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<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Ecila - Clinic APP</title>
<link rel="stylesheet" href="http://jquerymobile.com/test/css/themes/default/jquery.mobile.css" />
<link rel="stylesheet" href="http://jquerymobile.com/test/docs/_assets/css/jqm-docs.css"/>
<link rel="stylesheet" href="css/core.css"/>
<script src="http://code.jquery.com/jquery-1.8.2.min.js"></script>
<script src="http://code.jquery.com/mobile/1.2.0/jquery.mobile-1.2.0.min.js"></script>
<script src="http://dev.rugcentrumgent.be/wp/app/js/core.js"></script>
<script src="http://dev.rugcentrumgent.be/wp/app/js/history.js"></script>
</head>
<body>
<div data-role="page" class="type-home">
<div data-role="header" data-theme="b" data-position="fixed" data-id="header">
<h1>Login</h1>
</div>
<div data-role="content">
<div class="content-secondary">
<div id="jqm-homeheader">
<h1 id="jqm-logo"><img src="images/ecila_project.jpg" alt="ecila project" /></h1>
<p>The future of patient management</p>
</div>
</div><!--/content-primary-->
<div class="content-primary">
<div data-role="fieldcontain">
<input type="text" name="login" id="login" value="" placeholder="login" />
</div>
<div data-role="fieldcontain">
<input type="password" name="password" id="password value="" placeholder="password" />
</div>
<a href="#history" data-transition="slide"><button type="submit" data-theme="b" data-inline="true">Login</button></div></a>
</div>
</div>
<div data-role="footer" class="footer-docs" data-theme="c">
<p class="jqm-version"></p>
<p>© 2012 Ecila Project</p>
</div>
</div><div data-role="page" class="type-interior" id="history">
<div data-role="header" data-theme="f" data-position="fixed" data-id="header">
<h1>Patient: Thierry Duhameeuw</h1>
<a href="../../" data-icon="home" data-iconpos="notext" data-direction="reverse">Home</a>
<a href="../nav.html" data-icon="search" data-iconpos="notext" data-rel="dialog" data-transition="fade">Search</a>
</div>
<div data-role="content">
<div class="content-primary">
<h2>History</h2>
<p>History of patient John Doe....</p>
</div><!--/content-primary -->
<div class="content-secondary">
<div data-role="collapsible" data-collapsed="true" data-theme="b" data-content-theme="d">
<h3>History</h3>
<ul data-role="listview" data-theme="c" data-dividertheme="d">
<li data-role="list-divider">History</li>
<li id="complaint_1" onclick="glowItem(this)"><a href="#history-chief_complaint" data-transition="slide">Chief complaint</a></li>
<li id="complaint_2" onclick="glowItem(this)"><a href="#history-medications" data-transition="slide">Medications</a></li>
<li id="complaint_3" onclick="glowItem(this)"><a href="#history-family_history" data-transition="slide">Family History</a></li>
<li id="complaint_4" onclick="glowItem(this)"><a href="docs-navbar.html">Imaging</a></li>
<li id="complaint_5" onclick="glowItem(this)"><a href="bars-fixed.html">Accidents</a></li>
<li id="complaint_6" onclick="glowItem(this)"><a href="footer-persist-a.html">Activities</a></li>
<li id="complaint_7" onclick="glowItem(this)"><a href="bars-themes.html">Cardiovascular</a></li>
<li id="complaint_8" onclick="glowItem(this)"><a href="bars-themes.html">Endocrine</a></li>
<li id="complaint_9" onclick="glowItem(this)"><a href="bars-themes.html">Respiratory</a></li>
</ul>
</div><!-- /data-role -->
</div><!-- /content-secondary -->
</div><!-- /content -->
<div data-role="footer" data-id="navbar" data-position="fixed">
<div data-role="navbar">
<ul>
<li><a href="#" data-prefetch="true" class="ui-btn-active ui-state-persist">History</a></li>
<li><a href="../examination/examination.php" data-prefetch="true">Examination</a></li>
<li><a href="footer-persist-c.html" data-prefetch="true">Treamtment</a></li>
<li><a href="footer-persist-d.html" data-prefetch="true">Planning</a></li>
</ul>
</div><!-- /navbar -->
</div><!-- /footer -->
</div><!-- /history -->
