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9c1174b325
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ee88fc80e4 | ||
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e747ac7bda | ||
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f27ef0e113 | ||
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81fb560898 |
@ -101,7 +101,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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</Grid>
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</Grid>
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||||||
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||||||
<Grid item xs={4} className='collapsable-form-style '></Grid>
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<Grid item xs={4} className='collapsable-form-style '></Grid>
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||||||
<Grid item xs={4} className='collapsable-form-style '>
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<Grid item
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xs={12}
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||||||
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xl={3}
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||||||
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lg={4}
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||||||
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md={6}
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||||||
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sm={12}
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||||||
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className='collapsable-form-style '>
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||||||
<TextField
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<TextField
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||||||
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||||||
variant="outlined"
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variant="outlined"
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||||||
@ -119,7 +125,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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disabled={type=='display'}
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disabled={type=='display'}
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||||||
/>
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/>
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||||||
</Grid>
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</Grid>
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||||||
<Grid item xs={4} className='collapsable-form-style '>
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<Grid item
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xs={12}
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xl={3}
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lg={4}
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||||||
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md={6}
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||||||
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sm={12}
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className='collapsable-form-style '>
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<TextField
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<TextField
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||||||
// required
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// required
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variant="outlined"
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variant="outlined"
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||||||
@ -137,7 +149,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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/>
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/>
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</Grid>
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</Grid>
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<Grid item xs={4} className='collapsable-form-style '>
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<Grid item
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xs={12}
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||||||
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xl={3}
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||||||
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lg={4}
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||||||
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md={6}
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||||||
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sm={12}
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className='collapsable-form-style '>
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<TextField
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<TextField
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variant="outlined"
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variant="outlined"
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label="Hours/Week"
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label="Hours/Week"
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||||||
@ -155,7 +173,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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/>
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/>
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</Grid>
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</Grid>
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<Grid item xs={4} className='collapsable-form-style '>
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<Grid
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xs={12}
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xl={3}
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||||||
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lg={4}
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||||||
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md={6}
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||||||
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sm={12}
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className='collapsable-form-style '>
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<TextField
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<TextField
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variant="outlined"
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variant="outlined"
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label="Employer"
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label="Employer"
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@ -171,7 +195,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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disabled={type=='display'}
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disabled={type=='display'}
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/>
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/>
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</Grid>
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</Grid>
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<Grid item xs={4} className='collapsable-form-style '>
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<Grid item
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xs={12}
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xl={3}
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lg={4}
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md={6}
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||||||
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sm={12}
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className='collapsable-form-style '>
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<TextField
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<TextField
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variant="outlined"
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variant="outlined"
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label="Business Phone"
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label="Business Phone"
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@ -189,13 +219,24 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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/>
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/>
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</Grid>
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</Grid>
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||||||
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||||||
<Grid item xs={4} className='collapsable-form-style '></Grid>
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<Grid item
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xs={12}
