EVOLUTION-NINJA
Edit File: index.html
<!DOCTYPE html> <html> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1"> <meta http-equiv="X-UA-Compatible" content="IE=Edge" /> <title>Home</title> <link rel="stylesheet" type="text/css" href="<?php echo base_url('assets/css/main.css');?>"/> <link rel="stylesheet" type="text/css" href="<?php echo base_url('assets/css/bootstrap.min.css');?>"/> <link rel="stylesheet" type="text/css" href="<?php echo base_url('assets/css/font-awesome.min.css');?>"/> <link rel="preconnect" href="https://fonts.gstatic.com" crossorigin> <link href="https://fonts.googleapis.com/css2?family=Lato&display=swap" rel="stylesheet"> <link rel='shortcut icon' type='image/x-icon' href='<?php echo base_url('assets/images/fav_icon.jpg');?>' /> <link rel="stylesheet" type="text/css" href="<?php echo base_url('assets/css/jquery-ui.css');?>"/> <!-- <link rel="stylesheet" type="text/css" href="css/timepicker.css" /> --> <link rel="stylesheet" href="<?php echo base_url('assets/css/bootstrap-datetimepicker.css');?>"/> <!------------------------------JS--------------------------------------> <script type="text/javascript" src="<?php echo base_url('assets/js/jquery-3.6.0.min.js'); ?>"></script> <script type="text/javascript" src="<?php echo base_url('assets/js/bootstrap.min.js'); ?>"></script> <script type="text/javascript" src="<?php echo base_url('assets/js/jquery-ui.js'); ?>"></script> <script type="text/javascript" src="<?php echo base_url('assets/js/timepicker.js'); ?>"></script> <script type="text/javascript" src="<?php echo base_url('assets/js/moment.js'); ?>"></script> <!-- <script type="text/javascript" src="js/jquery-time-picker.js"></script> --> </head> <body> <!------------------------------header--------------------------------> <section class="header"> <div class="row"> <div class="col-sm-3"> <a href=""><img src="<?php echo base_url('assets/images/logo.png'); ?>" class="img-fluid d-block"></a> </div> <div class="col-sm-6"></div> <div class="col-sm-3"> <div class="right-menu"> <ul> <li><a href=""><img src="<?php echo base_url('assets/images/logout.png'); ?>"></a>Logout</li> <li><a href=""><img src="<?php echo base_url('assets/images/user.png'); ?>"></a>User</li> </ul> </div> </div> </div> </section> <!------------------------------header--------------------------------> <!------------------------------home----------------------------------> <section class="main"> <div class="container-fluid"> <div class="row"> <div class="col-sm-3"> <div class="box"> <div class="search"> <div class="form-group"> <input type="text" class="form-control" id="usr" placeholder="Search Patient" style="width:120%;border-radius: 20px;"> </div> <div class="add"> <a href="" data-toggle="modal" data-target="#myModal"><img src="<?php echo base_url('assets/images/Add.png'); ?>"></a> </div> </div> <div class="patient-list"> <p><a href="">Admin001</a></p> </div><!--patient-list--> <div class="form-check"> <label class="form-check-label" for="check2"> <input type="checkbox" class="form-check-input" id="check2" name="option2" value="something">Old Patients Record </label> </div> <div class="patient-summary"> <p>Total Patients<span>00</span></p> <p>Closed Patients Records<span>00</span></p> <p>Open Patient Records<span>00</span></p> </div> </div><!--box--> <!------------------------------------------------ADD-PATIENT-START------------------------------------> <section class="add-patient"> <!-- The Modal --> <div class="modal" id="myModal"> <div class="modal-dialog modal-lg"> <div class="modal-content"> <!-- Modal Header --> <div class="modal-header" id="add-header"> <h4 class="modal-title">Add New Patient</h4> <button type="button" class="close" data-dismiss="modal">×</button> </div> <!-- Modal body --> <div class="modal-body"> <form> <div class="row"> <div class="col-sm-2"><label>Name</label></div> <div class="col-sm-8"> <div class="form-group"> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-2"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Patient Email-ID</label></div> <div class="col-sm-8"> <div class="form-group"> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-2"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Patient ID <a href="#" data-toggle="tooltip" title="Enter Hospital Patient-Id here"><i class="fa fa-info-circle" aria-hidden="true"></i></a></label></div> <div class="col-sm-8"> <div class="form-group"> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-2"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Gender</label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Male</option> <option>Female</option> </select> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row" style="padding-top: 15px;"> <div class="col-sm-2"><label>Age<span class="mandat">*</span></label></div> <div class="col-sm-4"> <div class="form-group"> <input type="number" class="form-control" name=""> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Weight(kg)</label></div> <div class="col-sm-4"> <div class="form-group"> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row heigh"> <div class="col-sm-2"><label>Height</label></div> <div class="col-sm-10"> <ul> <li><input type="text" class="form-control" name="" id="hieght"><label>Feet</label></li> <li><input type="text" class="form-control" name="" id="hieght"><label>Inches or</label></li> <li><input type="text" class="form-control" name="" id="hieght"><label>cms</label></li> </ul> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>BMI</label></div> <div class="col-sm-4"> <div class="form-group"> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Block Procedure Date and Time<span class="mandat">*</span></label></div> <div class="col-sm-4"> <div class="form-group"> <!-- <input type="text" class="form-control" id="from_date" name=""> --> <input type="text" class="form-control" id='datetimepicker1' name="" placeholder=""> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-4"> <!-- <div class="form-group"> <input type="text" class="form-control" id='mytimeicker' name=""> </div> --> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>CNB done by<span class="mandat">*</span><a href="#" data-toggle="tooltip" title="Junior Consultant < 5 years experience , Senior Consultant > 5 years experience , Junior Trainee < 2 years experience , Senior Trainee > 2 years experience"><i class="fa fa-info-circle" aria-hidden="true"></i></a></label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Consultant</option> <option>Trainee</option> </select> <select class="form-control" style="margin: 15px 0;"> <option>Junior Consultant</option> <option>Senior Consultant</option> <option>Junior Trainee</option> <option>Senior Trianee</option> </select> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Supervision<span class="mandat">*</span></label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Direct Supervision</option> <option>Independent Supervision</option> </select> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row" style="padding-top:15px;"> <div class="col-sm-2"><label>Hospital</label></div> <div class="col-sm-4"> <input type="text" class="form-control" name=""> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-7"></div> <div class="col-sm-5 pt"> <button type="button" class="btn-save">Save</button> <button type="button" class="btn-close">Close</button> </div> </div><!--row--> </form> </div><!--Modal body--> </div><!--modal-content--> </div> </div><!--modal--> </section><!---add-patient---> <!------------------------------------------------ADD-PATIENT-END------------------------------------> <!------------------------------------------------EDIT-PATIENT-START--------------------------------> <section class="edit-patient"> <div class="modal" id="myModal1"> <div class="modal-dialog modal-lg"> <div class="modal-content"> <!-- Modal Header --> <div class="modal-header" id="add-header"> <h4 class="modal-title">Edit Patient</h4> <button type="button" class="close" data-dismiss="modal">×</button> </div> <!-- Modal body --> <div class="modal-body"> <form> <div class="row"> <div class="col-sm-2"><label>Name</label></div> <div class="col-sm-8"> <div class="form-group"> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-2"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Patient Email-ID</label></div> <div class="col-sm-8"> <div class="form-group"> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-2"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Patient ID <a href="#" data-toggle="tooltip" title="Enter Hospital Patient-Id here"><i class="fa fa-info-circle" aria-hidden="true"></i></a></label></div> <div class="col-sm-8"> <div class="form-group"> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-2"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Gender</label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Male</option> <option>Female</option> </select> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row" style="padding-top: 15px;"> <div class="col-sm-2"><label>Age<span class="mandat">*</span></label></div> <div class="col-sm-4"> <div class="form-group"> <input type="number" class="form-control" name=""> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Weight(kg)</label></div> <div class="col-sm-4"> <div class="form-group"> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row heigh"> <div class="col-sm-2"><label>Height</label></div> <div class="col-sm-10"> <ul> <li><input type="text" class="form-control" name="" id="hieght"><label>Feet</label></li> <li><input type="text" class="form-control" name="" id="hieght"><label>Inches or</label></li> <li><input type="text" class="form-control" name="" id="hieght"><label>cms</label></li> </ul> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>BMI</label></div> <div class="col-sm-4"> <div class="form-group"> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Block Procedure Date and Time<span class="mandat">*</span></label></div> <div class="col-sm-4"> <div class="form-group"> <!-- <input type="text" class="form-control" id="from_date" name=""> --> <input type="text" class="form-control" id='datetimepicker1' name="" placeholder=""> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-4"> <div class="form-group"> <input type="text" class="form-control" id='mytimeicker' name=""> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>CNB done by<span class="mandat">*</span></label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Consultant</option> <option>Trainee</option> </select> <select class="form-control" style="margin: 15px 0;"> <option>Junior Consultant</option> <option>Senior Consultant</option> <option>Junior Trainee</option> <option>Senior Trianee</option> </select> </div> <div class="col-sm-6"><a href="#" data-toggle="tooltip" title="Junior Consultant < 5 years experience , Senior Consultant > 5 years experience , Junior Trainee < 2 years experience , Senior Trainee > 2 years experience"><i class="fa fa-info-circle" aria-hidden="true"></i></a></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Supervision<span class="mandat">*</span></label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Direct Supervision</option> <option>Independent Supervision</option> </select> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row" style="padding-top:15px;"> <div class="col-sm-2"><label>Hospital</label></div> <div class="col-sm-4"> <input type="text" class="form-control" name=""> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-7"></div> <div class="col-sm-5 pt"> <button type="button" class="btn-save">Save</button> <button type="button" class="btn-close">Close</button> </div> </div><!