<div data-role="page" class="type-interior" id="history-chief_complaint">
<div data-role="header" data-theme="f" data-position="fixed" data-id="header">
<h1>Patient: Thierry Duhameeuw</h1>
<a href="#history" data-icon="back" data-iconpos="notext" data-direction="reverse" data-rel="back">Back</a>
<a href="../nav.html" data-icon="search" data-iconpos="notext" data-rel="dialog" data-transition="fade">Search</a>
</div>
<div data-role="content">
<div class="content-primary">
<h2>Chief complaints</h2>
<div data-role="controlgroup">
<legend>Select primary complaints</legend>
<input type="checkbox" name="neckpain" id="neckpain" onclick="toggleComplaint(this)"/>
<label for="neckpain">Neck Pain</label>
<input type="checkbox" name="ubp" id="ubp" class="custom" onclick="toggleComplaint(this)"/>
<label for="ubp">Upper back pain</label>
<input type="checkbox" name="chestpain" id="chestpain" class="custom" onclick="toggleComplaint(this)" />
<label for="chestpain">Chest pain</label>
<input type="checkbox" name="headaches" id="headaches" class="custom" onclick="toggleComplaint(this)" />
<label for="headaches">Headaches</label>
<input type="checkbox" name="armpain" id="arm" class="custom" onclick="toggleComplaint(this)" />
<label for="arm">Arm pain</label>
<input type="checkbox" name="sacralpain" id="sx" class="custom" onclick="toggleComplaint(this)" />
<label for="sx">Sacral pain</label>
<input type="checkbox" name="footpain" id="foot" class="custom" onclick="toggleComplaint(this)" />
<label for="foot">Foot Pain</label>
<input type="checkbox" name="anklepain" id="ankle" class="custom" onclick="toggleComplaint(this)" />
<label for="ankle">Ankle pain</label>
<input type="checkbox" name="kneepain" id="kneepain" class="custom" onclick="toggleComplaint(this)"/>
<label for="kneepain">Knee pain</label>
<input type="checkbox" name="handpain" id="hand" class="custom" onclick="toggleComplaint(this)" />
<label for="hand">Hand pain</label>
</div> <!-- /controlgroup -->
</div><!--/content-primary -->
<div class="content-secondary">
<div data-role="collapsible" data-collapsed="true" data-theme="b" data-content-theme="d">
<h3>Complaints</h3>
<ul class="complaints" data-role="listview" data-theme="c" data-dividertheme="d">
<li data-role="list-divider" data-theme="b">History - Chief Complaint</li>
<li id="neckpain_list" class="display-hidden" onclick="glowItem(this)"><a href="#neckpain_details" data-transition="slide">Neck Pain</a></li>
<li id="ubp_list" class="display-hidden" onclick="glowItem(this)"><a href="#ubp_details" data-transition="slide">Upper Back Pain</a></li>
<li id="chestpain_list" class="display-hidden" onclick="glowItem(this)"><a href="#chestpain_details" data-transition="slide">Chest Pain</a></li>
<li id="headaches_list" class="display-hidden" onclick="glowItem(this)"><a href="#headaches_details" data-transition="slide">Headaches</a></li>
<li id="armpain_list" class="display-hidden" onclick="glowItem(this)"><a href="#armpain_details" data-transition="slide">Arm Pain</a></li>
<li id="sacralpain_list" class="display-hidden" onclick="glowItem(this)"><a href="#sacralpain_details" data-transition="slide">Sacral Pain</a></li>
<li id="footpain_list" class="display-hidden" onclick="glowItem(this)"><a href="#footpain_details" data-transition="slide">Foot Pain</a></li>
<li id="anklepain_list" class="display-hidden" onclick="glowItem(this)"><a href="#anklepain_details" data-transition="slide">Ankle Pain</a></li>
<li id="kneepain_list" class="display-hidden" onclick="glowItem(this)"><a href="#kneepain_details" data-transition="slide">Knee Pain</a></li>
<li id="handpain_list" class="display-hidden" onclick="glowItem(this)"><a href="#handpain_details" data-transition="slide">Hand Pain</a></li>
</ul>
</div><!-- /data-role -->
</div><!-- /content-secondary -->
</div><!-- /content -->
<div data-role="footer" data-id="navbar" data-position="fixed">
<div data-role="navbar">
<ul>
<li><a href="#history" data-rel="back">Back</a></li>
