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7 changed files with 847 additions and 427 deletions

View File

@ -101,7 +101,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
</Grid>
<Grid item xs={4} className='collapsable-form-style '></Grid>
<Grid item xs={4} className='collapsable-form-style '>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style '>
<TextField
variant="outlined"
@ -119,7 +125,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
disabled={type=='display'}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style '>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style '>
<TextField
// required
variant="outlined"
@ -137,7 +149,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style '>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style '>
<TextField
variant="outlined"
label="Hours/Week"
@ -155,7 +173,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style '>
<Grid
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style '>
<TextField
variant="outlined"
label="Employer"
@ -171,7 +195,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
disabled={type=='display'}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style '>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style '>
<TextField
variant="outlined"
label="Business Phone"
@ -189,13 +219,24 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style '></Grid>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
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 '>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style '>
<TextField
variant="outlined"
label="Spouse's Name"
@ -211,7 +252,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
disabled={type=='display'}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style '>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style '>
<TextField
variant="outlined"
label="Spouse's Employer"
@ -227,7 +274,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
disabled={type=='display'}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style '>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style '>
<TextField
variant="outlined"
label="Business Phone"
@ -250,7 +303,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
</Grid>
<Grid item xs={4} className='collapsable-form-style '>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style '>
<TextField
variant="outlined"
label="Emergency Contact"
@ -266,7 +325,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
disabled={type=='display'}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style '>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style '>
<TextField
variant="outlined"
label="Relationship"
@ -282,7 +347,12 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
disabled={type=='display'}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style '>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style '>
<TextField
variant="outlined"
type="number"

View File

@ -76,7 +76,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
</Grid>
<Grid container direction="row">
<Grid item xs={4} className='collapsable-form-style'>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'>
<TextField
variant="outlined"
label="Family physician"
@ -91,7 +97,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
disabled={type=='display'}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'>
<TextField
variant="outlined"
label="City"
@ -106,7 +118,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
disabled={type=='display'}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'>
<TextField
variant="outlined"
label="State"
@ -121,7 +139,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
disabled={type=='display'}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'>
<TextField
variant="outlined"
label="Phone"
@ -138,14 +162,30 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'></Grid>
<Grid item xs={4} className='collapsable-form-style'></Grid>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style'></Grid>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12} 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'>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
sx={{paddingLeft:"14px",marginTop:2}} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Previous Chiropractic Care:</FormLabel>
<RadioGroup
@ -166,7 +206,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
</FormControl>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'>
<TextField
variant="outlined"
label="Chiropractor's Name"
@ -182,7 +228,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'>
<TextField
variant="outlined"
label="City/State"

View File

@ -121,7 +121,12 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
</Grid>
<Grid item xs={4} className='collapsable-form-style-form7'>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
variant="outlined"
label="If yes, when?"
@ -135,7 +140,12 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
}}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style-form7'>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
variant="outlined"
label="Was treatment provided?If yes, by whom?"
@ -150,7 +160,12 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
}}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style-form7'>
<Grid item
xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
variant="outlined"
label="Outcome?"
@ -287,7 +302,11 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
type={type}/>
</Grid>
<Grid item xs={6} className='collapsable-form-style-multiline'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-multiline'>
<FormLabel>Please list current supplements or drugs you may be taking:</FormLabel>
<TextField
multiline

View File

@ -507,7 +507,7 @@ export default function PatientForm({ type }: Props) {
id='panel9d-header'
>
<Typography sx={{ fontSize: 18 }}>
Patient's Injury Image
Patient's Pain Zone
</Typography>
</AccordionSummary>

