<cfquery name="GetP" datasource="#Application.DataSrc#">
	SELECT Patient_ID, Last_Name_M0040 AS Last_Name, First_Name_M0040 AS First_Name, Middle_Initial_M0040 AS Middle
	,Payer_ID
	FROM  #Request.prefix_db_agency#.patient
	WHERE Patient_Id = '#session.cs.patientid#'
	AND   Agency_Id = '#session.AgencyId#'
</cfquery>
<cfquery name="ViewMeds" datasource="#Application.DataSrc#">
    select PatientMeds.Drug_Name,
    Meds_New.Contraindications,
    Meds_New.Side_Effects,
    Meds_New.Interactions from #Request.prefix_db_agency#.PatientMeds inner join #Request.prefix_db_lookup#.Meds_New on PatientMeds.Medication_ID= Meds_New.Trade_ID
    where PatientMeds.Patient_ID=(Select Assessment_New.Patient_ID from #Request.prefix_db_agency#.Assessment_New where Assessment_New.Assessment_ID='#session.cs.AssessmentId#')
</cfquery>

<cfquery name="AssForm" datasource="#Application.DataSrc#">
	SELECT  * 
	FROM #Request.prefix_db_agency#.Assessment_New
	WHERE Assessment_New.Assessment_ID='#session.cs.AssessmentId#'
</cfquery>

<cfquery name="Createdby" datasource="#Application.DataSrc#">
	select Last_Name,First_Name from #Request.prefix_db_lookup#.Employee where Employee_ID = '#AssForm.Record_Created_By#'
</cfquery>

<cfquery name="Treatment" datasource="#Application.DataSrc#">
	select Pathway_Details.Description,Pathway_Details.Skill,Pathway_Details.Pathway_Details_ID from #Request.prefix_db_agency#.Pathway_Details where Pathway_Details.Assessment_ID='#session.cs.AssessmentId#'
</cfquery>

<cfif left(AssForm.Fall_A,1) NEQ "">
	<cfset FallA=left(AssForm.Fall_A,1) />
<cfelse>
	<cfset FallA=0 />
</cfif>
<cfif left(AssForm.Fall_B,1) NEQ "">
	<cfset FallB=left(AssForm.Fall_B,1) />
<cfelse>
	<cfset FallB=0 />
</cfif>
<cfif left(AssForm.Fall_C,1) NEQ "">
	<cfset FallC=left(AssForm.Fall_C,1) />
<cfelse>
	<cfset FallC=0 />
</cfif>
<cfif left(AssForm.Fall_D,1) NEQ "">
	<cfset FallD=left(AssForm.Fall_D,1) />
<cfelse>
	<cfset FallD=0 />
</cfif>
<cfif left(AssForm.Fall_E,1) NEQ "">
	<cfset FallE=left(AssForm.Fall_E,1) />
<cfelse>
	<cfset FallE=0 />
</cfif>
<cfif left(AssForm.Fall_F,1) NEQ "">
	<cfset FallF=left(AssForm.Fall_F,1) />
<cfelse>
	<cfset FallF=0 />
</cfif>
<cfif left(AssForm.Fall_G,1) NEQ "">
	<cfset FallG=left(AssForm.Fall_G,1) />
<cfelse>
	<cfset FallG=0 />
</cfif>
<cfif left(AssForm.Fall_H,1) NEQ "">
	<cfset FallH=left(AssForm.Fall_H,1) />
<cfelse>
	<cfset FallH=0 />
</cfif>
<cfif left(AssForm.Fall_I,1) NEQ "">
	<cfset FallI=left(AssForm.Fall_I,1) />
<cfelse>
	<cfset FallI=0 />
</cfif>
<cfset FallRate=FallA+FallB+FallC+FallD+FallE+FallF+FallG+FallH+FallI />

<cfif left(AssForm.Braden_1_Sensory,1) NEQ "">
	<cfif IsNumeric(left(AssForm.Braden_1_Sensory,1))>
		<cfset Sensory=left(AssForm.Braden_1_Sensory,1) />
	<cfelse>
		<cfset Sensory=0 />
	</cfif>
<cfelse>
	<cfset Sensory=0 />
</cfif>

<cfif left(AssForm.Braden_2_Moisture,1) NEQ "">
	<cfif IsNumeric(left(AssForm.Braden_2_Moisture,1))>
		<cfset Moisture=left(AssForm.Braden_2_Moisture,1) />
	<cfelse>
		<cfset Moisture=0 />
	</cfif>
<cfelse>
	<cfset Moisture=0 />
</cfif>

<cfif left(AssForm.Braden_3_Activity,1) NEQ "">
	<cfif IsNumeric(left(AssForm.Braden_3_Activity,1))>
		<cfset Activity=left(AssForm.Braden_3_Activity,1) />
	<cfelse>
		<cfset Activity=0 />
	</cfif>
<cfelse>
	<cfset Activity=0 />
</cfif>

<cfif left(AssForm.Braden_4_Mobility,1) NEQ "">
	<cfif IsNumeric(left(AssForm.Braden_4_Mobility,1))>
		<cfset Mobility=left(AssForm.Braden_4_Mobility,1) />
	<cfelse>
		<cfset Mobility=0 />
	</cfif>
<cfelse>
	<cfset Mobility=0 />
</cfif>

<cfif left(AssForm.Braden_5_Nutrition,1) NEQ "">
	<cfif IsNumeric(left(AssForm.Braden_5_Nutrition,1))>
		<cfset Nutrition=left(AssForm.Braden_5_Nutrition,1) />
	<cfelse>
		<cfset Nutrition=0 />
	</cfif>
<cfelse>
	<cfset Nutrition=0 />
</cfif>

<cfif left(AssForm.Braden_6_Friction,1) NEQ "">
	<cfif IsNumeric(left(AssForm.Braden_6_Friction,1))>
		<cfset Friction=left(AssForm.Braden_6_Friction,1) />
	<cfelse>
		<cfset Friction=0 />
	</cfif>
<cfelse>
	<cfset Friction=0 />
</cfif>
<cfset PressureRate=Sensory+Moisture+Activity+Mobility+Nutrition+Friction />

<cfparam name="form.searchfield" default="" />
<cfparam name="form.M1012searchfield" default="" />
<cfparam name="form.M1016searchfield" default="" />
<cfcookie name="WoundCount" value="" />
<cfset cookie.WoundCount="0" />

<cfoutput>
	<cfcookie name="M1302Pressure" value="#AssForm.M1302_Pressure#" />
	<cfcookie name="M1306Unhealed" value="#AssForm.M1306_Unhealed_Pressure#" />
	<cfcookie name="PressureUlcerStatus" value="#AssForm.Pressure_Ulcer_Status_M0464#" />

	<cfcookie name="M1310Length" value="#AssForm.M1310_Length#" />
	<cfcookie name="M13101" value="#AssForm.M1310_1#" />
	<cfcookie name="M1312Width" value="#AssForm.M1312_Width#" />
	<cfcookie name="M13121" value="#AssForm.M1312_1#" />
	<cfcookie name="M1314Depth" value="#AssForm.M1314_Depth#" />
	<cfcookie name="M13141" value="#AssForm.M1314_1#" />

	<cfcookie name="PressureUlcerbM0450" value="#AssForm.Pressure_Ulcer_b_M0450#" />
	<cfcookie name="PressureUlcercM0450" value="#AssForm.Pressure_Ulcer_c_M0450#" />
	<cfcookie name="PressureUlcerdM0450" value="#AssForm.Pressure_Ulcer_d_M0450#" />
	<cfcookie name="PressureUlcereM0450" value="#AssForm.Pressure_Ulcer_e_M0450#" />
	<cfcookie name="M1308d2Pressure" value="#AssForm.M1308_d_2_Pressure#" />
	<cfcookie name="M1308d3Pressure" value="#AssForm.M1308_d_3_Pressure#" />

	<cfcookie name="PressureUlceraM0450" value="#AssForm.Pressure_Ulcer_a_M0450#" />
	<cfcookie name="PressureUlcerStageM0460" value="#AssForm.Pressure_Ulcer_Stage_M0460#" />
	<cfcookie name="SurgicalWoundStatusM0488" value="#AssForm.Surgical_Wound_Status_M0488#" />

	<cfcookie name="StasisUlcerM0468" value="#AssForm.Stasis_Ulcer_M0468#" />
	<cfcookie name="StasisUlcerNumM0470" value="#AssForm.Stasis_Ulcer_Num_M0470#" />
	<cfcookie name="StasisUlcerStatusM0476" value="#AssForm.Stasis_Ulcer_Status_M0476#" />
	<cfcookie name="SurgicalWoundM0482" value="#AssForm.Surgical_Wound_M0482#" />
</cfoutput>

<cfquery name="ViewWnd" datasource="#Application.DataSrc#">
	SELECT count(Wnd_Type) as CouNt from #Request.prefix_db_agency#.PatientVisitDetails
	where Patient_ID='#session.cs.patientid#' and Assessment_ID='#session.cs.AssessmentId#'
	and Wnd_Location<>'' and Wnd_Type<>'' and trim(Type)='Wound'
</cfquery>

