streamline-emr/docker/streamline-src/Modules/Patients/Resources/views/triage/observations.blade.php

@if ($age_group == 1)

@push('scripts')
<script src="{{ asset('js/observations/0_28_days.js') }}"></script>
@endpush
<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" id="temp" value="Temperature" />
        <h5 class="text-center">Temperature</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="tempValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">36.7 - 37.2</p>
    </td>
    <td style="width: 20%;">
        <p id="tempKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Pulse (Awake)" />
        <h5 class="text-center">Pulse (Awake)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="pulseValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">110 - 160</p>
    </td>
    <td style="width: 20%;">
        <p id="pulseKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Respirations"/>
        <h5 class="text-center">Respirations</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="respValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">30 - 60</p>
    </td>
    <td style="width: 20%;">
        <p id="respKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="SaO2(%)"/>
        <h5 class="text-center">SaO2(%)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="saValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center"> > 94</p>
    </td>
    <td style="width: 20%;">
        <p id="saKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Conscious level"/>
        <h5 class="text-center">Conscious level</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="conValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="alert, feeding">Alert, Feeding</option>
            <option value="irritable">Irritable</option>
            <option value="floppy, difficult to rouse">Floppy, Difficult to Rouse</option>
            <option value="convulsing">Convulsing</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">Alert , Feeding</p>
    </td>
    <td style="width: 20%;">
        <p id="conKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="MUAC"/>
        <h5 class="text-center">MUAC</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="muacValue" value="" required class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">>12.5cm</p>
    </td>
    <td style="width: 20%;">
        <p id="muacKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Supplementary Oxygen?"/>
        <h5 class="text-center">Supplementary Oxygen?</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="suOxValue" required class="col-sm-12 compulsory form-control">
            <option value="">--select--</option>
            <option value="Yes">Yes</option>
            <option value="No">No</option>
        </select>
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Blood Pressure (bp)"/>
        <h5 class="text-center">Blood Pressure (bp)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="text" name="observationsValues[]" id="bpValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Blood glucose"/>
        <h5 class="text-center">Blood glucose</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="text" name="observationsValues[]" id="glucoseValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Weight"/>
        <h5 class="text-center">Weight</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="weightValue" required class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>


@elseif ($age_group == 2)

@push('scripts')
<script src="{{ asset('js/observations/1_12_months.js') }}"></script>
@endpush

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" id="temp" value="Temperature"/>
        <h5 class="text-center">Temperature</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="tempValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"/>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">36.5 - 37.4</p>
    </td>
    <td style="width: 20%;">
        <p id="tempKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Pulse"/>
        <h5 class="text-center">Pulse</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="pulseValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">121 - 160</p>
    </td>
    <td style="width: 20%;">
        <p id="pulseKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Respirations"/>
        <h5 class="text-center">Respirations</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="respValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">31 - 55</p>
    </td>
    <td style="width: 20%;">
        <p id="respKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="SaO2(%)"/>
        <h5 class="text-center">SaO2(%)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="saValue" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">> 94</p>
    </td>
    <td style="width: 20%;">
        <p id="saKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Respiratory Distress"/>
        <h5 class="text-center">Respiratory Distress</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="respdisValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="none">None</option>
            <option value="mild">Mild</option>
            <option value="severe">Severe</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">None</p>
    </td>
    <td style="width: 20%;">
        <p id="respdisKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Conscious level"/>
        <h5 class="text-center">Conscious level</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="conValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="alert">Alert</option>
            <option value="responds to voice">Responds to voice</option>
            <option value="responds to pain">Responds to pain</option>
            <option value="unresponsive">Unresponsive</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">Alert</p>
    </td>
    <td style="width: 20%;">
        <p id="conKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Feeding"/>
        <h5 class="text-center">Feeding</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="feedValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="normal">Normal</option>
            <option value="drinks poorly">Drinks poorly</option>
            <option value="unable to drink">Unable to drink</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">Normal</p>
    </td>
    <td style="width: 20%;">
        <p id="feedKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Vomiting"/>
        <h5 class="text-center">Vomiting</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="vomValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="none">None</option>
            <option value="occasional">Occasional</option>
            <option value="vomits everything">Vomits Everything</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">None</p>
    </td>
    <td style="width: 20%;">
        <p id="vomKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Convulsions"/>
        <h5 class="text-center">Convulsions</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="convValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="none">None</option>
            <option value="occasional reported">Occasional Reported</option>
            <option value="frequent reported">Frequent Reported</option>
            <option value="convulsing">Convulsing</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">None</p>
    </td>
    <td style="width: 20%;">
        <p id="convKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="MUAC"/>
        <h5 class="text-center">MUAC</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="muacValue" value="" required class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">>12.5cm</p>
    </td>
    <td style="width: 20%;">
        <p id="muacKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Supplementary Oxygen?"/>
        <h5 class="text-center">Supplementary Oxygen?</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="suOxValue" required class="col-sm-12 compulsory form-control">
            <option value="">--select--</option>
            <option value="Yes">Yes</option>
            <option value="No">No</option>
        </select>
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Blood Pressure (bp)"/>
        <h5 class="text-center">Blood Pressure (bp)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="text" name="observationsValues[]" id="bpValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Blood glucose"/>
        <h5 class="text-center">Blood glucose</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="text" name="observationsValues[]" id="glucoseValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Weight"/>
        <h5 class="text-center">Weight</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="weightValue" required class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>


