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Psychiatric Medication Management form #7

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Psychiatric Medication Management form #7

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3 changes: 3 additions & 0 deletions PMM/README.md
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# EHR_Forms
Optional clinical forms for LibreHealthEHR
Psychiatric Medication Management
1 change: 1 addition & 0 deletions PMM/info.txt
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Psy Med Management
305 changes: 305 additions & 0 deletions PMM/new.php
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321 changes: 321 additions & 0 deletions PMM/report.php
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<?php
//by Art Eaton
include_once("../../globals.php");
include_once("$srcdir/api.inc");
function pmm_report( $pid, $encounter, $cols, $id) {
$count = 0;
$obj = formFetch("form_pmm", $id);
?>

<?php html_header_show();?>
<STYLE TYPE="text/css">
<!--
@page { margin-right: 0.3in; margin-top: 0.2in; margin-bottom: 0.2in }
P { margin-bottom: 0.08in; direction: ltr; color: #000000; widows: 2; orphans: 2 }
P.western { font-family: "Frutiger 55 Roman"; font-size: 10pt; so-language: en-US }
P.cjk { font-family: "Times New Roman", serif; font-size: 10pt }
P.ctl { font-family: "Frutiger 55 Roman"; font-size: 14pt; so-language: ar-SA }
H1 { margin-top: 0.04in; margin-bottom: 0in; direction: ltr; text-transform: uppercase; color: #000000; widows: 2; orphans: 2 }
H1.western { font-family: "Frutiger 55 Roman"; font-size: 10pt; so-language: en-US }
H1.cjk { font-family: "Times New Roman", serif; font-size: 10pt }
H1.ctl { font-family: "Arial", sans-serif; font-size: 10pt; so-language: ar-SA }
A:link { color: #0000ff }
-->
</STYLE>


<span class="title"><center>Medication Management</center></span><br><br>

<?php $res = sqlStatement("SELECT fname,mname,lname,ss,street,city,state,postal_code,phone_home,DOB FROM patient_data WHERE pid = $pid");
$result = SqlFetchArray($res); ?>
<br>
<TABLE WIDTH=680 CELLPADDING=7 CELLSPACING=0 STYLE="page-break-before: always">
<COLGROUP>
<COL WIDTH=370>
</COLGROUP>
<COLGROUP>
<COL WIDTH=92>
<COL WIDTH=256>
</COLGROUP>
<TR>
<TD COLSPAN=2 WIDTH=680 VALIGN=TOP STYLE="border-top: 1.50pt solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0in 0.08in">
<P CLASS="western" STYLE="margin-top: 0.13in"><FONT FACE="Calibri, sans-serif"><b>Patient Name:&nbsp; <?php echo $result['fname'] . '&nbsp;' . $result['mname'] . '&nbsp;' . $result['lname'];?> </B></FONT>

</P>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 VALIGN=TOP BGCOLOR="#d9d9d9" STYLE="border-top: 1.50pt solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<H1 CLASS="western" ALIGN=CENTER>Medication Management</H1>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=43 VALIGN=TOP STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<H1 CLASS="western" STYLE="margin-bottom: 0.2in"><FONT FACE="Calibri, sans-serif">Chief
Complaint/Reason for ENCOUNTER:</FONT></H1>
<P CLASS="western"> <?if ($obj{"presenting_problem"}==""){echo("<font color=red>INCOMPLETE!!!</font>");}else{ echo stripslashes($obj{"presenting_problem"});}?>
</P>
</TD>
</TR>