<cfoutput><cfset cookie.WoundCount='#ViewWnd.CouNt#' /></cfoutput>
<cfset  soc_date_referal = 0>
<cfset  date_diff_M0104 = 0 />
<cfset  date_diff_M0102 = 0 />
<cfif AssForm.Start_of_Care_M0030 neq '' and  AssForm.M0104_Date_of_Referral neq ''>
<cfset date_diff_M0104 = #DateDiff("d", AssForm.Start_of_Care_M0030, AssForm.M0104_Date_of_Referral)# />
</cfif>
<cfif AssForm.Start_of_Care_M0030 neq '' and  AssForm.M0102_Physician_SOC neq ''>
<cfset date_diff_M0102 = #DateDiff("d", AssForm.Start_of_Care_M0030, AssForm.M0102_Physician_SOC)# />
</cfif>

<cfif <!---AssForm.M0102_Physician_SOC EQ ""  OR  AssForm.M0104_Date_of_Referral EQ "" OR--->  date_diff_M0104 gt 2  OR  date_diff_M0102 gt 2>
<input type="hidden" name="SOC_Count" id="SOC_Count" value="1" />
<cfset  soc_date_referal = 1>
<cfelse>
<input type="hidden" name="SOC_Count" id="SOC_Count" value="0" />
</cfif>


  <cfscript>
		pat = CreateObject("Component", "patientadmin_new.patient.assessment");
		get_pain_que = pat.get_pain_ques('1 - Start of care - further visits planned','pain'); 
		get_braden_que = pat.get_pain_ques('1 - Start of care - further visits planned','braden'); 
		get_fallrisk = pat.get_pain_ques('1 - Start of care - further visits planned','fall_risk'); 
		get_score = pat.get_live_score();
   </cfscript>

<cfcookie name="PathwayDescription" value="" />
<cfset cookie.PathwayDescription="" />
<cfoutput>
	<input type="hidden" name="assessmentcompleted" id="assessmentcompleted" value="#DateFormat(AssForm.Assessment_Completed_M0090,'yyyy-mm-dd')#"/>
	<input type="hidden" name="hdn_Assessment_note" id="hdn_Assessment_note" />	
	<input type="hidden" name="hdn_Strengths" id="hdn_Strengths" />
	<input type="hidden" name="hdn_Goals" id="hdn_Goals" />
	<input type="hidden" name="hdn_Care_Preference" id="hdn_Care_Preference" />
	<input type="hidden" name="hdn_Risk_Factor" id="hdn_Risk_Factor" />
	<input type="hidden" name="hdn_Interventions" id="hdn_Interventions" />		
</cfoutput>
<div class="portlet box blue">
		<div class="portlet-title">
			<div class="caption">
				<i class="fa fa-gear"></i>
				<cfoutput>#GetP.First_Name# #GetP.Last_Name#, Start of Care</cfoutput>
			</div>
			<div class="tools">
				<a href="javascript:;" class="collapse"></a>
			</div>
		</div>
		<div class="portlet-body form">
			<cfinclude template="startofcarewizard_includes/StartOfCare1.cfm" />
			<!---<cfinclude template="startofcarewizard_includes/StartOfCare2.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare3.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare4.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare5.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare6.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare7.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare8.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare9.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare10.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare11.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare12.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare13.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare14.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare15.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare16.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare17.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare18.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare19.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare20.cfm" />
			<cfinclude template="startofcarewizard_includes/StartOfCare21.cfm" />--->
			<cfinclude template="startofcarewizard_includes/Live_Score.cfm" />
			<script type="text/javascript">
				$('.progress_div').css("max-width", $('.nav_pagination').width());
			</script>
		</div>
	</div>

<cfwindow
	name="searchFormM0230SubWindow"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;"
	initshow="false">
    <form name="formM0230" id="formM0230" action="#">
		<div style="margin:0 15px;" id="refersh">
			<h4>Diagnosis Select</h4>
			<input type="hidden" name="M0230DiagnosisID" id="M0230DiagnosisID"/>
			<input type="hidden" name="M0230DiagnosisID1" id="M0230DiagnosisID1"/>
			<input type="hidden" name="vcodesdiag" id="vcodesdiag" value=""/>
			<input type="hidden" name="vcodesicd" id="vcodesicd" value=""/>
			
			
			<div class="form-group">
				<label>Diagnosis</label>
				<label id="DiagnosisA"></label>
			</div>
            <div class="row">
                <div class="col-md-4">
                	<div class="form-group">
                        <div class="label-stable">
                            <label>Primary?</label>
                            <div id="M0230Primaryd" class="radio-list">
                                <label>
                                <input type="radio" id="M0230Primary" name="M0230Primary" value="1" >Yes</label>
                                <label>
                                <input type="radio" id="M0230Primary" name="M0230Primary" value="0" >No</label>
                            </div>
                        </div>
					</div>
                </div>
                <div class="col-md-4">
                	<div class="form-group">
                        <div class="label-stable">
                            <label>Secondary?</label>
                            <div id="M0230Secondaryd" class="radio-list">
                                <label>
                                <input type="radio" id="M0230Secondary" name="M0230Secondary" value="1" >Yes</label>
                                <label>
                                <input type="radio" id="M0230Secondary" name="M0230Secondary" value="0" >No</label>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="col-md-4">
                	<div class="form-group">
                        <div class="label-stable">
                            <label>Onset or Exacerbation</label>
                            <div id="M0230Onsetd" class="radio-list">
                                <label>
                                <input type="radio" id="M0230Onset" name="M0230Onset" value="(O)" >(O)</label>
                                <label>
                                <input type="radio" id="M0230Onset" name="M0230Onset" value="(E)" >(E)</label>
                            </div>
                        </div>
                    </div>
                </div>
            </div>

            <div class="row">
                <div class="col-md-6">
                	<div class="form-group">
                        <label>*SEVERITY KEY</label>
                        <p style="font-size:13px;">0 - Asymptomatic, no treatment needed</p>
                        <p style="font-size:13px;">1 - Symptoms well controlled</p>
                        <p style="font-size:13px;">2 - Symptoms controlled with difficulty</p>
                        <p style="font-size:13px;">3 - Symptoms poorly controlled</p>
                        <p style="font-size:13px;">4 - history of rehospitalizations</p>
                    </div>
                </div>

                <div class="col-md-6">
                	<div class="form-group">
                        <div class="label-stable">
                            <label>Severity level?</label>
                            <div id="M0230Severityd" class="radio-list">
                                <label>
                                <input type="radio" id="M0230Severity" name="M0230Severity" value="0" >0</label>
                                <label>
                                <input type="radio" id="M0230Severity" name="M0230Severity" value="1" >1</label>
                                <label>
                                <input type="radio" id="M0230Severity" name="M0230Severity" value="2" >2</label>
                                <label>
                                <input type="radio" id="M0230Severity" name="M0230Severity" value="3" >3</label>
                                <label>
                                <input type="radio" id="M0230Severity" name="M0230Severity" value="4" >4</label>
                            </div>
                        </div>
                    </div>
                </div>
            </div>

			<div class="form-group">
				<label>Add Case Mix For ICD10 Z-Code <img src="../../images/icon_add.png" style="cursor:pointer" onclick="vcodeprocess();"/></label>
				<label id="DiagnosisB1"></label>
			</div>
			<div id="DivM0230SubPage1" class="well" style="display:none;">
				<div class="form-group">
					<label>Diagnosis Search</label>
					<textarea name="M1020Manifestsearch1" type="text" value="" class="form-control"></textarea>
				</div>
				<input class="btn btn-sm blue" name="btnM1020" type="button" value="Show All Results" onclick="SearchClickM0230M1();"/>
				<input class="btn btn-sm default" name="btnM0230cancel1" id="btnM0230cancel1" type="button" value="Cancel" />
			</div>
			<div class="form-group">
				<label>Add Manifestation For ICD10 Z-Code <img id="ImgM0230Add" name="ImgM1020Add" src="../../images/icon_add.png" style="cursor:pointer" /></label>
				<label id="DiagnosisB"></label>
			</div>
			<div id="DivM0230SubPage" class="well" style="display:none;">
				<div class="form-group">
					<label>Manifestation Diagnosis Search</label>
					<textarea name="M1020Manifestsearch" type="text" value="" class="form-control"></textarea>
				</div>
				<input class="btn btn-sm blue" name="btnM1020" type="button" value="Show All Results" onclick="SearchClickM0230M();"/>
				<input class="btn btn-sm default" name="btnM0230cancel" id="btnM0230cancel" type="button" value="Cancel" />
			</div>
			<div class="form-group">
				<label>If this is a ICD10 Z-Code, and you want to add a case mix diagnosis, click "add case mix..."now to include that data. Click "add manifestation" to add a manifestation code.</label>
			</div>
			<div class="form-group">
				<input class="btn blue" type="button" name="btndone" value="Done" onClick="UpdateSoc('M0230search');"/>
				<input class="btn btn-default" type="button" name="btnCancel" value="Cancel" onclick="ColdFusion.Window.hide('searchFormM0230SubWindow'); $('#StartOfCare4').show();"/>
			</div>
		</div>
	</form>
</cfwindow>

