<!DOCTYPE html>
<html ng-app="reports">
<head>
<meta charset="utf-8" />
<title>AngularJS Menus</title>
<script>
document.write('<base href="' + document.location + '" />');
</script>
<!-- CSS -->
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.6/css/bootstrap.min.css" integrity="sha384-1q8mTJOASx8j1Au+a5WDVnPi2lkFfwwEAa8hDDdjZlpLegxhjVME1fgjWPGmkzs7" crossorigin="anonymous">
<link rel="stylesheet" type="text/css" href="assets/css/mycss.css">
<!-- AngularJS -->
<script src="http://ajax.googleapis.com/ajax/libs/angularjs/1.4.8/angular.min.js"></script>
<script src="http://ajax.googleapis.com/ajax/libs/angularjs/1.4.8/angular-animate.js"></script>
</head>
<body>
<div class="container-fluid panel" ng-controller="NavigationController">
{{mainmenu.getPath()}}
<div>
<nav class="navbar navbar-dark bg-primary">
<a class="navbar-brand" href="#">
<img alt="Brand" height="20px" src="https://www.webreflection.co.uk/img/html5.svg" />
</a>
<ul class="nav navbar-nav" ng-repeat="division in mainmenu.getOptionsList()">
<li class="nav-item active : mainmenu.isOptionSelected($index)}">
<a class="nav-link" style="color:white" href ng-click="mainmenu.setOption($index)">{{division}} <span class="sr-only">(current)</span></a>
</li>
</ul>
<form class="form-inline pull-xs-right">
<input class="form-control" type="text" placeholder="Search">
<button class="btn btn-secondary-outline" style="color:primary" type="submit">Search</button>
</form>
</nav>
</div>
<!-- End heading navigation bar-->
<!-- Divisions with their panels -->
<div class="fixed-panel ">
<div class="slide-animation-container">
<div class="vertical-flip" ng-include="mainmenu.getPath()"></div>
</div>
</div>
<!-- End Menu and Panels-->
<!-- footer -->
<div class="footer navbar-fixed-bottom">
</div>
<!-- End main footer-->
</div>
<!-- Modules -->
<script type="text/javascript" src="app/app.js"></script>
<!--Factories-->
<script type="text/javascript" src="app/Factory.js"></script>
<!--Services-->
<script type="text/javascript" src="app/Services.js"></script>
<!-- Controllers -->
<script type="text/javascript" src="app/Controllers.js"></script>
</body>
</html>
var app = angular.module('reports', ['ngAnimate']);
app.value('MenuOptions', ['PATIENT', 'HOMEBOUND STATUS', 'CARDIOPULMONARY', 'RESPIRATORY', 'DIGESTIVE',
'GENITOURINARY', 'SKIN', 'MUSCULOSKELETAL', 'NEUROSENSORY', 'EMOTIONAL STATUS', 'PAIN', 'INTERVENTIONS-TECHNIQUES', 'INJECTION'
]);
app.value('NavigationOptions', ['HOME', 'NEW VISIT', 'NEW PATIENT', 'MY PROFILE', 'LOGIN']);
app.value('InjectionSteps', ['first', 'second', 'third', 'fourth', 'fifth']);
app.value('Patients', [{
name: 'Luis',
last: 'Alvarez',
tempMin: 98.0,
tempMax: 99.1,
pulseMin: 70,
pulseMax: 78,
respMin: 16,
respMax: 20,
diasMax: 130,
diasMin: 118,
sysMin: 74,
sysMax: 80,
injection: ['right arm', 'left arm', 'leg'],
assistant: 'caregiver'
}, {
name: 'Maria',
last: 'Perez',
tempMin: 96.0,
tempMax: 97.1,
pulseMin: 70,
pulseMax: 78,
respMin: 16,
respMax: 20,
diasMax: 130,
diasMin: 118,
sysMin: 74,
sysMax: 80,
injection: ['en el abdomen alto', 'en al abdomen bajo'],
assistant: 'caregiver'
}, {
name: 'Jose',
last: 'Robles',
tempMin: 96.0,
tempMax: 97.1,
pulseMin: 70,
pulseMax: 78,
respMin: 16,
respMax: 20,
diasMax: 130,
diasMin: 118,
sysMin: 74,
sysMax: 80,
injection: ['pierna derecha', 'pierna izquierda'],
assistant: 'caregiver'
}
]);
app.filter('percentage', ['$filter',
function($filter) {
return function(input, decimals) {
return $filter('number')(input * 100, decimals) + '%';
};
}
]);
(app.controller('MenuController', ['$scope', 'MenuFactory', 'MenuOptions',
function($scope, MenuFactory, MenuOptions) {
$scope.menu = new MenuFactory(0, MenuOptions, 'newpatientpanels');
}
]));
(app.controller('NavigationController', ['$scope', 'MenuFactory', 'NavigationOptions',
function($scope, MenuFactory, NavigationOptions) {
$scope.mainmenu = new MenuFactory(0, NavigationOptions, 'divisions');
}
]));
(app.controller('InjectionController', ['$scope', 'MenuFactory', 'InjectionSteps',
function($scope, MenuFactory, InjectionSteps) {
$scope.steps = new MenuFactory(0, InjectionSteps, 'newpatientpanels/injectionwizard');
}
]));
(app.controller('NewVisitController', ['$scope', 'Patients', 'Ranges',
function($scope, Patients, Ranges) {
$scope.ranges = Ranges;
$scope.patientsVitals = [];
$scope.patients = Patients;
$scope.date = Date.now();
$scope.visitPath = 'app/components/newvitals/vitals.html';
$scope.addPatient = function() {
if ($scope.currentPatient !== ''){
$scope.patientsVitals.push({
id: $scope.patientsVitals.length + 1,
title: $scope.currentPatient
});
}
};
$scope.deletePatient = function(index) {
$scope.patientsVitals.splice(index, 1);
};
}
]));
(app.factory('MenuFactory', function() {
var MenuFactory = function(option, optionsList, section) {
this.option = option;
this.optionsList = optionsList;
this.section = section;
};
MenuFactory.prototype.setOption = function(option) {
this.option = option;
};
MenuFactory.prototype.isOptionSelected = function(option) {
return this.option === option;
};
MenuFactory.prototype.getOptionI = function() {
return this.optionsList[this.option].replace('-', ' and ').replace('/', '');
};
MenuFactory.prototype.getOptionsList = function() {
return this.optionsList;
};
MenuFactory.prototype.getOptionTitle = function(index) {
return this.optionsList[index].replace('-', ' and ').replace('/', '');
};
MenuFactory.prototype.getPath = function() {
return 'app/components/' + this.section + '/' + this.optionsList[this.option].toLowerCase().replace(' ', '') + '.html';
};