--row--> </form> </div><!--modal-body--> </div><!--modal-content--> </div> </div> </section><!--edit-patient--> <!------------------------------------------------EDIT-PATIENT-END----------------------------------> </div><!--col-3--> <div class="col-sm-9"> <div class="home-right"> <ul class="nav nav-tabs" role="tablist"> <li role="presentation" class="active"><a href="#home" aria-controls="home" role="tab" data-toggle="tab">Patient Details</a></li> <li role="presentation"><a href="#consent" aria-controls="consent" role="tab" data-toggle="tab">E-Consent</a></li> <li role="presentation"><a href="#profile" aria-controls="profile" role="tab" data-toggle="tab">Pre Op</a></li> <li role="presentation"><a href="#messages" aria-controls="messages" role="tab" data-toggle="tab">Procedure</a></li> <li role="presentation"><a href="#settings" aria-controls="settings" role="tab" data-toggle="tab">PACU</a></li> <li role="presentation"><a href="#about" aria-controls="about" role="tab" data-toggle="tab">Follow Up</a></li> <li role="presentation"><a href="#contact" aria-controls="contact" role="tab" data-toggle="tab">Feedback</a></li> </ul> <!--Tab-Panes--> <div class="tab-content"> <!---------------------------------PATIENT-DETAILS-START--------------------------> <div role="tabpanel" class="tab-pane active" id="home"> <section class="patient-details"> <div class="row"> <div class="col-sm-4"></div> <div class="col-sm-8" style="text-align: end;"> <button type="button" class="btn-edit" data-toggle="modal" data-target="#myModal1" style="margin:5px;">Edit</button> <button type="button" class="btn-upload"style="margin:5px;">Upload Patient Record</button> <button type="button" class="btn-close">Delete Patient</button> </div> </div><!--row--> <div class="pat-table"> <div class="table-responsive"> <table class="table"> <thead> <tr> <th id="patid">Name</th> <th id="patid1">Paient ID</th> <th id="patid2">Paient Email-ID</th> <th id="patid3">RADUID</th> </tr> </thead> <tbody> <tr> <td>Admin001</td> <td>PAT1234</td> <td>admin001@gmail.com</td> <td>1HH8Y7TI3L</td> </tr> </tbody> </table> </div><!--table-responsive--> </div><!--pat-table--> <div class="pat-table"> <div class="table-responsive"> <table class="table"> <thead> <tr> <th id="patid">Gender</th> <th id="patid">Age</th> <th id="patid2">Weight(Kg)</th> <th id="patid">Height</th> <th>BMI</th> </tr> </thead> <tbody> <tr> <td>Female</td> <td>25</td> <td>95</td> <td>5.5</td> <td></td> </tr> </tbody> </table> </div><!--table-responsive--> </div><!--pat-table--> <h5><b>Details</b></h5> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Procedure <br> Date and Time</td> <td>1/31/2022 12:09:00 P.M</td> </tr> <tr> <td class="bg-pat2">CNB Done By</td> <td>Consultant</td> </tr> <tr> <td class="bg-pat2">Supervision</td> <td>Direct Supervision</td> </tr> <tr> <td class="bg-pat2">Hospital Name</td> <td>Text</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> </section> </div><!---Tab1---> <!---------------------------------PATIENT-DETAILS-END--------------------------> <!----------------------------------E-CONSENT START-----------------------------> <div role="tabpanel" class="tab-pane" id="consent"> <section class="e-consent"> <form> <h5><b>Patient E-Consent</b><a href="#" data-toggle="tooltip" data-placement="bottom" title="This section can be used to send electronic consent form to patients by email for use of their data in the quality improvement activity."><i class="fa fa-info-circle" aria-hidden="true"></i></a></h5> <p>I hereby give consent to the doctor to utilise my de-identified clinical data from routine activity on RAD app towards improvement in safety and quality.</p> <p>I also give consent to obtain e-feedback regarding Patient related outcome measures.</p> <div class="row"> <div class="col-sm-4"></div> <div class="col-sm-4 custom-check"> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>Agree </label> </div> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something">Optout </label> </div> </div> <div class="col-sm-4"></div> </div><!--row--> <p><i>Following is the text sent to patients for their consent. Do type an optional message that will also be added to the consent document which will be emailed to the patient.</i></p> <div class="email-to-patient"> <h5><b>Consent Email to Patients</b></h5> <h6><b>Hello Sir / Madam,</b></h6> <p style="text-align: initial;">Please note that you have provided consent to the doctor to utilize your de-identified clinical data from routine activity on RAD app towards improvement in safety and quality.</p> <h6><b>Message</b></h6> <div class="text-patient"> <input type="text" name=""> </div> <h6 id="consent-tag"><b>Thank You</b></h6> <h6 id="consent-tag"><b>Medusys - Global Anaeshesia Society</b></h6> <h6><b>Healthcare Team</b></h6> <div class="row"> <div class="col-sm-10"></div> <div class="col-sm-2"><button type="button">Send Email</button></div> </div> </div> </form> </section><!--e-consent--> </div><!---Tab2---> <!----------------------------------E-CONSENT START-----------------------------> <!-----------------------------------------ADD PRE-OP START-------------------------> <div role="tabpanel" class="tab-pane" id="profile"> <section class="add-preop"> <form> <h3>Add Pre-op</h3> <div class="row"> <div class="col-sm-2"><label>Speciality<span class="mandat">*</span></label></div> <div class="col-sm-6"> <div class="form-group"> <select class="form-control" id="sel1" name="sellist1"> <option>General Surgery</option> <option>Gynaecology</option> <option>Orthopaedics</option> <option>Plastic surgery</option> <option>Cardiothoracic surgery</option> <option>Vascular Surgery</option> <option>Neuro-spine</option> <option>Urology</option> <option>Other</option> </select> </div> </div> <div class="col-sm-4"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Surgery Location<span class="mandat">*</span></label></div> <div class="col-sm-6"> <select class="form-control"> <option>Select</option> <option>Thorax</option> <option>Spine and Spinal Cord</option> <option>Upper Abdomen</option> <option>Lowe Abdomen</option> <option>Pereneum</option> <option>Pelvis (Except Hip)</option> <option>Upper Leg (Except Knee)</option> <option>Knee and Popliteal Area</option> <option>Lower Leg (Below Knee)</option> </select> </div> <div class="col-sm-4"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Surgery<span class="mandat">*</span></label></div> <div class="col-sm-6"> <input type="text" class="form-control" name=""> <input list="browsers" class="form-control" name="browser" id="browser" style="margin:15px 0;"> <datalist id="browsers"> <option value="Edge"> <option value="Firefox"> <option value="Chrome"> <option value="Opera"> <option value="Safari"> </datalist> </div> <div class="col-sm-4"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Minimally invasive<span class="mandat">*</span></label></div> <div class="col-sm-4" id="add-minimal"> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> <a href="#" data-toggle="tooltip" title="Enter Hospital Patient-Id here"><i class="fa fa-info-circle" aria-hidden="true"></i></a> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-3"> <label>Operation/Procedure Category<span class="mandat">*</span></label> </div> <div class="col-sm-4"> <div class="form-check-inline"> <label class="form-check-label"> <input type="radio" class="form-check-input" name="optradio">Emergency </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="radio" class="form-check-input" name="optradio">Elective </label> </div> </div> <div class="col-sm-5"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>ASA</label></div> <div class="col-sm-4"> <div class="form-group"> <select class="form-control"> <option>Select</option> <option>ASA 1</option> <option>ASA 2</option> <option>ASA 3</option> </select> </div> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Co-morbid Conditions</label></div> <div class="col-sm-10"> <div class="t-switch"> <ul> <li> <div class="togle"> <label>Diabetes Mellitus</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> <li> <div class="togle"> <label>CVS disease</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> <li> <div class="togle"> <label>Respiratory disease</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> </ul><!--------------------> <ul> <li> <div class="togle"> <label>Fever / Infection</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> <li> <div class="togle"> <label>Renal Disorders</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> <li> <div class="togle"> <label>Bleeding disorder<a href="#" data-toggle="tooltip" title="For Bleeding disorder includes but not limited to Anti-Coagulation/Coagulopathy, Anti-platelet agent/platelet disorder, Vascular disorder"><i class="fa fa-info-circle" aria-hidden="true"></i></a></label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> </ul><!--------------------> <ul> <li> <div class="togle"> <label>Anaemia</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> <li> <div class="togle"> <label>Malignancy</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> <li> <div class="togle"> <label id="spine">Spine/back problems</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> </ul><!--------------------> <ul> <li> <div class="togle"> <label>Neurological disorders</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> <li> <div class="togle"> <label>Other</label> <div class= "box_1"> <input type="text" name="" style="border-radius: 20px;"> </div> </div> </li> </ul><!--------------------> </div> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Purpose of CNB<span class="mandat">*</span></label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Sole/Primary Anaesthetic</option> <option>For Analgesia only</option> </select> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Clinical Standards</label></div> <div class="col-sm-10"> <div class="t-switch"> <ul> <li> <div class="togle"> <label>Lipid Rescue Available</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> <li style="width: initial;"> <div class="togle"> <label style="width:initial">Resuscitation Equipment Available</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> </ul><!--------------------> <ul> <li> <div class="togle"> <label style="">Consent Taken</label> <div class="box_1"> <input type="checkbox" class="switch_1"> </div> </div> <div class="togle"> <label>Time Out / Correct Side Check Done</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> <div class="togle"> <label>Basic Monitoring (ECG, BP or Pulse Oximetry)</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> </ul><!--------------------> </div> </div> </div><!--row--> <div class="row"> <div class="col-sm-7"></div> <div class="col-sm-5"> <button type="button" class="btn-save">Save</button> <button type="button" class="btn-close">Close</button> </div> </div><!--row--> </form> </section><!--add-preop---> <!--------------------------------------PRE-OP-DETAILS--------------------------> <section class="pre-op-details" style="display:none;"> <div class="row"> <div class="col-sm-7"></div> <div class="col-sm-5" style="text-align:end;"> <button type="button" class="btn-edit" data-toggle="modal" data-target="#myModal3">Edit</button> <button type="button" class="btn-delete">Delete</button> </div> </div><!--row--> <div class="preop-table"> <div class="table-responsive"> <table class="table"> <thead> <tr> <th id="pre-op-head">Speciality</th> <th id="pre-op-head">Surgery Location</th> <th id="pre-op-head">Surgery</th> </tr> </thead> <tbody> <tr> <td>Obstetrics</td> <td>Thorax</td> <td>Text</td> </tr> </tbody> </table> </div><!