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9c1174b325
...
463fc03153
@ -101,13 +101,7 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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</Grid>
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</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 '></Grid>
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<Grid item
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<Grid item xs={4} className='collapsable-form-style '>
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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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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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@ -125,13 +119,7 @@ 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
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<Grid item xs={4} className='collapsable-form-style '>
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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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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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@ -149,13 +137,7 @@ 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
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<Grid item xs={4} className='collapsable-form-style '>
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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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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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@ -173,13 +155,7 @@ 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
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<Grid item xs={4} className='collapsable-form-style '>
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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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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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@ -195,13 +171,7 @@ 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
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<Grid item xs={4} className='collapsable-form-style '>
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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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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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@ -219,24 +189,13 @@ 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
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<Grid item xs={4} className='collapsable-form-style '></Grid>
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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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sm={12}
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className='collapsable-form-style '></Grid>
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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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<Grid item
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<Grid item xs={4} className='collapsable-form-style '>
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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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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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@ -252,13 +211,7 @@ 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
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<Grid item xs={4} className='collapsable-form-style '>
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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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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="Spouse's Employer"
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label="Spouse's Employer"
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@ -274,13 +227,7 @@ 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
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<Grid item xs={4} className='collapsable-form-style '>
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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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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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@ -303,13 +250,7 @@ export default function FamilyFormSection({handleFormSection2Data,patientDataDip
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</Grid>
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</Grid>
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<Grid item
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<Grid item xs={4} className='collapsable-form-style '>
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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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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="Emergency Contact"
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label="Emergency Contact"
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@ -325,13 +266,7 @@ 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
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<Grid item xs={4} className='collapsable-form-style '>
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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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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="Relationship"
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label="Relationship"
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@ -347,12 +282,7 @@ 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
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<Grid item xs={4} className='collapsable-form-style '>
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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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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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type="number"
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type="number"
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@ -76,13 +76,7 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
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</Grid>
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</Grid>
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<Grid container direction="row">
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<Grid container direction="row">
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<Grid item
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<Grid item xs={4} className='collapsable-form-style'>
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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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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="Family physician"
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label="Family physician"
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@ -97,13 +91,7 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
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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
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<Grid item xs={4} className='collapsable-form-style'>
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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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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="City"
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label="City"
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@ -118,13 +106,7 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
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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
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<Grid item xs={4} className='collapsable-form-style'>
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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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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="State"
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label="State"
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@ -139,13 +121,7 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
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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
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<Grid item xs={4} className='collapsable-form-style'>
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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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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="Phone"
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label="Phone"
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@ -162,30 +138,14 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
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/>
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/>
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</Grid>
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</Grid>
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<Grid item
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<Grid item xs={4} className='collapsable-form-style'></Grid>
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xs={12}
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<Grid item xs={4} className='collapsable-form-style'></Grid>
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xl={3}
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lg={4}
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md={6}
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sm={12} className='collapsable-form-style'></Grid>
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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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sm={12} className='collapsable-form-style'></Grid>
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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}}>Chiropractor Information:</FormLabel>
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<FormLabel sx={{fontWeight:600}}>Chiropractor Information:</FormLabel>
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</Grid>
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</Grid>
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<Grid item
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<Grid item xs={4} sx={{paddingLeft:"14px",marginTop:2}} className='collapsable-form-style-radioButtons'>
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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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sm={12}
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sx={{paddingLeft:"14px",marginTop:2}} className='collapsable-form-style-radioButtons'>
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<FormControl>
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<FormControl>
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<FormLabel>Previous Chiropractic Care:</FormLabel>
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<FormLabel>Previous Chiropractic Care:</FormLabel>
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<RadioGroup
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<RadioGroup
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@ -206,13 +166,7 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
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</FormControl>
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</FormControl>
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</Grid>
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</Grid>
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<Grid item
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<Grid item xs={4} className='collapsable-form-style'>
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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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|
||||||
sm={12}
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|
||||||
className='collapsable-form-style'>
|
|
||||||
<TextField
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
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||||||
label="Chiropractor's Name"
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label="Chiropractor's Name"
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||||||
@ -228,13 +182,7 @@ export default function MedicalHistoryForm({handleFormSection3Data,patientDataDi
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|||||||
/>
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/>
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||||||
</Grid>
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</Grid>
|
||||||
|
|
||||||
<Grid item
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<Grid item xs={4} className='collapsable-form-style'>
|
||||||
xs={12}
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|
||||||
xl={3}
|
|
||||||
lg={4}
|
|
||||||
md={6}
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|
||||||
sm={12}
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|
||||||
className='collapsable-form-style'>
|
|
||||||
<TextField
|
<TextField
|
||||||
variant="outlined"
|
variant="outlined"
|
||||||
label="City/State"
|
label="City/State"
|
||||||
|
|||||||
@ -121,12 +121,7 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
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|||||||
</Grid>
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</Grid>
|
||||||
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|
||||||
|
|
||||||
<Grid item
|
<Grid item xs={4} className='collapsable-form-style-form7'>
|
||||||
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?"
