Patient History

Menstrual H
Contraception H
Obstetric H
Past H
Family H

{assign var=tabactive value=0} {if $ProgramesettingData->menstrual == 1 }

{if $tabactive < 1 } {capture assign=tabactive}{$tabactive+1}{/capture} {/if}

Menstrual H

Menarche

Duration

Length

Regularity

Amount

Dysmenorrhoea

LMP

{assign var=i value=1} {foreach $allphmenstrual as $myallphmenstrual}

{if $ProgramesettingData->displaydoctorname eq 1}

{$myallphmenstrual->username}

{/if}

{capture assign=i}{$i+1}{/capture} {/foreach}

{/if} {if $ProgramesettingData->contraception == 1 }

{if $tabactive < 1 } {capture assign=tabactive}{$tabactive+1}{/capture} {/if}

Contraception H

Type

Duration

Stopped

Note

{assign var=i value=1} {foreach $allcontract as $myallcontract}

{if $ProgramesettingData->displaydoctorname eq 1}

{$myallcontract->username}

{/if}

{capture assign=i}{$i+1}{/capture} {/foreach}

{/if} {if $ProgramesettingData->obstetric == 1 }

{if $tabactive < 1 } {capture assign=tabactive}{$tabactive+1}{/capture} {/if}

Obstetric H

Direct Values

Duration

Termination

Place

Date

Out Come

Name

Note

{assign var=i value=1} {foreach $allobsteric as $myallobsteric}

{if $ProgramesettingData->displaydoctorname eq 1}

{$myallobsteric->username}

{/if}

obstermination} eq 1 || {$myallobsteric->obstermination} eq 2 } style="display:block" {else} style="display:none" {/if}>

outcomeid eq 0 || $myallobsteric->outcomeid eq 1}style="display:none;"{/if}>

obstermination} eq 1 || {$myallobsteric->obstermination} eq 2 } style="display:none" {else} style="display:block" {/if}> no out come

obstermination} eq 1 || {$myallobsteric->obstermination} eq 2 } style="display:block" {else} style="display:none" {/if} >

outcomeid} > 1} style="display:block" {else} style="display:none" {/if}>

outcomeid} eq 3} style="display:block" {else} style="display:none" {/if}>

{capture assign=i}{$i+1}{/capture} {/foreach}

{/if} {if $ProgramesettingData->past == 1 }

{if $tabactive < 1 } {capture assign=tabactive}{$tabactive+1}{/capture} {/if}

Medical
Surgical
Gynecological
ART

{assign var=xtabactive value=0} {if $ProgramesettingData->medical == 1 }

{if $xtabactive < 1 } {capture assign=xtabactive}{$xtabactive+1}{/capture} {/if}

Medical

Disease

Note

Husband

{assign var=i value=1} {foreach $mypastmedical as $myallphpastmedical}

{if $ProgramesettingData->displaydoctorname eq 1}

{$myallphpastmedical->username}

{/if}

for_husband == 1 } checked {/if}>

{capture assign=i}{$i+1}{/capture} {/foreach}

{/if} {if $ProgramesettingData->surgical == 1 }

{if $xtabactive < 1 } {capture assign=xtabactive}{$xtabactive+1}{/capture} {/if}

Surgical

Operation

Year

Surgeon

Note

Husband

{assign var=i value=1} {foreach $pastsurgical as $myallpastsurgical}

{if $ProgramesettingData->displaydoctorname eq 1}

{$myallpastsurgical->username}

{/if}

for_husband == 1 } checked {/if}>

{capture assign=i}{$i+1}{/capture} {/foreach}

{/if} {if $ProgramesettingData->gynecological == 1 }

{if $xtabactive < 1 } {capture assign=xtabactive}{$xtabactive+1}{/capture} {/if}

Gynecological

Operation

Year

Surgeon

Note

{assign var=i value=1} {foreach $phpastgynecological as $myallpastgynecological}

{if $ProgramesettingData->displaydoctorname eq 1}

{$myallpastgynecological->username}

{/if}

{capture assign=i}{$i+1}{/capture} {/foreach}

{/if} {if $ProgramesettingData->art == 1 }

{if $xtabactive < 1 } {capture assign=xtabactive}{$xtabactive+1}{/capture} {/if}

Art External
Art Internal

{assign var=arttabactive value=0} {if $ProgramesettingData->art_external == 1 } {capture assign=arttabactive}{$arttabactive+1}{/capture}

External ART

Type

Center

Year

Note

{assign var=i value=1} {foreach $phpastart as $myallphpastart}

{if $ProgramesettingData->displaydoctorname eq 1}

{$myallphpastart->username}

{/if}

arttype eq 0} {else} style="display: none;"{/if}>

Ovum Pick Up

Embryo transfer

Freezing

arttype eq 3 || $myallphpastart->arttype eq 2} {else} style="display: none;"{/if}>

{capture assign=i}{$i+1}{/capture} {/foreach}

{/if} {if $ProgramesettingData->art_internal == 1 }

{if $arttabactive < 1 } {capture assign=arttabactive}{$arttabactive+1}{/capture} {/if}

Internal Art

{foreach $monitorSheets as $data}

Type	Date	Place	Protocol	No. of Amp	No. of oocytes				No. of ET		Cryo-preserved E.		P4	Outcome
Type	Date	Place	Protocol	No. of Amp	Total	MI	MII	GV	Total	G1	Day	W0	P4	Outcome
{$data->procedure}	{$data->monitordate}		{$data->protocol}
Notes	{$data->notes}

{/foreach}

{/if}

{/if} {if $ProgramesettingData->family == 1 }

{if $tabactive < 1 } {capture assign=tabactive}{$tabactive+1}{/capture} {/if}

Family H

Disease

Relative

Note

{assign var=i value=1} {foreach $phfamily as $myallphfamily}

{if $ProgramesettingData->displaydoctorname eq 1}

{$myallphfamily->username}

{/if}

{capture assign=i}{$i+1}{/capture} {/foreach}

{/if}