MedicalFormLable('kidsHealthConcerns'); ?>

getValue('none', $kid_heathConcerns, false) ? 'disabled' : '';?>

km_display_pop_checked($kid_heathConcerns, 'none');?> class="km_noform" id="health-c-none" type="checkbox" >

id="health-c-add" name="forms[healthConcerns][add]" km_display_pop_checked($kid_heathConcerns, 'add');?> type="checkbox">
id="health-c-onMedicationForAdd" name="forms[healthConcerns][onMedicationForAdd]" km_display_pop_checked($kid_heathConcerns, 'onMedicationForAdd');?> type="checkbox">
id="health-c-adhd" name="forms[healthConcerns][adhd]" km_display_pop_checked($kid_heathConcerns, 'adhd');?> type="checkbox">
id="health-c-onMedicationForAdhd" name="forms[healthConcerns][onMedicationForAdhd]" km_display_pop_checked($kid_heathConcerns, 'onMedicationForAdhd');?> type="checkbox">
id="health-c-emotionalProblems" name="forms[healthConcerns][emotionalProblems]" km_display_pop_checked($kid_heathConcerns, 'emotionalProblems');?> type="checkbox">
id="health-c-behaviorProblems" name="forms[healthConcerns][behaviorProblems]" km_display_pop_checked($kid_heathConcerns, 'behaviorProblems');?> type="checkbox">
id="health-c-heartDeseaseOrDefect" name="forms[healthConcerns][heartDeseaseOrDefect]" km_display_pop_checked($kid_heathConcerns, 'heartDeseaseOrDefect');?> type="checkbox">
id="health-c-headachesOrMigrations" name="forms[healthConcerns][headachesOrMigrations]" km_display_pop_checked($kid_heathConcerns, 'headachesOrMigrations');?> type="checkbox">
id="health-c-concussionOrHeadInjury" name="forms[healthConcerns][concussionOrHeadInjury]" km_display_pop_checked($kid_heathConcerns, 'concussionOrHeadInjury');?> type="checkbox">
id="health-c-eczemaOrPsoriasis" name="forms[healthConcerns][eczemaOrPsoriasis]" km_display_pop_checked($kid_heathConcerns, 'eczemaOrPsoriasis');?> type="checkbox">
class="kid-form-checkbox" id="health-c-eyeglasses" name="forms[healthConcerns][eyeglasses]" km_display_pop_checked($kid_heathConcerns, 'eyeglasses');?> type="checkbox">
class="kid-form-checkbox" id="health-c-sprainsOrFracturesOrDislocations" name="forms[healthConcerns][sprainsOrFracturesOrDislocations]" km_display_pop_checked($kid_heathConcerns, 'sprainsOrFracturesOrDislocations');?> type="checkbox">
class="kid-form-checkbox" id="health-c-majorSurgeryOrIllness" name="forms[healthConcerns][majorSurgeryOrIllness]" km_display_pop_checked($kid_heathConcerns, 'majorSurgeryOrIllness');?> type="checkbox">
id="health-c-heatStrokeOrExhaustion" name="forms[healthConcerns][heatStrokeOrExhaustion]" km_display_pop_checked($kid_heathConcerns, 'heatStrokeOrExhaustion');?> type="checkbox">
id="health-c-seizuresOrEpilepsy" name="forms[healthConcerns][seizuresOrEpilepsy]" km_display_pop_checked($kid_heathConcerns, 'seizuresOrEpilepsy');?> type="checkbox">
id="health-c-diabetesType1" name="forms[healthConcerns][diabetesType1]" km_display_pop_checked($kid_heathConcerns, 'diabetesType1');?> type="checkbox">
id="health-c-diabetesType2" name="forms[healthConcerns][diabetesType2]" km_display_pop_checked($kid_heathConcerns, 'diabetesType2');?> type="checkbox">
id="health-c-insulin" name="forms[healthConcerns][insulin]" km_display_pop_checked($kid_heathConcerns, 'insulin');?> type="checkbox">
class="kid-form-checkbox" id="health-c-hearingLoss" name="forms[healthConcerns][hearingLoss]" km_display_pop_checked($kid_heathConcerns, 'hearingLoss');?> type="checkbox">
id="health-c-visionLoss" name="forms[healthConcerns][visionLoss]" km_display_pop_checked($kid_heathConcerns, 'visionLoss');?> type="checkbox">
class="kid-form-checkbox" id="health-c-contagiousDisease" name="forms[healthConcerns][contagiousDisease]" km_display_pop_checked($kid_heathConcerns, 'contagiousDisease');?> type="checkbox">
getvalue('additionalSpecifics', $kid_heathConcerns, false); $otherSkinCondition = $this->getvalue('otherSkinCondition', $kid_heathConcerns, false); ?> km_display_pop_checked($kid_heathConcerns, 'additionalSpecifics');?> km_display_pop_checked($kid_heathConcerns, 'otherSkinCondition');?> type="checkbox">
">

