<style type="text/css">
/*RED*/
.form-controlmy {
    border-color: #fd3995;
    padding-right: calc(1.47em + 1rem);
    background-image: url("data:image/svg+xml,%3csvg xmlns='http://www.w3.org/2000/svg' width='12' height='12' fill='none' stroke='%23fd3995' viewBox='0 0 12 12'%3e%3ccircle cx='6' cy='6' r='4.5'/%3e%3cpath stroke-linejoin='round' d='M5.8 3.6h.4L6 6.5z'/%3e%3ccircle cx='6' cy='8.2' r='.6' fill='%23fd3995' stroke='none'/%3e%3c/svg%3e");
    background-repeat: no-repeat;
    background-position: right calc(0.3675em + 0.25rem) center;
    background-size: calc(0.735em + 0.5rem) calc(0.735em + 0.5rem);
}

.is-invalidmy:focus {
    border-color: #fd3995;
    -webkit-box-shadow: 0 0 0 0.2rem rgba(253, 57, 149, 0.25);
    box-shadow: 0 0 0 0.2rem rgba(253, 57, 149, 0.25);
}

/*.was-validated textarea.form-control:invalid, textarea.form-control.is-invalid {
  padding-right: calc(1.47em + 1rem);
  background-position: top calc(0.3675em + 0.25rem) right calc(0.3675em + 0.25rem); }*/
.custom-selectmy {
    border-color: #fd3995;
    padding-right: calc(0.75em + 2.625rem);
    background: url("data:image/svg+xml,%3csvg xmlns='http://www.w3.org/2000/svg' width='4' height='5' viewBox='0 0 4 5'%3e%3cpath fill='%23343a40' d='M2 0L0 2h4zm0 5L0 3h4z'/%3e%3c/svg%3e") no-repeat right 0.875rem center/8px 10px, url("data:image/svg+xml,%3csvg xmlns='http://www.w3.org/2000/svg' width='12' height='12' fill='none' stroke='%23fd3995' viewBox='0 0 12 12'%3e%3ccircle cx='6' cy='6' r='4.5'/%3e%3cpath stroke-linejoin='round' d='M5.8 3.6h.4L6 6.5z'/%3e%3ccircle cx='6' cy='8.2' r='.6' fill='%23fd3995' stroke='none'/%3e%3c/svg%3e") #fff no-repeat center right 1.875rem/calc(0.735em + 0.5rem) calc(0.735em + 0.5rem);
}

/*GREEN*/
.is-validmy {
    border-color: #1dc9b7;
    padding-right: calc(1.47em + 1rem);
    background-image: url("data:image/svg+xml,%3csvg xmlns='http://www.w3.org/2000/svg' width='8' height='8' viewBox='0 0 8 8'%3e%3cpath fill='%231dc9b7' d='M2.3 6.73L.6 4.53c-.4-1.04.46-1.4 1.1-.8l1.1 1.4 3.4-3.8c.6-.63 1.6-.27 1.2.7l-4 4.6c-.43.5-.8.4-1.1.1z'/%3e%3c/svg%3e");
    background-repeat: no-repeat;
    background-position: right calc(0.3675em + 0.25rem) center;
    background-size: calc(0.735em + 0.5rem) calc(0.735em + 0.5rem);
}

.is-validmyf:focus {
    border-color: #1dc9b7;
    -webkit-box-shadow: 0 0 0 0.2rem rgba(29, 201, 183, 0.25);
    box-shadow: 0 0 0 0.2rem rgba(29, 201, 183, 0.25);
}

/*.was-validated textarea.form-control:valid, textarea.form-control.is-valid {
  padding-right: calc(1.47em + 1rem);
  background-position: top calc(0.3675em + 0.25rem) right calc(0.3675em + 0.25rem); }*/

.custom-selectisvalidmy {
    border-color: #1dc9b7;
    padding-right: calc(0.75em + 2.625rem);
    background: url("data:image/svg+xml,%3csvg xmlns='http://www.w3.org/2000/svg' width='4' height='5' viewBox='0 0 4 5'%3e%3cpath fill='%23343a40' d='M2 0L0 2h4zm0 5L0 3h4z'/%3e%3c/svg%3e") no-repeat right 0.875rem center/8px 10px, url("data:image/svg+xml,%3csvg xmlns='http://www.w3.org/2000/svg' width='8' height='8' viewBox='0 0 8 8'%3e%3cpath fill='%231dc9b7' d='M2.3 6.73L.6 4.53c-.4-1.04.46-1.4 1.1-.8l1.1 1.4 3.4-3.8c.6-.63 1.6-.27 1.2.7l-4 4.6c-.43.5-.8.4-1.1.1z'/%3e%3c/svg%3e") #fff no-repeat center right 1.875rem/calc(0.735em + 0.5rem) calc(0.735em + 0.5rem);
}

/*.inactiveLink {
   pointer-events: none;
   
}*/
.no-drop {
    cursor: no-drop !important
}

.color-white {
    background-color: #fff !important;
}
.ft13
{
    font-size: 13px;
}
</style>
<main id="js-page-content" role="main" class="page-content">


    <ol class="breadcrumb page-breadcrumb">
        <li class="breadcrumb-item"><a href="javascript:void(0);">IC Portal</a></li>
        <li class="breadcrumb-item">Surveillance Form</li>

        <li class="position-absolute pos-top pos-right d-none d-sm-block"><span class="js-get-date"></span></li>
    </ol>
    <div id="content">
        <div class="row mb-2">
            <div class="col-xs-12 col-sm-7 col-md-7 col-lg-4">
            <h1> <span class="page-title txt-color-blueDark">Surveillance Form</span></h1>
            </div>
            <div class="col-xs-12 col-sm-7 col-md-7 col-lg-8">
                <a href="/viewdata" class="btn btn-primary float-right bg-brand-gradient" type="button">View Submitted Form</a>
            </div>
        </div>
        <section>
            <div id="panel-12" class="panel mt">
                <div class="panel-hdr border-faded border-top-0 border-right-0 border-left-0 shadow-0">
                    <!-- <h2>
                      <span>  Surveillance Form</span>
                    </h2> -->
                    <div class="panel-toolbar pr-3 align-self-end">
                        <ul id="demo_panel-tabs" class="nav nav-tabs border-bottom-0" role="tablist">
                            <li class="nav-item">
                                <a id="first_tab" class="nav-link " data-toggle="tab" href="#js_pill_border_icon-1"
                                    role="tab">Primary Patient Information</a>
                            </li>
                            <li class="nav-item no-drop">
                                <a id="sec_tab" class="nav-link inactiveLink no-drop" data-toggle="tab"
                                    href="#js_pill_border_icon-2" role="tab">Daily Clinical Data</a>
                            </li>
                            <li class="nav-item no-drop">
                                <a id="third_tab" class="nav-link inactiveLink" data-toggle="tab" href="#js_pill_border_icon-3"
                                    role="tab">Hospital Acquired Infections</a>
                            </li>
                        </ul>
                    </div>
                </div>
                <form class="needs-validation" name='infectionform' id='infectionform' method='post' action="/info_submit"
                    onsubmit="return ValidateFrom3()" novalidate>
                    <div class="panel-container show">
                        <div class="panel-content">

                            <div class="tab-content py-3">
                                <div id="js_pill_border_icon-1" class="tab-pane fade" role="tabpanel">

                                    <div class="form-row">
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">M.R.#<span style="color: red">*</span></label>
                                            <input class="form-control" value="" placeholder="Enter M.R. Number" type="Number"
                                                min="0" id='mr_num' name='mr_num' required>
                                            <div class="invalid-feedback">
                                                Please Enter M.R. Number.
                                            </div>
                                        </div>

                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Name<span style="color: red">*</span></label>
                                            <input class="form-control " value="" placeholder="Enter Name" type="text"
                                                id='names' name='names' required>
                                            <div class="invalid-feedback">
                                                Please Enter Name.
                                            </div>
                                        </div>
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Ward<span style="color: red">*</span></label>
                                            <input class="form-control" value="" placeholder="Enter Ward Number" type="Number"
                                                min="0" id='ward' name='ward' required>
                                            <div class="invalid-feedback">
                                                Please Enter Ward Number.
                                            </div>
                                        </div>

                                    </div>
                                    <div class="form-row">
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Bed #<span style="color: red">*</span></label>
                                            <input class="form-control" value="" placeholder="Enter Bed Number" type="Number"
                                                min="0" id='bed' name='bed' required>
                                            <div class="invalid-feedback">
                                                Please Enter Bed Number.
                                            </div>
                                        </div>

                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Primary Diagnosis<span style="color: red">*</span></label>
                                            <input class="form-control" value="" placeholder="Enter Primary Diagnosis"
                                                type="text" id='primary_diagnosis' name='primary_diagnosis' required>
                                            <div class="invalid-feedback">
                                                Please Enter Primary Diagnosis.
                                            </div>
                                        </div>

                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Final Diagnosis<span style="color: red">*</span></label>
                                            <input class="form-control" value="" placeholder="Enter Final Diagnosis" type="text"
                                                id='final_diagnosis' name='final_diagnosis' required>
                                            <div class="invalid-feedback">
                                                Please Enter Final Diagnosis.
                                            </div>
                                        </div>




                                    </div>
                                    <div class="form-row">

                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Date Of Admission <span
                                                    style="color: red">*</span></label>
                                            <div class="input-group">
                                                <input type="text" style="background-color: white;" readonly=""
                                                    class="form-control aa" value="" id="date_of_admission"
                                                    name="date_of_admission">
                                                <div class="input-group-append">
                                                    <span class="input-group-text fs-xl">
                                                        <i class="fal fa-calendar-alt"></i>
                                                    </span>
                                                </div>
                                            </div>
                                            <div class="invalid-feedback">
                                                Please Select Date Of Admission.
                                            </div>
                                        </div>
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Date Of Discharge<span style="color: red">*</span></label>
                                            <div class="input-group">
                                                <input type="text" style="background-color: white;" readonly=""
                                                    class="form-control aa" value="" id="date_of_discharge"
                                                    name="date_of_discharge">
                                                <div class="input-group-append">
                                                    <span class="input-group-text fs-xl">
                                                        <i class="fal fa-calendar-alt"></i>
                                                    </span>
                                                </div>
                                            </div>
                                            <div class="invalid-feedback">
                                                Please Select Date Of Discharge .
                                            </div>
                                        </div>
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Condition On Discharge</label><span
                                                style="color: red">*</span>
                                            <select class="custom-select" name="condition_on_discharge"
                                                id="condition_on_discharge" required="">
                                                <option value="">Select </option>
                                                <option value="improved sent home">Improved Sent Home</option>
                                                <option value="shifted to another facility">shifted to another facility</option>
                                                <option value="left against medical advice">Left Against Medical Advice</option>
                                                <option value="discharge on request">Discharge On Request</option>
                                                <option value="expired">Expired</option>
                                            </select>
                                            <div class="invalid-feedback">
                                                Please Select Condition On Discharge.
                                            </div>
                                        </div>

                                    </div>

                                    <div class="row">
                                        <div class="col-md-6">
                                        </div>
                                        <div class="demo col-md-6 pull-right">
                                            <button class="btn btn-primary btn-md float-right"
                                                onclick="return ValidateFrom()"><i class="fas fa-angle-right"
                                                    style="margin-right: 4px"></i> Next</button>

                                        </div>
                                    </div>
                                </div>
                                <div id="js_pill_border_icon-2" class="tab-pane fade" role="tabpanel">
                                    <div class="form-row">
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Fever</label><span style="color: red">*</span>
                                            <!-- <select class="custom-select" name="fever" id="fever">
                                                <option value="">Select</option>
                                            </select> -->
                                            <input style="background-color: white" class="form-control " value="" placeholder="fever" type="text"
                                                    id='fever' name='fever ' readonly>
                                            <div class="invalid-feedback">
                                                Please Select Fever.
                                            </div>
                                        </div>
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Temperature<span style="color: red">*</span></label>
                                            <div class="input-group">
                                                <input class="form-control" value="" placeholder="Enter Name" type="number"
                                                    id='temperature' name='temperature ' required>
                                                <div class="input-group-append">
                                                    <span class="input-group-text fs-xl">
                                                        <i style="font-size: 13px"><b>&#8457;</b></i>
                                                    </span>
                                                </div>
                                            </div>
                                            <div class="invalid-feedback">
                                                Please Enter Temperature .
                                            </div>
                                        </div>
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Tachycardia </label><span style="color: red">*</span>
                                            <!-- <select class="custom-select" name="tachycardia" id="tachycardia" required="">
                                                <option value="">Select </option>
                                                
                                            </select> -->
                                            <input  style="background-color: white" class="form-control " value="" placeholder="Enter tachycardia" type="text"
                                                    id='tachycardia' name='tachycardia ' readonly>
                                            <div class="invalid-feedback">
                                                Please Select Tachycardia.
                                            </div>
                                        </div>

                                    </div>
                                    <div class="form-row">
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Pulse <span style="color: red">*</span></label>
                                            <div class="input-group">
                                                <input class="form-control" value="" placeholder="Enter Pulse" type="number"
                                                    id='pulse' name='pulse' required>
                                                <div class="input-group-append">
                                                    <span class="input-group-text fs-xl">
                                                        <i style="font-size: 13px"><b>bpm</b></i>
                                                    </span>
                                                </div>
                                            </div>
                                            <div class="invalid-feedback">
                                                Please Enter Pulse .
                                            </div>
                                        </div>
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Hypotension</label><span style="color: red">*</span>
                                            <select class="custom-select" name="hypotension" id="hypotension" required="">
                                                <option value="">Select </option>
                                                <option value="yes">Yes</option>
                                                <option value="no">No</option>
                                            </select>
                                            <div class="invalid-feedback">
                                                Please Select Hypotension.
                                            </div>
                                        </div>
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">BP<span style="color: red">*</span></label>
                                            <div class="input-group">
                                                <input class="form-control" value="" placeholder="Enter BP" type="number"
                                                    id='bp' name='bp' required>
                                                <div class="input-group-append">
                                                    <span class="input-group-text fs-xl">
                                                        <i style="font-size: 13px"><b>mm Hg</b></i>
                                                    </span>
                                                </div>
                                            </div>
                                            <div class="invalid-feedback">
                                                Please Enter BP .
                                            </div>
                                        </div>
                                    </div>
                                    <div class="form-row">
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Chills</label><span style="color: red">*</span>
                                            <select class="custom-select" name="chills" id="chills" required="">
                                                <option value="">Select </option>
                                                <option value="yes">Yes</option>
                                                <option value="no">No</option>
                                            </select>
                                            <div class="invalid-feedback">
                                                Please Select Chills.
                                            </div>
                                        </div>
                                        <div class="col-md-4 mb-4">
                                            <label class="form-label">WBC<span style="color: red">*</span></label>
                                            <div class="input-group">
                                                <input class="form-control" value="" placeholder="Enter WBC " type="number"
                                                    id='wbc' name='wbc' required>
                                                <div class="input-group-append">
                                                    <span class="input-group-text fs-xl">
                                                        <i style="font-size: 13px"><b>x 10<sup>9</sup></b></i>
                                                    </span>
                                                </div>

