GAD7
GAD7.html
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HTML,
10 kB (10242 bytes)
File contents
<html> <title>GAD-7</title> <head> <style type="text/css"> p.title{ text-transform: uppercase; font-size: 16; font-family: Arial; font-weight: bolder; text-align: left; color: black; } p.heading{ font-weight: bolder; text-decoration: underline; } td.heading1{ font-size: 12; font-family: Arial; font-weight: bold; text-align: left; vertical-align: top; color: white; background:black ; border-width: 1; } td.heading2{ font-size: 12; font-family: Arial; font-weight: bold; text-align: left; vertical-align: top; color: white; background: #444444; border-width: 1; } tr.even{ background-color: #ffffff; } tr.odd{ background-color: #dddddd; } td.question{ font-size: 12; font-family: Arial; font-weight: normal; text-align: left; vertical-align: top; color: black; border-width: 1; } td.answer{ font-size: 12; font-family: Arial; font-weight: normal; text-align: center; vertical-align: top; color: black; border-width: 1; } td.normaltext{ width: 100%; font-size: 12; font-family: Arial; font-weight: normal; text-align: left; vertical-align: top; color: black; background-color: white; border-width: 0; } input.formtext{ width: 100%; height: 100%; font-size: 12; font-family: Arial; font-weight: normal; text-align: left; vertical-align: top; color: black; background-color: white; border-width: 1; border-style: solid; } textarea.formtext{ width: 100%; height: auto; font-size: 12; font-family: Arial; font-weight: normal; text-align: left; vertical-align: top; color: black; background-color: white; border-width: 1; border-style: solid; } </style> <!-- CSS Script that removes textarea and textbox borders when printing ---(put this inbetween <header></header>)-----------------> <style type="text/css" media="print"> div.DoNotPrint { display: none; } input.noborder { border : 0px; background: transparent; } textarea.noborder { scrollbar-3dlight-color: transparent; scrollbar-3dlight-color: transparent; scrollbar-arrow-color: transparent; scrollbar-base-color: transparent; scrollbar-darkshadow-color: transparent; scrollbar-face-color: transparent; scrollbar-highlight-color: transparent; scrollbar-shadow-color: transparent; scrollbar-track-color: transparent; background: transparent; overflow: hidden; //scrollbar : none; border : 0px; } </style> <!-- ----------------------------------------------------------------------------------------- --> <script type="text/javascript" language="javascript"> function getCheckedValue(radioObj) { if(!radioObj) return parseInt(0); var radioLength = radioObj.length; if(radioLength == undefined) if(radioObj.checked) return parseInt(radioObj.value); else return parseInt(value); for(var i = 0; i < radioLength; i++) { if(radioObj[i].checked) { return parseInt(radioObj[i].value); } } return parseInt(0); } function totalScore(){ var i = 0; i += getCheckedValue(document.GAD7Form.Q1); i += getCheckedValue(document.GAD7Form.Q2); i += getCheckedValue(document.GAD7Form.Q3); i += getCheckedValue(document.GAD7Form.Q4); i += getCheckedValue(document.GAD7Form.Q5); i += getCheckedValue(document.GAD7Form.Q6); i += getCheckedValue(document.GAD7Form.Q7); document.GAD7Form.GAD7Score.value = i; if (i<=4){ document.getElementById("none").style.background='yellow'; document.getElementById("mild").style.background='white'; document.getElementById("moderate").style.background='white'; document.getElementById("severe").style.background='white'; } else if (i>=5 && i<=9){ document.getElementById("none").style.background='white'; document.getElementById("mild").style.background='yellow'; document.getElementById("moderate").style.background='white'; document.getElementById("severe").style.background='white'; } else if (i>=10 && i<=14){ document.getElementById("none").style.background='white'; document.getElementById("mild").style.background='white'; document.getElementById("moderate").style.background='yellow'; document.getElementById("severe").style.background='white'; } else if (i>=15 && i<=21){ document.getElementById("none").style.background='white'; document.getElementById("mild").style.background='white'; document.getElementById("moderate").style.background='white'; document.getElementById("severe").style.background='yellow'; } } </script> </head> <body> <form method="post" action="" name="GAD7Form"> <p class="title"> GAD-7 </p> <div name="demographics"> <table width="100%"> <tr> <td class="heading1" width=25%>Patient name</td> <td class="normaltext" width=75%><input class="formtext" name="PatientName" type="text" oscarDB=patient_name> </tr> <tr> <td class="heading1">Date:</td> <td class="normaltext"><input class="formtext" name="TodaysDate" type="text" oscarDB=today> </tr> </table> </div> <br> <div name="Questionnaire"> <table width="100%"> <tr> <td class="heading2" width=40%>A. Over the last 2 weeks, how often have you been bothered by any of the following problems?