Compare commits
2 Commits
28ba717201
...
133725b7a0
| Author | SHA1 | Date | |
|---|---|---|---|
|
133725b7a0 | ||
|
|
48a959bfd6 |
@ -3,7 +3,6 @@ import './App.css';
|
|||||||
import { QueryClient, QueryClientProvider } from '@tanstack/react-query';
|
import { QueryClient, QueryClientProvider } from '@tanstack/react-query';
|
||||||
import { BrowserRouter, Route, Routes } from 'react-router-dom';
|
import { BrowserRouter, Route, Routes } from 'react-router-dom';
|
||||||
import PatientForm from './Components/PatientForm/PatientForm';
|
import PatientForm from './Components/PatientForm/PatientForm';
|
||||||
import PatientDetails from './Components/PatientDetails/PatientDetails';
|
|
||||||
|
|
||||||
function App() {
|
function App() {
|
||||||
const queryClient = new QueryClient();
|
const queryClient = new QueryClient();
|
||||||
|
|||||||
@ -1,185 +0,0 @@
|
|||||||
import { Button, Checkbox, FormControl, FormControlLabel, FormGroup, FormLabel, Grid, Paper, Radio, RadioGroup, TextField } from '@mui/material';
|
|
||||||
import { useFormik } from "formik";
|
|
||||||
import * as yup from "yup";
|
|
||||||
import { LocalizationProvider, DatePicker } from '@mui/x-date-pickers';
|
|
||||||
|
|
||||||
interface FormValues {
|
|
||||||
maritalStatus: string;
|
|
||||||
numberOfChildren: string;
|
|
||||||
ages: string;
|
|
||||||
occupation: string;
|
|
||||||
hoursPerWeek: number | string;
|
|
||||||
employer: string;
|
|
||||||
businessPhone: string;
|
|
||||||
spouseName: string;
|
|
||||||
spouseEmployer: string;
|
|
||||||
spouseBusinessPhone: string;
|
|
||||||
emergencyContact: string;
|
|
||||||
relationship: string;
|
|
||||||
spousePhone: string;
|
|
||||||
}
|
|
||||||
|
|
||||||
interface Props {
|
|
||||||
familyDetails: FormValues;
|
|
||||||
}
|
|
||||||
|
|
||||||
export default function FamilyFormSection({familyDetails}:Props){
|
|
||||||
return(
|
|
||||||
<>
|
|
||||||
<Grid container direction="row">
|
|
||||||
<Grid item xs={8} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Marital Status</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
aria-labelledby="demo-radio-buttons-group-label"
|
|
||||||
defaultValue="married"
|
|
||||||
name="maritalStatus"
|
|
||||||
value={familyDetails.maritalStatus}
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="married" control={<Radio />} label="Married" />
|
|
||||||
<FormControlLabel value="single" control={<Radio />} label="Single" />
|
|
||||||
<FormControlLabel value="widowed" control={<Radio />} label="Widowed" />
|
|
||||||
<FormControlLabel value="seperated" control={<Radio />} label="Seperated" />
|
|
||||||
<FormControlLabel value="divorced" control={<Radio />} label="Divorced" />
|
|
||||||
</RadioGroup>
|
|
||||||
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '></Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
type="number"
|
|
||||||
label="Number of Children/Ages"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='numberOfChildren'
|
|
||||||
value={familyDetails.numberOfChildren}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Occupation"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='occupation'
|
|
||||||
value={familyDetails.occupation}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Hours/Week"
|
|
||||||
type="number"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='hoursPerWeek'
|
|
||||||
value={familyDetails.hoursPerWeek}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Employer"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='employer'
|
|
||||||
value={familyDetails.employer}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Business Phone"
|
|
||||||
type="number"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='businessPhone'
|
|
||||||
value={familyDetails.businessPhone}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '></Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style '>
|
|
||||||
<FormLabel sx={{fontWeight:600}}>Spouse's Information:</FormLabel>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Spouse's Name"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='spouseName'
|
|
||||||
value={familyDetails.spouseName}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Spouse's Employer"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='spouseEmployer'
|
|
||||||
value={familyDetails.spouseEmployer}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Business Phone"
|
|
||||||
type="number"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='spouseBusinessPhone'
|
|
||||||
value={familyDetails.spouseBusinessPhone}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style '>
|
|
||||||
<FormLabel sx={{fontWeight:600}}>Emergency:</FormLabel>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Emergency Contact"
|
|
||||||
type="number"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='emergencyContact'
|
|
||||||
value={familyDetails.emergencyContact}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Relationship"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='relationship'
|
|
||||||
value={familyDetails.relationship}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
type="number"
|
|
||||||
label="Phone"
|
|
||||||
className='collapsable-form-style'
|
|
||||||
name='spousePhone'
|
|
||||||
value={familyDetails.spousePhone}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
</Grid>
|
|
||||||
</>
|
|
||||||
)
|
|
||||||
};
|
|
||||||
@ -1,165 +0,0 @@
|
|||||||
import * as React from 'react';
|
|
||||||
import { Checkbox, FormControlLabel, TextField, FormGroup, Grid, FormControl, FormLabel, Radio, RadioGroup } from '@mui/material';
|
|
||||||
import { useFormik } from 'formik';
|
|
||||||
import * as Yup from 'yup';
|
|
||||||
|
|
||||||
interface FormValues {
|
|
||||||
physicianname: string;
|
|
||||||
physiciancity: string;
|
|
||||||
physicianstate: string;
|
|
||||||
physicianphone: string;
|
|
||||||
chiropractorName: string;
|
|
||||||
chiropractorState: string;
|
|
||||||
xray: boolean;
|
|
||||||
ctScan: boolean;
|
|
||||||
cdImages: boolean;
|
|
||||||
visitDetails: string;
|
|
||||||
cellPhoneProvider: string;
|
|
||||||
}
|
|
||||||
|
|
||||||
interface Props {
|
|
||||||
medicalHistory: FormValues;
|
|
||||||
}
|
|
||||||
|
|
||||||
export default function MedicalHistoryForm({medicalHistory}:Props){
|
|
||||||
return(
|
|
||||||
<>
|
|
||||||
<Grid item xs={12} className='collapsable-form-style '>
|
|
||||||
<FormLabel sx={{fontWeight:600}}>Physician Hisory Information:</FormLabel>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid container direction="row">
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Family physician"
|
|
||||||
name='physicianname'
|
|
||||||
value={medicalHistory.physicianname}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="City"
|
|
||||||
name='physiciancity'
|
|
||||||
value={medicalHistory.physiciancity}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="State"
|
|
||||||