<cfwindow
	name="pain"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="false"
	modal="true"
	bodystyle="background-color:white;" initshow="false">

		
	
</cfwindow>
<!---<div class="modal fade bs-modal-lg" id="pains" tabindex="-1" role="dialog" aria-hidden="true">--->
<div id="pains" class="modal fade" tabindex="-1" aria-hidden="true">
								<div class="modal-dialog modal-lg">
									<div class="modal-content">
										<div class="modal-header">
											<button type="button" class="close" data-dismiss="modal" aria-hidden="true"></button>
											<h4 class="modal-title">Add Pain Details</h4>
										</div>
										<form name="formpain" id="formpain">
	                                     <cfoutput>
										     <div class="modal-body">
											 <div class="row">
										      					 <cfloop query="get_pain_que">
																	   <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
																				  <label class="bold">#get_pain_que.questions#</label>
																					<cfscript>
																					   get_pain_anw = pat.get_pain_anw(#get_pain_que.id#); 
																					</cfscript>
																					<div class="form-group">
																					 <cfset  cheked_value = "AssForm."&get_pain_anw.answer_label />
																					<cfloop query="get_pain_anw">
																						<cfif answer_type EQ 'radio'>
																											   <div class="radio-list">
																													   <label> <input type="#answer_type#" name="#answer_label#" id="#answer_label#" value="#answer#" <cfif #Evaluate(Variables.cheked_value)#  EQ  #answer#>checked </cfif>><span>#answer#</span></label>
																												</div>
																								<cfelseif answer_type EQ 'checkbox'>
																												   <div class="checkbox-list">
																													  <label><input type="#answer_type#"  name="#answer_label#" id="#answer_label#" value="#answer#" <cfif #Evaluate(Variables.cheked_value)#  Contains  #answer#>checked</cfif>>#answer#
																													 </label>
																												</div>
																								</cfif>
																						</cfloop>
																					</div>
																			</div>
																		</cfloop>
																		</div>
																	  <table style="text-align:center;">
																			<tr>
																				<td width="10%">
																					<img src="../../images/smily0.gif" />
																				</td>
																				<td width="10%">
																					<img src="../../images/smily2.gif"/>
																				</td>
																				<td width="10%">
																					<img src="../../images/smily4.gif" />
																				</td>
																				<td width="10%">
																					<img src="../../images/smily6.gif"/>
																				</td>
																				<td width="10%">
																					<img src="../../images/smily8.gif" />
																				</td>
																				<td width="10%">
																					<img src="../../images/smily10.gif"/>
																				</td>
																			</tr>
																			<tr>
																				<td  width="10%">0</td>
																				<td width="10%">2</td>
																				<td width="10%">4</td>
																				<td width="10%">6</td>
																				<td width="10%">8</td>
																				<td width="10%">10</td>
																			</tr>
																		</table>
																		<p style="color:red">
																			<cfif AssForm.M0420_Assess NEQ "" AND AssForm.Pain1 NEQ "" AND AssForm.Pain2 NEQ "" AND AssForm.Pain3 NEQ "" AND AssForm.Pain4 NEQ "" AND AssForm.Pain5 NEQ "">
																				pain assessment indicates #AssForm.M0420_Assess# #AssForm.Pain2# requiring medication every as  needed pain relief resolves pain
																			<cfelse>
																				Pain assessment incomplete
																			</cfif>
																		</p>

										</div>
										<div class="modal-footer">
											<button type="button" class="btn default" data-dismiss="modal">Close</button>
											<button type="button" class="btn blue"  name="pain"  onclick="return other_assessment_validation('pain');">Update Pain Level</button>
										</div>
										</cfoutput>
										</form>
									</div>
									<!-- /.modal-content -->
								</div>
								<!-- /.modal-dialog -->
							</div>

<cfwindow
	name="AddvitalsignForm"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;" initshow="false">

	<form name="formVital" id="formVital">
		<div style="margin:0 15px;">
			<h4>Add vital</h4>
			<div class="row">
            	<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
                	<div class="form-group">
                        <div class="label-stable">
                            <label>Type</label><br />
                            <div class="radio-list">
                                <label>
                                <input type="radio" name="radtype" value="Temperature"/> Temperature</label>
                                <label>
                                <input type="radio" name="radtype" value="Heart Rate"/> Heart Rate </label>
                                <label>
                                <input type="radio" name="radtype" value="Respiratory Rate"/> Respiratory Rate </label>
                                <label>
                                <input type="radio" name="radtype" value="Blood Pressure Systolic"/> Blood Pressure Systolic </label>
                                <label>
                                <input type="radio" name="radtype" value="Blood Pressure Diastolic"/> Blood Pressure Diastolic </label>
								<label>
								<input type="radio" name="radtype" value="Blood Sugar Level"/> Blood Sugar Level </label>
                                <label>
                                <input type="radio" name="radtype" value="Weight"/> Weight </label>
                                <label>
                                <input type="radio" name="radtype" value="Height"/> Height </label>
                                <label>
                                <input type="radio" name="radtype" value="Pain (scale 1-10)"/> Pain (scale 1-10) </label>
                                <label>
                                <input type="radio" name="radtype" value="Abdominal Girth"/> Abdominal Girth </label>
                                <label>
                                <input type="radio" name="radtype" value="Head Circumference"/> Head Circumference </label>
                                <label>
                                <input type="radio" name="radtype" value="O2 Saturation"/> O2 Saturation</label>
                            </div>
                        </div>
                    </div>
            	</div>
                <div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
                	<div class="form-group">
                        <div class="label-stable">
                            <label>Severity</label>
                            <div class="radio-list">
                                <label>
                                <input type="radio" name="radsever" value="0"/> 0 asymptomatic </label>
                                <label>
                                <input type="radio" name="radsever" value="1"/> 1 well-controlled </label>
                                <label>
                                <input type="radio" name="radsever" value="2"/> 2 controlled with difficulty</label>
                                <label>
                                <input type="radio" name="radsever" value="3"/> 3 poorly controlled </label>
                                <label>
                                <input type="radio" name="radsever" value="4"/> 4 hx hospitalizations </label>
                            </div>
                        </div>
                    </div>
            	</div>
            </div>
			<div class="form-group">
				<label>Reading</label>
				<input class="form-control" type="Text" name="reading" id="reading"/>
			</div>
			<div class="form-group">
				<label>Notes</label>
				<textarea class="form-control" name="txtNotes" id="txtNotes"></textarea>
			</div>
			<div class="form-group">
				<input class="btn blue" type="button" name="Submit" value="Add Vital Sign" onclick="UpdateSoc('addvital');"/>
				<input class="btn btn-default" type="button" name="Cancel" value="Cancel" id="btncancelvital" onclick="vitalcancel();"/>
			</div>
		</div>
	</form>
</cfwindow>

<div id="braden_scale" class="modal fade" tabindex="-1" aria-hidden="true">
						<div class="modal-dialog modal-lg">
							<div class="modal-content">
								<div class="modal-header">
									<button type="button" class="close" data-dismiss="modal" aria-hidden="true"></button>
									<h4 class="modal-title"><b>Braden Scale For Predicting Pressure Sore Risk</b></h4>
								</div>
								<form name="formrisk" id="formrisk">
								   <div class="modal-body">
										<cfoutput>
										 <cfloop query="get_braden_que">
															   <div class="form-group">
																	   <label class="bold">#get_braden_que.questions#</label><br />
																			<cfscript>
																			   get_braden_anw = pat.get_pain_anw(#get_braden_que.id#); 
																			</cfscript>
																			 <cfset  cheked_value = "AssForm."&get_braden_anw.answer_label />
																				<cfloop query="get_braden_anw">
																					<div class="label-stable">
																					  <div id="#answer_type#_d" class="radio-list">
																						
																									<cfif answer_type EQ 'radio'>
																													   <div class="radio-list">
																															   <label> <input type="#answer_type#" name="#answer_label#" id="#answer_label#" value="#answer#" <cfif #Evaluate(Variables.cheked_value)#  EQ  #answer#>checked </cfif>><span>#answer#</span></label>
																														</div>
																										<cfelseif answer_type EQ 'checkbox'>
																														   <div class="checkbox-list">
																															  <label><input type="#answer_type#"  name="#answer_label#" id="#answer_label#" value="#answer#" <cfif #Evaluate(Variables.cheked_value)#  Contains  #answer#>checked</cfif>>#answer#
																															 </label>
																														</div>
																										</cfif>
																							