|
||||||
@ -140,12 +135,7 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
|
|||||||
}}
|
}}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item
|
<Grid item xs={4} className='collapsable-form-style-form7'>
|
||||||
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?"
|
||||||
@ -160,12 +150,7 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
|
|||||||
}}
|
}}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item
|
<Grid item xs={4} className='collapsable-form-style-form7'>
|
||||||
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?"
|
||||||
@ -302,11 +287,7 @@ export default function PastTreatment5({handleFormSection5Data,patientDataDiplay
|
|||||||
type={type}/>
|
type={type}/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-multiline'>
|
||||||
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 Pain Zone
|
Patient's Injury Image
|
||||||
</Typography>
|
</Typography>
|
||||||
</AccordionSummary>
|
</AccordionSummary>
|
||||||
|
|
||||||
|
|||||||
@ -1,540 +1,389 @@
|
|||||||
import * as React from 'react';
|
import * as React from 'react';
|
||||||
import {
|
import { Button, FormControl, FormControlLabel, FormLabel, Grid, Paper, Radio, RadioGroup, TextField } from '@mui/material';
|
||||||
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';
|
||||||
|
|
||||||
interface Patient {
|
interface Patient {
|
||||||
fullName: string;
|
fullName: string;
|
||||||
homePhone: string;
|
homePhone: string;
|
||||||
cellPhone: string;
|
cellPhone: string;
|
||||||
email: string;
|
email: string;
|
||||||
age: number | string;
|
age: number | string;
|
||||||
dateOfBirth: string;
|
dateOfBirth: string;
|
||||||
socialSecurityNumber: string;
|
socialSecurityNumber: string;
|
||||||
mailingAddress: string;
|
mailingAddress: string;
|
||||||
city: string;
|
city: string;
|
||||||
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,
|
export default function PersonalSection({handleFormSection1Data,patientDataDiplay,type}:Props){
|
||||||
patientDataDiplay,
|
|
||||||
type,
|
const [birthDateValue, setBirthDateValue] = React.useState<any>();
|
||||||
}: Props) {
|
const [patient, setPatient] = React.useState<any>({
|
||||||
const [birthDateValue, setBirthDateValue] = React.useState<any>();
|
fullName: "",
|
||||||
const [patient, setPatient] = React.useState<any>({
|
fullNameError:false,
|
||||||
fullName: '',
|
homePhone: "",
|
||||||
fullNameError: false,
|
cellPhone: "",
|
||||||
homePhone: '',
|
cellPhoneError: false,
|
||||||
cellPhone: '',
|
email: "",
|
||||||
cellPhoneError: false,
|
emailError: false,
|
||||||
email: '',
|
age: "",
|
||||||
emailError: false,
|
ageError: false,
|
||||||
age: '',
|
dateOfBirth: birthDateValue,
|
||||||
ageError: false,
|
socialSecurityNumber: "",
|
||||||
dateOfBirth: birthDateValue,
|
mailingAddress:"",
|
||||||
socialSecurityNumber: '',
|
mailingAddressFalse:false,
|
||||||
mailingAddress: '',
|
city: "",
|
||||||
mailingAddressFalse: false,
|
state: "",
|
||||||
city: '',
|
zipCode: "",
|
||||||
state: '',
|
gender: "male",
|
||||||
zipCode: '',
|
});
|
||||||
gender: 'male',
|
|
||||||
});
|
|
||||||
|
useEffect(()=>{
|
||||||
useEffect(() => {
|
handleFormSection1Data(
|
||||||
handleFormSection1Data(
|
patient.fullName,
|
||||||
patient.fullName,
|
patient.homePhone,
|
||||||
patient.homePhone,
|
patient.cellPhone,
|
||||||
patient.cellPhone,
|
patient.email,
|
||||||
patient.email,
|
patient.age,
|
||||||
patient.age,
|
birthDateValue,
|
||||||