name='physicianstate'
|
|
||||||
value={medicalHistory.physicianstate}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Phone"
|
|
||||||
type="number"
|
|
||||||
name='physicianphone'
|
|
||||||
value={medicalHistory.physicianphone}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'></Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'></Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style '>
|
|
||||||
<FormLabel sx={{fontWeight:600}}>Chiropractor Information:</FormLabel>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} sx={{paddingLeft:"14px",marginTop:2}} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Previous Chiropractic Care:</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
aria-labelledby="demo-radio-buttons-group-label"
|
|
||||||
name="radio-buttons-group"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="no" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Chiropractor's Name"
|
|
||||||
name='chiropractorName'
|
|
||||||
value={medicalHistory.chiropractorName}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="City/State"
|
|
||||||
name='chiropractorState'
|
|
||||||
value={medicalHistory.chiropractorState}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} sx={{paddingLeft:"14px",marginTop:2}} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Have you had an X-ray/CT Scan within the last 12 months? If yes, did you bring the CD of images for the doctor to review?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
// value={patient.gender}
|
|
||||||
aria-labelledby="demo-radio-buttons-group-label"
|
|
||||||
// defaultValue="yes"
|
|
||||||
name="radio-buttons-group"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="no" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Who can we thank for referring you to our office:</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
// value={patient.gender}
|
|
||||||
aria-labelledby="demo-radio-buttons-group-label"
|
|
||||||
// defaultValue="physician"
|
|
||||||
name="radio-buttons-group"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="friend" control={<Radio />} label="Friend" />
|
|
||||||
<FormControlLabel value="relative" control={<Radio />} label="Relative" />
|
|
||||||
<FormControlLabel value="physician" control={<Radio />} label="Physician" />
|
|
||||||
<FormControlLabel value="instagram" control={<Radio />} label="Instagram" />
|
|
||||||
<FormControlLabel value="google" control={<Radio />} label="Google" />
|
|
||||||
<FormControlLabel value="others" control={<Radio />} label="Others" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} sx={{paddingLeft:"14px",marginTop:2}} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>How do you prefer to be reminded of your appointments?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
// value={patient.gender}
|
|
||||||
aria-labelledby="demo-radio-buttons-group-label"
|
|
||||||
// defaultValue="email"
|
|
||||||
name="radio-buttons-group"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="email" control={<Radio />} label="Email" />
|
|
||||||
<FormControlLabel value="text" control={<Radio />} label="Text" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
</>
|
|
||||||
)}
|
|
||||||
|
|
||||||
@ -1,113 +0,0 @@
|
|||||||
import { Grid, FormLabel, TextField, FormControl, RadioGroup, FormControlLabel, Radio } from "@mui/material";
|
|
||||||
import { AdapterDayjs } from "@mui/x-date-pickers/AdapterDayjs";
|
|
||||||
import React from "react";
|
|
||||||
import { LocalizationProvider, DatePicker } from '@mui/x-date-pickers';
|
|
||||||
import dayjs from "dayjs";
|
|
||||||
|
|
||||||
interface FormValues {
|
|
||||||
familyHistory: string;
|
|
||||||
sleep: string;
|
|
||||||
pillow:string;
|
|
||||||
orthotics:string;
|
|
||||||
brestExam: any;
|
|
||||||
pregnancy:string;
|
|
||||||
menstralCycle: any;
|
|
||||||
}
|
|
||||||
|
|
||||||
export default function OtherDetails8(){
|
|
||||||
|
|
||||||
return(
|
|
||||||
<>
|
|
||||||
<Grid container direction="row">
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-multiline'>
|
|
||||||
<FormLabel>Family history and health status:</FormLabel><br></br>
|
|
||||||
<TextField
|
|
||||||
multiline
|
|
||||||
variant="outlined"
|
|
||||||
label=""
|
|
||||||
name='explanation'
|
|
||||||
value=''
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>How do you sleep?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Back" control={<Radio />} label="Back" />
|
|
||||||
<FormControlLabel value="Side" control={<Radio />} label="Side" />
|
|
||||||
<FormControlLabel value="Stomach" control={<Radio />} label="Stomach" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Do you use a pillow?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Do you wear orthotics or arch support?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormLabel>Date of last gynecological and brest exam?</FormLabel><br></br>
|
|
||||||
<FormControl>
|
|
||||||
<TextField
|
|
||||||
name=''
|
|
||||||
value=''
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
{/* <Grid item xs={6} className='collapsable-form-style' sx={{marginTop:4, marginBottom:2}}>
|
|
||||||
<FormLabel sx={{fontWeight:600}}>For X-Ray purposes:</FormLabel>
|
|
||||||
</Grid> */}
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Possible pregnancy?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormLabel>Date of last menstrual cycle?</FormLabel><br></br>
|
|
||||||
<FormControl>
|
|
||||||
<TextField
|
|
||||||
name=''
|
|
||||||
value=''
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
|
|
||||||
</Grid>
|
|
||||||
</>
|
|
||||||
)
|
|
||||||
}
|
|
||||||
@ -1,219 +0,0 @@
|
|||||||
import * as React from 'react';
|
|
||||||
import { Checkbox, FormControlLabel, TextField, FormGroup, Grid, FormControl, FormLabel, Radio, RadioGroup } from '@mui/material';
|
|
||||||
import { useFormik } from 'formik';
|
|
||||||
import * as Yup from 'yup';
|
|
||||||
|
|
||||||
interface FormValues {
|
|
||||||
chiefComplaint:string;
|
|
||||||
painQuality: string[];
|
|
||||||
painDuration: string;
|
|
||||||
currentTreatment: string;
|
|
||||||
treatmentResults: string;
|
|
||||||
treatmentGoal: string;
|
|
||||||
}
|
|
||||||
interface Props {
|
|
||||||
painAnalysis: FormValues;
|
|
||||||
}
|
|
||||||
|
|
||||||
export default function PainAnalysisSection4({painAnalysis}:Props){
|
|
||||||
return(
|
|
||||||
<>
|
|
||||||
<Grid item xs={12} className='collapsable-form-style '>
|
|
||||||
<FormLabel sx={{fontWeight:600}}>Issue Details:</FormLabel>
|
|
||||||
</Grid>
|
|
||||||
<Grid container direction="row">
|
|
||||||
<Grid item xs={4} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="How did your Chief complaint start?(ex-fell on ice)"
|
|
||||||
name='chiefComplaint'
|
|
||||||
value={painAnalysis.chiefComplaint}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>What makes your pain worse?</FormLabel>
|
|
||||||