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||||||
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xl={3}
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||||||
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lg={4}
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||||||
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md={6}
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||||||
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sm={12}
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||||||
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className='collapsable-form-style '></Grid>
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||||||
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||||||
<Grid item xs={12} className='collapsable-form-style '>
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<Grid item xs={12} className='collapsable-form-style '>
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<FormLabel sx={{fontWeight:600}}>Spouse's Information:</FormLabel>
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<FormLabel sx={{fontWeight:600}}>Spouse's Information:</FormLabel>
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</Grid>
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</Grid>
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||||||
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||||||
<Grid item xs={4} className='collapsable-form-style '>
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<Grid item
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||||||
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xs={12}
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||||||
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xl={3}
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||||||
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lg={4}
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||||||
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md={6}
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||||||
|
sm={12} className='collapsable-form-style '>
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||||||
<TextField
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<TextField
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||||||
variant="outlined"
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variant="outlined"
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||||||
label="Spouse's Name"
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label="Spouse's Name"
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||||||
@ -211,7 +252,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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|||||||
disabled={type=='display'}
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disabled={type=='display'}
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||||||
/>
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/>
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||||||
</Grid>
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</Grid>
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
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<Grid item
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||||||
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xs={12}
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||||||
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xl={3}
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||||||
|
lg={4}
|
||||||
|
md={6}
|
||||||
|
sm={12}
|
||||||
|
className='collapsable-form-style '>
|
||||||
<TextField
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<TextField
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||||||
variant="outlined"
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variant="outlined"
|
||||||
label="Spouse's Employer"
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label="Spouse's Employer"
|
||||||
@ -227,7 +274,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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|||||||
disabled={type=='display'}
|
disabled={type=='display'}
|
||||||
/>
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/>
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||||||
</Grid>
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</Grid>
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
|
<Grid item
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||||||
|
xs={12}
|
||||||
|
xl={3}
|
||||||
|
lg={4}
|
||||||
|
md={6}
|
||||||
|
sm={12}
|
||||||
|
className='collapsable-form-style '>
|
||||||
<TextField
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Business Phone"
|
label="Business Phone"
|
||||||
@ -250,7 +303,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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|||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style '>
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<Grid item
|
||||||
|
xs={12}
|
||||||
|
xl={3}
|
||||||
|
lg={4}
|
||||||
|
md={6}
|
||||||
|
sm={12}
|
||||||
|
className='collapsable-form-style '>
|
||||||
<TextField
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Emergency Contact"
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label="Emergency Contact"
|
||||||
@ -266,7 +325,13 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
|
|||||||
disabled={type=='display'}
|
disabled={type=='display'}
|
||||||
/>
|
/>
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||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Relationship"
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label="Relationship"
|
||||||
@ -282,7 +347,12 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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|||||||
disabled={type=='display'}
|
disabled={type=='display'}
|
||||||
/>
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/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
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variant="outlined"
|
||||||
type="number"
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type="number"
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||||||
|
|||||||
@ -76,7 +76,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
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|||||||
</Grid>
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</Grid>
|
||||||
|
|
||||||
<Grid container direction="row">
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<Grid container direction="row">
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
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<Grid item
|
||||||
|
xs={12}
|
||||||
|
xl={3}
|
||||||
|
lg={4}
|
||||||
|
md={6}
|
||||||
|
sm={12}
|
||||||
|
className='collapsable-form-style'>
|
||||||
<TextField
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Family physician"
|
label="Family physician"
|
||||||
@ -91,7 +97,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
|
|||||||
disabled={type=='display'}
|
disabled={type=='display'}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="City"
|
label="City"
|
||||||
@ -106,7 +118,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
|
|||||||
disabled={type=='display'}
|
disabled={type=='display'}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="State"
|
label="State"
|
||||||
@ -121,7 +139,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
|
|||||||
disabled={type=='display'}
|
disabled={type=='display'}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Phone"
|
label="Phone"
|
||||||
@ -138,14 +162,30 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'></Grid>
|
<Grid item
|
||||||
<Grid item xs={4} className='collapsable-form-style'></Grid>
|
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 '>
|
<Grid item xs={12} className='collapsable-form-style '>
|
||||||
<FormLabel sx={{fontWeight:600}}>Chiropractor Information:</FormLabel>
|
<FormLabel sx={{fontWeight:600}}>Chiropractor Information:</FormLabel>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Previous Chiropractic Care:</FormLabel>
|
<FormLabel>Previous Chiropractic Care:</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -166,7 +206,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Chiropractor's Name"
|
label="Chiropractor's Name"
|
||||||
@ -182,7 +228,13 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="City/State"
|
label="City/State"
|
||||||
|
|||||||
@ -121,7 +121,12 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
|
|||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="If yes, when?"
|
label="If yes, when?"
|
||||||
@ -135,7 +140,12 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
|
|||||||
}}
|
}}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Was treatment provided?If yes, by whom?"
|
label="Was treatment provided?If yes, by whom?"
|
||||||
@ -150,7 +160,12 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
|
|||||||
}}
|
}}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="Outcome?"
|
label="Outcome?"