</ul>
</div><!-- /navbar -->
</div><!-- /footer -->
</div><!-- /history-chief_complaint -->
<div data-role="page" class="" id="neckpain_details">
<div data-role="header" data-theme="f" data-position="fixed">
<h1>neckpain_details</h1>
<a href="#history-chief_complaint" data-icon="back" data-direction="reverse" data-rel="back">Back</a>
</div>
<div data-role="content" id="thierry">
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Onset:</legend>
<input type="radio" name="onset_neckpain_details" id="day" class="custom" onchange="toggleDateSelector(this)"/>
<label for="day">Day</label>
<input type="radio" name="onset_neckpain_details" id="week" class="custom" onchange="toggleDateSelector(this)"/>
<label for="week">Week</label>
<input type="radio" name="onset_neckpain_details" id="month" class="custom" onchange="toggleDateSelector(this)"/>
<label for="month">Month</label>
<input type="radio" name="onset_neckpain_details" id="year" class="custom" onchange="toggleDateSelector(this)"/>
<label for="year">year</label>
<input type="radio" name="onset_neckpain_details" id="specefic" value="specific" class="custom" onchange="toggleDateSelector(this)" />
<label for="specefic">specific</label>
</fieldset>
</div>
<div id="date_onset_neckpain_details" class="display-hidden">
<input type="date" name="date" id="date" value="" data-mini="true" />
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Mode:</legend>
<input type="radio" name="mode" id="lifting" class="custom" />
<label for="lifting">lifting</label>
<input type="radio" name="mode" id="accident" class="custom" />
<label for="accident">accident</label>
<input type="radio" name="mode" id="stress" class="custom" />
<label for="stress">stress</label>
<input type="radio" name="mode" id="other" class="custom" />
<label for="other">other</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Character:</legend>
<input type="checkbox" name="character" id="tingling" class="custom" />
<label for="tingling">tingling</label>
<input type="checkbox" name="character" id="throbbing" class="custom" />
<label for="throbbing">throbbing</label>
<input type="checkbox" name="character" id="dull" class="custom" />
<label for="dull">dull</label>
<input type="checkbox" name="character" id="shooting" class="custom" />
<label for="shooting">shooting</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<label for="slider-0">Scale:</label>
<input type="range" name="slider" id="slider-0" value="0" min="0" max="10" />
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Aggravating factors:</legend>
<input type="checkbox" id="sitting" class="custom" />
<label for="sitting">sitting</label>
<input type="checkbox" id="standing" class="custom" />
<label for="standing">standing</label>
<input type="checkbox" id="bending" class="custom" />
<label for="bending">bending</label>
<input type="checkbox" id="ice" class="custom" />
<label for="ice">ice</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Relieving factors:</legend>
<input type="checkbox" name="rf" id="moving" class="custom" />
<label for="moving">moving</label>
<input type="checkbox" name="rf" id="lying" class="custom" />
<label for="lying">lying</label>
<input type="checkbox" name="rf" id="rest" class="custom" />
<label for="rest">rest</label>
<input type="checkbox" name="rf" id="heat" class="custom" />
<label for="heat">heat</label>
</fieldset>
</div>
<a href="#history-chief_complaint" data-rel="back" data-role="button" data-inline="true">Back</a>
</div><!-- /content -->
<div data-role="footer" data-id="navbar" data-position="fixed">
<div data-role="navbar">
<ul>
<li><a href="#history-chief_complaint" data-rel="back" >Back</a></li>
</ul>
</div><!-- /navbar -->
</div><!-- /footer -->
</div><!-- /page - chief_complaint_detail -->
<div data-role="page" class="" id="ubp_details">
<div data-role="header" data-theme="f" data-position="fixed">
<h1>ubp_details</h1>