<FormGroup sx={{display:'flex', flexDirection:'row'}}>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="sharp" />}
|
|
||||||
label="Bending"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="dull" />}
|
|
||||||
label="Standing"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="burning" />}
|
|
||||||
label="Sitting"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="aching" />}
|
|
||||||
label="Walking"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="aching" />}
|
|
||||||
label="Others"
|
|
||||||
/>
|
|
||||||
</FormGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>What makes your pain better?</FormLabel>
|
|
||||||
<FormGroup sx={{display:'flex', flexDirection:'row'}}>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="sharp" />}
|
|
||||||
label="laying down"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="dull" />}
|
|
||||||
label="Standing"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="burning" />}
|
|
||||||
label="Sitting"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="aching" />}
|
|
||||||
label="Walking"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="aching" />}
|
|
||||||
label="Others"
|
|
||||||
/>
|
|
||||||
</FormGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>What is the quality of your pain?</FormLabel>
|
|
||||||
<FormGroup sx={{display:'flex', flexDirection:'row'}}>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="sharp" />}
|
|
||||||
label="Sharp"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="dull" />}
|
|
||||||
label="Dull/Ache"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="burning" />}
|
|
||||||
label="Throbbing"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="aching" />}
|
|
||||||
label="Tingling/Numbness/Burning"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="aching" />}
|
|
||||||
label="Others"
|
|
||||||
/>
|
|
||||||
</FormGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>What is the worst time for your pain?</FormLabel>
|
|
||||||
<FormGroup sx={{display:'flex', flexDirection:'row'}}>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="sharp" />}
|
|
||||||
label="Morning"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="dull" />}
|
|
||||||
label="During day"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="burning" />}
|
|
||||||
label="Evening"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="aching" />}
|
|
||||||
label="Lying in bed"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="aching" />}
|
|
||||||
label="Others"
|
|
||||||
/>
|
|
||||||
</FormGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>How much of the day do you experience your chief complaint?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
value={painAnalysis.painDuration}
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="0-25%" control={<Radio />} label="0-25%" />
|
|
||||||
<FormControlLabel value="25-50%" control={<Radio />} label="25-50%" />
|
|
||||||
<FormControlLabel value="50-75%" control={<Radio />} label="50-75%" />
|
|
||||||
<FormControlLabel value="75-100%" control={<Radio />} label="75-100%" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Has your current complaint caused any of the following?</FormLabel>
|
|
||||||
<FormGroup sx={{display:'flex', flexDirection:'row'}}>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="sharp" />}
|
|
||||||
label="Muscle weakness"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="dull" />}
|
|
||||||
label="Bowel/Bladder problem"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="burning" />}
|
|
||||||
label="Digestion"
|
|
||||||
/>
|
|
||||||
<FormControlLabel
|
|
||||||
control={<Checkbox name="aching" />}
|
|
||||||
label="Cardiac/Respiratory"
|
|
||||||
/>
|
|
||||||
|
|
||||||
</FormGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Have you tried any self treatment (ex-ice, heat, excercise) or taken any medication(over the counter or prescription)?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
value={painAnalysis.painDuration}
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="no" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style' sx={{marginTop:3 }}>
|
|
||||||
<FormLabel sx={{fontWeight:600}}>Expected Treatment Result:</FormLabel>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="What is your goal from treatment?(ex-play golf without pain)"
|
|
||||||
name='treatmentGoal'
|
|
||||||
value={painAnalysis.treatmentGoal}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
</Grid>
|
|
||||||
</>
|
|
||||||
)}
|
|
||||||
|
|
||||||
@ -1,170 +0,0 @@
|
|||||||
import { TextField, FormControlLabel,Grid,Checkbox, FormControl, FormLabel, Radio, RadioGroup } from '@mui/material';
|
|
||||||
import * as React from 'react';
|
|
||||||
import Table from '../Helper/AddNewTable';
|
|
||||||
|
|
||||||
interface FormValues {
|
|
||||||
generalHealth: string;
|
|
||||||
presentProblemBefore: string;
|
|
||||||
ifYespresentProblemBefore:string;
|
|
||||||
ifYestreatmentProvided: string;
|
|
||||||
ifYesOutcome: string;
|
|
||||||
strokeBloodclotting: string;
|
|
||||||
ifYesstrokeBloodclotting: string;
|
|
||||||
dizzinessFetigue: string;
|
|
||||||
ifyesdizzinessFetigue: string;
|
|
||||||
antiColligent: string;
|
|
||||||
injuriesHospitalization: string;
|
|
||||||
supplementsOrDrugs: string;
|
|
||||||
}
|
|
||||||
|
|
||||||
interface Props {
|
|
||||||
pastTreatement: FormValues
|
|
||||||
}
|
|
||||||
|
|
||||||
|
|
||||||
export default function PastTreatment5({pastTreatement}: Props){
|
|
||||||
return(
|
|
||||||
<>
|
|
||||||
<form>
|
|
||||||
<Grid container direction="row">
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Overall your General Healgth is:</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Excellent" control={<Radio />} label="Excellent" />
|
|
||||||
<FormControlLabel value="Very Good" control={<Radio />} label="Very Good" />
|
|
||||||
<FormControlLabel value="Good" control={<Radio />} label="Good" />
|
|
||||||
<FormControlLabel value="Fair" control={<Radio />} label="Fair" />
|
|
||||||
<FormControlLabel value="Poor" control={<Radio />} label="Poor" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Have you experienced your present problem before?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="If yes, when?"
|
|
||||||
name='treatmentGoal'
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Was treatment provided?If yes, by whom?"
|
|
||||||
name='treatmentGoal'
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Outcome?"
|
|
||||||
name='treatmentGoal'
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Have you ever had a stroke or issues with blood clotting?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="If yes, when?"
|
|
||||||
name='treatmentGoal'
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Have you recently experienced dizziness, unexplained fatigue, weight loss or blood loss?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="If yes, when?"