|
||||||
@ -287,7 +302,11 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
|
|||||||
type={type}/>
|
type={type}/>
|
||||||
</Grid>
|
</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>
|
<FormLabel>Please list current supplements or drugs you may be taking:</FormLabel>
|
||||||
<TextField
|
<TextField
|
||||||
multiline
|
multiline
|
||||||
|
|||||||
@ -507,7 +507,7 @@ export default function PatientForm({ type }: Props) {
|
|||||||
id='panel9d-header'
|
id='panel9d-header'
|
||||||
>
|
>
|
||||||
<Typography sx={{ fontSize: 18 }}>
|
<Typography sx={{ fontSize: 18 }}>
|
||||||
Patient's Injury Image
|
Patient's Pain Zone
|
||||||
</Typography>
|
</Typography>
|
||||||
</AccordionSummary>
|
</AccordionSummary>
|
||||||
|
|
||||||
|
|||||||
@ -1,5 +1,15 @@
|
|||||||
import * as React from 'react';
|
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 { LocalizationProvider, DatePicker } from '@mui/x-date-pickers';
|
||||||
import { AdapterDayjs } from '@mui/x-date-pickers/AdapterDayjs';
|
import { AdapterDayjs } from '@mui/x-date-pickers/AdapterDayjs';
|
||||||
import { useEffect } from 'react';
|
import { useEffect } from 'react';
|
||||||
@ -17,53 +27,54 @@ interface Patient {
|
|||||||
state: string;
|
state: string;
|
||||||
zipCode: string;
|
zipCode: string;
|
||||||
gender: string;
|
gender: string;
|
||||||
}
|
}
|
||||||
|
|
||||||
type Props = {
|
type Props = {
|
||||||
handleFormSection1Data:(
|
handleFormSection1Data: (
|
||||||
fullName?: string|undefined,
|
fullName?: string | undefined,
|
||||||
homePhone?: string|undefined,
|
homePhone?: string | undefined,
|
||||||
cellPhone?: string|undefined,
|
cellPhone?: string | undefined,
|
||||||
email?: string|undefined,
|
email?: string | undefined,
|
||||||
age?: number|undefined|string,
|
age?: number | undefined | string,
|
||||||
dateOfBirth?: string|undefined,
|
dateOfBirth?: string | undefined,
|
||||||
socialSecurityNumber?: string|undefined,
|
socialSecurityNumber?: string | undefined,
|
||||||
mailingAddress?: string|undefined,
|
mailingAddress?: string | undefined,
|
||||||
city?: string|undefined,
|
city?: string | undefined,
|
||||||
state?: string|undefined,
|
state?: string | undefined,
|
||||||
zipCode?: string|undefined,
|
zipCode?: string | undefined,
|
||||||
gender?: string|undefined,
|
gender?: string | undefined
|
||||||
)=> void
|
) => void;
|
||||||
patientDataDiplay:any;
|
patientDataDiplay: any;
|
||||||
type:string;
|
type: string;
|
||||||
}
|
};
|
||||||
|
|
||||||
|
|
||||||
export default function PersonalSection({handleFormSection1Data,patientDataDiplay,type}:Props){
|
|
||||||
|
|
||||||
|
export default function PersonalSection({
|
||||||
|
handleFormSection1Data,
|
||||||
|
patientDataDiplay,
|
||||||
|
type,
|
||||||
|
}: Props) {
|
||||||
const [birthDateValue, setBirthDateValue] = React.useState<any>();
|
const [birthDateValue, setBirthDateValue] = React.useState<any>();
|
||||||
const [patient, setPatient] = React.useState<any>({
|
const [patient, setPatient] = React.useState<any>({
|
||||||
fullName: "",
|
fullName: '',
|
||||||
fullNameError:false,
|
fullNameError: false,
|
||||||
homePhone: "",
|
homePhone: '',
|
||||||
cellPhone: "",
|
cellPhone: '',
|
||||||
cellPhoneError: false,
|
cellPhoneError: false,
|
||||||
email: "",
|
email: '',
|
||||||
emailError: false,
|
emailError: false,
|
||||||
age: "",
|
age: '',
|
||||||
ageError: false,
|
ageError: false,
|
||||||
dateOfBirth: birthDateValue,
|
dateOfBirth: birthDateValue,
|
||||||
socialSecurityNumber: "",
|
socialSecurityNumber: '',
|
||||||
mailingAddress:"",
|
mailingAddress: '',
|
||||||
mailingAddressFalse:false,
|
mailingAddressFalse: false,
|
||||||
city: "",
|
city: '',
|
||||||
state: "",
|
state: '',
|
||||||
zipCode: "",
|
zipCode: '',
|
||||||
gender: "male",
|
gender: 'male',
|
||||||
});
|
});
|
||||||
|
|
||||||
|
useEffect(() => {
|
||||||
useEffect(()=>{
|
|
||||||
handleFormSection1Data(
|
handleFormSection1Data(
|
||||||
patient.fullName,
|
patient.fullName,
|
||||||
patient.homePhone,
|
patient.homePhone,
|
||||||
@ -76,37 +87,45 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
patient.city,
|
patient.city,
|
||||||
patient.state,
|
patient.state,
|
||||||
patient.zipCode,
|
patient.zipCode,
|
||||||
patient.gender,
|
patient.gender
|
||||||
)
|
);
|
||||||
},[patient])
|
}, [patient]);
|
||||||
|
|
||||||
|
