<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;
}
</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);">SmartAdmin</a></li>
        <li class="breadcrumb-item">category_1</li>
        <li class="breadcrumb-item">category_2</li>
        <li class="breadcrumb-item active">Page Titile</li>
        <li class="position-absolute pos-top pos-right d-none d-sm-block"><span class="js-get-date"></span></li>
    </ol>
    <div id="panel-12" class="panel">
        <div class="panel-hdr border-faded border-top-0 border-right-0 border-left-0 shadow-0">
            <h2>
                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' 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 class="col-md-4 mb-3">    
                                    <label class="form-label">Date Of Cannula Insertion<span style="color: red">*</span></label>
                                    <div class="input-group">
                                        <input type="text" style="background-color: white;" readonly="" class="form-control aa" value="07/17/2021" id="date_of_cannula_insertion" name="date_of_cannula_insertion">
                                        <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 Cannula Insertion.
                                    </div>
                                </div> -->
                                <!--  <div class="col-md-4 mb-3">    
                                    <label class="form-label">Date Of Urinary Catheter Insertion<span style="color: red">*</span></label>
                                    <div class="input-group">
                                        <input type="text" style="background-color: white;"  readonly="" class="form-control aa" value="07/17/2021" id="date_of_urinary_catheter_insertion" name="date_of_urinary_catheter_insertion">
                                        <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 Urinary Catheter Insertion.
                                    </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="date1" name="date1">
                                        <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 class="col-md-4 mb-3">    
                                    <label class="form-label">Date Of Central Line Insertion<span style="color: red">*</span></label>
                                    <div class="input-group">
                                        <input type="text" readonly="" style="background-color: white;"  class="form-control aa" value="07/17/2021" id="date_of_central_line_insertion" name="date_of_central_line_insertion">
                                        <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 Central Line Insertion.
                                    </div>
                                </div> -->
                                <!--  <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" readonly="" style="background-color: white;"  class="form-control aa" value="07/17/2021" id="date_of_intubation" name="date_of_intubation">
                                        <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 Surgery<span style="color: red">*</span></label>
                                    <div class="input-group">
                                        <input type="text" readonly="" style="background-color: white;"  class="form-control aa" value="07/17/2021" id="date_of_surgery" name="date_of_surgery">
                                        <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>

