<div id="snhospicewizard2" style="display:none">
	<cfform name="formstep2" id="formstep2">
		<div class="form-body">
			<div class="margin-top-10 text-center">
				<ul class="pagination nav_pagination" style="margin:0;">
					<cfloop index=ind from="1" to="4">
						<cfoutput>
							<li class="nav_snhospicewizard#ind# <cfif ind eq 1>active</cfif>" onClick="$('##snhospicewizard2').hide(); $('##snhospicewizard#ind#').show(); $('.pagination li').removeClass('active'); $('.nav_snhospicewizard#ind#').addClass('active');">
								<a href="javascript:;">#ind#</a>
							</li>
						</cfoutput>
					</cfloop>
				</ul>
			
				<div class="dashboard-stat2 progress_div" style="margin: 0px auto; padding-top: 0px; max-width: 320px;">
					<div class="progress-info">
						<div class="progress" style="height: 9px">
							<span class="progress-bar progress-bar-success green-sharp">
								<span class="sr-only ">0% progress</span>
							</span>
						</div>
						<div class="status">
							<div class="status-title"> progress </div>
							<div class="status-number"> <span class="progressBar">0%</span> </div>
						</div>
					</div>
				</div>
			</div>
			
			<div class="well">
			<input type="text" style="width:0px;height:0px;border:0" name="txtfocus1" id="txtfocus1" value=""/>
			<div class="row">
				<div class="col-md-6">
					<div class="form-group">
						<div class="label-stable">
							<label>Skin</label>
							<div id="Skindiv" class="checkbox-list">
								<cfoutput>
									<label>
									<input type="checkbox" name="Skin"  value="Bruise(s)" <cfif #AssForm.M0440_Assess# contains 'Bruise(s)'>checked</cfif>  /> Bruise(s)</label>
									<label>
									<input type="checkbox" name="Skin"  value="Color Cyanotic" <cfif #AssForm.M0440_Assess# contains 'Color Cyanotic'>checked</cfif>  /> Color Cyanotic</label>
									<label>
									<input type="checkbox" name="Skin"  value="Color Jaundice" <cfif #AssForm.M0440_Assess# contains 'Color Jaundice'>checked</cfif>  /> Color Jaundice</label>
									<label>
									<input type="checkbox" name="Skin"  value="Color Pale" <cfif #AssForm.M0440_Assess# contains 'Color Pale'>checked</cfif>  /> Color Pale</label>
									<label>
									<input type="checkbox" name="Skin"  value="Dry Skin" <cfif #AssForm.M0440_Assess# contains 'Dry Skin'>checked</cfif>  /> Dry Skin</label>
									<label>
									<input type="checkbox" name="Skin"  value="Poor Skin Turgor" <cfif #AssForm.M0440_Assess# contains 'Poor Skin Turgor'>checked</cfif>  /> Poor Skin Turgor</label>
									<label>
									<input type="checkbox" name="Skin"  value="Rash(es)" <cfif #AssForm.M0440_Assess# contains 'Rash(es)'>checked</cfif>  /> Rash(es)</label>
									<label>
									<input type="checkbox" name="Skin"  value="Sweaty Skin" <cfif #AssForm.M0440_Assess# contains 'Sweaty Skin'>checked</cfif>  /> Sweaty Skin</label>
									<label>
									<input type="checkbox" name="Skin"  value="Asymptomatic" <cfif #AssForm.M0440_Assess# contains 'Asymptomatic'>checked</cfif>  /> Asymptomatic</label>
									<label>
									<input type="checkbox" name="Skin"  value="Other" <cfif #AssForm.M0440_Assess# contains 'Other'>checked</cfif>  /> Other</label>
								</cfoutput>
							</div>
						</div>
					</div>
					<cfoutput>
						<p class="btn blue margin-bottom-10" id="PainAssess" onClick="PainValidation();" style="cursor:pointer;">
							<cfif #AssForm.M0420_Assess# NEQ '' OR #AssForm.pain1# NEQ '' OR #AssForm.pain2 # NEQ '' OR  #AssForm.pain3# Neq '' OR #AssForm.pain4# neq '' OR #AssForm.pain5# neq ''>
								<span id="spnPain2">Pain assessment complete</span>
							<cfelse>
								<span id="spnPain2">Pain assessment incomplete</span>
							</cfif>
						</p>
					</cfoutput>
				</div>
				<div class="col-md-6">