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={12}
|
||||||
|
xl={3}
|
||||||
|
lg={4}
|
||||||
|
md={6}
|
||||||
|
sm={12}
|
||||||
|
className='collapsable-form-style '
|
||||||
|
>
|
||||||
<TextField
|
<TextField
|
||||||
variant="outlined"
|
variant='outlined'
|
||||||
label="Patient's Full Name"
|
label="Patient's Full Name"
|
||||||
name="fullName"
|
name='fullName'
|
||||||
placeholder='Please enter your name'
|
placeholder='Please enter your name'
|
||||||
value={type=='display'?patientDataDiplay.fullName:patient.fullName}
|
value={
|
||||||
disabled={type=='display'}
|
type == 'display' ? patientDataDiplay.fullName : patient.fullName
|
||||||
onChange={(e)=>{
|
}
|
||||||
setPatient((prevValues:any) => ({
|
disabled={type == 'display'}
|
||||||
|
onChange={(e) => {
|
||||||
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
fullName: e.target.value,
|
fullName: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
onBlur={(e) => {
|
onBlur={(e) => {
|
||||||
if (e.target.value === "") {
|
if (e.target.value === '') {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
fullNameError: true,
|
fullNameError: true,
|
||||||
}));
|
}));
|
||||||
} else {
|
} else {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
fullNameError: false,
|
fullNameError: false,
|
||||||
}));
|
}));
|
||||||
@ -114,56 +133,88 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
}}
|
}}
|
||||||
required
|
required
|
||||||
error={patient.fullNameError}
|
error={patient.fullNameError}
|
||||||
helperText={patient.fullNameError ? "Please enter your name" : ""}
|
helperText={patient.fullNameError ? 'Please enter your name' : ''}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
|
<Grid
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
item
|
||||||
|
xs={12}
|
||||||
|
xl={3}
|
||||||
|
lg={4}
|
||||||
|
md={6}
|
||||||
|
sm={12}
|
||||||
|
className='collapsable-form-style'
|
||||||
|
>
|
||||||
<TextField
|
<TextField
|
||||||
required
|
required
|
||||||
variant="outlined"
|
variant='outlined'
|
||||||
label="Phone Number"
|
label='Phone Number'
|
||||||
name="cellPhone"
|
name='cellPhone'
|
||||||
type="number"
|
type='number'
|
||||||
placeholder='Please enter your cell Phone number'
|
placeholder='Please enter your cell Phone number'
|
||||||
value={type=='display'?patientDataDiplay.cellPhone:patient.cellPhone}
|
value={
|
||||||
disabled={type=='display'}
|
type == 'display'
|
||||||
onChange={(e)=>{
|
? patientDataDiplay.cellPhone
|
||||||
setPatient((prevValues:any) => ({
|
: patient.cellPhone
|
||||||
|
}
|
||||||
|
disabled={type == 'display'}
|
||||||
|
onChange={(e) => {
|
||||||
|
let value = e.target.value;
|
||||||
|
if (value[0] === '0') {
|
||||||
|
value = value.slice(1);
|
||||||
|
}
|
||||||
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
cellPhone: e.target.value,
|
cellPhone: value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
onBlur={(e) => {
|
onBlur={(e) => {
|
||||||
if (!(/^\d{10}$/.test(e.target.value))) {
|
if (!/^\d{10}$/.test(e.target.value)) {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
cellPhoneError: true,
|
cellPhoneError: true,
|
||||||
}));
|
}));
|
||||||
} else {
|
} else {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
cellPhoneError: false,
|
cellPhoneError: false,
|
||||||
}));
|
}));
|
||||||
}
|
}
|
||||||
}}
|
}}
|
||||||
error={patient.cellPhoneError}
|
error={patient.cellPhoneError}
|
||||||
helperText={patient.cellPhoneError? "Please enter a valid 10-digit phone number" : ""}
|
helperText={
|
||||||
|
patient.cellPhoneError
|
||||||
|
? 'Please enter a valid 10-digit phone number'
|
||||||
|
: ''
|
||||||
|
}
|
||||||
/>
|
/>
|
||||||
|
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant='outlined'
|
||||||
label="Home Phone Number"
|
label='Home Phone Number'
|
||||||
name="homePhone"
|
name='homePhone'
|
||||||
type='number'
|
type='number'
|
||||||
placeholder='Please enter your home phone'
|
placeholder='Please enter your home phone'
|
||||||
value={type=='display'?patientDataDiplay.homePhone:patient.homePhone}
|
value={
|
||||||
disabled={type=='display'}
|
type == 'display'
|
||||||
onChange={(e)=>{
|
? patientDataDiplay.homePhone
|
||||||
setPatient((prevValues:any) => ({
|
: patient.homePhone
|
||||||
|
}
|
||||||
|
disabled={type == 'display'}
|
||||||
|
onChange={(e) => {
|
||||||
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
