| Les deux révisions précédentesRévision précédente | Prochaine révisionLes deux révisions suivantes |
| go_far_calculator [2017/02/28 18:27] – ariane | go_far_calculator [2017/02/28 18:32] – ariane |
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| <OPTION>-- Select age group ---</OPTION> | <OPTION>-- Select age group ---</OPTION> |
| <option value="choix1"> less than 70 </option> | <option value="choix1"> less than 70 </option> |
| <option value="choix2"> from 70 to 74 </option> | <option value="choix2"> from 70 to 74 </option> |
| <option value="choix3"> from 75 to 79 </option> | <option value="choix3"> from 75 to 79 </option> |
| <option value="choix4"> from 80 to 84 </option> | <option value="choix4"> from 80 to 84 </option> |
| <label><input type="checkbox" name="options[]" value="4" onClick="checkCalcul(this)" /> Metastatic or hematologic cancer </label><br> | <label><input type="checkbox" name="options[]" value="4" onClick="checkCalcul(this)" /> Metastatic or hematologic cancer </label><br> |
| <label><input type="checkbox" name="options[]" value="5" onClick="checkCalcul(this)" /> Septicemia </label><br> | <label><input type="checkbox" name="options[]" value="5" onClick="checkCalcul(this)" /> Septicemia </label><br> |
| <label><input type="checkbox" name="options[]" value="6" onClick="checkCalcul(this)" />Medical noncardiac diagnosis </label><br> | <label><input type="checkbox" name="options[]" value="6" onClick="checkCalcul(this)" /> Medical noncardiac diagnosis </label><br> |
| <label><input type="checkbox" name="options[]" value="7" onClick="checkCalcul(this)" /> Hepatic insufficiency</label><br> | <label><input type="checkbox" name="options[]" value="7" onClick="checkCalcul(this)" /> Hepatic insufficiency</label><br> |
| <label><input type="checkbox" name="options[]" value="8" onClick="checkCalcul(this)" />Admission from a skilled nursing facility </label><br> | <label><input type="checkbox" name="options[]" value="8" onClick="checkCalcul(this)" /> Admission from a skilled nursing facility </label><br> |
| <label><input type="checkbox" name="options[]" value="9" onClick="checkCalcul(this)" />Hypotension or hypoperfusion</label><br> | <label><input type="checkbox" name="options[]" value="9" onClick="checkCalcul(this)" /> Hypotension or hypoperfusion</label><br> |
| <label><input type="checkbox" name="options[]" value="10" onClick="checkCalcul(this)" />Renal insufficiency or dialysis </label><br> | <label><input type="checkbox" name="options[]" value="10" onClick="checkCalcul(this)" /> Renal insufficiency or dialysis </label><br> |
| <label><input type="checkbox" name="options[]" value="11" onClick="checkCalcul(this)" />Respiratory insufficiency </label><br> | <label><input type="checkbox" name="options[]" value="11" onClick="checkCalcul(this)" /> Respiratory insufficiency </label><br> |
| <label><input type="checkbox" name="options[]" value="12" onClick="checkCalcul(this)" /> Pneumonia</label><br> | <label><input type="checkbox" name="options[]" value="12" onClick="checkCalcul(this)" /> Pneumonia</label><br> |
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