--table-responsive--> </div><!--preop-table--> <div class="preop-table"> <div class="table-responsive"> <table class="table"> <thead> <tr> <th id="pre-op-head">Minimally invasive</th> <th id="pre-op-head">Operation/Procedure Category</th> <th id="pre-op-head">ASA</th> </tr> </thead> <tbody> <tr> <td>No</td> <td>Emergency</td> <td>ASA1</td> </tr> </tbody> </table> </div><!--table-responsive--> </div><!--preop-table--> <h5><b>Co-morbid Conditions</b></h5> <div class="preop-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Diabetes Mellitus</td> <td>Yes</td> </tr> <tr> <td class="bg-pat2">CVS disease</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Respiratory disease</td> <td>Yes</td> </tr> <tr> <td class="bg-pat2">Neurological disorders</td> <td>Yes</td> </tr> <tr> <td class="bg-pat2">Renal Disorders</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Spine/back problems</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Fever/Infection</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Bleeding disorder</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Anaemia</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Malignancy</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Other</td> <td>No</td> </tr> </tbody> </table> </div> </div><!--preop-table2--> <div class="preop-table"> <div class="table-responsive"> <table class="table"> <thead> <tr> <th id="">Purpose of CNB</th> </tr> </thead> <tbody> <tr> <td>Sale Anaesthetic & Analgesic</td> </tr> </tbody> </table> </div><!--table-responsive--> </div><!--preop-table--> <h5><b>Clinical Standards</b></h5> <div class="preop-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Basic Monitoring (ECG, BP or Pulse Oximetry)</td> <td>Yes</td> </tr> <tr> <td class="bg-pat2">Resuscitation Equipment Available</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Lipid Rescue Available</td> <td>Yes</td> </tr> <tr> <td class="bg-pat2">Time Out / Correct Side Check Done</td> <td>Yes</td> </tr> <tr> <td class="bg-pat2">Consent Taken/td> <td>Yes</td> </tr> </tbody> </table> </div> </div><!--preop-table2--> </section><!--pre-op-details--> <!--------------------------------edit preop----------------------------------> <section class="edit-preop"> <!-- The Modal --> <div class="modal" id="myModal3"> <div class="modal-dialog modal-lg"> <div class="modal-content"> <!-- Modal Header --> <div class="modal-header" id="add-header"> <h4 class="modal-title">Edit Preop</h4> <button type="button" class="close" data-dismiss="modal">×</button> </div> <!-- Modal body --> <div class="modal-body"> <form> <div class="row"> <div class="col-sm-2"><label>Speciality</label></div> <div class="col-sm-6"> <div class="form-group"> <select class="form-control" id="sel1" name="sellist1"> <option>General Surgery</option> </select> </div> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>ASA</label></div> <div class="col-sm-4"> <div class="form-group"> <select class="form-control"> <option>ASA 1</option> </select> </div> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Co-morbid Conditions</label></div> <div class="col-sm-10"> <div class="t-switch"> <ul> <li> <div class="togle"> <label>Diabetes Mellitus</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> </ul><!--------------------> </div> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Clinical Standards</label></div> <div class="col-sm-10"> <div class="t-switch"> <ul> <li> <div class="togle"> <label>Lipid Rescue Available</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> </ul><!--------------------> </div> </div> </div><!--row--> <div class="row"> <div class="col-sm-7"></div> <div class="col-sm-5"> <button type="button" class="btn-save">Save</button> <button type="button" class="btn-close">Close</button> </div> </div> </form> </div><!--modal-body--> </div> </div> </div> </section> </div><!---Tab3---> <!----------------------------------------ADD PRE-OP END----------------------------> <!-------------------------------------------PROCEDURE START-----------------------> <div role="tabpanel" class="tab-pane" id="messages"> <div class="procedure-buttons"> <div class="row"> <button type="button" class="btn-procedure" data-toggle="modal" data-target="#spinal-epi"> Combined Spianl Epidural </button> </div> <div class="row pt"> <button type="button" class="btn-procedure" data-toggle="modal" data-target="#epidural"> Epidural </button> </div> <div class="row pt"> <button type="button" class="btn-procedure" data-toggle="modal" data-target="#spinal"> Spianl </button> </div> <div class="row pt"> <button type="button" class="btn-procedure" data-toggle="modal" data-target="#csa"> CSA - Continous Spinal Anaesthesia </button> </div> </div><!--procedure-buttons--> <!---------------------------------modal-spinal--------------------------> <div class="modal" id="spinal-epi"> <div class="modal-dialog modal-lg"> <div class="modal-content"> <!-- Modal Header --> <div class="modal-header" id="add-header"> <h4 class="modal-title">Add Combined Spianl Epidural</h4> <button type="button" class="close" data-dismiss="modal">×</button> </div> <!-- Modal body --> <div class="modal-body"> <section class="comb-spinal-epi"> <form> <label>Patient status during Neuraxial Block<span class="mandat">*</span></label> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-6"> <div class="form-check"> <label class="form-check-label"> <input type="radio" class="form-check-input" name="optradio">Awake </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="radio" class="form-check-input" name="optradio">Sedation </label> </div> <div class="pt"> <select class="form-control" readonly> <option>Select</option> <option>1-Mild easy to rouse</option> <option>2-Moderate,easy to rouse,unable to remain awake</option> <option>3-Difficult to rouse</option> </select> </div> <div class="form-check"> <label class="form-check-label"> <input type="radio" class="form-check-input" name="optradio">GA </label> </div> </div> <div class="col-sm-4"></div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"><label style="font-size:13px;">Patient Position<span class="mandat">*</span></label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Lateral</option> <option>Sitting</option> <option>Prone</option> </select> </div> <div class="col-sm-4"></div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"><label>Asepsis<span class="mandat">*</span></label></div> <div class="col-sm-10"> <div class="t-switch"> <ul> <li> <div class="togle"> <label>Wearing cap and mask</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> <li> <div class="togle"> <label>Hand washing</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> </ul><!--------------------> <ul> <li> <div class="togle"> <label>Sterile gown</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> <li> <div class="togle"> <label>Sterile draping</label> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> </li> </ul><!--------------------> </div> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Skin Prep<span class="mandat">*</span></label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Alcohol</option> <option>Chlorhexitine</option> <option>Betadine</option> <option>Combinations</option> <option>Other</option> </select> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"><span><b>CSE Technique</b><span class="mandat">*</span></span></div> <div class="col-sm-5"> <select class="form-control"> <option>Select</option> <option>Single Interspace Technique(Needle through Needle)</option> <option>Double Interspace Technique</option> <option>DPE:Dural Puncture Epidural Technique</option> </select> </div> <div class="col-sm-5"></div> </div><!--row--> <!-- <h5><b>Epidural<span class="mandat">*</span></b></h5> --> <div class="row pt"> <div class="col-sm-2"><label>Anatomical Landmark<span class="mandat">*</span></label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Easily Palpable</option> <option>Poorly Palpable</option> <option>Non Palpable</option> </select> </div> </div><!--row--> <div class="row"> <div class="col-sm-3"><h5><b>Epidural Level</b></h5></div> <div class="col-sm-2"><button type="button" class="btn">C4-5</button></div> <div class="col-sm-7"></div> </div><!--row--> <div class="row human-skeleton"> <div class="col-sm-12"> <img src="images/Lev.png" class="img-fluid d-block mx-auto"> <button type="button" class="btn">C1-2</button> <button type="button" class="btn" id="c2-3">C2-3</button> <button type="button" class="btn" id="c2-4">C2-4</button> <button type="button" class="btn" id="c2-5">C2-5</button> <button type="button" class="btn" id="c2-6">C2-6</button> <button type="button" class="btn" id="c2-7">C2-7</button> <button type="button" class="btn" id="c2-8">C2-7</button> <button type="button" class="btn" id="c2-9">C2-7</button> <button type="button" class="btn" id="c2-10">C2-7</button> <button type="button" class="btn" id="c2-11">C2-7</button> <button type="button" class="btn" id="c2-12">C2-7</button> <button type="button" class="btn" id="c2-13">C2-7</button> <button type="button" class="btn" id="c2-14">C2-7</button> <button type="button" class="btn" id="c2-15">C2-7</button> <button type="button" class="btn" id="c2-16">C2-7</button> <button type="button" class="btn" id="c2-17">C2-7</button> <button type="button" class="btn" id="c2-18">C2-7</button> <button type="button" class="btn" id="c2-19">C2-7</button> <button type="button" class="btn" id="c2-20">C2-7</button> <button type="button" class="btn" id="c2-21">C2-7</button> <button type="button" class="btn" id="c2-22">C2-7</button> <button type="button" class="btn" id="c2-23">C2-7</button> <button type="button" class="btn" id="c2-24">C2-7</button> <button type="button" class="btn" id="c2-25">C2-7</button> <button type="button" class="btn" id="c2-26">C2-7</button> </div> </div><!--row--> <h4><b>Epidural Section of CSE</b></h4> <h5><b>Ultrasound</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-4"> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"></div> <div class="col-sm-2"><span>Probe Cover</span></div> <div class="col-sm-4"> <select class="form-control"> <option>Select probe cover</option> <option>Yes</option> <option>No</option> </select> </div> <div class="col-sm-4"></div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"></div> <div class="col-sm-2"><span>Image Quality</span></div> <div class="col-sm-4"> <select class="form-control"> <option>Select image quality</option> <option>Good</option> <option>Average</option> <option>Poor</option> </select> </div> <div class="col-sm-4"></div> </div><!--row--> <h5><b>Needle Brand,Type and Size</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10"> <span>Select Needle Brand</span> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>B-Braun</option> <option>Vygon</option> <option>Polymed</option> <option>Portex</option> <option>Top</option> <option>BD</option> <option>Parjunk</option> <option>Romsons</option> <option>Other</option> </select> </div> <div class="col-sm-6"></div> </div> </div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"></div> <div class="col-sm-10"> <span>Select Epidural Needle Type</span> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Touhy</option> <option>Crawford</option> <option>Hustead</option> <option>Other</option> </select> </div> <div class="col-sm-6"></div> </div> </div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"></div> <div class="col-sm-10"> <span>Select Epidural Needle Size</span> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-4"> <select class="form-control"> <option>Select needle size</option> <option>16G</option> <option>17G</option> <option>18G</option> <option>19G</option> <option>20G</option> <option>21G</option> <option>22G</option> <option>23G</option> <option>24G</option> </select> </div> <div class="col-sm-6"></div> </div> </div> </div><!