<a href="#history-chief_complaint" data-icon="back" data-direction="reverse" data-rel="back">Back</a>
</div>
<div data-role="content" id="thierry">
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Onset:</legend>
<input type="radio" name="onset_ubp_details" id="day" class="custom" onchange="toggleDateSelector(this)"/>
<label for="day">Day</label>
<input type="radio" name="onset_ubp_details" id="week" class="custom" onchange="toggleDateSelector(this)"/>
<label for="week">Week</label>
<input type="radio" name="onset_ubp_details" id="month" class="custom" onchange="toggleDateSelector(this)"/>
<label for="month">Month</label>
<input type="radio" name="onset_ubp_details" id="year" class="custom" onchange="toggleDateSelector(this)"/>
<label for="year">year</label>
<input type="radio" name="onset_ubp_details" id="specefic" value="specific" class="custom" onchange="toggleDateSelector(this)" />
<label for="specefic">specific</label>
</fieldset>
</div>
<div id="date_onset_ubp_details" class="display-hidden">
<input type="date" name="date" id="date" value="" data-mini="true" />
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Mode:</legend>
<input type="radio" name="mode" id="lifting" class="custom" />
<label for="lifting">lifting</label>
<input type="radio" name="mode" id="accident" class="custom" />
<label for="accident">accident</label>
<input type="radio" name="mode" id="stress" class="custom" />
<label for="stress">stress</label>
<input type="radio" name="mode" id="other" class="custom" />
<label for="other">other</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Character:</legend>
<input type="checkbox" name="character" id="tingling" class="custom" />
<label for="tingling">tingling</label>
<input type="checkbox" name="character" id="throbbing" class="custom" />
<label for="throbbing">throbbing</label>
<input type="checkbox" name="character" id="dull" class="custom" />
<label for="dull">dull</label>
<input type="checkbox" name="character" id="shooting" class="custom" />
<label for="shooting">shooting</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<label for="slider-0">Scale:</label>
<input type="range" name="slider" id="slider-0" value="0" min="0" max="10" />
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Aggravating factors:</legend>
<input type="checkbox" id="sitting" class="custom" />
<label for="sitting">sitting</label>
<input type="checkbox" id="standing" class="custom" />
<label for="standing">standing</label>
<input type="checkbox" id="bending" class="custom" />
<label for="bending">bending</label>
<input type="checkbox" id="ice" class="custom" />
<label for="ice">ice</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Relieving factors:</legend>
<input type="checkbox" name="rf" id="moving" class="custom" />
<label for="moving">moving</label>
<input type="checkbox" name="rf" id="lying" class="custom" />
<label for="lying">lying</label>
<input type="checkbox" name="rf" id="rest" class="custom" />
<label for="rest">rest</label>
<input type="checkbox" name="rf" id="heat" class="custom" />
<label for="heat">heat</label>
</fieldset>
</div>
<a href="#history-chief_complaint" data-rel="back" data-role="button" data-inline="true">Back</a>
</div><!-- /content -->
<div data-role="footer" data-id="navbar" data-position="fixed">
<div data-role="navbar">
<ul>
<li><a href="#history-chief_complaint" data-rel="back" >Back</a></li>
</ul>
</div><!-- /navbar -->
</div><!-- /footer -->
</div><!-- /page - chief_complaint_detail -->
<div data-role="page" class="" id="chestpain_details">
<div data-role="header" data-theme="f" data-position="fixed">
<h1>chestpain_details</h1>
<a href="#history-chief_complaint" data-icon="back" data-direction="reverse" data-rel="back">Back</a>
</div>
<div data-role="content" id="thierry">
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Onset:</legend>
<input type="radio" name="onset_chestpain_details" id="day" class="custom" onchange="toggleDateSelector(this)"/>