																						</div>
																				   </div>
																			</cfloop>
															 </div>
													 </cfloop>
											</cfoutput>
											<p id="spnTotalScore" style="color:red;font-size:14px;">
											<span id="spnPressureUlcerstotal">Total Score = <cfoutput>#PressureRate#</cfoutput></span>
											<span id="spnPressureUlcers">
												<cfif PressureRate gt 15 OR PressureRate eq 15>
													LOW RISK  for Pressure Ulcers
												<cfelseif PressureRate gt 13 OR PressureRate eq 13 OR PressureRate eq 14>
													MODERATE RISK  for Pressure Ulcers
												<cfelseif PressureRate lt 12 OR PressureRate eq 12>
													HIGH RISK  for Pressure Ulcers
												</cfif>
											</span>
										</p>
										<p id="SpnCopyright" style="font-size:14px;">Copyright Barbara Braden and Nancy Bergstrom, 1988 All rights reserved </p>
										<p id="spnHigh" style="font-size:14px;">1 - 12 =HIGH RISK</p>
										<p id="spnModerate" style="font-size:14px;">13 - 14 =MODERATE RISK</p>
										<p id="spnLow" style="font-size:14px;">15 - 23 =LOW RISK</p>
									</div>
					               <div class="modal-footer">
										<button type="button" class="btn default" data-dismiss="modal">Close</button>
										<button type="button" class="btn blue"  name="braden"  onclick="return other_assessment_validation('braden');">Update</button>
									</div>
								</form>
							</div>
				    </div>
				</div>

				<div id="fall_risk" class="modal fade" tabindex="-1" aria-hidden="true">
										<div class="modal-dialog modal-lg">
											<div class="modal-content">
												<div class="modal-header">
													<button type="button" class="close" data-dismiss="modal" aria-hidden="true"></button>
													<h4 class="modal-title"><b>Fall Risk Assessment</b></h4>
												</div>
												<form name="fallrisk" id="fallrisk">
												   <div class="modal-body">
														<cfoutput>
														<cfloop query="get_fallrisk">
																			   <div class="form-group">
																					   <label class="bold">#get_fallrisk.questions#</label><br />
																							<cfscript>
																							   get_fallrisk_ans = pat.get_pain_anw(#get_fallrisk.id#); 
																							</cfscript>
																							 <cfset  cheked_value = "AssForm."&get_fallrisk_ans.answer_label />
																								<cfloop query="get_fallrisk_ans">
																									<div class="label-stable">
																									  <div id="#answer_type#_d" class="radio-list">
																										
																													<cfif answer_type EQ 'radio'>
																																	   <div class="radio-list">
																																			   <label> <input type="#answer_type#" name="#answer_label#" id="#answer_label#" value="#answer#" <cfif #Evaluate(Variables.cheked_value)#  EQ  #answer#>checked </cfif>><span>#answer#</span></label>
																																		</div>
																														<cfelseif answer_type EQ 'checkbox'>
																																		   <div class="checkbox-list">
																																			  <label><input type="#answer_type#"  name="#answer_label#" id="#answer_label#" value="#answer#" <cfif #Evaluate(Variables.cheked_value)#  Contains  #answer#>checked</cfif>>#answer#
																																			 </label>
																																		</div>
																														</cfif>
																											
																										</div>
																								   </div>
																							</cfloop>
																						</div>
														</cfloop>
														</cfoutput>
														
														<p style="color:red;">
														<span id="spnFalls">
															<cfif FallRate gt 10>
																Total Score = <cfoutput>#FallRate#</cfoutput> HIGH RISK for Falls
															<cfelseif FallRate lt 10>
																Total Score = <cfoutput>#FallRate#</cfoutput> LOW RISK for Falls
															</cfif>
														</span>
													</p>
					                              <div class="modal-footer">
														<button type="button" class="btn default" data-dismiss="modal">Close</button>
														<button type="button" class="btn blue"  name="fallrisk"   onclick="return other_assessment_validation('fall_risk');">Update</button>
													</div>
												</form>
											</div>
									</div>
								</div>
				
				

<cfwindow
	name="vital"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="false"
	modal="true"
	bodystyle="background-color:white;" initshow="false">