|
|
||||||
name='treatmentGoal'
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Are you currently taking anti-coagulant or blood thinning medication?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons-fullwidth'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Have you ever had any major illness, injuries, hospitalization or surgeries?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} sx={{marginLeft:2, marginBottom:3}} >
|
|
||||||
<Table />
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-multiline'>
|
|
||||||
<FormLabel>Please list current supplements or drugs you may be taking:</FormLabel>
|
|
||||||
<TextField
|
|
||||||
multiline
|
|
||||||
variant="outlined"
|
|
||||||
label=""
|
|
||||||
name='treatmentGoal'
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
</Grid>
|
|
||||||
</form>
|
|
||||||
</>
|
|
||||||
)
|
|
||||||
}
|
|
||||||
@ -1,335 +0,0 @@
|
|||||||
import * as React from 'react';
|
|
||||||
import Typography from '@mui/material/Typography';
|
|
||||||
import ExpandMoreIcon from '@mui/icons-material/ExpandMore';
|
|
||||||
import Footer from "../Footer";
|
|
||||||
import Header from "../Header";
|
|
||||||
import {Button, Checkbox, FormControlLabel, FormGroup, FormLabel, Grid, Paper, Radio, RadioGroup, TextField } from '@mui/material';
|
|
||||||
import PersonalSection from './PersonalSection1';
|
|
||||||
import { styled } from '@mui/material/styles';
|
|
||||||
import ArrowForwardIosSharpIcon from '@mui/icons-material/ArrowForwardIosSharp';
|
|
||||||
import MuiAccordion, { AccordionProps } from '@mui/material/Accordion';
|
|
||||||
import MuiAccordionSummary, {
|
|
||||||
AccordionSummaryProps,
|
|
||||||
} from '@mui/material/AccordionSummary';
|
|
||||||
import MuiAccordionDetails from '@mui/material/AccordionDetails';
|
|
||||||
import MedicalHistory from './MedicalHistorySection3';
|
|
||||||
import FamilyFormSection from './FamilyFormSection2';
|
|
||||||
import PainAnalysisSection4 from './PainAnalysisSection4';
|
|
||||||
import PastTreatment5 from './PastTreatment5';
|
|
||||||
import SystemReviewSection6 from './SyestemReviewSection6';
|
|
||||||
import RecreationalHobbiesSection7 from './RecreationalHobbiesSection7';
|
|
||||||
import OtherDetails8 from './OtherDetails8';
|
|
||||||
import PatientImageMarker from '../ImageMarker/PatientImageMarker';
|
|
||||||
import ViewPatientImageMarker from '../ImageMarker/ViewPatientImageMarker';
|
|
||||||
|
|
||||||
interface Patient {
|
|
||||||
fullName: string;
|
|
||||||
homePhone: string;
|
|
||||||
cellPhone: string;
|
|
||||||
email: string;
|
|
||||||
age: number;
|
|
||||||
dateOfBirth: string;
|
|
||||||
socialSecurityNumber: string;
|
|
||||||
mailingAddress: string;
|
|
||||||
city: string;
|
|
||||||
state: string;
|
|
||||||
zipCode: string;
|
|
||||||
gender: string;
|
|
||||||
maritalStatus: string;
|
|
||||||
}
|
|
||||||
|
|
||||||
const personalData : Patient = {
|
|
||||||
fullName: "Vipeesh",
|
|
||||||
homePhone: "7259910917",
|
|
||||||
cellPhone: "7259910917",
|
|
||||||
email: "vipeesh191@gmail.com",
|
|
||||||
age: 33,
|
|
||||||
dateOfBirth: "27-4-1990",
|
|
||||||
socialSecurityNumber: "",
|
|
||||||
mailingAddress: "",
|
|
||||||
city: "Kannur",
|
|
||||||
state: "Kerala",
|
|
||||||
zipCode: "670643",
|
|
||||||
gender: "male",
|
|
||||||
maritalStatus: "",
|
|
||||||
}
|
|
||||||
|
|
||||||
const familyData = {
|
|
||||||
maritalStatus:'',
|
|
||||||
numberOfChildren:'',
|
|
||||||
ages:'',
|
|
||||||
occupation:'',
|
|
||||||
hoursPerWeek:'',
|
|
||||||
employer:'',
|
|
||||||
businessPhone:'',
|
|
||||||
spouseName:'',
|
|
||||||
spouseEmployer:'',
|
|
||||||
spouseBusinessPhone:'',
|
|
||||||
emergencyContact:'',
|
|
||||||
relationship:'',
|
|
||||||
spousePhone:''
|
|
||||||
}
|
|
||||||
|
|
||||||
const medicalHstory = {
|
|
||||||
physicianname: '',
|
|
||||||
physiciancity: '',
|
|
||||||
physicianstate: '',
|
|
||||||
physicianphone: '',
|
|
||||||
chiropractorName: '',
|
|
||||||
chiropractorState: '',
|
|
||||||
xray: false,
|
|
||||||
ctScan: false,
|
|
||||||
cdImages: false,
|
|
||||||
visitDetails: '',
|
|
||||||
cellPhoneProvider: '',
|
|
||||||
}
|
|
||||||
|
|
||||||
const painAnalysis = {
|
|
||||||
chiefComplaint:'',
|
|
||||||
painQuality:[],
|
|
||||||
painDuration:'',
|
|
||||||
currentTreatment:'',
|
|
||||||
treatmentResults:'',
|
|
||||||
treatmentGoal:'',
|
|
||||||
}
|
|
||||||
|
|
||||||
const pastTreatement = {
|
|
||||||
generalHealth: '',
|
|
||||||
presentProblemBefore: '',
|
|
||||||
ifYespresentProblemBefore:'',
|
|
||||||
ifYestreatmentProvided:'',
|
|
||||||
ifYesOutcome:'',
|
|
||||||
strokeBloodclotting: '',
|
|
||||||
ifYesstrokeBloodclotting: '',
|
|
||||||
dizzinessFetigue: '',
|
|
||||||
ifyesdizzinessFetigue:'',
|
|
||||||
antiColligent: '',
|
|
||||||
injuriesHospitalization: '',
|
|
||||||
supplementsOrDrugs:''
|
|
||||||
}
|
|
||||||
|
|
||||||
const Accordion = styled((props: AccordionProps) => (
|
|
||||||
<MuiAccordion disableGutters elevation={0} square {...props} />
|
|
||||||
))(({ theme }) => ({
|
|
||||||
border: `1px solid ${theme.palette.divider}`,
|
|
||||||
'&:not(:last-child)': {
|
|
||||||
borderBottom: 0,
|
|
||||||
},
|
|
||||||
'&:before': {
|
|
||||||
display: 'none',
|
|
||||||
},
|
|
||||||
}));
|
|
||||||
|
|
||||||
const AccordionSummary = styled((props: AccordionSummaryProps) => (
|
|
||||||
<MuiAccordionSummary
|
|
||||||
expandIcon={<ArrowForwardIosSharpIcon sx={{ fontSize: '0.9rem' }} />}
|
|
||||||
{...props}
|
|
||||||
/>
|
|
||||||
))(({ theme }) => ({
|
|
||||||
backgroundColor:
|
|
||||||
theme.palette.mode === 'dark'
|
|
||||||
? 'rgba(255, 255, 255, .05)'
|
|
||||||
: 'rgba(0, 0, 0, .03)',
|
|
||||||
flexDirection: 'row-reverse',
|
|
||||||
'& .MuiAccordionSummary-expandIconWrapper.Mui-expanded': {
|
|
||||||
transform: 'rotate(90deg)',
|
|
||||||
},
|
|
||||||
'& .MuiAccordionSummary-content': {
|
|
||||||
marginLeft: theme.spacing(1),
|
|
||||||
},
|
|
||||||
}));
|
|
||||||
|
|
||||||
const AccordionDetails = styled(MuiAccordionDetails)(({ theme }) => ({
|
|
||||||
padding: theme.spacing(2),
|
|
||||||
borderTop: '1px solid rgba(0, 0, 0, .125)',
