100% complete
{{--
Animated stripes
--}}
@if($patient->general)
@else
| Weight | {{ $patient->general->weight }} pounds |
|---|---|
| Height | {{ $patient->general->height }}cm |
| BMI | {{ $patient->general->bmi }} |
| Gender | {{ $patient->general->gender }} |
| Age | {{ $patient->general->age }} |
| Age | {{ $patient->general->education_level }} |
| First time surgery? | {{ $patient->general->first_time_surgery }} |
| Medication Allergies | {{ $patient->general->medication_allergies }} |
Please complete this questionnaire
@endif--}}
{{--
--}}
--}}
{{--
--}}
{{-- --}} {{-- --}} {{-- Surgical--}} {{-- --}} {{--
--}} {{----}}
{{--
--}}
{{-- --}}
{{-- @if($patient->surgical)--}}
{{-- --}}
{{--
--}}
{{-- @else--}}
{{--
--}}
{{-- | Surgery Name | --}} {{--{{ $patient->surgical->surgery_name }} | --}} {{--
|---|---|
| Surgery Date | --}} {{--{{ $patient->surgical->surgery_date }}cm | --}} {{--
| Sedation Type | --}} {{--{{ $patient->surgical->sedation_type }} | --}} {{--
| Anasthetic Complications | --}} {{--{{ $patient->surgical->anasthetic_complications }} | --}} {{--
Please complete this questionnaire
--}} {{-- @endif--}} {{--
@if($patient->cardiac)
@else
| Blood Pressure medication? | {{ $patient->cardiac->blood_pressure_medication }} |
|---|---|
| Lower Blood Pressure | {{ $patient->cardiac->bottom_blood_pressure }} |
| Upper Blood Pressure | {{ $patient->cardiac->top_blood_pressure }} |
| Had Heart Surgery? | {{ $patient->cardiac->had_heart_surgery }} |
| Heart Surgery Name | {{ $patient->cardiac->heart_surgery_name }} |
| Heart Surgery Year | {{ $patient->cardiac->heart_surgery_year }} |
| Stents Placed | {{ $patient->cardiac->stents_placed }} |
| Valves Placed | {{ $patient->cardiac->valves_placed }} |
| Chest Pain? | {{ $patient->cardiac->chest_pain }} |
| Cardiologist Name | {{ $patient->cardiac->cardiologist_nme }} |
| Informed Primary Care Physician? | {{ $patient->cardiac->informed_primary_care_physician }} |
| Have Abnormal Heart Rhythm | {{ $patient->cardiac->have_abnormal_heart_rhythm }} |
| Had Heart Attack? | {{ $patient->cardiac->had_heart_attack }} |
| Have Heart Failure? | {{ $patient->cardiac->have_heart_failure }} |
| Able to lie flat? | {{ $patient->cardiac->able_to_lie_flat }} |
| Have Valve Disease? | {{ $patient->cardiac->have_valve_disease }} |
| On Blood Thinners? | {{ $patient->cardiac->on_blood_thinners }} |
| Had Stess Test? | {{ $patient->cardiac->had_stress_test }} |
| Had Catherization? | {{ $patient->cardiac->had_catherization }} |
| Have Pacemaker? | {{ $patient->cardiac->have_pacemaker }} |
Please complete this questionnaire
@endif
@if($patient->pulmonary)
@else
| Have Asthma? | {{ $patient->pulmonary->have_asthma }} |
|---|---|
| Have Rescue Inhaler? | {{ $patient->pulmonary->have_rescue_inhaler }} |
| Last Asthma Attack? | {{ $patient->pulmonary->last_asthma_attack }} |
| Been Hospitalised from Asthma? | {{ $patient->pulmonary->hospital_asthma_attack }} |
| Have COPD? | {{ $patient->pulmonary->have_copd }} |
| Do you have home oxygen for COPD? | {{ $patient->pulmonary->copd_home_oxygen }} |
| Recent Bronchitis Infection? | {{ $patient->pulmonary->recent_bronchitis_infection }} |
| Do you Smoke? | {{ $patient->pulmonary->do_you_smoke }} |
| Packs Per Day | {{ $patient->pulmonary->packs_per_day }} |
| Do you see a Lung Doctor | {{ $patient->pulmonary->see_lung_doctor }} |
| Have you had lung testing? | {{ $patient->pulmonary->had_lung_testing }} |
| Do you have sleep apnia or CPAP? | {{ $patient->pulmonary->sleep_apnia_or_cpap }} |
| Habe you had Pneumonia? | {{ $patient->pulmonary->had_pneumonia }} |
| Have you had Thacheostomy? | {{ $patient->pulmonary->had_tracheostomy }} |