                            <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" required="">
                                        <option value="">Select</option>
                                        <option value="yes">Yes</option>
                                        <option value="no">No</option>
                                    </select>
                                    <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>
                                        <option value="yes">Yes</option>
                                        <option value="no">No</option>
                                    </select>
                                    <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>
                                                            <select class="custom-select" name="intravenous_cannula"
                                                                id="intravenous_cannula" onclick="Intravenous()"
                                                                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=""
                                                                        id="datepicker-3" 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 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">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="options0"
                                                                                id="option0" checked="checked">CLABSI no
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options1"
                                                                                id="option1"> Suspected
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options2"
                                                                                id="option2"> Confirm
                                                                        </label>
                                                                    </div>
                                                                </div>
                                                            </div>
                                                            <div class="col-md-4 mb-3">
                                                                <label class="form-label">Culture Report </label><span
                                                                    style="color: red">*</span>
                                                                <select class="custom-select" name="culture_report"
                                                                    id="culture_report" onclick="Culture()" 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="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="createNewElement();"><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="newElementId">
                                                                            <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="datepicker"
                                                                                            name="datepicker">
                                                                                        <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="Source" id="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="result" id="result"
                                                                                        required="">
                                                                                        <option value="">Select result
                                                                                        </option>
                                                                                        <option value="Positive">
                                                                                            Positive</option>
                                                                                        <option value="Negative">
                                                                                            Negative</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="organism" id="organism"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Staphylococcus aureus">
                                                                                            Staphylococcus aureus
                                                                                        </option>
                                                                                        <option value="Enterococcus">
                                                                                            Enterococcus</option>
                                                                                        <option
                                                                                            value="Pseudomonas aeruginosa">
                                                                                            Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </div>
                                                                                <div class="col-md-4 mb-3">
                                                                                    <label class="form-label"
                                                                                        for="multiple-placeholder">
                                                                                        Multi Select Placeholder
                                                                                    </label>
                                                                                    <select
                                                                                        class="select2-placeholder-multiple form-control"
                                                                                        multiple="multiple"
                                                                                        id="multiple-placeholder1">
                                                                                        <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">MDR
                                                                                        Name</label><span
                                                                                        style="color: red">*</span>
                                                                                    <select class="custom-select"
                                                                                        name="mdr_name" id="mdr_name"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Methicilin resistant Staphylococcus aureus (MRSA)">
                                                                                            Methicilin resistant
                                                                                            Staphylococcus aureus (MRSA)
                                                                                        </option>
                                                                                        <option
                                                                                            value="Vancomycin resistant Enterococcus (VRE)">
                                                                                            Vancomycin resistant
                                                                                            Enterococcus (VRE)</option>
                                                                                        <option
                                                                                            value="MDR Pseudomonas aeruginosa">
                                                                                            MDR Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </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">Urinary Tract
                                                                Infection</label><span style="color: red">*</span>
                                                            <select class="custom-select" name="urinary_catheter"
                                                                id="urinary_catheter" onclick="UrinaryCatheter()"
                                                                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="datepicker2" name="datepicker2" 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">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="options0"
                                                                                id="option0" checked="checked">CLABSI no
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options1"
                                                                                id="option1"> Suspected
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options2"
                                                                                id="option2"> 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="culture_report1"
                                                                    id="culture_report1" onclick="Culture1()"
                                                                    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="culture_div1" style="display: none;">
                                                        <div class="col-md-12">
                                                            <div id="panel-3" class="">
                                                                <div class="panel-hdr">
                                                                    <h2>
                                                                        Culture Report
                                                                    </h2>
                                                                    <div id="dynamicCheck1">
                                                                        <button type="button" class="btn btn-primary"
                                                                            onclick="createNewElement1();"><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="newElementId1">
                                                                            <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="datepicker4"
                                                                                            name="datepicker4">
                                                                                        <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="Source1" id="Source1"
                                                                                        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="result1" id="result1"
                                                                                        required="">
                                                                                        <option value="">Select result
                                                                                        </option>
                                                                                        <option value="Positive">
                                                                                            Positive</option>
                                                                                        <option value="Negative">
                                                                                            Negative</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="organism" id="organism"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Staphylococcus aureus">
                                                                                            Staphylococcus aureus
                                                                                        </option>
                                                                                        <option value="Enterococcus">
                                                                                            Enterococcus</option>
                                                                                        <option
                                                                                            value="Pseudomonas aeruginosa">
                                                                                            Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </div>
                                                                                <div class="col-md-4 mb-3">
                                                                                    <label class="form-label"
                                                                                        for="multiple-placeholder">
                                                                                        Multi Select Placeholder
                                                                                    </label>
                                                                                    <select
                                                                                        class="select2-placeholder-multiple form-control"
                                                                                        multiple="multiple"
                                                                                        id="multiple-placeholder2">
                                                                                        <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">MDR
                                                                                        Name</label><span
                                                                                        style="color: red">*</span>
                                                                                    <select class="custom-select"
                                                                                        name="mdr_name" id="mdr_name"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Methicilin resistant Staphylococcus aureus (MRSA)">
                                                                                            Methicilin resistant
                                                                                            Staphylococcus aureus (MRSA)
                                                                                        </option>
                                                                                        <option
                                                                                            value="Vancomycin resistant Enterococcus (VRE)">