                                            </div>

                                        </div>
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Neutrophils<span style="color: red">*</span></label>
                                            <input class="form-control" value="" placeholder="Enter Neutrophils " type="number"
                                                id='ln' name='ln' required>
                                            <div class="invalid-feedback">
                                                Please Enter neutrophils.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="form-row">
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Lymphocytes<span style="color: red">*</span></label>
                                            <input class="form-control" value="" placeholder="Enter lymphocytes " type="number"
                                                id='lymphocytes' name='lymphocytes' required>
                                            <div class="invalid-feedback">
                                                Please Enter neutrophils.
                                            </div>
                                        </div>
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Worsening CXR</label><span style="color: red">*</span>
                                            <select class="custom-select" name="worsening_cxr" id="worsening_cxr" required="">
                                                <option value="">Select </option>
                                                <option value="yes">Yes</option>
                                                <option value="no">No</option>
                                            </select>
                                            <div class="invalid-feedback">
                                                Please Select Worsening CXR.
                                            </div>
                                        </div>
                                        <div class="col-md-4 mb-3">
                                            <label class="form-label">Worsening Tracheal Secretions</label><span
                                                style="color: red">*</span>
                                            <select class="custom-select" name="worsening_tracheal_secretions"
                                                id="worsening_tracheal_secretions" required="">
                                                <option value="">Select </option>
                                                <option value="yes">Yes</option>
                                                <option value="no">No</option>
                                            </select>
                                            <div class="invalid-feedback">
                                                Please Select Worsening Tracheal Secretions.
                                            </div>
                                        </div>
                                    </div>
                                    <div class="row">
                                        <div class="col-md-6">
                                        </div>
                                        <div class="demo col-md-6 pull-right">
                                            <button id='bb' class="btn btn-primary btn-md float-right"
                                                onclick="return ValidateFrom2()"><i class="fas fa-angle-right"
                                                    style="margin-right: 4px"></i> Next</button>
                                        </div>
                                    </div>
                                </div>
                                <div class="tab-pane fade" id="js_pill_border_icon-3" role="tabpanel">
                                    <div id="content">

                                        <div class="row">
                                            <div class="col-xl-12">
                                                <div id="panel-1" class="panel">
                                                    <div class="panel-container show">
                                                        <div class="panel-content">

                                                            <div class="form-row">
                                                                <div class="col-md-4 mb-3">
                                                                    <label class="form-label">Phlebitis</label><span
                                                                        style="color: red">*</span><br>
                                                                        <label class="form-label ft13"><i>Cannula present or not?</i></label>
                                                                    <select class="custom-select" name="intravenous_cannula"
                                                                        id="intravenous_cannula" required="">
                                                                        <option value="">Select</option>
                                                                        <option value="yes">Yes</option>
                                                                        <option value="no">No</option>
                                                                    </select>
                                                                    <div class="invalid-feedback">
                                                                        Please Select Intravenous Cannula.
                                                                    </div>
                                                                </div>

                                                            </div>
                                                            <div id="demo" style="display: none">
                                                                <div class="form-row">
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Date Of Insertion<span
                                                                                style="color: red">*</span></label>
                                                                        <div class="input-group">
                                                                            <input type="text" style="background-color: white"
                                                                                class="form-control aa" value=""
                                                                                name="phlebitis_date_of_insertion"
                                                                                id="phlebitis_date_of_insertion" readonly="">
                                                                            <div class="input-group-append">
                                                                                <span class="input-group-text fs-xl">
                                                                                    <i class="fal fa-calendar-alt"></i>
                                                                                </span>
                                                                            </div>
                                                                        </div>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Date Of Insertion.
                                                                        </div>
                                                                    </div>
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Site<span
                                                                                style="color: red">*</span></label>
                                                                        <input class="form-control" value=""
                                                                            placeholder="Enter Site" type="text"
                                                                            id='phlebitis_sife' name='phlebitis_sife' required>
                                                                        <div class="invalid-feedback">
                                                                            Please Enter Site.
                                                                        </div>
                                                                    </div>



                                                                   <!--  <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Phlebitis </label><span
                                                                            style="color: red">*</span>
                                                                        <select class="custom-select" name="phlebitis_phlebitis"
                                                                            id="phlebitis_phlebitis" required="">
                                                                            <option value="">Select </option>
                                                                            <option value="yes">Yes</option>
                                                                            <option value="no">No</option>
                                                                        </select>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Phlebitis.
                                                                        </div>
                                                                    </div> -->
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Check <span
                                                                                style="color: red">*</span></label>

                                                                        <div class="frame-wrap mb-0">
                                                                            <div class="btn-group btn-group-toggle"
                                                                                data-toggle="buttons">
                                                                                <label class="btn btn-info active">
                                                                                    <input type="radio" name="phlebitis_options"
                                                                                        id="phlebitis_option0" value="phlebitis"
                                                                                        checked="checked">phlebitis
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio" name="phlebitis_options"
                                                                                        id="phlebitis_option1"
                                                                                        value="Suspected"> Suspected
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio" name="phlebitis_options"
                                                                                        id="phlebitis_option2" value="Confirm">
                                                                                    Confirm
                                                                                </label>
                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                                <div class="form-row">
                                                                    
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Culture Report </label><span
                                                                            style="color: red">*</span>
                                                                        <select class="custom-select"
                                                                            name="phlebitis_culture_report"
                                                                            id="phlebitis_culture_report" required="">
                                                                            <option value="">Select </option>
                                                                            <option value="yes">Yes</option>
                                                                            <option value="no">No</option>
                                                                        </select>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Culture Report.
                                                                        </div>
                                                                    </div>

                                                                </div>

                                                            </div>

                                                            <div id="phlebitis_culture_div" style="display: none;">
                                                                <div class="col-md-12">
                                                                    <div id="panel-3" class="">
                                                                        <div class="panel-hdr">
                                                                            <h2>
                                                                                Culture Report
                                                                            </h2>
                                                                            <div id="dynamicCheck">
                                                                                <button type="button" class="btn btn-primary"
                                                                                    onclick="PhlebitisCreateNewElement();"><i
                                                                                        class="fas fa-plus"
                                                                                        style="margin-right: 4px"></i>Add More
                                                                                </button>
                                                                            </div>
                                                                        </div>
                                                                        <div class="panel-container show">
                                                                            <div class="panel-content">
                                                                                <div id="phlebitis_new_elementid">
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label">Date<span
                                                                                                    style="color: red">*</span></label>
                                                                                            <div class="input-group">
                                                                                                <input type="text"
                                                                                                    style="background-color: white"
                                                                                                    readonly=""
                                                                                                    class="form-control aa"
                                                                                                    value="07/17/2020"
                                                                                                    id="phlebitis_date"
                                                                                                    name="phlebitis_date[]">
                                                                                                <div class="input-group-append">
                                                                                                    <span
                                                                                                        class="input-group-text fs-xl">
                                                                                                        <i
                                                                                                            class="fal fa-calendar-alt"></i>
                                                                                                    </span>
                                                                                                </div>
                                                                                            </div>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Date .
                                                                                            </div>
                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Source</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="phlebitis_source[]"
                                                                                                id="phlebitis_source"
                                                                                                required="">
                                                                                                <option value="">Select</option>
                                                                                                <option
                                                                                                    value="peripheral blood">
                                                                                                    Peripheral Blood</option>
                                                                                                <option
                                                                                                    value="central line blood">
                                                                                                    Central Line Blood</option>
                                                                                                <option
                                                                                                    value="mid stream urine">Mid
                                                                                                    Stream Urine</option>
                                                                                                <option
                                                                                                    value="suprapubic urine">
                                                                                                    Supra Pubic Urine In
                                                                                                </option>
                                                                                                <option
                                                                                                    value="supra pubic urine out">
                                                                                                    Supra Pubic Urine Out
                                                                                                </option>
                                                                                                <option
                                                                                                    value="tracheal aspirate">
                                                                                                    Tracheal Aspirate</option>
                                                                                                <option value="sputum">Sputum
                                                                                                </option>
                                                                                                <option
                                                                                                    value="broncho alveolar lavage">
                                                                                                    Bronchoc Alveolar Lavage
                                                                                                </option>
                                                                                                <option value="bronchial wash">
                                                                                                    Bronchial Wash</option>
                                                                                                <option
                                                                                                    value="bronchial brushing">
                                                                                                    Bronchial Brushing</option>
                                                                                                <option value="tissue">Tissue
                                                                                                </option>
                                                                                                <option value="pus swab">Pus
                                                                                                    Swab</option>
                                                                                                <option value="pus">Pus</option>
                                                                                                <option value="stool">Stool
                                                                                                </option>
                                                                                                <option
                                                                                                    value="High vaginal swab">
                                                                                                    High Vaginal Swab</option>
                                                                                                <option value="urethral swab">
                                                                                                    Urethral Swab</option>
                                                                                                <option value="FNAC">FNAC
                                                                                                </option>
                                                                                                <option value="lung biopsy">Lung
                                                                                                    Biopsy</option>
                                                                                            </select>

                                                                                        </div>



                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">Result
                                                                                            </label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="phlebitis_result[]"
                                                                                                id="phlebitis_result"
                                                                                                required="">
                                                                                                <option value="">Select result
                                                                                                </option>
                                                                                                <option value="Positive">
                                                                                                    Positive</option>
                                                                                                <option value="Negative">
                                                                                                    Negative</option>
                                                                                                    <option value="Pending">
                                                                                                    Pending</option>
                                                                                            </select>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Result.
                                                                                            </div>
                                                                                        </div>
                                                                                    </div>
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Organism</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select phlebitis"
                                                                                                name="phlebitis_organism[]"
                                                                                                id="phlebitis_organism0"
                                                                                                required="" onchange="getAntibiotics(this)">
                                                                                                <option value="">Select</option>
                                                                                                <?php for($i=0; $i< count($lovs); $i++){ ?>
                                                                                                <option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option>
                                                                                                <?php } ?>
                                                                                            </select>

                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label"
                                                                                                for="multiple-placeholder">
                                                                                                Resistance Antibiotic
                                                                                            </label>
                                                                                            <select
                                                                                                class="select2-placeholder-multiple form-control "
                                                                                                multiple="multiple"
                                                                                                id="phlebitis_antibiotic0"
                                                                                                name="phlebitis_antibiotic[0][]">
                                                                                                
                                                                                                
                                                                                                

                                                                                            </select>
                                                                                        </div>
                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">MDRO</label><span
                                                                                                style="color: red">*</span>
                                                                                            <input class="form-control"
                                                                                                name="phlebitis_mdr_name[]"
                                                                                                id="phlebitis_mdr_name0"
                                                                                                required="" type="text" placeholder="Enter MBRO " style="background-color: white;" readonly="">
                                                                                                

                                                                                        </div>
                                                                                    </div>
                                                                                </div>

                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>




                                                        </div>

                                                    </div>

                                                </div>

                                            </div>
                                        </div>

                                        <div class="row">
                                            <div class="col-xl-12">
                                                <div id="panel-1" class="panel">
                                                    <div class="panel-container show">
                                                        <div class="panel-content">

                                                            <div class="form-row">
                                                                <div class="col-md-4 mb-3">
                                                                    <label class="form-label">Catheter Associated Urinary Tract Infection</label><span style="color: red">*</span><br><label class="form-label ft13"><i>Catheter present or not?</i></label>
                                                                    <select class="custom-select" name="urinary_catheter"
                                                                        id="urinary_catheter" required="">
                                                                        <option value="">Select</option>
                                                                        <option value="yes">Yes</option>
                                                                        <option value="no">No</option>
                                                                    </select>
                                                                    <div class="invalid-feedback">
                                                                        Please Select Urinary Catheter.
                                                                    </div>
                                                                </div>

                                                            </div>
                                                            <div id="demo2" style="display: none">
                                                                <div class="form-row">
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Date Of Insertion<span
                                                                                style="color: red">*</span></label>
                                                                        <div class="input-group">
                                                                            <input type="text" style="background-color: white"
                                                                                class="form-control aa" value=""
                                                                                id="urinary_date_of_insertion"
                                                                                name="urinary_date_of_insertion" readonly="">
                                                                            <div class="input-group-append">
                                                                                <span class="input-group-text fs-xl">
                                                                                    <i class="fal fa-calendar-alt"></i>
                                                                                </span>
                                                                            </div>
                                                                        </div>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Date Of Insertion.
                                                                        </div>
                                                                    </div>
                                                                    <div class="col-md-4 mb-3">
                                                                    <label class="form-label">Type Of Catheter </label>
                                                                    <select class="custom-select" name="urinary_type_of_catheter"
                                                                        id="urinary_type_of_catheter" required="">
                                                                        <option value="">Select</option>
                                                                        <option value="yes">Yes</option>
                                                                        <option value="no">No</option>
                                                                    </select>
                                                                    <div class="invalid-feedback">
                                                                        Please Select Urinary Catheter.
                                                                    </div>
                                                                </div>

                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Check <span
                                                                                style="color: red">*</span></label>

                                                                        <div class="frame-wrap mb-0">
                                                                            <div class="btn-group btn-group-toggle"
                                                                                data-toggle="buttons">
                                                                                <label class="btn btn-info active">
                                                                                    <input type="radio" name="urinary_options"
                                                                                        id="urinary_option0" value="CAUTI"
                                                                                        checked="checked">CAUTI
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio" name="urinary_options"
                                                                                        id="urinary_option1" value="Suspected">
                                                                                    Suspected
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio" name="urinary_options"
                                                                                        id="urinary_option2" value="Confirm">
                                                                                    Confirm
                                                                                </label>
                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                    <!-- <div class="col-md-4 mb-3"> 
                                            <label class="form-label" >Site<span style="color: red">*</span></label>
                                        <input class="form-control" value="" 
                                        placeholder="Enter sife" type="text" id='sife' name='sife' required>
                                            <div class="invalid-feedback">
                                                Please Enter Site.
                                            </div>
                                        </div> -->



                                                                    <!-- <div class="col-md-4 mb-3"> 
                                            <label class="form-label">Phlebitis </label><span style="color: red">*</span>
                                            <select class="custom-select" name="phlebitis" id="phlebitis" required="">
                                                <option value="">Select </option>
                                                <option value="yes">Yes</option>
                                                <option value="no">No</option>
                                            </select>
                                            <div class="invalid-feedback">
                                                Please Select Phlebitis.
                                            </div>
                                        </div> -->
                                                                </div>
                                                                <div class="form-row">
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Culture Report </label><span
                                                                            style="color: red">*</span>
                                                                        <select class="custom-select"
                                                                            name="urinary_culture_report"
                                                                            id="urinary_culture_report" required="">
                                                                            <option value="">Select </option>
                                                                            <option value="yes">Yes</option>
                                                                            <option value="no">No</option>
                                                                        </select>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Culture Report.
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>