homePhone: e.target.value,
|
homePhone: e.target.value,
|
||||||
}));
|
}));
|
||||||
@ -173,99 +224,141 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
required
|
required
|
||||||
variant="outlined"
|
variant='outlined'
|
||||||
label="Email"
|
label='Email'
|
||||||
name="email"
|
name='email'
|
||||||
placeholder='Please enter your email'
|
placeholder='Please enter your email'
|
||||||
value={type=='display'?patientDataDiplay.email:patient.email}
|
value={type == 'display' ? patientDataDiplay.email : patient.email}
|
||||||
disabled={type=='display'}
|
disabled={type == 'display'}
|
||||||
onChange={(e)=>{
|
onChange={(e) => {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
email: e.target.value,
|
email: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
onBlur={(e) => {
|
onBlur={(e) => {
|
||||||
if (!(/^\S+@\S+\.\S+$/.test(e.target.value))) {
|
if (!/^\S+@\S+\.\S+$/.test(e.target.value)) {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
emailError: true,
|
emailError: true,
|
||||||
}));
|
}));
|
||||||
} else {
|
} else {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
emailError: false,
|
emailError: false,
|
||||||
}));
|
}));
|
||||||
}
|
}
|
||||||
}}
|
}}
|
||||||
error={patient.emailError}
|
error={patient.emailError}
|
||||||
helperText={patient.emailError? "Please enter a valid email address" : ""}
|
helperText={
|
||||||
|
patient.emailError ? 'Please enter a valid email address' : ''
|
||||||
|
}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
required
|
required
|
||||||
variant="outlined"
|
variant='outlined'
|
||||||
label="Age"
|
label='Age'
|
||||||
name="age"
|
name='age'
|
||||||
type="number"
|
type='number'
|
||||||
placeholder='Please enter your age'
|
placeholder='Please enter your age'
|
||||||
value={type=='display'?patientDataDiplay.age:patient.age}
|
value={type == 'display' ? patientDataDiplay.age : patient.age}
|
||||||
disabled={type=='display'}
|
disabled={type == 'display'}
|
||||||
onChange={(e)=>{
|
onChange={(e) => {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
age: e.target.value,
|
age: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
onBlur={(e) => {
|
onBlur={(e) => {
|
||||||
if (e.target.value === "") {
|
if (e.target.value === '') {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
ageError: true,
|
ageError: true,
|
||||||
}));
|
}));
|
||||||
} else {
|
} else {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
ageError: false,
|
ageError: false,
|
||||||
}));
|
}));
|
||||||
}
|
}
|
||||||
}}
|
}}
|
||||||
error={patient.ageError}
|
error={patient.ageError}
|
||||||
helperText={patient.ageError ? "Please enter your age" : ""}
|
helperText={patient.ageError ? 'Please enter your age' : ''}
|
||||||
|
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style'>
|
<Grid
|
||||||
<FormControl >
|
item
|
||||||
|
xs={12}
|
||||||
|
xl={3}
|
||||||
|
lg={4}
|
||||||
|
md={6}
|
||||||
|
sm={12}
|
||||||
|
className='collapsable-form-style'
|
||||||
|
>
|
||||||
|
<FormControl>
|
||||||
<LocalizationProvider dateAdapter={AdapterDayjs}>
|
<LocalizationProvider dateAdapter={AdapterDayjs}>
|
||||||
<DatePicker
|
<DatePicker
|
||||||
label="Date of Birth"
|
label='Date of Birth'
|
||||||
value={type=='display'?patientDataDiplay.dateOfBirth:birthDateValue}
|
value={
|
||||||
disabled={type=='display'}
|
type == 'display'
|
||||||
|
? patientDataDiplay.dateOfBirth
|
||||||
|
: birthDateValue
|
||||||
|
}
|
||||||
|
disabled={type == 'display'}
|
||||||
onChange={(newValue) => {
|
onChange={(newValue) => {
|
||||||
setBirthDateValue(newValue);
|
setBirthDateValue(newValue);
|
||||||
}}
|
}}
|
||||||
renderInput={(params) => <TextField variant="outlined" {...params} />}
|
renderInput={(params) => (
|
||||||
|
<TextField variant='outlined' {...params} />
|
||||||
|
)}
|
||||||
/>
|
/>
|
||||||
</LocalizationProvider>
|
</LocalizationProvider>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
|
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant='outlined'
|
||||||
label="Social Security Number"
|
label='Social Security Number'
|
||||||
name="socialSecurityNumber"
|
name='socialSecurityNumber'
|
||||||
value={type=='display'?patientDataDiplay.socialSecurityNumber:patient.socialSecurityNumber}
|
value={
|
||||||
disabled={type=='display'}
|
type == 'display'
|
||||||
onChange={(e)=>{
|
