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<!doctype html>
<html lang="zh-Hant-TW">
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<title>eyeForm - Neurobit AI</title>
<link rel="apple-touch-icon" sizes="180x180" href="favicon/apple-touch-icon.png">
<link rel="icon" type="image/png" sizes="32x32" href="favicon/favicon-32x32.png">
<link rel="icon" type="image/png" sizes="16x16" href="favicon/favicon-16x16.png">
<link rel="manifest" href="favicon/site.webmanifest">
<!-- <link href="https://fonts.googleapis.com/css?family=Oswald:300,400|Roboto+Mono&display=swap" rel="stylesheet"> -->
<!-- <link rel="stylesheet" href="fonts/icomoon/style.css"> -->
<link rel="stylesheet" href="css/bootstrap.513.min.css">
<link rel="stylesheet" href="css/style.css">
<script src="js/jquery-3.3.1.min.js"></script>
<script src="js/popper.min.js"></script>
<script src="js/bootstrap.bundle.min.js"></script>
<script src="js/jquery.validate.min.js"></script>
<script src="js/main.js"></script>
</head>
<body class="bg-light">
<script src="js/jwt-decode.js"></script>
<script src="https://accounts.google.com/gsi/client" async defer></script>
<script>
function handleCredentialResponse(response) {
var token = response.credential;
var decoded = jwt_decode(token);
console.log(decoded.name);
console.log(decoded.email);
document.getElementById('name').value = decoded.name;
document.getElementById('email').value = decoded.email;
$('#staticBackdrop').modal('hide');
$.ajax({
url: 'https://aw7c8d4hh6.execute-api.ap-east-1.amazonaws.com/suggestion',
type: 'POST',
dataType: 'json',
data: JSON.stringify([1,2,3,4,5,6,7,8,9,10]),
complete: function(data) {
console.log(data['responseText']);
}
});
}
window.onload = function () {
google.accounts.id.initialize({
client_id: "804327021269-tvgs2une4gdpepaslb7niggg1c0pldjp.apps.googleusercontent.com",
callback: handleCredentialResponse
});
google.accounts.id.renderButton(
document.getElementById("buttonDiv"),
{ theme: "filled_blue", size: "large", text: "continue_with" } // customization attributes
);
// google.accounts.id.prompt(); // also display the One Tap dialog
}
</script>
<script type="text/javascript">
$(window).on('load', function() {
$('#staticBackdrop').modal('show');
});
</script>
<div class="modal fade" id="staticBackdrop" data-bs-backdrop="static" data-bs-keyboard="false" tabindex="-1" aria-labelledby="staticBackdropLabel" aria-hidden="true">
<div class="modal-dialog">
<div class="modal-content">
<div class="modal-header">
<h5 class="modal-title" id="staticBackdropLabel">eyeForm學齡兒童近視追蹤</h5>
<!-- <button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button> -->
</div>
<div class="modal-body" id="buttonDiv">
...
</div>
<div class="modal-footer">
©2023神經元科技
<!-- <button type="button" class="btn btn-secondary" data-bs-dismiss="modal">Close</button>
<button type="button" class="btn btn-primary">Understood</button> -->
</div>
</div>
</div>
</div>
<div class="content">
<div class="container">
<div class="row justify-content-center">
<div class="col">
<div class="float-end form-group form-check form-switch">
<input class="form-check-input" type="checkbox" id="darkMode">
<label class="form-check-label" for="darkMode">深色模式</label>
</div>
</div>
<form method="post" id="eyeForm" name="eyeForm">
<input type="hidden" name="odRisk" id="odRisk">
<input type="hidden" name="osRisk" id="osRisk">
<input type="hidden" name="name" id="name">
<input type="hidden" name="email" id="email">
<div class="row">
<div class="col-6 form-group">
<label class="form-label" for="medRecNo">病歷號</label>
<input type="text" class="form-control" name="medRecNo" id="medRecNo">
</div>
<div class="col-3 form-group">
<label class="form-label" for="site">院所</label>
<select class="form-select" name="site" id="site">
<option value=""></option>
<option value="三總">三總</option>
<option value="皓明">皓明</option>
</select>
</div>
<div class="col-3 form-group">
<label class="form-label" for="caseNo">案號</label>
<input type="number" class="form-control" name="caseNo" id="caseNo" disabled>
</div>
</div>
<div class="row">
<div class="col-6 form-group">
<label class="form-label" for="dateOfVisit">就診西元年/月/日</label>
<input type="date" class="form-control" name="dateOfVisit" id="dateOfVisit">
</div>
<div class="col-6 form-group">