                                                                                            Vancomycin resistant
                                                                                            Enterococcus (VRE)</option>
                                                                                        <option
                                                                                            value="MDR Pseudomonas aeruginosa">
                                                                                            MDR Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </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">Central Line Associated
                                                                Bloodstream Infection</label><span
                                                                style="color: red">*</span>
                                                            <select class="custom-select" name="central_line"
                                                                id="central_line" onclick="CentralLine()" 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="datepicker3" name="datepicker3" 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="type" id="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="options0"
                                                                                id="option0" checked="checked">CLABSI no
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options1"
                                                                                id="option1"> Suspected
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options2"
                                                                                id="option2"> 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="culture_report3"
                                                                    id="culture_report3" onclick="Culture2()"
                                                                    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="culture_div2" 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="createNewElement2();"><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="newElementId2">
                                                                            <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="datepicker5"
                                                                                            name="datepicker5">
                                                                                        <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="Source2" id="Source2"
                                                                                        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="result2" id="result2"
                                                                                        required="">
                                                                                        <option value="">Select result
                                                                                        </option>
                                                                                        <option value="Positive">
                                                                                            Positive</option>
                                                                                        <option value="Negative">
                                                                                            Negative</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="organism" id="organism"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Staphylococcus aureus">
                                                                                            Staphylococcus aureus
                                                                                        </option>
                                                                                        <option value="Enterococcus">
                                                                                            Enterococcus</option>
                                                                                        <option
                                                                                            value="Pseudomonas aeruginosa">
                                                                                            Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </div>
                                                                                <div class="col-md-4 mb-3">
                                                                                    <label class="form-label"
                                                                                        for="multiple-placeholder">
                                                                                        Multi Select Placeholder
                                                                                    </label>
                                                                                    <select
                                                                                        class="select2-placeholder-multiple form-control"
                                                                                        multiple="multiple"
                                                                                        id="multiple-placeholder3">
                                                                                        <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">MDR
                                                                                        Name</label><span
                                                                                        style="color: red">*</span>
                                                                                    <select class="custom-select"
                                                                                        name="mdr_name" id="mdr_name"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Methicilin resistant Staphylococcus aureus (MRSA)">
                                                                                            Methicilin resistant
                                                                                            Staphylococcus aureus (MRSA)
                                                                                        </option>
                                                                                        <option
                                                                                            value="Vancomycin resistant Enterococcus (VRE)">
                                                                                            Vancomycin resistant
                                                                                            Enterococcus (VRE)</option>
                                                                                        <option
                                                                                            value="MDR Pseudomonas aeruginosa">
                                                                                            MDR Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </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>
                                                            <select class="custom-select"
                                                                name="hospital_acquired_pneumonia"
                                                                id="hospital_acquired_pneumonia"
                                                                onclick="HospitalAcquired()" 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="demo4" 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="datepicker6" name="datepicker6" 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">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="options0"
                                                                                id="option0" checked="checked">HAP NO
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options1"
                                                                                id="option1"> Suspected
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options2"
                                                                                id="option2"> 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="culture_report4"
                                                                    id="culture_report4" onclick="Culture3()"
                                                                    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="culture_div3" 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="createNewElement3();"><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="newElementId3">
                                                                            <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="datepicker7"
                                                                                            name="datepicker7">
                                                                                        <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="Source3" id="Source3"
                                                                                        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="result3" id="result3"
                                                                                        required="">
                                                                                        <option value="">Select result
                                                                                        </option>
                                                                                        <option value="Positive">
                                                                                            Positive</option>
                                                                                        <option value="Negative">
                                                                                            Negative</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="organism" id="organism"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Staphylococcus aureus">
                                                                                            Staphylococcus aureus
                                                                                        </option>
                                                                                        <option value="Enterococcus">
                                                                                            Enterococcus</option>
                                                                                        <option
                                                                                            value="Pseudomonas aeruginosa">
                                                                                            Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </div>
                                                                                <div class="col-md-4 mb-3">
                                                                                    <label class="form-label"
                                                                                        for="multiple-placeholder">
                                                                                        Multi Select Placeholder
                                                                                    </label>
                                                                                    <select
                                                                                        class="select2-placeholder-multiple form-control"
                                                                                        multiple="multiple"
                                                                                        id="multiple-placeholder4">
                                                                                        <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">MDR
                                                                                        Name</label><span
                                                                                        style="color: red">*</span>
                                                                                    <select class="custom-select"
                                                                                        name="mdr_name" id="mdr_name"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Methicilin resistant Staphylococcus aureus (MRSA)">
                                                                                            Methicilin resistant
                                                                                            Staphylococcus aureus (MRSA)
                                                                                        </option>
                                                                                        <option
                                                                                            value="Vancomycin resistant Enterococcus (VRE)">
                                                                                            Vancomycin resistant
                                                                                            Enterococcus (VRE)</option>
                                                                                        <option
                                                                                            value="MDR Pseudomonas aeruginosa">
                                                                                            MDR Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </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>
                                                            <select class="custom-select"
                                                                name="ventilator_associated_pneumonia"
                                                                id="ventilator_associated_pneumonia"
                                                                onclick="VentilatorAssociated()" 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 Insertion<span
                                                                        style="color: red">*</span></label>