? patientDataDiplay.socialSecurityNumber
|
||||||
setPatient((prevValues:any) => ({
|
: patient.socialSecurityNumber
|
||||||
|
}
|
||||||
|
disabled={type == 'display'}
|
||||||
|
onChange={(e) => {
|
||||||
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
socialSecurityNumber: e.target.value,
|
socialSecurityNumber: e.target.value,
|
||||||
}));
|
}));
|
||||||
@ -276,47 +369,71 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
required
|
required
|
||||||
variant="outlined"
|
variant='outlined'
|
||||||
label="Mailing Address"
|
label='Mailing Address'
|
||||||
name="mailingAddress"
|
name='mailingAddress'
|
||||||
value={type=='display'?patientDataDiplay.mailingAddress:patient.mailingAddress}
|
value={
|
||||||
disabled={type=='display'}
|
type == 'display'
|
||||||
onChange={(e)=>{
|
? patientDataDiplay.mailingAddress
|
||||||
setPatient((prevValues:any) => ({
|
: patient.mailingAddress
|
||||||
|
}
|
||||||
|
disabled={type == 'display'}
|
||||||
|
onChange={(e) => {
|
||||||
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
mailingAddress: e.target.value,
|
mailingAddress: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
onBlur={(e) => {
|
onBlur={(e) => {
|
||||||
if (e.target.value === "") {
|
if (e.target.value === '') {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
mailingAddressError: true,
|
mailingAddressError: true,
|
||||||
}));
|
}));
|
||||||
} else {
|
} else {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
mailingAddressError: false,
|
mailingAddressError: false,
|
||||||
}));
|
}));
|
||||||
}
|
}
|
||||||
}}
|
}}
|
||||||
error={patient.mailingAddressError}
|
error={patient.mailingAddressError}
|
||||||
helperText={patient.mailingAddressError? "Please enter your mailing address" : ""}
|
helperText={
|
||||||
|
patient.mailingAddressError
|
||||||
|
? 'Please enter your mailing address'
|
||||||
|
: ''
|
||||||
|
}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant='outlined'
|
||||||
label="State"
|
label='State'
|
||||||
name="state"
|
name='state'
|
||||||
value={type=='display'?patientDataDiplay.state:patient.state}
|
value={type == 'display' ? patientDataDiplay.state : patient.state}
|
||||||
disabled={type=='display'}
|
disabled={type == 'display'}
|
||||||
onChange={(e)=>{
|
onChange={(e) => {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
state: e.target.value,
|
state: e.target.value,
|
||||||
}));
|
}));
|
||||||
@ -324,15 +441,23 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant='outlined'
|
||||||
label="City"
|
label='City'
|
||||||
name="city"
|
name='city'
|
||||||
value={type=='display'?patientDataDiplay.city:patient.city}
|
value={type == 'display' ? patientDataDiplay.city : patient.city}
|
||||||
disabled={type=='display'}
|
disabled={type == 'display'}
|
||||||
onChange={(e)=>{
|
onChange={(e) => {
|
||||||
setPatient((prevValues:any) => ({
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
city: e.target.value,
|
city: e.target.value,
|
||||||
}));
|
}));
|
||||||
@ -340,15 +465,25 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
variant="outlined"
|
variant='outlined'
|
||||||
label="Zip Code"
|
label='Zip Code'
|
||||||
name="zipCode"
|
name='zipCode'
|
||||||
value={type=='display'?patientDataDiplay.zipCode:patient.zipCode}
|
value={
|
||||||
disabled={type=='display'}
|
type == 'display' ? patientDataDiplay.zipCode : patient.zipCode
|
||||||
onChange={(e)=>{
|
}
|
||||||
setPatient((prevValues:any) => ({
|
disabled={type == 'display'}
|
||||||
|
onChange={(e) => {
|
||||||
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
zipCode: e.target.value,
|
zipCode: e.target.value,
|
||||||
}));
|
}));
|
||||||
@ -359,31 +494,47 @@ export default function PersonalSection({handleFormSection1Data,patientDataDipla
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={4} className='collapsable-form-style-radioButtons'>
|
<Grid
|
||||||
<FormControl >
|
item
|
||||||
|
xs={12}
|
||||||
|
xl={3}
|
||||||
|
lg={4}
|
||||||
|
md={6}
|
||||||
|
sm={12}
|
||||||
|
className='collapsable-form-style-radioButtons'
|
||||||
|
>
|
||||||
|
<FormControl>
|
||||||
<FormLabel>Gender</FormLabel>
|
<FormLabel>Gender</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
aria-labelledby="demo-radio-buttons-group-label"
|
aria-labelledby='demo-radio-buttons-group-label'
|
||||||
defaultValue={type=='display'?patientDataDiplay.gender:patient.gender}
|