<label class="form-label" for="dateOfBirth">出生西元年/月/日</label>
<input type="date" class="form-control" name="dateOfBirth" id="dateOfBirth">
</div>
</div>
<div class="row">
<div class="col-3 form-group">
<label class="form-label" for="age">實歲</label>
<input type="text" class="form-control" name="age" id="age" disabled>
</div>
<div class="col-3 form-group">
<label class="form-label" for="height">身高(cm)</label>
<input type="number" min=1 step=0.1 class="form-control" name="height" id="height">
</div>
<div class="col-6 form-group">
<label class="form-label" for="pretermW">早產週數</label>
<div class="row g-0">
<div class="col-5 form-group">
<input type="number" min=0 step=1 class="form-control" name="pretermW" id="pretermW">
</div>
<div class="col-1 form-group">
<label class="form-label" for="pretermW">週</label>
</div>
<div class="col-5 form-group">
<input type="number" min=0 step=1 max=6 class="form-control" name="pretermD" id="pretermD">
</div>
<div class="col-1 form-group">
<label class="form-label" for="pretermD">天</label>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-6 form-group">
<label class="form-label">性別</label>
<input type="radio" class="form-check-input" name="sex" id="sexM" value="男">
<label class="form-label" for="sexM">男 </label>
<input type="radio" class="form-check-input" name="sex" id="sexF" value="女">
<label class="form-label" for="sexF">女 </label>
</div>
<div class="col-6 form-group">
<label class="form-label">胎別</label>
<input type="radio" class="form-check-input" name="birth" id="birth" value="單">
<label class="form-label" for="birth">單 </label>
<input type="radio" class="form-check-input" name="birth" id="births" value="多">
<label class="form-label" for="births">多 </label>
</div>
</div>
<div class="row">
<div class="col-6 form-group">
<label class="form-label" for="fatherD">父：近視度數 ≦ -5D</label>
<input type="number" max=-5 step=0.5 class="form-control" name="fatherD" id="fatherD">
</div>
<div class="col-6 form-group">
<label class="form-label" for="motherD">母：近視度數 ≦ -5D</label>
<input type="number" max=-5 step=0.5 class="form-control" name="motherD" id="motherD">
</div>
</div>
<br><hr style="color:red"><br>
<div class="row">
<div class="col-6 form-group">
<label class="form-label" for="od1">右眼最佳矯正視力<span class="form-range-value" id="od1value"></span></label>
<label class="form-label" for="od0">戴眼鏡</label>
<input type="checkbox" class="form-check-input" name="od0" id="od0" value="G">
<input type="range" class="form-range" min=0 max=1 step=0.1 name="od1" id="od1">
</div>
<div class="col-6 form-group">
<label class="form-label" for="os1">左眼最佳矯正視力<span class="form-range-value" id="os1value"></span></label>
<label class="form-label" for="os0">戴眼鏡</label>
<input type="checkbox" class="form-check-input" name="os0" id="os0" value="G">
<input type="range" class="form-range" min=0 max=1 step=0.1 name="os1" id="os1">
</div>
</div>
<div class="row">
<div class="col-6 form-group">
<label class="form-label" for="od2">右眼球面度數 <span class="form-range-value" id="od2value"></span></label>
<input type="range" class="form-range" min=-10 max=10 step=0.25 name="od2" id="od2">
</div>
<div class="col-6 form-group">
<label class="form-label" for="os2">左眼球面度數 <span class="form-range-value" id="os2value"></span></label>
<input type="range" class="form-range" min=-10 max=10 step=0.25 name="os2" id="os2">
</div>
</div>
<div class="row">
<div class="col-6 form-group">
<label class="form-label" for="od3">右眼散光度數 <span class="form-range-value" id="od3value"></span></label>
<input type="range" class="form-range" min=-7 max=0 step=0.25 name="od3" id="od3">
</div>
<div class="col-6 form-group">
<label class="form-label" for="os3">左眼散光度數 <span class="form-range-value" id="os3value"></span></label>
<input type="range" class="form-range" min=-7 max=0 step=0.25 name="os3" id="os3">
</div>
</div>
<div class="row">
<div class="col-6 form-group">
<label class="form-label" for="od4">右眼軸度</label>
<select class="form-select" name="od4" id="od4">
<option value=""></option>
<optgroup label="常見">
<option value="0">0</option>
<option value="90">90</option>
<option value="180">180</option>
<option value="10">10</option>
<option value="170">170</option>
<option value="20">20</option>
<option value="160">160</option>
</optgroup>
<optgroup label="--------------------">