                                                            <div id="urinary_culture_div" style="display: none;">
                                                                <div class="col-md-12">
                                                                    <div id="panel-3" class="">
                                                                        <div class="panel-hdr">
                                                                            <h2>
                                                                                Culture Report
                                                                            </h2>
                                                                            <div id="urinary_dynamic_check">
                                                                                <button type="button" class="btn btn-primary"
                                                                                    onclick="UrinaryCreateNewElement();"><i
                                                                                        class="fas fa-plus"
                                                                                        style="margin-right: 4px"></i>Add
                                                                                    More</button>
                                                                            </div>
                                                                        </div>
                                                                        <div class="panel-container show">
                                                                            <div class="panel-content">
                                                                                <div id="urinary_new_elementid">
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label">Date<span
                                                                                                    style="color: red">*</span></label>
                                                                                            <div class="input-group">
                                                                                                <input type="text"
                                                                                                    style="background-color: white"
                                                                                                    readonly=""
                                                                                                    class="form-control aa"
                                                                                                    value="07/17/2020"
                                                                                                    id="urinary_date"
                                                                                                    name="urinary_date[]">
                                                                                                <div class="input-group-append">
                                                                                                    <span
                                                                                                        class="input-group-text fs-xl">
                                                                                                        <i
                                                                                                            class="fal fa-calendar-alt"></i>
                                                                                                    </span>
                                                                                                </div>
                                                                                            </div>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Date .
                                                                                            </div>
                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Source</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="urinary_source[]"
                                                                                                id="urinary_source" required="">
                                                                                                <option value="">Select</option>
                                                                                                <option
                                                                                                    value="peripheral blood">
                                                                                                    Peripheral Blood</option>
                                                                                                <option
                                                                                                    value="central line blood">
                                                                                                    Central Line Blood</option>
                                                                                                <option
                                                                                                    value="mid stream urine">Mid
                                                                                                    Stream Urine</option>
                                                                                                <option
                                                                                                    value="suprapubic urine">
                                                                                                    Supra Pubic Urine In
                                                                                                </option>
                                                                                                <option
                                                                                                    value="supra pubic urine out">
                                                                                                    Supra Pubic Urine Out
                                                                                                </option>
                                                                                                <option
                                                                                                    value="tracheal aspirate">
                                                                                                    Tracheal Aspirate</option>
                                                                                                <option value="sputum">Sputum
                                                                                                </option>
                                                                                                <option
                                                                                                    value="broncho alveolar lavage">
                                                                                                    Bronchoc Alveolar Lavage
                                                                                                </option>
                                                                                                <option value="bronchial wash">
                                                                                                    Bronchial Wash</option>
                                                                                                <option
                                                                                                    value="bronchial brushing">
                                                                                                    Bronchial Brushing</option>
                                                                                                <option value="tissue">Tissue
                                                                                                </option>
                                                                                                <option value="pus swab">Pus
                                                                                                    Swab</option>
                                                                                                <option value="pus">Pus</option>
                                                                                                <option value="stool">Stool
                                                                                                </option>
                                                                                                <option
                                                                                                    value="High vaginal swab">
                                                                                                    High Vaginal Swab</option>
                                                                                                <option value="urethral swab">
                                                                                                    Urethral Swab</option>
                                                                                                <option value="FNAC">FNAC
                                                                                                </option>
                                                                                                <option value="lung biopsy">Lung
                                                                                                    Biopsy</option>
                                                                                            </select>

                                                                                        </div>



                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">Result
                                                                                            </label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="urinary_result[]"
                                                                                                id="urinary_result" required="">
                                                                                                <option value="">Select result
                                                                                                </option>
                                                                                                <option value="Positive">
                                                                                                    Positive</option>
                                                                                                <option value="Negative">
                                                                                                    Negative</option>
                                                                                                    <option value="Pending">
                                                                                                    Pending</option>
                                                                                            </select>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Result.
                                                                                            </div>
                                                                                        </div>
                                                                                    </div>
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Organism</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="urinary_organism[]"
                                                                                                id="urinary_organism0"
                                                                                                required="" onchange="getAntibiotics(this)">
                                                                                                <option value="">Select</option>
                                                                                                <?php for($i=0; $i< count($lovs); $i++){ ?>
                                                                                                <option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option>
                                                                                                <?php } ?>
                                                                                            </select>

                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label"
                                                                                                for="multiple-placeholder">
                                                                                                Resistance Antibiotic
                                                                                            </label>
                                                                                            <select
                                                                                                class="select2-placeholder-multiple form-control"
                                                                                                multiple="multiple"
                                                                                                id="urinary_antibiotic0"
                                                                                                name="urinary_antibiotic[0][]">
                                                                                               
                                                                                                
                   
                                                                                            

                    
                                              

                                                                                            </select>
                                                                                        </div>
                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">MDRO
                                                                                                </label><span
                                                                                                style="color: red">*</span>
                                                                                            <input class="form-control"
                                                                                                name="urinary_mdr_name[]"
                                                                                                id="urinary_mdr_name0"
                                                                                                required="" placeholder="Enter MBRO" style="background-color: white;" readonly>
                                                                                            

                                                                                        </div>
                                                                                    </div>
                                                                                </div>

                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>




                                                        </div>

                                                    </div>

                                                </div>

                                            </div>
                                        </div>


                                        <div class="row">
                                            <div class="col-xl-12">
                                                <div id="panel-1" class="panel">
                                                    <div class="panel-container show">
                                                        <div class="panel-content">

                                                            <div class="form-row">
                                                                <div class="col-md-4 mb-4">
                                                                    <label class="form-label">Central Line Associated
                                                                        Bloodstream </label><span
                                                                        style="color: red">*</span><br><label class="form-label ft13"><i>Central line present or not?</i></label>
                                                                    <select class="custom-select" name="central_line"
                                                                        id="central_line" required="">
                                                                        <option value="">Select</option>
                                                                        <option value="yes">Yes</option>
                                                                        <option value="no">No</option>
                                                                    </select>
                                                                    <div class="invalid-feedback">
                                                                        Please Select Central Line.
                                                                    </div>
                                                                </div>

                                                            </div>
                                                            <div id="demo3" style="display: none">
                                                                <div class="form-row">
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Date Of Insertion<span
                                                                                style="color: red">*</span></label>
                                                                        <div class="input-group">
                                                                            <input type="text" style="background-color: white"
                                                                                class="form-control aa" value=""
                                                                                id="central_date_of_insertion"
                                                                                name="central_date_of_insertion" readonly="">
                                                                            <div class="input-group-append">
                                                                                <span class="input-group-text fs-xl">
                                                                                    <i class="fal fa-calendar-alt"></i>
                                                                                </span>
                                                                            </div>
                                                                        </div>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Date Of Insertion.
                                                                        </div>
                                                                    </div>

                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Tpye</label> <span
                                                                            style="color: red">*</span>
                                                                        <select class="custom-select" name="central_type"
                                                                            id="central_type" required="">
                                                                            <option value="">Select</option>
                                                                            <option value="CVP">CVP</option>
                                                                            <option value="DICFD">Double Lumen catheter for
                                                                                dialysis</option>
                                                                            <option value="hickman">Hickman</option>
                                                                            <option value="jo-cath">Jo-cath</option>
                                                                            <option value="perma-cath">Perma-cath</option>

                                                                        </select>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Type.
                                                                        </div>
                                                                    </div>
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Check <span
                                                                                style="color: red">*</span></label>

                                                                        <div class="frame-wrap mb-0">
                                                                            <div class="btn-group btn-group-toggle"
                                                                                data-toggle="buttons">
                                                                                <label class="btn btn-info active">
                                                                                    <input type="radio" name="central_options"
                                                                                        id="central_option0" value="CLABSI"
                                                                                        checked="checked">CLABSI
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio" name="central_options"
                                                                                        id="central_option1" value="Suspected">
                                                                                    Suspected
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio" name="central_options"
                                                                                        id="central_option2" value="Confirm">
                                                                                    Confirm
                                                                                </label>
                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                    <!-- <div class="col-md-4 mb-3"> 
                                            <label class="form-label" >Site<span style="color: red">*</span></label>
                                        <input class="form-control" value="" 
                                        placeholder="Enter sife" type="text" id='sife' name='sife' required>
                                            <div class="invalid-feedback">
                                                Please Enter Site.
                                            </div>
                                        </div> -->



                                                                    <!-- <div class="col-md-4 mb-3"> 
                                            <label class="form-label">Phlebitis </label><span style="color: red">*</span>
                                            <select class="custom-select" name="phlebitis" id="phlebitis" required="">
                                                <option value="">Select </option>
                                                <option value="yes">Yes</option>
                                                <option value="no">No</option>
                                            </select>
                                            <div class="invalid-feedback">
                                                Please Select Phlebitis.
                                            </div>
                                        </div> -->
                                                                </div>
                                                                <div class="form-row">
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Culture Report </label><span
                                                                            style="color: red">*</span>
                                                                        <select class="custom-select"
                                                                            name="central_culture_report"
                                                                            id="central_culture_report" required="">
                                                                            <option value="">Select </option>
                                                                            <option value="yes">Yes</option>
                                                                            <option value="no">No</option>
                                                                        </select>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Culture Report.
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>

                                                            <div id="central_culture_div" style="display: none;">
                                                                <div class="col-md-12">
                                                                    <div id="panel-3" class="">
                                                                        <div class="panel-hdr">
                                                                            <h2>
                                                                                Culture Report
                                                                            </h2>
                                                                            <div id="dynamicCheck2">
                                                                                <button type="button" class="btn btn-primary"
                                                                                    onclick="CentralCreateNewElement();"><i
                                                                                        class="fas fa-plus"
                                                                                        style="margin-right: 4px"></i>Add
                                                                                    More</button>
                                                                            </div>
                                                                        </div>
                                                                        <div class="panel-container show">
                                                                            <div class="panel-content">
                                                                                <div id="central_new_elementid">
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label">Date<span
                                                                                                    style="color: red">*</span></label>
                                                                                            <div class="input-group">
                                                                                                <input type="text"
                                                                                                    style="background-color: white"
                                                                                                    readonly=""
                                                                                                    class="form-control aa"
                                                                                                    value="07/17/2020"
                                                                                                    id="central_date"
                                                                                                    name="central_date[]">
                                                                                                <div class="input-group-append">
                                                                                                    <span
                                                                                                        class="input-group-text fs-xl">
                                                                                                        <i
                                                                                                            class="fal fa-calendar-alt"></i>
                                                                                                    </span>
                                                                                                </div>
                                                                                            </div>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Date .
                                                                                            </div>
                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Source</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="central_source[]"
                                                                                                id="central_source" required="">
                                                                                                <option value="">Select</option>
                                                                                                <option
                                                                                                    value="peripheral blood">
                                                                                                    Peripheral Blood</option>
                                                                                                <option
                                                                                                    value="central line blood">
                                                                                                    Central Line Blood</option>
                                                                                                <option
                                                                                                    value="mid stream urine">Mid
                                                                                                    Stream Urine</option>
                                                                                                <option
                                                                                                    value="suprapubic urine">
                                                                                                    Supra Pubic Urine In
                                                                                                </option>
                                                                                                <option
                                                                                                    value="supra pubic urine out">
                                                                                                    Supra Pubic Urine Out
                                                                                                </option>
                                                                                                <option
                                                                                                    value="tracheal aspirate">
                                                                                                    Tracheal Aspirate</option>
                                                                                                <option value="sputum">Sputum
                                                                                                </option>
                                                                                                <option
                                                                                                    value="broncho alveolar lavage">
                                                                                                    Bronchoc Alveolar Lavage
                                                                                                </option>
                                                                                                <option value="bronchial wash">
                                                                                                    Bronchial Wash</option>
                                                                                                <option
                                                                                                    value="bronchial brushing">
                                                                                                    Bronchial Brushing</option>
                                                                                                <option value="tissue">Tissue
                                                                                                </option>
                                                                                                <option value="pus swab">Pus
                                                                                                    Swab</option>
                                                                                                <option value="pus">Pus</option>
                                                                                                <option value="stool">Stool
                                                                                                </option>
                                                                                                <option
                                                                                                    value="High vaginal swab">
                                                                                                    High Vaginal Swab</option>
                                                                                                <option value="urethral swab">
                                                                                                    Urethral Swab</option>
                                                                                                <option value="FNAC">FNAC
                                                                                                </option>
                                                                                                <option value="lung biopsy">Lung
                                                                                                    Biopsy</option>
                                                                                            </select>

                                                                                        </div>



                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">Result
                                                                                            </label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="central_result[]"
                                                                                                id="central_result" required="">
                                                                                                <option value="">Select result
                                                                                                </option>
                                                                                                <option value="Positive">
                                                                                                    Positive</option>
                                                                                                <option value="Negative">
                                                                                                    Negative</option>
                                                                                                    <option value="Pending">
                                                                                                    Pending</option>
                                                                                            </select>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Result.
                                                                                            </div>
                                                                                        </div>
                                                                                    </div>
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Organism</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="central_organism[]"
                                                                                                id="central_organism0"
                                                                                                required="" onchange="getAntibiotics(this)">
                                                                                                <option value="">Select</option>
                                                                                                <?php for($i=0; $i< count($lovs); $i++){ ?>
                                                                                                <option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option>
                                                                                                <?php } ?>
                                                                                            </select>

                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label"
                                                                                                for="multiple-placeholder">
                                                                                                Resistance Antibiotic
                                                                                            </label>
                                                                                            <select
                                                                                                class="select2-placeholder-multiple form-control"
                                                                                                multiple="multiple"
                                                                                                id="central_antibiotic0"
                                                                                                name="central_antibiotic[0][]">
                                                                                                
                                                                                                </select>
                                                                                                </div>
                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">MDRO</label><span
                                                                                                style="color: red">*</span>
                                                                                            <input type='text' class="form-control"
                                                                                                name="central_mdr_name[]"
                                                                                                id="central_mdr_name0"
                                                                                                required="" placeholder="Enter MDRO" style="background-color: white;" readonly>
                                                                                                

                                                                                        </div>
                                                                                    </div>
                                                                                </div>

                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>




                                                        </div>

                                                    </div>

                                                </div>

                                            </div>
                                        </div>

                                        <div class="row">
                                            <div class="col-xl-12">
                                                <div id="panel-1" class="panel">
                                                    <div class="panel-container show">
                                                        <div class="panel-content">

                                                            <div class="form-row">
                                                                <div class="col-md-4 mb-3">
                                                                    <label class="form-label">Hospital Acquired
                                                                        Pneumonia</label><span style="color: red">*</span><label class="form-label ft13"><i>
                                                                        Pneumonia present or not?</i></label>
                                                                    <select class="custom-select"
                                                                        name="hospital_acquired_pneumonia"
                                                                        id="hospital_acquired_pneumonia" required="">
                                                                        <option value="">Select</option>
                                                                        <option value="yes">Yes</option>
                                                                        <option value="no">No</option>
                                                                    </select>
                                                                    <div class="invalid-feedback">
                                                                        Please Select Hospital Acquired Pneumonia.
                                                                    </div>
                                                                </div>

