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sick-report.html
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sick-report.html
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<!--
For reporting pain
-->
<!DOCTYPE html>
<html>
<head>
<title>Sick Report</title>
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="http://code.jquery.com/mobile/1.2.0-rc.2/jquery.mobile-1.2.0-rc.2.min.css" />
<script src="http://code.jquery.com/jquery-1.8.1.min.js"></script>
<script src="http://code.jquery.com/mobile/1.2.0-rc.2/jquery.mobile-1.2.0-rc.2.min.js"></script>
</head>
<body>
<div data-role="page">
<div data-role="header">
<h1>Sick Report</h1>
<a href="index.html" data-icon="home" data-direction="reverse">Home</a>
</div><!-- /header -->
<div data-role="content">
<label for="select-choice-0" class="select">Where is the pain?</label>
<select name="select-choice-0" id="select-choice-0">
<option value="head">Head</option>
<option value="shoulders">Shoulders</option>
<option value="knees">Knees</option>
<option value="toes">Toes</option>
</select>
<fieldset data-role="controlgroup">
<input type="radio" name="radio-mini" id="radio-mini-1" value="choice-1" checked="checked" />
<label for="radio-mini-1">no pain</label>
<input type="radio" name="radio-mini" id="radio-mini-2" value="choice-2" />
<label for="radio-mini-2">mild pain</label>
<input type="radio" name="radio-mini" id="radio-mini-3" value="choice-3" />
<label for="radio-mini-3">moderate pain</label>
<input type="radio" name="radio-mini" id="radio-mini-4" value="choice-4" />
<label for="radio-mini-4">severe pain</label>
<input type="radio" name="radio-mini" id="radio-mini-5" value="choice-5" />
<label for="radio-mini-5">very severe pain</label>
</fieldset>
<button type="submit" data-theme="a">Add</button>
<a href="#" data-role="button">Past Reports</a>
<!--
<ul data-role="listview" data-inset="true">
<li><a href="#">Medical Data</a></li>
<li><a href="#">Settings</a></li>
</ul>
-->
<!--
recently added data
-->
</div><!-- /content -->
</div><!-- /page -->
</body>
</html>