Parents\u2019 marital status (at childhood):<\/p>\n \n <\/option>\n Married\/Common-law partners<\/option>\n Divorced\/separated<\/option>\n Remarried<\/option>\n Single parent<\/option>\n Deceased<\/option>\n Other<\/option>\n <\/select>\n <\/textarea>\n <\/div>\n <div style=\"display: flex;align-items: center;gap:1rem;flex-wrap: wrap;position: relative;width: 100%;\">\n <p>Patient\u2019s marital status:<\/p>\n <select id=\"patient_civil_status\" name=\"patient_civil_status\" aria-controls=\"patient_civil_status_details\" required>\n <option value=\"null\"><\/option>\n <option value=\"N\/A\">Not Applicable<\/option>\n <option value=\"Mari\u00e9s \/ Conjoints de fait\">Married\/Common-law partners<\/option>\n <option value=\"Divorc\u00e9s \/ s\u00e9par\u00e9s\">Divorced\/separated<\/option>\n <option value=\"Remari\u00e9s\">Remarried<\/option>\n <option value=\"Monoparentale\">Single parent<\/option>\n <option value=\"Autre\">Other<\/option>\n <\/select>\n <textarea id=\"patient_civil_status_details\" name=\"patient_civil_status_details\" placeholder=\"Specify\"><\/textarea>\n <\/div> \n <div style=\"display: flex;align-items: center;gap:1rem;flex-wrap: wrap;position: relative;width: 100%;\">\n <p>The patient lives with:<\/p>\n <select id=\"patient_lives_with\" name=\"patient_lives_with\" aria-controls=\"patient_lives_with_details\" required>\n <option value=\"null\"><\/option>\n <option value=\"Chez lui\">His home<\/option>\n <option value=\"Ses deux parents\">Both his parents<\/option>\n <option value=\"En garde partag\u00e9e\">Shared custody<\/option>\n <option value=\"La m\u00e8re\">The mother<\/option>\n <option value=\"Le p\u00e8re\">The father<\/option>\n <option value=\"Famille reconstitu\u00e9e\">Blended family<\/option>\n <option value=\"Conjoint \/ Conjointe\">Spouse<\/option>\n <option value=\"Autre\">Other<\/option>\n <\/select>\n <textarea id=\"patient_lives_with_details\" name=\"patient_lives_with_details\" placeholder=\"Specify\"><\/textarea>\n <\/div> \n <div style=\"display: flex;align-items: center;gap:1rem;flex-wrap: wrap;position: relative;width: 100%;\">\n <p>Is the patient adopted?<\/p> \n <label>\n <input type=\"radio\" value=\"Oui\" name=\"patient_is_adopted\" required>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" value=\"Non\" name=\"patient_is_adopted\" required>\n No\n <\/label>\n <\/div>\n <div style=\"display: flex;align-items: center;gap:1rem;flex-wrap: wrap;position: relative;width: 100%;\">\n <p>Is the patient in or has he ever been in foster care?<\/p> \n <label>\n <input type=\"radio\" value=\"Oui\" name=\"patient_was_in_foster_family\" required>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" value=\"Non\" name=\"patient_was_in_foster_family\" required>\n No\n <\/label>\n <\/div>\n <div style=\"display: flex;gap:1rem;flex-direction:column; position: relative;width: 100%;\">\n <div style=\"display: flex;gap:1rem;flex-direction:row; position: relative;width: 100%;\">\n <p>Does the patient have brothers or sisters?<\/p> \n <label>\n <input type=\"radio\" value=\"Oui\" aria-controls=\"sibling_tool\" name=\"patient_has_siblings\" required>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" value=\"Non\" aria-controls=\"sibling_tool\" name=\"patient_has_siblings\" required>\n No\n <\/label>\n <\/div>\n <div id=\"sibling_tool\">\n <p>For each brother \/ sister, indicate:<\/p>\n <div id=\"sibling_container\">\n <\/div>\n <button id=\"add_sibling_button\" class=\"add_button\">Add a sibling<\/button>\n <\/div> \n <\/div>\n <div>\n <div style=\"display:flex;gap:1rem;align-items: center;\">\n <label>Language spoken at home?<\/label>\n <select name=\"home_spoken_language\" aria-controls=\"other_home_spoken_language\" required>\n <option value=\"null\"><\/option>\n <option value=\"Fran\u00e7ais\">French<\/option>\n <option vaue=\"Anglais\">English<\/option>\n <option value=\"Espagnol\">Spanish<\/option>\n <option value=\"Autre\">Other<\/option>\n <\/select>\n <\/div> \n <input id=\"other_home_spoken_language\" name=\"other_home_spoken_language\" placeholder=\"Specify\"\/>\n <\/div>\n <\/div>\n <\/section>\n\n <section class=\"section\">\n <h2 class=\"section-title\">Pregnancy and birth history<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;\">\n <div style=\"display:flex; gap:1rem;\">\n <span>Were there any problems during pregnancy or childbirth?<\/span>\n <label>\n <input name=\"had_pregnancy_issues\" type=\"radio\" aria-controls=\"had_pregnancy_issues_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"had_pregnancy_issues\" type=\"radio\" aria-controls=\"had_pregnancy_issues_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"had_pregnancy_issues_details\" name=\"had_pregnancy_issues_details\" placeholder=\"Specify\"><\/textarea>\n <div style=\"display:flex; gap:1rem;align-items: center;\">\n <span>The patient was born by:<\/span>\n <label>\n <input name=\"born_by\" type=\"radio\" value=\"C\u00e9sarienne\" required\/>\n Caesarean section\n <\/label>\n <label>\n <input name=\"born_by\" type=\"radio\" value=\"Voie naturelle\" required\/>\n Natural way\n <\/label>\n <\/div>\n <div style=\"display:flex; gap:1rem;align-items: center;\">\n <p>Was the patient born at term?<\/p>\n <label>\n <input name=\"born_at\" type=\"radio\" aria-controls=\"born_at_details\" value=\"Terme\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"born_at\" type=\"radio\" aria-controls=\"born_at_details\" value=\"\" required\/>\n No\n <\/label>\n <input id=\"born_at_details\" type=\"text\" name=\"born_at_details\" class=\"ch30_input\" placeholder=\"How many weeks was he born?\" required><\/input>\n <\/div>\n <div style=\"display:flex; gap:1rem;\"> \n <span>At birth, was the patient’s weight less than 6lbs?<\/span>\n <label>\n <input name=\"born_lightweight\" type=\"radio\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"born_lightweight\" type=\"radio\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <div style=\"display:flex; gap:1rem;align-items: center;\">\n <p>Can you provide the patient’s APGAR score? (Leave blank if unknown)<\/p>\n <input name=\"apgar_score\"\/>\n <\/div>\n <div style=\"display:flex; gap:1rem;align-items: center;\"> \n <span>Did the patient have any problems following delivery?<\/span>\n <label>\n <input name=\"post_born_issues\" type=\"radio\" aria-controls=\"post_born_issues_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"post_born_issues\" type=\"radio\" aria-controls=\"post_born_issues_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div> \n <textarea id=\"post_born_issues_details\" name=\"post_born_issues_details\" placeholder=\"Specify\"><\/textarea> \n <\/div>\n <div class=\"sub_section\">\n <p>Did the patient’s mother use or take any medications during pregnancy? (Check what applies)<\/p>\n <div style=\"display:grid;grid-template-columns: repeat(4, auto);position: relative;width: 100%;\">\n <label>\n <input name=\"mother_took_meds_while_pregnant\" type=\"checkbox\"\/>\n Medication\n <\/label>\n <label>\n <input name=\"mother_took_alcool_while_pregnant\" type=\"checkbox\"\/>\n Alcohol\n <\/label>\n <label>\n <input name=\"mother_took_cigarets_while_pregnant\" type=\"checkbox\"\/>\n Cigarettes\n <\/label>\n <label>\n <input name=\"mother_took_drugs_while_pregnant\" type=\"checkbox\"\/>\n Drugs\n <\/label>\n <\/div> \n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">General Medical History<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;\">\n <div style=\"display:flex;gap:1rem;\">\n <span>Allergies :<\/span>\n <label>\n <input name=\"has_allergies\" type=\"radio\" aria-controls=\"has_allergies_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_allergies\" type=\"radio\" aria-controls=\"has_allergies_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div> \n <textarea id=\"has_allergies_details\" name=\"has_allergies_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <span>Intolerances:<\/span>\n <label>\n <input name=\"has_intolerances\" type=\"radio\" aria-controls=\"has_intolerances_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_intolerances\" type=\"radio\" aria-controls=\"has_intolerances_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div> \n <textarea id=\"has_intolerances_details\" name=\"has_intolerances_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Diseases:<\/p>\n <label>\n <input name=\"has_illness\" type=\"radio\" aria-controls=\"has_illness_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_illness\" type=\"radio\" aria-controls=\"has_illness_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div> \n <textarea id=\"has_illness_details\" name=\"has_illness_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <span>Surgical :<\/span>\n <label>\n <input name=\"has_surgeries\" type=\"radio\" aria-controls=\"has_surgeries_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_surgeries\" type=\"radio\" aria-controls=\"has_surgeries_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_surgeries_details\" name=\"has_surgeries_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <span>Visual disorders:<\/span>\n <label>\n <input name=\"has_visual_issues\" type=\"radio\" aria-controls=\"has_visual_issues_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_visual_issues\" type=\"radio\" aria-controls=\"has_visual_issues_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_visual_issues_details\" name=\"has_visual_issues_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Hearing problems:<\/p>\n <label>\n <input name=\"has_earing_issues\" type=\"radio\" aria-controls=\"has_earing_issues_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_earing_issues\" type=\"radio\" aria-controls=\"has_earing_issues_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_earing_issues_details\" name=\"has_earing_issues_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;align-items: flex-start;flex-direction: column;\">\n <label>Date of last physical exam: (Leave blank if you don’t know)\n <input id=\"last_physical_exam_date\" name=\"last_physical_exam_date\" aria-controls=\"last_physical_exam_details\" type=\"date\"\/>\n <\/label>\n <textarea id=\"last_physical_exam_details\" name=\"last_physical_exam_details\" placeholder=\"Details to be provided in connection with the last physical examination (optional)\"><\/textarea>\n <\/div> \n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">Neurological History \/ Endocrinology<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;\">\n <div style=\"display:flex;gap:1rem;\">\n <span>Epilepsy or seizures:<\/span>\n <label>\n <input name=\"has_epilepsy\" type=\"radio\" aria-controls=\"has_epilepsy_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_epilepsy\" type=\"radio\" aria-controls=\"has_epilepsy_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_epilepsy_details\" name=\"has_epilepsy_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <span>Head trauma:<\/span>\n <label>\n <input name=\"has_head_trauma\" type=\"radio\" aria-controls=\"has_head_trauma_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_head_trauma\" type=\"radio\" aria-controls=\"has_head_trauma_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div> \n <textarea id=\"has_head_trauma_details\" name=\"has_head_trauma_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <span>Coordination problems:<\/span>\n <label>\n <input name=\"has_coordination_problems\" type=\"radio\" aria-controls=\"has_coordination_problems_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_coordination_problems\" type=\"radio\" aria-controls=\"has_coordination_problems_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_coordination_problems_details\" name=\"has_coordination_problems_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <span>Diabetes \/ thyroid problems:<\/span>\n <label>\n <input name=\"has_diabetes\" type=\"radio\" aria-controls=\"has_diabetes_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_diabetes\" type=\"radio\" aria-controls=\"has_diabetes_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_diabetes_details\" name=\"has_diabetes_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <span>Growth failure or anemia:<\/span>\n <label>\n <input name=\"has_growth_retardation\" type=\"radio\" aria-controls=\"has_growth_retardation_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_growth_retardation\" type=\"radio\" aria-controls=\"has_growth_retardation_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_growth_retardation_details\" name=\"has_growth_retardation_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">History – ENT \/ Pneumology<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;\">\n <div style=\"display:flex;gap:1rem;\">\n <span>Repeated ear infections?