	<form name="formvital" id="formvital">
		<div id="divvital">
			<table border="0" cellspacing="0" cellpadding="0" width="98%" align="center">
				<tr>
					<td  valign="top" style="font-family: Arial; font-size: 16px" colspan="3">
						<b>Parameters for Physician Notification</b>
						<img name="imgbtnCls" onclick="ColdFusion.Window.hide('vital');VitalCount();" title="Close" style="cursor:pointer;"id="imgbtnCls" src="../../images/icon_back.gif" width="33" height="35" />
					</td>
				</tr>
				<tr>
					<td height="15px"></td>
				</tr>
				<tr>
					<td bgcolor="#c3c3c3" width="20%" valign="top" style="font-family: Arial; font-size: 12px">Vital 1</td>
					<td valign="top" style="font-family: Arial; font-size: 12px; padding-left:5px">
						<SELECT NAME="drpvital1" style="width:170px;font-family: Arial;font-size: 12px">
							<option value="select" style="background-color:#CCCCFF;"></option>
							<OPTION title="Temperature" VALUE="Temperature">Temperature</OPTION>
							<OPTION title="Heart Rate" VALUE="Heart Rate">Heart Rate</OPTION>
							<OPTION title="Respiratory Rate" VALUE="Respiratory Rate">Respiratory Rate</OPTION>
							<OPTION title="BP Systolic" VALUE="BP Systolic">BP Systolic</OPTION>
							<OPTION title="BP Diastolic" VALUE="BP Diastolic">BP Diastolic</OPTION>
							<OPTION title="Weight" VALUE="Weight">Weight</OPTION>
							<OPTION title="Other..." VALUE="Other">Other...</OPTION>
						</SELECT>
						<br /><br />
						less than       <input name="txtlessthan" id="txtlessthanvital1" type="text" style="background-color:	 #6699cc; width:50px"/><br /><br />
						greater than  <input name="txtgreaterthan" id="txtgreatthanvital1" type="text" style="background-color:#6699cc; width:50px"/>
					</td>
				</tr>
				<tr>
					<td height="5px"></td>
				</tr>
				<tr>
					<td bgcolor="#c3c3c3" width="20%" valign="top" style="font-family: Arial; font-size: 12px">Vital 2</td>
					<td valign="top" style="font-family: Arial; font-size: 12px; padding-left:5px">
						<SELECT NAME="drpvital2" style="width:170px;font-family: Arial;font-size: 12px">
							<option value="select" style="background-color:#CCCCFF;"></option>
							<OPTION title="Temperature" VALUE="Temperature">Temperature</OPTION>
							<OPTION title="Heart Rate" VALUE="Heart Rate">Heart Rate</OPTION>
							<OPTION title="Respiratory Rate" VALUE="Respiratory Rate">Respiratory Rate</OPTION>
							<OPTION title="BP Systolic" VALUE="BP Systolic">BP Systolic</OPTION>
							<OPTION title="BP Diastolic" VALUE="BP Diastolic">BP Diastolic</OPTION>
							<OPTION title="Weight" VALUE="Weight">Weight</OPTION>
							<OPTION title="Other..." VALUE="Other">Other...</OPTION>
						</SELECT>
						<br /><br />
						less than       <input name="txtlessthanv1" id="txtlessthanvital2" type="text" style="background-color:#6699cc; width:50px"/><br /><br />
						greater than  <input name="txtgreaterthan2" type="text" style="background-color:#6699cc; width:50px"/>
					</td>
				</tr>
				<tr>
					<td height="5px"></td>
				</tr>
				<tr>
					<td bgcolor="#c3c3c3" width="20%" valign="top" style="font-family: Arial; font-size: 12px">Vital 3</td>
					<td valign="top" style="font-family: Arial; font-size: 12px; padding-left:5px">
					<SELECT NAME="drpvital3" style="width:170px;font-family: Arial;font-size: 12px">
						<option value="select" style="background-color:#CCCCFF;"></option>
						<OPTION title="Temperature" VALUE="Temperature">Temperature</OPTION>
						<OPTION title="Heart Rate" VALUE="Heart Rate">Heart Rate</OPTION>
						<OPTION title="Respiratory Rate" VALUE="Respiratory Rate">Respiratory Rate</OPTION>
						<OPTION title="BP Systolic" VALUE="BP Systolic">BP Systolic</OPTION>
						<OPTION title="BP Diastolic" VALUE="BP Diastolic">BP Diastolic</OPTION>
						<OPTION title="Weight" VALUE="Weight">Weight</OPTION>
						<OPTION title="Other..." VALUE="Other">Other</OPTION><br /><br />
					</SELECT>
					<br /><br />
					less than       <input name="txtlessthanvital3" type="text" style="background-color:#6699cc; width:50px"/><br /><br />
					greater than  <input name="txtgreaterthan3" type="text" style="background-color:#6699cc; width:50px"/>
					</td>
				</tr>
				<tr>
					<td height="5px"></td>
				</tr>
				<tr>
					<td bgcolor="#c3c3c3" width="20%" valign="top" style="font-family: Arial; font-size: 12px">Vital4</td>
					<td valign="top" style="font-family: Arial; font-size: 12px; padding-left:5px">
						<SELECT NAME="drpvital4" style="width:170px;font-family: Arial;font-size: 12px">
							<option value="select" style="background-color:#CCCCFF;"></option>
							<OPTION title="Temperature" VALUE="Temperature">Temperature</OPTION>
							<OPTION title="Heart Rate" VALUE="Heart Rate">Heart Rate</OPTION>
							<OPTION title="Respiratory Rate" VALUE="Respiratory Rate">Respiratory Rate</OPTION>
							<OPTION title="BP Systolic" VALUE="BP Systolic">BP Systolic</OPTION>
							<OPTION title="BP Diastolic" VALUE="BP Diastolic">BP Diastolic</OPTION>
							<OPTION title="Weight" VALUE="Weight">Weight</OPTION>
							<OPTION title="Other..." VALUE="Other">Other</OPTION><br /><br />
						</SELECT><br /><br />
						less than       <input name="txtlessthanvital4" type="text" style="background-color:#6699cc; width:50px"/><br /><br />
						greater than  <input name="txtgreaterthan4" type="text" style="background-color:#6699cc; width:50px"/>
					</td>
					<td colspan="2" align="left">
						<div id="divtxtshow" style="display:none">
							<input name="txtother" type="text" style="background-color:#6699cc; width:270px; height:100px"/><br />
							<input type="submit" name="Ok" value="Ok" onclick="return clickother()">
							<input type="button" name="Cancel" value="Cancel" onclick="return cancel()" />
						</div>
					</td>
					<td colspan="2" align="left">
						<div id="divtxtshow2" style="display:none">
							<input name="txtother2" type="text" style="background-color:#6699cc; width:270px; height:100px"/><br />
							<input type="submit" name="Ok" value="Ok" onclick="return clickother2()">
							<input type="button" name="Cancel" value="Cancel" onclick="return cancel2()" />
						</div>
					</td>
					<td colspan="2" align="left">
						<div id="divtxtshow3" style="display:none">
						<input name="txtother3" type="text" style="background-color:#6699cc; width:270px; height:100px"/><br />
						<input type="submit" name="Ok" value="Ok" onclick="return clickother3()">
						<input type="button" name="Cancel" value="Cancel" onclick="return cancel3()" />
						</div>
					</td>
					<td colspan="2" align="left">
						<div id="divtxtshow4" style="display:none">
							<input name="txtother4" type="text" style="background-color:#6699cc; width:270px; height:100px"/><br />
							<input type="submit" name="Ok" value="Ok" onclick="return clickother4()">
							<input type="button" name="Cancel" value="Cancel" onclick="return cancel4()" />
						</div>
					</td>
					<td colspan="2" align="left">
						<div id="divtxtshow5" style="display:none">
							<input name="txtother5" type="text" style="background-color:#6699cc; width:270px; height:100px"/><br />
							<input type="submit" name="Ok" value="Ok" onclick="return clickother5()">
							<input type="button" name="Cancel" value="Cancel" onclick="return cancel5()" />
						</div>
					</td>
					<td colspan="2" align="left">
						<div id="divtxtshow6" style="display:none">
							<input name="txtother6" type="text" style="background-color:#6699cc; width:270px; height:100px"/><br />
							<input type="submit" name="Ok" value="Ok" onclick="return clickother6()">
							<input type="button" name="Cancel" value="Cancel" onclick="return cancel6()" />
						</div>
					</td>
					<td colspan="2" align="left">
						<div id="divtxtshow7" style="display:none">
							<input name="txtother7" type="text" style="background-color:#6699cc; width:270px; height:100px"/><br/>
							<input type="submit" name="Ok" value="Ok" onclick="return clickother7()">
							<input type="button" name="Cancel" value="Cancel" onclick="return cancel7()" />
						</div>
					</td>
				</tr>
					<tr>
						<td height="5px"></td>
					</tr>
				<tr>
					<td bgcolor="#c3c3c3" width="20%" valign="top" style="font-family: Arial; font-size: 12px">Vital 5</td>
					<td valign="top" style="font-family: Arial; font-size: 12px; padding-left:5px">
						<SELECT NAME="drpvital5" style="width:170px;font-family: Arial;font-size: 12px">
							<option value="select" style="background-color:#CCCCFF;"></option>
							<OPTION title="Temperature" VALUE="Temperature">Temperature</OPTION>
							<OPTION title="Heart Rate" VALUE="Heart Rate">Heart Rate</OPTION>
							<OPTION title="Respiratory Rate" VALUE="Respiratory Rate">Respiratory Rate</OPTION>
							<OPTION title="BP Systolic" VALUE="BP Systolic">BP Systolic</OPTION>
							<OPTION title="BP Diastolic" VALUE="BP Diastolic">BP Diastolic</OPTION>
							<OPTION title="Weight" VALUE="Weight">Weight</OPTION>
							<OPTION title="Other..." VALUE="Other">Other</OPTION><br /><br />
						</SELECT><br /><br />
						less than       <input name="txtlessthanvital5" type="text" style="background-color:#6699cc; width:50px"/><br /><br />
						greater than  <input name="txtgreaterthan5" type="text" style="background-color:#6699cc; width:50px"/>
					</td>
				</tr>
				<tr>
					<td height="5px"></td>
				</tr>
				<tr>
					<td bgcolor="#c3c3c3" width="20%" valign="top" style="font-family: Arial; font-size: 12px">Vital 6</td>
					<td valign="top" style="font-family: Arial; font-size: 12px; padding-left:5px">
						<SELECT NAME="drpvital6" style="width:170px;font-family: Arial;font-size: 12px">
							<option value="select" style="background-color:#CCCCFF;"></option>
							<OPTION title="Temperature" VALUE="Temperature">Temperature</OPTION>
							<OPTION title="Heart Rate" VALUE="Heart Rate">Heart Rate</OPTION>
							<OPTION title="Respiratory Rate" VALUE="Respiratory Rate">Respiratory Rate</OPTION>
							<OPTION title="BP Systolic" VALUE="BP Systolic">BP Systolic</OPTION>
							<OPTION title="BP Diastolic" VALUE="BP Diastolic">BP Diastolic</OPTION>
							<OPTION title="Weight" VALUE="Weight">Weight</OPTION>
							<OPTION title="Other..." VALUE="Other">Other</OPTION><br /><br />
						</SELECT><br /><br />
						less than       <input name="txtlessthanvital6" type="text" style="background-color:#6699cc; width:50px"/><br /><br />
						greater than  <input name="txtgreaterthan6" type="text" style="background-color:#6699cc; width:50px"/>
					</td>
				</tr>
				<tr>
					<td height="5px"></td>
				</tr>
				<tr>
					<td bgcolor="#c3c3c3" width="20%" valign="top" style="font-family: Arial; font-size: 12px">Vital 7</td>
					<td valign="top" style="font-family: Arial; font-size: 12px; padding-left:5px">
						<SELECT NAME="drpvital7" style="width:170px;font-family: Arial;font-size: 12px">
							<option value="select" style="background-color:#CCCCFF;"></option>
							<OPTION title="Temperature" VALUE="Temperature">Temperature</OPTION>
							<OPTION title="Heart Rate" VALUE="Heart Rate">Heart Rate</OPTION>
							<OPTION title="Respiratory Rate" VALUE="Respiratory Rate">Respiratory Rate</OPTION>
							<OPTION title="BP Systolic" VALUE="BP Systolic">BP Systolic</OPTION>
							<OPTION title="BP Diastolic" VALUE="BP Diastolic">BP Diastolic</OPTION>
							<OPTION title="Weight" VALUE="Weight">Weight</OPTION>
							<OPTION title="Other..." VALUE="Other">Other</OPTION><br /><br />
						</SELECT><br /><br />
						less than       <input name="txtlessthanvital7" type="text" style="background-color:#6699cc; width:50px"/><br /><br />
						greater than  <input name="txtgreaterthan7" type="text" style="background-color:#6699cc; width:50px"/>
					</td>
				</tr>
				<tr>
					<td height="5px"></td>
				</tr>
			</table>
		</div>
	</form>
</cfwindow>

<cfwindow
	name="Vitaldiv"
	title=""
	height="500"
	width="800"
	resizable="true"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	initshow="false"
	bodystyle="background-color:white;" >

	<form name="formvital" id="formvital">
		<div style="margin:0 15px;">
			<img title="Close" name="imgbtnSkinCloseVital" style="border:none;cursor:pointer;float:right;" id="imgbtnSkinCloseVital" onClick="ColdFusion.Window.hide('Vitaldiv');" src="../../images/icon_back.gif" width="33" height="35" />
			<h4>Vital</h4>
			<div id="wounlist" style="display:block">
				<div class="form-group">
					<label>
						Add Vital <img name="ImgVitalAdd" id="ImgVitalAdd" onclick="ColdFusion.Window.show('AddvitalsignForm');ColdFusion.Window.hide('Vitaldiv'); " src="../../images/icon_add.png" style="border:none;cursor:pointer"/>
					</label>
				</div>
				<cfdiv bind="url:#Application.siteURL#/patientadmin_new/vitaldetails.cfm" style="height:150" ID="theVitalDiv"></cfdiv>
			</div>
		</div>
	</form>
</cfwindow>

