91 lines
2.9 KiB
Cheetah
91 lines
2.9 KiB
Cheetah
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<!DOCTYPE html>
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<html>
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<head>
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<meta charset="UTF-8">
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<meta name="MobileOptimized" content="320" />
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<meta name="HandheldFriendly" content="true" />
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<meta http-equiv="X-UA-Compatible" content="ie-edge">
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<meta name="viewport" content="initial-scale=1.0, maximum-scale=1.0, width=device-width, user-scalable=no" />
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<title>TheRedPhone.xyz: Paramedics</title>
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<link rel="icon" type="image/x-icon" href="images/theredphone.ico" />
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<link rel="stylesheet" type="text/css" href="styles/main.css" />
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<link rel="stylesheet" type="text/css" href="styles/paramedic.css" />
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</head>
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<body>
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<div class="paramedic-form">
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<div class="paramedic-form__title">
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<h1>TheRedPhone.xyz: Paramedics</h1>
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<h2>You Are Ambulance Crew Number: 9836283762</h2>
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</div>
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<form method="POST" action="/paramedicForm">
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<div class="form-block">
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<h3>Categorization</h3>
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<label for="medical-or-trauma">Medical or Trauma?</label>
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<select id="medical-or-truama" name="medical-or-trauma">
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<option value="medical">Medical</option>
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<option value="trauma">Trauma</option>
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</select>
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</div>
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<hr />
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<div class="form-block">
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<h3>Patient Data</h3>
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<label for="age">Age:</label>
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<input type="number" name="age" id="age" />
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<label for="sex">Sex:</label>
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<select id="sex" name="sex">
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<option value="male">Male</option>
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<option value="female">Female</option>
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<option value="nocontroversy">Non-Controversial Third Option</option>
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</select>
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<label for="nhs-number">NHS Number:</label>
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<input type="text" name="nhs-number" id="nhs-number" />
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</div>
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<hr />
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<div class="form-block">
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<h3>Observations</h3>
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<label for="heart-rate">Heart rate:</label>
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<input type="number" name="heart-rate" id="heart-rate" />
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<label for="respiratory-rate">Respiratory rate:</label>
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<input type="number" name="respiratory-rate" id="respiratory-rate" />
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<label for="oxygen-saturation">Oxygen saturation:</label>
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<input type="number" name="oxygen-saturation" id="oxygen-saturation" />
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<label for="gcs">GCS:</label>
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<input type="number" name="gcs" id="gcs" />
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<label for="blood-pressure">Blood pressure:</label>
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<input type="number" name="blood-pressure" id="blood-pressure" />
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</div>
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<hr />
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<div class="form-block">
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<h3>Extra Information</h3>
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<label for="eta">Estimated Time of Arrival:</label>
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<input type="text" name="eta" id="eta" />
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<label for="interventions">Interventions given:</label>
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<textarea name="interventions" id="interventions" cols="50"></textarea>
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<label for="background">Background info:</label>
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<textarea name="background" id="background" cols="50" rows="20"></textarea>
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</div>
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<div class="form-block">
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<input type="submit" value="Send Report" />
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</div>
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</form>
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</div>
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</body>
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</html>
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