<\/span>\n <label>\n <input name=\"has_repeated_otitis\" type=\"radio\" aria-controls=\"has_repeated_otitis_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_repeated_otitis\" type=\"radio\" aria-controls=\"has_repeated_otitis_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_repeated_otitis_details\" name=\"has_repeated_otitis_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Sleep apnea?<\/p>\n <label>\n <input name=\"has_sleep_apnea\" type=\"radio\" aria-controls=\"has_sleep_apnea_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_sleep_apnea\" type=\"radio\" aria-controls=\"has_sleep_apnea_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_sleep_apnea_details\" name=\"has_sleep_apnea_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Asthma ?<\/p>\n <label>\n <input name=\"has_asthma\" type=\"radio\" aria-controls=\"has_asthma_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_asthma\" type=\"radio\" aria-controls=\"has_asthma_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div> \n <textarea id=\"has_asthma_details\" name=\"has_asthma_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <span>Hypertrophy of the Adenoids \/ Tonsils?<\/span>\n <label>\n <input name=\"has_enlarged_adenoids\" type=\"radio\" aria-controls=\"has_enlarged_adenoids_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input name=\"has_enlarged_adenoids\" type=\"radio\" aria-controls=\"has_enlarged_adenoids_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_enlarged_adenoids_details\" name=\"has_enlarged_adenoids_details\" placeholder=\"Specify (Optional)\"><\/textarea> \n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">History – Cardio-Vascular<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;\">\n <div style=\"display:flex;gap:1rem;\">\n <span>Heart murmur?<\/span>\n <label>\n <input type=\"radio\" name=\"has_heart_murmur\" aria-controls=\"has_heart_murmur_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_heart_murmur\" aria-controls=\"has_heart_murmur_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_heart_murmur_details\" name=\"has_heart_murmur_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <span>Palpitations, Arrhythmia or tachycardia?<\/span>\n <label>\n <input type=\"radio\" name=\"has_palpitations\" aria-controls=\"has_palpitations_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_palpitations\" aria-controls=\"has_palpitations_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_palpitations_details\" name=\"has_palpitations_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Pertes de conscience ?<\/p>\n <label>\n <input type=\"radio\" name=\"has_consciousness_loss\" aria-controls=\"has_consciousness_loss_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_consciousness_loss\" aria-controls=\"has_consciousness_loss_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_consciousness_loss_details\" name=\"has_consciousness_loss_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Dyspnea, Shortness of breath and breathing difficulties?<\/p>\n <label>\n <input type=\"radio\" name=\"has_dispnea\" aria-controls=\"has_dispnea_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_dispnea\" aria-controls=\"has_dispnea_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_dispnea_details\" name=\"has_dispnea_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Hypertension ?<\/p>\n <label>\n <input type=\"radio\" name=\"has_hypertension\" aria-controls=\"has_hypertension_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_hypertension\" aria-controls=\"has_hypertension_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_hypertension_details\" name=\"has_hypertension_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Chest pain?<\/p>\n <label>\n <input type=\"radio\" name=\"has_chest_pain\" aria-controls=\"has_chest_pain_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_chest_pain\" aria-controls=\"has_chest_pain_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_chest_pain_details\" name=\"has_chest_pain_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Positive laboratory results or ECG?<\/p>\n <label>\n <input type=\"radio\" name=\"has_positive_ecg\" aria-controls=\"has_positive_ecg_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_positive_ecg\" aria-controls=\"has_positive_ecg_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_positive_ecg_details\" name=\"has_positive_ecg_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">History – Development (early childhood)<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;\">\n <div style=\"display:flex;gap:1rem;\">\n <p>Abnormal language acquisition?<\/p>\n <label>\n <input type=\"radio\" name=\"has_language_issues\" aria-controls=\"has_language_issues_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_language_issues\" aria-controls=\"has_language_issues_details\" value=\"Non\" required\/>\n No\n <\/label> \n <\/div>\n <textarea id=\"has_language_issues_details\" name=\"has_language_issues_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Abnormal acquisition of gross motor skills?<\/p>\n <label>\n <input type=\"radio\" name=\"has_gross_motor_problems\" aria-controls=\"has_gross_motor_problems_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_gross_motor_problems\" aria-controls=\"has_gross_motor_problems_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div> \n <textarea id=\"has_gross_motor_problems_details\" name=\"has_gross_motor_problems_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Abnormal acquisition of fine motor skills?<\/p>\n <label>\n <input type=\"radio\" name=\"has_fine_motor_problems\" aria-controls=\"has_fine_motor_problems_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_fine_motor_problems\" aria-controls=\"has_fine_motor_problems_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_fine_motor_problems_details\" name=\"has_fine_motor_problems_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Enuresis or Encopresis?<\/p>\n <label>\n <input type=\"radio\" name=\"has_enuresis\" aria-controls=\"has_enuresis_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_enuresis\" aria-controls=\"has_enuresis_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_enuresis_details\" name=\"has_enuresis_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Problems with behavior or social interactions?<\/p>\n <label>\n <input type=\"radio\" name=\"has_behavior_problems\" aria-controls=\"has_behavior_problems_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_behavior_problems\" aria-controls=\"has_behavior_problems_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_behavior_problems_details\" name=\"has_behavior_problems_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Symptoms of sensory hypersensitivity?<\/p>\n <label>\n <input type=\"radio\" name=\"has_sensory_hypersensitivity\" aria-controls=\"has_sensory_hypersensitivity_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_sensory_hypersensitivity\" aria-controls=\"has_sensory_hypersensitivity_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_sensory_hypersensitivity_details\" name=\"has_sensory_hypersensitivity_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Ticks or mannerisms?<\/p>\n <label>\n <input type=\"radio\" name=\"has_mannerism\" aria-controls=\"has_mannerism_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_mannerism\" aria-controls=\"has_mannerism_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div> \n <textarea id=\"has_mannerism_details\" name=\"has_mannerism_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">History – Learning Disability<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;\">\n <div style=\"display:flex;gap:1rem;\">\n <p>Dyslexia ?<\/p>\n <label>\n <input type=\"radio\" name=\"has_dyslexia\" aria-controls=\"has_dyslexia_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_dyslexia\" aria-controls=\"has_dyslexia_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_dyslexia_details\" name=\"has_dyslexia_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Dysorthographie ?<\/p>\n <label>\n <input type=\"radio\" name=\"has_dysorthography\" aria-controls=\"has_dysorthography_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_dysorthography\" aria-controls=\"has_dysorthography_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_dysorthography_details\" name=\"has_dysorthography_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Dyscalculia?<\/p>\n <label>\n <input type=\"radio\" name=\"has_dyscalculia\" aria-controls=\"has_dyscalculia_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_dyscalculia\" aria-controls=\"has_dyscalculia_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_dyscalculia_details\" name=\"has_dyscalculia_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Dysphasia?<\/p>\n <label>\n <input type=\"radio\" name=\"has_dysphasia\" aria-controls=\"has_dysphasia_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_dysphasia\" aria-controls=\"has_dysphasia_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_dysphasia_details\" name=\"has_dysphasia_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Dyspraxia (Motor Coordination)?<\/p>\n <label>\n <input type=\"radio\" name=\"has_dyspraxia\" aria-controls=\"has_dyspraxia_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_dyspraxia\" aria-controls=\"has_dyspraxia_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_dyspraxia_details\" name=\"has_dyspraxia_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">Background – Other statement<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;\">\n <div style=\"display:flex;gap:1rem;\">\n <p>High potential \/ Giftedness \/ Mental retardation<\/p>\n <label>\n <input type=\"radio\" name=\"has_giftedness\" aria-controls=\"has_giftedness_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_giftedness\" aria-controls=\"has_giftedness_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div> \n <textarea id=\"has_giftedness_details\" name=\"has_giftedness_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <div style=\"display:flex;gap:1rem;\">\n <p>Is the patient experiencing medical complications caused by drugs or alcohol?<\/p>\n <label>\n <input type=\"radio\" name=\"has_med_complications\" aria-controls=\"has_med_complications_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_med_complications\" aria-controls=\"has_med_complications_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <textarea id=\"has_med_complications_details\" name=\"has_med_complications_details\" placeholder=\"Specify (Optional)\"><\/textarea>\n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">Paramedical monitoring<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;align-items: center;\">\n <p>Has the patient been or is he being followed by a specialist?