View File

@ -1,389 +1,540 @@
import * as React from 'react';
import { Button, FormControl, FormControlLabel, FormLabel, Grid, Paper, Radio, RadioGroup, TextField } from '@mui/material';
import {
Button,
FormControl,
FormControlLabel,
FormLabel,
Grid,
Paper,
Radio,
RadioGroup,
TextField,
} from '@mui/material';
import { LocalizationProvider, DatePicker } from '@mui/x-date-pickers';
import { AdapterDayjs } from '@mui/x-date-pickers/AdapterDayjs';
import { useEffect } from 'react';
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;
}
type Props = {
handleFormSection1Data:(
fullName?: string|undefined,
homePhone?: string|undefined,
cellPhone?: string|undefined,
email?: string|undefined,
age?: number|undefined|string,
dateOfBirth?: string|undefined,
socialSecurityNumber?: string|undefined,
mailingAddress?: string|undefined,
city?: string|undefined,
state?: string|undefined,
zipCode?: string|undefined,
gender?: string|undefined,
)=> void
patientDataDiplay:any;
type:string;
}
export default function PersonalSection({handleFormSection1Data,patientDataDiplay,type}:Props){
const [birthDateValue, setBirthDateValue] = React.useState<any>();
const [patient, setPatient] = React.useState<any>({
fullName: "",
fullNameError:false,
homePhone: "",
cellPhone: "",
cellPhoneError: false,
email: "",
emailError: false,
age: "",
ageError: false,
dateOfBirth: birthDateValue,
socialSecurityNumber: "",
mailingAddress:"",
mailingAddressFalse:false,
city: "",
state: "",
zipCode: "",
gender: "male",
});
useEffect(()=>{
handleFormSection1Data(
patient.fullName,
patient.homePhone,
patient.cellPhone,
patient.email,
patient.age,
birthDateValue,
patient.socialSecurityNumber,
patient.mailingAddress,
patient.city,
patient.state,
patient.zipCode,
patient.gender,
)
},[patient])
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={type=='display'?patientDataDiplay.fullName:patient.fullName}
disabled={type=='display'}
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
fullName: e.target.value,
}));
}}
onBlur={(e) => {
if (e.target.value === "") {
setPatient((prevValues:any) => ({
...prevValues,
fullNameError: true,
}));
} else {
setPatient((prevValues:any) => ({
...prevValues,
fullNameError: false,
}));
}
}}
required
error={patient.fullNameError}
helperText={patient.fullNameError ? "Please enter your name" : ""}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<TextField
required
variant="outlined"
label="Phone Number"
name="cellPhone"
type="number"
placeholder='Please enter your cell Phone number'
value={type=='display'?patientDataDiplay.cellPhone:patient.cellPhone}
disabled={type=='display'}
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
cellPhone: e.target.value,
}));
}}
onBlur={(e) => {
if (!(/^\d{10}$/.test(e.target.value))) {
setPatient((prevValues:any) => ({
...prevValues,
cellPhoneError: true,
}));
} else {
setPatient((prevValues:any) => ({
...prevValues,
cellPhoneError: false,
}));
}
}}
error={patient.cellPhoneError}
helperText={patient.cellPhoneError? "Please enter a valid 10-digit phone number" : ""}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<TextField
variant="outlined"
label="Home Phone Number"
name="homePhone"
type='number'
placeholder='Please enter your home phone'
value={type=='display'?patientDataDiplay.homePhone:patient.homePhone}
disabled={type=='display'}
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
homePhone: e.target.value,
}));
}}
// error={!(/^\d{10}$/.test(patient.homePhone))}
// helperText={!(/^\d{10}$/.test(patient.homePhone)) ? "Please enter a valid 10-digit phone number" : ""}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<TextField
required
variant="outlined"
label="Email"
name="email"
placeholder='Please enter your email'
value={type=='display'?patientDataDiplay.email:patient.email}
disabled={type=='display'}
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
email: e.target.value,
}));
}}
onBlur={(e) => {
if (!(/^\S+@\S+\.\S+$/.test(e.target.value))) {
setPatient((prevValues:any) => ({
...prevValues,
emailError: true,
}));
} else {
setPatient((prevValues:any) => ({
...prevValues,
emailError: false,
}));
}
}}