<option value="5">5</option>
<option value="10">10</option>
<option value="15">15</option>
<option value="20">20</option>
<option value="25">25</option>
<option value="30">30</option>
<option value="35">35</option>
<option value="40">40</option>
<option value="45">45</option>
<option value="50">50</option>
<option value="55">55</option>
<option value="60">60</option>
<option value="65">65</option>
<option value="70">70</option>
<option value="75">75</option>
<option value="80">80</option>
<option value="85">85</option>
<option value="90">90</option>
<option value="95">95</option>
<option value="100">100</option>
<option value="105">105</option>
<option value="110">110</option>
<option value="115">115</option>
<option value="120">120</option>
<option value="125">125</option>
<option value="130">130</option>
<option value="135">135</option>
<option value="140">140</option>
<option value="145">145</option>
<option value="150">150</option>
<option value="155">155</option>
<option value="160">160</option>
<option value="165">165</option>
<option value="170">170</option>
<option value="175">175</option>
</optgroup>
</select>
</div>
<div class="col-6 form-group">
<label class="form-label" for="os4">左眼軸度</label>
<select class="form-select" name="os4" id="os4">
<option value=""></option>
<optgroup label="常見">
<option value="0">0</option>
<option value="90">90</option>
<option value="180">180</option>
<option value="10">10</option>
<option value="170">170</option>
<option value="20">20</option>
<option value="160">160</option>
</optgroup>
<optgroup label="--------------------">
<option value="5">5</option>
<option value="10">10</option>
<option value="15">15</option>
<option value="20">20</option>
<option value="25">25</option>
<option value="30">30</option>
<option value="35">35</option>
<option value="40">40</option>
<option value="45">45</option>
<option value="50">50</option>
<option value="55">55</option>
<option value="60">60</option>
<option value="65">65</option>
<option value="70">70</option>
<option value="75">75</option>
<option value="80">80</option>
<option value="85">85</option>
<option value="90">90</option>
<option value="95">95</option>
<option value="100">100</option>
<option value="105">105</option>
<option value="110">110</option>
<option value="115">115</option>
<option value="120">120</option>
<option value="125">125</option>
<option value="130">130</option>
<option value="135">135</option>
<option value="140">140</option>
<option value="145">145</option>
<option value="150">150</option>
<option value="155">155</option>
<option value="160">160</option>
<option value="165">165</option>
<option value="170">170</option>
<option value="175">175</option>
</optgroup>
</select>
</div>
</div>
<div class="row">
<div class="col-6 form-group">
<label class="form-label" for="od5int">右眼軸長(mm)</label>
<div class="row g-0">
<div class="col-6 form-group">
<select class="form-select" name="od5int" id="od5int">
<option value=""></option>
<option value="< 20">< 20</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="> 30">> 30</option>
</select>
</div>
<div class="col-6 form-group">
<select class="form-select" name="od5dec" id="od5dec">
<option value=".00">.00</option>
<option value=".01">.01</option>
<option value=".02">.02</option>
<option value=".03">.03</option>
<option value=".04">.04</option>
<option value=".05">.05</option>
<option value=".06">.06</option>
<option value=".07">.07</option>
<option value=".08">.08</option>
<option value=".09">.09</option>
<option value=".10">.10</option>
<option value=".11">.11</option>
<option value=".12">.12</option>
<option value=".13">.13</option>
<option value=".14">.14</option>
<option value=".15">.15</option>
<option value=".16">.16</option>
<option value=".17">.17</option>
<option value=".18">.18</option>
<option value=".19">.19</option>
<option value=".20">.20</option>
<option value=".21">.21</option>
<option value=".22">.22</option>
<option value=".23">.23</option>
<option value=".24">.24</option>
<option value=".25">.25</option>
<option value=".26">.26</option>
<option value=".27">.27</option>
<option value=".28">.28</option>
<option value=".29">.29</option>
<option value=".30">.30</option>
<option value=".31">.31</option>
<option value=".32">.32</option>