birthDateValue,
|
patient.socialSecurityNumber,
|
||||||
patient.socialSecurityNumber,
|
patient.mailingAddress,
|
||||||
patient.mailingAddress,
|
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
|
<Grid container direction="row" className='section1-test-class'>
|
||||||
item
|
<Grid item xs={4} className='collapsable-form-style '>
|
||||||
xs={12}
|
<TextField
|
||||||
xl={3}
|
variant="outlined"
|
||||||
lg={4}
|
label="Patient's Full Name"
|
||||||
md={6}
|
name="fullName"
|
||||||
sm={12}
|
placeholder='Please enter your name'
|
||||||
className='collapsable-form-style '
|
value={type=='display'?patientDataDiplay.fullName:patient.fullName}
|
||||||
>
|
disabled={type=='display'}
|
||||||
<TextField
|
onChange={(e)=>{
|
||||||
variant='outlined'
|
setPatient((prevValues:any) => ({
|
||||||
label="Patient's Full Name"
|
...prevValues,
|
||||||
name='fullName'
|
fullName: e.target.value,
|
||||||
placeholder='Please enter your name'
|
}));
|
||||||
value={
|
}}
|
||||||
type == 'display' ? patientDataDiplay.fullName : patient.fullName
|
onBlur={(e) => {
|
||||||
}
|
if (e.target.value === "") {
|
||||||
disabled={type == 'display'}
|
setPatient((prevValues:any) => ({
|
||||||
onChange={(e) => {
|
...prevValues,
|
||||||
setPatient((prevValues: any) => ({
|
fullNameError: true,
|
||||||
...prevValues,
|
}));
|
||||||
fullName: e.target.value,
|
} else {
|
||||||
}));
|
setPatient((prevValues:any) => ({
|
||||||
}}
|
...prevValues,
|
||||||
onBlur={(e) => {
|
fullNameError: false,
|
||||||
if (e.target.value === '') {
|
}));
|
||||||
setPatient((prevValues: any) => ({
|
}
|
||||||
...prevValues,
|
}}
|
||||||
fullNameError: true,
|
required
|
||||||
}));
|
error={patient.fullNameError}
|
||||||
} else {
|
helperText={patient.fullNameError ? "Please enter your name" : ""}
|
||||||
setPatient((prevValues: any) => ({
|
/>
|
||||||
...prevValues,
|
</Grid>
|
||||||
fullNameError: false,
|
|
||||||
}));
|
|
||||||
}
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
}}
|
<TextField
|
||||||
required
|
required
|
||||||
error={patient.fullNameError}
|
variant="outlined"
|
||||||
helperText={patient.fullNameError ? 'Please enter your name' : ''}
|
label="Phone Number"
|
||||||
/>
|
name="cellPhone"
|
||||||
</Grid>
|
type="number"
|
||||||
|
placeholder='Please enter your cell Phone number'
|
||||||
<Grid
|
value={type=='display'?patientDataDiplay.cellPhone:patient.cellPhone}
|
||||||
item
|
disabled={type=='display'}
|
||||||
xs={12}
|
onChange={(e)=>{
|
||||||
xl={3}
|
setPatient((prevValues:any) => ({
|
||||||
lg={4}
|
...prevValues,
|
||||||
md={6}
|
cellPhone: e.target.value,
|
||||||
sm={12}
|
}));
|
||||||
className='collapsable-form-style'
|
}}
|
||||||
>
|
onBlur={(e) => {
|
||||||
<TextField
|
if (!(/^\d{10}$/.test(e.target.value))) {
|
||||||
required
|
setPatient((prevValues:any) => ({
|
||||||
variant='outlined'
|
...prevValues,
|
||||||
label='Phone Number'
|
cellPhoneError: true,
|
||||||
name='cellPhone'
|
}));
|
||||||
type='number'
|
} else {
|
||||||
placeholder='Please enter your cell Phone number'
|
setPatient((prevValues:any) => ({
|
||||||
value={
|
...prevValues,
|
||||||
type == 'display'
|
cellPhoneError: false,
|
||||||
? patientDataDiplay.cellPhone
|
}));
|
||||||
: patient.cellPhone
|
}
|
||||||
}
|
}}
|
||||||
disabled={type == 'display'}
|
error={patient.cellPhoneError}
|
||||||
onChange={(e) => {
|
helperText={patient.cellPhoneError? "Please enter a valid 10-digit phone number" : ""}
|
||||||