error={patient.emailError}
helperText={patient.emailError? "Please enter a valid email address" : ""}
/>
</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={type=='display'?patientDataDiplay.age:patient.age}
disabled={type=='display'}
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
age: e.target.value,
}));
}}
onBlur={(e) => {
if (e.target.value === "") {
setPatient((prevValues:any) => ({
...prevValues,
ageError: true,
}));
} else {
setPatient((prevValues:any) => ({
...prevValues,
ageError: false,
}));
}
}}
error={patient.ageError}
helperText={patient.ageError ? "Please enter your age" : ""}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<FormControl >
<LocalizationProvider dateAdapter={AdapterDayjs}>
<DatePicker
label="Date of Birth"
value={type=='display'?patientDataDiplay.dateOfBirth:birthDateValue}
disabled={type=='display'}
onChange={(newValue) => {
setBirthDateValue(newValue);
}}
renderInput={(params) => <TextField variant="outlined" {...params} />}
/>
</LocalizationProvider>
</FormControl>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<TextField
variant="outlined"
label="Social Security Number"
name="socialSecurityNumber"
value={type=='display'?patientDataDiplay.socialSecurityNumber:patient.socialSecurityNumber}
disabled={type=='display'}
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
socialSecurityNumber: e.target.value,
}));
}}
// onBlur={formik.handleBlur}
// error={formik.touched.socialSecurityNumber && Boolean(formik.errors.socialSecurityNumber)}
// helperText={formik.touched.socialSecurityNumber && formik.errors.socialSecurityNumber}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<TextField
required
variant="outlined"
label="Mailing Address"
name="mailingAddress"
value={type=='display'?patientDataDiplay.mailingAddress:patient.mailingAddress}
disabled={type=='display'}
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
mailingAddress: e.target.value,
}));
}}
onBlur={(e) => {
if (e.target.value === "") {
setPatient((prevValues:any) => ({
...prevValues,
mailingAddressError: true,
}));
} else {
setPatient((prevValues:any) => ({
...prevValues,
mailingAddressError: false,
}));
}
}}
error={patient.mailingAddressError}
helperText={patient.mailingAddressError? "Please enter your mailing address" : ""}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<TextField
variant="outlined"
label="State"
name="state"
value={type=='display'?patientDataDiplay.state:patient.state}
disabled={type=='display'}
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
state: e.target.value,
}));
}}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<TextField
variant="outlined"
label="City"
name="city"
value={type=='display'?patientDataDiplay.city:patient.city}
disabled={type=='display'}
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
city: e.target.value,
}));
}}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style'>
<TextField
variant="outlined"
label="Zip Code"
name="zipCode"
value={type=='display'?patientDataDiplay.zipCode:patient.zipCode}
disabled={type=='display'}
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
zipCode: e.target.value,
}));
}}
// onBlur={formik.handleBlur}
// error={formik.touched.zipCode && Boolean(formik.errors.zipCode)}
// helperText={formik.touched.zipCode && formik.errors.zipCode}
/>
</Grid>
<Grid item xs={4} className='collapsable-form-style-radioButtons'>
<FormControl >
<FormLabel>Gender</FormLabel>
<RadioGroup
aria-labelledby="demo-radio-buttons-group-label"
defaultValue={type=='display'?patientDataDiplay.gender:patient.gender}
name="radio-buttons-group"
onChange={(e)=>{
setPatient((prevValues:any) => ({
...prevValues,
gender: e.target.value,
}));
}}
sx={{display:'flex', flexDirection:'row'}}
>
<FormControlLabel
disabled={type=='display'}
value="male" control={<Radio />} label="Male" />
<FormControlLabel
disabled={type=='display'}
value="female" control={<Radio />} label="Female" />
</RadioGroup>
</FormControl>
</Grid>
</Grid>
</>
)
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;
}
type Props = {
handleFormSection1Data: (
fullName?: string | undefined,
homePhone?: string | undefined,