<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=79 VALIGN=TOP STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<H1 CLASS="western" STYLE="margin-bottom: 0.2in; font-style: normal">
<FONT FACE="Arial Narrow, sans-serif" SIZE=1 STYLE="font-size: 8pt">Current
Medications</FONT></H1>
<P CLASS="western"> <?php echo stripslashes($obj{"currentmeds"});?>
</P>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=42 VALIGN=TOP STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<H1 CLASS="western" STYLE="margin-bottom: 0.2in; font-style: normal">
<SPAN STYLE="font-variant: normal"><FONT FACE="Arial Narrow, sans-serif"><FONT SIZE=1 STYLE="font-size: 8pt">ALLERGIES</FONT></FONT></SPAN></H1>
<P CLASS="western"><?php echo stripslashes($obj{"allergies"});?>
</P>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=42 VALIGN=TOP STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<H1 CLASS="western" STYLE="margin-bottom: 0.2in"><FONT FACE="Calibri, sans-serif">Mental
Status Exam</FONT></H1>
<P CLASS="western">Appearance:<BR> <?php if ($obj{"appearance"}==""){echo("<font color=red>Nothing recorded for this section.</font>");}else{ echo stripslashes($obj{"appearance"});} ?>
</P>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=42 VALIGN=TOP STYLE="border-top: none; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding-top: 0in; padding-bottom: 0.02in; padding-left: 0.08in; padding-right: 0.08in">
<P CLASS="western"><FONT FACE="Calibri, sans-serif">General
Behavior/Attitude:<BR> <?php if ($obj{"general"}==""){echo("<font color=red>Nothing recorded for this section.</font>");}else{ echo stripslashes($obj{"general"});} ?>
</FONT>
</P>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=42 VALIGN=TOP STYLE="border-top: none; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding-top: 0in; padding-bottom: 0.02in; padding-left: 0.08in; padding-right: 0.08in">
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Mood/Affect:
<BR> <?php if ($obj{"affect_mood"}==""){echo("<font color=red>Nothing recorded for this section</font>");}else{ echo stripslashes($obj{"affect_mood"});}?>
</FONT>
</P>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=39 VALIGN=TOP STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<UL>
<P CLASS="western"><FONT FACE="Calibri, sans-serif"><LI>Speech:</LI>
<BR>
<?php
$validate=0;
if ($obj{"speech1"} == "on") {echo "Clear/Coherent<BR> ";$validate+=1;}
if($obj{"speech2"} == "on") {echo "Slow<BR>";$validate+=1; }
if($obj{"speech3"} == "on") {echo "Soft-Spoken<BR>";$validate+=1;}
if ($obj{"speech4"} == "on") {echo "Mumbled/Unclear<BR>";$validate+=1;}
if ($obj{"speech5"} == "on") {echo "Excessive/Rapid<BR>";$validate+=1;}
if ($obj{"speech6"} == "on") {echo "Negative/Critical<BR>";$validate+=1;}
if ($validate==0) echo("<font color=red>INCOMPLETE!!!</font>");
?>
<BR>Note abnormalities: (e.g., perseveration, paucity of language)<BR>
<?php echo stripslashes($obj{"speech_notes"});?> </FONT></P>
</UL>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=39 VALIGN=TOP STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<UL>
<P CLASS="western"><FONT FACE="Calibri, sans-serif"><LI>Thought processes:</LI>
<?php
$validate=0;
if ($obj{"thought1"} == "on") {echo "No Abnormality<BR>";$validate+=1;}
if ($obj{"thought2"} == "on") {echo "Tangential<BR>";$validate+=1;}
if ($obj{"thought3"} == "on") {echo "Perseverative/Obsessive<BR>";$validate+=1;}
if ($obj{"thought4"} == "on") {echo "Delusions/Hallucinations<BR>";$validate+=1;}
if ($validate==0) echo("<font color=red>INCOMPLETE!!!</font>");
?>
<BR>Note abnormalities: <BR>
<?php echo stripslashes($obj{"thought_notes"});?></FONT></P>
</UL>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=32 VALIGN=TOP STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<UL>
<P CLASS="western"><FONT FACE="Calibri, sans-serif"><LI>Potential for Suicide:</LI>
<BR>
<?php
if ($obj{"psychoa"} == 1) {echo " None";}
if ($obj{"psychoa"} == 2) {echo "Mild";}
if ($obj{"psychoa"} == 3) {echo "Moderate";}
if ($obj{"psychoa"} == 4) {echo "Severe";}
if ($obj{"psychoa"} == 0) {echo("<font color=red>INCOMPLETE!!!</font>");}
?>

</FONT></P>
</UL>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=36 VALIGN=TOP STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<UL>
<P CLASS="western"><FONT FACE="Calibri, sans-serif"><LI>Potential for Homicide:</LI>
<BR>
<?php
if ($obj{"psychob"} == 1) {echo "None";}
if ($obj{"psychob"} == 2) {echo "Mild";}
if ($obj{"psychob"} == 3) {echo "Moderate";}
if ($obj{"psychob"} == 4) {echo "Severe";}
if ($obj{"psychob"} == 0) echo("<font color=red>INCOMPLETE!!!</font>");
?>
</FONT></P>
</UL>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=36 VALIGN=TOP STYLE="border-top: none; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding-top: 0in; padding-bottom: 0.02in; padding-left: 0.08in; padding-right: 0.08in">
<UL>
<P CLASS="western"><FONT FACE="Calibri, sans-serif"><LI>Potential for Violence:</LI>
<BR>
<?php
$validate=0;
if ($obj{"psychoc"} == 1) {echo "None";}
if ($obj{"psychoc"} == 2) {echo "Mild";}
if ($obj{"psychoc"} == 3) {echo "Moderate";}
if ($obj{"psychoc"} == 4) {echo "Severe";}
if ($obj{"psychoc"} == 0) echo("<font color=red>INCOMPLETE!!!</font>");
?>