@elseif ($age_group == 3)

@push('scripts')
<script src="{{ asset('js/observations/1_5_years.js') }}"></script>
@endpush

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" id="temp" value="Temperature"/>
        <h5 class="text-center">Temperature</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="tempValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">36.5 - 37.4</p>
    </td>
    <td style="width: 20%;">
        <p id="tempKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Pulse"/>
        <h5 class="text-center">Pulse</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="pulseValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">76 - 130</p>
    </td>
    <td style="width: 20%;">
        <p id="pulseKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Respirations"/>
        <h5 class="text-center">Respirations</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="respValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">21 - 40</p>
    </td>
    <td style="width: 20%;">
        <p id="respKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="SaO2(%)"/>
        <h5 class="text-center">SaO2(%)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="saValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center"> >94</p>
    </td>
    <td style="width: 20%;">
        <p id="saKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Respiratory Distress"/>
        <h5 class="text-center">Respiratory Distress</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="respdisValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="none">None</option>
            <option value="mild">Mild</option>
            <option value="severe">Severe</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">None</p>
    </td>
    <td style="width: 20%;">
        <p id="respdisKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Conscious level"/>
        <h5 class="text-center">Conscious level</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="conValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="alert">Alert</option>
            <option value="responds to voice">Responds to voice</option>
            <option value="responds to pain">Responds to pain</option>
            <option value="unresponsive">Unresponsive</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">Alert</p>
    </td>
    <td style="width: 20%;">
        <p id="conKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Feeding"/>
        <h5 class="text-center">Feeding</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="feedValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="normal">Normal</option>
            <option value="drinks poorly">Drinks poorly</option>
            <option value="unable to drink">Unable to drink</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">Normal</p>
    </td>
    <td style="width: 20%;">
        <p id="feedKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Vomiting"/>
        <h5 class="text-center">Vomiting</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="vomValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="none">None</option>
            <option value="occasional">Occasional</option>
            <option value="vomits everything">Vomits Everything</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">None</p>
    </td>
    <td style="width: 20%;">
        <p id="vomKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Convulsions"/>
        <h5 class="text-center">Convulsions</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="convValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="none">None</option>
            <option value="occasional reported">Occasional Reported</option>
            <option value="frequent reported">Frequent Reported</option>
            <option value="convulsing">Convulsing</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">None</p>
    </td>
    <td style="width: 20%;">
        <p id="convKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="MUAC"/>
        <h5 class="text-center">MUAC</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="muacValue" value="" required class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">>12.5cm</p>
    </td>
    <td style="width: 20%;">
        <p id="muacKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Supplementary Oxygen?"/>
        <h5 class="text-center">Supplementary Oxygen?</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="suOxValue" required class="col-sm-12 compulsory form-control">
            <option value="">--select--</option>
            <option value="Yes">Yes</option>
            <option value="No">No</option>
        </select>
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Blood Pressure (bp)"/>
        <h5 class="text-center">Blood Pressure (bp)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="text" name="observationsValues[]" id="bpValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Blood glucose"/>
        <h5 class="text-center">Blood glucose</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="text" name="observationsValues[]" id="glucoseValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Weight"/>
        <h5 class="text-center">Weight</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="weightValue" required class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