MenuFactory.prototype.lastOption = function() {
return this.option === this.optionsList.length - 1;
};
MenuFactory.prototype.firstOption = function() {
return this.option === 0;
};
MenuFactory.prototype.optionForward = function() {
return this.option += 1;
};
MenuFactory.prototype.optionBackward = function() {
return this.option -= 1;
};
MenuFactory.prototype.progress = function() {
return 1 / (this.optionsList.length-1) * (this.option);
};
return MenuFactory;
}));
(app.service('Ranges', function() {
this.Range = function(min, max, inc) {
var range = [];
for (var i = min; i < max + 1; i += inc) {
range.push(i);
}
return range;
};
this.IntRange = function(min, max) {
return this.Range(min, max, 1);
};
this.DecRange = function(min, max, inc) {
var arr = this.Range(min, max, inc);
var result = [];
for (var i = 0; i < arr.length; i++) {
result.push(parseFloat(arr[i].toFixed(2)));
}
return result;
};
this.pulseRange = this.IntRange(50, 100);
this.respirationRange = this.IntRange(12, 24);
this.bSLRange = this.IntRange(60, 450);
this.diastolicRange = this.IntRange(40, 120);
this.systolicRange = this.IntRange(90, 180);
this.temperatureRange = this.DecRange(95.5, 105.0, 0.1);
}));
<div class="container">
<div class="login">
<div class="col-lg-4 col-lg-offset-4">
<div class="well">
<h4>Login to OnlineNotas</h4>
<hr>
<div>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<span class="glyphicon glyphicon-user"></span>
</div>
<input type="email" class="form-control email" id="email-input" placeholder="Enter email">
</div>
</div>
</div>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<span class="glyphicon glyphicon-lock"></span>
</div>
<input type="password" class="form-control password" id="password-input" placeholder="Password">
</div>
</div>
</div>
<div class="row">
<div class="col-lg-2">
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Remember me</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
</div>
</div>
<div role="form-inline">
<div class="form-group">
<input class="btn btn-block btn-lg btn-success submit" type="submit" value="Login">
</div>
</div>
<div class="row">
<div class="col-lg-6">
<button type="button" class="btn btn-block btn-primary btn-sm"><strong>Register</strong>
</button>
</div>
<div class="col-lg-6">
<button type="button" class="btn btn-block btn-default btn-sm"><strong>Forgot password</strong>
</button>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="container">
<div class="panel panel-default">
<div class="panel-heading">
<h3 class="panel-title text-center">My profile</h3>
</div>
<div class="panel-body">
<div class="row">
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>First name</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Last name</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
</div>
<div class="well">
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<strong>License</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
</div>
<div class="form-group">
<form role="form-inline">
<div class="col-lg-3">
<div class="input-group">
<div class="input-group-addon">
<label class="radio-inline pull-left">
<input name="grasp" type="radio" id="eLUEck" value="option1"><strong>LPN</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="col-lg-3">
<div class="input-group">
<div class="input-group-addon">
<label class="radio-inline pull-left">
<input name="grasp" type="radio" id="eLUEck" value="option1"><strong>RN</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<strong>License</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<form role="form-inline">
<div class="input-group">
<div class="input-group-addon">
<label class="radio-inline pull-left">
<input name="grasp" type="radio" id="eLUEck" value="option1"><strong>LPN</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="panel panel-footer">
<nav>
<ul class="pager">
<li><a href="#">Save changes</a>
</li>
</ul>
</nav>
</div>
</div>
</div>
<div class="container-fluid" ng-controller="MenuController">
<div class="row">
<div class="col-lg-2" id="menubar">
<ul class="nav nav-pills nav-stacked" ng-repeat="tab in menu.getOptionsList()">
<li ng-class="{active : menu.isOptionSelected($index)}">
<a href ng-click="menu.setOption($index)">{{menu.getOptionTitle($index)}}</a>
</li>
</ul>
</div>{{menu.getPath()}}
<!-- End main menu-->
<div class="col-lg-10 " id="content-panel">
<div class="panel panel-default">
<div class="panel-heading">
<h3 class="panel-title text-center"><strong>{{menu.getOptionI()}}</strong></h3>
</div>
<div class="panel-body">
<div class="newpatient" ng-include="menu.getPath()">
</div>
</div>
<!-- Show each panel-->
<div class="panel panel-footer navbar-fixed-bottom">
<nav>
<ul class="pager">
<li ng-hide="menu.firstOption()" ng-click="menu.optionBackward()"><a href="#"><strong>Previous</strong></a>
</li>
<li ng-hide="menu.lastOption()" ng-click="menu.optionForward()"><a href="#"><strong>Next</strong></a>
</li>
</ul>
</nav>
<!-- Navigation buttons -->
</div>
</div>
</div>
<!-- End main menu-panels -->
</div>
</div>
<div class="container-fluid" ng-controller="NewVisitController">
<div class="row">
<div class="col-lg-5 col-centered">
<div class="well">
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Patient</strong>
</label>
</div>
<select class="form-control" ng-model="currentPatient" ng-options="patient.name for patient in patients"></select>
</div>
</div>
<button type="submit" class="btn btn-primary" ng-click="addPatient()">
<strong>Enter values</strong>
</button>
{{currentPatient === null}}
</div>
</div>
</div>
</div>