                                                                <div class="input-group">
                                                                    <input type="text" style="background-color: white"
                                                                        class="form-control aa" value=""
                                                                        id="datepicker7" name="datepicker7" 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 Extubation <span
                                                                        style="color: red">*</span></label>
                                                                <div class="input-group">
                                                                    <input type="text" style="background-color: white"
                                                                        class="form-control aa" value=""
                                                                        id="datepicker8" name="datepicker8" 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="options0"
                                                                                id="option0" checked="checked">HAP NO
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options1"
                                                                                id="option1"> Suspected
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options2"
                                                                                id="option2"> 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="culture_report5"
                                                                    id="culture_report5" onclick="Culture4()"
                                                                    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="culture_div4" 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="createNewElement4();"><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="newElementId4">
                                                                            <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="datepicker10"
                                                                                            name="datepicker10">
                                                                                        <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="Source4" id="Source4"
                                                                                        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="result4" id="result4"
                                                                                        required="">
                                                                                        <option value="">Select result
                                                                                        </option>
                                                                                        <option value="Positive">
                                                                                            Positive</option>
                                                                                        <option value="Negative">
                                                                                            Negative</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="organism" id="organism"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Staphylococcus aureus">
                                                                                            Staphylococcus aureus
                                                                                        </option>
                                                                                        <option value="Enterococcus">
                                                                                            Enterococcus</option>
                                                                                        <option
                                                                                            value="Pseudomonas aeruginosa">
                                                                                            Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </div>
                                                                                <div class="col-md-4 mb-3">
                                                                                    <label class="form-label"
                                                                                        for="multiple-placeholder">
                                                                                        Multi Select Placeholder
                                                                                    </label>
                                                                                    <select
                                                                                        class="select2-placeholder-multiple form-control"
                                                                                        multiple="multiple"
                                                                                        id="multiple-placeholder5">
                                                                                        <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">MDR
                                                                                        Name</label><span
                                                                                        style="color: red">*</span>
                                                                                    <select class="custom-select"
                                                                                        name="mdr_name" id="mdr_name"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Methicilin resistant Staphylococcus aureus (MRSA)">
                                                                                            Methicilin resistant
                                                                                            Staphylococcus aureus (MRSA)
                                                                                        </option>
                                                                                        <option
                                                                                            value="Vancomycin resistant Enterococcus (VRE)">
                                                                                            Vancomycin resistant
                                                                                            Enterococcus (VRE)</option>
                                                                                        <option
                                                                                            value="MDR Pseudomonas aeruginosa">
                                                                                            MDR Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </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>
                                                            <select class="custom-select" name="surgical_site_infection"
                                                                id="surgical_site_infection"
                                                                onclick="SurgicalSiteInfection()" 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="datepicker11" name="datepicker11"
                                                                        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="datepicker12" name="datepicker12"
                                                                        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="options0"
                                                                                id="option0" checked="checked">HAP NO
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options1"
                                                                                id="option1"> Suspected
                                                                        </label>
                                                                        <label class="btn btn-info">
                                                                            <input type="radio" name="options2"
                                                                                id="option2"> 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="culture_report6"
                                                                    id="culture_report6" onclick="Culture5()"
                                                                    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="culture_div5" 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="createNewElement5();"><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="newElementId5">
                                                                            <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="datepicker13"
                                                                                            name="datepicker13">
                                                                                        <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="Source5" id="Source5"
                                                                                        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="result5" id="result5"
                                                                                        required="">
                                                                                        <option value="">Select result
                                                                                        </option>
                                                                                        <option value="Positive">
                                                                                            Positive</option>
                                                                                        <option value="Negative">
                                                                                            Negative</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="organism" id="organism"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Staphylococcus aureus">
                                                                                            Staphylococcus aureus
                                                                                        </option>
                                                                                        <option value="Enterococcus">
                                                                                            Enterococcus</option>
                                                                                        <option
                                                                                            value="Pseudomonas aeruginosa">
                                                                                            Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </div>
                                                                                <div class="col-md-4 mb-3">
                                                                                    <label class="form-label"
                                                                                        for="multiple-placeholder">
                                                                                        Multi Select Placeholder
                                                                                    </label>
                                                                                    <select
                                                                                        class="select2-placeholder-multiple form-control"
                                                                                        multiple="multiple"
                                                                                        id="multiple-placeholder6">
                                                                                        <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">MDR
                                                                                        Name</label><span
                                                                                        style="color: red">*</span>
                                                                                    <select class="custom-select"
                                                                                        name="mdr_name" id="mdr_name"
                                                                                        required="">
                                                                                        <option value="">Select</option>
                                                                                        <option
                                                                                            value="Methicilin resistant Staphylococcus aureus (MRSA)">
                                                                                            Methicilin resistant
                                                                                            Staphylococcus aureus (MRSA)
                                                                                        </option>
                                                                                        <option
                                                                                            value="Vancomycin resistant Enterococcus (VRE)">
                                                                                            Vancomycin resistant
                                                                                            Enterococcus (VRE)</option>
                                                                                        <option
                                                                                            value="MDR Pseudomonas aeruginosa">
                                                                                            MDR Pseudomonas aeruginosa
                                                                                        </option>
                                                                                    </select>