@elseif ($age_group == 4)

@push('scripts')
<script src="{{ asset('js/observations/6_12_years.js') }}"></script>
@endpush

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" id="temp" value="Temperature"/>
        <h5 class="text-center">Temperature</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="tempValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">36.5 - 37.4</p>
    </td>
    <td style="width: 20%;">
        <p id="tempKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Pulse"/>
        <h5 class="text-center">Pulse</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="pulseValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">76 - 100</p>
    </td>
    <td style="width: 20%;">
        <p id="pulseKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Respirations"/>
        <h5 class="text-center">Respirations</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="respValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">18 - 30</p>
    </td>
    <td style="width: 20%;">
        <p id="respKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="SaO2(%)"/>
        <h5 class="text-center">SaO2(%)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="saValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">>94</p>
    </td>
    <td style="width: 20%;">
        <p id="saKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Respiratory Distress"/>
        <h5 class="text-center">Respiratory Distress</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="respdisValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="none">None</option>
            <option value="mild">Mild</option>
            <option value="severe">Severe</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">None</p>
    </td>
    <td style="width: 20%;">
        <p id="respdisKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Conscious level"/>
        <h5 class="text-center">Conscious level</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="conValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="alert">Alert</option>
            <option value="responds to voice/irritable">Responds to voice / Irritable</option>
            <option value="responds to pain">Responds to pain</option>
            <option value="unresponsive">Unresponsive</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">Alert</p>
    </td>
    <td style="width: 20%;">
        <p id="conKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Feeding"/>
        <h5 class="text-center">Feeding</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="feedValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="normal">Normal</option>
            <option value="drinks poorly">Drinks poorly</option>
            <option value="unable to drink">Unable to drink</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">Normal</p>
    </td>
    <td style="width: 20%;">
        <p id="feedKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Vomiting"/>
        <h5 class="text-center">Vomiting</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="vomValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="none">None</option>
            <option value="occasional">Occasional</option>
            <option value="vomits everything">Vomits Everything</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">None</p>
    </td>
    <td style="width: 20%;">
        <p id="vomKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Convulsions"/>
        <h5 class="text-center">Convulsions</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="convValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="none">None</option>
            <option value="occasional reported">Occasional Reported</option>
            <option value="frequent reported">Frequent Reported</option>
            <option value="convulsing">Convulsing</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">None</p>
    </td>
    <td style="width: 20%;">
        <p id="convKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="MUAC"/>
        <h5 class="text-center">MUAC</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="muacValue" value="" required class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">>12.5cm</p>
    </td>
    <td style="width: 20%;">
        <p id="muacKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Supplementary Oxygen?"/>
        <h5 class="text-center">Supplementary Oxygen?</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="suOxValue" required class="col-sm-12 compulsory form-control">
            <option value="">--select--</option>
            <option value="Yes">Yes</option>
            <option value="No">No</option>
        </select>
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Blood Pressure (bp)"/>
        <h5 class="text-center">Blood Pressure (bp)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="text" name="observationsValues[]" id="bpValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Blood glucose"/>
        <h5 class="text-center">Blood glucose</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="text" name="observationsValues[]" id="glucoseValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Height(m)"/>
        <h5 class="text-center">Height(m)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" step="0.1" name="observationsValues[]" id="heightValue" class="col-sm-12 compulsory form-control" required
        style="width: 100%" />
    </td>
    <td colspan="2" style="width: 40%;">
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Weight"/>
        <h5 class="text-center">Weight</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="weightValue" required class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td colspan="2" style="width: 40%">
        <input type="hidden" readonly="readonly" name="observationsNames[]" value="BMI" class="col-sm-12" style="width: 100%" /> BMI &nbsp;
        <input type="number" readonly="readonly" name="observationsValues[]" id="bmi" class="col-sm-4 form-control"
        />
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Alcohol use"/>
        <h5 class="text-center">Alcohol use</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="alcoholValue" class="col-sm-12 form-control" required>
            <option value="">--select--</option>
            <option value="High">High</option>
            <option value="Moderate">Moderate</option>
            <option value="Low">Low</option>
            <option value="Nil">Nil</option>
        </select>
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Tobacco use"/>
        <h5 class="text-center">Tobacco use</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="tobaccoValue" class="col-sm-12 form-control" required>
            <option value="">--select--</option>
            <option value="High">High</option>
            <option value="Moderate">Moderate</option>
            <option value="Low">Low</option>
            <option value="Nil">Nil</option>
        </select>
    </td>
    <td colspan="2" style="width: 40%;"></td>
</tr>


