<div id="step6" style="display:none">
	 <form name="formstep6" id="formstep6">
                <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="8">
								<cfoutput>
									<li class="nav_recertstep#ind# <cfif ind eq 1>active</cfif>" onClick="$('##step6').hide(); $('##step#ind#').show(); $('.pagination li').removeClass('active'); $('.nav_recertstep#ind#').addClass('active');">
										<a href="javascript:;">#ind#</a>
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						</ul>

						<div class="dashboard-stat2 progress_div" style="margin: 0px auto; padding-top: 0px; max-width: 310px;">
							<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>
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					</div>
					
					<div class="well">
                    <input type="text" style="width:0px;height:0px;border:0" name="txtfocus1" id="txtfocus1" value=""/>
					<h4>
                        <b>Swallowing(Age Appropriate)</b>
                    </h4>
					<div class="row">
                        <div class="col-md-4">
                            <div class="form-group">
                                <div class="label-stable">
                                    <label>Chewing Ability</label>
                                    <div class="radio-list">
                                        <label>
											<input type="radio"  name="Chew" value="0 - Unable" <cfif #AssForm.Surgical_Wound_Status_M0488# contains '0 - Unable' >checked</cfif>/> <span>0 - Unable</span>
                                        </label>
                                        <label>
											<input type="radio"  name="Chew" value="1 - Severe Impairment" <cfif #AssForm.Surgical_Wound_Status_M0488# contains '1 - Severe Impairment' >checked</cfif>/> <span>1 - Severe Impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="Chew" value="2 - Moderate Impairment" <cfif #AssForm.Surgical_Wound_Status_M0488# contains '2 - Moderate Impairment' >checked</cfif>/> <span>2 - Moderate Impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="Chew" value="3 - Mild impairment" <cfif #AssForm.Surgical_Wound_Status_M0488# contains '3 - Mild impairment' >checked</cfif>/> <span>3 - Mild impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="Chew" value="4 - Within Functional Limits" <cfif #AssForm.Surgical_Wound_Status_M0488# contains '4 - Within Functional Limits' >checked</cfif>/> <span>4 - Within Functional Limits</span>	
                                        </label>
										<label>
										<input type="radio"  name="Chew" value="5 - Infant Skill not Age Appropriate" <cfif #AssForm.Surgical_Wound_Status_M0488# contains '5 - Infant Skill not Age Appropriate' >checked</cfif>/> <span>5 - Infant Skill not Age Appropriate</span>
										</label>
                                    </div>
                                </div>
                            </div>
                        </div>
						 <div class="col-md-4">
                            <div class="form-group">
                                <div class="label-stable">
                                    <label>Oral Stage Management</label>
                                    <div class="radio-list">
                                        <label>
											<input type="radio"  name="OralStage" value="0 - Unable" <cfif #AssForm.Breathing_M0490# contains '0 - Unable' >checked</cfif>/> <span>0 - Unable</span>
                                        </label>
                                        <label>
											<input type="radio"  name="OralStage" value="1 - Severe Impairment" <cfif #AssForm.Breathing_M0490# contains '1 - Severe Impairment' >checked</cfif>/> <span>1 - Severe Impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="OralStage" value="2 - Moderate Impairment" <cfif #AssForm.Breathing_M0490# contains '2 - Moderate Impairment' >checked</cfif>/> <span>2 - Moderate Impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="OralStage" value="3 - Mild impairment" <cfif #AssForm.Breathing_M0490# contains '3 - Mild impairment' >checked</cfif>/> <span>3 - Mild impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="OralStage" value="4 - Within Functional Limits" <cfif #AssForm.Breathing_M0490# contains '4 - Within Functional Limits' >checked</cfif>/> <span>4 - Within Functional Limits</span>	
                                        </label>
										<label>
										<input type="radio"  name="OralStage" value="5 - Infant Skill not Age Appropriate" <cfif #AssForm.Breathing_M0490# contains '5 - Infant Skill not Age Appropriate' >checked</cfif>/> <span>5 - Infant Skill not Age Appropriate</span>
										</label>
                                    </div>
                                </div>
                            </div>
                        </div>
                        