                                                                                </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="button"
                                                                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>




</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>
$(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');
    //jQuery('#js_pill_border_icon-2').addClass('tab-pane fade');
});

$("#names").keypress(function(e) {
    var keyCode = e.keyCode || e.which;
    var regex = /^[A-Za-z0-9 ]+$/;
    var isValid = regex.test(String.fromCharCode(keyCode));
    if (!isValid) {
        return false
    }
    if ($("#names").val().length > 35) {
        return false;
    }
});

$("#sife").keypress(function(e) {
    var keyCode = e.keyCode || e.which;
    var regex = /^[A-Za-z0-9 ]+$/;
    var isValid = regex.test(String.fromCharCode(keyCode));
    if (!isValid) {
        return false
    }
    if ($("#sife").val().length > 35) {
        return false;
    }
});
$("#source").keypress(function(e) {
    var keyCode = e.keyCode || e.which;
    var regex = /^[A-Za-z0-9 ]+$/;
    var isValid = regex.test(String.fromCharCode(keyCode));
    if (!isValid) {
        return false
    }
    if ($("#source").val().length > 35) {
        return false;
    }
});

$("#bed").keypress(function(e) {
    var keyCode = e.keyCode || e.which;
    var regex = /^[0-9 ]+$/;
    var isValid = regex.test(String.fromCharCode(keyCode));
    if (!isValid) {
        return false
    }
    if ($("#bed").val().length > 35) {
        return false;
    }
});
$("#mr_num").keypress(function(e) {
    var keyCode = e.keyCode || e.which;
    var regex = /^[0-9 ]+$/;
    var isValid = regex.test(String.fromCharCode(keyCode));
    if (!isValid) {
        return false
    }
    if ($("#mr_num").val().length > 35) {
        return false;
    }
});


function ValidateFrom() {


    var nameW = document.getElementById('names').value;

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


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

    }

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

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

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

    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();
        return false;

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

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

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

    //  dateOfUrinaryCatheterInsertion=document.getElementById('date_of_urinary_catheter_insertion').value;

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

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

    //  dateOfCentralLineInsertion=document.getElementById('date_of_central_line_insertion').value;

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

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


    //  dateOfIntubation=document.getElementById('date_of_intubation').value;

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

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

    //  dateOfSurgery=document.getElementById('date_of_surgery').value;

    //  if(dateOfSurgery=="")
    // {
    //  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");

    datepicker3 = document.getElementById('datepicker-3').value;
    if (datepicker3 == "") {
        document.getElementById("datepicker-3").classList.add("form-controlmy");
        document.getElementById("datepicker-3").classList.add("is-invalidmy");
        $("#datepicker-3").focus();
        return false;

    }
    document.getElementById("datepicker-3").classList.remove("form-controlmy");
    document.getElementById("datepicker-3").classList.add("is-validmyf");
    document.getElementById("datepicker-3").classList.add("is-validmy");

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

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

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

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

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

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

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

    }
    document.getElementById("culture_report").classList.remove("custom-selectmy");
    document.getElementById("culture_report").classList.add("custom-selectisvalidmy");
    document.getElementById("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");

    die("asdsa");
}


function Intravenous() {
    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"
    }

}

function Culture() {
    var x = document.getElementById("culture_report").value;
    if (x == 'yes') {
        var show = document.getElementById("culture_div");
        show.style.display = "block";
    } else {
        var show = document.getElementById("culture_div");
        show.style.display = "none"
    }