@elseif ($age_group == 5)

@push('scripts')
<script src="{{ asset('js/observations/over_12_years.js') }}"></script>
<script src="{{ asset('js/observations/over_12_years_news.js') }}"></script>
@endpush

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" id="temp" value="Temperature"/>
        <h5 class="text-center">Temperature</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="tempValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">36.0 - 37.7</p>
    </td>
    <td style="width: 10%;">
        <p id="tempKews" class="text-center"></p>
    </td>
    <td style="width: 10%;">
        <p id="tempNewsText" class="text-center"></p>
        <input type="hidden" id="tempNews" name="tempNews" value="" class="col-sm-12" />
        <input type="hidden" name="adult" id="adult" value="adult" class="col-sm-12" />
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Pulse"/>
        <h5 class="text-center">Pulse</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="pulseValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">51 - 100</p>
    </td>
    <td style="width: 10%;">
        <p id="pulseKews" class="text-center"></p>
    </td>
    <td style="width: 10%;">
        <input type="hidden" name="pulseNews" id="pulseNews" value=""/>
        <p id="pulseNewsText" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Respirations"/>
        <h5 class="text-center">Respirations</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="respValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">9 - 18</p>
    </td>
    <td style="width: 10%;">
        <p id="respKews" class="text-center"></p>
    </td>
    <td style="width: 10%;">
        <input type="hidden" name="respNews" id="respNews" value=""/>
        <p id="respNewsText" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="SaO2(%)"/>
        <h5 class="text-center">SaO2(%)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="saValue" value="" class="col-sm-12 form-control" style="width: 100%" />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">>94</p>
    </td>
    <td style="width: 10%;">
        <p id="saKews" class="text-center"></p>
    </td>
    <td style="width: 10%;">
        <input type="hidden" name="saNews" id="saNews"/>
        <p id="saNewsText" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Systolic bp"/>
        <h5 class="text-center">Systolic bp</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="sysValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">101 - 159</p>
    </td>
    <td style="width: 10%;">
        <p id="sysKews" class="text-center"></p>
    </td>
    <td style="width: 10%;">
        <input type="hidden" name="sysNews" id="sysNews" value=""/>
        <p id="sysNewsText" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Diastolic bp"/>
        <h5 class="text-center">Diastolic bp</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" required name="observationsValues[]" id="diaValue" value="" class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">< 95</p>
    </td>
    <td style="width: 10%;">
        <p id="diaKews" class="text-center"></p>
    </td>
    <td style="width: 10%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Conscious level"/>
        <h5 class="text-center">Conscious level</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="conValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="alert">Alert</option>
            <option value="responds to voice/irritated">Responds to voice / Irritated</option>
            <option value="responds to pain">Responds to pain</option>
            <option value="unresponsive">Unresponsive</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">Alert</p>
    </td>
    <td style="width: 10%;">
        <p id="conKews" class="text-center"></p>
    </td>
    <td style="width: 10%;">
        <input type="hidden" name="conNews" id="conNews" value=""/>
        <p id="conNewsText" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Urine Output"/>