</FONT></P>
</UL>
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Notes:<BR>
<?php echo stripslashes($obj{"psycho_notes"});?> </FONT></P>

</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=42 VALIGN=TOP STYLE="border-top: 1px solid #000000; border-bottom: 1.50pt solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Lab Tests Reviewed:<BR>
<?php
if ($obj{"labs"} == "0") {echo "N/A";}
if ($obj{"labs"} == "1") {echo "Sees Pediatrician";}
if ($obj{"labs"} == "2") {echo "Pending";}
if ($obj{"labs"} == "3") {echo "Routed";}
if ($obj{"labs"} == "4") {echo "Complete";}
if ($obj{"labs"} == "5") {echo "Canceled";}
if ($obj{"labs"} == NULL) echo("<font color=red>INCOMPLETE!!!</font>");
?>
</FONT></P>
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Notes:<BR>
<?php echo stripslashes($obj{"other"});?></FONT></P>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=18 BGCOLOR="#d9d9d9" STYLE="border-top: 1.50pt solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<P CLASS="western" ALIGN=CENTER STYLE="text-transform: uppercase">
<B>Plan</B></P>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=42 VALIGN=TOP STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<P CLASS="western" STYLE="text-indent: 0.34in"><FONT FACE="Calibri, sans-serif">Informed
Consent:<BR>Information was fully disclosed and discussed
regarding the nature of the treatment, potential benefits,
potential risks, and any alternatives to the treatment including:
Potential benefits; Risks; Risk of no treatment at all. Any
specific comments are noted below. The individual/guardian
consented to the proposed medication/treatment.</FONT></P>
</TD>
</TR>
<TR VALIGN=TOP>
<TD WIDTH=340 HEIGHT=15 BGCOLOR="#d9d9d9" STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: none; padding-top: 0.02in; padding-bottom: 0.02in; padding-left: 0.08in; padding-right: 0in">
<P CLASS="western" ALIGN=CENTER STYLE="text-indent: 0.34in"><FONT FACE="Calibri, sans-serif"><FONT SIZE=2 STYLE="font-size: 11pt"><B>Diagnoses
</B></FONT></FONT>
</P>
</TD>
<TD WIDTH=340 BGCOLOR="#d9d9d9" STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<P CLASS="western" ALIGN=CENTER><FONT FACE="Calibri, sans-serif"><FONT SIZE=2 STYLE="font-size: 11pt"><B>Treatment
Plan</B></FONT></FONT></P>
</TD>
</TR>
<TR VALIGN=TOP>
<TD disabled ROWSPAN=4 WIDTH=340 STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1.50pt solid #000000; border-right: none; padding-top: 0.02in; padding-bottom: 0.02in; padding-left: 0.08in; padding-right: 0in">
<P CLASS="western" STYLE="margin-bottom: 0in"><FONT FACE="Calibri, sans-serif">Change Notes:
<BR> <?php echo stripslashes($obj{"diagchange"});?> </FONT></P>
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Current CGAS:<BR>
<?php echo stripslashes($obj{"cgas"});?> </FONT></P>
</TD>
<TD WIDTH=340 STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Medication Changes<BR>
<?php echo stripslashes($obj{"medchanges"});?> </FONT></P>
</TD>
</TR>
<TR VALIGN=TOP>
<TD WIDTH=340 STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">

<P CLASS="western"><FONT FACE="Calibri, sans-serif">Medication Change Reasons:<BR>
<?php
if ($obj{"changereason"} == "1") {echo "No Changes";}
if ($obj{"changereason"} == "2") {echo "Medication Adjustment ";}
if ($obj{"changereason"} == "3") {echo "Informed Consent Obtained for New Medications/Treatment";}
if ($obj{"changereason"} == "4") {echo "Other";}
if ($obj{"changereason"} == 0) echo("<font color=red>INCOMPLETE!!!</font>");
?>

</FONT></P>
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Other:<BR>
<?php echo stripslashes($obj{"changeother"});?></FONT></P>

</TD>
</TR>
<TR VALIGN=TOP>
<TD WIDTH=340 STYLE="border-top: 1px solid #000000; border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">

<P CLASS="western"><FONT FACE="Calibri, sans-serif">Labs Ordered for Next Appointment:<BR>
<?php
if ($obj{"laborder"} == "0") {echo "N/A";}
if ($obj{"laborder"} == "1") {echo "Sees Pediatrician";}
if ($obj{"laborder"} == "2") {echo "Pending";}
if ($obj{"laborder"} == "3") {echo "Routed";}
if ($obj{"laborder"} == "4") {echo "Complete";}
if ($obj{"laborder"} == "5") {echo "Canceled";}
if ($obj{"laborder"} == NULL) {echo("<font color=red>INCOMPLETE!!!</font>"); }
?>
</FONT></P>
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Notes:<BR>
<?php echo stripslashes($obj{"labother"});?> </FONT></P>