<cfwindow
	name="Wounddiv"
	title=""
	height="500"
	width="800"
	resizable="true"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	initshow="false"
	bodystyle="background-color:white;" >
	<form name="formwound" id="formwound">
	<input type="hidden" name="Woundid" id="Woundid"/>
	<input type="hidden" name="hdnColor" id="hdnColor" />
		<div style="margin:0 15px;">
			<img title="Close" name="imgbtnSkinClose" style="cursor:pointer;float:right;" id="imgbtnSkinClose" onClick="ColdFusion.Window.hide('Wounddiv');" src="../../images/icon_back.gif" width="33" height="35" />
			<h4>Wounds</h4>
			<div id="wounlist" style="display:block">
				<div class="form-group">
					<label>Add <img name="ImgWound1Add" id="ImgWound1Add" onclick="WoundDiaplay();" src="../../images/icon_add.png" style="border:none;cursor:pointer"/></label>
				</div>
				<cfdiv bind="url:#Application.siteURL#/patientadmin_new/WoundGrid.cfm" ID="theWoundDiv" style="height:150"></cfdiv>
			</div>
			<div id="Divwound" style="display:none;">
				<div class="form-group">
					<label>Wound Type</label><br>
					<div class="row">
						<div class="col-md-6">
							<div id="Wnd_Typed" class="label-stable">
								<div class="radio-list">
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Abrasion"> Abrasion</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Bite"> Bite</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Burn"> Burn</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Contusion"> Contusion</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Diabetic Ulcer"> Diabetic Ulcer</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Graft"> Graft</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Gunshot"> Gunshot</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Laceration"> Laceration</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Nodule"> Nodule</label>
								</div>
							</div>
						</div>
						<div class="col-md-6">
							<div id="Wnd_Typed" class="label-stable">
								<div class="radio-list">
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Pressure Ulcer"> Pressure Ulcer</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Puncture"> Puncture</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Skin Tear"> Skin Tear</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Stab"> Stab</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Stasis Ulcer"> Stasis Ulcer</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Surgical Wound"> Surgical Wound</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Welt"> Welt</label>
									<label>
									<input type="radio" name="Wnd_Type" id="Wnd_Type" value="Other"> Other</label>
								</div>
							</div>
						</div>
					</div>
				</div>
				<div class="form-group text-center">
					<img src='../../images/human_frond.gif' border="0"  usemap="#shapes" />
					<map name="shapes" id="shapes">
						<area shape="circle" coords="104,74,19" href="javascript:;" onclick="javascript:bindmap('Anterior Left Shoulder');" />
						<area shape="circle" coords="25,74,19" href="javascript:;" onclick="javascript:bindmap('Anterior Right Shoulder');" />
						<area shape="circle" coords="50,90,12" href="javascript:;" onclick="javascript:bindmap('Anterior Right Upper Chest');" />
						<area shape="rect" coords="33,235,58,256" href="javascript:;" onclick="javascript:bindmap('Anterior Right Above Knee');" />
						<area shape="rect" coords="32,334,52,351" href="javascript:;" onclick="javascript:bindmap('Anterior Right Ankle');"  />
						<area shape="circle" coords="80,90,12" href="javascript:;" onclick="javascript:bindmap('Anterior Left Upper Chest');"/>
						<area shape="rect" coords="50,8,64,47" href="javascript:;" onclick="javascript:bindmap('Anterior Right Face');" />
						<area shape="rect" coords="65,8,85,47" href="javascript:;" onclick="javascript:bindmap('Anterior Left Face');" />
						<area shape="rect" coords="3,94,31,126" href="javascript:;" onclick="javascript:bindmap('Anterior Right Upper Arm');" />
						<area shape="rect" coords="100,94,127,126" href="javascript:;" onclick="javascript:bindmap('Anterior Left Upper Arm');" />
						<area shape="rect" coords="67,69,72,191" href="javascript:;" onclick="javascript:bindmap('Anterior Right Above Knee');" />
						<area shape="rect" coords="41,137,65,175" href="javascript:;" onclick="javascript:bindmap('Anterior Right Abdomen');"  />
						<area shape="circle" coords="43,270,11" href="javascript:;"  onclick="javascript:bindmap('Anterior Right Knee');"/>
						<area shape="rect" coords="75,137,98,173" href="javascript:;" onclick="javascript:bindmap('Anterior Left Abdomen');"/>
						<area shape="rect" coords="1,132,22,185" href="javascript:;" onclick="javascript:bindmap('Anterior Right Elbow/Forearm');" />
						<area shape="rect" coords="112,132,139,185" href="javascript:;" onclick="javascript:bindmap('Anterior Left Elbow/Forearm');" />
						<area shape="rect" coords="3,188,29,211" href="javascript:;" onclick="javascript:bindmap('Anterior Right Wrist/Hand');"/>
						<area shape="rect" coords="115,190,134,211" href="javascript:;" onclick="javascript:bindmap('Anterior Left Wrist/Hand');"/>
						<area shape="rect" coords="36,188,66,232" href="javascript:;" onclick="javascript:bindmap('Anterior Right Thigh');" />
						<area shape="rect" coords="79,186,106,231" href="javascript:;"  onclick="javascript:bindmap('Anterior Left Thigh');" />
						<area shape="rect" coords="31,189,36,232" href="javascript:;" onclick="javascript:bindmap('Anterior Right Hip');"/>
						<area shape="rect" coords="107,178,112,232" href="javascript:;" onclick="javascript:bindmap('Anterior Left Hip');"/>
						<area shape="circle" coords="88,181,8" href="javascript:;" onclick="javascript:bindmap('Anterior Left Groin');" />
						<area shape="rect" coords="79,232,107,253" href="javascript:;"  onclick="javascript:bindmap('Anterior Left Above Knee');" />
						<area shape="rect" coords="85,332,106,350" href="javascript:;" onclick="javascript:bindmap('Anterior Left Ankle');" />
						<area shape="circle" coords="94,265,11" href="javascript:;" onclick="javascript:bindmap('Anterior Left Knee');"  />
						<area shape="rect" coords="24,287,57,330" href="javascript:;" onclick="javascript:bindmap('Anterior Right Below Knee');" />
						<area shape="rect" coords="82,282,111,329" href="javascript:;" onclick="javascript:bindmap('Anterior Left Below Knee');" />
						<area shape="rect" coords="24,352,48,380" href="javascript:;" onclick="javascript:bindmap('Anterior Right Foot');" />
						<area shape="rect" coords="83,352,110,381" href="javascript:;" onclick="javascript:bindmap('Anterior Left Foot');" />
					</map>
					<img src='../../images/human_back.gif' border="0"  usemap="#backshapes" />
					<map name="backshapes" id="backshapes" >
						<area shape="rect" coords="47,4,64,36" href="javascript:;" onclick="javascript:bindmap('Posterior Left Head');" />
						<area shape="rect" coords="66,4,82,36" href="javascript:;" onclick="javascript:bindmap('Posterior Right Head');"/>
						<area shape="circle" coords="56,48,10" href="javascript:;" onclick="javascript:bindmap('Posterior Left Neck');"/>
						<area shape="circle" coords="78,48,10" href="javascript:;" onclick="javascript:bindmap('Posterior Right Neck');" />
						<area shape="rect" coords="63,60,69,155" href="javascript:;" onclick="javascript:bindmap('Posterior Midline');" />
						<area shape="rect" coords="28,62,59,94" href="javascript:;" onclick="javascript:bindmap('Posterior Left Shoulder/Upper Back');" />
						<area shape="rect" coords="78,62,105,94" href="javascript:;" onclick="javascript:bindmap('Posterior Right Shoulder/Upper Back');" />
						<area shape="circle" coords="88,113,18" onclick="javascript:bindmap('Posterior Right Middle/Lower Back');" href="javascript:;" /><area shape="circle" coords="47,112,17" href="javascript:;" onclick="javascript:bindmap('Posterior Left Middle Back');" />
						<area shape="rect" coords="11,68,30,134" href="javascript:;" onclick="javascript:bindmap('Posterior Left Upper Arm');" />
						<area shape="rect" coords="105,69,124,133" href="javascript:;" onclick="javascript:bindmap('Posterior Right Shoulder/Upper Arm');" />
						<area shape="rect" coords="1,142,20,191" href="javascript:;" onclick="javascript:bindmap('Posterior Left Elbow/Forearm');" /><area shape="rect" coords="111,144,133,184" href="javascript:;" onclick="javascript:bindmap('Posterior Right Elbow/Forearm');" /><area shape="circle" coords="119,193,7" href="javascript:;" onclick="javascript:bindmap('Posterior Right Wrist');"/>
						<area shape="rect" coords="107,200,131,210" href="javascript:;" onclick="javascript:bindmap('Posterior Right Hand');" />
						<area shape="circle" coords="14,206,9" href="javascript:;" onclick="javascript:bindmap('Posterior Left Hand');" />
						<area shape="circle" coords="44,228,18" href="javascript:;" onclick="javascript:bindmap('Posterior Left Thigh');" />
						<area shape="circle" coords="92,231,17" href="javascript:;" onclick="javascript:bindmap('Posterior Right Thigh');" />
						<area shape="rect" coords="25,282,55,337" href="javascript:;" onclick="javascript:bindmap('Posterior Left Calf');" />
						<area shape="circle" coords="82,189,17" href="javascript:;" onclick="javascript:bindmap('Posterior Right Buttock');"/>
						<area shape="rect" coords="84,287,109,340" href="javascript:;" onclick="javascript:bindmap('Posterior Right Calf');" />
						<area shape="circle" coords="46,184,17" href="javascript:;" onclick="javascript:bindmap('Posterior Left Buttock');" />
						<area shape="circle" coords="44,263,13" href="javascript:;" onclick="javascript:bindmap('Posterior Left Knee');"/>
						<area shape="circle" coords="96,268,14" href="javascript:;" onclick="javascript:bindmap('Posterior Right Knee');" />
						<area shape="circle" coords="46,352,11" href="javascript:;" onclick="javascript:bindmap('Posterior Left Ankle/Foot');" />
						<area shape="circle" coords="99,351,8" href="javascript:;" onclick="javascript:bindmap('Posterior Right Ankle/Foot');" />
						<area shape="rect" coords="33,364,55,372" href="javascript:;" onclick="javascript:bindmap('Posterior Left Heel');"/>
						<area shape="rect" coords="88,362,109,372" href="javascript:;" onclick="javascript:bindmap('Posterior Right Heel');" />
					</map>
				</div>
				<div class="row">
					<div class="col-md-6">
						<div class="form-group">
							<label>If pressure ulcer stage</label>
							<select class="form-control" id="selectstage" name="selectstage">
								<option value="1 - Intact skin with non-blanchable redness of a localized area usually over a bony prominence."> 1 - Intact skin with non-blanchable redness of a localized area usually over a bony prominence. </option>
								<option value="2 - Partial thickness loss of dermis presenting as a shallow open ulcer with red pink wound bed."> 2 - Partial thickness loss of dermis presenting as a shallow open ulcer with red pink wound bed. </option>
								<option value="3 - Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscles not exposed."> 3 - Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscles not exposed. </option>
								<option value="4 - Full thickness tissue loss with visible bone, tendon, or muscle. Slough or eschar may be present."> 4 - Full thickness tissue loss with visible bone, tendon, or muscle. Slough or eschar may be present. </option>
								<option value="5 - Unstageable due to non-removable dressing, slough or eschar.">5 - Unstageable due to non-removable dressing, slough or eschar.</option>
								<option value="6 - Unstageable due to coverage of wound bed by slough and/or eschar.">6 - Unstageable due to coverage of wound bed by slough and/or eschar.</option>
								<option value="7 - Unstageable due to suspected deep tissue injury in evolution.">7 - Unstageable due to suspected deep tissue injury in evolution.</option>
							</select>
						</div>
					</div>
					<div class="col-md-6">
						<div class="form-group">
							<label>Status</label>
							<select class="form-control" id="selectstatus" name="selectstatus">
								<option value="0 - Re-epithelialized or healed">0 - Re-epithelialized or healed</option>
								<option value="1 - Fully granulating">1 - Fully granulating</option>
								<option value="2 - Early/partial granulation">2 - Early/partial granulation</option>
								<option value="3 - Not healing">3 - Not healing</option>
								<option value="NA - Not applicable or no observable wound/ulcer">NA - Not applicable or no observable wound/ulcer</option>
							</select>
						</div>
					</div>
				</div>
				<div class="row">
					<div class="col-md-6">
						<div class="form-group">
							<label>Length</label><br>
							<div class="spinner1 margin-right-10" style="display:inline-block;vertical-align:middle;">
								<div class="input-group input-small">
									<input type="text" onChange="bindtext('lengthmin');" class="spinner-input form-control" name="lengthmin" id="lengthmin" value="0" maxlength="3">