defaultValue={
|
||||||
name="radio-buttons-group"
|
type == 'display' ? patientDataDiplay.gender : patient.gender
|
||||||
onChange={(e)=>{
|
}
|
||||||
setPatient((prevValues:any) => ({
|
name='radio-buttons-group'
|
||||||
|
onChange={(e) => {
|
||||||
|
setPatient((prevValues: any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
gender: e.target.value,
|
gender: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
sx={{display:'flex', flexDirection:'row'}}
|
sx={{ display: 'flex', flexDirection: 'row' }}
|
||||||
>
|
>
|
||||||
<FormControlLabel
|
<FormControlLabel
|
||||||
disabled={type=='display'}
|
disabled={type == 'display'}
|
||||||
value="male" control={<Radio />} label="Male" />
|
value='male'
|
||||||
|
control={<Radio />}
|
||||||
|
label='Male'
|
||||||
|
/>
|
||||||
<FormControlLabel
|
<FormControlLabel
|
||||||
disabled={type=='display'}
|
disabled={type == 'display'}
|
||||||
value="female" control={<Radio />} label="Female" />
|
value='female'
|
||||||
|
control={<Radio />}
|
||||||
|
label='Female'
|
||||||
|
/>
|
||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
</Grid>
|
</Grid>
|
||||||
</>
|
</>
|
||||||
)
|
);
|
||||||
}
|
}
|
||||||
@ -136,7 +136,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Do you excercise?</FormLabel>
|
<FormLabel>Do you excercise?</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -156,7 +160,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
disabled={patient.excercise!=='Yes'||type=='display'}
|
disabled={patient.excercise!=='Yes'||type=='display'}
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
@ -172,7 +180,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Use tobacco?</FormLabel>
|
<FormLabel>Use tobacco?</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -192,7 +204,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
disabled={patient.tobacco!=='Yes'||type=='display'}
|
disabled={patient.tobacco!=='Yes'||type=='display'}
|
||||||
value={type=='display'?patientDataDiplay.tobaccoExplanation:patient.tobaccoExplanation}
|
value={type=='display'?patientDataDiplay.tobaccoExplanation:patient.tobaccoExplanation}
|
||||||
@ -208,7 +224,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Consume alcohol?</FormLabel>
|
<FormLabel>Consume alcohol?</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -228,7 +248,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
disabled={patient.alcohol!=='Yes'||type=='display'}
|
disabled={patient.alcohol!=='Yes'||type=='display'}
|
||||||
value={type=='display'?patientDataDiplay.alcoholExplanation:patient.alcoholExplanation}
|
value={type=='display'?patientDataDiplay.alcoholExplanation:patient.alcoholExplanation}
|
||||||
@ -244,7 +268,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Have a healthy diet?</FormLabel>
|
<FormLabel>Have a healthy diet?</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -264,7 +292,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
disabled={patient.healthyDiet!=='No'||type=='display'}
|
disabled={patient.healthyDiet!=='No'||type=='display'}
|
||||||
value={type=='display'?patientDataDiplay.healthyDietExplanation:patient.healthyDietExplanation}
|
value={type=='display'?patientDataDiplay.healthyDietExplanation:patient.healthyDietExplanation}
|
||||||
@ -280,7 +312,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Get adequate sleep?</FormLabel>
|
<FormLabel>Get adequate sleep?</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -300,7 +336,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
disabled={patient.sleep!=='No'||type=='display'}
|
disabled={patient.sleep!=='No'||type=='display'}
|
||||||
value={type=='display'?patientDataDiplay.sleepExplanation:patient.sleepExplanation}
|
value={type=='display'?patientDataDiplay.sleepExplanation:patient.sleepExplanation}
|
||||||
@ -316,7 +356,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Is Work/School stressful to you?</FormLabel>
|
<FormLabel>Is Work/School stressful to you?</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -336,7 +380,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
disabled={patient.workSchool!=='Yes'||type=='display'}
|
disabled={patient.workSchool!=='Yes'||type=='display'}
|
||||||
value={type=='display'?patientDataDiplay.workSchool:patient.workSchool}
|
value={type=='display'?patientDataDiplay.workSchool:patient.workSchool}
|
||||||