let value = e.target.value;
|
/>
|
||||||
if (value[0] === '0') {
|
</Grid>
|
||||||
value = value.slice(1);
|
|
||||||
}
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
setPatient((prevValues: any) => ({
|
<TextField
|
||||||
...prevValues,
|
variant="outlined"
|
||||||
cellPhone: value,
|
label="Home Phone Number"
|
||||||
}));
|
name="homePhone"
|
||||||
}}
|
type='number'
|
||||||
onBlur={(e) => {
|
placeholder='Please enter your home phone'
|
||||||
if (!/^\d{10}$/.test(e.target.value)) {
|
value={type=='display'?patientDataDiplay.homePhone:patient.homePhone}
|
||||||
setPatient((prevValues: any) => ({
|
disabled={type=='display'}
|
||||||
...prevValues,
|
onChange={(e)=>{
|
||||||
cellPhoneError: true,
|
setPatient((prevValues:any) => ({
|
||||||
}));
|
...prevValues,
|
||||||
} else {
|
homePhone: e.target.value,
|
||||||
setPatient((prevValues: any) => ({
|
}));
|
||||||
...prevValues,
|
}}
|
||||||
cellPhoneError: false,
|
// error={!(/^\d{10}$/.test(patient.homePhone))}
|
||||||
}));
|
// helperText={!(/^\d{10}$/.test(patient.homePhone)) ? "Please enter a valid 10-digit phone number" : ""}
|
||||||
}
|
/>
|
||||||
}}
|
</Grid>
|
||||||
error={patient.cellPhoneError}
|
|
||||||
helperText={
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
patient.cellPhoneError
|
<TextField
|
||||||
? 'Please enter a valid 10-digit phone number'
|
required
|
||||||
: ''
|
variant="outlined"
|
||||||
}
|
label="Email"
|
||||||
/>
|
name="email"
|
||||||
|
placeholder='Please enter your email'
|
||||||
</Grid>
|
value={type=='display'?patientDataDiplay.email:patient.email}
|
||||||
|
disabled={type=='display'}
|
||||||
<Grid
|
onChange={(e)=>{
|
||||||
item
|
setPatient((prevValues:any) => ({
|
||||||
xs={12}
|
...prevValues,
|
||||||
xl={3}
|
email: e.target.value,
|
||||||
lg={4}
|
}));
|
||||||
md={6}
|
}}
|
||||||
sm={12}
|
onBlur={(e) => {
|
||||||
className='collapsable-form-style'
|
if (!(/^\S+@\S+\.\S+$/.test(e.target.value))) {
|
||||||
>
|
setPatient((prevValues:any) => ({
|
||||||
<TextField
|
...prevValues,
|
||||||
variant='outlined'
|
emailError: true,
|
||||||
label='Home Phone Number'
|
}));
|
||||||
name='homePhone'
|
} else {
|
||||||
type='number'
|
setPatient((prevValues:any) => ({
|
||||||
placeholder='Please enter your home phone'
|
...prevValues,
|
||||||
value={
|
emailError: false,
|
||||||
type == 'display'
|
}));
|
||||||
? patientDataDiplay.homePhone
|
}
|
||||||
: patient.homePhone
|
}}
|
||||||
}
|
error={patient.emailError}
|
||||||
disabled={type == 'display'}
|
helperText={patient.emailError? "Please enter a valid email address" : ""}
|
||||||
onChange={(e) => {
|
/>
|
||||||
setPatient((prevValues: any) => ({
|
</Grid>
|
||||||
...prevValues,
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
homePhone: e.target.value,
|
<TextField
|
||||||
}));
|
required
|
||||||
}}
|
variant="outlined"
|
||||||
// error={!(/^\d{10}$/.test(patient.homePhone))}
|
label="Age"
|
||||||
// helperText={!(/^\d{10}$/.test(patient.homePhone)) ? "Please enter a valid 10-digit phone number" : ""}
|
name="age"
|
||||||
/>
|
type="number"
|
||||||
</Grid>
|
placeholder='Please enter your age'
|
||||||
|
value={type=='display'?patientDataDiplay.age:patient.age}
|
||||||
<Grid
|
disabled={type=='display'}
|
||||||
item
|
onChange={(e)=>{
|
||||||
xs={12}
|
setPatient((prevValues:any) => ({
|
||||||
xl={3}
|
...prevValues,
|
||||||
lg={4}
|
age: e.target.value,
|
||||||
md={6}
|
}));
|
||||||
sm={12}
|
}}
|