|
|
||||||
}));
|
|
||||||
|
|
||||||
export default function PatientDetails(){
|
|
||||||
const [expanded, setExpanded] = React.useState<string | false>('panel1');
|
|
||||||
const [isChecked, setIsChecked] = React.useState(false);
|
|
||||||
const [signature,setSignature]=React.useState('');
|
|
||||||
|
|
||||||
const [patient, setPatient] = React.useState<Patient>({
|
|
||||||
fullName: "",
|
|
||||||
homePhone: "",
|
|
||||||
cellPhone: "",
|
|
||||||
email: "",
|
|
||||||
age: 0,
|
|
||||||
dateOfBirth: "",
|
|
||||||
socialSecurityNumber: "",
|
|
||||||
mailingAddress: "",
|
|
||||||
city: "",
|
|
||||||
state: "",
|
|
||||||
zipCode: "",
|
|
||||||
gender: "",
|
|
||||||
maritalStatus: "",
|
|
||||||
});
|
|
||||||
|
|
||||||
const handleSubmit = (event: React.FormEvent<HTMLFormElement>) => {
|
|
||||||
event.preventDefault();
|
|
||||||
};
|
|
||||||
|
|
||||||
const handleExpandChange =
|
|
||||||
(panel: string) => (event: React.SyntheticEvent, newExpanded: boolean) => {
|
|
||||||
setExpanded(newExpanded ? panel : false);
|
|
||||||
};
|
|
||||||
|
|
||||||
const handleCheckboxChange = (event:any) => {
|
|
||||||
setIsChecked(event.target.checked);
|
|
||||||
};
|
|
||||||
|
|
||||||
//@ts-ignore
|
|
||||||
const patientData = localStorage.getItem('patientData') ? JSON.parse(localStorage.getItem('patientData')) : [];
|
|
||||||
|
|
||||||
return(
|
|
||||||
<>
|
|
||||||
<Paper elevation={0} className='app-screen-constants'>
|
|
||||||
<Header/>
|
|
||||||
<Paper elevation={0} sx={{margin:4, minHeight:550}} >
|
|
||||||
<form onSubmit={handleSubmit}>
|
|
||||||
<Typography sx={{fontSize:20}} gutterBottom>
|
|
||||||
Confidential Patient Information
|
|
||||||
</Typography>
|
|
||||||
<Grid>
|
|
||||||
<Accordion expanded={expanded === 'panel1'} onChange={handleExpandChange('panel1')}>
|
|
||||||
|
|
||||||
<AccordionSummary
|
|
||||||
expandIcon={<ExpandMoreIcon />}
|
|
||||||
aria-controls="panel1a-content"
|
|
||||||
id="panel1a-header"
|
|
||||||
>
|
|
||||||
<Typography sx={{fontSize:18}}>Patient's Personal Information</Typography>
|
|
||||||
</AccordionSummary>
|
|
||||||
|
|
||||||
<AccordionDetails>
|
|
||||||
<PersonalSection personalData={patientData?.section1} />
|
|
||||||
</AccordionDetails>
|
|
||||||
|
|
||||||
</Accordion>
|
|
||||||
|
|
||||||
<Accordion expanded={expanded === 'panel2'} onChange={handleExpandChange('panel2')}>
|
|
||||||
<AccordionSummary aria-controls="panel2d-content" id="panel2d-header">
|
|
||||||
<Typography sx={{fontSize:18}}>Patient's Family Information</Typography>
|
|
||||||
</AccordionSummary>
|
|
||||||
|
|
||||||
<AccordionDetails>
|
|
||||||
<FamilyFormSection familyDetails={patientData?.section2}/>
|
|
||||||
</AccordionDetails>
|
|
||||||
</Accordion>
|
|
||||||
|
|
||||||
<Accordion expanded={expanded === 'panel3'} onChange={handleExpandChange('panel3')}>
|
|
||||||
<AccordionSummary aria-controls="panel3d-content" id="panel3d-header">
|
|
||||||
<Typography sx={{fontSize:18}}>Patient's Medical History Information</Typography>
|
|
||||||
</AccordionSummary>
|
|
||||||
|
|
||||||
<AccordionDetails>
|
|
||||||
<MedicalHistory medicalHistory={medicalHstory}/>
|
|
||||||
</AccordionDetails>
|
|
||||||
</Accordion>
|
|
||||||
|
|
||||||
<Accordion expanded={expanded === 'panel9'} onChange={handleExpandChange('panel9')}>
|
|
||||||
<AccordionSummary aria-controls="panel9d-content" id="panel9d-header">
|
|
||||||
<Typography sx={{fontSize:18}}>Patient's Injury Image</Typography>
|
|
||||||
</AccordionSummary>
|
|
||||||
|
|
||||||
<AccordionDetails>
|
|
||||||
<ViewPatientImageMarker />
|
|
||||||
</AccordionDetails>
|
|
||||||
</Accordion>
|
|
||||||
|
|
||||||
|
|
||||||
<Accordion expanded={expanded === 'panel4'} onChange={handleExpandChange('panel4')}>
|
|
||||||
<AccordionSummary aria-controls="panel4d-content" id="panel4d-header">
|
|
||||||
<Typography sx={{fontSize:18}}>Patient's Injury Details</Typography>
|
|
||||||
</AccordionSummary>
|
|
||||||
|
|
||||||
<AccordionDetails>
|
|
||||||
<PainAnalysisSection4 painAnalysis={painAnalysis} />
|
|
||||||
</AccordionDetails>
|
|
||||||
</Accordion>
|
|
||||||
|
|
||||||
<Accordion expanded={expanded === 'panel5'} onChange={handleExpandChange('panel5')}>
|
|
||||||
<AccordionSummary aria-controls="panel5d-content" id="panel5d-header">
|
|
||||||
<Typography sx={{fontSize:18}}>Patient's Past Treatment Details</Typography>
|
|
||||||
</AccordionSummary>
|
|
||||||
|
|
||||||
<AccordionDetails>
|
|
||||||
<PastTreatment5 pastTreatement={pastTreatement} />
|
|
||||||
</AccordionDetails>
|
|
||||||
</Accordion>
|
|
||||||
|
|
||||||
<Accordion expanded={expanded === 'panel6'} onChange={handleExpandChange('panel6')}>
|
|
||||||
<AccordionSummary aria-controls="panel6d-content" id="panel6d-header">
|
|
||||||
<Typography sx={{fontSize:18}}>System Review Questions</Typography>
|
|
||||||
</AccordionSummary>
|
|
||||||
|
|
||||||
<AccordionDetails>
|
|
||||||
<SystemReviewSection6/>
|
|
||||||
</AccordionDetails>
|
|
||||||
</Accordion>
|
|
||||||
|
|
||||||
<Accordion expanded={expanded === 'panel7'} onChange={handleExpandChange('panel7')}>
|
|
||||||
<AccordionSummary aria-controls="panel7d-content" id="panel7d-header">
|
|
||||||
<Typography sx={{fontSize:18}}>Recreational Activities/Hobbies Details</Typography>
|
|
||||||
</AccordionSummary>
|
|
||||||
|
|
||||||
<AccordionDetails>
|
|
||||||
<RecreationalHobbiesSection7/>
|
|
||||||
</AccordionDetails>
|
|
||||||
</Accordion>
|
|
||||||
|
|
||||||
<Accordion expanded={expanded === 'panel8'} onChange={handleExpandChange('panel8')}>
|
|
||||||
<AccordionSummary aria-controls="panel8d-content" id="panel8d-header">
|
|
||||||
<Typography sx={{fontSize:18}}>Other Details</Typography>
|
|
||||||
</AccordionSummary>
|
|
||||||
|
|
||||||
<AccordionDetails>
|
|
||||||
<OtherDetails8/>
|
|
||||||
</AccordionDetails>
|
|
||||||
</Accordion>
|
|
||||||
|
|
||||||
<Grid container>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-multiline'>
|
|
||||||
<FormGroup sx={{ marginTop: 3 }}>
|
|
||||||
<FormControlLabel
|
|
||||||
required
|
|
||||||