--row--> <h5><b>Epidural Technique</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-6"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">LOR Saline </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">LOR Air </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Hanging Drop </label> </div> <div class="form-check" id="proced-plus" style="display:flex;"> <label class="form-check-label" style="margin-right:8px;"> <input type="checkbox" class="form-check-input" value="">Other </label> <input type="text" class="form-control" name="" readonly=""> <button><i class="fa fa-plus" aria-hidden="true"></i></button> </div> </div> <div class="col-sm-4"></div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"><label>Approach</label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Midline</option> <option>Paramedian</option> </select> </div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"><label>Number Of Attempts</label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>1</option> <option>2</option> <option>3</option> <option>4</option> <option>5</option> <option>6</option> <option>7</option> <option>8</option> <option>9</option> <option>10</option> <option>11</option> <option>12</option> <option>13</option> <option>14</option> <option>15</option> <option>16</option> <option>17</option> <option>18</option> <option>19</option> <option>20</option> </select> </div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"><label>Epidural Depth(cm)</label></div> <div class="col-sm-4"> <input type="text" class="form-control" name=""> </div> </div><!--row--> <label>Technique</label> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-8"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Single Shot </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Catheter </label> </div> <div class="pt" style="display:flex;"> <span>Catheter mark at Skin (cm)</span> <input type="text" class="form-control" name="" readonly="" style="width:30%;"> </div> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Test Dose</label></div> <div class="col-sm-4"> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Intra Operative LA Regimen</label></div> <div class="col-sm-4"> <select class="form-control" readonly> <option>Select</option> <option>Continous Infusion</option> <option>Intermitten Bolus</option> </select> </div> <div class="col-sm-6"></div> </div><!--row--> <h5 class="pt"><b>Total Intra Operative LA & Adjuvant Consumption<a href="#" data-toggle="tooltip" title="This includes Test Dose,Initial Dose and Total Intra Operative Use"><i class="fa fa-info-circle" aria-hidden="true"></i></a></b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10"> <label>Local Anaesthetic</label> <div class="pac-box"> <div class="pacu-1"><p>Ropivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Bupivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Levobupivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Lignocaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> </div><!--col-10--> </div><!--row--> <div class="row pt"> <div class="col-sm-2"></div> <div class="col-sm-10"> <h5><b>Adjuvant</b></h5> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Opioid </label> </div> <div class="pt" id="proced-plus" style=""> <div class="row" style="margin-left:3%;"> <div class="col-sm-4"><span>Opioid Name</span></div> <div class="col-sm-6"><input type="text" class="form-control" name="" readonly></div> <div class="col-sm-2"> <button><i class="fa fa-plus" aria-hidden="true"></i></button></div> </div><!--row--> <div class="row pt" style="margin-left:3%;"> <div class="col-sm-4"><span>Opioid Dose(microgram equivalent)</span></div> <div class="col-sm-8"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row pt"> <div class="col-sm-5"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Clonidne with Dose(mcgm) </label> </div> </div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row pt"> <div class="col-sm-5"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Dexmeditomidine with Dose(mcgm) </label> </div> </div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row pt"> <div class="col-sm-5"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Dexamethasone with Dose(mg) </label> </div> </div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row pt"> <div class="col-sm-5"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Tramadol with Dose(mg) </label> </div> </div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row pt"> <div class="col-sm-5"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Adrenaline(Epinephrine)(mcmg) </label> </div> </div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row"> <div class="col-sm-8"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Other </label> </div> <div class="row pt"> <div class="col-sm-4"><span>Adjuvant Name</span></div> <div class="col-sm-7" id="proced-plus" style="display: flex;"><input type="text" class="form-control" name=""> <button><i class="fa fa-plus" aria-hidden="true"></i></button></div> <div class="col-sm-1"></div> </div> <div class="row pt"> <div class="col-sm-4"><span>Adjuvant Dose(mg)</span></div> <div class="col-sm-7"><input type="text" class="form-control" name=""></div> <div class="col-sm-1"></div> </div> </div> </div><!--row--> </div> </div> </div><!--row--> <h4><b>Spinal Anaesthesia<span class="mandat">*</span></b></h4> <div class="row"> <div class="col-sm-2"><label>Anatomical Landmark</label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Easily Palpable</option> </select> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Spinal Level</label></div> <div class="col-sm-2"><button type="button" class="btn">T3-4</button></div> <div class="col-sm-8"></div> </div><!--row--> <div class="row human-skeleton"> <div class="col-sm-12"> <img src="images/level.png" class="img-fluid d-block mx-auto"> <button type="button" class="btn">C1-2</button> <button type="button" class="btn" id="c2-3">C2-3</button> </div> </div><!--row--> <h5><b>Spinal Needle Type and Size</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10"> <span>Select Spinal Needle Brand</span> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-4 pt"> <select class="form-control"> <option>Select</option> <option>B-Braun</option> <option>Vygon</option> <option>Polymed</option> <option>Portex</option> <option>Top</option> <option>BD</option> <option>Parjunk</option> <option>Romsons</option> <option>Other</option> </select> </div> <div class="col-sm-6"></div> </div> </div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"></div> <div class="col-sm-10"> <span>Select Spinal Needle Type</span> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-4 pt"> <select class="form-control"> <option>Select</option> <option>Quincke</option> <option>Sprotte</option> <option>Whitacre</option> <option>Other</option> </select> </div> <div class="col-sm-6"></div> </div> </div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"></div> <div class="col-sm-10"> <span>Select Spinal Needle Size</span> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-4 pt"> <select class="form-control"> <option>Select needle size</option> <option>18G</option> <option>19G</option> <option>20G</option> <option>21G</option> <option>22G</option> <option>23G</option> <option>24G</option> <option>25G</option> <option>26G</option> <option>27G</option> <option>28G</option> <option>29G</option> <option>30G</option> <option>31G</option> <option>32G</option> </select> </div> <div class="col-sm-6"></div> </div> </div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"><label>Approach</label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>Midline</option> <option>Paramedian</option> </select> </div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"><label>Number of Attempts</label></div> <div class="col-sm-4"> <select class="form-control"> <option>Select</option> <option>1</option> <option>2</option> <option>3</option> <option>4</option> <option>5</option> <option>6</option> <option>7</option> <option>8</option> <option>9</option> <option>10</option> <option>11</option> <option>12</option> <option>13</option> <option>14</option> <option>15</option> <option>16</option> <option>17</option> <option>18</option> <option>19</option> <option>20</option> </select> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"><label>Spinal Anaesthetic</label></div> <div class="col-sm-4"> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10"> <span><b>Local Anaesthetic</b></span> <div class="procedure-cse"> <div class="pac-box"> <div class="pacu-1"><p>Lignocaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Heavy</option> <option>Iso/Hypobaric</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Bupivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Heavy</option> <option>Iso/Hypobaric</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Ropivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Heavy</option> <option>Iso/Hypobaric</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Prilocaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Heavy</option> <option>Iso/Hypobaric</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>2-chloroprocaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Heavy</option> <option>Iso/Hypobaric</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <p>Other</p> <div class="pac-box"> <div class="pacu-1"><p>Name</p></div> <div class="pacu-1-x"> <input type="text" class="form-control" name=""> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> </div><!--procedure-cse--> </div> </div><!--row--> <div class="row pt"> <div class="col-sm-2"> <h5><b>Adjuvant</b></h5> </div> <div class="col-sm-2"> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> <div class="col-sm-8"></div> </div><!--row--> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10"> <div class="pt" id="proced-plus" style=""> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Opioid </label> </div> <div class="row" style="margin-left: 3%;"> <div class="col-sm-5"> <span>Opioid Name</span> </div> <div class="col-sm-7" style="display: flex;"><input type="text" class="form-control" name="" readonly><button><i class="fa fa-plus" aria-hidden="true"></i></button></div> </div><!--row--> <div class="row pt" style="margin-left: 3%;"> <div class="col-sm-5"><span>Opioid Dose(microgram equivalent)</span></div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row pt"> <div class="col-sm-5"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Clonidne with Dose(mcgm) </label> </div> </div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row pt"> <div class="col-sm-5"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Dexmeditomidine with Dose(mcgm) </label> </div> </div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row pt"> <div class="col-sm-5"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Dexamethasone with Dose(mg) </label> </div> </div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row pt"> <div class="col-sm-5"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Tramadol with Dose(mg) </label> </div> </div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row pt"> <div class="col-sm-5"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Adrenaline(Epinephrine)(mcmg) </label> </div> </div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="row"> <div class="col-sm-8"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Other </label> </div> <div class="row pt"> <div class="col-sm-4"><span>Adjuvant Name</span></div> <div class="col-sm-7" id="proced-plus" style="display: flex;"><input type="text" class="form-control" name="" readonly> <button><i class="fa fa-plus" aria-hidden="true"></i></button></div> <div class="col-sm-1"></div> </div> <div class="row pt"> <div class="col-sm-4"><span>Adjuvant Dose(mg)</span></div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> <div class="col-sm-1"></div> </div> </div> </div><!