					<div class="form-group">
						<div class="label-stable">
							<label>Nutritional Therapies</label>
							<div id="NutriTherapdiv" class="checkbox-list">
								<cfoutput>
									<label>
									<input type="checkbox" name="NutriTherap"  value="1 - Intravenous or Infusion Therapy (excludes TPN)" <cfif #AssForm.Therapies_Home_M0250# contains '1 - Intravenous or Infusion Therapy (excludes TPN)'>checked</cfif>  /> 1 - Intravenous or Infusion Therapy (excludes TPN)</label>
									<label>
									<input type="checkbox" name="NutriTherap"  value="2 - Parenteral Nutrition (TPN or liquids)" <cfif #AssForm.Therapies_Home_M0250# contains '2 - Parenteral Nutrition (TPN or liquids)'>checked</cfif>  /> 2 - Parenteral Nutrition (TPN or liquids)</label>
									<label>
									<input type="checkbox" name="NutriTherap"  value="3 - Enteral Nutrition (Nasogastric, Gastrostomy, Jejunostomy, etc)" <cfif #AssForm.Therapies_Home_M0250# contains '3 - Enteral Nutrition (Nasogastric, Gastrostomy, Jejunostomy, etc)'>checked</cfif>  /> 3 - Enteral Nutrition (Nasogastric, Gastrostomy, Jejunostomy, etc)</label>
									<label>
									<input type="checkbox" name="NutriTherap"  value="4 - None of the above" <cfif #AssForm.Therapies_Home_M0250# contains '4 - None of the above'>checked</cfif>  /> 4 - None of the above</label>
								</cfoutput>
							</div>
						</div>
					</div>
					<div class="form-group">
						<div class="label-stable">
							<label>Endocrine</label>
							<div id="Endocrinediv" class="checkbox-list">
								<cfoutput>
									<label>
									<input type="checkbox" name="Endocrine"  value="Hyperglycemia: Thirst, Tiredness, Apathy, increased Sleeping" <cfif #AssForm.Endocrine_Assess# contains 'Hyperglycemia: Thirst, Tiredness, Apathy, increased Sleeping'>checked</cfif>  /> Hyperglycemia: Thirst, Tiredness, Apathy, increased Sleeping</label>
									<label>
									<input type="checkbox" name="Endocrine"  value="Hypoglycemia: Hunger, Dizziness, Shaking, Nervousness" <cfif #AssForm.Endocrine_Assess# contains 'Hypoglycemia: Hunger, Dizziness, Shaking, Nervousness'>checked</cfif>  /> Hypoglycemia: Hunger, Dizziness, Shaking, Nervousness</label>
									<label>
									<input type="checkbox" name="Endocrine"  value="Serum <> between 65 - 99 mg/dL" <cfif #AssForm.Endocrine_Assess# contains 'Serum <> between 65 - 99 mg/dL'>checked</cfif>  /> Serum <> between 65 - 99 mg/dL</label>
									<label>
									<input type="checkbox" name="Endocrine"  value="Sugar in urine" <cfif #AssForm.Endocrine_Assess# contains 'Sugar in urine'>checked</cfif>  /> Sugar in urine</label>
									<label>
									<input type="checkbox" name="Endocrine"  value="Asymptomatic" <cfif #AssForm.Endocrine_Assess# contains 'Asymptomatic'>checked</cfif>  /> Asymptomatic</label>
									<label>
									<input type="checkbox" name="Endocrine"  value="Other" <cfif #AssForm.Endocrine_Assess# contains 'Other'>checked</cfif>  /> Other</label>
								</cfoutput>
							</div>
						</div>
					</div>		
				</div>
			</div>	
			<div class="form-group">
				<label>Comments</label>
				<cfoutput><textarea class="form-control" name="txtComment" id="txtComment" onBlur="ChangeBlur('formstep2','txtComment')" rows="3">#AssForm.Assessment_Note#</textarea></cfoutput>
			</div>
		</div>
		</div>
		
		<div class="form-actions">
			<input class="btn blue" type="button" value="Previous" onClick="$('#snhospicewizard2').hide(); $('#snhospicewizard1').show();$('.pagination li').removeClass('active'); $('.nav_snhospicewizard1').addClass('active'); $('html, body').animate({scrollTop: '0px'}, 300);">
			<input class="btn default" type="button" value="Cancel" onClick="StepClose('2');">
			<input class="btn green" type="button" value="Next" onClick="UpdateSoc(2);">
		</div>
	</cfform>
</div>