<div class="row-fluid">
<ul class="nav">
<li ng-repeat="currentPatient in patientsVitals" id="currentPatient{{currentPatient.id}}" class="newvisit" ng-include="visitPath">
</li>
</ul>
</div>
</div>
<div class="row">
<div class="col-lg-6">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Fluid Retention</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="none">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Chest pain</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="denied">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Neck vein distention</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Edema</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<div class="row">
<div class="col-lg-3">
<div class="form-group">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>RUE</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-3">
<div class="form-group">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>LUE</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-3">
<div class="form-group">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>RLE</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-3">
<div class="form-group">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>LLE</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Ascites</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Peripheral pulse</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="present X 4">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Arrythmia</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Other</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Bowel sounds</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Last bowel movement</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
</div>
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Nausea</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Vomiting</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Anorexia</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>NPO</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Epigastric distress</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Constipation</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Impaction</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Diarrhea</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Difficulty swallowing</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Abdominal distention</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Colostomy</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Ileostomy</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Bowel incontinence</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<div class="row">
<div class="col-lg-3">
<div>
<label class="control-label"></label>
</div>
<div>
<label class="control-label">Oriented</label>
</div>
<div>
<label class="control-label">Disoriented</label>
</div>
</div>
<div class="col-lg-2">
<div>
<label class="control-label">Time</label>
</div>
<div>
<input type="radio" name="time" id="eRUEck" value="option1" checked="checked">
</div>
<div>
<input type="radio" name="time" id="eRUEck" value="option1">
</div>
</div>
<div class="col-lg-2">
<div>
<label class="control-label">Place</label>
</div>
<div>
<input type="radio" name="place" id="eRUEck" value="option1" checked="checked">
</div>
<div>
<input type="radio" name="place" id="eRUEck" value="option1">
</div>
</div>
<div class="col-lg-2">
<div>
<label class="control-label">Person</label>
</div>
<div>
<input type="radio" name="person" id="eRUEck" value="option1" checked="checked">
</div>
<div>
<input type="radio" name="person" id="eRUEck" value="option1">
</div>
</div>
</div>
</div>
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Forgetful</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Confused</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Lethargic</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Comatose</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Restles</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Agitated</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Anxious</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Depressed</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Other</strong>
</label>
</div>
<textarea class="form-control" id="fRettext" rows="2"></textarea>
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Burning</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Dysuria</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Distention</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Retention</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Frequency</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Urgency</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Hesitancy</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Hematuria</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Pain</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Discharge</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Catheter</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Ileoconduit</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Bladder incontinency</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Foley catheter</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<div class="row">
<div class="col-md-6">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">Size</div>
<input type="text-" class="form-control" id="fReqtext">
<div class="input-group-addon">fr</div>
</div>
</div>
</form>
</div>