cellPhone?: string | undefined,
email?: string | undefined,
age?: number | undefined | string,
dateOfBirth?: string | undefined,
socialSecurityNumber?: string | undefined,
mailingAddress?: string | undefined,
city?: string | undefined,
state?: string | undefined,
zipCode?: string | undefined,
gender?: string | undefined
) => void;
patientDataDiplay: any;
type: string;
};
export default function PersonalSection({
handleFormSection1Data,
patientDataDiplay,
type,
}: Props) {
const [birthDateValue, setBirthDateValue] = React.useState<any>();
const [patient, setPatient] = React.useState<any>({
fullName: '',
fullNameError: false,
homePhone: '',
cellPhone: '',
cellPhoneError: false,
email: '',
emailError: false,
age: '',
ageError: false,
dateOfBirth: birthDateValue,
socialSecurityNumber: '',
mailingAddress: '',
mailingAddressFalse: false,
city: '',
state: '',
zipCode: '',
gender: 'male',
});
useEffect(() => {
handleFormSection1Data(
patient.fullName,
patient.homePhone,
patient.cellPhone,
patient.email,
patient.age,
birthDateValue,
patient.socialSecurityNumber,
patient.mailingAddress,
patient.city,
patient.state,
patient.zipCode,
patient.gender
);
}, [patient]);
return (
<>
<Grid container direction='row' className='section1-test-class'>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style '
>
<TextField
variant='outlined'
label="Patient's Full Name"
name='fullName'
placeholder='Please enter your name'
value={
type == 'display' ? patientDataDiplay.fullName : patient.fullName
}
disabled={type == 'display'}
onChange={(e) => {
setPatient((prevValues: any) => ({
...prevValues,
fullName: e.target.value,
}));
}}
onBlur={(e) => {
if (e.target.value === '') {
setPatient((prevValues: any) => ({
...prevValues,
fullNameError: true,
}));
} else {
setPatient((prevValues: any) => ({
...prevValues,
fullNameError: false,
}));
}
}}
required
error={patient.fullNameError}
helperText={patient.fullNameError ? 'Please enter your name' : ''}
/>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'
>
<TextField
required
variant='outlined'
label='Phone Number'
name='cellPhone'
type='number'
placeholder='Please enter your cell Phone number'
value={
type == 'display'
? patientDataDiplay.cellPhone
: patient.cellPhone
}
disabled={type == 'display'}
onChange={(e) => {
let value = e.target.value;
if (value[0] === '0') {
value = value.slice(1);
}
setPatient((prevValues: any) => ({
...prevValues,
cellPhone: value,
}));
}}
onBlur={(e) => {
if (!/^\d{10}$/.test(e.target.value)) {
setPatient((prevValues: any) => ({
...prevValues,
cellPhoneError: true,
}));
} else {
setPatient((prevValues: any) => ({
...prevValues,
cellPhoneError: false,
}));
}
}}
error={patient.cellPhoneError}
helperText={
patient.cellPhoneError
? 'Please enter a valid 10-digit phone number'
: ''
}
/>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'
>
<TextField
variant='outlined'
label='Home Phone Number'
name='homePhone'
type='number'
placeholder='Please enter your home phone'
value={
type == 'display'
? patientDataDiplay.homePhone
: patient.homePhone
}
disabled={type == 'display'}
onChange={(e) => {
setPatient((prevValues: any) => ({
...prevValues,
homePhone: e.target.value,
}));
}}
// error={!(/^\d{10}$/.test(patient.homePhone))}
// helperText={!(/^\d{10}$/.test(patient.homePhone)) ? "Please enter a valid 10-digit phone number" : ""}
/>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'
>
<TextField
required
variant='outlined'
label='Email'
name='email'
placeholder='Please enter your email'
value={type == 'display' ? patientDataDiplay.email : patient.email}
disabled={type == 'display'}
onChange={(e) => {
setPatient((prevValues: any) => ({
...prevValues,
email: e.target.value,
}));
}}
onBlur={(e) => {
if (!/^\S+@\S+\.\S+$/.test(e.target.value)) {
setPatient((prevValues: any) => ({
...prevValues,
emailError: true,
}));
} else {
setPatient((prevValues: any) => ({
...prevValues,
emailError: false,
}));
}
}}
error={patient.emailError}
helperText={
patient.emailError ? 'Please enter a valid email address' : ''
}
/>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'
>
<TextField
required
variant='outlined'
label='Age'