control={<Checkbox checked={isChecked} onChange={handleCheckboxChange} />}
|
|
||||||
label="I hereby state that all the information I have provided is complete and truthful and that I have fully disclosed my health history."
|
|
||||||
/>
|
|
||||||
</FormGroup>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
|
|
||||||
variant="outlined"
|
|
||||||
label="SIGNATURE"
|
|
||||||
name='treatmentGoal'
|
|
||||||
placeholder='Please type your name'
|
|
||||||
onChange={(event) => {
|
|
||||||
setSignature(event.target.value)
|
|
||||||
}}
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
</Grid>
|
|
||||||
<Grid>
|
|
||||||
<Button
|
|
||||||
type="submit"
|
|
||||||
variant="contained"
|
|
||||||
color="primary"
|
|
||||||
sx={{ margin: 5, left: '40%', width: '200px' }}
|
|
||||||
disabled={isChecked==false || signature==''}
|
|
||||||
>
|
|
||||||
Submit
|
|
||||||
</Button>
|
|
||||||
</Grid>
|
|
||||||
</Grid>
|
|
||||||
</form>
|
|
||||||
|
|
||||||
</Paper>
|
|
||||||
<Footer/>
|
|
||||||
</Paper>
|
|
||||||
</>
|
|
||||||
)
|
|
||||||
}
|
|
||||||
@ -1,170 +0,0 @@
|
|||||||
import * as React from 'react';
|
|
||||||
import { Button, FormControl, FormControlLabel, FormLabel, Grid, Paper, Radio, RadioGroup, TextField } from '@mui/material';
|
|
||||||
import { useFormik } from "formik";
|
|
||||||
import * as yup from "yup";
|
|
||||||
import { LocalizationProvider, DatePicker } from '@mui/x-date-pickers';
|
|
||||||
import { AdapterDayjs } from '@mui/x-date-pickers/AdapterDayjs';
|
|
||||||
import PatientDetails from './PatientDetails';
|
|
||||||
|
|
||||||
interface Patient {
|
|
||||||
fullName: string;
|
|
||||||
homePhone: string;
|
|
||||||
cellPhone: string;
|
|
||||||
email: string;
|
|
||||||
age: number | string;
|
|
||||||
dateOfBirth: string;
|
|
||||||
socialSecurityNumber: string;
|
|
||||||
mailingAddress: string;
|
|
||||||
city: string;
|
|
||||||
state: string;
|
|
||||||
zipCode: string;
|
|
||||||
gender: string;
|
|
||||||
maritalStatus: string;
|
|
||||||
}
|
|
||||||
|
|
||||||
interface Props {
|
|
||||||
personalData: Patient;
|
|
||||||
}
|
|
||||||
|
|
||||||
export default function PersonalSection({personalData} : Props){
|
|
||||||
return(
|
|
||||||
<>
|
|
||||||
<Grid container direction="row" className='section1-test-class'>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Patient's Full Name"
|
|
||||||
name="fullName"
|
|
||||||
placeholder='Please enter your name'
|
|
||||||
value={personalData.fullName}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
required
|
|
||||||
variant="outlined"
|
|
||||||
label="Phone Number"
|
|
||||||
name="cellPhone"
|
|
||||||
placeholder='Please enter your cell Phone number'
|
|
||||||
value={personalData.cellPhone}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Home Phone Number"
|
|
||||||
name="homePhone"
|
|
||||||
placeholder='Please enter your home phone'
|
|
||||||
value={personalData.homePhone}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Email"
|
|
||||||
name="email"
|
|
||||||
placeholder='Please enter your email'
|
|
||||||
value={personalData.email}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
required
|
|
||||||
variant="outlined"
|
|
||||||
label="Age"
|
|
||||||
name="age"
|
|
||||||
type="number"
|
|
||||||
placeholder='Please enter your age'
|
|
||||||
value={personalData.age}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<FormControl >
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Date of birth"
|
|
||||||
name="dob"
|
|
||||||
value={personalData.dateOfBirth}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</FormControl>
|
|
||||||
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Social Security Number"
|
|
||||||
name="socialSecurityNumber"
|
|
||||||
value={personalData.socialSecurityNumber}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
required
|
|
||||||
variant="outlined"
|
|
||||||
label="Mailing Address"
|
|
||||||
name="mailingAddress"
|
|
||||||
value={personalData.mailingAddress}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="State"
|
|
||||||
name="state"
|
|
||||||
value={personalData.state}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
required
|
|
||||||
variant="outlined"
|
|
||||||
label="City"
|
|
||||||
name="city"
|
|
||||||
value={personalData.city}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="Zip Code"
|
|
||||||
name="zipCode"
|
|
||||||
value={personalData.zipCode}
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl >
|
|
||||||
<FormLabel>Gender</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
aria-labelledby="demo-radio-buttons-group-label"
|
|
||||||
defaultValue="male"
|
|
||||||
name="radio-buttons-group"
|
|
||||||
sx={{ display: 'flex', flexDirection: 'row' }}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="male" control={<Radio />} label="Male" checked={personalData.gender === 'male'} />
|
|
||||||
<FormControlLabel value="female" control={<Radio />} label="Female" checked={personalData.gender === 'female'} />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
</Grid>
|
|
||||||
</>
|
|
||||||
)
|
|
||||||
}
|
|
||||||
@ -1,243 +0,0 @@
|
|||||||
import { FormControl, FormControlLabel, FormLabel, Grid, Radio, RadioGroup, TextField } from "@mui/material";
|
|
||||||
import React from "react";
|
|
||||||
|
|
||||||
interface FormValues {
|
|
||||||
hobbies: string;
|
|
||||||
educationLevel: string;
|
|
||||||
excercise: string;
|
|
||||||
excerciseExplanation: string;
|
|
||||||
tobacco: string;
|
|
||||||
tobaccoExplanation: string;
|
|
||||||
alcohol: string;
|
|
||||||
alcoholExplanation: string;
|
|
||||||
healthyDiet: string;
|
|
||||||
healthyDietExplanation: string;
|
|
||||||
sleep: string;
|
|
||||||
sleepExplanation: string;
|
|
||||||
workSchool: string;
|
|
||||||
workSchoolExplanation: string;
|
|
||||||
familyLife: string;
|
|
||||||
familyLifeExplanation: string;
|
|
||||||
drugs: string;
|
|
||||||
drugsExplanation:string;
|
|
||||||
}
|
|
||||||
|
|
||||||
export default function RecreationalHobbiesSection7(){
|
|
||||||
return(
|
|
||||||
<>
|
|
||||||
|
|
||||||
<Grid container direction="row">
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-multiline'>