<\/p>\n <label>\n <input type=\"radio\" name=\"saw_specialist\" aria-controls=\"specialist_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"saw_specialist\" aria-controls=\"specialist_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <div id=\"specialist_details\" class=\"sub_section\" style=\"flex-direction: column;align-items: center;\">\n <p>Specify (Psychologist, Psychiatrist, Neurologist, Occupational therapist, Speech therapist, Special education specialist, social worker, specialized doctor, etc.) <\/p>\n <div id=\"specialist_container\">\n <\/div>\n <button id=\"add_specialist_button\" class=\"add_button\">Add a specialist<\/button>\n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">Family history<\/h2>\n <div class=\"sub_section\">\n <h3 class=\"section-title\">Check all that apply<\/h3>\n <div style=\"display:grid;grid-template-columns: repeat(4, auto);grid-gap:0.5rem;\">\n <div class=\"toggle_label\"> \n <input type=\"checkbox\" name=\"probable_adhd\"> \n <label>ADHD (Possible)<\/label>\n <input type=\"text\" name=\"probable_adhd_who\" placeholder=\"Who ? (relationship)\">\n <\/div> \n <div class=\"toggle_label\"> \n <input type=\"checkbox\" name=\"confirmed_adhd\">\n <label>ADHD (Confirmed)<\/label>\n <input type=\"text\" name=\"confirmed_adhd_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"learning_issues\">\n <label>Learning disorder(s) (e.g. Dyslexia)<\/label>\n <input type=\"text\" name=\"learning_issues_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"giftedness\">\n <label>Mental Retardation \/ Giftedness<\/label>\n <input type=\"text\" name=\"giftedness_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"autism\">\n <label>Autism spectrum disorder (Asperger’s)<\/label>\n <input type=\"text\" name=\"autism_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"congenital_disorder\">\n <label>Congenital disorders<\/label>\n <input type=\"text\" name=\"congenital_disorder_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"anxiety\">\n <label>Anxiety<\/label>\n <input type=\"text\" name=\"anxiety_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"depression\">\n <label>Depression<\/label>\n <input type=\"text\" name=\"depression_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"bipolar\">\n <label>Bipolar<\/label>\n <input type=\"text\" name=\"bipolar_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"phychosis\">\n <label>Psychosis<\/label>\n <input type=\"text\" name=\"phychosis_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"sleep_disorder\">\n <label>Sleep disorder (Apnea)<\/label>\n <input type=\"text\" name=\"sleep_disorder_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"tourette\">\n <label>Tourette \/ Tics<\/label>\n <input type=\"text\" name=\"tourette_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"epilepsy\">\n <label>Epilepsy<\/label>\n <input type=\"text\" name=\"epilepsy_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"drugs\">\n <label>Drugs<\/label>\n <input type=\"text\" name=\"drugs_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"criminal_record\">\n <label>Criminal record<\/label>\n <input type=\"text\" name=\"criminal_record_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"premature_cardiac_death\">\n <label>History of premature cardiac death<\/label>\n <input type=\"text\" name=\"premature_cardiac_death_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"arrhythmia\">\n <label>Known arrhythmias<\/label>\n <input type=\"text\" name=\"arrhythmia_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"hypertension\">\n <label>Hypertension<\/label>\n <input type=\"text\" name=\"hypertension_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"thyroid\">\n <label>Thyroid gland disorder<\/label>\n <input type=\"text\" name=\"thyroid_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <div class=\"toggle_label\">\n <input type=\"checkbox\" name=\"alzheimer\">\n <label>Alzheimer’s disease<\/label>\n <input type=\"text\" name=\"alzheimer_who\" placeholder=\"Who ? (relationship)\">\n <\/div>\n <\/div>\n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">Sleep<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;\">\n <div style=\"display:flex;gap:1rem;align-items: center;\">\n <p>Does the patient have sleep problems?<\/p>\n <label>\n <input type=\"radio\" name=\"has_sleep_disorder\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_sleep_disorder\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <div style=\"display:flex;gap:1rem;align-items: center;\">\n <label> In general, during the week, the patient gets up around: <\/label> \n <input type=\"time\" name=\"week_out\" required\/> \n <\/div>\n <div style=\"display:flex;gap:1rem;align-items: center;\">\n <label> In general, during the week, the patient goes to bed around: <\/label> \n <input type=\"time\" name=\"week_in\" required\/> \n <\/div>\n <div style=\"display:flex;gap:1rem;align-items: center;\">\n <label> Generally, on weekends, the patient gets up around: <\/label> \n <input type=\"time\" name=\"weekend_out\" required\/> \n <\/div> \n <div style=\"display:flex;gap:1rem;align-items: center;\">\n <label> Generally, on weekends, the patient goes to bed around: <\/label> \n <input type=\"time\" name=\"weekend_in\" required\/> \n <\/div> \n <div style=\"display:flex;gap:1rem;align-items: center;\"> \n <label> Typically, how long does it take for the patient to fall asleep? (Minutes or hours)<\/label> \n <input type=\"text\" name=\"get_to_sleep_time\" required\/> \n <\/div>\n <div style=\"display:flex;gap:1rem;align-items: center;\">\n <label> Typically, is the patient exposed to a screen before falling asleep? <\/label> \n <label>\n <input type=\"radio\" name=\"is_exposed_to_screen_before_sleep\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"is_exposed_to_screen_before_sleep\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">School History<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;\">\n <div style=\"display:flex;gap:1rem;align-items: center;\">\n <p>Is the patient studying?<\/p>\n <label>\n <input type=\"radio\" name=\"is_at_school\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"is_at_school\" value=\"Non\" required\/>\n No\n <\/label>\n <input id=\"current_school\" type=\"text\" name=\"current_school\" class=\"ch40_input\" style=\"display:none;\" placeholder=\"What school is he at?\" required\/>\n <input id=\"school_year\" type=\"text\" name=\"school_year\" class=\"ch40_input\" style=\"display:none;\" placeholder=\"What year or session is it in?\" required\/>\n <\/div> \n <div style=\"display:flex;gap:1rem;align-items: center;\">\n <label>\n What type of class is the patient in?\n <\/label>\n <select name=\"class_type\" aria-controls=\"class_type_details\" required>\n <option value=\"null\"><\/option>\n <option value=\"Priv\u00e9e\">Private<\/option>\n <option value=\"Publique\">Public<\/option>\n <option value=\"Adapt\u00e9e\">Adapted<\/option>\n <option value=\"Sp\u00e9cialis\u00e9e (sport, Alternatif, Internationale, etc)\">Specialized (sport, Alternative, International, etc.)<\/option>\n <option value=\"Vocation\">Vocation<\/option>\n <option value=\"Autre\">Other<\/option>\n <\/select>\n <\/div> \n <textarea id=\"class_type_details\" name=\"class_type_details\" placeholder=\"Specify.\"><\/textarea>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;flex-direction: column;align-items: center;\">\n <p>What other school(s) have you attended before?<\/p>\n <div id=\"past_school_container\">\n <\/div>\n <button id=\"add_school_button\" class=\"add_button\">Add a school<\/button>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;\">\n <p>Describe the patient’s behavior in class.<\/p>\n <textarea id=\"school_behavior\" name=\"school_behavior\" placeholder=\"\" required><\/textarea>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;\">\n <p>Does the patient already have or use services at school?<\/p>\n <label>\n <input type=\"radio\" name=\"uses_or_used_services\" aria-controls=\"uses_or_used_services_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"uses_or_used_services\" aria-controls=\"uses_or_used_services_details\" value=\"Non\" required\/>\n No\n <\/label>\n <textarea id=\"uses_or_used_services_details\" name=\"uses_or_used_services_details\" placeholder=\"Nommez les services utilis\u00e9s\"><\/textarea>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;\">\n <p>Has the patient already had or does he have an intervention plan in place?<\/p>\n <label>\n <input type=\"radio\" name=\"got_intervention_plan\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"got_intervention_plan\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;\">\n <p>Has the patient ever been in detention?<\/p>\n <label>\n <input type=\"radio\" name=\"got_detention\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"got_detention\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;\">\n <p>Has the patient ever been suspended?<\/p>\n <label>\n <input type=\"radio\" name=\"got_suspended\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"got_suspended\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;\">\n <p>Has the patient already been expelled?<\/p>\n <label>\n <input type=\"radio\" name=\"got_expelled\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"got_expelled\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;\">\n <p>Has the patient already doubled a year?<\/p>\n <label>\n <input type=\"radio\" name=\"restarted_year_or_session\" aria-controls=\"restarted_year_or_session_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"restarted_year_or_session\" aria-controls=\"restarted_year_or_session_details\" value=\"Non\" required\/>\n No\n <\/label>\n <textarea id=\"restarted_year_or_session_details\" name=\"restarted_year_or_session_details\" placeholder=\"Which one(s)?\" style=\"display: none;\" required><\/textarea>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;\">\n <p>Name the difficulties that the patient experiences or has experienced in her school career<\/p>\n <textarea id=\"school_difficulties\" name=\"school_difficulties\" placeholder=\"Please separate them with a comma ','\"><\/textarea>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;\">\n <p>Name the failures that the patient experiences or has experienced in her school career<\/p>\n <textarea id=\"school_failures\" name=\"school_failures\" placeholder=\"Please separate them with a comma ',' \"><\/textarea>\n <\/div>\n <\/section>\n\n <section class=\"section\">\n <h2 class=\"section-title\">Professional history<\/h2>\n <div class=\"sub_section\" style=\"gap:1rem;\">\n <p>Does the patient have a professional history?<\/p>\n <label>\n <input type=\"radio\" name=\"has_professional_history\" aria-controls=\"work_details\" value=\"Oui\" required\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" name=\"has_professional_history\" aria-controls=\"work_details\" value=\"Non\" required\/>\n No\n <\/label>\n <\/div>\n <div id=\"work_details\" class=\"sub_section\" style=\"flex-direction: column;align-items: center;\">\n <p>Indicate the year, position, employer and a summary of duties<\/p>\n <div id=\"work_container\">\n <\/div>\n <button id=\"add_work_button\" class=\"add_button\">Add a job<\/button>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;align-items: center;\">\n <label>How many times have you been fired?<\/label>\n <input type=\"number\" min=\"0\" name=\"how_many_times_got_fired\" placeholder=\"0\" required>\n <\/div>\n <div class=\"sub_section\" style=\"gap:1rem;align-items: center;\">\n <textarea name=\"work_problems_details\" placeholder=\"Name any things causing problems at the work.\"><\/textarea> \n <\/div>\n <\/section>\n \n <section class=\"section\">\n <h2 class=\"section-title\">Medication<\/h2>\n <div class=\"sub_section\" style=\"flex-direction: column;align-items: center;\">\n <p>Indicate current and previous medications and natural products.<\/p>\n <label>Indicate the Name, dosage, duration of treatment and result(s) or side effect(s)<\/label>\n <div id=\"meds_container\">\n <\/div>\n <button id=\"add_med_button\" class=\"add_button\">Add a medication<\/button>\n <\/div>\n <div class=\"sub_section\" style=\"align-items: center;gap:1rem;\">\n <p>Does the patient have difficulty swallowing pills?<\/p>\n <select id=\"has_difficulty_swallowing_pills\" name=\"has_difficulty_swallowing_pills\" required>\n <option value=\"null\"><\/option>\n <option value=\"Oui\">Yes<\/option>\n <option value=\"Non\">No<\/option>\n <option value=\"Jamais essay\u00e9\">Never tried<\/option>\n <\/select>\n <\/div> \n <\/section> \n\n <section class=\"section\">\n <h2 class=\"section-title\">Consultation<\/h2> \n <div class=\"sub_section\"> \n <textarea id=\"consult_reason\" name=\"consult_reason\" placeholder=\"State why you believe a consultation is necessary.\" required><\/textarea>\n <textarea id=\"optional_info\" name=\"optional_info\" placeholder=\"Additional information for evaluation. (Optional)\"><\/textarea>\n <\/div> \n <\/section>\n\n <section class=\"section\">\n <div class=\"sub_section\" style=\"display:flex;justify-content: center;align-items: flex-start;flex-direction: column;\">\n <p>By clicking on “I understand and I accept” below, you agree that ExcelleMD collects all the personal information registered in this form (including personal health information of a potentially delicate nature) and uses it for the purpose of Evaluate, plan and possibly provide you with medical services.\n You consent to ExcelleMD discloses this information to third parties, if necessary to provide you with these services.<\/p> \n\n <ul style=\"margin-left: 3rem;\">\n <li> The information collected will be sent securely to Adobe servers to create a PDF.