<option value=".33">.33</option>
<option value=".34">.34</option>
<option value=".35">.35</option>
<option value=".36">.36</option>
<option value=".37">.37</option>
<option value=".38">.38</option>
<option value=".39">.39</option>
<option value=".40">.40</option>
<option value=".41">.41</option>
<option value=".42">.42</option>
<option value=".43">.43</option>
<option value=".44">.44</option>
<option value=".45">.45</option>
<option value=".46">.46</option>
<option value=".47">.47</option>
<option value=".48">.48</option>
<option value=".49">.49</option>
<option value=".50">.50</option>
<option value=".51">.51</option>
<option value=".52">.52</option>
<option value=".53">.53</option>
<option value=".54">.54</option>
<option value=".55">.55</option>
<option value=".56">.56</option>
<option value=".57">.57</option>
<option value=".58">.58</option>
<option value=".59">.59</option>
<option value=".60">.60</option>
<option value=".61">.61</option>
<option value=".62">.62</option>
<option value=".63">.63</option>
<option value=".64">.64</option>
<option value=".65">.65</option>
<option value=".66">.66</option>
<option value=".67">.67</option>
<option value=".68">.68</option>
<option value=".69">.69</option>
<option value=".70">.70</option>
<option value=".71">.71</option>
<option value=".72">.72</option>
<option value=".73">.73</option>
<option value=".74">.74</option>
<option value=".75">.75</option>
<option value=".76">.76</option>
<option value=".77">.77</option>
<option value=".78">.78</option>
<option value=".79">.79</option>
<option value=".80">.80</option>
<option value=".81">.81</option>
<option value=".82">.82</option>
<option value=".83">.83</option>
<option value=".84">.84</option>
<option value=".85">.85</option>
<option value=".86">.86</option>
<option value=".87">.87</option>
<option value=".88">.88</option>
<option value=".89">.89</option>
<option value=".90">.90</option>
<option value=".91">.91</option>
<option value=".92">.92</option>
<option value=".93">.93</option>
<option value=".94">.94</option>
<option value=".95">.95</option>
<option value=".96">.96</option>
<option value=".97">.97</option>
<option value=".98">.98</option>
<option value=".99">.99</option>
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<div class="col-6 form-group">
<label class="form-label" for="os5int">左眼軸長(mm)</label>
<div class="row g-0">
<div class="col-6 form-group">
<select class="form-select" name="os5int" id="os5int">
<option value=""></option>
<option value="< 20">< 20</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
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<option value="26">26</option>
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<div class="col-6 form-group">
<select class="form-select" name="os5dec" id="os5dec">
<option value=".00">.00</option>
<option value=".01">.01</option>
<option value=".02">.02</option>
<option value=".03">.03</option>
<option value=".04">.04</option>
<option value=".05">.05</option>
<option value=".06">.06</option>
<option value=".07">.07</option>
<option value=".08">.08</option>
<option value=".09">.09</option>
<option value=".10">.10</option>
<option value=".11">.11</option>
<option value=".12">.12</option>
<option value=".13">.13</option>
<option value=".14">.14</option>
<option value=".15">.15</option>
<option value=".16">.16</option>
<option value=".17">.17</option>
<option value=".18">.18</option>
<option value=".19">.19</option>
<option value=".20">.20</option>
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<option value=".22">.22</option>
<option value=".23">.23</option>
<option value=".24">.24</option>
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<option value=".26">.26</option>
<option value=".27">.27</option>
<option value=".28">.28</option>
<option value=".29">.29</option>
<option value=".30">.30</option>
<option value=".31">.31</option>
<option value=".32">.32</option>
<option value=".33">.33</option>
<option value=".34">.34</option>
<option value=".35">.35</option>
<option value=".36">.36</option>
<option value=".37">.37</option>
<option value=".38">.38</option>
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<option value=".41">.41</option>
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<option value=".44">.44</option>
<option value=".45">.45</option>