|
|
||||||
<FormLabel>Recreational Activities/Hobbies:</FormLabel><br></br>
|
|
||||||
<TextField
|
|
||||||
multiline
|
|
||||||
variant="outlined"
|
|
||||||
label=""
|
|
||||||
name='explanation'
|
|
||||||
value=''
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Your education level:</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="High School" control={<Radio />} label="High School" />
|
|
||||||
<FormControlLabel value="Some college" control={<Radio />} label="Some college" />
|
|
||||||
<FormControlLabel value="College Graduate" control={<Radio />} label="College Graduate" />
|
|
||||||
<FormControlLabel value="Post college" control={<Radio />} label="Post college" />
|
|
||||||
<FormControlLabel value="Other" control={<Radio />} label="Other" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Do you excercise?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
disabled
|
|
||||||
variant="outlined"
|
|
||||||
label="Times per week?"
|
|
||||||
name='treatmentGoal'
|
|
||||||
value=''
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Use tobacco?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
disabled
|
|
||||||
variant="outlined"
|
|
||||||
label="Packs/Cans per day(If you have quit, when did you quit?)"
|
|
||||||
name='treatmentGoal'
|
|
||||||
value=''
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Consume alcohol?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
disabled
|
|
||||||
variant="outlined"
|
|
||||||
label="How many drinks per week?"
|
|
||||||
name='treatmentGoal'
|
|
||||||
value=''
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Have a healthy diet?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
disabled
|
|
||||||
variant="outlined"
|
|
||||||
label="If no, explain"
|
|
||||||
name='treatmentGoal'
|
|
||||||
value=''
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Get adequate sleep?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
disabled
|
|
||||||
variant="outlined"
|
|
||||||
label="If no, explain"
|
|
||||||
name='treatmentGoal'
|
|
||||||
value=''
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Is Work/School stressful to you?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
variant="outlined"
|
|
||||||
label="If yes, explain"
|
|
||||||
name='treatmentGoal'
|
|
||||||
value=''
|
|
||||||
disabled
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Family life stressful to you?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
disabled
|
|
||||||
variant="outlined"
|
|
||||||
label="If yes, explain"
|
|
||||||
name='treatmentGoal'
|
|
||||||
value=''
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Use recreational drugs?</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-form7'>
|
|
||||||
<TextField
|
|
||||||
disabled
|
|
||||||
variant="outlined"
|
|
||||||
label="If yes, explain"
|
|
||||||
name='treatmentGoal'
|
|
||||||
value=''
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
</Grid>
|
|
||||||
</>
|
|
||||||
)
|
|
||||||
}
|
|
||||||
@ -1,237 +0,0 @@
|
|||||||
import { FormControl, FormControlLabel, FormLabel, Grid, Radio, RadioGroup, TextField } from "@mui/material";
|
|
||||||
import React from "react";
|
|
||||||
|
|
||||||
interface FormValues {
|
|
||||||
eyes: string;
|
|
||||||
IntestinesBowls: string;
|
|
||||||
jointsBones:string;
|
|
||||||
allergies: string;
|
|
||||||
earsNoseMouth: string;
|
|
||||||
urinary: string;
|
|
||||||
skin: string;
|
|
||||||
psychological: string;
|
|
||||||
heart: string;
|
|
||||||
muscles: string;
|
|
||||||
internalOrgans: string;
|
|
||||||
gynecological: string;
|
|
||||||
lungsBreathing: string;
|
|
||||||
nerves: string;
|
|
||||||
blood: string;
|
|
||||||
prostate: string;
|
|
||||||
explanation:string;
|
|
||||||
}
|
|
||||||
|
|
||||||
export default function SystemReviewSection6(){
|
|
||||||
return(
|
|
||||||
<>
|
|
||||||
<Grid item xs={12} className='collapsable-form-style '>
|
|
||||||
<FormLabel sx={{fontWeight:600}}>Please choose body areas or systems where you may have problems:</FormLabel>
|
|
||||||
</Grid>
|
|
||||||
<Grid container direction="row">
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Eyes</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Intestines/Bowls</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Joints/Bones</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Allergies</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Ears, Nose, Mouth, Throat</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Urinary</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Skin</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Psychological/Emotional</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Heart</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Muscles</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Internal Organs</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Gynecological menstrual/Brest</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Lungs/Breathing</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Nerves</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Blood</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
|
||||||
<FormLabel>Prostate/Testicular/Penile</FormLabel>
|
|
||||||
<RadioGroup
|
|
||||||
name="painDuration"
|
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
|
||||||
>
|
|
||||||
<FormControlLabel value="Yes" control={<Radio />} label="Yes" />
|
|
||||||
<FormControlLabel value="No" control={<Radio />} label="No" />
|
|
||||||
</RadioGroup>
|
|
||||||
</FormControl>
|
|
||||||
</Grid>
|
|
||||||
<Grid item xs={6} className='collapsable-form-style-multiline'>
|
|
||||||
<FormLabel>Please explain your check marks:</FormLabel><br></br>
|
|
||||||
<TextField
|
|
||||||
multiline
|
|
||||||
variant="outlined"
|
|
||||||
label=""
|
|
||||||
name='explanation'
|
|
||||||
/>
|
|
||||||
</Grid>
|
|
||||||
|
|
||||||
</Grid>
|
|
||||||
</>
|
|
||||||
)
|
|
||||||
}
|
|
||||||
@ -47,7 +47,7 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
homePhone: "",
|
homePhone: "",
|
||||||
cellPhone: "",
|
cellPhone: "",
|
||||||
email: "",
|