                                                            </div>
                                                            <div id="hospital_demo" style="display: none">
                                                                <div class="form-row">
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Date Of First Event<span
                                                                                style="color: red">*</span></label>
                                                                        <div class="input-group">
                                                                            <input type="text" style="background-color: white"
                                                                                class="form-control aa" value=""
                                                                                id="hospital_date_of_first_event"
                                                                                name="hospital_date_of_first_event" readonly="">
                                                                            <div class="input-group-append">
                                                                                <span class="input-group-text fs-xl">
                                                                                    <i class="fal fa-calendar-alt"></i>
                                                                                </span>
                                                                            </div>
                                                                        </div>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Date Of First Event.
                                                                        </div>
                                                                    </div>


                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Check <span
                                                                                style="color: red">*</span></label>

                                                                        <div class="frame-wrap mb-0">
                                                                            <div class="btn-group btn-group-toggle"
                                                                                data-toggle="buttons">
                                                                                <label class="btn btn-info active">
                                                                                    <input type="radio" name="hospital_options"
                                                                                        id="option0" value="HAP"
                                                                                        checked="checked">HAP
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio" name="hospital_options"
                                                                                        id="option1" value="Suspected">
                                                                                    Suspected
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio" name="hospital_options"
                                                                                        id="option2" value="Confirm"> Confirm
                                                                                </label>
                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                    <!-- <div class="col-md-4 mb-3"> 
                                            <label class="form-label" >Site<span style="color: red">*</span></label>
                                        <input class="form-control" value="" 
                                        placeholder="Enter sife" type="text" id='sife' name='sife' required>
                                            <div class="invalid-feedback">
                                                Please Enter Site.
                                            </div>
                                        </div> -->



                                                                    <!-- <div class="col-md-4 mb-3"> 
                                            <label class="form-label">Phlebitis </label><span style="color: red">*</span>
                                            <select class="custom-select" name="phlebitis" id="phlebitis" required="">
                                                <option value="">Select </option>
                                                <option value="yes">Yes</option>
                                                <option value="no">No</option>
                                            </select>
                                            <div class="invalid-feedback">
                                                Please Select Phlebitis.
                                            </div>
                                        </div> -->
                                                                </div>
                                                                <div class="form-row">
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Culture Report </label><span
                                                                            style="color: red">*</span>
                                                                        <select class="custom-select"
                                                                            name="hospital_culture_report"
                                                                            id="hospital_culture_report" required="">
                                                                            <option value="">Select </option>
                                                                            <option value="yes">Yes</option>
                                                                            <option value="no">No</option>
                                                                        </select>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Culture Report.
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>

                                                            <div id="hostipal_culture_div" style="display: none;">
                                                                <div class="col-md-12">
                                                                    <div id="panel-3" class="">
                                                                        <div class="panel-hdr">
                                                                            <h2>
                                                                                Culture Report
                                                                            </h2>
                                                                            <div id="dynamicCheck3">
                                                                                <button type="button" class="btn btn-primary"
                                                                                    onclick="HospitalCreateNewElement();"><i
                                                                                        class="fas fa-plus"
                                                                                        style="margin-right: 4px"></i>Add
                                                                                    More</button>
                                                                            </div>
                                                                        </div>
                                                                        <div class="panel-container show">
                                                                            <div class="panel-content">
                                                                                <div id="hospital_new_elementid">
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label">Date<span
                                                                                                    style="color: red">*</span></label>
                                                                                            <div class="input-group">
                                                                                                <input type="text"
                                                                                                    style="background-color: white"
                                                                                                    readonly=""
                                                                                                    class="form-control aa"
                                                                                                    value="07/17/2020"
                                                                                                    id="hospital_date"
                                                                                                    name="hospital_date[]">
                                                                                                <div class="input-group-append">
                                                                                                    <span
                                                                                                        class="input-group-text fs-xl">
                                                                                                        <i
                                                                                                            class="fal fa-calendar-alt"></i>
                                                                                                    </span>
                                                                                                </div>
                                                                                            </div>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Date .
                                                                                            </div>
                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Source</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="hospital_source[]"
                                                                                                id="hospital_source"
                                                                                                required="">
                                                                                                <option value="">Select</option>
                                                                                                <option
                                                                                                    value="peripheral blood">
                                                                                                    Peripheral Blood</option>
                                                                                                <option
                                                                                                    value="central line blood">
                                                                                                    Central Line Blood</option>
                                                                                                <option
                                                                                                    value="mid stream urine">Mid
                                                                                                    Stream Urine</option>
                                                                                                <option
                                                                                                    value="suprapubic urine">
                                                                                                    Supra Pubic Urine In
                                                                                                </option>
                                                                                                <option
                                                                                                    value="supra pubic urine out">
                                                                                                    Supra Pubic Urine Out
                                                                                                </option>
                                                                                                <option
                                                                                                    value="tracheal aspirate">
                                                                                                    Tracheal Aspirate</option>
                                                                                                <option value="sputum">Sputum
                                                                                                </option>
                                                                                                <option
                                                                                                    value="broncho alveolar lavage">
                                                                                                    Bronchoc Alveolar Lavage
                                                                                                </option>
                                                                                                <option value="bronchial wash">
                                                                                                    Bronchial Wash</option>
                                                                                                <option
                                                                                                    value="bronchial brushing">
                                                                                                    Bronchial Brushing</option>
                                                                                                <option value="tissue">Tissue
                                                                                                </option>
                                                                                                <option value="pus swab">Pus
                                                                                                    Swab</option>
                                                                                                <option value="pus">Pus</option>
                                                                                                <option value="stool">Stool
                                                                                                </option>
                                                                                                <option
                                                                                                    value="High vaginal swab">
                                                                                                    High Vaginal Swab</option>
                                                                                                <option value="urethral swab">
                                                                                                    Urethral Swab</option>
                                                                                                <option value="FNAC">FNAC
                                                                                                </option>
                                                                                                <option value="lung biopsy">Lung
                                                                                                    Biopsy</option>
                                                                                            </select>

                                                                                        </div>



                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">Result
                                                                                            </label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="hospital_result[]"
                                                                                                id="hospital_result"
                                                                                                required="">
                                                                                                <option value="">Select result
                                                                                                </option>
                                                                                                <option value="Positive">
                                                                                                    Positive</option>
                                                                                                <option value="Negative">
                                                                                                    Negative</option>
                                                                                                    <option value="Pending">
                                                                                                    Pending</option>
                                                                                            </select>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Result.
                                                                                            </div>
                                                                                        </div>
                                                                                    </div>
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Organism</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="hospital_organism[]"
                                                                                                id="hospital_organism0"
                                                                                                required="" onchange="getAntibiotics(this)">
                                                                                                <option value="">Select</option>
                                                                                                <?php for($i=0; $i< count($lovs); $i++){ ?>
                                                                                                <option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option>
                                                                                                <?php } ?>
                                                                                            </select>

                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label"
                                                                                                for="multiple-placeholder">
                                                                                                Resistance Antibiotic
                                                                                            </label>
                                                                                            <select
                                                                                                class="select2-placeholder-multiple form-control"
                                                                                                multiple="multiple"
                                                                                                id="hospital_antibiotic0"
                                                                                                name="hospital_antibiotic[0][]">
                                                                                                
                                                                                                
                                                                                                                            
                                     
                                                                                                
                                         

                                                                                            </select>
                                                                                        </div>
                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">MDRO</label><span
                                                                                                style="color: red">*</span>
                                                                                            <input class="form-control"
                                                                                                name="hospital_mdr_name[]"
                                                                                                id="hospital_mdr_name0"
                                                                                                required="" placeholder="Enter MBRO" style="background-color: white;" readonly>
                                                                                                
                                                                                                
                                                                                                   
                                                                                            

                                                                                        </div>
                                                                                    </div>
                                                                                </div>

                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>




                                                        </div>

                                                    </div>

                                                </div>

                                            </div>
                                        </div>

                                        <div class="row">
                                            <div class="col-xl-12">
                                                <div id="panel-1" class="panel">
                                                    <div class="panel-container show">
                                                        <div class="panel-content">

                                                            <div class="form-row">
                                                                <div class="col-md-4 mb-3">
                                                                    <label class="form-label">Ventilator Associated
                                                                        Pneumonia</label><span style="color: red">*</span><br><label class="form-label ft13"><i>Ventilator present or not?</i></label>
                                                                    <select class="custom-select"
                                                                        name="ventilator_associated_pneumonia"
                                                                        id="ventilator_associated_pneumonia" required="">
                                                                        <option value="">Select</option>
                                                                        <option value="yes">Yes</option>
                                                                        <option value="no">No</option>
                                                                    </select>
                                                                    <div class="invalid-feedback">
                                                                        Please Select Ventilator Associated Pneumonia.
                                                                    </div>
                                                                </div>

                                                            </div>
                                                            <div id="demo5" style="display: none">
                                                                <div class="form-row">
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Date Of Intubation<span
                                                                                style="color: red">*</span></label>
                                                                        <div class="input-group">
                                                                            <input type="text" style="background-color: white"
                                                                                class="form-control aa" value=""
                                                                                id="ventilator_date_of_intubation"
                                                                                name="ventilator_date_of_intubation" readonly="">
                                                                            <div class="input-group-append">
                                                                                <span class="input-group-text fs-xl">
                                                                                    <i class="fal fa-calendar-alt"></i>
                                                                                </span>
                                                                            </div>
                                                                        </div>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Date Of Intubation.
                                                                        </div>
                                                                    </div>
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Date Of Extubation <span
                                                                                style="color: red">*</span></label>
                                                                        <div class="input-group">
                                                                            <input type="text" style="background-color: white"
                                                                                class="form-control aa" value=""
                                                                                id="ventilator_date_of_extubation "
                                                                                name="ventilator_date_of_extubation"
                                                                                readonly="">
                                                                            <div class="input-group-append">
                                                                                <span class="input-group-text fs-xl">
                                                                                    <i class="fal fa-calendar-alt"></i>
                                                                                </span>
                                                                            </div>
                                                                        </div>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Date Of Extubation.
                                                                        </div>
                                                                    </div>


                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Check <span
                                                                                style="color: red">*</span></label>

                                                                        <div class="frame-wrap mb-0">
                                                                            <div class="btn-group btn-group-toggle"
                                                                                data-toggle="buttons">
                                                                                <label class="btn btn-info active">
                                                                                    <input type="radio"
                                                                                        name="ventilator_options"
                                                                                        id="ventilator_option0"
                                                                                        checked="checked" value="HAP">VAP
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio"
                                                                                        name="ventilator_options"
                                                                                        id="ventilator_option1"
                                                                                        value="Suspected"> Suspected
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio"
                                                                                        name="ventilator_options"
                                                                                        id="ventilator_option2" value="Confirm">
                                                                                    Confirm
                                                                                </label>
                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                    <!-- <div class="col-md-4 mb-3"> 
                                            <label class="form-label" >Site<span style="color: red">*</span></label>
                                        <input class="form-control" value="" 
                                        placeholder="Enter sife" type="text" id='sife' name='sife' required>
                                            <div class="invalid-feedback">
                                                Please Enter Site.
                                            </div>
                                        </div> -->



                                                                    <!-- <div class="col-md-4 mb-3"> 
                                            <label class="form-label">Phlebitis </label><span style="color: red">*</span>
                                            <select class="custom-select" name="phlebitis" id="phlebitis" required="">
                                                <option value="">Select </option>
                                                <option value="yes">Yes</option>
                                                <option value="no">No</option>
                                            </select>
                                            <div class="invalid-feedback">
                                                Please Select Phlebitis.
                                            </div>
                                        </div> -->
                                                                </div>
                                                                <div class="form-row">
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Culture Report </label><span
                                                                            style="color: red">*</span>
                                                                        <select class="custom-select"
                                                                            name="ventilator_culture_report"
                                                                            id="ventilator_culture_report" required="">
                                                                            <option value="">Select </option>
                                                                            <option value="yes">Yes</option>
                                                                            <option value="no">No</option>
                                                                        </select>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Culture Report.
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>

                                                            <div id="ventilator_culture_div" style="display: none;">
                                                                <div class="col-md-12">
                                                                    <div id="panel-3" class="">
                                                                        <div class="panel-hdr">
                                                                            <h2>
                                                                                Culture Report
                                                                            </h2>
                                                                            <div id="dynamicCheck4">
                                                                                <button type="button" class="btn btn-primary"
                                                                                    onclick="VentilatorCreateNewElement();"><i
                                                                                        class="fas fa-plus"
                                                                                        style="margin-right: 4px"></i>Add
                                                                                    More</button>
                                                                            </div>
                                                                        </div>
                                                                        <div class="panel-container show">
                                                                            <div class="panel-content">
                                                                                <div id="ventilator_new_elementid">
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label">Date<span
                                                                                                    style="color: red">*</span></label>
                                                                                            <div class="input-group">
                                                                                                <input type="text"
                                                                                                    style="background-color: white"
                                                                                                    readonly=""
                                                                                                    class="form-control aa"
                                                                                                    value="07/17/2020"
                                                                                                    id="ventilator_date"
                                                                                                    name="ventilator_date[]">
                                                                                                <div class="input-group-append">
                                                                                                    <span
                                                                                                        class="input-group-text fs-xl">
                                                                                                        <i
                                                                                                            class="fal fa-calendar-alt"></i>
                                                                                                    </span>
                                                                                                </div>
                                                                                            </div>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Date .
                                                                                            </div>
                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Source</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="ventilator_source[]"
                                                                                                id="ventilator_source"
                                                                                                required="">
                                                                                                <option value="">Select</option>
                                                                                                <option
                                                                                                    value="peripheral blood">
                                                                                                    Peripheral Blood</option>
                                                                                                <option
                                                                                                    value="central line blood">
                                                                                                    Central Line Blood</option>
                                                                                                <option
                                                                                                    value="mid stream urine">Mid
                                                                                                    Stream Urine</option>
                                                                                                <option
                                                                                                    value="suprapubic urine">
                                                                                                    Supra Pubic Urine In
                                                                                                </option>
                                                                                                <option
                                                                                                    value="supra pubic urine out">
                                                                                                    Supra Pubic Urine Out
                                                                                                </option>
                                                                                                <option
                                                                                                    value="tracheal aspirate">
                                                                                                    Tracheal Aspirate</option>
                                                                                                <option value="sputum">Sputum
                                                                                                </option>
                                                                                                <option
                                                                                                    value="broncho alveolar lavage">
                                                                                                    Bronchoc Alveolar Lavage
                                                                                                </option>
                                                                                                <option value="bronchial wash">
                                                                                                    Bronchial Wash</option>
                                                                                                <option
                                                                                                    value="bronchial brushing">
                                                                                                    Bronchial Brushing</option>
                                                                                                <option value="tissue">Tissue
                                                                                                </option>
                                                                                                <option value="pus swab">Pus
                                                                                                    Swab</option>
                                                                                                <option value="pus">Pus</option>
                                                                                                <option value="stool">Stool
                                                                                                </option>
                                                                                                <option
                                                                                                    value="High vaginal swab">
                                                                                                    High Vaginal Swab</option>
                                                                                                <option value="urethral swab">
                                                                                                    Urethral Swab</option>
                                                                                                <option value="FNAC">FNAC
                                                                                                </option>
                                                                                                <option value="lung biopsy">Lung
                                                                                                    Biopsy</option>
                                                                                            </select>

