@extends('layouts.app') @section('content')
Back to Patients

Patient Assessment Form

Review patient information and prescription request

Pending Review
Personal Information

{{ $patient['first_name'] }}

{{ $patient['last_name'] }}

{{ \Carbon\Carbon::parse($patient['date_of_birth'])->format('m/d/Y') }}

{{ $patient['gender'] }}

{{ $patient['contact_number'] }}

{{ $patient['email'] }}

{{ $patient['street_address'] }}
{{ $patient['city'] }}, {{ $patient['state'] }} {{ $patient['zip_code'] }}

Medical Information

{{ $patient['chief_complaint'] }}

{{ $patient['medication'] }}

{{ $patient['is_pregnant'] === 'yes' ? 'Yes' : 'No' }}

{{ $patient['is_breastfeeding'] === 'yes' ? 'Yes' : 'No' }}

@if($patient['has_medical_conditions'] === 'yes')

{{ $patient['medical_conditions_list'] }}

@else

None reported

@endif
@if($patient['has_other_medications'] === 'yes')

{{ $patient['other_medications_list'] }}

@else

None reported

@endif
@if($patient['has_drug_allergies'] === 'yes')

{{ $patient['drug_allergies_list'] }}

@else

None reported

@endif
Pharmacy Information

{{ $patient['pharmacy'] }}

@if($patient['request_type'] === 'refill') Refill Request @else New Prescription @endif

Approval & Sig
@csrf

Directions have been auto-generated based on the medication type

This is a clickthrough prototype - directions are auto-generated

@if(session('approved')) @endif @endsection