<div class="col-md-6">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<input type="text" class="form-control" id="fReqtext45">
<div class="input-group-addon">cc</div>
</div>
</div>
</form>
</div>
</div>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Irrigation</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Last changed </strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Catheter leakage</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Dislodgement</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Urine</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Output</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Color</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Consistency</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Odor</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
</div>
</div>
<!-- end -->
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Assist of 1-2 persons</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Taxing effort to leave home</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Unsteady gait</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Painful ambulance</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Compromised disease status</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Generalized weakness</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline pull-left">
<input type="checkbox" id="eLUEck" value="option1"><strong>Poor endurance</strong>
</label>
<label class="checkbox-inline pull-left">
<input type="checkbox" id="eLUEck" value="option2"><strong>Limited ambulation</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Bedbound</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline pull-left">
<input type="checkbox" id="eLUEck" value="option1"><strong>Limited movility</strong>
</label>
<label class="checkbox-inline pull-left">
<input type="checkbox" id="eLUEck" value="option2"><strong>Ambulatory device used</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline pull-left">
<input type="checkbox" id="eLUEck" value="option1"><strong>Angina</strong>
</label>
<label class="checkbox-inline pull-left">
<input type="checkbox" id="eLUEck" value="option2"><strong>Dyspnea on minimal exertion</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
<div ng-controller="InjectionController">{{steps.progress()}}
<div class="well">
<div ng-include="steps.getPath()">
</div>
<nav>
<ul class="pager">
<li class="previous" ng-hide="steps.firstOption()" ng-click="steps.optionBackward()"><a href="#"><span aria-hidden="true">←</span> Back</a>
</li>
<li class="next" ng-hide="steps.lastOption()" ng-click="steps.optionForward()"><a href="#">Next <span aria-hidden="true">→</span></a>
</li>
</ul>
</nav>
<div class="progress">
<div class="progress-bar progress-bar-striped active" role="progressbar" aria-valuenow="45" aria-valuemin="0" aria-valuemax="100" style="width:{{steps.progress() | percentage:0}}">{{steps.progress() | percentage:0}}
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Patient properly identified as per agency protocol</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Skilled nurse observation</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Skilled nurse assessment</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Foley change</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Foley irrigation</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Wound care</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Dressing change</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Preparation</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>administration of insulin</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Intramuscular injection</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Subcutaneous injection</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Diabetic observation care</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Diabetic observation care</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Observation/instruction on medication</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Instructed about safety precaution</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Inst. about emergency preparation</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Instructed disease process</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Universal precautions followed</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Aseptic techniques used</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Safety factors management conducted</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Balance</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Unsteady gait</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Endurance</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Weakness</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Ambulance with assistance</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Limited movement</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>ROM</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Assist device</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<div class="row">
<div class="col-lg-4">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Chair bound</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Bed bound</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Contracture</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Paralysis</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Syncope</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Vertigo</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Dizzines</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Headache</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