                                                                                        </div>



                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">Result
                                                                                            </label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="ventilator_result[]"
                                                                                                id="ventilator_result"
                                                                                                required="">
                                                                                                <option value="">Select result
                                                                                                </option>
                                                                                                <option value="Positive">
                                                                                                    Positive</option>
                                                                                                <option value="Negative">
                                                                                                    Negative</option>
                                                                                                    <option value="Pending">
                                                                                                    Pending</option>
                                                                                            </select>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Result.
                                                                                            </div>
                                                                                        </div>
                                                                                    </div>
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Organism</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="ventilator_organism[]"
                                                                                                id="ventilator_organism0"
                                                                                                required="" onchange="getAntibiotics(this)">
                                                                                                <option value="">Select</option>
                                                                                                <?php for($i=0; $i< count($lovs); $i++){ ?>
                                                                                                <option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option>
                                                                                                <?php } ?>
                                                                                            </select>

                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label"
                                                                                                for="multiple-placeholder">
                                                                                                Resistance Antibiotic
                                                                                            </label>
                                                                                            <select
                                                                                                class="select2-placeholder-multiple form-control"
                                                                                                multiple="multiple"
                                                                                                id="ventilator_antibiotic0"
                                                                                                name="ventilator_antibiotic[0][]">
                                                                                               
                                                                                               
                                                                                                
                                                                                                

                                         

                                                                                            </select>
                                                                                        </div>
                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">MDRO</label><span
                                                                                                style="color: red">*</span>
                                                                                            <input type="text" class="form-control"
                                                                                                name="ventilator_mdr_name[]"
                                                                                                id="ventilator_mdr_name0"
                                                                                                required="" placeholder="Enter MBRO" style="background-color: white;" readonly>
                                                                                                
                                                                                                

                                                                                        </div>
                                                                                    </div>
                                                                                </div>

                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>




                                                        </div>

                                                    </div>

                                                </div>

                                            </div>
                                        </div>
                                        <div class="row">
                                            <div class="col-xl-12">
                                                <div id="panel-1" class="panel">
                                                    <div class="panel-container show">
                                                        <div class="panel-content">

                                                            <div class="form-row">
                                                                <div class="col-md-4 mb-3">
                                                                    <label class="form-label">Surgical Site
                                                                        Infection</label><span style="color: red">*</span><br><label class="form-label ft13"><i>Surgical site
                                                                        present or not</i></label>
                                                                    <select class="custom-select" name="surgical_site_infection"
                                                                        id="surgical_site_infection" required="">
                                                                        <option value="">Select</option>
                                                                        <option value="yes">Yes</option>
                                                                        <option value="no">No</option>
                                                                    </select>
                                                                    <div class="invalid-feedback">
                                                                        Please Select Surgical Site Infection.
                                                                    </div>
                                                                </div>

                                                            </div>
                                                            <div id="demo6" style="display: none">
                                                                <div class="form-row">
                                                                    <!-- <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Date Of Insertion<span
                                                                                style="color: red">*</span></label>
                                                                        <div class="input-group">
                                                                            <input type="text" style="background-color: white"
                                                                                class="form-control aa" value=""
                                                                                id="surgical_date_of_insertion"
                                                                                name="surgical_date_of_insertion" readonly="">
                                                                            <div class="input-group-append">
                                                                                <span class="input-group-text fs-xl">
                                                                                    <i class="fal fa-calendar-alt"></i>
                                                                                </span>
                                                                            </div>
                                                                        </div>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Date Of Insertion.
                                                                        </div>
                                                                    </div> -->
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Date Of Surgery <span
                                                                                style="color: red">*</span></label>
                                                                        <div class="input-group">
                                                                            <input type="text" style="background-color: white"
                                                                                class="form-control aa" value=""
                                                                                id="surgical_date_of_surgery"
                                                                                name="surgical_date_of_surgery" readonly="">
                                                                            <div class="input-group-append">
                                                                                <span class="input-group-text fs-xl">
                                                                                    <i class="fal fa-calendar-alt"></i>
                                                                                </span>
                                                                            </div>
                                                                        </div>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Date Of Surgery.
                                                                        </div>
                                                                    </div>


                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Check <span
                                                                                style="color: red">*</span></label>

                                                                        <div class="frame-wrap mb-0">
                                                                            <div class="btn-group btn-group-toggle"
                                                                                data-toggle="buttons">
                                                                                <label class="btn btn-info active">
                                                                                    <input type="radio" name="surgical_options"
                                                                                        id="surgical_option0" checked="checked"
                                                                                        value="SSI">SSI
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio" name="surgical_options"
                                                                                        id="surgical_option1" value="Suspected">
                                                                                    Suspected
                                                                                </label>
                                                                                <label class="btn btn-info">
                                                                                    <input type="radio" name="surgical_options"
                                                                                        id="surgical_option2" value="Confirm">
                                                                                    Confirm
                                                                                </label>
                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                    <!-- <div class="col-md-4 mb-3"> 
                                            <label class="form-label" >Site<span style="color: red">*</span></label>
                                        <input class="form-control" value="" 
                                        placeholder="Enter sife" type="text" id='sife' name='sife' required>
                                            <div class="invalid-feedback">
                                                Please Enter Site.
                                            </div>
                                        </div> -->



                                                                    <!-- <div class="col-md-4 mb-3"> 
                                            <label class="form-label">Phlebitis </label><span style="color: red">*</span>
                                            <select class="custom-select" name="phlebitis" id="phlebitis" required="">
                                                <option value="">Select </option>
                                                <option value="yes">Yes</option>
                                                <option value="no">No</option>
                                            </select>
                                            <div class="invalid-feedback">
                                                Please Select Phlebitis.
                                            </div>
                                        </div> -->
                                                                </div>
                                                                <div class="form-row">
                                                                    <div class="col-md-4 mb-3">
                                                                        <label class="form-label">Culture Report </label><span
                                                                            style="color: red">*</span>
                                                                        <select class="custom-select"
                                                                            name="surgical_culture_report"
                                                                            id="surgical_culture_report" required="">
                                                                            <option value="">Select </option>
                                                                            <option value="yes">Yes</option>
                                                                            <option value="no">No</option>
                                                                        </select>
                                                                        <div class="invalid-feedback">
                                                                            Please Select Culture Report.
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>

                                                            <div id="surgical_culture_div" style="display: none;">
                                                                <div class="col-md-12">
                                                                    <div id="panel-3" class="">
                                                                        <div class="panel-hdr">
                                                                            <h2>
                                                                                Culture Report
                                                                            </h2>
                                                                            <div id="dynamicCheck5">
                                                                                <button type="button" class="btn btn-primary"
                                                                                    onclick="SurgicalCreateNewElement();"><i
                                                                                        class="fas fa-plus"
                                                                                        style="margin-right: 4px"></i>Add
                                                                                    More</button>
                                                                            </div>
                                                                        </div>
                                                                        <div class="panel-container show">
                                                                            <div class="panel-content">
                                                                                <div id="surgical_new_elementid">
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label">Date<span
                                                                                                    style="color: red">*</span></label>
                                                                                            <div class="input-group">
                                                                                                <input type="text"
                                                                                                    style="background-color: white"
                                                                                                    readonly=""
                                                                                                    class="form-control aa"
                                                                                                    value="07/17/2020"
                                                                                                    id="surgical_date"
                                                                                                    name="surgical_date[]">
                                                                                                <div class="input-group-append">
                                                                                                    <span
                                                                                                        class="input-group-text fs-xl">
                                                                                                        <i
                                                                                                            class="fal fa-calendar-alt"></i>
                                                                                                    </span>
                                                                                                </div>
                                                                                            </div>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Date .
                                                                                            </div>
                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Source</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="surgical_source[]"
                                                                                                id="surgical_source"
                                                                                                required="">
                                                                                                <option value="">Select</option>
                                                                                                <option
                                                                                                    value="peripheral blood">
                                                                                                    Peripheral Blood</option>
                                                                                                <option
                                                                                                    value="central line blood">
                                                                                                    Central Line Blood</option>
                                                                                                <option
                                                                                                    value="mid stream urine">Mid
                                                                                                    Stream Urine</option>
                                                                                                <option
                                                                                                    value="suprapubic urine">
                                                                                                    Supra Pubic Urine In
                                                                                                </option>
                                                                                                <option
                                                                                                    value="supra pubic urine out">
                                                                                                    Supra Pubic Urine Out
                                                                                                </option>
                                                                                                <option
                                                                                                    value="tracheal aspirate">
                                                                                                    Tracheal Aspirate</option>
                                                                                                <option value="sputum">Sputum
                                                                                                </option>
                                                                                                <option
                                                                                                    value="broncho alveolar lavage">
                                                                                                    Bronchoc Alveolar Lavage
                                                                                                </option>
                                                                                                <option value="bronchial wash">
                                                                                                    Bronchial Wash</option>
                                                                                                <option
                                                                                                    value="bronchial brushing">
                                                                                                    Bronchial Brushing</option>
                                                                                                <option value="tissue">Tissue
                                                                                                </option>
                                                                                                <option value="pus swab">Pus
                                                                                                    Swab</option>
                                                                                                <option value="pus">Pus</option>
                                                                                                <option value="stool">Stool
                                                                                                </option>
                                                                                                <option
                                                                                                    value="High vaginal swab">
                                                                                                    High Vaginal Swab</option>
                                                                                                <option value="urethral swab">
                                                                                                    Urethral Swab</option>
                                                                                                <option value="FNAC">FNAC
                                                                                                </option>
                                                                                                <option value="lung biopsy">Lung
                                                                                                    Biopsy</option>
                                                                                            </select>

                                                                                        </div>



                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">Result
                                                                                            </label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="surgical_result[]"
                                                                                                id="surgical_result"
                                                                                                required="">
                                                                                                <option value="">Select result
                                                                                                </option>
                                                                                                <option value="Positive">
                                                                                                    Positive</option>
                                                                                                <option value="Negative">
                                                                                                    Negative</option>
                                                                                                    <option value="Pending">
                                                                                                    Pending</option>
                                                                                            </select>
                                                                                            <div class="invalid-feedback">
                                                                                                Please Select Result.
                                                                                            </div>
                                                                                        </div>
                                                                                    </div>
                                                                                    <div class="form-row">
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label
                                                                                                class="form-label">Organism</label><span
                                                                                                style="color: red">*</span>
                                                                                            <select class="custom-select"
                                                                                                name="surgical_organism[]"
                                                                                                id="surgical_organism0"
                                                                                                required="" onchange="getAntibiotics(this)">
                                                                                                <option value="">Select</option>
                                                                                                <?php for($i=0; $i< count($lovs); $i++){ ?>
                                                                                                <option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option>
                                                                                                <?php } ?>
                                                                                            </select>

                                                                                        </div>
                                                                                        <div class="col-md-4 mb-3">
                                                                                            <label class="form-label"
                                                                                                for="multiple-placeholder">
                                                                                                Resistance Antibiotic
                                                                                            </label>
                                                                                            <select
                                                                                                class="select2-placeholder-multiple form-control"
                                                                                                multiple="multiple"
                                                                                                id="surgical_antibiotic0"
                                                                                                name="surgical_antibiotic[0][]">
                                                                                                

                                                                                            </select>
                                                                                        </div>
                                                                                        <div class="col-md-3 mb-3">
                                                                                            <label class="form-label">MDRO</label><span
                                                                                                style="color: red">*</span>
                                                                                            <input placeholder="Enter MBRO" class="form-control"
                                                                                                name="surgical_mdr_name[]"
                                                                                                id="surgical_mdr_name0" type="text"
                                                                                                required="" style="background-color: white;" readonly>
                                                                                                
                                                                                            

                                                                                        </div>
                                                                                    </div>
                                                                                </div>

                                                                            </div>
                                                                        </div>
                                                                    </div>
                                                                </div>
                                                            </div>




                                                        </div>

                                                    </div>

                                                </div>

                                            </div>
                                        </div>


                                        <div class="row">
                                            <div class="col-xl-12">
                                                <div id="panel-1" class="panel">
                                                    <div class="panel-container show">
                                                        <div class="panel-content">
                                                            <div class="row">
                                                                <div class="col-md-6">
                                                                </div>
                                                                <div class="demo col-md-6 pull-right">
                                                                    <button class="btn btn-primary btn-md float-right"
                                                                        type="reset" onclick="window.location.reload();"><i
                                                                            class="fas fa-times-circle"
                                                                            style="margin-right: 4px"></i>Cancel</button>
                                                                    <button id="jsbtn"
                                                                        class="btn btn-primary btn-md float-right" type="submit"
                                                                        onclick="ValidateFrom3()"><i class="fas fa-plus"
                                                                            style="margin-right: 4px"></i> Submit</button>
                                                                </div>
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </div>
                </form>
            </div>
        </section>
    </div>




</main>
<!-- this overlay is activated only when mobile menu is triggered -->
<div class="page-content-overlay" data-action="toggle" data-class="mobile-nav-on"></div> <!-- END Page Content -->

<script>

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$(document).ready(function() {


    $('#first_tab').trigger('click');
    // $('#sec_tab').trigger('click');
    // $('#third_tab').trigger('click');

    //jQuery('#js_pill_border_icon-1').removeClass('tab-pane fade active show');
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});

$("#names").keypress(function(e) {
    var keyCode = e.keyCode || e.which;
    var regex = /^[A-Za-z0-9 ]+$/;
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    dateOfAdmission = document.getElementById('date_of_admission').value;
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    mrNum = document.getElementById('mr_num').value;
    if (mrNum == "") {
        document.getElementById("mr_num").classList.add("form-controlmy");
        document.getElementById("mr_num").classList.add("is-invalidmy");
        $("#mr_num").focus();
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    document.getElementById("mr_num").classList.add("is-validmyf");
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    //  dateOfCannulaInsertion=document.getElementById('date_of_cannula_insertion').value;
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    // {
    //  document.getElementById("date_of_surgery").classList.add("form-controlmy");
    //  document.getElementById("date_of_surgery").classList.add("is-invalidmy");
    //     $("#date_of_surgery").focus();
    //     return false;

    // }
    //  document.getElementById("date_of_surgery").classList.remove("form-controlmy");
    //  document.getElementById("date_of_surgery").classList.add("is-validmyf");
    //  document.getElementById("date_of_surgery").classList.add("is-validmy");

    $('#sec_tab').trigger('click');

    return false;
}

function ValidateFrom2() {
    fever = document.getElementById('fever').value;
    if (fever == "") {
        document.getElementById("fever").classList.add("custom-selectmy");
        document.getElementById("fever").classList.add("is-invalidmy");

        $("#fever").focus();
        return false;

    }
    document.getElementById("fever").classList.remove("custom-selectmy");
    document.getElementById("fever").classList.add("custom-selectisvalidmy");
    document.getElementById("fever").classList.add("is-validmyf");

    temperature = document.getElementById('temperature').value;
    if (temperature == "") {
        document.getElementById("temperature").classList.add("form-controlmy");
        document.getElementById("temperature").classList.add("is-invalidmy");
        $("#temperature").focus();
        return false;