}






var count = 0;

function createNewElement() {
    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="date_' +
        count +
        '" name="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="Source[]" id="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="result[]" id="result' + count +
        '"name="result1[]" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option></select><div class="invalid-feedback">Please Select Result.</div></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("newElementId").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
        });
    });
}

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

}

function UrinaryCatheter() {
    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"
    }

}

function Culture1() {
    var x = document.getElementById("culture_report1").value;
    if (x == 'yes') {
        var show = document.getElementById("culture_div1");
        show.style.display = "block";
    } else {
        var show = document.getElementById("culture_div1");
        show.style.display = "none"
    }

}

var count1 = 0;

function createNewElement1() {
    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="date1_' +
        count1 +
        '" name="date1[]" ><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="Source1[]" id="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="result[]" id="result1' + count1 +
        '" name="result1[]" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option></select><div class="invalid-feedback">Please Select Result.</div></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("newElementId1").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
        });
    });
}

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

}

function CentralLine() {
    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"
    }

}

function Culture2() {
    var x = document.getElementById("culture_report3").value;
    if (x == 'yes') {
        var show = document.getElementById("culture_div2");
        show.style.display = "block";
    } else {
        var show = document.getElementById("culture_div2");
        show.style.display = "none"
    }

}

var count2 = 0;

function createNewElement2() {
    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="date1_' +
        count2 +
        '" name="date1[]" ><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="Source12[]" id="Source12' +
        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="result[]" id="result1' + count2 +
        '" name="result1[]" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option></select><div class="invalid-feedback">Please Select Result.</div></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("newElementId2").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
        });
    });
}

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

}


function HospitalAcquired() {
    var x = document.getElementById("hospital_acquired_pneumonia").value;
    if (x == 'yes') {
        var show = document.getElementById("demo4");
        show.style.display = "block";
    } else {
        var show = document.getElementById("demo4");
        show.style.display = "none"
    }

}

function Culture3() {
    var x = document.getElementById("culture_report4").value;
    if (x == 'yes') {
        var show = document.getElementById("culture_div3");
        show.style.display = "block";
    } else {
        var show = document.getElementById("culture_div3");
        show.style.display = "none"
    }

}

var count3 = 0;

function createNewElement3() {
    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="date3_' +
        count3 +
        '" name="date3[]" ><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="Source123[]" id="Source123' +
        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="result[]" id="result13' + count3 +
        '" name="result13[]" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option></select><div class="invalid-feedback">Please Select Result.</div></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("newElementId3").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
        });
    });
}

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

}


function VentilatorAssociated() {
    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"
    }

}

function Culture4() {
    var x = document.getElementById("culture_report5").value;
    if (x == 'yes') {
        var show = document.getElementById("culture_div4");
        show.style.display = "block";
    } else {
        var show = document.getElementById("culture_div4");
        show.style.display = "none"
    }

}

var count4 = 0;

function createNewElement4() {
    count4++;
    var txtNewInputBox4 = document.createElement('div');

    txtNewInputBox4.innerHTML = '<div class="" id="remove3' + 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="date4_' +
        count4 +
        '" name="date4[]" ><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="Source1234[]" id="Source1234' +
        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="result[]" id="result134' + count4 +
        '" name="result134[]" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option></select><div class="invalid-feedback">Please Select Result.</div></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("newElementId4").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
        });
    });
}

function delrows4(count) {
    if (confirm("Are you sure you want to Delete?")) {
        var el = count4;
        $('#remove4' + el).remove();
    }

}


function SurgicalSiteInfection() {
    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"
    }

}

function Culture5() {
    var x = document.getElementById("culture_report6").value;
    if (x == 'yes') {
        var show = document.getElementById("culture_div5");
        show.style.display = "block";
    } else {
        var show = document.getElementById("culture_div5");
        show.style.display = "none"
    }

}

var count5 = 0;

function createNewElement5() {
    count5++;
    var txtNewInputBox5 = document.createElement('div');

    txtNewInputBox5.innerHTML = '<div class="" id="remove3' + 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="date5_' +
        count5 +
        '" name="date5[]" ><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="Source12345[]" id="Source12345' +
        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="result[]" id="result1345' + count5 +
        '" name="result1345[]" required=""><option value="">Select result</option><option value="Positive">Positive</option><option value="Negative">Negative</option></select><div class="invalid-feedback">Please Select Result.</div></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("newElementId5").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
        });
    });
}

function delrows5(count) {
    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
    // });
});
</script>