<\/li>\n <Li> The PDF will then be saved on ExcelleMD’s Microsoft Secure Servers and in ExcelleMD’s Electronic Medical Record software. <\/li>\n <li> All personal information will be protected and kept in accordance with ExcelleMD privacy policy. <\/li>\n <\/ul>\n \n <p>Please refer to our <a href=\"https:\/\/excellemd.com\/en\/terms-of-use\/\">terms of use<\/a> page for more details.<\/p>\n <p>Please refer to our <a href=\"https:\/\/excellemd.com\/en\/privacy\/\">privacy<\/a> page for more details.<\/p>\n <label style=\"align-self: center;\"> I understand and I accept\n <input id=\"accepts_terms\" name=\"accepts_terms\" type=\"checkbox\" required>\n <\/label>\n <\/div>\n <div class=\"sub_section\" style=\"display:flex;justify-content: center;align-items: center;\">\n <button id=\"submit_button\" class=\"add_button\">Submit<\/button>\n <\/div>\n <\/section>\n <\/div>\n <\/form>\n\n\n\n<div id=\"custom_adhd_form_loading\">\n <p>Please wait…<\/p>\n \n <\/div>\n\n\n\n<div id=\"custom_adhd_form_success\">\n <p>The form was submitted successfully. Thank you !<\/p>\n <br>\n <p>Your personal data was deleted from the browser.<\/p>\n <\/div>\n\n\n\n<div id=\"custom_adhd_form_error\">\n <p>Sorry, something unexpected happened…<\/p>\n <\/div>\n\n\n\n<script defer>\n\n class Sibling {\n id;\n name;\n age;\n gender;\n relation;\n details;\n\n constructor(id, name = \"\", age = \"\", gender = \"\", relation = \"\", details = \"\") {\n this.id = id;\n this.name = name;\n this.age = age;\n this.gender = gender;\n this.relation = relation;\n this.details = details;\n }\n }\n\n class Specialist {\n id;\n consult_age;\n consult_goal;\n specialist_type;\n\n constructor(id, consult_age = \"\", consult_goal = \"\", specialist_type = \"\") {\n this.id = id;\n this.consult_age = consult_age;\n this.consult_goal = consult_goal;\n this.specialist_type = specialist_type;\n }\n }\n\n class School {\n id;\n year_start;\n year_end;\n name;\n\n constructor(id, name = \"\", year_start = \"\", year_end = \"\") {\n this.id = id;\n this.name = name;\n this.year_start = year_start;\n this.year_end = year_end;\n }\n }\n\n class Medication {\n id;\n dosage;\n treatment_time;\n name;\n results;\n\n constructor(id, name = \"\", dosage = \"\", treatment_time = \"\", results = \"\") {\n this.id = id;\n this.name = name;\n this.dosage = dosage;\n this.treatment_time = treatment_time;\n this.results = results;\n }\n }\n\n class Job {\n id;\n start_year;\n end_year;\n company;\n role;\n tasks;\n\n constructor(id, start_year = \"\", end_year = \"\", company = \"\", role = \"\", tasks = \"\") {\n this.id = id;\n this.start_year = start_year;\n this.end_year = end_year;\n this.company = company;\n this.role = role;\n this.tasks = tasks;\n }\n }\n\n function hideAutoSavePrompt() {\n\n let oneIsChecked = false;\n\n document.querySelectorAll(\"[name=do_not_remember_autosave]\").forEach( radio => {\n console.log(radio);\n if(radio.checked) {\n window.localStorage.setItem(\"do_not_remember_autosave\", radio.value);\n oneIsChecked = true;\n }\n })\n\n if(oneIsChecked) {\n document.querySelector(\"#Content\").removeChild(document.querySelector(\".autosave_container\"));\n document.querySelector(\"#Wrapper\").style.overflowY = \"scroll\";\ndocument.querySelector(\"#Wrapper\").style.maxHeight = \"inherit\";\ndocument.querySelector(\"#Content\").style.maxHeight = \"inherit\";\n }\n }\n\n function showAutoSavePrompt() {\n let check = window.localStorage.getItem(\"do_not_remember_autosave\") || \"No\";\n\n if(check !== \"Yes\") {\n let container = document.createElement(\"div\");\n container.classList.add(\"autosave_container\");\n\n let prompt = document.createElement(\"div\");\n prompt.classList.add(\"autosave_prompt\");\n\n let header = document.createElement(\"div\");\n header.innerHTML = `<p class=\"section-title\" style=\"font-size:20px\">Attention<\/p>`\n let content = document.createElement(\"div\");\n content.innerHTML = ` \n <p>You can start filling out the form and come back to it later <b style=\"font-weight:bolder\">ON THE SAME COMPUTER<\/b>. <br \/> <br\/> The data will be saved in your browser until the form is submitted.<\/p>\n <br \/>\n <div style=\"display:flex;gap:1rem;\">\n <p>Don't remind me again?<\/p>\n <label>\n <input type=\"radio\" value=\"Yes\" name=\"do_not_remember_autosave\"\/>\n Yes\n <\/label>\n <label>\n <input type=\"radio\" value=\"No\" name=\"do_not_remember_autosave\"\/>\n No\n <\/label>\n <\/div>\n `\n let footer = document.createElement(\"div\");\n\n let ok_btn = document.createElement(\"button\");\n ok_btn.innerText = \"Ok\";\n ok_btn.classList.add(\"add_button\");\n ok_btn.style.marginInline = \"auto\";\n ok_btn.addEventListener('click', (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n hideAutoSavePrompt();\n })\n\n footer.append(ok_btn);\n\n prompt.append(header, content, footer);\n container.appendChild(prompt);\nlet contentWrapper = document.querySelector(\"#Content\");\ncontentWrapper.style.position = \"relative\";\ncontentWrapper.style.maxHeight = \"100vh\";\n contentWrapper.appendChild(container);\n window.scrollTo({ top: 0, behavior: 'smooth'});\n document.querySelector(\"#Wrapper\").style.overflowY = \"hidden\";\ndocument.querySelector(\"#Wrapper\").style.maxHeight = \"100vh\";\n }\n }\n\n function updateLocalStorage(e) {\n window.localStorage.setItem(e.target.name, e.target.value);\n }\n\n function updateDynamicInputLocalStorage(e) {\n let siblings = JSON.parse(window.localStorage.getItem(\"siblings\"));\n siblings[parseInt(e.target.getAttribute(\"data-index\"))-1][e.target.getAttribute(\"field\")] = e.target.value;\n window.localStorage.setItem(\"siblings\", JSON.stringify(siblings));\n }\n\n function updateDynamicSpecialistLocalStorage(e) {\n let specialists = JSON.parse(window.localStorage.getItem(\"specialists\"));\n specialists[parseInt(e.target.getAttribute(\"data-index\"))-1][e.target.getAttribute(\"field\")] = e.target.value;\n window.localStorage.setItem(\"specialists\", JSON.stringify(specialists));\n }\n\n function updateDynamicSchoolLocalStorage(e) {\n let past_schools = JSON.parse(window.localStorage.getItem(\"past_schools\"));\n past_schools[parseInt(e.target.getAttribute(\"data-index\"))-1][e.target.getAttribute(\"field\")] = e.target.value;\n window.localStorage.setItem(\"past_schools\", JSON.stringify(past_schools));\n }\n\n function updateDynamicMedLocalStorage(e) {\n let meds = JSON.parse(window.localStorage.getItem(\"meds\"));\n meds[parseInt(e.target.getAttribute(\"data-index\"))-1][e.target.getAttribute(\"field\")] = e.target.value;\n window.localStorage.setItem(\"meds\", JSON.stringify(meds));\n }\n\n function updateDynamicJobLocalStorage(e) {\n let jobs = JSON.parse(window.localStorage.getItem(\"jobs\"));\n jobs[parseInt(e.target.getAttribute(\"data-index\"))-1][e.target.getAttribute(\"field\")] = e.target.value;\n window.localStorage.setItem(\"jobs\", JSON.stringify(jobs));\n }\n\n function removeSiblingLine(e, entry) {\n e.preventDefault();\n e.stopPropagation();\n\n let container = document.querySelector(\"#sibling_container\");\n container.removeChild(entry);\n\n container = document.querySelector(\"#sibling_container\");\n\n let siblings = JSON.parse(window.localStorage.getItem(\"siblings\")); \n siblings.splice(parseInt(entry.getAttribute(\"data-sibling-id\"))-1, 1);\n \n document.querySelectorAll(\"#sibling_container > div\").forEach( (entry, index) => {\n siblings[index].id = (index + 1);\n entry.setAttribute(\"data-sibling-id\", (index + 1));\n entry.childNodes.forEach( (child) => { \n child.childNodes.forEach( input => {\n input.name = input.name.substring(0,input.name.lastIndexOf(\"_\")+1) + (index + 1);\n input.setAttribute(\"data-index\", (index + 1));\n input.removeEventListener('change', updateDynamicInputLocalStorage)\n input.addEventListener('change', updateDynamicInputLocalStorage)\n });\n }) \n });\n \n window.localStorage.setItem(\"siblings\", JSON.stringify(siblings)); \n window.localStorage.setItem(\"sibling_count\", container.children.length)\n }\n\n function addSiblingLine() {\n let container = document.querySelector(\"#sibling_container\");\n \n let sibling_count = parseInt(window.localStorage.getItem(\"sibling_count\")) || 0;\n\n let entry = document.createElement('div');\n entry.name = `sibling_${sibling_count}`;\n entry.classList.add(\"sibling_entry\");\n entry.setAttribute(\"data-sibling-id\", `${sibling_count + 1}`);\n\n let sibling_entry_top = document.createElement('div');\n sibling_entry_top.classList.add(\"sibling_entry_top\");\n\n let sibling_entry_bottom = document.createElement('div');\n sibling_entry_bottom.classList.add(\"sibling_entry_bottom\");\n\n let sibling_name_input = document.createElement(\"input\");\n let sibling_age_input = document.createElement(\"input\");\n let sibling_gender_input = document.createElement(\"input\");\n let sibling_relationship_input = document.createElement(\"input\");\n let sibling_details_input = document.createElement(\"textarea\");\n let delete_button = document.createElement(\"button\");\n\n sibling_name_input.name = `sibling_name_${sibling_count + 1}`;\n sibling_name_input.placeholder = \"Sibling's name\";\n sibling_name_input.setAttribute(\"data-index\", sibling_count + 1);\n sibling_name_input.addEventListener(\"change\", updateDynamicInputLocalStorage)\n sibling_name_input.setAttribute(\"field\", \"name\");\n sibling_age_input.name = `sibling_age_${sibling_count + 1}`;\n sibling_age_input.placeholder = \"Sibling's age\";\n sibling_age_input.setAttribute(\"data-index\", sibling_count + 1);\n sibling_age_input.addEventListener(\"change\", updateDynamicInputLocalStorage)\n sibling_age_input.setAttribute(\"field\", \"age\");\n sibling_gender_input.name = `sibling_gender_${sibling_count + 1}`;\n sibling_gender_input.placeholder = \"Gender\";\n sibling_gender_input.setAttribute(\"data-index\", sibling_count + 1);\n sibling_gender_input.addEventListener(\"change\", updateDynamicInputLocalStorage)\n sibling_gender_input.setAttribute(\"field\", \"gender\");\n sibling_relationship_input.name = `sibling_relationship_${sibling_count + 1}`;\n sibling_relationship_input.placeholder = \"Relationship\";\n sibling_relationship_input.setAttribute(\"data-index\", sibling_count + 1);\n sibling_relationship_input.addEventListener(\"change\", updateDynamicInputLocalStorage)\n sibling_relationship_input.setAttribute(\"field\", \"relation\");\n sibling_details_input.name = `sibling_details_${sibling_count + 1}`;\n sibling_details_input.placeholder = \"Relevant details about this relationship (Optional)\";\n sibling_details_input.setAttribute(\"data-index\", sibling_count + 1);\n sibling_details_input.addEventListener(\"change\", updateDynamicInputLocalStorage);\n sibling_details_input.setAttribute(\"field\", \"details\");\n delete_button.name = `delete_sibling_${sibling_count + 1}`;\n delete_button.innerText = \"Delete\";\n delete_button.setAttribute(\"data-index\", sibling_count + 1);\n delete_button.addEventListener('click', (e) => {removeSiblingLine(e, entry)});\n delete_button.classList.add(\"delete_btn\");\n\n sibling_entry_top.append(sibling_name_input, sibling_age_input, sibling_gender_input, sibling_relationship_input, delete_button);\n sibling_entry_bottom.append(sibling_details_input);\n\n entry.append(sibling_entry_top, sibling_entry_bottom);\n container.append(entry);\n\n let siblings = JSON.parse(window.localStorage.getItem(\"siblings\")) || [];\n siblings.push(new Sibling(container.children.length));\n\n window.localStorage.setItem(\"siblings\", JSON.stringify(siblings));\n window.localStorage.setItem(\"sibling_count\", container.children.length);\n }\n \n function removeSpecialistLine(e, entry) {\n e.preventDefault();\n e.stopPropagation();\n\n let container = document.querySelector(\"#specialist_container\");\n container.removeChild(entry);\n\n let specialists = JSON.parse(window.localStorage.getItem(\"specialists\")); \n specialists.splice(parseInt(entry.getAttribute(\"data-specialist-id\"))-1, 1);\n\n document.querySelectorAll(\"#specialist_container > div\").forEach( (entry, index) => {\n\n specialists[index].id = (index + 1);\n entry.setAttribute(\"data-specialist-id\", (index + 1));\n entry.childNodes.forEach( (child) => { \n child.childNodes.forEach( input => {\n input.name = input.name.substring(0,input.name.lastIndexOf(\"_\")+1) + (index + 1);\n