</div>
<div class="well">
<div class="row">
<div class="col-lg-4">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="radio-inline pull-left">
<input type="radio" name="handsgrasp" id="UEck" value="option11" checked><strong>Grasp equal</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="radio-inline pull-left">
<input type="radio" name="handsgrasp" id="eLUEck" value="option1"><strong>Grasp unequal</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
<div class="col-lg-8">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Right</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Left</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
</div>
</div>
</div>
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Movement</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="limited">
</div>
</div>
</form>
<div class="row">
<div class="col-lg-3">
<div class="form-group">
<form role="form-inline">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>RUE</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</form>
</div>
</div>
<div class="col-lg-3">
<div class="form-group">
<form role="form-inline">
<div class="form-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>LUE</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</form>
</div>
</div>
<div class="col-lg-3">
<div class="form-group">
<form role="form-inline">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>RLE</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</form>
</div>
</div>
<div class="col-lg-3">
<div class="form-group">
<form role="form-inline">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline pull-left">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>LLE</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<div class="row">
<div class="col-lg-6">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="radio-inline pull-left">
<input name="pupilreaction" type="radio" id="eLUEck" value="option1" checked><strong>Pupil reaction brisk</strong>
</label>
</div>
<div class="input-group-addon"></div>
</div>
</div>
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="radio-inline pull-left">
<input name="pupilreaction" type="radio" id="eLUEck" value="option1"><strong>Pupil reaction sluggish</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
<div class="col-lg-6">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Right</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="PERRLA">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Left</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="PERRLA">
</div>
</div>
</form>
</div>
</div>
</div>
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Hands tremors</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Poor hand-eye coordination</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Poor manual dexterity</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Speech impairment</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Hearing impairment</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Visual impairment</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Blindness</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Tactile sentation</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Ptosis</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="">
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-5">
<div class="well">
<div>
<label for="fRettext" class="control-label ">Frequency of pain........</label>
</div>
<div>
<div>
<label class="radio-inline">
<input type="radio" name="painfrequency" id="eRUEck" value="option1"><strong>Patient has no pain...</strong>
</label>
</div>
<div>
<label class="radio-inline">
<input type="radio" name="painfrequency" id="eRUEck" value="option1"><strong>Left often than daily</strong>
</label>
</div>
<div>
<label class="radio-inline">
<input type="radio" name="painfrequency" id="eRUEck" value="option1"><strong>Daily, but not constantly</strong>
</label>
</div>
<div>
<label class="radio-inline">
<input type="radio" name="painfrequency" id="eRUEck" value="option1"><strong>All the time</strong>
</label>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-4">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label>Pain profile origin: </label>
<label class="radio-inline">
<input name="painprofile" type="radio" id="eLUEck" value="option1"><strong>Dull</strong>
</label>
<label class="radio-inline">
<input name="painprofile" type="radio" id="eLUEck" value="option2"><strong>Burning</strong>
</label>
</div>
<div class="input-group-addon">
<label> </label>
</div>
</div>
</div>
</form>
</div>
</div>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Primary site:</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="control-label">Intensity </label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>0</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>1</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>2</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>3</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>4</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>5</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>6</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>7</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>8</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>9</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>10</strong>