<label for="day">Day</label>
<input type="radio" name="onset_chestpain_details" id="week" class="custom" onchange="toggleDateSelector(this)"/>
<label for="week">Week</label>
<input type="radio" name="onset_chestpain_details" id="month" class="custom" onchange="toggleDateSelector(this)"/>
<label for="month">Month</label>
<input type="radio" name="onset_chestpain_details" id="year" class="custom" onchange="toggleDateSelector(this)"/>
<label for="year">year</label>
<input type="radio" name="onset_chestpain_details" id="specefic" value="specific" class="custom" onchange="toggleDateSelector(this)" />
<label for="specefic">specific</label>
</fieldset>
</div>
<div id="date_onset_chestpain_details" class="display-hidden">
<input type="date" name="date" id="date" value="" data-mini="true" />
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Mode:</legend>
<input type="radio" name="mode" id="lifting" class="custom" />
<label for="lifting">lifting</label>
<input type="radio" name="mode" id="accident" class="custom" />
<label for="accident">accident</label>
<input type="radio" name="mode" id="stress" class="custom" />
<label for="stress">stress</label>
<input type="radio" name="mode" id="other" class="custom" />
<label for="other">other</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Character:</legend>
<input type="checkbox" name="character" id="tingling" class="custom" />
<label for="tingling">tingling</label>
<input type="checkbox" name="character" id="throbbing" class="custom" />
<label for="throbbing">throbbing</label>
<input type="checkbox" name="character" id="dull" class="custom" />
<label for="dull">dull</label>
<input type="checkbox" name="character" id="shooting" class="custom" />
<label for="shooting">shooting</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<label for="slider-0">Scale:</label>
<input type="range" name="slider" id="slider-0" value="0" min="0" max="10" />
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Aggravating factors:</legend>
<input type="checkbox" id="sitting" class="custom" />
<label for="sitting">sitting</label>
<input type="checkbox" id="standing" class="custom" />
<label for="standing">standing</label>
<input type="checkbox" id="bending" class="custom" />
<label for="bending">bending</label>
<input type="checkbox" id="ice" class="custom" />
<label for="ice">ice</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Relieving factors:</legend>
<input type="checkbox" name="rf" id="moving" class="custom" />
<label for="moving">moving</label>
<input type="checkbox" name="rf" id="lying" class="custom" />
<label for="lying">lying</label>
<input type="checkbox" name="rf" id="rest" class="custom" />
<label for="rest">rest</label>
<input type="checkbox" name="rf" id="heat" class="custom" />
<label for="heat">heat</label>
</fieldset>
</div>
<a href="#history-chief_complaint" data-rel="back" data-role="button" data-inline="true">Back</a>
</div><!-- /content -->
<div data-role="footer" data-id="navbar" data-position="fixed">
<div data-role="navbar">
<ul>
<li><a href="#history-chief_complaint" data-rel="back" >Back</a></li>
</ul>
</div><!-- /navbar -->
</div><!-- /footer -->
</div><!-- /page - chief_complaint_detail -->
<div data-role="page" class="" id="headaches_details">
<div data-role="header" data-theme="f" data-position="fixed">
<h1>headaches_details</h1>
<a href="#history-chief_complaint" data-icon="back" data-direction="reverse" data-rel="back">Back</a>
</div>
<div data-role="content" id="thierry">
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Onset:</legend>
<input type="radio" name="onset_headaches_details" id="day" class="custom" onchange="toggleDateSelector(this)"/>
<label for="day">Day</label>
<input type="radio" name="onset_headaches_details" id="week" class="custom" onchange="toggleDateSelector(this)"/>
<label for="week">Week</label>
