@endif
@if (between($years, 16, 50) && !$triage_without_etat)
@include('patients::triage.family_planning_questions')
@endif
@if (between($years, 0, 12) && !$triage_without_etat)
@include('patients::triage.emergency_signs')
@php $age = 1 @endphp
@endif
@if (between($age_diff_months, 0, 5) && is_smart_discharge_enabled() && !$triage_without_etat)
Social Health Indicators
{{ Form::label('child_with_proven_infection', 'Does the child have a proven or suspected infection e.g is the child having fever, cough, diarrhoea?') }}
{{ Form::radio('child_with_proven_infection', 1, false, ['onclick' => 'show_proven_infection_questions()']) }}
Yes    
{{ Form::radio('child_with_proven_infection', 0, false, ['onclick' => 'hide_proven_infection_questions()']) }}
No
{{ Form::label('hospital_travel_duration', 'How long did it take you to travel to the hospital?') }}
{{ Form::select('hospital_travel_duration', ['' => '-- select --', '1' => '< 30 mins', '2' => '30 mins – 1 hour', '3' => '1 - 4 hours', '4' => '> 4 hours'], null, ['class' => 'form-control']) }}
{{ Form::label('illness_duration', 'What is the duration of the present illness at the time of admission?') }}
{{ Form::select('illness_duration', ['' => '-- select --', '1' => '< 48 hours', '2' => '48 hours - 7 days', '3' => '7 days - 1 month', '4' => 'More than a month'], null, ['class' => 'form-control']) }}
{{ Form::label('tone_normal_6mo', 'Muscle Tone') }}
{{ Form::select('tone_normal_6mo', ['' => '-- select --', '1' => 'Increased (Stiff)', '2' => 'Normal', '3' => 'Decreased (floppy)', '4' => 'Do not know'], null, ['class' => 'form-control']) }}
@endif
@if (between($age_diff_months, 6, 60) && is_smart_discharge_enabled() && !$triage_without_etat)
Social Health Indicators
{{ Form::label('child_with_proven_infection', 'Does the child have a proven or suspected infection e.g is the child having fever, cough, diarrhoea?') }}
{{ Form::radio('child_with_proven_infection', 1, false, ['onclick' => 'show_proven_infection_questions()']) }}
Yes
{{ Form::radio('child_with_proven_infection', 0, false, ['onclick' => 'hide_proven_infection_questions()']) }}
No
{{ Form::label('last_hospitalization', 'Time since last hospitalization') }}
{{ Form::select('last_hospitalization', ['' => '-- select --', '1' => 'Less than 7 days ago', '2' => '7 to 30 days ago', '3' => '30 days to 1 year ago', '4' => 'More than 1 year ago', '5' => 'Never'], null, ['class' => 'form-control']) }}
{{ Form::label('water_source', 'Primary water source for drinking water') }}
-- select --
Protected spring
Bore hole
Municipal water
Open source (unprotected, stagnant water, dam)
Slow running water
Fast running water
{{ Form::label('safe_water', 'Do you boil, filter (good sand/ceramic) or disinfect (using bleach/waterguard) all drinking water?') }}
{{ Form::radio('safe_water', 1, false) }} Yes
{{ Form::radio('safe_water', 0, false) }} No
{{ Form::label('child_mosquito_net', 'Does your child sleep under a mosquito net?') }}
{{ Form::select('child_mosquito_net', ['' => '-- select --', '1' => 'Never', '2' => 'Sometimes', '3' => 'Always'], null, ['class' => 'form-control']) }}
{{ Form::label('mother_education_level', 'What is the education level of the child’s mother?') }}
{{ Form::select('mother_education_level', ['' => '-- select --', '1' => 'No school', '2' => '<= P3', '3' => 'P4-P7', '4' => 'S1-S6', '5' => 'Post secondary (including post S4 technical school)', '6' => 'Do not know'], null, ['class' => 'form-control']) }}
{{ Form::label('hospital_travel_duration', 'How long did it take you to travel to the hospital?') }}
{{ Form::select('hospital_travel_duration', ['' => '-- select --', '1' => '< 30 mins', '2' => '30 mins – 1 hour', '3' => '1 - 4 hours', '4' => '> 4 hours'], null, ['class' => 'form-control']) }}
{{ Form::label('maternal_hiv', 'Maternal HIV') }}
-- select --
HIV Positive
HIV Negative
HIV Unknown
{{ Form::label('child_hiv', 'Child HIV') }}
{{ Form::select('child_hiv', ['' => '-- select --', '1' => 'HIV Positive', '0' => 'HIV Negative / Unknown'], null, ['class' => 'form-control']) }}
{{ Form::label('bcs_eye_movement', 'Eye movement') }}
{{ Form::select('bcs_eye_movement', ['' => '-- select --', '1' => 'Watches or follows', '0' => 'Fails to watch or follow'], null, ['class' => 'form-control']) }}
{{ Form::label('bcs_best_mortal', 'Best motor response') }}
{{ Form::select('bcs_best_mortal', ['' => '-- select --', '0' => 'No response or inappropriate response', '1' => 'Withdraws limb from pain stimulus', '2' => 'Localizes painful stimulus'], null, ['class' => 'form-control']) }}
{{ Form::label('bcs_best_verbal', 'Best verbal response') }}
{{ Form::select('bcs_best_verbal', ['' => '-- select --', '0' => 'No vocal response to pain', '1' => 'Moan or abnormal cry with pain', '2' => 'Cries appropriately with pain (or speaks if verbal)'], null, ['class' => 'form-control']) }}
{{ Form::label('maternal_age', 'Mother\'s age') }}
{{ Form::number('maternal_age', 0, ['class' => 'form-control']) }}