</label>
</div>
<div class="input-group-addon">
<label> </label>
</div>
</div>
</div>
</form>
</div>
<div class="col-lg-7">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Current pain management and effectivenenss</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<div class="row">
<div class="col-lg-3">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input name="grasp" type="checkbox" id="eLUEck" value="option1"><strong>Pain management teaching to patient/family</strong>
</label>
</div>
<div class="input-group-addon"> </div>
</div>
</div>
</form>
</div>
</div>
<hr>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Patient pain goal</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Progress toward pain goal</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form class="form-inline">
<div class="row">
<div class="col-lg-4">
<div class="form-group">
<label for="wArmStext" class="control-label">First name</label>
<div class="input-group">
<input type="text" class="form-control" id="wArmStext">
</div>
</div>
</div>
<div class="col-lg-4">
<div class="form-group">
<label for="dRyStext" class="control-label">M.</label>
<div class="input-group">
<input type="text" class="form-control" id="dRyStext">
</div>
</div>
</div>
<div class="col-lg-4">
<div class="form-group">
<label for="wArmStext" class="control-label">Last</label>
<div class="input-group">
<input type="text" class="form-control" id="wArmStext" placeholder="">
</div>
</div>
</div>
</div>
</form>
</div>
<div class="well">
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<label for="wArmStext" class="control-label">Agency</label>
<input type="text" class="form-control" id="wArmStext">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label for="dRyStext" class="control-label">Medical record</label>
<input type="text" class="form-control" id="dRyStext">
</div>
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="row">
<div class="form-group">
<div class="input-group">
<div class="col-lg-4">
<label for="minResnum" class="control-label">Respiration</label>
</div>
<div class="col-lg-4">
<div class="input-group">
<select class="form-control" id="minResnum">
<option>12</option>
<option>14</option>
<option>16</option>
<option>18</option>
<option>20</option>
</select>
<div class="input-group-addon">min</div>
</div>
</div>
<div class="col-lg-4">
<div class="input-group">
<select class="form-control" id="maxResnum">
<option>16</option>
<option>18</option>
<option>20</option>
<option>22</option>
<option>24</option>
</select>
<div class="input-group-addon">max</div>
</div>
</div>
</div>
</div>
</div>
</form>
<!-- Respiration-->
<form role="form-inline">
<div class="row">
<div class="form-group">
<div class="input-group">
<div class="col-lg-4">
<label for="minPulnum" class="control-label">Pulse</label>
</div>
<div class="col-lg-4">
<div class="input-group">
<select class="form-control" id="minPulnum">
<option>60</option>
<option>66</option>
<option>70</option>
<option>76</option>
<option>84</option>
</select>
<div class="input-group-addon">min</div>
</div>
</div>
<div class="col-lg-4">
<div class="input-group">
<select class="form-control" id="maxPulnum">
<option>70</option>
<option>78</option>
<option>84</option>
<option>90</option>
<option>98</option>
</select>
<div class="input-group-addon">max</div>
</div>
</div>
</div>
</div>
</div>
</form>
<!-- Pulse-->
<form role="form-inline">
<div class="row">
<div class="form-group">
<div class="input-group">
<div class="col-lg-4">
<label for="minTempnum" class="control-label">Temperature</label>
</div>
<div class="col-lg-4">
<div class="input-group">
<select class="form-control" id="minTempnum">
<option>66</option>
<option>66</option>
<option>70</option>
<option>76</option>
<option>84</option>
</select>
<div class="input-group-addon">min</div>
</div>
</div>
<div class="col-lg-4">
<div class="input-group">
<select class="form-control" id="maxTemnum">
<option>70</option>
<option>78</option>
<option>84</option>
<option>90</option>
<option>98</option>
</select>
<div class="input-group-addon">max</div>
</div>
</div>
</div>
</div>
</div>
</form>
<!-- Temperature-->
<form role="form-inline">
<div class="row">
<div class="form-group">
<div class="input-group">
<div class="col-lg-4">
<label for="minDianum" class="control-label">Diastolic blood pressure</label>
</div>
<div class="col-lg-4">
<div class="input-group">
<select class="form-control" id="minDiapnum">
<option>66</option>
<option>66</option>
<option>70</option>
<option>76</option>
<option>84</option>
</select>
<div class="input-group-addon">min</div>
</div>
</div>
<div class="col-lg-4">
<div class="input-group">
<select class="form-control" id="maxDianum">
<option>70</option>
<option>78</option>
<option>84</option>
<option>90</option>
<option>98</option>
</select>
<div class="input-group-addon">max</div>
</div>
</div>
</div>
</div>
</div>
</form>
<!-- Diastolic pressure-->
<form role="form-inline">
<div class="row">
<div class="form-group">
<div class="input-group">
<div class="col-lg-4">
<label for="minSyynum" class="control-label">Systolic blood pressure</label>
</div>
<div class="col-lg-4">
<div class="input-group">
<select class="form-control" id="minSyspnum">
<option>66</option>
<option>66</option>
<option>70</option>
<option>76</option>
<option>84</option>
</select>
<div class="input-group-addon">min</div>
</div>
</div>
<div class="col-lg-4">
<div class="input-group">
<select class="form-control" id="maxSysnum">
<option>70</option>
<option>78</option>