| Do you get shortness of breath? | {{ $patient->pulmonary->shortness_of_breath }} |
Please complete this questionnaire
@endif
@if($patient->renal)
@else
| Have Renal Disease? | {{ $patient->renal->have_renal_disease }} |
|---|---|
| Renal Stage | {{ $patient->renal->renal_stage }} |
| Dialysis Days | {{ $patient->renal->dialysis_days }} |
Please complete this questionnaire
@endif
@if($patient->endocrine)
@else
| Do you have any endocrine disorders? | {{ $patient->endocrine->have_endocrine_disorders }} |
|---|---|
| Do you have diabetes? | {{ $patient->endocrine->have_diabetes }} |
| What type of insulin? | {{ $patient->endocrine->insulin_type }} |
| Average glucose reading | {{ $patient->endocrine->avg_glucose_reading }} |
| Last H1AC test | {{ $patient->endocrine->last_h1ac_test }} |
| Hypo? | {{ $patient->endocrine->hypo }} |
| Last TSH | {{ $patient->endocrine->last_tsh }} |
| Do you have Arthiritis? | {{ $patient->endocrine->have_arthiritis }} |
| Do you take Steroids? | {{ $patient->endocrine->take_steroids }} |
| Do you have Lupus? | {{ $patient->endocrine->have_lupus }} |
| Any Blood Disorders | {{ $patient->endocrine->blood_disorders }} |
| Do you have HIV or Aids? | {{ $patient->endocrine->have_hiv_aids }} |
| Last DC4 Test? | {{ $patient->endocrine->last_dc4_test }} |
Please complete this questionnaire
@endif
@if($patient->neurological)
@else
| Have you had a stroke? | {{ $patient->neurological->had_stroke }} |
|---|---|
| Date of stroke | {{ $patient->neurological->date_of_stroke }} |
| Do you have any weakness from the stroke? | {{ $patient->neurological->stroke_weakness_where }} |
| Do you get seizures? | {{ $patient->neurological->get_seizures }} |
| Date of seizure | {{ $patient->neurological->date_of_seizure }} |
| Type of seizure | {{ $patient->neurological->type_of_seizure }} |
| Do you have multiple sclerosis? | {{ $patient->neurological->have_multiple_sclerosis }} |
| Do you have AMS? | {{ $patient->neurological->have_ams }} |
| Do you have dementia? | {{ $patient->neurological->have_dementia }} |
| How long have you had dementia? | {{ $patient->neurological->how_long_had_dementia }} |
| What stage is the dementia at? | {{ $patient->neurological->dementia_stage }} |
| Do you have any psychiatric disorders? | {{ $patient->neurological->psychiatric_disorders }} |
Please complete this questionnaire
@endif
@if($patient->gastrointestinal)
@else
| Do you have Hepititis? | {{ $patient->gastrointestinal->have_hepititis }} |
|---|---|
| Do you have GERD? | {{ $patient->gastrointestinal->have_gerd }} |
| Do you get nausea or vomiting? | {{ $patient->gastrointestinal->nausea_or_vomiting }} |
| Do you have Barrett's Esophagitis | {{ $patient->gastrointestinal->have_barretts }} |
| Do you have Irritable Bowel Syndrome? | {{ $patient->gastrointestinal->have_irritable_bowel }} |
| Do you have stomach ulcers? | {{ $patient->gastrointestinal->have_stomach_ulcers }} |
Please complete this questionnaire
@endif
@if($patient->misc)
@else
| Do you use illegal drugs or Marijuana? | {{ $patient->misc->use_illegal_drugs }} |
|---|---|
| Which drugs? | {{ $patient->misc->which_drugs }} |
| How often do you use drugs? | {{ $patient->misc->drugs_how_often }} |
| Do you drink? | {{ $patient->misc->do_you_drink }} |
| How much do you drink? | {{ $patient->misc->drink_how_much }} |
| How often do you drink? | {{ $patient->misc->drink_how_often }} |
| Do you take pain medication? | {{ $patient->misc->take_pain_medication }} |
| How often do you take pain medication? | {{ $patient->misc->pain_med_how_often }} |
Please complete this questionnaire
@endif