<input type="radio" name="onset_headaches_details" id="month" class="custom" onchange="toggleDateSelector(this)"/>
<label for="month">Month</label>
<input type="radio" name="onset_headaches_details" id="year" class="custom" onchange="toggleDateSelector(this)"/>
<label for="year">year</label>
<input type="radio" name="onset_headaches_details" id="specefic" value="specific" class="custom" onchange="toggleDateSelector(this)" />
<label for="specefic">specific</label>
</fieldset>
</div>
<div id="date_onset_headaches_details" class="display-hidden">
<input type="date" name="date" id="date" value="" data-mini="true" />
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Mode:</legend>
<input type="radio" name="mode" id="lifting" class="custom" />
<label for="lifting">lifting</label>
<input type="radio" name="mode" id="accident" class="custom" />
<label for="accident">accident</label>
<input type="radio" name="mode" id="stress" class="custom" />
<label for="stress">stress</label>
<input type="radio" name="mode" id="other" class="custom" />
<label for="other">other</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Character:</legend>
<input type="checkbox" name="character" id="tingling" class="custom" />
<label for="tingling">tingling</label>
<input type="checkbox" name="character" id="throbbing" class="custom" />
<label for="throbbing">throbbing</label>
<input type="checkbox" name="character" id="dull" class="custom" />
<label for="dull">dull</label>
<input type="checkbox" name="character" id="shooting" class="custom" />
<label for="shooting">shooting</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<label for="slider-0">Scale:</label>
<input type="range" name="slider" id="slider-0" value="0" min="0" max="10" />
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Aggravating factors:</legend>
<input type="checkbox" id="sitting" class="custom" />
<label for="sitting">sitting</label>
<input type="checkbox" id="standing" class="custom" />
<label for="standing">standing</label>
<input type="checkbox" id="bending" class="custom" />
<label for="bending">bending</label>
<input type="checkbox" id="ice" class="custom" />
<label for="ice">ice</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Relieving factors:</legend>
<input type="checkbox" name="rf" id="moving" class="custom" />
<label for="moving">moving</label>
<input type="checkbox" name="rf" id="lying" class="custom" />
<label for="lying">lying</label>
<input type="checkbox" name="rf" id="rest" class="custom" />
<label for="rest">rest</label>
<input type="checkbox" name="rf" id="heat" class="custom" />
<label for="heat">heat</label>
</fieldset>
</div>
<a href="#history-chief_complaint" data-rel="back" data-role="button" data-inline="true">Back</a>
</div><!-- /content -->
<div data-role="footer" data-id="navbar" data-position="fixed">
<div data-role="navbar">
<ul>
<li><a href="#history-chief_complaint" data-rel="back" >Back</a></li>
</ul>
</div><!-- /navbar -->
</div><!-- /footer -->
</div><!-- /page - chief_complaint_detail -->
<div data-role="page" class="" id="armpain_details">
<div data-role="header" data-theme="f" data-position="fixed">
<h1>armpain_details</h1>
<a href="#history-chief_complaint" data-icon="back" data-direction="reverse" data-rel="back">Back</a>
</div>
<div data-role="content" id="thierry">
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Onset:</legend>
<input type="radio" name="onset_armpain_details" id="day" class="custom" onchange="toggleDateSelector(this)"/>
<label for="day">Day</label>
<input type="radio" name="onset_armpain_details" id="week" class="custom" onchange="toggleDateSelector(this)"/>
<label for="week">Week</label>
<input type="radio" name="onset_armpain_details" id="month" class="custom" onchange="toggleDateSelector(this)"/>
<label for="month">Month</label>
<input type="radio" name="onset_armpain_details" id="year" class="custom" onchange="toggleDateSelector(this)"/>
<label for="year">year</label>