        <h5 class="text-center">Urine Output</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="urValue" required class="col-sm-12 compulsory form-control">
            <option value="">--Select--</option>
            <option value="normal">Normal</option>
            <option value="reduced">Reduced</option>
            <option value="none for 24 hours">None for 24 Hours</option>
        </select>
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center">Normal</p>
    </td>
    <td style="width: 10%;">
        <p id="urKews" class="text-center"></p>
    </td>
    <td style="width: 10%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="MUAC"/>
        <h5 class="text-center">MUAC</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="muacValue" value="" required class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td style="width: 20%;">
        <p style="color: #0000FF" class="text-center"> >12.5cm</p>
    </td>
    <td style="width: 10%;" colspan="2">
        <p id="muacKews" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Supplementary Oxygen?"/>
        <h5 class="text-center">Supplementary Oxygen?</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="suOxValue" required class="col-sm-12 compulsory form-control">
            <option value="">--select--</option>
            <option value="Yes">Yes</option>
            <option value="No">No</option>
        </select>
    </td>
    <td style="width: 20%;"></td>
    <td style="width: 10%;"></td>
    <td style="width: 10%;">
        <input type="hidden" name="suOxNews" id="suOxNews" value=""/>
        <p id="suOxNewsText" class="text-center"></p>
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Height(m)"/>
        <h5 class="text-center">Height(m)</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" step="0.1" name="observationsValues[]" id="heightValue" class="col-sm-12 compulsory form-control" required
        style="width: 100%" />
    </td>
    <td colspan="3" style="width: 40%;">
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Weight"/>
        <h5 class="text-center">Weight</h5>
    </td>
    <td style="width: 20%;" class="center">
        <input type="number" name="observationsValues[]" id="weightValue" required class="col-sm-12 compulsory form-control" style="width: 100%"
        />
    </td>
    <td colspan="3" style="width: 40%">
        <input type="hidden" readonly="readonly" name="observationsNames[]" value="BMI" class="col-sm-12" style="width: 100%" /> BMI &nbsp;
        <input type="number" readonly="readonly" name="observationsValues[]" id="bmi" class="col-sm-4 form-control"
        />
    </td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Alcohol use"/>
        <h5 class="text-center">Alcohol use</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="alcoholValue" class="col-sm-12 form-control" required>
            <option value="">--select--</option>
            <option value="High">High</option>
            <option value="Moderate">Moderate</option>
            <option value="Low">Low</option>
            <option value="Nil">Nil</option>
        </select>
    </td>
    <td colspan="3" style="width: 40%;"></td>
</tr>

<tr>
    <td style="width: 1%;">
        <input type="checkbox" name="chk" id="chk" />
    </td>
    <td style="width: 25%;">
        <input type="hidden" name="observationsNames[]" value="Tobacco use"/>
        <h5 class="text-center">Tobacco use</h5>
    </td>
    <td style="width: 20%;" class="center">
        <select name="observationsValues[]" id="tobaccoValue" class="col-sm-12 form-control" required>
            <option value="">--select--</option>
            <option value="High">High</option>
            <option value="Moderate">Moderate</option>
            <option value="Low">Low</option>
            <option value="Nil">Nil</option>
        </select>
    </td>
    <td colspan="3" style="width: 40%;"></td>
</tr>


@else
<tr>
    <td colspan="5" class="center" style="width: 100%; color: maroon">Please check the patient\'s date of birth</td>
</tr>


@endif