</TD>
</TR>
<TR VALIGN=TOP>
<TD WIDTH=340 STYLE="border-top: 1px solid #000000; border-bottom: 1.50pt solid #000000; border-left: 1px solid #000000; border-right: 1.50pt solid #000000; padding: 0.02in 0.08in">
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Medication Recommendations are listed in Patient Prescription Record</FONT></P>
</TD>
</TR>
<TR>
<TD COLSPAN=2 WIDTH=680 HEIGHT=89 VALIGN=TOP STYLE="border: 1.50pt solid #000000; padding: 0.02in 0.08in">
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Follow-up appointment in:<BR>
<?php
if ($obj{"appt"} == "1") {echo "1-2 Weeks";}
if ($obj{"appt"} == "2") {echo "3-4 Weeks";}
if ($obj{"appt"} == "3") {echo "6 Weeks";}
if ($obj{"appt"} == "4") {echo "2 Months";}
if ($obj{"appt"} == "5") {echo "3 Months";}
if ($obj{"appt"} == "6") {echo "Other";}
if ($obj{"appt"} == 0) {echo("<font color=red>INCOMPLETE!!!</font>"); }
?>
</FONT></P>
<P CLASS="western"><FONT FACE="Calibri, sans-serif">Appointment Notes:<BR>
<?php echo stripslashes($obj{"apptother"});?> </FONT></P>
</TD>
</TR>


</TABLE>
<center>
<?php if($obj{"finalize"}!="on"){
echo"<b>This Progress Note is IN PROCESS.</b>";
}else{echo"This form has been finalized and may not be edited!";}?>
</center>
<?php
}
?>
62 changes: 62 additions & 0 deletions PMM/save.php
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<?php
//by Art Eaton
include_once("../../globals.php");
include_once("$srcdir/api.inc");
include_once("$srcdir/forms.inc");
foreach ($_POST as $k => $var) {
$_POST[$k] = mysql_escape_string($var);
echo "$var\n";
}
if ($encounter == "")
$encounter = date("Ymd");



if ($_GET["mode"] == "new"){

$newid = formSubmit("form_pmm", $_POST, $_GET["id"], $userauthorized);
//save the pmm form using the forms api to redirect back to encounter
addForm($encounter, "Psy Med Manage", $newid, "pmm", $pid, $userauthorized);
}elseif ($_GET["mode"] == "update") {
sqlInsert("update form_pmm set pid = {$_SESSION["pid"]},groupname='".$_SESSION["authProvider"]."',user='".$_SESSION["authUser"]."',authorized=$userauthorized,activity=1, date = NOW(),
presenting_problem ='".$_POST["presenting_problem"]."',
currentmeds ='".$_POST["currentmeds"]."',
allergies ='".$_POST["allergies"]."',
appearance ='".$_POST["appearance"]."',
general ='".$_POST["general"]."',
affect_mood ='".$_POST["affect_mood"]."',
speech1 ='".$_POST["speech1"]."',
speech2 ='".$_POST["speech2"]."',
speech3 ='".$_POST["speech3"]."',
speech4 ='".$_POST["speech4"]."',
speech5 ='".$_POST["speech5"]."',
speech6 ='".$_POST["speech6"]."',
speech_notes ='".$_POST["speech_notes"]."',
thought1 ='".$_POST["thought1"]."',
thought2 ='".$_POST["thought2"]."',
thought3 ='".$_POST["thought3"]."',
thought4 ='".$_POST["thought4"]."',
thought_notes ='".$_POST["thought_notes"]."',
psychoa ='".$_POST["psychoa"]."',
psychob ='".$_POST["psychob"]."',
psychoc ='".$_POST["psychoc"]."',
psycho_notes ='".$_POST["psycho_notes"]."',
labs ='".$_POST["labs"]."',
other ='".$_POST["other"]."',
diagchange ='".$_POST["diagchange"]."',
cgas ='".$_POST["cgas"]."',
medchanges ='".$_POST["medchanges"]."',
changereason ='".$_POST["changereason"]."',
changeother ='".$_POST["changeother"]."',
laborder ='".$_POST["laborder"]."',
labother ='".$_POST["labother"]."',
appt ='".$_POST["appt"]."',
apptother ='".$_POST["apptother"]."',
finalize ='".$_POST["finalize"]."' where id=$id");}
//Finish up business.
$_SESSION["encounter"] = $encounter;
formHeader("Redirecting....");
formJump();
formFooter();
?>

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