--row--> </div> </div><!--col-10--> </div><!--row--> <h4 class="pt"><b>Analgesia supplementation required<span class="mandat">*</span></b></h4> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10"> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> <div class="analg-box"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Inhalation Analgesia </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">IV Analgesia </label> </div> <div class="form-check" style="margin-left: 3%;"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Opioids </label> </div> <div class="row" style="margin-left: 3%;"> <div class="col-sm-5"> <span>Opioid Name</span> </div> <div class="col-sm-7" id="proced-plus" style="display: flex;"><input type="text" class="form-control" name="" readonly><button><i class="fa fa-plus" aria-hidden="true"></i></button></div> </div><!--row--> <div class="row pt" style="margin-left: 3%;"> <div class="col-sm-5"><span>Opioid Dose(microgram equivalent)</span></div> <div class="col-sm-7"><input type="text" class="form-control" name="" readonly></div> </div><!--row--> <div class="form-check" style="margin-left: 3%;"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Multi-Modal Analgesia </label> </div> <div class="form-check" style="margin-left: 5%;"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Ketamine </label> </div> <div class="form-check" style="margin-left: 5%;"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Dexmedetomidine </label> </div> <div class="form-check" style="margin-left: 5%;"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Clonidine </label> </div> <div class="form-check" style="margin-left: 5%;"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Tramadol </label> </div> <div class="form-check" style="margin-left: 5%;"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Magnesium </label> </div> <div class="form-check" style="margin-left: 5%;"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Other IV Adjuncts </label> </div> <div class="row"> <div class="col-sm-1"></div> <div class="col-sm-3"><label>Adjuvnat Name</label></div> <div class="col-sm-4"> <input type="text" class="form-control" name="" readonly> </div> <div class="col-sm-4"></div> </div> <div class="row pt"> <div class="col-sm-1"></div> <div class="col-sm-3"><label>Adjuvnat Dose(mg)</label></div> <div class="col-sm-4"> <input type="text" class="form-control" name="" readonly> </div> <div class="col-sm-4"></div> </div> </div> </div><!--col-10--> </div><!--row--> <h4 class="pt"><b>Technical complications<span class="mandat">*</span></b> <a href="#" data-toggle="tooltip" title="hi"><i class="fa fa-info-circle" aria-hidden="true"></i></a></h4> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10"> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> <div class="tech-compli"> <ul> <li> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Equipment related </label> </div> </li> <li> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Multiple attempts </label> </div> </li> <li> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">2nd Anaesthetist </label> </div> </li> </ul> <ul> <li> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Technique abandoned/failure to find space </label> </div> </li> <li> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Catheter related </label> </div> </li> </ul> <ul> <li> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Other </label> </div> </li> <li> <input type="text" class="form-control" name="" readonly> </li> </ul> </div> </div> </div><!--row--> <h4 class="pt"><b>Acute complications<span class="mandat">*</span></b></h4> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10"> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Epidural re-sited </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Local Anaesthetic systemic toxicity(LAST) </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Respiratory Arrest </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Cardiac Arrest </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Radicular Pain (needle/catheter) </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Paresthesia Pain (needle/catheter) </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Bloody Tap (needle/catheter) </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Wet Tap/Dural puncture (needle/catheter) </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Hypotension <a href="#" data-toggle="tooltip" title="hi"><i class="fa fa-info-circle" aria-hidden="true"></i></a> </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Nausea </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Vomiting </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">High Block <a href="#" data-toggle="tooltip" title="hi"><i class="fa fa-info-circle" aria-hidden="true"></i></a> </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Subdural Block </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Motor Block </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Tatal Spinal <a href="#" data-toggle="tooltip" title="hi"><i class="fa fa-info-circle" aria-hidden="true"></i></a> </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Accidental Dural Puncture </label> </div> <div class="form-check" style="display: flex;"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Other </label> <input type="text" class="form-control" name="" style="width: 30%;" readonly> </div> </div> </div><!--row--> <h4 class="pt"><b>Success<span class="mandat">*</span></b></h4> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-6"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Compelete Success<a href="#" data-toggle="tooltip" title="hi"><i class="fa fa-info-circle" aria-hidden="true"></i></a> </label> </div> <ul class="success-list"> <li>Onset</li> <li><input type="text" class="form-control" name="" readonly></li> <li>(Mins)</li> </ul> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Partial Success </label> </div> <ul class="success-list"> <li>Onset</li> <li><input type="text" class="form-control" name="" readonly></li> <li>(Mins)</li> </ul> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Failure </label> </div> </div> <div class="col-sm-4"></div> </div><!--row--> <h4><b>Sensory Level</b><span class="mandat">*</span><a href="#" data-toggle="tooltip" title="hi"><i class="fa fa-info-circle" aria-hidden="true"></i></a></h4> </form> </section><!--comb-spinal-epi--> </div><!--modal-body--> </div> </div> </div><!--spinal-epi--> </div><!--Tab4--> <!----------------------------------------PROCEDURE END----------------------------> <!-----------------------------------PACU START-----------------------------------> <div role="tabpanel" class="tab-pane" id="settings"> <section class="add-pacu"> <h3>Add Post-Op Care Unit/Recovery</h3> <form> <h5><b>Pain Score (0-10) (0:Min,10:Max)</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>Post Procedure</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select pain score on arrival</option> <option>0</option> <option>1</option> <option>2</option> <option>3</option> <option>4</option> <option>5</option> <option>6</option> <option>7</option> <option>8</option> <option>9</option> <option>10</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>30 Min</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select pain score in 30 min</option> <option>0</option> <option>1</option> <option>2</option> <option>3</option> <option>4</option> <option>5</option> <option>6</option> <option>7</option> <option>8</option> <option>9</option> <option>10</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>One Hour</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select pain score in one hour</option> <option>0</option> <option>1</option> <option>2</option> <option>3</option> <option>4</option> <option>5</option> <option>6</option> <option>7</option> <option>8</option> <option>9</option> <option>10</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <h5><b>Nausea & Vomiting Score (0-3)</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>Post Procedure</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select score at arrival</option> <option>0-No Nausea</option> <option>1-Mild Nausea not requiring treatment</option> <option>2-Vomiting</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>30 Min</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select score at 30 min</option> <option>0-No Nausea</option> <option>1-Mild Nausea not requiring treatment</option> <option>2-Vomiting</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>One Hour</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select score at 1 hour</option> <option>0-No Nausea</option> <option>1-Mild Nausea not requiring treatment</option> <option>2-Vomiting</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <h5><b>Sedation Score (1-3)</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>Post Procedure</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select sedation score on arrival</option> <option>0-Awake</option> <option>1-Mild,easy to rouse</option> <option>2-Moderate,eay to rouse, unable to remain...</option> <option>3-Difficult to rouse</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>30 Min</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select sedation score in 30 min</option> <option>0-Awake</option> <option>1-Mild,easy to rouse</option> <option>2-Moderate,eay to rouse, unable to remain...</option> <option>3-Difficult to rouse</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>One Hour</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select sedation score in one hour</option> <option>0</option> <option>1</option> <option>2</option> <option>3</option> <option>4</option> <option>5</option> <option>6</option> <option>7</option> <option>8</option> <option>9</option> <option>10</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-4"><label>Time Spent in Recovery (mins)</label></div> <div class="col-sm-4"> <input type="number" class="form-control" name=""> </div> <div class="col-sm-4"></div> </div><!--row--> <h5><b>Analgesia Supplement in Recovery</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-6"> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> <div class="form-check" id="id"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Intravenous Opioids </label> <a href="#" data-toggle="tooltip" title="Intravenous Opioids includes but not restricted to Fenatanyl,morphine,oxycodone,pethidina,Pentazocina,bupranorphina,butorphenol,nalbuphine,hydromorphine,hydrocodone,tapentadol. All dosages must be entered in milligram equvivalent only"><i class="fa fa-info-circle" aria-hidden="true"></i></a> </div> <div class="row" style="padding-top:15px;"> <div class="col-sm-6"> <div class="" id="id"> <span>Name</span> <input type="text" class="form-control" name=""> </div> </div> <div class="col-sm-6"></div> </div> <div class="row" style="padding-top:15px;"> <div class="col-sm-10"> <div class="" id="id"> <span>Dosage</span> <input type="text" class="form-control" name=""> <button><i class="fa fa-plus" aria-hidden="true"></i></button> <button><i class="fa fa-times" aria-hidden="true"></i></button> </div> </div> <div class="col-sm-2"></div> </div> <div class="form-check" id="id"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Oral Opiodis </label> <a href="#" data-toggle="tooltip" title="Oral Opiodis includes but not restricted to codine,morphine,oxycodone,hydromorphine,hydrocodone,tapentadol.All dosages must be entered in milligram equvivalent only."