<input type="radio" name="onset_armpain_details" id="specefic" value="specific" class="custom" onchange="toggleDateSelector(this)" />
<label for="specefic">specific</label>
</fieldset>
</div>
<div id="date_onset_armpain_details" class="display-hidden">
<input type="date" name="date" id="date" value="" data-mini="true" />
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Mode:</legend>
<input type="radio" name="mode" id="lifting" class="custom" />
<label for="lifting">lifting</label>
<input type="radio" name="mode" id="accident" class="custom" />
<label for="accident">accident</label>
<input type="radio" name="mode" id="stress" class="custom" />
<label for="stress">stress</label>
<input type="radio" name="mode" id="other" class="custom" />
<label for="other">other</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Character:</legend>
<input type="checkbox" name="character" id="tingling" class="custom" />
<label for="tingling">tingling</label>
<input type="checkbox" name="character" id="throbbing" class="custom" />
<label for="throbbing">throbbing</label>
<input type="checkbox" name="character" id="dull" class="custom" />
<label for="dull">dull</label>
<input type="checkbox" name="character" id="shooting" class="custom" />
<label for="shooting">shooting</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<label for="slider-0">Scale:</label>
<input type="range" name="slider" id="slider-0" value="0" min="0" max="10" />
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Aggravating factors:</legend>
<input type="checkbox" id="sitting" class="custom" />
<label for="sitting">sitting</label>
<input type="checkbox" id="standing" class="custom" />
<label for="standing">standing</label>
<input type="checkbox" id="bending" class="custom" />
<label for="bending">bending</label>
<input type="checkbox" id="ice" class="custom" />
<label for="ice">ice</label>
</fieldset>
</div>
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Relieving factors:</legend>
<input type="checkbox" name="rf" id="moving" class="custom" />
<label for="moving">moving</label>
<input type="checkbox" name="rf" id="lying" class="custom" />
<label for="lying">lying</label>
<input type="checkbox" name="rf" id="rest" class="custom" />
<label for="rest">rest</label>
<input type="checkbox" name="rf" id="heat" class="custom" />
<label for="heat">heat</label>
</fieldset>
</div>
<a href="#history-chief_complaint" data-rel="back" data-role="button" data-inline="true">Back</a>
</div><!-- /content -->
<div data-role="footer" data-id="navbar" data-position="fixed">
<div data-role="navbar">
<ul>
<li><a href="#history-chief_complaint" data-rel="back" >Back</a></li>
</ul>
</div><!-- /navbar -->
</div><!-- /footer -->
</div><!-- /page - chief_complaint_detail -->
<div data-role="page" class="" id="sacralpain_details">
<div data-role="header" data-theme="f" data-position="fixed">
<h1>sacralpain_details</h1>
<a href="#history-chief_complaint" data-icon="back" data-direction="reverse" data-rel="back">Back</a>
</div>
<div data-role="content" id="thierry">
<div data-role="fieldcontain">
<fieldset data-role="controlgroup" data-type="horizontal">
<legend>Onset:</legend>
<input type="radio" name="onset_sacralpain_details" id="day" class="custom" onchange="toggleDateSelector(this)"/>
<label for="day">Day</label>
<input type="radio" name="onset_sacralpain_details" id="week" class="custom" onchange="toggleDateSelector(this)"/>
<label for="week">Week</label>
<input type="radio" name="onset_sacralpain_details" id="month" class="custom" onchange="toggleDateSelector(this)"/>
<label for="month">Month</label>
<input type="radio" name="onset_sacralpain_details" id="year" class="custom" onchange="toggleDateSelector(this)"/>
<label for="year">year</label>
<input type="radio" name="onset_sacralpain_details" id="specefic" value="specific" class="custom" onchange="toggleDateSelector(this)" />
<label for="specefic">specific</label>
</fieldset>
</div>