									<div class="spinner-buttons input-group-btn btn-group-vertical">
										<button type="button" class="btn spinner-up btn-xs blue"> <i class="fa fa-angle-up"></i></button>
										<button type="button" class="btn spinner-down btn-xs blue"> <i class="fa fa-angle-down"></i></button>
									</div>
								</div>
							</div>
							<div class=" margin-right-10" style="display:inline-block;">.</div>
							<div class="spinner1 margin-right-10" style="display:inline-block;vertical-align:middle;">
								<div class="input-group input-small">
									<input type="text" onChange="bindtext('lenghtmax');" class="spinner-input form-control" name="lenghtmax" id="lenghtmax" value="0" maxlength="3">

									<div class="spinner-buttons input-group-btn btn-group-vertical">
										<button type="button" class="btn spinner-up btn-xs blue"> <i class="fa fa-angle-up"></i></button>
										<button type="button" class="btn spinner-down btn-xs blue"> <i class="fa fa-angle-down"></i></button>
									</div>
								</div>
							</div>
							<div style="display:inline-block;">cm</div>
						</div>
						<div class="form-group">
							<label>Width</label><br>
							<div class="spinner1 margin-right-10" style="display:inline-block;vertical-align:middle;">
								<div class="input-group input-small">
									<input type="text" onChange="bindtext('widthmin');" class="spinner-input form-control" name="widthmin" id="widthmin" value="0" maxlength="3">

									<div class="spinner-buttons input-group-btn btn-group-vertical">
										<button type="button" class="btn spinner-up btn-xs blue"> <i class="fa fa-angle-up"></i></button>
										<button type="button" class="btn spinner-down btn-xs blue"> <i class="fa fa-angle-down"></i></button>
									</div>
								</div>
							</div>
							<div class=" margin-right-10" style="display:inline-block;">.</div>
							<div class="spinner1 margin-right-10" style="display:inline-block;vertical-align:middle;">
								<div class="input-group input-small">
									<input type="text" onChange="bindtext('widthmax');" class="spinner-input form-control" name="widthmax" id="widthmax" value="0" maxlength="3">

									<div class="spinner-buttons input-group-btn btn-group-vertical">
										<button type="button" class="btn spinner-up btn-xs blue"> <i class="fa fa-angle-up"></i></button>
										<button type="button" class="btn spinner-down btn-xs blue"> <i class="fa fa-angle-down"></i></button>
									</div>
								</div>
							</div>
							<div style="display:inline-block;">cm</div>
						</div>
						<div class="form-group">
							<label>Depth</label><br>
							<div class="spinner1 margin-right-10" style="display:inline-block;vertical-align:middle;">
								<div class="input-group input-small">
									<input type="text" onChange="bindtext('depthmin');" class="spinner-input form-control" name="depthmin" id="depthmin" value="0" maxlength="3">

									<div class="spinner-buttons input-group-btn btn-group-vertical">
										<button type="button" class="btn spinner-up btn-xs blue"> <i class="fa fa-angle-up"></i></button>
										<button type="button" class="btn spinner-down btn-xs blue"> <i class="fa fa-angle-down"></i></button>
									</div>
								</div>
							</div>
							<div class=" margin-right-10" style="display:inline-block;">.</div>
							<div class="spinner1 margin-right-10" style="display:inline-block;vertical-align:middle;">
								<div class="input-group input-small">
									<input type="text" onChange="bindtext('depthmax');" class="spinner-input form-control" name="depthmax" id="depthmax" value="0" maxlength="3">