><i class="fa fa-info-circle" aria-hidden="true"></i></a> </div> <div class="form-check" id="id"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="All dosages must be entered in milligram equvivalent only.">Tramadol </label> <a href="#" data-toggle="tooltip" title="All dosages must be entered in milligram equvivalent only"><i class="fa fa-info-circle" aria-hidden="true"></i></a> </div> <div class="form-check" id="id"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">NSAID </label> <a href="#" data-toggle="tooltip" title="All dosages must be entered in milligram equvivalent only."><i class="fa fa-info-circle" aria-hidden="true"></i></a> </div> <div class="form-check" id="id"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Paracetemol </label> <a href="#" data-toggle="tooltip" title="All dosages must be entered in milligram equvivalent only."><i class="fa fa-info-circle" aria-hidden="true"></i></a> </div> <div class="form-check" id="id"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">LA Regimen </label> </div> <div class="" style="padding:15px 0;"> <select class="form-control"> <option>Select</option> <option>Intermittent Bolus</option> <option>LA Infusion</option> <option>PCEA</option> </select> </div> <h6><b>Total PACU (Reovery) LA & Adjuvant Consumption <a href="#" data-toggle="tooltip" title="If user enter % and vol(ml) only.The mgis calculated using the formula below mg=(concentration*vol in ml*10 . However the user should be able to edit the mg and enter the mg directly.)"><i class="fa fa-info-circle" aria-hidden="true"></i></a></b></h6> <h6 style="margin-bottom:15px;"><b>LA Regimen <a href="#" data-toggle="tooltip" title="Local Anasthetic solution(%) & volume(ml)-Ropivacaine,Bupivacaine,Levobupivacaine,Lignocaine plain,Lignocaine with or without adrenaline."><i class="fa fa-info-circle" aria-hidden="true"></i></a></b></h6> <h6><b>Local Anaesthetic</b></h6> </div><!--col-6--> </div><!--row--> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10"> <div class="pac-box"> <div class="pacu-1"><p>Ropivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Bupivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Levobupivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Legnocaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Repeat Block<a href="#" data-toggle="tooltip" title="Local Anasthetic solution(%) & volume(ml)-Ropivacaine,Bupivacaine,Levobupivacaine,Lignocaine plain,Lignocaine with or without adrenaline."><i class="fa fa-info-circle" aria-hidden="true"></i></a> </label> </div> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10"> <div class="pac-box"> <div class="pacu-1"><p>Ropivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Bupivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Levobupivacaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> <div class="pac-box"> <div class="pacu-1"><p>Legnocaine</p></div> <div class="pacu-1-x"> <select class="form-control"> <option>Select</option> <option>Without Adrenaline</option> <option>With Adrenaline</option> </select> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">%</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">ml</span> </div> <div class="pacu-1" id="id"> <input type="number" class="form-control" name="" value="0"><span style="padding-top:5px;">mg</span> </div> </div><!--pac-box--> </div> </div><!--row--> <div class="row"> <div class="col-sm-2"> </div> <div class="col-sm-10"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Other <a href="#" data-toggle="tooltip" title="All dosages must be entered in milligram equvivalent only"><i class="fa fa-info-circle" aria-hidden="true"></i></a> </label> </div> <div class="row"> <div class="" style="display:flex;"> <label style="margin-right: 5px;">Name</label> <input type="text" class="form-control" name=""> <label style="margin-right: 5px;">Dosage</label> <input type="number" class="form-control" name=""> </div> </div> </div> </div><!--row--> <h6><b>Vasopressor Use in Recovery</b></h6> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-2"> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </div> <div class="col-sm-8"></div> </div> <div class="row"> <div class="col-sm-7"></div> <div class="col-sm-5"> <button type="button" class="btn-save">Save</button> <button type="button" class="btn-close">Reset</button> </div> </div><!--row--> </form> </section><!--add-pacu--> <!--------------------------PACU DETAILS START-------------------> <section class="pacu-details" style="display:none;"> <div class="row"> <div class="col-sm-8"></div> <div class="col-sm-4"> <button type="button" class="btn-edit" data-toggle="modal" data-target="#pacu-edit" style="margin:5px;">Edit</button> <button type="button" class="btn-close">Delete Patient</button> </div> </div> <h4><b>Pain Score</b></h4> <h6>Pain Score(0-10)(0:Min,10:Max)</h6> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Post Procedure</td> <td>02</td> </tr> <tr> <td class="bg-pat2">30 Min</td> <td>03</td> </tr> <tr> <td class="bg-pat2">One Hour</td> <td>03</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <h6 class="pt">Nausea & Vomiting Score(0-3)</h6> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Post Procedure</td> <td>0-No Nausea</td> </tr> <tr> <td class="bg-pat2">30 Min</td> <td>1-Mid nausea not requiring treatment</td> </tr> <tr> <td class="bg-pat2">One Hour</td> <td>2-Vomiting</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <h6 class="pt">Sedation Score (1-3)</h6> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Post Procedure</td> <td>1-Mid,easy to use</td> </tr> <tr> <td class="bg-pat2">30 Min</td> <td>2-Moderate,easy to rouse,unable to remain awake</td> </tr> <tr> <td class="bg-pat2">One Hour</td> <td>0-Awake</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <h6 class="pt">Time spent in Recovery</h6> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Time spent in Recovery</td> <td>02</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <h4><b>Post-Op Care Unit / Recovery</b></h4> <h6 class="pt">Analgesia Supplement in Recovery</h6> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Intravenous Opiodis</td> </tr> <tr> <td class="bg-pat2">Name</td> <td>Text</td> </tr> <tr> <td class="bg-pat2">Dosage</td> <td>200</td> </tr> <tr> <td class="bg-pat2">Oral Opiodis</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Tramadol</td> <td>No</td> </tr> <tr> <td class="bg-pat2">NSAID</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Paracetemol</td> <td>No</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <h6 class="pt">LA Regimen</h6> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">LA Regimen</td> <td>Intermittent Bolus</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <h5 class="pt"><b>Total PACU (Recovery) LA & Adjuvant Consumption</b></h5> <h6 class="pt"><b>LA Regimen</b></h6> <div class="pac-table"> <div class="table-responsive"> <table class="table"> <thead> <tr> <th>Solution</th> <th>Dosage(%)</th> <th>Dosage(ml)</th> <th>Dosage(mg)</th> </tr> </thead> <tbody> <tr> <td>Ropivacaine</td> <td>2.000</td> <td>2</td> <td>20</td> </tr> <tr> <td>Bupivacaine</td> <td>2.000</td> <td>4</td> <td>20</td> </tr> <tr> <td>Levabupivacaine</td> <td>2.000</td> <td>4</td> <td>20</td> </tr> <tr> <td>Lignocaine</td> <td>2.000</td> <td>4</td> <td>20</td> </tr> </tbody> </table> </div> </div><!--pac-table--> <h6 class="pt"><b>Repeat Block</b></h6> <div class="pac-table"> <div class="table-responsive"> <table class="table"> <thead> <tr> <th>Solution</th> <th>Dosage(%)</th> <th>Dosage(ml)</th> <th>Dosage(mg)</th> </tr> </thead> <tbody> <tr> <td>Ropivacaine</td> <td>2.000</td> <td>2</td> <td>20</td> </tr> <tr> <td>Bupivacaine</td> <td>2.000</td> <td>4</td> <td>20</td> </tr> <tr> <td>Levabupivacaine</td> <td>2.000</td> <td>4</td> <td>20</td> </tr> <tr> <td>Lignocaine</td> <td>2.000</td> <td>4</td> <td>20</td> </tr> </tbody> </table> </div> </div><!--pac-table--> <h6 class="pt"><b>Vasopressor Use in Recovery</b></h6> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Vasopressor Use in Recovery</td> <td>No</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> </section> <!--------------------------PACU DETAILS END-------------------> <!---------------------------EDIT-PACU-START------------------------> <section class="edit-pacu"> <!-- The Modal --> <div class="modal" id="pacu-edit"> <div class="modal-dialog modal-lg"> <div class="modal-content"> <!-- Modal Header --> <div class="modal-header" id="add-header"> <h4 class="modal-title">EDIT Post-Op Care Unit/Recovery</h4> <button type="button" class="close" data-dismiss="modal">×</button> </div> <!-- Modal body --> <div class="modal-body"> <form> <h5><b>Pain Score (0-10) (0:Min,10:Max)</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>Post Procedure</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select pain score on arrival</option> <option>0</option> <option>1</option> <option>2</option> <option>3</option> <option>4</option> <option>5</option> <option>6</option> <option>7</option> <option>8</option> <option>9</option> <option>10</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>30 Min</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select pain score in 30 min</option> <option>0</option> <option>1</option> <option>2</option> <option>3</option> <option>4</option> <option>5</option> <option>6</option> <option>7</option> <option>8</option> <option>9</option> <option>10</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>One Hour</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select pain score in one hour</option> <option>0</option> <option>1</option> <option>2</option> <option>3</option> <option>4</option> <option>5</option> <option>6</option> <option>7</option> <option>8</option> <option>9</option> <option>10</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <h5><b>Nausea & Vomiting Score (0-3)</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>Post Procedure</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select score at arrival</option> <option>0-No Nausea</option> <option>1-Mild Nausea not requiring treatment</option> <option>2-Vomiting</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>30 Min</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select score at 30 min</option> <option>0-No Nausea</option> <option>1-Mild Nausea not requiring treatment</option> <option>2-Vomiting</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row" style="padding-top:12px;"> <div class="col-sm-2"></div> <div class="col-sm-2"> <span>One Hour</span> </div> <div class="col-sm-5"> <select class="form-control"> <option>Select score at 1 hour</option> <option>0-No Nausea</option> <option>1-Mild Nausea not requiring treatment</option> <option>2-Vomiting</option> <option>Unable to score</option> </select> </div> <div class="col-sm-3"></div> </div><!