||||||
className='collapsable-form-style'
|
onBlur={(e) => {
|
||||||
>
|
if (e.target.value === "") {
|
||||||
<TextField
|
setPatient((prevValues:any) => ({
|
||||||
required
|
...prevValues,
|
||||||
variant='outlined'
|
ageError: true,
|
||||||
label='Email'
|
}));
|
||||||
name='email'
|
} else {
|
||||||
placeholder='Please enter your email'
|
setPatient((prevValues:any) => ({
|
||||||
value={type == 'display' ? patientDataDiplay.email : patient.email}
|
...prevValues,
|
||||||
disabled={type == 'display'}
|
ageError: false,
|
||||||
onChange={(e) => {
|
}));
|
||||||
setPatient((prevValues: any) => ({
|
}
|
||||||
...prevValues,
|
}}
|
||||||
email: e.target.value,
|
error={patient.ageError}
|
||||||
}));
|
helperText={patient.ageError ? "Please enter your age" : ""}
|
||||||
}}
|
|
||||||
onBlur={(e) => {
|
/>
|
||||||
if (!/^\S+@\S+\.\S+$/.test(e.target.value)) {
|
</Grid>
|
||||||
setPatient((prevValues: any) => ({
|
|
||||||
...prevValues,
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
emailError: true,
|
<FormControl >
|
||||||
}));
|
<LocalizationProvider dateAdapter={AdapterDayjs}>
|
||||||
} else {
|
<DatePicker
|
||||||
setPatient((prevValues: any) => ({
|
label="Date of Birth"
|
||||||
...prevValues,
|
value={type=='display'?patientDataDiplay.dateOfBirth:birthDateValue}
|
||||||
emailError: false,
|
disabled={type=='display'}
|
||||||
}));
|
onChange={(newValue) => {
|
||||||
}
|
setBirthDateValue(newValue);
|
||||||
}}
|
}}
|
||||||
error={patient.emailError}
|
renderInput={(params) => <TextField variant="outlined" {...params} />}
|
||||||
helperText={
|
/>
|
||||||
patient.emailError ? 'Please enter a valid email address' : ''
|
</LocalizationProvider>
|
||||||
}
|
</FormControl>
|
||||||
/>
|
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid
|
|
||||||
item
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
xs={12}
|
<TextField
|
||||||
xl={3}
|
variant="outlined"
|
||||||
lg={4}
|
label="Social Security Number"
|
||||||
md={6}
|
name="socialSecurityNumber"
|
||||||
sm={12}
|
value={type=='display'?patientDataDiplay.socialSecurityNumber:patient.socialSecurityNumber}
|
||||||
className='collapsable-form-style'
|
disabled={type=='display'}
|
||||||
>
|
onChange={(e)=>{
|
||||||
<TextField
|
setPatient((prevValues:any) => ({
|
||||||
required
|
...prevValues,
|
||||||
variant='outlined'
|
socialSecurityNumber: e.target.value,
|
||||||
label='Age'
|
}));
|
||||||
name='age'
|
}}
|
||||||
type='number'
|
// onBlur={formik.handleBlur}
|
||||||
placeholder='Please enter your age'
|
// error={formik.touched.socialSecurityNumber && Boolean(formik.errors.socialSecurityNumber)}
|
||||||
value={type == 'display' ? patientDataDiplay.age : patient.age}
|
// helperText={formik.touched.socialSecurityNumber && formik.errors.socialSecurityNumber}
|
||||||
disabled={type == 'display'}
|
/>
|
||||||
onChange={(e) => {
|
</Grid>
|
||||||
setPatient((prevValues: any) => ({
|
|
||||||
...prevValues,
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
age: e.target.value,
|
<TextField
|
||||||
}));
|
required
|
||||||
}}
|
variant="outlined"
|
||||||
onBlur={(e) => {
|
label="Mailing Address"
|
||||||
if (e.target.value === '') {
|
name="mailingAddress"
|
||||||
setPatient((prevValues: any) => ({
|
value={type=='display'?patientDataDiplay.mailingAddress:patient.mailingAddress}
|
||||||
...prevValues,
|
disabled={type=='display'}
|
||||||
ageError: true,
|
onChange={(e)=>{
|
||||||
}));
|
setPatient((prevValues:any) => ({
