                        <input type="radio" name="currentpain" value="pain level 10 (high)"  <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 10 (high)'>checked</cfif>/> <span>pain level 10 (high)</span></label>
                        <label>
                        <input type="radio" name="currentpain" value="pain level 5 (med)" <cfif #AssForm.Dress_Upper_M0650# contains 'pain level 5 (med)'>checked</cfif>/> <span>pain level 5 (med)</span></label>
                    </div>
                </div>
            </div>
                </div>
 			</div>               
            
            <table border="0" cellpadding="0" cellspacing="0" width="100%" class="text-center">
                <tr>
                    <td><img src="../../images/smily0.gif" /></td>
                    <td><img src="../../images/smily2.gif"/></td>
                    <td><img src="../../images/smily4.gif" /></td>
                    <td><img src="../../images/smily6.gif"/></td>
                    <td><img src="../../images/smily8.gif" /></td>
                    <td><img src="../../images/smily10.gif"/></td>
                </tr>
                <tr>
                    <td>0</td>
                    <td>2</td>
                    <td>4</td>
                    <td>6</td>
                    <td>8</td>
                    <td>10</td>
                </tr>
            </table>
            <br>
             <div class="row">
             	<div class="col-md-6">
                	<div class="form-group">
                <div class="label-stable">
                    <label>Pain Characteristics</label>
                    <div class="checkbox-list">
                        <label>
                        <input type="checkbox"  name="chkthrobbing" value="Throbbing" <cfif #AssForm.Grooming_M0640# contains 'Throbbing'>checked</cfif>/>  Throbbing</label>
                        <label>
                        <input type="checkbox"  name="chkthrobbing" value="Stabbing" <cfif #AssForm.Grooming_M0640# contains 'Stabbing'>checked</cfif>/>  Stabbing</label>
                        <label>
                        <input type="checkbox"  name="chkthrobbing" value="Sharp"  <cfif #AssForm.Grooming_M0640# contains 'Sharp'>checked</cfif>/> Sharp</label>
                        <label>
                        <input type="checkbox"  name="chkthrobbing" value="Aching" <cfif #AssForm.Grooming_M0640# contains 'Aching'>checked</cfif> /> Aching</label>
                        <label>
                        <input type="checkbox"  name="chkthrobbing" value="Burning" <cfif #AssForm.Grooming_M0640# contains 'Burning'>checked</cfif>/>  Burning</label>
                        <label>
                        <input type="checkbox"  name="chkthrobbing" value="Numb" <cfif #AssForm.Grooming_M0640# contains 'Numb'>checked</cfif>  /> Numb</label>
                        <label>
                        <input type="checkbox"  name="chkthrobbing" value="Shooting" <cfif #AssForm.Grooming_M0640# contains 'Shooting'>checked</cfif>/> Shooting</label>
                        <label>
                        <input type="checkbox"  name="chkthrobbing" value="Not Applicable" <cfif #AssForm.Grooming_M0640# contains 'Not Applicable'>checked</cfif>/> Not Applicable</label>
                        <label>
                        <input type="checkbox"  name="chkthrobbing" value="Other" <cfif #AssForm.Grooming_M0640# contains 'Other'>checked</cfif>/>  Other</label>
                    </div>
                </div>
            </div>
                </div>
                <div class="col-md-6">
                	<div class="form-group">
                <div class="label-stable">
                    <label>How long does each  work before needing another</label>
                    <div class="radio-list">
                        <label>
                        <input type="radio"  name="doeseach"  value="30 minutes" <cfif #AssForm.Dress_Upper_M0650p# contains '30 minutes'>checked</cfif>/> <span>30 minutes</span></label>
                        <label>
                        <input type="radio"  name="doeseach"  value="1 hour" <cfif #AssForm.Dress_Upper_M0650p# contains '1 hour'>checked</cfif>/> <span>1 hour</span></label>
                        <label>
                        <input type="radio"  name="doeseach"  value="2 hours" <cfif #AssForm.Dress_Upper_M0650p# contains '2 hours'>checked</cfif>/> <span>2 hours</span></label>
                        <label>
                        <input type="radio"  name="doeseach"  value="3 hours" <cfif #AssForm.Dress_Upper_M0650p# contains '3 hours'>checked</cfif>/> <span>3 hours</span></label>
                        <label>
                        <input type="radio"  name="doeseach"  value="4 hours" <cfif #AssForm.Dress_Upper_M0650p# contains '4 hours'>checked</cfif>/> <span>4 hours</span></label>
                        <label>
                        <input type="radio"  name="doeseach"  value="6 hours" <cfif #AssForm.Dress_Upper_M0650p# contains '6 hours'>checked</cfif>/> <span>6 hours</span></label>
                        <label>
                        <input type="radio"  name="doeseach"  value="12 hours" <cfif #AssForm.Dress_Upper_M0650p# contains '12 hours'>checked</cfif>/> <span>12 hours</span></label>
                        <label>
                        <input type="radio"  name="doeseach"  value="24 hours" <cfif #AssForm.Dress_Upper_M0650p# contains '24 hours'>checked</cfif>/> <span>24 hours</span></label>
    
                    </div>
                </div>
            </div>
                </div>
             </div>
             
             <div class="row">
             	<div class="col-md-6">
                	<div class="form-group">
                <div class="label-stable">
                    <label>Pain Threshold</label>
                    <div class="radio-list">
                        <label>
                        <input type="radio" name="radthreshold" value="at rest" <cfif #AssForm.Grooming_M0640p# contains 'at rest'>checked</cfif>/> <span>At rest</span></label>
                        <label>
                        <input type="radio" name="radthreshold" value="with minimal activity" <cfif #AssForm.Grooming_M0640p# contains 'with minimal activity'>checked</cfif> /> <span>With minimal activity</span></label>
                        <label>
                        <input type="radio" name="radthreshold" value="with moderate activity" <cfif #AssForm.Grooming_M0640p# contains 'with moderate activity'>checked</cfif>/> <span>With moderate activity</span></label>
                        <label>
                        <input type="radio" name="radthreshold" value="with strenuous activity" <cfif #AssForm.Grooming_M0640p# contains 'with strenuous activity'>checked</cfif>/> <span>With strenuous activity</span></label>
                        <label>
                        <input type="radio" name="radthreshold" value="Not Applicable" <cfif #AssForm.Grooming_M0640p# contains 'Not Applicable'>checked</cfif>/> <span>Not Applicable</span></label>
                        <label>
                        <input type="radio" name="radthreshold" value="Other" <cfif #AssForm.Grooming_M0640p# contains 'Other'>checked</cfif>/> <span>Other</span></label>
                    </div>
                </div>
            </div>
                </div>
                
             </div>
             
		</div>
	</cfform>
</cfwindow>