email: "",
|
||||||
age: 0,
|
age: "",
|
||||||
dateOfBirth: birthDateValue,
|
dateOfBirth: birthDateValue,
|
||||||
socialSecurityNumber: "",
|
socialSecurityNumber: "",
|
||||||
mailingAddress:"",
|
mailingAddress:"",
|
||||||
@ -80,8 +80,8 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
return(
|
return(
|
||||||
<>
|
<>
|
||||||
<Grid container direction="row" className='section1-test-class'>
|
<Grid container direction="row" className='section1-test-class'>
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
<Grid item xs={4} className='collapsable-form-style '>
|
||||||
<TextField
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Patient's Full Name"
|
label="Patient's Full Name"
|
||||||
name="fullName"
|
name="fullName"
|
||||||
@ -95,6 +95,8 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
required
|
required
|
||||||
|
error={patient.fullName === ""}
|
||||||
|
helperText={patient.fullName === "" ? "Please enter your name" : ""}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
@ -104,6 +106,7 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Phone Number"
|
label="Phone Number"
|
||||||
name="cellPhone"
|
name="cellPhone"
|
||||||
|
type="number"
|
||||||
placeholder='Please enter your cell Phone number'
|
placeholder='Please enter your cell Phone number'
|
||||||
value={type=='display'?patientDataDiplay.cellPhone:patient.cellPhone}
|
value={type=='display'?patientDataDiplay.cellPhone:patient.cellPhone}
|
||||||
disabled={type=='display'}
|
disabled={type=='display'}
|
||||||
@ -113,9 +116,8 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
cellPhone: e.target.value,
|
cellPhone: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
// onBlur={formik.handleBlur}
|
error={!(/^\d{10}$/.test(patient.cellPhone))}
|
||||||
// error={formik.touched.cellPhone && Boolean(formik.errors.cellPhone)}
|
helperText={!(/^\d{10}$/.test(patient.cellPhone)) ? "Please enter a valid 10-digit phone number" : ""}
|
||||||
// helperText={formik.touched.cellPhone && formik.errors.cellPhone}
|
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
@ -124,6 +126,7 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Home Phone Number"
|
label="Home Phone Number"
|
||||||
name="homePhone"
|
name="homePhone"
|
||||||
|
type='number'
|
||||||
placeholder='Please enter your home phone'
|
placeholder='Please enter your home phone'
|
||||||
value={type=='display'?patientDataDiplay.homePhone:patient.homePhone}
|
value={type=='display'?patientDataDiplay.homePhone:patient.homePhone}
|
||||||
disabled={type=='display'}
|
disabled={type=='display'}
|
||||||
@ -133,9 +136,8 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
homePhone: e.target.value,
|
homePhone: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
// onBlur={formik.handleBlur}
|
error={!(/^\d{10}$/.test(patient.homePhone))}
|
||||||
// error={formik.touched.homePhone && Boolean(formik.errors.homePhone)}
|
helperText={!(/^\d{10}$/.test(patient.homePhone)) ? "Please enter a valid 10-digit phone number" : ""}
|
||||||
// helperText={formik.touched.homePhone && formik.errors.homePhone}
|
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
@ -153,9 +155,8 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
email: e.target.value,
|
email: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
// onBlur={formik.handleBlur}
|
error={!(/^\S+@\S+\.\S+$/.test(patient.email))}
|
||||||
// error={formik.touched.email && Boolean(formik.errors.email)}
|
helperText={!(/^\S+@\S+\.\S+$/.test(patient.email)) ? "Please enter a valid email address" : ""}
|
||||||
// helperText={formik.touched.email && formik.errors.email}
|
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
@ -174,14 +175,14 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
age: e.target.value,
|
age: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
// onBlur={formik.handleBlur}
|
error={patient.age === ""}
|
||||||
// error={formik.touched.age && Boolean(formik.errors.age)}
|
helperText={patient.age === "" ? "Please enter your age" : ""}
|
||||||
// helperText={formik.touched.age && formik.errors.age}
|
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
<FormControl >
|
<FormControl >
|
||||||
|
|
||||||
<LocalizationProvider dateAdapter={AdapterDayjs}>
|
<LocalizationProvider dateAdapter={AdapterDayjs}>
|
||||||
<DatePicker
|
<DatePicker
|
||||||
label="Date of Birth"
|
label="Date of Birth"
|
||||||
@ -196,6 +197,7 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
|
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
<TextField
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
@ -229,9 +231,8 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
mailingAddress: e.target.value,
|
mailingAddress: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
// onBlur={formik.handleBlur}
|
error={patient.mailingAddress === ""}
|
||||||
// error={formik.touched.mailingAddress && Boolean(formik.errors.mailingAddress)}
|
helperText={patient.mailingAddress === "" ? "Please enter your mailing address" : ""}
|
||||||
// helperText={formik.touched.mailingAddress && formik.errors.mailingAddress}
|
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
@ -248,15 +249,11 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
state: e.target.value,
|
state: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
// onBlur={formik.handleBlur}
|
|
||||||
// error={formik.touched.state && Boolean(formik.errors.state)}
|
|
||||||
// helperText={formik.touched.state && formik.errors.state}
|
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
<TextField
|
<TextField
|
||||||
required
|
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="City"
|
label="City"
|
||||||
name="city"
|
name="city"
|
||||||
@ -268,9 +265,6 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
city: e.target.value,
|
city: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
// onBlur={formik.handleBlur}
|
|
||||||
// error={formik.touched.city && Boolean(formik.errors.city)}
|
|
||||||
// helperText={formik.touched.city && formik.errors.city}
|
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
|
|||||||
Loading…
x
Reference in New Issue
Block a user