    }


    document.getElementById("temperature").classList.remove("form-controlmy");
    document.getElementById("temperature").classList.add("is-validmyf");
    document.getElementById("temperature").classList.add("is-validmy");


    tachycardia = document.getElementById('tachycardia').value;
    if (tachycardia == "") {
        document.getElementById("tachycardia").classList.add("custom-selectmy");
        document.getElementById("tachycardia").classList.add("is-invalidmy");
        $("#tachycardia").focus();
        return false;

    }
    document.getElementById("tachycardia").classList.remove("custom-selectmy");
    document.getElementById("tachycardia").classList.add("custom-selectisvalidmy");
    document.getElementById("tachycardia").classList.add("is-validmyf");

    pulse = document.getElementById('pulse').value;


    if (pulse == "") {
        document.getElementById("pulse").classList.add("form-controlmy");
        document.getElementById("pulse").classList.add("is-invalidmy");
        $("#pulse").focus();
        return false;

    }


    document.getElementById("pulse").classList.remove("form-controlmy");
    document.getElementById("pulse").classList.add("is-validmyf");
    document.getElementById("pulse").classList.add("is-validmy");


    hypotension = document.getElementById('hypotension').value;
    if (hypotension == "") {
        document.getElementById("hypotension").classList.add("custom-selectmy");
        document.getElementById("hypotension").classList.add("is-invalidmy");
        $("#hypotension").focus();
        return false;

    }
    document.getElementById("hypotension").classList.remove("form-controlmy");
    document.getElementById("hypotension").classList.add("is-validmyf");
    document.getElementById("hypotension").classList.add("is-validmy");

    bp = document.getElementById('bp').value;

    if (bp == "") {
        document.getElementById("bp").classList.add("form-controlmy");
        document.getElementById("bp").classList.add("is-invalidmy");
        $("#bp").focus();
        return false;

    }


    document.getElementById("bp").classList.remove("form-controlmy");
    document.getElementById("bp").classList.add("is-validmyf");
    document.getElementById("bp").classList.add("is-validmy");

    chills = document.getElementById('chills').value;
    if (chills == "") {
        document.getElementById("chills").classList.add("custom-selectmy");
        document.getElementById("chills").classList.add("is-invalidmy");
        $("#chills").focus();
        return false;

    }
    document.getElementById("chills").classList.remove("custom-selectmy");
    document.getElementById("chills").classList.add("custom-selectisvalidmy");
    document.getElementById("chills").classList.add("is-validmyf");

    wbc = document.getElementById('wbc').value;

    if (wbc == "") {
        document.getElementById("wbc").classList.add("form-controlmy");
        document.getElementById("wbc").classList.add("is-invalidmy");
        $("#wbc").focus();
        return false;

    }


    document.getElementById("wbc").classList.remove("form-controlmy");
    document.getElementById("wbc").classList.add("is-validmyf");
    document.getElementById("wbc").classList.add("is-validmy");


    ln = document.getElementById('ln').value;

    if (ln == "") {
        document.getElementById("ln").classList.add("form-controlmy");
        document.getElementById("ln").classList.add("is-invalidmy");
        $("#ln").focus();
        return false;

    }


    document.getElementById("ln").classList.remove("form-controlmy");
    document.getElementById("ln").classList.add("is-validmyf");
    document.getElementById("ln").classList.add("is-validmy");

    worseningCxr = document.getElementById('worsening_cxr').value;
    if (worseningCxr == "") {
        document.getElementById("worsening_cxr").classList.add("custom-selectmy");
        document.getElementById("worsening_cxr").classList.add("is-invalidmy");
        $("#worsening_cxr").focus();
        return false;

    }
    document.getElementById("worsening_cxr").classList.remove("custom-selectmy");
    document.getElementById("worsening_cxr").classList.add("custom-selectisvalidmy");
    document.getElementById("worsening_cxr").classList.add("is-validmyf");

    worseningTrachealSecretions = document.getElementById('worsening_tracheal_secretions').value;

    if (worseningTrachealSecretions == "") {
        document.getElementById("worsening_tracheal_secretions").classList.add("custom-selectmy");
        document.getElementById("worsening_tracheal_secretions").classList.add("is-invalidmy");
        $("#worsening_tracheal_secretions").focus();
        return false;

    }
    document.getElementById("worsening_tracheal_secretions").classList.remove("custom-selectmy");
    document.getElementById("worsening_tracheal_secretions").classList.add("custom-selectisvalidmy");
    document.getElementById("worsening_tracheal_secretions").classList.add("is-validmyf");
    $('#js_pill_border_icon-2').removeClass('active show');
    $('#third_tab').trigger('click');

    return false;
}

function ValidateFrom3() {
    intravenousCannula = document.getElementById('intravenous_cannula').value;
    if (intravenousCannula == "") {
        document.getElementById("intravenous_cannula").classList.add("custom-selectmy");
        document.getElementById("intravenous_cannula").classList.add("is-invalidmy");

        $("#intravenous_cannula").focus();
        return false;

    }
    document.getElementById("intravenous_cannula").classList.remove("custom-selectmy");
    document.getElementById("intravenous_cannula").classList.add("custom-selectisvalidmy");
    document.getElementById("intravenous_cannula").classList.add("is-validmyf");

    phlebitisDateOfInsertion = document.getElementById('phlebitis_date_of_insertion').value;
    if (phlebitisDateOfInsertion == "") {
        document.getElementById("phlebitis_date_of_insertion").classList.add("form-controlmy");
        document.getElementById("phlebitis_date_of_insertion").classList.add("is-invalidmy");
        $("#phlebitis_date_of_insertion").focus();
        return false;

    }
    document.getElementById("phlebitis_date_of_insertion").classList.remove("form-controlmy");
    document.getElementById("phlebitis_date_of_insertion").classList.add("is-validmyf");
    document.getElementById("phlebitis_date_of_insertion").classList.add("is-validmy");

    var phlebitisSife = document.getElementById('phlebitis_sife').value;

    if (phlebitisSife == "") {
        document.getElementById("phlebitis_sife").classList.add("form-controlmy");
        document.getElementById("phlebitis_sife").classList.add("is-invalidmy");
        $("#phlebitis_sife").focus();
        return false;
    }
    document.getElementById("phlebitis_sife").classList.remove("form-controlmy");
    document.getElementById("phlebitis_sife").classList.add("is-validmyf");
    document.getElementById("phlebitis_sife").classList.add("is-validmy");

    phlebitisPhlebitis = document.getElementById('phlebitis_phlebitis').value;
    if (phlebitisPhlebitis == "") {
        document.getElementById("phlebitis_phlebitis").classList.add("custom-selectmy");
        document.getElementById("phlebitis_phlebitis").classList.add("is-invalidmy");

        $("#phlebitis_phlebitis").focus();
        return false;

    }
    document.getElementById("phlebitis_phlebitis").classList.remove("custom-selectmy");
    document.getElementById("phlebitis_phlebitis").classList.add("custom-selectisvalidmy");
    document.getElementById("phlebitis_phlebitis").classList.add("is-validmyf");

    phlebitisCultureReport = document.getElementById('phlebitis_culture_report').value;
    if (phlebitisCultureReport == "") {
        document.getElementById("phlebitis_culture_report").classList.add("custom-selectmy");
        document.getElementById("phlebitis_culture_report").classList.add("is-invalidmy");

        $("#phlebitis_culture_report").focus();
        return false;

    }
    document.getElementById("phlebitis_culture_report").classList.remove("custom-selectmy");
    document.getElementById("phlebitis_culture_report").classList.add("custom-selectisvalidmy");
    document.getElementById("phlebitis_culture_report").classList.add("is-validmyf");

    datepicker = document.getElementById('datepicker').value;
    if (datepicker == "") {
        document.getElementById("datepicker").classList.add("form-controlmy");
        document.getElementById("datepicker").classList.add("is-invalidmy");
        $("#datepicker").focus();
        return false;

    }
    document.getElementById("datepicker").classList.remove("form-controlmy");
    document.getElementById("datepicker").classList.add("is-validmyf");
    document.getElementById("datepicker").classList.add("is-validmy");

    var source = document.getElementById('source').value;

    if (source == "") {
        document.getElementById("source").classList.add("form-controlmy");
        document.getElementById("source").classList.add("is-invalidmy");
        $("#source").focus();
        return false;
    }
    document.getElementById("source").classList.remove("form-controlmy");
    document.getElementById("source").classList.add("is-validmyf");
    document.getElementById("source").classList.add("is-validmy");

    result = document.getElementById('result').value;
    if (result == "") {
        document.getElementById("result").classList.add("custom-selectmy");
        document.getElementById("result").classList.add("is-invalidmy");

        $("#result").focus();
        return false;

    }
    document.getElementById("result").classList.remove("custom-selectmy");
    document.getElementById("result").classList.add("custom-selectisvalidmy");
    document.getElementById("result").classList.add("is-validmyf");

    return true;
}

$(document).ready(function() {
    $("#intravenous_cannula").click(function() {

        var x = document.getElementById("intravenous_cannula").value;
        if (x == 'yes') {
            var show = document.getElementById("demo");
            show.style.display = "block";
        } else {
            var show = document.getElementById("demo");
            show.style.display = "none"
        }
    });
    $("#phlebitis_culture_report").click(function() {

        var x = document.getElementById("phlebitis_culture_report").value;
        if (x == 'yes') {
            var show = document.getElementById("phlebitis_culture_div");
            show.style.display = "block";
        } else {
            var show = document.getElementById("phlebitis_culture_div");
            show.style.display = "none"
        }
    });




    $("#urinary_catheter").click(function() {

        var x = document.getElementById("urinary_catheter").value;
        if (x == 'yes') {
            var show = document.getElementById("demo2");
            show.style.display = "block";
        } else {
            var show = document.getElementById("demo2");
            show.style.display = "none"
        }
    });

    $("#urinary_culture_report").click(function() {

        var x = document.getElementById("urinary_culture_report").value;
        if (x == 'yes') {
            var show = document.getElementById("urinary_culture_div");
            show.style.display = "block";
        } else {
            var show = document.getElementById("urinary_culture_div");
            show.style.display = "none"
        }
    });

    $("#central_line").click(function() {
        var x = document.getElementById("central_line").value;
        if (x == 'yes') {
            var show = document.getElementById("demo3");
            show.style.display = "block";
        } else {
            var show = document.getElementById("demo3");
            show.style.display = "none"
        }
    });
    $("#central_culture_report").click(function() {
        var x = document.getElementById("central_culture_report").value;
        if (x == 'yes') {
            var show = document.getElementById("central_culture_div");
            show.style.display = "block";
        } else {
            var show = document.getElementById("central_culture_div");
            show.style.display = "none"
        }
    });



    $("#hospital_acquired_pneumonia").click(function() {
        var x = document.getElementById("hospital_acquired_pneumonia").value;
        if (x == 'yes') {
            var show = document.getElementById("hospital_demo");
            show.style.display = "block";
        } else {
            var show = document.getElementById("hospital_demo");
            show.style.display = "none"
        }
    });

    $("#hospital_culture_report").click(function() {

        var x = document.getElementById("hospital_culture_report").value;
        if (x == 'yes') {
            var show = document.getElementById("hostipal_culture_div");
            show.style.display = "block";
        } else {
            var show = document.getElementById("hostipal_culture_div");
            show.style.display = "none"
        }
    });

    $("#ventilator_associated_pneumonia").click(function() {
        var x = document.getElementById("ventilator_associated_pneumonia").value;
        if (x == 'yes') {
            var show = document.getElementById("demo5");
            show.style.display = "block";
        } else {
            var show = document.getElementById("demo5");
            show.style.display = "none"
        }
    });


    $("#ventilator_culture_report").click(function() {
        var x = document.getElementById("ventilator_culture_report").value;
        if (x == 'yes') {
            var show = document.getElementById("ventilator_culture_div");
            show.style.display = "block";
        } else {
            var show = document.getElementById("ventilator_culture_div");
            show.style.display = "none"
        }
    });

    $("#surgical_site_infection").click(function() {
        var x = document.getElementById("surgical_site_infection").value;
        if (x == 'yes') {
            var show = document.getElementById("demo6");
            show.style.display = "block";
        } else {
            var show = document.getElementById("demo6");
            show.style.display = "none"
        }

    });

    $("#surgical_culture_report").click(function() {
        var x = document.getElementById("surgical_culture_report").value;
        if (x == 'yes') {
            var show = document.getElementById("surgical_culture_div");
            show.style.display = "block";
        } else {
            var show = document.getElementById("surgical_culture_div");
            show.style.display = "none"
        }

    });

});






var count = 0;

function PhlebitisCreateNewElement() {
    count++;
    var txtNewInputBox = document.createElement('div');

    txtNewInputBox.innerHTML = '<div class="" id="remove' + count +
        '" ><div class="form-row"><div class="col-md-4 mb-3"><label>Date #' + count +
        '</label><div class="input-group"><input type="text" class="form-control aa" value="07/17/2020" id="phlebitis_date_' +
        count +
        '" name="phlebitis_date[]" ><div class="input-group-append"><span class="input-group-text fs-xl"><i class="fal fa-calendar-alt"></i></span></div></div><div class="invalid-feedback"> Please Select Date .</div></div><div class="col-md-4 mb-3"><label class="form-label">Source ' +
        count +
        '</label><span style="color: red">*</span><select class="custom-select" name="phlebitis_source[]" id="phlebitis_source' +
        count +
        '"  required=""><option value="">Select</option><option value="peripheral blood">Peripheral Blood</option><option value="central line blood">Central Line Blood</option><option value="mid stream urine">Mid Stream Urine</option><option value="suprapubic urine">Supra Pubic Urine In</option><option value="supra pubic urine out">Supra Pubic Urine Out</option><option value="tracheal aspirate">Tracheal Aspirate</option><option value="sputum">Sputum</option><option value="broncho alveolar lavage">Bronchoc Alveolar Lavage</option><option value="bronchial wash">Bronchial Wash</option><option value="bronchial brushing">Bronchial Brushing</option><option value="tissue">Tissue</option><option value="pus swab">Pus Swab</option><option value="pus">Pus</option><option value="stool">Stool</option><option value="High vaginal swab">High Vaginal Swab</option><option value="urethral swab">Urethral Swab</option><option value="FNAC">FNAC</option><option value="lung biopsy">Lung Biopsy</option></select></div>  <div class="col-md-3 mb-3"> <label class="form-label">Result #' +
        count + ' </label><select class="custom-select" name="phlebitis_result[]" id="phlebitis_result' + count +
        '" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option><option value="Pending">Pending</option></select><div class="invalid-feedback">Please Select Result.</div></div></div><div class="form-row"><div class="col-md-4 mb-3"> <label class="form-label">Organism #' +
        count +
        '</label><span style="color: red">*</span><select class="custom-select phlebitis" name="phlebitis_organism[]" id="phlebitis_organism' +
        count +
        '"  required="" onchange="getAntibiotics(this)"><option value="">Select</option><?php for($i=0; $i< count($lovs); $i++){ ?><option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option><?php } ?></select></div><div class="col-md-4 mb-3"> <label class="form-label" for="multiple-placeholder">Resistance Antibiotic #' +
        count +
        '</label><select class="select2-placeholder-multiple form-control" multiple="multiple" id="phlebitis_antibiotic'+
        count + '" name="phlebitis_antibiotic['+ count +
        '][]"></select></div><div class="col-md-3 mb-3"> <label class="form-label">MDRO #' +
        count +
        '</label><span style="color: red">*</span><input class="form-control " type="text" name="phlebitis_mdr_name[]" id="phlebitis_mdr_name' +
        count +
        '"  required="" placeholder="Enter MBRO " style="background-color: white;" readonly=""></div> <div class="col-md-1" style="margin-top: 23px"><button class="btn btn-danger"  onclick="delrows(' +
        count + ');" type="button" ><i class="fal fa-times"></i></button></div></div></div>';

    document.getElementById("phlebitis_new_elementid").appendChild(txtNewInputBox);