|
||||||
} else {
|
...prevValues,
|
||||||
setPatient((prevValues: any) => ({
|
mailingAddress: e.target.value,
|
||||||
...prevValues,
|
}));
|
||||||
ageError: false,
|
}}
|
||||||
}));
|
onBlur={(e) => {
|
||||||
}
|
if (e.target.value === "") {
|
||||||
}}
|
setPatient((prevValues:any) => ({
|
||||||
error={patient.ageError}
|
...prevValues,
|
||||||
helperText={patient.ageError ? 'Please enter your age' : ''}
|
mailingAddressError: true,
|
||||||
/>
|
}));
|
||||||
</Grid>
|
} else {
|
||||||
|
setPatient((prevValues:any) => ({
|
||||||
<Grid
|
...prevValues,
|
||||||
item
|
mailingAddressError: false,
|
||||||
xs={12}
|
}));
|
||||||
xl={3}
|
}
|
||||||
lg={4}
|
}}
|
||||||
md={6}
|
error={patient.mailingAddressError}
|
||||||
sm={12}
|
helperText={patient.mailingAddressError? "Please enter your mailing address" : ""}
|
||||||
className='collapsable-form-style'
|
/>
|
||||||
>
|
</Grid>
|
||||||
<FormControl>
|
|
||||||
<LocalizationProvider dateAdapter={AdapterDayjs}>
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
<DatePicker
|
<TextField
|
||||||
label='Date of Birth'
|
variant="outlined"
|
||||||
value={
|
label="State"
|
||||||
type == 'display'
|
name="state"
|
||||||
? patientDataDiplay.dateOfBirth
|
value={type=='display'?patientDataDiplay.state:patient.state}
|
||||||
: birthDateValue
|
disabled={type=='display'}
|
||||||
}
|
onChange={(e)=>{
|
||||||
disabled={type == 'display'}
|
setPatient((prevValues:any) => ({
|
||||||
onChange={(newValue) => {
|
...prevValues,
|
||||||
setBirthDateValue(newValue);
|
state: e.target.value,
|
||||||
}}
|
}));
|
||||||
renderInput={(params) => (
|
}}
|
||||||
<TextField variant='outlined' {...params} />
|
/>
|
||||||
)}
|
</Grid>
|
||||||
/>
|
|
||||||
</LocalizationProvider>
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
</FormControl>
|
<TextField
|
||||||
</Grid>
|
variant="outlined"
|
||||||
|
label="City"
|
||||||
<Grid
|
name="city"
|
||||||
item
|
value={type=='display'?patientDataDiplay.city:patient.city}
|
||||||
xs={12}
|
disabled={type=='display'}
|
||||||
xl={3}
|
onChange={(e)=>{
|
||||||
lg={4}
|
setPatient((prevValues:any) => ({
|
||||||
md={6}
|
...prevValues,
|
||||||
sm={12}
|
city: e.target.value,
|
||||||
className='collapsable-form-style'
|
}));
|
||||||
>
|
}}
|
||||||
<TextField
|
/>
|
||||||
variant='outlined'
|
</Grid>
|
||||||
label='Social Security Number'
|
|
||||||
name='socialSecurityNumber'
|
<Grid item xs={4} className='collapsable-form-style'>
|
||||||
value={
|
<TextField
|
||||||
type == 'display'
|
variant="outlined"
|
||||||
? patientDataDiplay.socialSecurityNumber
|
label="Zip Code"
|
||||||
: patient.socialSecurityNumber
|
name="zipCode"
|
||||||
}
|
value={type=='display'?patientDataDiplay.zipCode:patient.zipCode}
|
||||||
disabled={type == 'display'}
|
disabled={type=='display'}
|
||||||
onChange={(e) => {
|
onChange={(e)=>{
|
||||||
setPatient((prevValues: any) => ({
|
setPatient((prevValues:any) => ({
|
||||||
...prevValues,
|
...prevValues,
|
||||||
socialSecurityNumber: e.target.value,
|
zipCode: e.target.value,
|
||||||
}));
|
}));
|
||||||
}}
|
}}
|
||||||
// onBlur={formik.handleBlur}
|
// onBlur={formik.handleBlur}
|
||||||
// error={formik.touched.socialSecurityNumber && Boolean(formik.errors.socialSecurityNumber)}
|
// error={formik.touched.zipCode && Boolean(formik.errors.zipCode)}
|
||||||
// helperText={formik.touched.socialSecurityNumber && formik.errors.socialSecurityNumber}
|