</td> <td class="heading2" width=15%>Not at all (0)</td> <td class="heading2" width=15%>Several days (1)</td> <td class="heading2" width=15%>More than half the days (2)</td> <td class="heading2" width=15%>Nearly every day (3) </td> </tr> <tr class="odd"> <td class="question"> Q1. Feeling nervous, anxious or on edge</td> <td class="answer"><input type="radio" name="Q1" value="0"></td> <td class="answer"><input type="radio" name="Q1" value="1"></td> <td class="answer"><input type="radio" name="Q1" value="2"></td> <td class="answer"><input type="radio" name="Q1" value="3"></td> </tr> <tr class="even"> <td class="question">Q2. Not being able to stop or control worrying</td> <td class="answer"><input type="radio" name="Q2" value="0"></td> <td class="answer"><input type="radio" name="Q2" value="1"></td> <td class="answer"><input type="radio" name="Q2" value="2"></td> <td class="answer"><input type="radio" name="Q2" value="3"></td> </tr> <tr class="odd"> <td class="question">Q3. Worrying too much about different things</td> <td class="answer"><input type="radio" name="Q3" value="0"></td> <td class="answer"><input type="radio" name="Q3" value="1"></td> <td class="answer"><input type="radio" name="Q3" value="2"></td> <td class="answer"><input type="radio" name="Q3" value="3"></td> </tr> <tr class="even"> <td class="question">Q4. Trouble relaxing</td> <td class="answer"><input type="radio" name="Q4" value="0"></td> <td class="answer"><input type="radio" name="Q4" value="1"></td> <td class="answer"><input type="radio" name="Q4" value="2"></td> <td class="answer"><input type="radio" name="Q4" value="3"></td> </tr> <tr class="odd"> <td class="question">Q5. Being so restless that it is hard to sit still</td> <td class="answer"><input type="radio" name="Q5" value="0"></td> <td class="answer"><input type="radio" name="Q5" value="1"></td> <td class="answer"><input type="radio" name="Q5" value="2"></td> <td class="answer"><input type="radio" name="Q5" value="3"></td> </tr> <tr class="even"> <td class="question"> Q6. Becoming easily annoyed or irritable</td> <td class="answer"><input type="radio" name="Q6" value="0"></td> <td class="answer"><input type="radio" name="Q6" value="1"></td> <td class="answer"><input type="radio" name="Q6" value="2"></td> <td class="answer"><input type="radio" name="Q6" value="3"></td> </tr> <tr class="odd"> <td class="question">Q7. Felling afraid as if something awful might happen</td> <td class="answer"><input type="radio" name="Q7" value="0"></td> <td class="answer"><input type="radio" name="Q7" value="1"></td> <td class="answer"><input type="radio" name="Q7" value="2"></td> <td class="answer"><input type="radio" name="Q7" value="3"></td> </tr> </table> <br> <table width="100%" class="DoNotPrint"> <tr> <td class="heading2" width=40%>B. If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?</td> <td class="answer" width=15%><input type="radio" name="Q10" value="Not difficult at all">Not difficult at all</td> <td class="answer" width=15%><input type="radio" name="Q10" value="Somewhat difficult">Somewhat difficult</td> <td class="answer" width=15%><input type="radio" name="Q10" value="Very difficult">Very difficult</td> <td class="answer" width=15%><input type="radio" name="Q10" value="Extremely difficult">Extremely difficult</td> </tr> </table> <table> <tr> <td><input type="button" onclick="totalScore()" value="Calculate Total Score"></td> <td><input type="text" name="GAD7Score" size="10" value=""></td> </tr> </table> </div> <br> <br> <div name="Instructions" class="DoNotPrint"> <table> <tr> <td class="heading2">Score</td> <td class="heading2">Action</td> </tr> <tr id="none"> <td>0-4</td> <td>No anxiety </td> </tr> <tr id="mild"> <td>5-9</td> <td>Mild anxiety </td> </tr> <tr id="moderate"> <td> 10-14</td> <td>Moderate anxiety </td> </tr> <tr id="severe"> <td>15-21</td> <td>Severe anxiety </td> </tr> </table> </td> </tr> </table> </div> <br> <br> <!-- The submit/print/reset buttons -------------------------------------------------------------> <div name="FunctionButtons" class="DoNotPrint"> <table> <tr> <td class="subjectline"> Subject: <input name="subject" size="40" type="text"> <input value="Submit" name="SubmitButton" type="submit"> <input value="Reset" name="ResetButton" type="reset"> <input value="Print" name="PrintButton" onclick="javascript:window.print()" type="button"> </td> </tr> </table> </div> </form> <!-- ------End of submit/print/reset buttons-----------------------------------------------------> </body> </html>
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