input.setAttribute(\"data-index\", (index + 1));\n input.removeEventListener('change', updateDynamicSpecialistLocalStorage)\n input.addEventListener('change', updateDynamicSpecialistLocalStorage)\n });\n })\n })\n\n window.localStorage.setItem(\"specialists\", JSON.stringify(specialists));\n window.localStorage.setItem(\"specialist_count\", container.children.length)\n }\n\n function addSpecialistLine() {\n let container = document.querySelector(\"#specialist_container\");\n \n let specialist_count = parseInt(window.localStorage.getItem(\"specialist_count\")) || 0;\n\n let entry = document.createElement('div');\n entry.name = `specialist_${specialist_count}`;\n entry.classList.add(\"work_entry\");\n entry.setAttribute(\"data-specialist-id\", `${specialist_count + 1}`);\n\n let work_entry_top = document.createElement('div');\n work_entry_top.classList.add(\"specialist_entry_top\");\n\n let work_entry_bottom = document.createElement('div');\n work_entry_bottom.classList.add(\"specialist_entry_bottom\");\n\n let specialist_consult_age_input = document.createElement(\"input\");\n let specialist_type_input = document.createElement(\"input\");\n let goal_input = document.createElement(\"textarea\");\n let delete_button = document.createElement(\"button\");\n\n specialist_consult_age_input.name = `specialist_consult_age_${specialist_count + 1}`;\n specialist_consult_age_input.placeholder = \"Patient's age\";\n specialist_consult_age_input.setAttribute(\"data-index\", specialist_count + 1);\n specialist_consult_age_input.addEventListener(\"change\", updateDynamicSpecialistLocalStorage);\n specialist_consult_age_input.setAttribute(\"field\", \"consult_age\");\n specialist_type_input.name = `specialist_type_${specialist_count + 1}`;\n specialist_type_input.placeholder = \"Specialist\";\n specialist_type_input.setAttribute(\"data-index\", specialist_count + 1);\n specialist_type_input.addEventListener(\"change\", updateDynamicSpecialistLocalStorage);\n specialist_type_input.setAttribute(\"field\", \"specialist_type\");\n goal_input.name = `specialist_goal_${specialist_count + 1}`;\n goal_input.placeholder = \"Indicate the purpose of the consultation\";\n goal_input.setAttribute(\"data-index\", specialist_count + 1);\n goal_input.addEventListener(\"change\", updateDynamicSpecialistLocalStorage);\n goal_input.setAttribute(\"field\", \"consult_goal\");\n delete_button.name = `delete_specialist_${specialist_count + 1}`;\n delete_button.innerText = \"Delete\";\n delete_button.setAttribute(\"data-index\", specialist_count + 1);\n delete_button.addEventListener('click', (e) => {removeSpecialistLine(e, entry)});\n delete_button.classList.add(\"delete_btn\");\n\n work_entry_top.append(specialist_consult_age_input, specialist_type_input, delete_button);\n work_entry_bottom.append(goal_input);\n\n entry.append(work_entry_top, work_entry_bottom);\n container.append(entry);\n\n let specialists = JSON.parse(window.localStorage.getItem(\"specialists\")) || [];\n specialists.push(new Specialist(container.children.length));\n\n window.localStorage.setItem(\"specialists\", JSON.stringify(specialists));\n window.localStorage.setItem(\"specialist_count\", container.children.length);\n }\n\n function removeSchoolLine(e, entry) {\n e.preventDefault();\n e.stopPropagation();\n\n let container = document.querySelector(\"#past_school_container\");\n container.removeChild(entry)\n\n let past_schools = JSON.parse(window.localStorage.getItem(\"past_schools\")); \n past_schools.splice(parseInt(entry.getAttribute(\"data-school-id\"))-1, 1);\n\n document.querySelectorAll(\"#past_school_container > div\").forEach( (entry, index) => {\n console.log(entry);\n past_schools[index].id = (index + 1);\n entry.setAttribute(\"data-school-id\", (index + 1));\n entry.childNodes.forEach( (child) => {\n child.name = child.name.substring(0, child.name.lastIndexOf(\"_\")+1) + (index + 1);\n child.setAttribute(\"data-index\", (index+ 1));\n child.removeEventListener('change', updateDynamicSchoolLocalStorage)\n child.addEventListener('change', updateDynamicSchoolLocalStorage)\n })\n })\n\n window.localStorage.setItem(\"past_schools\", JSON.stringify(past_schools));\n window.localStorage.setItem(\"school_count\", container.children.length)\n }\n\n function addSchoolLine() {\n let container = document.querySelector(\"#past_school_container\");\n \n let school_count = parseInt(window.localStorage.getItem(\"school_count\")) || 0;\n\n let entry = document.createElement('div');\n entry.name = `work_${school_count}`;\n entry.classList.add(\"school_entry\");\n entry.setAttribute(\"data-school-id\", `${school_count + 1}`);\n\n let school_start_year_input = document.createElement(\"input\");\n let school_end_year_input = document.createElement(\"input\");\n let school_name_input = document.createElement(\"input\");\n let delete_button = document.createElement(\"button\");\n\n school_start_year_input.name = `school_start_year_${school_count + 1}`;\n school_start_year_input.placeholder = \"Start year\";\n school_start_year_input.setAttribute(\"data-index\", school_count + 1);\n school_start_year_input.setAttribute(\"type\", \"text\");\n school_start_year_input.addEventListener(\"change\", updateDynamicSchoolLocalStorage);\n school_start_year_input.setAttribute(\"field\", \"year_start\");\n school_end_year_input.name = `school_end_year_${school_count + 1}`;\n school_end_year_input.placeholder = \"End year\";\n school_end_year_input.setAttribute(\"data-index\", school_count + 1);\n school_end_year_input.setAttribute(\"type\", \"text\");\n school_end_year_input.addEventListener(\"change\", updateDynamicSchoolLocalStorage);\n school_end_year_input.setAttribute(\"field\", \"year_end\");\n school_name_input.name = `school_name_${school_count + 1}`;\n school_name_input.placeholder = \"School name\";\n school_name_input.setAttribute(\"data-index\", school_count + 1);\n school_name_input.setAttribute(\"field\", \"name\");\n school_name_input.addEventListener(\"change\", updateDynamicSchoolLocalStorage);\n delete_button.name = `delete_school_${school_count + 1}`;\n delete_button.innerText = \"Delete\";\n delete_button.setAttribute(\"data-index\", school_count + 1);\n delete_button.addEventListener('click', (e) => {removeSchoolLine(e, entry)});\n delete_button.classList.add(\"delete_btn\");\n\n entry.append(school_start_year_input, school_end_year_input, school_name_input, delete_button);\n container.append(entry);\n\n let past_schools = JSON.parse(window.localStorage.getItem(\"past_schools\")) || [];\n past_schools.push(new School(container.children.length));\n\n window.localStorage.setItem(\"past_schools\", JSON.stringify(past_schools));\n window.localStorage.setItem(\"school_count\", container.children.length);\n }\n\n function removeWork(e, entry) {\n e.preventDefault();\n e.stopPropagation();\n\n let container = document.querySelector(\"#work_container\");\n container.removeChild(entry)\n\n let jobs = JSON.parse(window.localStorage.getItem(\"jobs\")); \n jobs.splice(parseInt(entry.getAttribute(\"data-job-id\"))-1, 1);\n\n document.querySelectorAll(\"#work_container > div\").forEach( (entry, index) => {\n jobs[index].id = (index + 1);\n entry.setAttribute(\"data-job-id\", (index + 1)); \n entry.childNodes.forEach( (child) => {\n child.childNodes.forEach( input => {\n input.name = input.name.substring(0,input.name.lastIndexOf(\"_\")+1) + (index + 1);\n input.setAttribute(\"data-index\", (index + 1));\n input.removeEventListener('change', updateDynamicJobLocalStorage)\n input.addEventListener('change', updateDynamicJobLocalStorage)\n });\n })\n })\n\n window.localStorage.setItem(\"jobs\", JSON.stringify(jobs));\n window.localStorage.setItem(\"work_count\", container.children.length)\n }\n\n function addWorkLine() {\n let container = document.querySelector(\"#work_container\");\n \n let work_count = parseInt(window.localStorage.getItem(\"work_count\")) || 0;\n\n let entry = document.createElement('div');\n entry.name = `work_${work_count}`;\n entry.classList.add(\"work_entry\");\n\n let work_entry_top = document.createElement('div');\n work_entry_top.classList.add(\"work_entry_top\");\n\n let work_entry_bottom = document.createElement('div');\n work_entry_bottom.classList.add(\"work_entry_bottom\");\n\n let work_start_year_input = document.createElement(\"input\");\n let work_end_year_input = document.createElement(\"input\");\n let role_input = document.createElement(\"input\");\n let company_input = document.createElement(\"input\");\n let tasks_input = document.createElement(\"textarea\");\n let delete_button = document.createElement(\"button\");\n\n work_start_year_input.name = `work_start_year_${work_count + 1}`;\n work_start_year_input.placeholder = \"Start year\";\n work_start_year_input.setAttribute(\"data-index\", work_count + 1);\n work_start_year_input.setAttribute(\"type\", \"text\");\n work_start_year_input.addEventListener(\"change\", updateDynamicJobLocalStorage);\n work_start_year_input.setAttribute(\"field\", \"start_year\");\n work_end_year_input.name = `work_end_year_${work_count + 1}`;\n work_end_year_input.placeholder = \"End year\";\n work_end_year_input.setAttribute(\"data-index\", work_count + 1);\n work_end_year_input.setAttribute(\"type\", \"text\");\n work_end_year_input.addEventListener(\"change\", updateDynamicJobLocalStorage);\n work_end_year_input.setAttribute(\"field\", \"end_year\");\n role_input.name = `work_role_${work_count + 1}`;\n role_input.placeholder = \"Job title\";\n role_input.setAttribute(\"data-index\", work_count + 1);\n role_input.addEventListener(\"change\", updateDynamicJobLocalStorage);\n role_input.setAttribute(\"field\", \"role\");\n company_input.name = `work_company_${work_count + 1}`;\n company_input.placeholder = \"Company\";\n company_input.setAttribute(\"data-index\", work_count + 1);\n company_input.addEventListener(\"change\", updateDynamicJobLocalStorage);\n company_input.setAttribute(\"field\", \"company\");\n tasks_input.name = `work_tasks_${work_count + 1}`;\n tasks_input.style.gridRow = \"2\/3\";\n tasks_input.placeholder = \"Indicate the tasks you had.\";\n tasks_input.setAttribute(\"data-index\", work_count + 1);\n tasks_input.addEventListener(\"change\", updateDynamicJobLocalStorage);\n tasks_input.setAttribute(\"field\", \"tasks\");\n delete_button.name = `delete_work_${work_count + 1}`;\n delete_button.innerText = \"Delete\";\n delete_button.setAttribute(\"data-index\", work_count + 1);\n delete_button.addEventListener('click', (e) => {removeWork(e, entry)});\n delete_button.classList.add(\"delete_btn\");\n\n work_entry_top.append(work_start_year_input, work_end_year_input, role_input, company_input, delete_button);\n work_entry_bottom.append(tasks_input);\n\n entry.append(work_entry_top, work_entry_bottom);\n container.append(entry);\n\n let jobs = JSON.parse(window.localStorage.getItem(\"jobs\")) || [];\n jobs.push(new Job(container.children.length));\n\n window.localStorage.setItem(\"jobs\", JSON.stringify(jobs));\n window.localStorage.setItem(\"work_count\", container.children.length);\n }\n\n function removeMed(e, entry) {\n e.preventDefault();\n e.stopPropagation();\n\n let container = document.querySelector(\"#meds_container\");\n container.removeChild(entry)\n\n let meds = JSON.parse(window.localStorage.getItem(\"meds\")); \n meds.splice(parseInt(entry.getAttribute(\"data-med-id\"))-1, 1);\n\n document.querySelectorAll(\"#meds_container > div\").forEach( (entry, index) => {\n meds[index].id = (index + 1);\n entry.setAttribute(\"data-med-id\", (index + 1)); \n entry.childNodes.forEach( (child) => {\n child.name = child.name.substring(0,child.name.lastIndexOf(\"_\")+1) + (index + 1);\n child.setAttribute(\"data-index\", (index + 1));\n child.removeEventListener('change', updateDynamicMedLocalStorage)\n child.addEventListener('change', updateDynamicMedLocalStorage)\n })\n })\n\n window.localStorage.setItem(\"meds\", JSON.stringify(meds));\n window.localStorage.setItem(\"med_count\",container.children.length)\n }\n\n function addMedLine() {\n let container = document.querySelector(\"#meds_container\");\n \n let med_count = parseInt(window.localStorage.getItem(\"med_count\")) || 0;\n\n let entry = document.createElement('div');\n entry.name = `med_${med_count}`;\n entry.classList.add(\"med_entry\");\n entry.setAttribute(\"data-med-id\", `${med_count + 1}`);\n\n let name_input = document.createElement(\"input\");\n let dosage_input = document.createElement(\"input\");\n let duration_input = document.createElement(\"input\");\n let details_input = document.createElement(\"textarea\");\n let delete_button = document.createElement(\"button\");\n\n name_input.name = `meds_name_${med_count + 1}`;\n name_input.placeholder = \"Medication name\";\n name_input.setAttribute(\"data-index\", med_count + 1);\n name_input.addEventListener(\"change\", updateDynamicMedLocalStorage);\n name_input.setAttribute(\"field\", \"name\");\n dosage_input.name = `meds_dosage_${med_count + 1}`;\n dosage_input.placeholder = \"Dosage\";\n dosage_input.setAttribute(\"data-index\", med_count + 1);\n dosage_input.addEventListener(\"change\", updateDynamicMedLocalStorage);\n dosage_input.setAttribute(\"field\", \"dosage\");\n duration_input.name = `meds_duration_${med_count + 1}`;\n duration_input.placeholder = \"Duration of treatment\";\n duration_input.setAttribute(\"data-index\", med_count + 1);\n duration_input.addEventListener(\"change\", updateDynamicMedLocalStorage);\n duration_input.setAttribute(\"field\", \"treatment_time\");\n details_input.name = `meds_details_${med_count + 1}`;\n details_input.placeholder = \"Indicate the result(s) or side effect(s)\";\n details_input.setAttribute(\"data-index\", med_count + 1);\n details_input.addEventListener(\"change\", updateDynamicMedLocalStorage);\n details_input.setAttribute(\"field\", \"results\");\n delete_button.name = `delete_med_${med_count + 1}`;\n delete_button.innerText = \"Delete\";\n delete_button.setAttribute(\"data-index\", med_count + 1);\n delete_button.addEventListener('click', (e) => {removeMed(e, entry)});\n delete_button.classList.add(\"delete_btn\");\n\n entry.append(name_input, dosage_input, duration_input, details_input, delete_button);\n container.append(entry);\n\n let meds = JSON.parse(window.localStorage.getItem(\"meds\")) || [];\n meds.push(new Medication(container.children.length));\n\n window.localStorage.setItem(\"meds\", JSON.stringify(meds));\n window.localStorage.setItem(\"med_count\", container.children.length);\n }\n \n document.querySelector(\"#parent_civil_status\").addEventListener(\"change\", (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n if(e.target.value === \"Autre\") {\n console.log(\"displaying\")\n document.querySelector(\"#parent_civil_status_details\").style.display = \"block\";\n } else {\n console.log(\"hidding\")\n document.querySelector(\"#parent_civil_status_details\").style.display = \"none\";\n }\n })\n\n document.querySelector(\"#patient_civil_status\").addEventListener(\"change\", (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n if(e.target.value === \"Autre\") {\n document.querySelector(\"#patient_civil_status_details\").style.display = \"block\";\n } else {\n document.querySelector(\"#patient_civil_status_details\").style.display = \"none\";\n }\n })\n\n document.querySelector(\"#patient_lives_with\").addEventListener(\"change\", (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n if(e.target.value === \"Autre\") {\n document.querySelector(\"#patient_lives_with_details\").style.display = \"block\";\n } else {\n document.querySelector(\"#patient_lives_with_details\").style.display = \"none\";\n }\n })\n\n document.querySelectorAll(\"input[name=patient_has_siblings]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"#sibling_tool\").style.display = \"flex\";\n } else {\n document.querySelector(\"#sibling_tool\").style.display = \"none\";\n }\n })\n })\n\n document.querySelector(\"#add_sibling_button\").addEventListener('click', (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n addSiblingLine();\n });\n\n document.querySelector(\"select[name=home_spoken_language]\").addEventListener('change', (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n if(e.target.value === \"Autre\") {\n document.querySelector(\"input[name=other_home_spoken_language]\").style.display = \"block\";\n } else {\n document.querySelector(\"input[name=other_home_spoken_language]\").style.display = \"none\";\n }\n })\n\n document.querySelectorAll(\"input[name=had_pregnancy_issues]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=had_pregnancy_issues_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=had_pregnancy_issues_details]\").style.display = \"none\";\n }\n })\n })\n\n document.querySelectorAll(\"input[name=born_at]\").forEach( input => { \n\n if(window.localStorage.getItem(\"born_at\") === \"Terme\" || window.localStorage.getItem(\"born_at\") === null){\n document.querySelector(\"input[name=born_at_details]\").style.display = \"none\";\n } else {\n document.querySelector(\"input[name=born_at_details]\").style.display = \"block\";\n }\n\n input.addEventListener(\"change\", (e) => {\n if(e.target.value !== \"Terme\") {\n document.querySelector(\"input[name=born_at_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"input[name=born_at_details]\").style.display = \"none\";\n }\n })\n })\n\n document.querySelectorAll(\"input[name=post_born_issues]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=post_born_issues_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=post_born_issues_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=has_allergies]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_allergies_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_allergies_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=has_intolerances]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_intolerances_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_intolerances_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_illness]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_illness_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_illness_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_surgeries]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_surgeries_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_surgeries_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=has_visual_issues]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_visual_issues_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_visual_issues_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=has_earing_issues]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_earing_issues_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_earing_issues_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=last_physical_exam_date]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"\") {\n document.querySelector(\"textarea[name=last_physical_exam_details]\").style.display = \"none\";\n } else {\n document.querySelector(\"textarea[name=last_physical_exam_details]\").style.display = \"block\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=has_epilepsy]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_epilepsy_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_epilepsy_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=has_head_trauma]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_head_trauma_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_head_trauma_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=has_coordination_problems]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_coordination_problems_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_coordination_problems_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=has_diabetes]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_diabetes_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_diabetes_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=has_growth_retardation]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_growth_retardation_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_growth_retardation_details]\").style.display = \"none\";\n }\n })\n });\n \n document.querySelectorAll(\"input[name=has_repeated_otitis]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_repeated_otitis_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_repeated_otitis_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_sleep_apnea]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_sleep_apnea_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_sleep_apnea_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_asthma]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_asthma_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_asthma_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_enlarged_adenoids]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_enlarged_adenoids_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_enlarged_adenoids_details]\").style.display = \"none\";\n }\n })\n });\n\n\n document.querySelectorAll(\"input[name=has_heart_murmur]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_heart_murmur_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_heart_murmur_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_palpitations]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_palpitations_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_palpitations_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_consciousness_loss]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_consciousness_loss_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_consciousness_loss_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_dispnea]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_dispnea_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_dispnea_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_hypertension]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_hypertension_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_hypertension_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_chest_pain]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_chest_pain_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_chest_pain_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_positive_ecg]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_positive_ecg_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_positive_ecg_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=has_language_issues]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_language_issues_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_language_issues_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_gross_motor_problems]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_gross_motor_problems_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_gross_motor_problems_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_fine_motor_problems]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_fine_motor_problems_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_fine_motor_problems_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_enuresis]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_enuresis_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_enuresis_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_behavior_problems]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_behavior_problems_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_behavior_problems_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_sensory_hypersensitivity]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_sensory_hypersensitivity_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_sensory_hypersensitivity_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_mannerism]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_mannerism_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_mannerism_details]\").style.display = \"none\";\n }\n })\n });\n\n \/\/ ANT\u00c9C\u00c9DENTS TROUBLE D'APPRENTISSAGE\n\n document.querySelectorAll(\"input[name=has_dyslexia]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_dyslexia_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_dyslexia_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_dysorthography]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_dysorthography_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_dysorthography_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_dyscalculia]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_dyscalculia_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_dyscalculia_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_dysphasia]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_dysphasia_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_dysphasia_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_dyspraxia]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_dyspraxia_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_dyspraxia_details]\").style.display = \"none\";\n }\n })\n });\n\n \/\/ Ant\u00e9c\u00e9dents - Autres d\u00e9clarations \n\n document.querySelectorAll(\"input[name=has_giftedness]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_giftedness_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_giftedness_details]\").style.display = \"none\";\n }\n })\n });\n document.querySelectorAll(\"input[name=has_med_complications]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=has_med_complications_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=has_med_complications_details]\").style.display = \"none\";\n }\n })\n });\n\n \/\/ Suivi(s) param\u00e9dicaux\n\n document.querySelectorAll(\"input[name=saw_specialist]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"#specialist_details\").style.display = \"flex\";\n } else {\n document.querySelector(\"#specialist_details\").style.display = \"none\";\n }\n })\n });\n\n \n document.querySelector(\"#add_specialist_button\").addEventListener('click', (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n addSpecialistLine();\n });\n\n \/\/ Historique scholaire \n\n document.querySelectorAll(\"input[name=is_at_school]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"input[name=school_year]\").style.display = \"block\";\n document.querySelector(\"input[name=current_school]\").style.display = \"block\";\n } else {\n document.querySelector(\"input[name=school_year]\").style.display = \"none\";\n document.querySelector(\"input[name=current_school]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelector(\"select[name=class_type]\").addEventListener(\"change\", (e) => {\n if(e.target.value === \"Autre\") {\n document.querySelector(\"textarea[name=class_type_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=class_type_details]\").style.display = \"none\";\n }\n });\n\n document.querySelectorAll(\"input[name=uses_or_used_services]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=uses_or_used_services_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=uses_or_used_services_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelectorAll(\"input[name=restarted_year_or_session]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"textarea[name=restarted_year_or_session_details]\").style.display = \"block\";\n } else {\n document.querySelector(\"textarea[name=restarted_year_or_session_details]\").style.display = \"none\";\n }\n })\n });\n\n document.querySelector(\"#add_school_button\").addEventListener('click', (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n addSchoolLine();\n });\n\n \/\/ Historique professionnel\n\n\n document.querySelectorAll(\"input[name=has_professional_history]\").forEach( input => {\n input.addEventListener(\"change\", (e) => {\n if(e.target.value === \"Oui\") {\n document.querySelector(\"#work_details\").style.display = \"flex\";\n } else {\n document.querySelector(\"#work_details\").style.display = \"none\";\n }\n })\n });\n\n document.querySelector(\"#add_med_button\").addEventListener('click', (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n addMedLine();\n });\n\n document.querySelector(\"#add_work_button\").addEventListener('click', (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n addWorkLine();\n })\n\n document.querySelector(\"#patient_birthday\").addEventListener('click', (e) => {e.target.setAttribute(\"type\", \"date\"); e.target.showPicker();})\n document.querySelector(\"#patient_birthday\").addEventListener('focusout', (e) => {if(!e.target.value){e.target.setAttribute(\"type\", \"text\");e.target.setAttribute(\"placeholder\", \"Date de naissance\")}})\n \n document.querySelectorAll(\"input, select, textarea\").forEach( input => {\n if(input.getAttribute(\"type\") === \"checkbox\")\n input.addEventListener('click', (e) => {\n window.localStorage.setItem(e.target.name, e.target.checked ? \"Oui\" : \"Non\")\n });\n else\n input.addEventListener('change', (e) => {\n window.localStorage.setItem(e.target.name, e.target.value);\n switch(input.nodeName) {\n case \"INPUT\":\n switch(input.getAttribute(\"type\")){\n case \"text\":\n case \"date\":\n case \"time\":\n case \"number\":\n if(input.name === \"current_school\" || input.name === \"school_year\") {\n if(input.style.display !== \"none\" && input.value === \"\")\n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n return;\n }\n if(input.value === \"\") \n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n break;\n case \"radio\":\n if(document.querySelectorAll(`input[name=${input.name}]:checked`).length === 0) \n document.querySelectorAll(`input[name=${input.name}]`).forEach( radio => {\n radio.classList.add(\"bad_radio\");\n }) \n else\n document.querySelectorAll(`input[name=${input.name}]`).forEach( radio => {\n radio.classList.remove(\"bad_radio\");\n }) \n break;\n }\n break;\n case \"SELECT\":\n if(input.value === \"null\")\n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n break;\n case \"TEXTAREA\":\n if(input.name === \"restarted_year_or_session_details\") {\n if(input.style.display !== \"none\" && input.value === \"\")\n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n return;\n }\n if(input.value === \"\")\n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n break;\n }\n })\n })\n \n const last_physical_exam_handler = () => {\n let str = \"\";\n if(window.localStorage.getItem(\"last_physical_exam_date\") !== null && window.localStorage.getItem(\"last_physical_exam_date\") !== \"\") {\n str += window.localStorage.getItem(\"last_physical_exam_date\");\n if(window.localStorage.getItem(\"last_physical_exam_details\") !== null)\n str += `, ${window.localStorage.getItem(\"last_physical_exam_details\")}`;\n\n return str;\n }\n return \"Inconnu\";\n }\n\n const pregnancy_issues_handler = () => {\n if(window.localStorage.getItem(\"had_pregnancy_issues\") === null || window.localStorage.getItem(\"had_pregnancy_issues\") === \"Non\")\n return \"Non\";\n else\n return window.localStorage.getItem(\"had_pregnancy_issues_details\")\n }\n\n const born_at_handler = () => {\n if(window.localStorage.getItem(\"born_at\") === \"\" && window.localStorage.getItem(\"born_at\") !== null && window.localStorage.getItem(\"born_at_details\") !== \"\" && window.localStorage.getItem(\"born_at_details\") !== null) {\n return window.localStorage.getItem(\"born_at_details\");\n }\n return \"Terme\"; \n }\n\n const primary_phone_handler = (field) => {\n if(window.localStorage.getItem(\"primary_phone\") === field)\n return window.localStorage.getItem(field) + \" *\";\n return window.localStorage.getItem(field); \n }\n\n const used_school_services_handler = () => {\n if(window.localStorage.getItem(\"uses_or_used_services\") === \"Non\" || window.localStorage.getItem(\"uses_or_used_services\") === null)\n return \"Non\"\n return window.localStorage.getItem(\"uses_or_used_services_details\");\n } \n\n const restarted_year_or_session_handler = () => {\n if(window.localStorage.getItem(\"restarted_year_or_session\") === \"Non\" || window.localStorage.getItem(\"restarted_year_or_session\") === null)\n return \"Non\"\n return window.localStorage.getItem(\"restarted_year_or_session_details\");\n }\n\n const isFilled = () => {\n let isFilled = false;\n\n let reqInputs = document.querySelectorAll(\"input[required], select[required], textarea[required]\");\n reqInputs.forEach( input => {\n switch(input.nodeName) {\n case \"INPUT\":\n switch(input.getAttribute(\"type\")){\n case \"text\":\n case \"date\":\n case \"time\":\n case \"number\":\n if(input.name === \"born_at_details\") {\n if(input.style.display !== \"none\" && input.value === \"\")\n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n return;\n }\n if(input.name === \"current_school\" || input.name === \"school_year\") {\n if(input.style.display !== \"none\" && input.value === \"\")\n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n return;\n } \n if(input.value === \"\")\n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n break;\n case \"radio\":\n if(document.querySelectorAll(`input[name=${input.name}]:checked`).length === 0) \n input.classList.add(\"bad_radio\");\n else\n input.classList.remove(\"bad_radio\");\n break;\n }\n break;\n case \"SELECT\":\n if(input.value === \"null\")\n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n break;\n case \"TEXTAREA\":\n if(input.name === \"restarted_year_or_session_details\") {\n if(input.style.display !== \"none\" && input.value === \"\")\n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n return;\n }\n if(input.value === \"\")\n input.classList.add(\"bad\");\n else\n input.classList.remove(\"bad\");\n break;\n }\n })\n\n let badInputs = document.querySelectorAll(\".bad, .bad_radio\")\n console.log(badInputs);\n isFilled = badInputs.length === 0;\n\n return isFilled;\n }\n\n document.querySelector(\"#submit_button\").addEventListener('click', (e) => {\n e.preventDefault();\n e.stopPropagation();\n\n if(!isFilled()) {\n window.alert(\"Make sure to fill out the required fields. (in red)\");\n return;\n }\n\n if(document.querySelector(\"input[name=accepts_terms]\").checked) {\n\n let data = {\n patient: {\n fullname: window.localStorage.getItem(\"patient_fullname\"),\n ramq: window.localStorage.getItem(\"patient_nam\"),\n ramq_exp: window.localStorage.getItem(\"patient_nam_exp\"),\n birthday: window.localStorage.getItem(\"patient_birthday\"),\n gender: window.localStorage.getItem(\"patient_gender\"),\n father_name: window.localStorage.getItem(\"patient_father_name\"),\n mother_name: window.localStorage.getItem(\"patient_mother_name\"),\n address: {\n street_number: window.localStorage.getItem(\"patient_address\"),\n city: window.localStorage.getItem(\"patient_city\"),\n zip: window.localStorage.getItem(\"patient_zip\")\n },\n home_phone: primary_phone_handler(\"patient_home_phone\"),\n other_phone: primary_phone_handler(\"patient_other_phone\"),\n resource_phone: primary_phone_handler(\"patient_resource_phone\"),\n email: window.localStorage.getItem(\"patient_email\"),\n family_dr: window.localStorage.getItem(\"family_dr\"),\n insurance: window.localStorage.getItem(\"insurance_type\"), \n is_adult: new Date(Date.now()) - new Date(window.localStorage.getItem(\"patient_birthday\"))\n },\n pharmacy: {\n name: window.localStorage.getItem(\"pharmacy_name\"),\n address: window.localStorage.getItem(\"pharmacy_address\")\n },\n family_history: {\n mother_occupation: window.localStorage.getItem(\"patient_mother_occupation\"),\n mother_scholarship: window.localStorage.getItem(\"patient_mother_scholarship\"),\n father_occupation: window.localStorage.getItem(\"patient_father_occupation\"),\n father_scholarship: window.localStorage.getItem(\"patient_father_scholarship\"),\n parent_civil_status: window.localStorage.getItem(\"parent_civil_status\"),\n parent_civil_status_details: window.localStorage.getItem(\"parent_civil_status_details\"),\n patient_civil_status: window.localStorage.getItem(\"patient_civil_status\"),\n patient_civil_status_details: window.localStorage.getItem(\"patient_civil_status_details\"),\n patient_living_with: window.localStorage.getItem(\"patient_lives_with\"),\n patient_living_with_details: window.localStorage.getItem(\"patient_lives_width_details\"),\n patient_adopted: window.localStorage.getItem(\"patient_is_adopted\"),\n patient_was_in_foster_family: window.localStorage.getItem(\"patient_was_in_foster_family\"),\n patient_has_siblings: window.localStorage.getItem(\"patient_has_siblings\"),\n siblings: JSON.parse(window.localStorage.getItem(\"siblings\")) || [],\n home_spoken_language: window.localStorage.getItem(\"home_spoken_language\") + \" \" + window.localStorage.getItem(\"home_spoken_language\") !== null && window.localStorage.getItem(\"home_spoken_language\") !