// helperText={formik.touched.zipCode && formik.errors.zipCode}
|
||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid
|
<Grid item xs={4} className='collapsable-form-style-radioButtons'>
|
||||||
item
|
<FormControl >
|
||||||
xs={12}
|
<FormLabel>Gender</FormLabel>
|
||||||
xl={3}
|
<RadioGroup
|
||||||
lg={4}
|
aria-labelledby="demo-radio-buttons-group-label"
|
||||||
md={6}
|
defaultValue={type=='display'?patientDataDiplay.gender:patient.gender}
|
||||||
sm={12}
|
name="radio-buttons-group"
|
||||||
className='collapsable-form-style'
|
onChange={(e)=>{
|
||||||
>
|
setPatient((prevValues:any) => ({
|
||||||
<TextField
|
...prevValues,
|
||||||
required
|
gender: e.target.value,
|
||||||
variant='outlined'
|
}));
|
||||||
label='Mailing Address'
|
}}
|
||||||
name='mailingAddress'
|
sx={{display:'flex', flexDirection:'row'}}
|
||||||
value={
|
>
|
||||||
type == 'display'
|
<FormControlLabel
|
||||||
? patientDataDiplay.mailingAddress
|
disabled={type=='display'}
|
||||||
: patient.mailingAddress
|
value="male" control={<Radio />} label="Male" />
|
||||||
}
|
<FormControlLabel
|
||||||
disabled={type == 'display'}
|
disabled={type=='display'}
|
||||||
onChange={(e) => {
|
value="female" control={<Radio />} label="Female" />
|
||||||
setPatient((prevValues: any) => ({
|
</RadioGroup>
|
||||||
...prevValues,
|
</FormControl>
|
||||||
mailingAddress: e.target.value,
|
</Grid>
|
||||||
}));
|
</Grid>
|
||||||
}}
|
</>
|
||||||
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>
|
|
||||||
</>
|
|
||||||
);
|
|
||||||
}
|
}
|
||||||
@ -136,11 +136,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -160,11 +156,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-form7'>
|
||||||
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"
|
||||||
@ -180,11 +172,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -204,11 +192,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-form7'>
|
||||||
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}
|
||||||
@ -224,11 +208,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -248,11 +228,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-form7'>
|
||||||
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}
|
||||||
@ -268,11 +244,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -292,11 +264,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-form7'>
|
||||||
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}
|
||||||
@ -312,11 +280,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -336,11 +300,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-form7'>
|
||||||
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}
|
||||||
@ -356,11 +316,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -380,11 +336,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-form7'>
|
||||||
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}
|
||||||
@ -400,11 +352,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -424,11 +372,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-form7'>
|
||||||
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}
|
||||||
@ -444,11 +388,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
/>
|
/>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -468,11 +408,7 @@ export default function RecreationalHobbiesSection7({handleFormSection7Data,pati
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={6} className='collapsable-form-style-form7'>
|
||||||
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}
|
||||||
|
|||||||