MedicalFormLable('kidsTreatments'); ?>

getValue('none', $kid_treatments, false) ? 'disabled' : '';?>

km_display_pop_checked($kid_treatments, 'none');?> type="checkbox" >

class="kid-form-checkbox" id="trts-epiAnySymptoms" name="forms[treatments][epiAnySymptoms]" km_display_pop_checked($kid_treatments, 'epiAnySymptoms');?> type="checkbox">
class="kid-form-checkbox" id="trts-epiSevereSymptoms" name="forms[treatments][epiSevereSymptoms]" km_display_pop_checked($kid_treatments, 'epiSevereSymptoms');?> type="checkbox">
class="kid-form-checkbox" id="trts-antihistamineMildSymptoms" name="forms[treatments][antihistamineMildSymptoms]" km_display_pop_checked($kid_treatments, 'antihistamineMildSymptoms');?> type="checkbox">
getvalue('epiNoSymptoms', $kid_treatments, false); $hasValue = ($this->getvalue('dosage', $epiNoSymptoms, false) || $this->getvalue('dosage', $epiNoSymptoms, false)) ? true : false; ?> class="km_hasextra_form kid-form-checkbox" id="trts-epiNoSymptoms" type="checkbox" >
">
class="km_hasextra_form kid-form-checkbox" km_display_pop_checked($this->getvalue('antihistamineSevereSymptoms', $kid_treatments, false), 'medication'); $this->km_display_pop_checked($this->getvalue('antihistamineSevereSymptoms', $kid_treatments, false), 'dosage');?> id="trts-antihistamineSevereSymptoms" type="checkbox">
"> getvalue('antihistamineSevereSymptoms', $kid_treatments, false);?>
class="km_hasextra_form kid-form-checkbox" id="trts-otherMedication" km_display_pop_checked($this->getvalue('otherMedication', $kid_treatments, false), 'dosage'); $this->km_display_pop_checked($this->getvalue('otherMedication', $kid_treatments, false), 'medication'); $this->km_display_pop_checked($this->getvalue('otherMedication', $kid_treatments, false), 'medication');?> type="checkbox">
"> getvalue('otherMedication', $kid_treatments, false);?>
getvalue('additionalSpecifics', $kid_treatments, false);?> km_display_pop_checked($kid_treatments, 'additionalSpecifics');?> type="checkbox">
">

MedicalFormLable('kidsSymptoms'); ?>

getValue('none', $kid_symptoms, false) ? 'disabled' : '';?>

km_display_pop_checked($kid_symptoms, 'none');?> type="checkbox" >

class="kid-form-checkbox" id="sym-extr-lung" name="forms[symptoms][extremelyReactive][lung]" km_display_pop_checked($extremelyReactive, 'lung');?> type="checkbox">
class="kid-form-checkbox" id="sym-extr-mouth" name="forms[symptoms][extremelyReactive][mouth]" km_display_pop_checked($extremelyReactive, 'mouth');?> type="checkbox">
class="kid-form-checkbox" id="sym-extr-heart" name="forms[symptoms][extremelyReactive][heart]" km_display_pop_checked($extremelyReactive, 'heart');?> type="checkbox">
class="kid-form-checkbox" id="sym-extr-skin" name="forms[symptoms][extremelyReactive][skin]" km_display_pop_checked($extremelyReactive, 'skin');?> type="checkbox">
class="kid-form-checkbox" id="sym-extr-throat" name="forms[symptoms][extremelyReactive][throat]" km_display_pop_checked($extremelyReactive, 'throat');?> type="checkbox">
class="kid-form-checkbox" id="sym-extr-digestive" name="forms[symptoms][extremelyReactive][digestive]" km_display_pop_checked($extremelyReactive, 'digestive');?> type="checkbox">
class="km_hasextra_form kid-form-checkbox" id="sym-extr-other-checkbox" km_display_pop_checked($extremelyReactive, 'other');?> type="checkbox">
">

getValue('mildSymptoms', $kid_symptoms, false);?>

class="kid-form-checkbox" id="mild-sym-mildNausea" name="forms[symptoms][mildSymptoms][mildNausea]" km_display_pop_checked($mildSymptoms, 'mildNausea');?> type="checkbox">
class="kid-form-checkbox" id="mild-sym-mouth" name="forms[symptoms][mildSymptoms][mouth]" km_display_pop_checked($mildSymptoms, 'mouth');?> type="checkbox">
class="kid-form-checkbox" id="mild-sym-skin" name="forms[symptoms][mildSymptoms][skin]" km_display_pop_checked($mildSymptoms, 'skin');?> type="checkbox">
class="km_hasextra_form kid-form-checkbox" id="mild-sym-other-checkbox" value="" km_display_pop_checked($mildSymptoms, 'other');?> type="checkbox">