== \"null\" ? window.localStorage.getItem(\"home_spoken_language\") : \"\",\n }, \n birth_history: {\n pregnancy_issues: pregnancy_issues_handler(),\n born_by: window.localStorage.getItem(\"born_by\") || \"Voie naturelle\",\n born_at: born_at_handler(),\n took_meds: window.localStorage.getItem(\"mother_took_meds_while_pregnant\") || \"Non\",\n took_alcool: window.localStorage.getItem(\"mother_took_alcool_while_pregnant\") || \"Non\",\n took_cigarets: window.localStorage.getItem(\"mother_took_cigarets_while_pregnant\") || \"Non\",\n took_drugs: window.localStorage.getItem(\"mother_took_drugs_while_pregnant\") || \"Non\",\n born_lightweight: window.localStorage.getItem(\"born_lightweight\") || \"Non\",\n apgar_score: window.localStorage.getItem(\"apgar_score\") || \"\",\n post_born_issues: window.localStorage.getItem(\"post_born_issues\") || \"Non\",\n post_born_issues_details: window.localStorage.getItem(\"post_born_issues_details\") || \"\",\n },\n medical_history: {\n has_allergies: window.localStorage.getItem(\"has_allergies\") || \"Non\",\n has_allergies_details: window.localStorage.getItem(\"has_allergies_details\") || \"\",\n has_intolerances: window.localStorage.getItem(\"has_intolerances\") || \"Non\",\n has_intolerances_details: window.localStorage.getItem(\"has_intolerances_details\") || \"\",\n has_illness: window.localStorage.getItem(\"has_illness\") || \"Non\",\n has_illness_details: window.localStorage.getItem(\"has_illness_details\") || \"\",\n has_surgeries: window.localStorage.getItem(\"has_surgeries\") || \"Non\",\n has_surgeries_details: window.localStorage.getItem(\"has_surgeries_details\") || \"\",\n has_viewing_issues: window.localStorage.getItem(\"has_viewing_issues\") || \"Non\",\n has_viewing_issues_details: window.localStorage.getItem(\"has_viewing_issues_details\") || \"\",\n has_earing_issues: window.localStorage.getItem(\"has_earing_issues\") || \"Non\",\n has_earing_issues_details: window.localStorage.getItem(\"has_earing_issues_details\") || \"\",\n last_physical_exam_date: last_physical_exam_handler(),\n }, \n neurology_history: {\n has_convulsion: window.localStorage.getItem(\"has_epilepsy\") || \"Non\",\n has_convulsion_details: window.localStorage.getItem(\"has_epilepsy_details\") || \"\",\n has_head_trauma: window.localStorage.getItem(\"has_head_trauma\") || \"Non\",\n has_head_trauma_details: window.localStorage.getItem(\"has_head_trauma_details\") || \"\",\n has_coordination_problems: window.localStorage.getItem(\"has_coordination_problems\") || \"Non\",\n has_coordination_problems_details: window.localStorage.getItem(\"has_coordination_problems_details\") || \"\",\n has_diabetes: window.localStorage.getItem(\"has_diabetes\") || \"Non\",\n has_diabetes_details: window.localStorage.getItem(\"has_diabetes_details\") || \"\",\n has_growth_retardation: window.localStorage.getItem(\"has_growth_retardation\") || \"Non\",\n has_growth_retardation_details: window.localStorage.getItem(\"has_growth_retardation_details\") || \"\",\n },\n ent_history: {\n has_recurrent_ear_infections: window.localStorage.getItem(\"has_repeated_otitis\") || \"Non\",\n has_recurrent_ear_infections_details: window.localStorage.getItem(\"has_repeated_otitis_details\") || \"\",\n has_sleep_disorder: window.localStorage.getItem(\"has_sleep_apnea\") || \"Non\",\n has_sleep_disorder_details: window.localStorage.getItem(\"has_sleep_apnea_details\") || \"\",\n has_asthma: window.localStorage.getItem(\"has_asthma\") || \"Non\",\n has_asthma_details: window.localStorage.getItem(\"has_asthma_details\") || \"\",\n has_enlarged_adenoids: window.localStorage.getItem(\"has_enlarged_adenoids\") || \"Non\",\n has_enlarged_adenoids_details: window.localStorage.getItem(\"has_enlarged_adenoids_details\") || \"\",\n },\n cardiovascular_history: {\n has_heart_murmur: window.localStorage.getItem(\"has_heart_murmur\") || \"Non\",\n has_heart_murmur_details: window.localStorage.getItem(\"has_heart_murmur_details\") || \"\",\n has_palpitations: window.localStorage.getItem(\"has_palpitations\") || \"Non\",\n has_palpitations_details: window.localStorage.getItem(\"has_palpitations_details\") || \"\",\n has_consciousness_loss: window.localStorage.getItem(\"has_consciousness_loss\") || \"Non\",\n has_consciousness_loss_details: window.localStorage.getItem(\"has_consciousness_loss_details\") || \"\",\n has_dispnea: window.localStorage.getItem(\"has_dispnea\") || \"Non\",\n has_dispnea_details: window.localStorage.getItem(\"has_dispnea_details\") || \"\",\n has_hypertension: window.localStorage.getItem(\"has_hypertension\") || \"Non\",\n has_hypertension_details: window.localStorage.getItem(\"has_hypertension_details\") || \"\",\n has_chest_pain: window.localStorage.getItem(\"has_chest_pain\") || \"Non\",\n has_chest_pain_details:window.localStorage.getItem(\"has_chest_pain_details\") || \"\",\n has_positive_ecg: window.localStorage.getItem(\"has_positive_ecg\") || \"Non\",\n has_positive_ecg_details: window.localStorage.getItem(\"has_positive_ecg_details\") || \"\",\n },\n childhood_history: {\n has_language_issues: window.localStorage.getItem(\"has_language_issues\") || \"Non\",\n has_language_issues_details: window.localStorage.getItem(\"has_language_issues_details\") || \"\",\n has_gross_motor_problems: window.localStorage.getItem(\"has_gross_motor_problems\") || \"Non\",\n has_gross_motor_problems_details: window.localStorage.getItem(\"has_gross_motor_problems_details\") || \"\",\n has_fine_motor_problems: window.localStorage.getItem(\"has_fine_motor_problems\") || \"Non\",\n has_fine_motor_problems_details: window.localStorage.getItem(\"has_fine_motor_problems_details\") || \"\",\n has_enuresis: window.localStorage.getItem(\"has_enuresis\") || \"Non\",\n has_enuresis_details: window.localStorage.getItem(\"has_enuresis_details\") || \"\",\n has_behavior_problems: window.localStorage.getItem(\"has_behavior_problems\") || \"Non\",\n has_behavior_problems_details: window.localStorage.getItem(\"has_behavior_problems_details\") || \"\",\n has_sensory_hypersensitivity: window.localStorage.getItem(\"has_sensory_hypersensitivity\") || \"Non\",\n has_sensory_hypersensitivity_details: window.localStorage.getItem(\"has_sensory_hypersensitivity_details\") || \"\",\n has_mannerism: window.localStorage.getItem(\"has_mannerism\") || \"Non\",\n has_mannerism_details: window.localStorage.getItem(\"has_mannerism_details\") || \"\"\n },\n learning_history: {\n has_dyslexia: window.localStorage.getItem(\"has_dyslexia\") || \"Non\",\n has_dyslexia_details: window.localStorage.getItem(\"has_dyslexia_details\") || \"\",\n has_dysorthography: window.localStorage.getItem(\"has_dysorthography\") || \"Non\",\n has_dysorthography_details: window.localStorage.getItem(\"has_dysorthography_details\") || \"\",\n has_dyscalculia: window.localStorage.getItem(\"has_dyscalculia\") || \"Non\",\n has_dyscalculia_details: window.localStorage.getItem(\"has_dyscalculia_details\") || \"\",\n has_dysphasia: window.localStorage.getItem(\"has_dysphasia\") || \"Non\",\n has_dysphasia_details: window.localStorage.getItem(\"has_dysphasia_details\") || \"\",\n has_dyspraxia: window.localStorage.getItem(\"has_dyspraxia\") || \"Non\",\n has_dyspraxia_details: window.localStorage.getItem(\"has_dyspraxia_details\") || \"\"\n },\n other_history: {\n has_giftedness: window.localStorage.getItem(\"has_giftedness\") || \"Non\",\n has_giftedness_details: window.localStorage.getItem(\"has_giftedness_details\") || \"\",\n has_med_complications: window.localStorage.getItem(\"has_med_complications\") || \"Non\",\n has_med_complications_details: window.localStorage.getItem(\"has_med_complications_details\") || \"\"\n },\n paramedical_follow_ups: {\n saw_specialists: window.localStorage.getItem(\"saw_specialist\") || \"Non\",\n specialists: JSON.parse(window.localStorage.getItem(\"specialists\")) || []\n },\n specialists: JSON.parse(window.localStorage.getItem(\"specialists\")) || [],\n family_medical_history: {\n probable_adhd: window.localStorage.getItem(\"probable_adhd\") || \"Non\",\n probable_adhd_who: window.localStorage.getItem(\"probable_adhd_who\") || \"\",\n confirmed_adhd: window.localStorage.getItem(\"confirmed_adhd\") || \"Non\",\n confirmed_adhd_who: window.localStorage.getItem(\"confirmed_adhd_who\") || \"\",\n learning_issues: window.localStorage.getItem(\"learning_issues\") || \"Non\",\n learning_issues_who: window.localStorage.getItem(\"learning_issues_who\") || \"\",\n giftedness: window.localStorage.getItem(\"giftedness\") || \"Non\",\n giftedness_who: window.localStorage.getItem(\"giftedness_who\") || \"\",\n autism: window.localStorage.getItem(\"autism\") || \"Non\",\n autism_who: window.localStorage.getItem(\"autism_who\") || \"\",\n congenital_disorder: window.localStorage.getItem(\"congenital_disorder\") || \"Non\",\n congenital_disorder_who: window.localStorage.getItem(\"congenital_disorder_who\") || \"\",\n anxiety: window.localStorage.getItem(\"anxiety\") || \"Non\",\n anxiety_who: window.localStorage.getItem(\"anxiety_who\") || \"\",\n depression: window.localStorage.getItem(\"depression\") || \"Non\",\n depression_who: window.localStorage.getItem(\"depression_who\") || \"\",\n bipolar: window.localStorage.getItem(\"bipolar\") || \"Non\",\n bipolar_who: window.localStorage.getItem(\"bipolar_who\") || \"\",\n phychosis: window.localStorage.getItem(\"phychosis\") || \"Non\",\n phychosis_who: window.localStorage.getItem(\"phychosis_who\") || \"\",\n personality_disorder: window.localStorage.getItem(\"personality_disorder\") || \"Non\",\n personality_disorder_who: window.localStorage.getItem(\"personality_disorder_who\") || \"\",\n suicide: window.localStorage.getItem(\"suicide\") || \"Non\",\n suicide_who: window.localStorage.getItem(\"suicide_who\") || \"\",\n sleep_disorder: window.localStorage.getItem(\"sleep_disorder\") || \"Non\",\n sleep_disorder_who: window.localStorage.getItem(\"sleep_disorder_who\") || \"\",\n tourette: window.localStorage.getItem(\"tourette\") || \"Non\",\n tourette_who: window.localStorage.getItem(\"tourette_who\") || \"\",\n epilepsy: window.localStorage.getItem(\"epilepsy\") || \"Non\",\n epilepsy_who: window.localStorage.getItem(\" epilepsy_who\") || \"\",\n drugs:window.localStorage.getItem(\"drugs\") || \"Non\",\n drugs_who: window.localStorage.getItem(\"drugs_who\") || \"\",\n criminal_record: window.localStorage.getItem(\"criminal_record\") || \"Non\",\n criminal_record_who: window.localStorage.getItem(\" criminal_record_who\") || \"\",\n premature_cardiac_death: window.localStorage.getItem(\"premature_cardiac_death\") || \"Non\",\n premature_cardiac_death_who: window.localStorage.getItem(\"premature_cardiac_death_who\") || \"\",\n arrhythmia: window.localStorage.getItem(\"arrhythmia\") || \"Non\",\n arrhythmia_who: window.localStorage.getItem(\" arrhythmia_who\") || \"\",\n hypertension: window.localStorage.getItem(\"hypertension\") || \"Non\",\n hypertension_who: window.localStorage.getItem(\"hypertension_who\") || \"\",\n thyroid: window.localStorage.getItem(\"thyroid\") || \"Non\",\n thyroid_who: window.localStorage.getItem(\"thyroid_who\") || \"\",\n alzheimer: window.localStorage.getItem(\"alzheimer\") || \"Non\",\n alzheimer_who: window.localStorage.getItem(\"alzheimer_who\") || \"\"\n },\n sleep_history: {\n has_sleeping_issues: window.localStorage.getItem(\"has_sleeping_disorder\") || \"Non\",\n week_out: window.localStorage.getItem(\"week_out\") || \"\",\n week_in: window.localStorage.getItem(\"week_in\") || \"\",\n weekend_out: window.localStorage.getItem(\"weekend_out\") || \"\",\n weekend_in: window.localStorage.getItem(\"weekend_in\") || \"\",\n get_to_sleep_time: window.localStorage.getItem(\"get_to_sleep_time\") || \"\",\n is_exposed_to_screen_before_sleep: window.localStorage.getItem(\"is_exposed_to_screen_before_sleep\") || \"Non\"\n },\n school_history: {\n is_at_school: window.localStorage.getItem(\"is_at_school\") || \"Non\",\n current_school: window.localStorage.getItem(\"current_school\") || \"\",\n past_schools: JSON.parse(window.localStorage.getItem(\"past_schools\")) || [],\n patient_is_in_grade: window.localStorage.getItem(\"school_year\") || \"\",\n class_type: window.localStorage.getItem(\"class_type\") || \"\" + \" \" + window.localStorage.getItem(\"class_type_details\") !== null && window.localStorage.getItem(\"class_type_details\") !== \"null\" ? window.localStorage.getItem(\"class_type_details\") : \"\",\n spoken_language: \"\",\n got_detention: window.localStorage.getItem(\"got_detention\") || \"Non\",\n got_suspended: window.localStorage.getItem(\"got_suspended\") || \"Non\",\n got_expelled: window.localStorage.getItem(\"got_expelled\") || \"Non\",\n got_intervention_plan: window.localStorage.getItem(\"got_intervention_plan\") || \"Non\",\n uses_or_used_services: used_school_services_handler(),\n behavior_in_class: window.localStorage.getItem(\"school_behavior\") || \"\",\n 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