@ -93,11 +93,7 @@ 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={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
xl={3}
|
|
||||||
lg={4}
|
|
||||||
md={6}
|
|
||||||
sm={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
<FormControl>
|
||||||
<FormLabel>Eyes</FormLabel>
|
<FormLabel>Eyes</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -116,11 +112,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -139,11 +131,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -162,11 +150,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
xl={3}
|
|
||||||
lg={4}
|
|
||||||
md={6}
|
|
||||||
sm={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
<FormControl>
|
||||||
<FormLabel>Allergies</FormLabel>
|
<FormLabel>Allergies</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -185,11 +169,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -208,11 +188,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
xl={3}
|
|
||||||
lg={4}
|
|
||||||
md={6}
|
|
||||||
sm={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
<FormControl>
|
||||||
<FormLabel>Urinary</FormLabel>
|
<FormLabel>Urinary</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -231,11 +207,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
xl={3}
|
|
||||||
lg={4}
|
|
||||||
md={6}
|
|
||||||
sm={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
<FormControl>
|
||||||
<FormLabel>Skin</FormLabel>
|
<FormLabel>Skin</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -254,11 +226,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -277,11 +245,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
xl={3}
|
|
||||||
lg={4}
|
|
||||||
md={6}
|
|
||||||
sm={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
<FormControl>
|
||||||
<FormLabel>Heart</FormLabel>
|
<FormLabel>Heart</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -300,11 +264,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
xl={3}
|
|
||||||
lg={4}
|
|
||||||
md={6}
|
|
||||||
sm={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
<FormControl>
|
||||||
<FormLabel>Muscles</FormLabel>
|
<FormLabel>Muscles</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -323,11 +283,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -346,11 +302,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -370,11 +322,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
|
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
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
|
||||||
@ -393,11 +341,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
xl={3}
|
|
||||||
lg={4}
|
|
||||||
md={6}
|
|
||||||
sm={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
<FormControl>
|
||||||
<FormLabel>Nerves</FormLabel>
|
<FormLabel>Nerves</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -416,11 +360,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
xl={3}
|
|
||||||
lg={4}
|
|
||||||
md={6}
|
|
||||||
sm={12} className='collapsable-form-style-radioButtons'>
|
|
||||||
<FormControl>
|
<FormControl>
|
||||||
<FormLabel>Blood</FormLabel>
|
<FormLabel>Blood</FormLabel>
|
||||||
<RadioGroup
|
<RadioGroup
|
||||||
@ -439,11 +379,7 @@ export default function SystemReviewSection6({handleFormSection6Data,patientData
|
|||||||
</RadioGroup>
|
</RadioGroup>
|
||||||
</FormControl>
|
</FormControl>
|
||||||
</Grid>
|
</Grid>
|
||||||
<Grid item xs={12}
|
<Grid item xs={3} className='collapsable-form-style-radioButtons'>
|
||||||
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