--row--> <div class="row"> <div class="col-sm-7"></div> <div class="col-sm-5 pt"> <button type="button" class="btn-save">Save</button> <button type="button" class="btn-close">Close</button> </div> </div><!--row--> </form> </div><!--modal-body--> </div><!--modal-content--> </div> </div> </section><!--edit-pacu--> <!--------------------------EDIT-PACU-END---------------------------> </div><!---Tab-5---> <!-----------------------------------PACU END-----------------------------------> <!-----------------------------------FOLLOW UP START-----------------------------> <div role="tabpanel" class="tab-pane" id="about"> <section class="add-follow-up"> <h3>Add Follow up</h3> <form> <div class="row"> <div class="col-sm-2"><label>Duration of stay in hospital (days)</label></div> <div class="col-sm-4"> <input type="number" class="form-control" name=""> </div> <div class="col-sm-6"></div> </div><!--row--> <label style="margin-bottom: 0;">Cumulative LA Consumption</label> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-6"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Day 1 </label> </div> <label>LA <a href="#" data-toggle="tooltip" title="mg=(Concentration*volume in ml*10)"><i class="fa fa-info-circle" aria-hidden="true"></i></a></label> <div class="followup-box"> <ul> <li>Ropivacaine</li> <li><input type="number" class="form-control" name=""></li> <li><span>mg</span></li> </ul> <ul> <li>Bupivacaine</li> <li><input type="number" class="form-control" name=""></li> <li><span>mg</span></li> </ul> <ul> <li>Levobupivacaine</li> <li><input type="number" class="form-control" name=""></li> <li><span>mg</span></li> </ul> <ul> <li>Lignocaine</li> <li><input type="number" class="form-control" name=""></li> <li><span>mg</span></li> </ul> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Day 2 </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Day 3 </label> </div> <p class="plus"><i class="fa fa-plus" aria-hidden="true"></i></p> </div> <div class="col-sm-4"></div> </div><!--row--> <ul class="late"> <li><h4>Late Complications</h4></li> <li> <div class= "box_1"> <input type="checkbox" class="switch_1"> </div> </li> </ul> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-10" id="follow-up-late"> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Post-dural puncture headache (PDPH) </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check1--> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Backache at epidural site </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check2--> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Persistent motor deficit <2 weeks </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check3--> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Persistent sensory deficit <2 weeks </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check4--> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Aseptic meningitis </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check5--> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Bacterial meningitis </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check6--> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Epidural abscess </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check7--> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Permanent Neurological Complication </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check8--> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Catheter related issues (same as PNB) </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check9--> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Epidural Haematoma </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check10--> <div class="form-check" style="display:flex;"> <label class="form-check-label" style="width:40%;"> <input type="checkbox" class="form-check-input" value="">Other </label> <input type="text" class="form-control" name="" readonly="" style="margin-left:12px;width: 50%;"> <a href=""><i class="fa fa-plus" aria-hidden="true" id="plus"></i></a> </div><!--check11--> </div> </div><!--row--> <h5><b>Select Follow up Procedure</b></h5> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-4"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Direct Interview </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Telephone </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Notes </label> </div> </div> <div class="col-sm-6"></div> </div><!--row--> <div class="row"> <div class="col-sm-7"></div> <div class="col-sm-5"> <button type="button" class="btn-save">Save</button> <button type="button" class="btn-close">Reset</button> </div> </div><!--row--> </form> </section><!--add-follow-up--> <!-------------------------------FOLLOW UP DETAILS START---------------------------> <section class="followup-details" style="display:none;"> <div class="row"> <div class="col-sm-8"></div> <div class="col-sm-4"> <button type="button" class="btn-edit"data-toggle="modal" data-target="#follow-details">Edit</button> <button type="button" class="btn-close">Delete</button> </div> </div><!--row--> <h5><b>Duration of stay in hospital (days)</b></h5> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Duration of stay in hospital</td> <td>3</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <h5 class="pt"><b>Cumulative LA Consumption</b></h5> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Day 1</td> <td></td> </tr> <tr> <td class="bg-pat2">Ropivacaine</td> <td>00mg</td> </tr> <tr> <td class="bg-pat2">Bupivacaine</td> <td>00mg</td> </tr> <tr> <td class="bg-pat2">Levobupivacaine</td> <td>00mg</td> </tr> <tr> <td class="bg-pat2">Lignocaine</td> <td>00mg</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <h5 class="pt"><b>Late complications</b></h5> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Post-dural puncture headache (PDPH)</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Backache at epidural site</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Persistent motor deficit <2 weeks</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Persistent sensory deficit <2 weeks</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Aseptic meningitis</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Bacterial meningitis</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Epidural abscess</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Permanent Neurological Complication</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Catheter related issues (same as PNB)</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Epidural Haematoma</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Other</td> <td>No</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <h5 class="pt"><b>Follow up Procedure</b></h5> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Follow up Procedure</td> <td>Direct Interview</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> </section> <!-------------------------------FOLLOW UP DETAILS END---------------------------> <!--------------------------------EDIT-FOLLOW UP START----------------------------> <section class="edit-followup"> <!-- The Modal --> <div class="modal" id="follow-details"> <div class="modal-dialog modal-lg"> <div class="modal-content"> <!-- Modal Header --> <div class="modal-header" id="add-header"> <h4 class="modal-title">Edit FollowUp</h4> <button type="button" class="close" data-dismiss="modal">×</button> </div> <!-- Modal body --> <div class="modal-body"> <form> <div class="row"> <div class="col-sm-2"><label>Duration of stay in hospital (days)</label></div> <div class="col-sm-4"> <input type="number" class="form-control" name=""> </div> <div class="col-sm-6"></div> </div><!--row--> <label style="margin-bottom: 0;">Cumulative LA Consumption</label> <div class="row"> <div class="col-sm-2"></div> <div class="col-sm-6"> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Day 1 </label> </div> <label>LA <a href="#" data-toggle="tooltip" title="mg=(Concentration*volume in ml*10)"><i class="fa fa-info-circle" aria-hidden="true"></i></a></label> <div class="followup-box"> <ul> <li>Ropivacaine</li> <li><input type="number" class="form-control" name=""></li> <li><span>mg</span></li> </ul> <ul> <li>Bupivacaine</li> <li><input type="number" class="form-control" name=""></li> <li><span>mg</span></li> </ul> <ul> <li>Levobupivacaine</li> <li><input type="number" class="form-control" name=""></li> <li><span>mg</span></li> </ul> <ul> <li>Lignocaine</li> <li><input type="number" class="form-control" name=""></li> <li><span>mg</span></li> </ul> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Day 2 </label> </div> <div class="form-check"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Day 3 </label> </div> <p class="plus"><i class="fa fa-plus" aria-hidden="true"></i></p> </div> <div class="col-sm-4"></div> </div><!--row--> </form> </div><!--modal-body--> </div><!--modal-content--> </div> </div> </section><!--edit-followup--> <!--------------------------------EDIT-FOLLOW UP END------------------------------> </div><!---Tab-6---> <!-----------------------------------FOLLOW UP END-----------------------------> <!----------------------------------FEEDBACK START-----------------------------> <div role="tabpanel" class="tab-pane" id="contact"> <section class="feedback-manual"> <ul class="nav nav-tabs" role="tablist" id="feed-tabs"> <li role="presentation" class="active"><a href="#feedback" aria-controls="feedback" role="tab" data-toggle="tab">Add Feedback Manually</a></li> <li role="presentation"><a href="#e-feedback" aria-controls="e-feedback" role="tab" data-toggle="tab">E-Feedback</a></li> </ul> <div class="tab-content"> <div role="tabpanel" class="tab-pane" id="feedback"> <form> <h3>Add Feedback Manually</h3> <div class="feed-card"> <div class="card-header"> <h4>1.During or after the procedure,did you experience (rate the severity)</h4> </div> <div class="card-body"> <ul> <li id="first-case"><b>a) Drowsiness</b></li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>No </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Mild </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Moderate </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Severe </label> </div><!--form-check--> </li> </ul><!--ul--> <ul> <li id="first-case"><b>b) Pain at the Site of Surgery</b></li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>No </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Mild </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Moderate </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Severe </label> </div><!--form-check--> </li> </ul><!--ul--> <ul> <li id="first-case"><b>c) Thirst</b></li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>No </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Mild </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Moderate </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Severe </label> </div><!--form-check--> </li> </ul><!--ul--> <ul> <li id="first-case"><b>d) Hoarseness</b></li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>No </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Mild </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Moderate </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Severe </label> </div><!--form-check--> </li> </ul><!--ul--> <ul> <li id="first-case"><b>e)Sore Throat</b></li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>No </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Mild </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Moderate </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Severe </label> </div><!--form-check--> </li> </ul><!