									<div class="spinner-buttons input-group-btn btn-group-vertical">
										<button type="button" class="btn spinner-up btn-xs blue"> <i class="fa fa-angle-up"></i></button>
										<button type="button" class="btn spinner-down btn-xs blue"> <i class="fa fa-angle-down"></i></button>
									</div>
								</div>
							</div>
							<div style="display:inline-block;">cm</div>
						</div>
					</div>
					<div class="col-md-6">
						<div class="form-group">
							<div id="Wnd_Surr_Tisscolor" class="label-stable">
								<label>Surrounding Tissues</label>
								<div class="checkbox-list">
									<label>
									<input type="checkbox" name="Wnd_Surr_Tiss" Value="clean"> clean</label>
									<label>
									<input type="checkbox" name="Wnd_Surr_Tiss" Value="scabbed"> scabbed</label>
									<label>
									<input type="checkbox" name="Wnd_Surr_Tiss" Value="crusted"> crusted</label>
									<label>
									<input type="checkbox" name="Wnd_Surr_Tiss" Value="indurated"> indurated</label>
									<label>
									<input type="checkbox" name="Wnd_Surr_Tiss" Value="gaping"> gaping</label>
									<label>
									<input type="checkbox" name="Wnd_Surr_Tiss" Value="blistered"> blistered</label>
									<label>
									<input type="checkbox" name="Wnd_Surr_Tiss" Value="separated"> separated</label>
									<label>
									<input type="checkbox" name="Wnd_Surr_Tiss" Value="bruised"> bruised</label>
								</div>
							</div>
						</div>
					</div>
				</div>
				<div class="form-group">
					<!---<div id="Wnd_Characolor" class="label-stable" style="width:100%;">
						<label>Characteriscts</label>
						<div class="row">
							<div class="col-md-4">
								<div class="checkbox-list">
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="clean"> clean</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="crusted"> crusted</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="gaping"> gaping</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="separated"> separated</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="scabbed"> scabbed</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="indurated"> indurated</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="blistered"> blistered</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="bruised"> bruised</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="cynanotic"> cynanotic</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="eschar"> eschar</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="excoriated"> excoriated</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="Flaking"> Flaking</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="hard"> hard</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="necrotic"> necrotic</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="reddened"> reddened</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="rough"> rough</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="weeping"> weeping</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="sloughing"> sloughing</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="green"> green</label>
								</div>
							</div>
							<div class="col-md-4">
								<div class="checkbox-list">
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="dry"> dry</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="cracked"> cracked</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="muschy"> muschy</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="soft"> soft</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="loose"> loose</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="SHAPE"> --SHAPE--</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="straight"> straight</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="circular"> circular</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="irregular"> irregular</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="oblong"> oblong</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="rectangle"> rectangle</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="square"> square</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="drainage"> drainage</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="no drainage"> no drainage</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="block"> block</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="brown"> brown</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="clear"> clear</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="gray"> gray</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="moist"> moist</label>
								</div>
							</div>
							<div class="col-md-4">
								<div class="checkbox-list">
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="pink" > pink</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="red"> red</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="reddish purple"> reddish purple</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="serosanguineous"> serosanguineous</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="serous"> serous</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="tan" > tan</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="yellow"> yellow</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="white"> white</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="haemoserous"> haemoserous</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="AMOUNT"> --AMOUNT--</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="scant"> scant</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="minimal"> minimal</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="moderate"> moderate</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="copious"> copious</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="ODOR"> --ODOR--</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="foul odor"> foul odor</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="no odor"> no odor</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="Other"> Other..</label>
								</div>
							</div>
						</div>
					</div>--->
					<div id="Wnd_Characolor" class="label-stable" style="width:100%;">
						<label>Characteristics</label>
						<div class="row">
							<div class="col-md-4">
								<div class="checkbox-list">
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="clean"> clean</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="crusted"> crusted</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="gaping"> gaping</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="separated"> separated</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="scabbed"> scabbed</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="indurated"> indurated</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="blistered"> blistered</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="bruised"> bruised</label>
									</div>
								</div>
								<div class="col-md-4">
								 <div class="checkbox-list">
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="cynanotic"> cynanotic</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="eschar"> eschar</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="excoriated"> excoriated</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="Flaking"> Flaking</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="hard"> hard</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="necrotic"> necrotic</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="reddened"> reddened</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="rough"> rough</label>
								</div>
							</div>
							<div class="col-md-4">
								<div class="checkbox-list">
								    <label>
									<input type="checkbox" name="Wnd_Chara" Value="weeping"> weeping</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="sloughing"> sloughing</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="green"> green</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="dry"> dry</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="cracked"> cracked</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="muschy"> muschy</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="soft"> soft</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="loose"> loose</label>
									</div>
								</div>
							</div>
							<br />
						<div class="row">
							 <div class="col-md-4">
							   <p style="font-weight:bold;">SHAPE</p>
								<div class="checkbox-list">
							      <!---  <label>
									<input type="checkbox" name="Wnd_Chara" Value="SHAPE"> --SHAPE--</label>--->
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="straight"> straight</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="circular"> circular</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="irregular"> irregular</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="oblong"> oblong</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="rectangle"> rectangle</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="square"> square</label>
									</div>
								</div>
						      <div class="col-md-4">
							    <p style="font-weight:bold;">AMOUNT</p>
								<div class="checkbox-list">
									<!---<label>
									<input type="checkbox" name="Wnd_Chara" Value="AMOUNT"> --AMOUNT--</label>--->
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="scant"> scant</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="minimal"> minimal</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="moderate"> moderate</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="copious"> copious</label>
									</div>
								</div>
								<div class="col-md-4">
								   <p style="font-weight:bold;">ODOR</p>
							       <div class="checkbox-list">
								    <!---<label>
									<input type="checkbox" name="Wnd_Chara" Value="ODOR"> --ODOR--</label>--->
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="foul odor"> foul odor</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="no odor"> no odor</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="Other"> Other..</label>
								</div>
							</div>
						</div>
						<br />
						<div class="row">
						  <div class="col-md-4">
						   <p style="font-weight:bold;">DRAINAGE</p>
							       <div class="checkbox-list">
									     <!---<label>
									<input type="checkbox" name="Wnd_Chara" Value="drainage"> drainage</label>--->
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="no drainage"> no drainage</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="block"> block</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="brown"> brown</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="clear"> clear</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="gray"> gray</label>
									</div>
								</div>
								<br /><br />
								<div class="col-md-4">
							       <div class="checkbox-list">
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="moist"> moist</label>
								    <label>
									<input type="checkbox" name="Wnd_Chara" Value="pink" > pink</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="red"> red</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="reddish purple"> reddish purple</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="serosanguineous"> serosanguineous</label>
									</div>
								</div>
								<div class="col-md-4">
							       <div class="checkbox-list">
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="serous"> serous</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="tan" > tan</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="yellow"> yellow</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="white"> white</label>
									<label>
									<input type="checkbox" name="Wnd_Chara" Value="haemoserous"> haemoserous</label>
									</div>
							 </div>
						</div>
							 
					</div>
				</div>
				<div class="row">
					<div class="col-md-6">
						<div class="form-group">
							<label>Location</label>
							<textarea class="form-control" onBlur="ChangeBlur('formwound','txtmap')" name="txtmap" id="txtmap"></textarea>
						</div>
					</div>
					<div class="col-md-6">
						<div class="form-group">
							<label>Notes</label>
							<textarea class="form-control" name="txtNotes" id="txtNotes"></textarea>
						</div>
					</div>
				</div>
				<div class="form-group">
					<input class="btn blue" type="button" onClick="btnWoundClick();" value="Add Wound" />
					<input class="btn default" type="button" value="Cancel" id="btnwoundcancel" name="btnwoundcancel" onClick="ColdFusion.Window.hide('Wounddiv');"/>
				</div>
			</div>
		</div>
	</form>
</cfwindow>

<cfif #AssForm.Assessment_Completed_M0090# lt '2015-01-01'>
	<cfwindow
		name="searchFormM1012"
		title=""
		height="500"
		width="800"
		resizable="false"
		center="true"
		closable="false"
		draggable="true"
		modal="true"
		bodystyle="background-color:white;"
		initshow="false"
		refreshOnShow = "true"
		source="#Application.siteURL#/patientadmin_new/AddSearchValue.cfm?text={formstep2:M1012searchfield}&M1020=search">
	</cfwindow>
</cfif>

<cfif #AssForm.Assessment_Completed_M0090# lt '2019-01-01'>
<cfwindow
	name="searchForm"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;"
	initshow="false"
	refreshOnShow = "true"
	source="#Application.siteURL#/patientadmin_new/AddSearchValue.cfm?text={formstep1:searchfield}&M1010=search">
</cfwindow>

<cfwindow
	name="searchFormM1016"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;"
	initshow="false"
	refreshOnShow = "true"
	source="#Application.siteURL#/patientadmin_new/AddSearchValue.cfm?text={formstep2:M1016searchfield}&M1016=search">
</cfwindow>

<cfwindow
	name="searchMedication"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;"
	initshow="false"
	refreshOnShow = "true"
	source="#Application.siteURL#/patientadmin_new/AddSearchValue.cfm?text={formstep2:hdnmedssearch}&MSearch=search">
</cfwindow>

<cfwindow
	name="searchMedication2"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;"
	initshow="false"
	refreshOnShow = "true"
	source="#Application.siteURL#/patientadmin_new/AddSearchValue.cfm?text={formstep2:hdnmedssearch2}&MSearch2=search">
</cfwindow>

</cfif>
<cfwindow
	name="searchFormM0230"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;"
	initshow="false"
	refreshOnShow = "true"
	source="#Application.siteURL#/patientadmin_new/AddSearchValue.cfm?text={formstep4:M0230txtsearch}&M0230=search">
</cfwindow>

<cfwindow
	name="searchFormM0230M"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;"
	initshow="false"
	refreshOnShow = "true"
	source="#Application.siteURL#/patientadmin_new/AddSearchValue.cfm?text={formM0230:M1020Manifestsearch}&M0230M=search">
</cfwindow>

<cfwindow
	name="searchFormM0230M1"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;"
	initshow="false"
	refreshOnShow = "true"
	source="#Application.siteURL#/patientadmin_new/AddSearchValue.cfm?text={formM0230:M1020Manifestsearch1}&M0230M1=search">
</cfwindow>

<cfwindow
	name="MedicationWindow"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;"
	initshow="false"
	refreshOnShow = "true"
	source="#Application.siteURL#/patientadmin_new/PopUPMedication.cfm">
</cfwindow>



<cfwindow
	name="ReviewMedsWindow"
	title=""
	height="500"
	width="800"
	resizable="false"
	center="true"
	closable="false"
	draggable="true"
	modal="true"
	bodystyle="background-color:white;"
	initshow="false"
	refreshOnShow = "true"
	source="#Application.siteURL#/patientadmin_new/ReviewMeds.cfm">
</cfwindow>

<cfinclude template="startofcarewizard_script.cfm" />