name='age'
type='number'
placeholder='Please enter your age'
value={type == 'display' ? patientDataDiplay.age : patient.age}
disabled={type == 'display'}
onChange={(e) => {
setPatient((prevValues: any) => ({
...prevValues,
age: e.target.value,
}));
}}
onBlur={(e) => {
if (e.target.value === '') {
setPatient((prevValues: any) => ({
...prevValues,
ageError: true,
}));
} else {
setPatient((prevValues: any) => ({
...prevValues,
ageError: false,
}));
}
}}
error={patient.ageError}
helperText={patient.ageError ? 'Please enter your age' : ''}
/>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'
>
<FormControl>
<LocalizationProvider dateAdapter={AdapterDayjs}>
<DatePicker
label='Date of Birth'
value={
type == 'display'
? patientDataDiplay.dateOfBirth
: birthDateValue
}
disabled={type == 'display'}
onChange={(newValue) => {
setBirthDateValue(newValue);
}}
renderInput={(params) => (
<TextField variant='outlined' {...params} />
)}
/>
</LocalizationProvider>
</FormControl>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'
>
<TextField
variant='outlined'
label='Social Security Number'
name='socialSecurityNumber'
value={
type == 'display'
? patientDataDiplay.socialSecurityNumber
: patient.socialSecurityNumber
}
disabled={type == 'display'}
onChange={(e) => {
setPatient((prevValues: any) => ({
...prevValues,
socialSecurityNumber: e.target.value,
}));
}}
// onBlur={formik.handleBlur}
// error={formik.touched.socialSecurityNumber && Boolean(formik.errors.socialSecurityNumber)}
// helperText={formik.touched.socialSecurityNumber && formik.errors.socialSecurityNumber}
/>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'
>
<TextField
required
variant='outlined'
label='Mailing Address'
name='mailingAddress'
value={
type == 'display'
? patientDataDiplay.mailingAddress
: patient.mailingAddress
}
disabled={type == 'display'}
onChange={(e) => {
setPatient((prevValues: any) => ({
...prevValues,
mailingAddress: e.target.value,
}));
}}
onBlur={(e) => {
if (e.target.value === '') {
setPatient((prevValues: any) => ({
...prevValues,
mailingAddressError: true,
}));
} else {
setPatient((prevValues: any) => ({
...prevValues,
mailingAddressError: false,
}));
}
}}
error={patient.mailingAddressError}
helperText={
patient.mailingAddressError
? 'Please enter your mailing address'
: ''
}
/>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'
>
<TextField
variant='outlined'
label='State'
name='state'
value={type == 'display' ? patientDataDiplay.state : patient.state}
disabled={type == 'display'}
onChange={(e) => {
setPatient((prevValues: any) => ({
...prevValues,
state: e.target.value,
}));
}}
/>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'
>
<TextField
variant='outlined'
label='City'
name='city'
value={type == 'display' ? patientDataDiplay.city : patient.city}
disabled={type == 'display'}
onChange={(e) => {
setPatient((prevValues: any) => ({
...prevValues,
city: e.target.value,
}));
}}
/>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style'
>
<TextField
variant='outlined'
label='Zip Code'
name='zipCode'
value={
type == 'display' ? patientDataDiplay.zipCode : patient.zipCode
}
disabled={type == 'display'}
onChange={(e) => {
setPatient((prevValues: any) => ({
...prevValues,
zipCode: e.target.value,
}));
}}
// onBlur={formik.handleBlur}
// error={formik.touched.zipCode && Boolean(formik.errors.zipCode)}
// helperText={formik.touched.zipCode && formik.errors.zipCode}
/>
</Grid>
<Grid
item
xs={12}
xl={3}
lg={4}
md={6}
sm={12}
className='collapsable-form-style-radioButtons'
>
<FormControl>
<FormLabel>Gender</FormLabel>
<RadioGroup
aria-labelledby='demo-radio-buttons-group-label'
defaultValue={
type == 'display' ? patientDataDiplay.gender : patient.gender
}
name='radio-buttons-group'
onChange={(e) => {
setPatient((prevValues: any) => ({
...prevValues,
gender: e.target.value,
}));
}}
sx={{ display: 'flex', flexDirection: 'row' }}
>
<FormControlLabel
disabled={type == 'display'}
value='male'
control={<Radio />}
label='Male'
/>
<FormControlLabel
disabled={type == 'display'}
value='female'
control={<Radio />}
label='Female'
/>
</RadioGroup>
</FormControl>
</Grid>
</Grid>
</>
);
}