--ul--> <ul> <li id="first-case"><b>f) Nausea or vomiting</b></li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>No </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Mild </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Moderate </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Severe </label> </div><!--form-check--> </li> </ul><!--ul--> <ul> <li id="first-case"><b>g) Feeling Cold</b></li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>No </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Mild </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Moderate </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Severe </label> </div><!--form-check--> </li> </ul><!--ul--> <ul> <li id="first-case"><b>h) Confusion or disorientation</b></li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>No </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Mild </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Moderate </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Severe </label> </div><!--form-check--> </li> </ul><!--ul--> <ul> <li id="first-case"><b>i) Backpain(pain at the site of the anaesthetic injection)</b></li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>No </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Mild </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Moderate </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Severe </label> </div><!--form-check--> </li> </ul><!--ul--> <ul> <li id="first-case"><b>j) Shivering</b></li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" checked>No </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Mild </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Moderate </label> </div><!--form-check--> </li> <li> <div class="form-check"> <label class="form-check-label" for="check1"> <input type="checkbox" class="form-check-input" id="check1" name="option1" value="something" >Severe </label> </div><!--form-check--> </li> </ul><!--ul--> </div> </div><!--feed-card--> <div class="feed-card"> <div class="card-header"> <h4>Satisfaction with Anaesthesia care(please tick one box)</h4> </div> <div class="card-body"> <div class="card-info1"> <h6>1).Did you had pain before surgery ?</h6> <div class="row"> <div class="col-sm-1"></div> <div class="col-sm-11 py-2"> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Yes </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">No </label> </div> </div> </div><!--row--> <div class="row py-2"> <div class="col-sm-6"> <span>a) Was your anaesthetist involved in managing your pain before surgery ?</span> </div> <div class="col-sm-4"> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Yes </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">No </label> </div> </div> <div class="col-sm-2"></div> </div><!--row--> <div class="row py-2"> <div class="col-sm-6"> <span>b)How well was it managed ?</span> </div> <div class="col-sm-6"> <ul> <li> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Very Satisfied </label> </div> </li> <li> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Satisfied </label> </div> </li> <li> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">dissatisfied </label> </div> </li> <li> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Very dissatisfied </label> </div> </li> <li class="pt"> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Unable to answer </label> </div> </li> </ul> </div> </div><!--row--> </div><!--card-info1--> <div class="card-info1"> <h6>2).Did you feel you had time to ask your anaesthetist,questions before your surgery?</h6> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Yes </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">No </label> </div> </div><!--card-info1--> <div class="card-info1"> <h6>3).How satisfied were you with the information on Regional anaesthesia provided by your anaesthetist?</h6> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Very satisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Satisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Dissatisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">VeryDissatisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Unable to Answer </label> </div> </div><!--card-info1--> <div class="card-info1"> <h6>4).How satisfied were you from anaesthesia ?</h6> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Very satisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Satisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Dissatisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">VeryDissatisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Unable to Answer </label> </div> </div><!--card-info1--> <div class="card-info1"> <h6>5).How satisfied have you been with pain theraphy after surgery ?</h6> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Very satisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Satisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Dissatisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">VeryDissatisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Unable to Answer </label> </div> </div><!--card-info1--> <div class="card-info1"> <h6>6).How satisfied were you with treatment of nausea and vomiting after the operation?</h6> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Very satisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Satisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Dissatisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">VeryDissatisfied </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Unable to Answer </label> </div> </div><!--card-info1--> <div class="card-info1"> <h6>7).To what degree after the operation,did numbness or heaviness of the anaesthetised limb or body part bother you ?</h6> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">None </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Mild-Barely noticeable </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Moderate:definetly noticeable </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Severe:very pre-occupied by the symptom </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Unable to Answer </label> </div> </div><!--card-info1--> <div class="card-info1"> <h6>8).When the numbness/heaviness related to the regional anaesthesia wore off,how much pain did you experience ?</h6> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">None </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Mild-Barely noticeable </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Moderate Pain </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Severe Pain </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Unable to Answer </label> </div> </div><!--card-info1--> <div class="card-info1"> <h6>9).Were you to require a similar operation again,would you be happy to have the same type of a regional anaesthetic again ?</h6> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Yes </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">No </label> </div> <div class="form-check-inline"> <label class="form-check-label"> <input type="checkbox" class="form-check-input" value="">Unable to Answer </label> </div> </div><!--card-info1--> <div class="card-info1"> <h6>10).Overall satisfaction score(1:Least satisfied to 10:most satisfied)</h6> <input type="number" class="form-control" name="" style="width: 50%;"> </div><!--card-info1--> <div class="card-info1"> <h6>11).Is there any suggestion you would like to make to improve the quality of anaesthesia care?</h6> <textarea class="form-control" rows="3" style="width:75%;"></textarea> </div><!--card-info1--> <div class="row"> <div class="col-sm-9"></div> <div class="col-sm-3"><button type="button" class="btn-submit">Submit</button></div> </div> </div> </div><!--feed-card--> </form> </div><!--feedback-tab--> <section class="edit-feedback" style="display:none;"> <div class="row"> <div class="col-sm-9"></div> <div class="col-sm-3"><button type="button" class="btn-close">Delete</button></div> </div> <h5><b>During or after the procedure,did you experience</b></h5> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Drowsiness</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Pain at the Site of Surgery</td> <td>No</td> </tr> <tr> <td class="bg-pat2"> Pain at the Site of Surgery</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Hoarseness</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Sore Throat</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Nausea or vomiting</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Feeling Cold</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Confusion or disorientation</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Backpain(pain at the site of the anaesthetic injection)</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Shivering</td> <td>No</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <h5 class="pt"><b>Satisfaction with Anaesthesia care</b></h5> <div class="pat-table2"> <div class="table-responsive"> <table class="table"> <tbody> <tr> <td class="bg-pat2">Did you had pain before surgery ?</td> <td>No</td> </tr> <tr> <td class="bg-pat2">Was your anaesthetist involved in managing your pain before surgery ?</td> <td>No</td> </tr> <tr> <td class="bg-pat2">How well was it managed ?</td> <td>Satisfied</td> </tr> </tbody> </table> </div> </div><!--pat-table2--> <div class="questions"> <div class="card"> <div class="card-header"> <h5>Did you feel you had time to ask your anaesthetist,questions before your surgery?</h5> </div> <div class="card-body"> <p>No</p> </div> </div><!--card--> <div class="card"> <div class="card-header"> <h5>How satisfied were you with the information on Regional anaesthesia provided by your anaesthetist?</h5> </div> <div class="card-body"> <p>Very satisfied</p> </div> </div><!--card--> <div class="card"> <div class="card-header"> <h5>How satisfied were you from anaesthesia ?</h5> </div> <div class="card-body"> <p>Very satisfied</p> </div> </div><!--card--> <div class="card"> <div class="card-header"> <h5>How satisfied have you been with pain theraphy after surgery ?</h5> </div> <div class="card-body"> <p>Very satisfied</p> </div> </div><!--card--> <div class="card"> <div class="card-header"> <h5>How satisfied were you with treatment of nausea and vomiting after the operation ?</h5> </div> <div class="card-body"> <p>Very satisfied</p> </div> </div><!--card--> <div class="card"> <div class="card-header"> <h5>To what degree after the operation,did numbness or heaviness of the anaesthetised limb or body part bother you?</h5> </div> <div class="card-body"> <p>Mild-Barely noticeable</p> </div> </div><!--card--> <div class="card"> <div class="card-header"> <h5>When the numbness/heaviness related to the regional anaesthesia wore off,how much pain did you experience?</h5> </div> <div class="card-body"> <p>Mild-Barely noticeable</p> </div> </div><!--card--> <div class="card"> <div class="card-header"> <h5>Were you to require a similar operation again,would you be happy to have the same type of a regional anaesthetic again?</h5> </div> <div class="card-body"> <p>Mild-Barely noticeable</p> </div> </div><!--card--> <div class="card"> <div class="card-header"> <h5>Overall satisfaction score(1:Least satisfied to 10:most satisfied)</h5> </div> <div class="card-body"> <p>10</p> </div> </div><!--card--> <div class="card"> <div class="card-header"> <h5>Is there any suggestion you would like to make to improve the quality of anaesthesia care ?</h5> </div> <div class="card-body"> <p>Text</p> </div> </div><!--card--> 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