    // $('input[name="date[]"]').each(function(index){

    //         var i= index+1;

    //           $('#date_'+i).daterangepicker({

    //                singleDatePicker: true,
    //                 showDropdowns: true
    //             });
    //           console.log('date_'+i);

    //          });
    $(document).ready(function() {
        $('.aa').daterangepicker({
            singleDatePicker: true,
            showDropdowns: true
        });
        $(".select2-placeholder-multiple").select2({
            placeholder: "Select State"
        });
    });
}

function delrows(count) {
    if (confirm("Are you sure you want to Delete?")) {
        var el = count;
        $('#remove' + el).remove();
    }

}



var count1 = 0;

function UrinaryCreateNewElement() {
    count1++;
    var txtNewInputBox1 = document.createElement('div');

    txtNewInputBox1.innerHTML = '<div class="" id="remove1' + count1 +
        '" ><div class="form-row"><div class="col-md-4 mb-3"><label>Date #' + count1 +
        '</label><div class="input-group"><input type="text" class="form-control aa" value="07/17/2020" id="urinary_date1_' +
        count1 +
        '" name="urinary_date[]" ><div class="input-group-append"><span class="input-group-text fs-xl"><i class="fal fa-calendar-alt"></i></span></div></div><div class="invalid-feedback"> Please Select Date .</div></div><div class="col-md-4 mb-3"><label class="form-label">Source ' +
        count1 +
        '</label><span style="color: red">*</span><select class="custom-select" name="urinary_source[]" id="urinary_source1' +
        count1 +
        '"  required=""><option value="">Select</option><option value="peripheral blood">Peripheral Blood</option><option value="central line blood">Central Line Blood</option><option value="mid stream urine">Mid Stream Urine</option><option value="suprapubic urine">Supra Pubic Urine In</option><option value="supra pubic urine out">Supra Pubic Urine Out</option><option value="tracheal aspirate">Tracheal Aspirate</option><option value="sputum">Sputum</option><option value="broncho alveolar lavage">Bronchoc Alveolar Lavage</option><option value="bronchial wash">Bronchial Wash</option><option value="bronchial brushing">Bronchial Brushing</option><option value="tissue">Tissue</option><option value="pus swab">Pus Swab</option><option value="pus">Pus</option><option value="stool">Stool</option><option value="High vaginal swab">High Vaginal Swab</option><option value="urethral swab">Urethral Swab</option><option value="FNAC">FNAC</option><option value="lung biopsy">Lung Biopsy</option></select></div>  <div class="col-md-3 mb-3"> <label class="form-label">Result #' +
        count1 + ' </label><select class="custom-select" name="urinary_result[]" id="urinary_result1' + count1 +
        '" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option><option value="Pending">Pending</option></select><div class="invalid-feedback">Please Select Result.</div></div></div><div class="form-row"><div class="col-md-4 mb-3"> <label class="form-label">Organism #' +
        count1 +
        '</label><span style="color: red">*</span><select class="custom-select" name="urinary_organism[]" id="urinary_organism' +
        count1 +
        '"  required="" onchange="getAntibiotics(this)"><option value="">Select</option><?php for($i=0; $i< count($lovs); $i++){ ?><option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option><?php } ?></select></div><div class="col-md-4 mb-3"> <label class="form-label" for="multiple-placeholder">Resistance Antibiotic #' +
        count1 +
        '</label><select class="select2-placeholder-multiple form-control" multiple="multiple" id="urinary_antibiotic' +
        count1 +
        '" name="urinary_antibiotic['+ count1 +'][]"></select></div><div class="col-md-3 mb-3"> <label class="form-label">MDRO #' +
        count1 +
        '</label><span style="color: red">*</span><input class="form-control" name="urinary_mdr_name[]" id="urinary_mdr_name' +
        count1 +
        '"  required="" placeholder="Enter MBRO" style="background-color: white;" readonly></div> <div class="col-md-1" style="margin-top: 23px"><button class="btn btn-danger"  onclick="delrows1(' +
        count1 + ');" type="button" ><i class="fal fa-times"></i></button></div></div></div>';

    document.getElementById("urinary_new_elementid").appendChild(txtNewInputBox1);

    // $('input[name="date[]"]').each(function(index){

    //         var i= index+1;

    //           $('#date_'+i).daterangepicker({

    //                singleDatePicker: true,
    //                 showDropdowns: true
    //             });
    //           console.log('date_'+i);

    //          });
    $(document).ready(function() {
        $('.aa').daterangepicker({
            singleDatePicker: true,
            showDropdowns: true
        });
        $(".select2-placeholder-multiple").select2({
            placeholder: "Select State"
        });
    });
}

function delrows1(count1) {
    if (confirm("Are you sure you want to Delete?")) {
        var el = count1;
        $('#remove1' + el).remove();
    }

}


var count2 = 0;

function CentralCreateNewElement() {
    count2++;
    var txtNewInputBox2 = document.createElement('div');

    txtNewInputBox2.innerHTML = '<div class="" id="remove2' + count2 +
        '" ><div class="form-row"><div class="col-md-4 mb-3"><label>Date #' + count2 +
        '</label><div class="input-group"><input type="text" class="form-control aa" value="07/17/2020" id="central_date1_' +
        count2 +
        '" name="central_date[]" ><div class="input-group-append"><span class="input-group-text fs-xl"><i class="fal fa-calendar-alt"></i></span></div></div><div class="invalid-feedback"> Please Select Date .</div></div><div class="col-md-4 mb-3"><label class="form-label">Source ' +
        count2 +
        '</label><span style="color: red">*</span><select class="custom-select" name="central_source[]" id="central_source1' +
        count2 +
        '"  required=""><option value="">Select</option><option value="peripheral blood">Peripheral Blood</option><option value="central line blood">Central Line Blood</option><option value="mid stream urine">Mid Stream Urine</option><option value="suprapubic urine">Supra Pubic Urine In</option><option value="supra pubic urine out">Supra Pubic Urine Out</option><option value="tracheal aspirate">Tracheal Aspirate</option><option value="sputum">Sputum</option><option value="broncho alveolar lavage">Bronchoc Alveolar Lavage</option><option value="bronchial wash">Bronchial Wash</option><option value="bronchial brushing">Bronchial Brushing</option><option value="tissue">Tissue</option><option value="pus swab">Pus Swab</option><option value="pus">Pus</option><option value="stool">Stool</option><option value="High vaginal swab">High Vaginal Swab</option><option value="urethral swab">Urethral Swab</option><option value="FNAC">FNAC</option><option value="lung biopsy">Lung Biopsy</option></select></div>  <div class="col-md-3 mb-3"> <label class="form-label">Result #' +
        count2 + ' </label><select class="custom-select" name="central_result[]" id="central_result1' + count2 +
        '" name="result1[]" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option><option value="Pending">Pending</option></select><div class="invalid-feedback">Please Select Result.</div></div></div><div class="form-row"><div class="col-md-4 mb-3"> <label class="form-label">Organism #' +
        count2 +
        '</label><span style="color: red">*</span><select class="custom-select" name="central_organism[]" id="central_organism' +
        count2 +
        '"  required="" onchange="getAntibiotics(this)"><option value="">Select</option><?php for($i=0; $i< count($lovs); $i++){ ?><option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option><?php } ?></select></div><div class="col-md-4 mb-3"> <label class="form-label" for="multiple-placeholder">Resistance Antibiotic #' +
        count2 +
        '</label><select class="select2-placeholder-multiple form-control" multiple="multiple" id="central_antibiotic' +
        count2 +
        '" name="central_antibiotic['+ count2 +'][]"></select></div><div class="col-md-3 mb-3"> <label class="form-label">MDRO #' +
        count2 +
        '</label><span style="color: red">*</span><input class="form-control" name="central_mdr_name[]" id="central_mdr_name' +
        count2 +
        '"  required="" placeholder="Enter MBRO" style="background-color: white;" readonly></div><div class="col-md-1" style="margin-top: 23px"><button class="btn btn-danger"  onclick="delrows2(' +
        count2 + ');" type="button" ><i class="fal fa-times"></i></button></div></div></div>';

    document.getElementById("central_new_elementid").appendChild(txtNewInputBox2);

    // $('input[name="date[]"]').each(function(index){

    //         var i= index+1;

    //           $('#date_'+i).daterangepicker({

    //                singleDatePicker: true,
    //                 showDropdowns: true
    //             });
    //           console.log('date_'+i);

    //          });
    $(document).ready(function() {
        $('.aa').daterangepicker({
            singleDatePicker: true,
            showDropdowns: true
        });
        $(".select2-placeholder-multiple").select2({
            placeholder: "Select State"
        });
    });
}

function delrows2(count2) {
    if (confirm("Are you sure you want to Delete?")) {
        var el = count2;
        $('#remove2' + el).remove();
    }

}





var count3 = 0;

function HospitalCreateNewElement() {
    count3++;
    var txtNewInputBox3 = document.createElement('div');

    txtNewInputBox3.innerHTML = '<div class="" id="remove3' + count3 +
        '" ><div class="form-row"><div class="col-md-4 mb-3"><label>Date #' + count3 +
        '</label><div class="input-group"><input type="text" class="form-control aa" value="07/17/2020" id="hospital_date1_' +
        count3 +
        '" name="hospital_date[]" ><div class="input-group-append"><span class="input-group-text fs-xl"><i class="fal fa-calendar-alt"></i></span></div></div><div class="invalid-feedback"> Please Select Date .</div></div><div class="col-md-4 mb-3"><label class="form-label">Source ' +
        count3 +
        '</label><span style="color: red">*</span><select class="custom-select" name="hospital_source[]" id="hospital_source1' +
        count3 +
        '"  required=""><option value="">Select</option><option value="peripheral blood">Peripheral Blood</option><option value="central line blood">Central Line Blood</option><option value="mid stream urine">Mid Stream Urine</option><option value="suprapubic urine">Supra Pubic Urine In</option><option value="supra pubic urine out">Supra Pubic Urine Out</option><option value="tracheal aspirate">Tracheal Aspirate</option><option value="sputum">Sputum</option><option value="broncho alveolar lavage">Bronchoc Alveolar Lavage</option><option value="bronchial wash">Bronchial Wash</option><option value="bronchial brushing">Bronchial Brushing</option><option value="tissue">Tissue</option><option value="pus swab">Pus Swab</option><option value="pus">Pus</option><option value="stool">Stool</option><option value="High vaginal swab">High Vaginal Swab</option><option value="urethral swab">Urethral Swab</option><option value="FNAC">FNAC</option><option value="lung biopsy">Lung Biopsy</option></select></div>  <div class="col-md-3 mb-3"> <label class="form-label">Result #' +
        count3 + ' </label><select class="custom-select" name="hospital_result[]" id="hospital_result1' + count3 +
        '" name="result13[]" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option><option value="Pending">Pending</option></select><div class="invalid-feedback">Please Select Result.</div></div></div> <div class="form-row"><div class="col-md-4 mb-3"> <label class="form-label">Organism #' +
        count3 +
        '</label><span style="color: red">*</span><select class="custom-select" name="hospital_organism[]" id="hospital_organism' +
        count3 +
        '"  required="" onchange="getAntibiotics(this)"><option value="">Select</option><?php for($i=0; $i< count($lovs); $i++){ ?><option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option><?php } ?></select></div><div class="col-md-4 mb-3"> <label class="form-label" for="multiple-placeholder">Resistance Antibiotic </label><select class="select2-placeholder-multiple form-control" multiple="multiple" id="hospital_antibiotic' +
        count3 +
        '" name="hospital_antibiotic['+ count3 +'][]"></select></div><div class="col-md-3 mb-3"> <label class="form-label">MDRO</label><span style="color: red">*</span><input class="form-control" name="hospital_mdr_name[]" id="hospital_mdr_name' +
        count3 +
        '"  required="" style="background-color: white;" readonly placeholder="Enter MBRO"></div><div class="col-md-1" style="margin-top: 23px"><button class="btn btn-danger"  onclick="delrows3(' +
        count3 + ');" type="button" ><i class="fal fa-times"></i></button></div></div></div>';

    document.getElementById("hospital_new_elementid").appendChild(txtNewInputBox3);

    // $('input[name="date[]"]').each(function(index){

    //         var i= index+1;

    //           $('#date_'+i).daterangepicker({

    //                singleDatePicker: true,
    //                 showDropdowns: true
    //             });
    //           console.log('date_'+i);

    //          });
    $(document).ready(function() {
        $('.aa').daterangepicker({
            singleDatePicker: true,
            showDropdowns: true
        });
        $(".select2-placeholder-multiple").select2({
            placeholder: "Select State"
        });
    });
}

function delrows3(count3) {
    if (confirm("Are you sure you want to Delete?")) {
        var el = count3;
        $('#remove3' + el).remove();
    }