<option>84</option>
<option>90</option>
<option>98</option>
</select>
<div class="input-group-addon">max</div>
</div>
</div>
</div>
</div>
</div>
</form>
</div>
<!-- Systolic pressure-->
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Right lung sound</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="clear">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Left lung sound</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext" value="clear">
</div>
</div>
</form>
</div>
<div class="well">
<form class="form-inline">
<div class="row">
<div class="col-md-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">O2</div>
<input type="text" class="form-control" id="fReqtext">
<div class="input-group-addon">LPM</div>
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">Via</div>
<input type="text" class="form-control" id="fReqtext">
</div>
</div>
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Dyspnea</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>SOB</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Rales</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Rhonchi</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Wheeze</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Cough</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Sputum</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Orthopnea</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Warm</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Dry</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Cold</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Calmmy</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Jaundice</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Payor</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Cyanosis</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Integrity</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Chills</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
</div>
</div>
<div class="col-lg-6">
<div class="well">
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Decubitus</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Wounds</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Ulcer</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3"><strong>Stage </strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>I</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>II</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>III</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Rash</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Itching</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Discoloration</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option3">
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option1"><strong>Turgor</strong>
</label>
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Hydration</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Tube insertion site</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
<form role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label class="checkbox-inline">
<input type="checkbox" id="eLUEck" value="option2"><strong>Other</strong>
</label>
</div>
<input type="text" class="form-control" id="fRettext">
</div>
</div>
</form>
</div>
</div>
<!-- end -->
<div class="row">
<div class="well">
<h1>Step 5</h1>
</div>
<div class="well">
<p>This is the injection sentence</p>
</div>
</div>
<div class="row">
<div class="well">
1
</div>
<div class="well">
<p>This is the injection sentence</p>
</div>
</div>
<div class="row">
<div class="well">
<h1>Step 4</h1>
</div>
<div class="well">
<p>This is the injection sentence</p>
</div>
</div>
<div class="row">
<div class="well">
<h1>Step 2</h1>
</div>
<div class="well">
<p>This is the injection sentence</p>
</div>
</div>
<div class="row">
<div class="well">
<h1>Step 3</h1>
</div>
<div class="well">
<p>This is the injection sentence</p>
</div>
</div>
<div class="col-lg-3">
<div class="panel panel-primary">
<div class="panel-heading">
<h4 class="panel-title inline">{{currentPatient.title.name + ' ' + currentPatient.title.last}}
<div ng-click="deletePatient($index)" class="pull-right close-button"><strong>x</strong></div>
</h4>
</div>
<div class="panel-body">
<form name="nnewVisit" novalidate>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Date</strong>
</label>
</div>
<input type="text" ng-model="currentPatient.date" class="form-control" id="fRettext" value="{{date | date:'shortDate'}}">
</div>
</div>
</div>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Time in</strong>
</label>
</div>
<input type="text" ng-model="currentPatient.timeIn" class="form-control" id="fRettext" value="{{date | date:'shortTime'}}">
</div>
</div>
</div>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Time out</strong>
</label>
</div>
<input type="text" ng-model="currentPatient.timeOut" class="form-control" id="fRettext" value="{{date + 30 | date:'shortTime'}}">
</div>
</div>
</div>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>BSL</strong>
</label>
</div>
<select class="form-control" ng-model="currentPatient.bSL" ng-options="bloodSL for bloodSL in ranges.bSLRange">
<option value="">-</option>
</select>
</div>
</div>
</div>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Respiration</strong>
</label>
</div>
<select class="form-control" ng-model="currentPatient.resp" ng-options="resp for resp in ranges.respirationRange">
<option value="">-</option>
</select>
</div>
</div>
</div>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>B. Pressure</strong>