View File

@ -136,7 +136,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
</FormControl>
</Grid>
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Do you excercise?</FormLabel>
<RadioGroup
@ -156,7 +160,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
</FormControl>
</Grid>
<Grid item xs={6} className='collapsable-form-style-form7'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
disabled={patient.excercise!=='Yes'||type=='display'}
variant="outlined"
@ -172,7 +180,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
/>
</Grid>
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Use tobacco?</FormLabel>
<RadioGroup
@ -192,7 +204,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
</FormControl>
</Grid>
<Grid item xs={6} className='collapsable-form-style-form7'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
disabled={patient.tobacco!=='Yes'||type=='display'}
value={type=='display'?patientDataDiplay.tobaccoExplanation:patient.tobaccoExplanation}
@ -208,7 +224,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
/>
</Grid>
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Consume alcohol?</FormLabel>
<RadioGroup
@ -228,7 +248,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
</FormControl>
</Grid>
<Grid item xs={6} className='collapsable-form-style-form7'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
disabled={patient.alcohol!=='Yes'||type=='display'}
value={type=='display'?patientDataDiplay.alcoholExplanation:patient.alcoholExplanation}
@ -244,7 +268,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
/>
</Grid>
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Have a healthy diet?</FormLabel>
<RadioGroup
@ -264,7 +292,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
</FormControl>
</Grid>
<Grid item xs={6} className='collapsable-form-style-form7'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
disabled={patient.healthyDiet!=='No'||type=='display'}
value={type=='display'?patientDataDiplay.healthyDietExplanation:patient.healthyDietExplanation}
@ -280,7 +312,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
/>
</Grid>
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Get adequate sleep?</FormLabel>
<RadioGroup
@ -300,7 +336,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
</FormControl>
</Grid>
<Grid item xs={6} className='collapsable-form-style-form7'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
disabled={patient.sleep!=='No'||type=='display'}
value={type=='display'?patientDataDiplay.sleepExplanation:patient.sleepExplanation}
@ -316,7 +356,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
/>
</Grid>
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Is Work/School stressful to you?</FormLabel>
<RadioGroup
@ -336,7 +380,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
</FormControl>
</Grid>
<Grid item xs={6} className='collapsable-form-style-form7'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
disabled={patient.workSchool!=='Yes'||type=='display'}
value={type=='display'?patientDataDiplay.workSchool:patient.workSchool}
@ -352,7 +400,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
/>
</Grid>
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Family life stressful to you?</FormLabel>
<RadioGroup
@ -372,7 +424,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
</FormControl>
</Grid>
<Grid item xs={6} className='collapsable-form-style-form7'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
disabled={patient.familyLife!=='Yes'||type=='display'}
value={type=='display'?patientDataDiplay.familyLifeExplanation:patient.familyLifeExplanation}
@ -388,7 +444,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
/>
</Grid>
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Use recreational drugs?</FormLabel>
<RadioGroup
@ -408,7 +468,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
</FormControl>
</Grid>
<Grid item xs={6} className='collapsable-form-style-form7'>
<Grid item xs={12}
xl={3}
// lg={4}
md={6}
sm={12} className='collapsable-form-style-form7'>
<TextField
disabled={patient.drugs!=='Yes'||type=='display'}
value={type=='display'?patientDataDiplay.drugsExplanation:patient.drugsExplanation}

View File

@ -93,7 +93,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
<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'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Eyes</FormLabel>
<RadioGroup
@ -112,7 +116,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Intestines/Bowls</FormLabel>
<RadioGroup
@ -131,7 +139,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Joints/Bones</FormLabel>
<RadioGroup
@ -150,7 +162,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Allergies</FormLabel>
<RadioGroup
@ -169,7 +185,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Ears, Nose, Mouth, Throat</FormLabel>
<RadioGroup
@ -188,7 +208,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Urinary</FormLabel>
<RadioGroup
@ -207,7 +231,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Skin</FormLabel>
<RadioGroup
@ -226,7 +254,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Psychological/Emotional</FormLabel>
<RadioGroup
@ -245,7 +277,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Heart</FormLabel>
<RadioGroup
@ -264,7 +300,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Muscles</FormLabel>
<RadioGroup
@ -283,7 +323,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Internal Organs</FormLabel>
<RadioGroup
@ -302,7 +346,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Gynecological menstrual/Brest</FormLabel>
<RadioGroup
@ -322,7 +370,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Lungs/Breathing</FormLabel>
<RadioGroup
@ -341,7 +393,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Nerves</FormLabel>
<RadioGroup
@ -360,7 +416,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Blood</FormLabel>
<RadioGroup
@ -379,7 +439,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
</RadioGroup>
</FormControl>
</Grid>
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
<Grid item xs={12}
xl={3}
lg={4}
md={6}
sm={12} className='collapsable-form-style-radioButtons'>
<FormControl>
<FormLabel>Prostate/Testicular/Penile</FormLabel>
<RadioGroup