                        <div class="col-md-4">
                            <div class="form-group">
                                <div class="label-stable">
                                    <label>Pharyngeal Stage Management</label>
                                    <div class="radio-list">
                                        <label>
											<input type="radio"  name="Resp" value="0 - Unable" <cfif #AssForm.Resp_Treatments_M0500# contains '0 - Unable' >checked</cfif>/> <span>0 - Unable</span>
                                        </label>
                                        <label>
											<input type="radio"  name="Resp" value="1 - Severe Impairment" <cfif #AssForm.Resp_Treatments_M0500# contains '1 - Severe Impairment' >checked</cfif>/> <span>1 - Severe Impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="Resp" value="2 - Moderate Impairment" <cfif #AssForm.Resp_Treatments_M0500# contains '2 - Moderate Impairment' >checked</cfif>/> <span>2 - Moderate Impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="Resp" value="3 - Mild impairment" <cfif #AssForm.Resp_Treatments_M0500# contains '3 - Mild impairment' >checked</cfif>/> <span>3 - Mild impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="Resp" value="4 - Within Functional Limits" <cfif #AssForm.Resp_Treatments_M0500# contains '4 - Within Functional Limits' >checked</cfif>/> <span>4 - Within Functional Limits</span>	
                                        </label>
										<label>
										<input type="radio"  name="Resp" value="5 - Infant Skill not Age Appropriate" <cfif #AssForm.Resp_Treatments_M0500# contains '5 - Infant Skill not Age Appropriate' >checked</cfif>/> <span>5 - Infant Skill not Age Appropriate</span>
										</label>
                                    </div>
                                </div>
                            </div>
                        </div>
                    
                	</div>
					<div class="row">
                        <div class="col-md-4">
                            <div class="form-group">
                                <div class="label-stable">
                                    <label>Reflex Time</label>
                                    <div class="radio-list">
                                        <label>
											<input type="radio"  name="Reflex" value="0 - Unable" <cfif #AssForm.UTI_M0510# contains '0 - Unable' >checked</cfif>/> <span>0 - Unable</span>
                                        </label>
                                        <label>
											<input type="radio"  name="Reflex" value="1 - Severe Impairment" <cfif #AssForm.UTI_M0510# contains '1 - Severe Impairment' >checked</cfif>/> <span>1 - Severe Impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="Reflex" value="2 - Moderate Impairment" <cfif #AssForm.UTI_M0510# contains '2 - Moderate Impairment' >checked</cfif>/> <span>2 - Moderate Impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="Reflex" value="3 - Mild impairment" <cfif #AssForm.UTI_M0510# contains '3 - Mild impairment' >checked</cfif>/> <span>3 - Mild impairment</span>	
                                        </label>
                                        <label>
											<input type="radio"  name="Reflex" value="4 - Within Functional Limits" <cfif #AssForm.UTI_M0510# contains '4 - Within Functional Limits' >checked</cfif>/> <span>4 - Within Functional Limits</span>
                                        </label>
										<label>
										<input type="radio"  name="Reflex" value="5 - Infant Skill not Age Appropriate" <cfif #AssForm.UTI_M0510# contains '5 - Infant Skill not Age Appropriate' >checked</cfif>/> <span>5 - Infant Skill not Age Appropriate</span>
										</label>
                                    </div>
                                </div>
                            </div>
                        </div>
                        
                        <div class="col-md-7">
                            <div class="form-group">
                                <label>Comments</label>
                                <textarea name="txtComment" id="txtComment" onBlur="ChangeBlur('formstep6','txtComment')" class="form-control" rows="5"><cfoutput>#AssForm.Assessment_Note#</cfoutput></textarea>
                            </div>
                        </div>
                        <div class="col-md-1">
                        </div>
                        
                    </div>
                    </div>
                </div>
                
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	</form>
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