<option value=".46">.46</option>
<option value=".47">.47</option>
<option value=".48">.48</option>
<option value=".49">.49</option>
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<option value=".52">.52</option>
<option value=".53">.53</option>
<option value=".54">.54</option>
<option value=".55">.55</option>
<option value=".56">.56</option>
<option value=".57">.57</option>
<option value=".58">.58</option>
<option value=".59">.59</option>
<option value=".60">.60</option>
<option value=".61">.61</option>
<option value=".62">.62</option>
<option value=".63">.63</option>
<option value=".64">.64</option>
<option value=".65">.65</option>
<option value=".66">.66</option>
<option value=".67">.67</option>
<option value=".68">.68</option>
<option value=".69">.69</option>
<option value=".70">.70</option>
<option value=".71">.71</option>
<option value=".72">.72</option>
<option value=".73">.73</option>
<option value=".74">.74</option>
<option value=".75">.75</option>
<option value=".76">.76</option>
<option value=".77">.77</option>
<option value=".78">.78</option>
<option value=".79">.79</option>
<option value=".80">.80</option>
<option value=".81">.81</option>
<option value=".82">.82</option>
<option value=".83">.83</option>
<option value=".84">.84</option>
<option value=".85">.85</option>
<option value=".86">.86</option>
<option value=".87">.87</option>
<option value=".88">.88</option>
<option value=".89">.89</option>
<option value=".90">.90</option>
<option value=".91">.91</option>
<option value=".92">.92</option>
<option value=".93">.93</option>
<option value=".94">.94</option>
<option value=".95">.95</option>
<option value=".96">.96</option>
<option value=".97">.97</option>
<option value=".98">.98</option>
<option value=".99">.99</option>
</select>
</div>
</div>
</div>
</div>
<br><hr style="color:red"><br>
<div class="row">
<div class="col-9 form-group">
<input type="radio" class="form-check-input" name="treatment" id="treatmentN" value="N" checked>
<label class="form-label" for="treatmentN">未治療或觀察 </label>
<input type="radio" class="form-check-input" name="treatment" id="treatmentY" value="Y">
<label class="form-label" for="treatmentY">治療處置 </label>
</div>
</div>
<br>
<div class="row g-2">
<div class="col-4 form-group">
<label class="form-label" for="treatment1">眼鏡</label>
<select class="form-select" name="treatment1" id="treatment1" disabled>
<option value=""></option>
<option value="一般眼鏡">一般眼鏡</option>
<option value="近視控制眼鏡_Zeiss_MyoVision">近視控制眼鏡_Zeiss_MyoVision</option>
<option value="近視控制眼鏡_Hoya_MiyoSmart">近視控制眼鏡_Hoya_MiyoSmart</option>
<option value="近視控制眼鏡_依視路_星趣控">近視控制眼鏡_依視路_星趣控</option>
<option value="近視控制隱形眼鏡_酷柏_MiSight">近視控制隱形眼鏡_酷柏_MiSight</option>
</select>
</div>
<div class="col-4 form-group">
<label class="form-label" for="treatment2">散瞳劑</label>
<select class="form-select" name="treatment2" id="treatment2" disabled>
<option value=""></option>
<option value="短效">短效</option>
<option value="0.01%">0.01%</option>
<option value="0.02%">0.02%</option>
<option value="0.03%">0.03%</option>
<option value="0.05%">0.05%</option>
<option value="0.1%">0.1%</option>
<option value="0.3%">0.3%</option>
<option value="0.5%">0.5%</option>
<option value="1.0%">1.0%</option>
</select>
</div>
<div class="col-4 form-group">
<label class="form-label" for="treatment3">角膜塑型片</label>
<select class="form-select" name="treatment3" id="treatment3" disabled>
<option value=""></option>
<option value="角膜塑型片">角膜塑型片</option>
</select>
</div>
</div>
<br><hr style="color:red"><br>
<div class="col">
<div class="float-end form-group">
<label class="form-label">提醒您，自動填入的最近就診日期要更新喔👆</label><br>
<button type="button" id="suggestion" class="btn btn-outline-primary btn-rounded py-0 px-4">
處置建議
</button>
<button type="button" id="report1" class="btn btn-outline-primary btn-rounded py-0 px-4">
軸長危險度分析
</button>
<button type="button" id="report2" class="btn btn-outline-primary btn-rounded py-0 px-4">
球面度數危險度分析
</button>
<input type="submit" id="submit" value="上傳" class="btn btn-outline-primary btn-rounded py-0 px-4">
<span class="submitting"></span>
</div>
</div>
<br><br>
</form>
<div id="form-message-warning mt-4"></div>
<div id="form-message-success">
上傳完畢！
</div>
</div>
</div>
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