}





var count4 = 0;

function VentilatorCreateNewElement() {
    count4++;
    var txtNewInputBox4 = document.createElement('div');

    txtNewInputBox4.innerHTML = '<div class="" id="remove4' + count4 +
        '" ><div class="form-row"><div class="col-md-4 mb-3"><label>Date #' + count4 +
        '</label><div class="input-group"><input type="text" class="form-control aa" value="07/17/2020" id="ventilator_date1_' +
        count4 +
        '" name="ventilator_date[]" ><div class="input-group-append"><span class="input-group-text fs-xl"><i class="fal fa-calendar-alt"></i></span></div></div><div class="invalid-feedback"> Please Select Date .</div></div><div class="col-md-4 mb-3"><label class="form-label">Source ' +
        count4 +
        '</label><span style="color: red">*</span><select class="custom-select" name="ventilator_source[]" id="ventilator_source1_' +
        count4 +
        '"  required=""><option value="">Select</option><option value="peripheral blood">Peripheral Blood</option><option value="central line blood">Central Line Blood</option><option value="mid stream urine">Mid Stream Urine</option><option value="suprapubic urine">Supra Pubic Urine In</option><option value="supra pubic urine out">Supra Pubic Urine Out</option><option value="tracheal aspirate">Tracheal Aspirate</option><option value="sputum">Sputum</option><option value="broncho alveolar lavage">Bronchoc Alveolar Lavage</option><option value="bronchial wash">Bronchial Wash</option><option value="bronchial brushing">Bronchial Brushing</option><option value="tissue">Tissue</option><option value="pus swab">Pus Swab</option><option value="pus">Pus</option><option value="stool">Stool</option><option value="High vaginal swab">High Vaginal Swab</option><option value="urethral swab">Urethral Swab</option><option value="FNAC">FNAC</option><option value="lung biopsy">Lung Biopsy</option></select></div>  <div class="col-md-3 mb-3"> <label class="form-label">Result #' +
        count4 + ' </label><select class="custom-select" name="ventilator_result[]" id="ventilator_result1' + count4 +
        '" name="ventilator_result1[]" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option><option value="Pending">Pending</option></select><div class="invalid-feedback">Please Select Result.</div></div><div class="form-row"><div class="col-md-4 mb-3"> <label class="form-label">Organism #' +
        count4 +
        '</label><span style="color: red">*</span><select class="custom-select" name="ventilator_organism[]" id="ventilator_organism' +
        count4 +
        '"  required="" onchange="getAntibiotics(this)"><option value="">Select</option><?php for($i=0; $i< count($lovs); $i++){ ?><option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option><?php } ?></select></div><div class="col-md-4 mb-3"> <label class="form-label" for="multiple-placeholder">Resistance Antibiotic #' +
        count4 +
        '</label><select class="select2-placeholder-multiple form-control" multiple="multiple" id="ventilator_antibiotic' +
        count4 +
        '" name="ventilator_antibiotic['+ count4 +'][]"><optgroup label="Antibiotic class 1"><option value="oxacillin">oxacillin</option><option value="Vancomycin">Vancomycin</option></optgroup><optgroup label="Antibiotic class 2"><option value=" fluoroquinolone">fluoroquinolone</option><option value="Ciprofloxacin">Ciprofloxacin</option></optgroup><optgroup label="Antibiotic class 3"><option value="Ceftazidime">Ceftazidime</option><option value="Ceftazidime">Ceftazidime</option></optgroup><optgroup label="Antibiotic class 4"><option value="piperacillin">piperacillin</option><option value="ticarcilin">ticarcilin</option></optgroup><optgroup label="Antibiotic class 5"><option value="polymyxin b">polymyxin B</option><option value="colistin">colistin</option></optgroup><optgroup label="Antibiotic class 6"><option value="meropenem"> meropenem</option><option value="imipenem ">imipenem</option></optgroup><optgroup label="Antibiotic class 7"><option value="piperacillin tazobactam">piperacillin tazobactam</option><option value="piperacillin tazobactam">piperacillin tazobactam</option></optgroup></select></div><div class="col-md-3 mb-3"> <label class="form-label">MDRO #' +
        count4 +
        '</label><span style="color: red">*</span><input placeholder="Enter MBRO" type="text" class="form-control" name="ventilator_mdr_name[]" id="ventilator_mdr_name' +
        count4 +
        '"  required="" style="background-color: white;" readonly></div><div class="col-md-1" style="margin-top: 23px"><button class="btn btn-danger"  onclick="delrows4(' +
        count4 + ');" type="button" ><i class="fal fa-times"></i></button></div></div></div>';

    document.getElementById("ventilator_new_elementid").appendChild(txtNewInputBox4);

    // $('input[name="date[]"]').each(function(index){

    //         var i= index+1;

    //           $('#date_'+i).daterangepicker({

    //                singleDatePicker: true,
    //                 showDropdowns: true
    //             });
    //           console.log('date_'+i);

    //          });
    $(document).ready(function() {
        $('.aa').daterangepicker({
            singleDatePicker: true,
            showDropdowns: true
        });
        $(".select2-placeholder-multiple").select2({
            placeholder: "Select State"
        });
    });
}

function delrows4(count4) {
    if (confirm("Are you sure you want to Delete?")) {

        var el = count4;
        $('#remove4' + el).remove();
    }

}



var count5 = 0;

function SurgicalCreateNewElement() {
    count5++;

    var txtNewInputBox5 = document.createElement('div');

    txtNewInputBox5.innerHTML = '<div class="" id="remove5' + count5 +
        '" ><div class="form-row"><div class="col-md-4 mb-3"><label>Date #' + count5 +
        '</label><div class="input-group"><input type="text" class="form-control aa" value="07/17/2020" id="surgical_date1_' +
        count5 +
        '" name="surgical_date[]" ><div class="input-group-append"><span class="input-group-text fs-xl"><i class="fal fa-calendar-alt"></i></span></div></div><div class="invalid-feedback"> Please Select Date .</div></div><div class="col-md-4 mb-3"><label class="form-label">Source ' +
        count5 +
        '</label><span style="color: red">*</span><select class="custom-select" name="surgical_source[]" id="surgical_source1' +
        count5 +
        '"  required=""><option value="">Select</option><option value="peripheral blood">Peripheral Blood</option><option value="central line blood">Central Line Blood</option><option value="mid stream urine">Mid Stream Urine</option><option value="suprapubic urine">Supra Pubic Urine In</option><option value="supra pubic urine out">Supra Pubic Urine Out</option><option value="tracheal aspirate">Tracheal Aspirate</option><option value="sputum">Sputum</option><option value="broncho alveolar lavage">Bronchoc Alveolar Lavage</option><option value="bronchial wash">Bronchial Wash</option><option value="bronchial brushing">Bronchial Brushing</option><option value="tissue">Tissue</option><option value="pus swab">Pus Swab</option><option value="pus">Pus</option><option value="stool">Stool</option><option value="High vaginal swab">High Vaginal Swab</option><option value="urethral swab">Urethral Swab</option><option value="FNAC">FNAC</option><option value="lung biopsy">Lung Biopsy</option></select></div>  <div class="col-md-3 mb-3"> <label class="form-label">Result #' +
        count5 + ' </label><select class="custom-select" name="surgical_result[]" id="surgical_result1' + count5 +
        '" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option><option value="Pending">Pending</option></select><div class="invalid-feedback">Please Select Result.</div></div></div><div class="form-row"><div class="col-md-4 mb-3"> <label class="form-label">Organism #' +
        count5 +
        '</label><span style="color: red">*</span><select class="custom-select" name="surgical_organism[]" id="surgical_organism' +
        count5 +
        '"  required="" onchange="getAntibiotics(this)"><option value="">Select</option><?php for($i=0; $i< count($lovs); $i++){ ?><option value="<?php echo $lovs[$i]['organism_name'] ?>"><?php echo $lovs[$i]['organism_name']; ?></option><?php } ?></select></div><div class="col-md-4 mb-3"> <label class="form-label" for="multiple-placeholder">Resistance Antibiotic </label><select class="select2-placeholder-multiple form-control" multiple="multiple" id="surgical_antibiotic' +
        count5 +
        '" name="surgical_antibiotic['+ count5 +'][]"></select></div><div class="col-md-3 mb-3"> <label class="form-label">MDRO</label><span style="color: red">*</span><input type="text" placeholder="Enter MBRO" class="form-control" name="surgical_mdr_name[]" id="surgical_mdr_name' +
        count5 +
        '"  required="" style="background-color: white;" readonly></div> <div class="col-md-1" style="margin-top: 23px"><button class="btn btn-danger"  onclick="delrows5(' +
        count5 + ');" type="button" ><i class="fal fa-times"></i></button></div></div></div>';
    document.getElementById("surgical_new_elementid").appendChild(txtNewInputBox5);

    // $('input[name="date[]"]').each(function(index){

    //         var i= index+1;

    //           $('#date_'+i).daterangepicker({

    //                singleDatePicker: true,
    //                 showDropdowns: true
    //             });
    //           console.log('date_'+i);

    //          });
    $(document).ready(function() {
        $('.aa').daterangepicker({
            singleDatePicker: true,
            showDropdowns: true
        });
        $(".select2-placeholder-multiple").select2({
            placeholder: "Select State"
        });
    });
}

function delrows5(count5) {

    if (confirm("Are you sure you want to Delete?")) {

        var el = count5;

        $('#remove5' + el).remove();
    }

}

$(document).ready(function() {
    $('.aa').daterangepicker({
        singleDatePicker: true,
        showDropdowns: true
    });
    $(".select2-placeholder-multiple").select2({
        placeholder: "Select State"
    });


    //  $('#date_of_intubation').daterangepicker(
    // {
    //     singleDatePicker: true,
    //     showDropdowns: true
    // });

    // $('#date_of_central_line_insertion').daterangepicker(
    // {
    //     singleDatePicker: true,
    //     showDropdowns: true
    // });
    //  $('#date_of_cannula_insertion').daterangepicker(
    // {
    //     singleDatePicker: true,
    //     showDropdowns: true
    // });
    //   $('#date_of_urinary_catheter_insertion').daterangepicker(
    // {
    //     singleDatePicker: true,
    //     showDropdowns: true
    // });
    // $('#date_of_admission').daterangepicker(
    // {
    //     singleDatePicker: true,
    //     showDropdowns: true
    // });

    // $('#datepicker').daterangepicker(
    // {
    //     singleDatePicker: true,
    //     showDropdowns: true
    // });

    // $('#datepicker-3').daterangepicker(
    // {
    //     singleDatePicker: true,
    //     showDropdowns: true
    // });
});

function lookup(arg){
 var id = arg.getAttribute('id');
 var value = arg.value;
 // do your stuff
 alert(id);
}

function getAntibiotics(val)
{
    var id = val.getAttribute('id');
 var value = val.value;
 // do your stuff
 for(i=0;i<=count;i++)
 {
 if(id=='phlebitis_organism'+i)
 {
   var phlebitisAnti='phlebitis_antibiotic'+i;
   var phlebitisMdrName='phlebitis_mdr_name'+i;
 }
}
for(j=0;j<=count1;j++)
 {
 if(id=='urinary_organism'+j)
 {
   var urinaryAnti='urinary_antibiotic'+j;
   var urinaryMdrName='urinary_mdr_name'+j;
 }
}
for(k=0;k<=count2;k++)
 {
 if(id=='central_organism'+k)
 {
   var centralAnti='central_antibiotic'+k;
   var centralMdrName='central_mdr_name'+k;
 }
}
for(a=0;a<=count3;a++)
 {
 if(id=='hospital_organism'+a)
 {
   var hospitalAnti='hospital_antibiotic'+a;
   var hospitalMdrName='hospital_mdr_name'+a;
 }
}
for(b=0;b<=count4;b++)
 {
 if(id=='ventilator_organism'+b)
 {
   var ventilatorAnti='ventilator_antibiotic'+b;
   var ventilatorMdrName='ventilator_mdr_name'+b;
 }
}
for(c=0;c<=count5;c++)
 {
 if(id=='surgical_organism'+c)
 {
   var surgicalAnti='surgical_antibiotic'+c;
   var surgicalMdrName='surgical_mdr_name'+c;
 }
}
// console.log(phlebitisAnti);
 //alert(urinaryAnti);
 //alert(urinaryMdrName);

    
    // var data = $("#").serialize();
    var data = { organism_name: value };
    $.ajax({
        url: baseurl + 'get_antibiotic',
        type: 'POST',
        data: data,
        success: function(result) {

            //var result = jQuery.parseJSON(result);
            if(result){
                var result = jQuery.parseJSON(result);
                console.log( result);
                
               if(phlebitisAnti != null)
               {
                  
                document.getElementById(phlebitisAnti).innerHTML='<option value='+result.antibiotic_class_1+'>'+result.antibiotic_class_1+'</option><option value='+result.antibiotic_class_2+'>'+result.antibiotic_class_2+'</option><option value='+result.antibiotic_class_3+'>'+result.antibiotic_class_3+'</option><option value='+result.antibiotic_class_4+'>'+result.antibiotic_class_4+'</option>';
                 var a1=  document.getElementById(phlebitisMdrName)
                 a1.value=result.mbr_name;
               }
               if(urinaryAnti != null){
               
                document.getElementById(urinaryAnti).innerHTML='<option value='+result.antibiotic_class_1+'>'+result.antibiotic_class_1+'</option><option value='+result.antibiotic_class_2+'>'+result.antibiotic_class_2+'</option><option value='+result.antibiotic_class_3+'>'+result.antibiotic_class_3+'</option><option value='+result.antibiotic_class_4+'>'+result.antibiotic_class_4+'</option>';
                var a2=  document.getElementById(urinaryMdrName)
                a2.value=result.mbr_name;
                 console.log(result.mbr_name);
               }
               if(centralAnti != null){
                
                document.getElementById(centralAnti).innerHTML='<option value='+result.antibiotic_class_1+'>'+result.antibiotic_class_1+'</option><option value='+result.antibiotic_class_2+'>'+result.antibiotic_class_2+'</option><option value='+result.antibiotic_class_3+'>'+result.antibiotic_class_3+'</option><option value='+result.antibiotic_class_4+'>'+result.antibiotic_class_4+'</option>';
                var a3=  document.getElementById(centralMdrName)
                a3.value=result.mbr_name;
                 console.log(result.mbr_name);
               }
               if(hospitalAnti != null){
                
                document.getElementById(hospitalAnti).innerHTML='<option value='+result.antibiotic_class_1+'>'+result.antibiotic_class_1+'</option><option value='+result.antibiotic_class_2+'>'+result.antibiotic_class_2+'</option><option value='+result.antibiotic_class_3+'>'+result.antibiotic_class_3+'</option><option value='+result.antibiotic_class_4+'>'+result.antibiotic_class_4+'</option>';
                var a4=  document.getElementById(hospitalMdrName)
                a4.value=result.mbr_name;
                 console.log(result.mbr_name);
               }
               if(ventilatorAnti != null){
                
                document.getElementById(ventilatorAnti).innerHTML='<option value='+result.antibiotic_class_1+'>'+result.antibiotic_class_1+'</option><option value='+result.antibiotic_class_2+'>'+result.antibiotic_class_2+'</option><option value='+result.antibiotic_class_3+'>'+result.antibiotic_class_3+'</option><option value='+result.antibiotic_class_4+'>'+result.antibiotic_class_4+'</option>';
                var a5=  document.getElementById(ventilatorMdrName)
                a5.value=result.mbr_name;
                 console.log(result.mbr_name);
               }
               if(surgicalAnti != null){
               
                document.getElementById(surgicalAnti).innerHTML='<option value='+result.antibiotic_class_1+'>'+result.antibiotic_class_1+'</option><option value='+result.antibiotic_class_2+'>'+result.antibiotic_class_2+'</option><option value='+result.antibiotic_class_3+'>'+result.antibiotic_class_3+'</option><option value='+result.antibiotic_class_4+'>'+result.antibiotic_class_4+'</option>';
                var a6=  document.getElementById(surgicalMdrName)
                a6.value=result.mbr_name;
                 console.log(result.mbr_name);
               }
            } 
            
         
            // $('#order_total_amount').text(Math.round(total_amount));

        },
        error: function(xhr, textStatus, errorThrown) {
            alert(xhr.responseText);
        }
    });

}
</script>