</label>
</div>
<select class="form-control" ng-model="currentPatient.sys" ng-options="sys for sys in ranges.systolicRange">
<option value="">-</option>
</select>
<div class="input-group-addon">
<label><strong>/</strong>
</label>
</div>
<select class="form-control" ng-model="currentPatient.dias" ng-options="dias for dias in ranges.diastolicRange">
<option value="">-</option>
</select>
</div>
</div>
</div>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Injection site</strong>
</label>
</div>
<select class="form-control" ng-model="currentPatient.site" ng-options="site for site in patient.injection">
<option value="">-</option>
</select>
</div>
</div>
</div>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Pulse</strong>
</label>
</div>
<select class="form-control" ng-model="currentPatient.puls" ng-options="puls for puls in ranges.pulseRange">
<option value="">-</option>
</select>
</div>
</div>
</div>
<div role="form-inline">
<div class="form-group">
<div class="input-group">
<div class="input-group-addon">
<label><strong>Temperature</strong>
</label>
</div>
<select class="form-control" ng-model="currentPatient.temp" ng-options="temp for temp in ranges.temperatureRange">
<option value="">-</option>
</select>
</div>
</div>
</div>
</form>
<p>{{currentPatient}}</p>
</div>
</div>
</div>
body {
padding-bottom: 70px;
}
.col-centered{
float: none;
margin: 0 auto;
}
.animate-show {
line-height: 20px;
opacity: 1;
padding: 10px;
}
.animate-show.ng-hide-add, .animate-show.ng-hide-remove {
transition: all linear 0.5s;
}
.animate-show.ng-hide {
line-height: 0;
opacity: 0;
padding: 0 10px;
}
.slide-animation-container {
position: relative;
}
.slide-animation.ng-enter, .slide-animation.ng-leave {
-webkit-transition: all linear 0.5s;
-moz-transition: all linear 0.5s;
-o-transition: all linear 0.5s;
transition: all linear 0.5s;
opacity:0;
left:100%;
}
.slide-animation.ng-enter.ng-enter-active, .slide-animation.ng-leave {
left:0;
opacity:1;
}
.slide-animation.ng-leave.ng-leave-active {
left:-100%;
opacity:0;
}
.close-button {
border-radius : 100%;
width : 20px;
height : 20px;
color : white;
text-align : center;
}
.close-button:hover {
color : #337ab7;
background-color : white;
text-align : center;
}
.close-button:active {
background-color : red;
}
/*
.vertical-flip.ng-leave {
-webkit-transform: rotateY(0deg);
-moz-transform: rotateY(0deg);
-ms-transform: rotateY(0deg);
-o-transform: rotateY(0deg);
transform: rotateY(0deg);
-webkit-backface-visibility: hidden;
-moz-backface-visibility: hidden;
-ms-backface-visibility: hidden;
-o-backface-visibility: hidden;
backface-visibility: hidden;
-webkit-transition-property: -webkit-transform;
-moz-transition-property: -moz-transform;
-o-transition-property: -o-transform;
transition-property: transform;
-webkit-transition-duration: 0.5s;
-moz-transition-duration: 0.5s;
-o-transition-duration: 0.5s;
transition-duration: 0.5s;
-webkit-transform-origin: center center;
-moz-transform-origin: center center;
-ms-transform-origin: center center;
-o-transform-origin: center center;
transform-origin: center center;
position: absolute;
top: 0px;
left: 0px;
z-index: 20;
}
.vertical-flip.ng-leave-active {
-webkit-transform: rotateY(180deg);
-moz-transform: rotateY(180deg);
-ms-transform: rotateY(180deg);
-o-transform: rotateY(180deg);
transform: rotateY(180deg);
z-index: 10;
}
*/
.vertical-flip.ng-enter {
-webkit-transform: rotateY(-180deg);
-moz-transform: rotateY(-180deg);
-ms-transform: rotateY(-180deg);
-o-transform: rotateY(-180deg);
transform: rotateY(-180deg);
-webkit-backface-visibility: hidden;
-moz-backface-visibility: hidden;
-ms-backface-visibility: hidden;
-o-backface-visibility: hidden;
backface-visibility: hidden;
-webkit-transition-property: -webkit-transform;
-moz-transition-property: -moz-transform;
-o-transition-property: -o-transform;
transition-property: transform;
-webkit-transition-duration: 0.5s;
-moz-transition-duration: 0.5s;
-o-transition-duration: 0.5s;
transition-duration: 0.5s;
-webkit-transform-origin: center center;
-moz-transform-origin: center center;
-ms-transform-origin: center center;
-o-transform-origin: center center;
transform-origin: center center;
top: 0;
left: 0;
z-index: 10;
}
.vertical-flip.ng-enter-active {
-webkit-transform: rotateX(0deg);
-moz-transform: rotateX(0deg);
-ms-transform: rotateX(0deg);
-o-transform: rotateX(0deg);
transform: rotateX(0deg);
z-index: 20;
}
.ng-enter {
-webkit-transition: 1s;
-moz-transition: 1s;
-o-transition: 1s;
transition: 1s;
margin-left: 100%;
}
.ng-enter-active {
margin-left: 0;
}
/*
.newvisit.ng-enter {
-webkit-transition: 1s;
-moz-transition: 1s;
-o-transition: 1s;
transition: 1s;
margin-left: 100%;
}
.newvisit.ng-hide-add, .newvisit.ng-hide-remove {
transition: all linear 0.5s;
}
.newvisit.ng-hide {
line-height: 0;
opacity: 0;
padding: 0 10px;
}
*/
/*
.ng-leave {
-webkit-transition: 1s;
-moz-transition: 1s;
-o-transition: 1s;
transition: 1s;
margin-left: 0;
}
.ng-leave-active {
margin-left: 100%;
}
*/
.ng-move {
-webkit-transition: 1s;
-moz-transition: 1s;
-o-transition: 1s;
transition: 1s;
background: gold;
}
.ng-move-active {
background: #fff;
}
.newvisit {
position: relative;
}
.newvisit.ng-enter,
.newvisit.ng-leave {
-webkit-transition: 0.5s linear all;
-moz-transition: 0.5s linear all;
-o-transition: 0.5s linear all;
transition: 0.5s linear all;
}
.newvisit.ng-enter {
z-index: 100;
opacity: 0;
}
.newvisit.ng-enter.ng-enter-active {
opacity: 1;
}
.newvisit.ng-leave {
z-index: 101;
opacity: 1;
}
.newvisit.ng-leave.ng-leave-active {
opacity: 0;
}