@ -352,7 +400,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Family life stressful to you?</FormLabel>
|
<FormLabel>Family life stressful to you?</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -372,7 +424,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
disabled={patient.familyLife!=='Yes'||type=='display'}
|
disabled={patient.familyLife!=='Yes'||type=='display'}
|
||||||
value={type=='display'?patientDataDiplay.familyLifeExplanation:patient.familyLifeExplanation}
|
value={type=='display'?patientDataDiplay.familyLifeExplanation:patient.familyLifeExplanation}
|
||||||
@ -388,7 +444,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Use recreational drugs?</FormLabel>
|
<FormLabel>Use recreational drugs?</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -408,7 +468,11 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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
|
<TextField
|
||||||
disabled={patient.drugs!=='Yes'||type=='display'}
|
disabled={patient.drugs!=='Yes'||type=='display'}
|
||||||
value={type=='display'?patientDataDiplay.drugsExplanation:patient.drugsExplanation}
|
value={type=='display'?patientDataDiplay.drugsExplanation:patient.drugsExplanation}
|
||||||
|
|||||||
@ -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>
|
<FormLabel sx={{fontWeight:600}}>Please choose body areas or systems where you may have problems:</FormLabel>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid container direction="row">
|
<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>
|
<FormControl>
|
||||||
<FormLabel>Eyes</FormLabel>
|
<FormLabel>Eyes</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -112,7 +116,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Intestines/Bowls</FormLabel>
|
<FormLabel>Intestines/Bowls</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -131,7 +139,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Joints/Bones</FormLabel>
|
<FormLabel>Joints/Bones</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -150,7 +162,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Allergies</FormLabel>
|
<FormLabel>Allergies</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -169,7 +185,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Ears, Nose, Mouth, Throat</FormLabel>
|
<FormLabel>Ears, Nose, Mouth, Throat</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -188,7 +208,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Urinary</FormLabel>
|
<FormLabel>Urinary</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -207,7 +231,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Skin</FormLabel>
|
<FormLabel>Skin</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -226,7 +254,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Psychological/Emotional</FormLabel>
|
<FormLabel>Psychological/Emotional</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -245,7 +277,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Heart</FormLabel>
|
<FormLabel>Heart</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -264,7 +300,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Muscles</FormLabel>
|
<FormLabel>Muscles</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -283,7 +323,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Internal Organs</FormLabel>
|
<FormLabel>Internal Organs</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -302,7 +346,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Gynecological menstrual/Brest</FormLabel>
|
<FormLabel>Gynecological menstrual/Brest</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -322,7 +370,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Lungs/Breathing</FormLabel>
|
<FormLabel>Lungs/Breathing</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -341,7 +393,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Nerves</FormLabel>
|
<FormLabel>Nerves</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -360,7 +416,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Blood</FormLabel>
|
<FormLabel>Blood</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -379,7 +439,11 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</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>
|
<FormControl>
|
||||||
<FormLabel>Prostate/Testicular/Penile</FormLabel>
|
<FormLabel>Prostate/Testicular/Penile</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
|
|||||||
Loading…
x
Reference in New Issue
Block a user