CS202-Assignment 1 Solution Spring 2021
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<h1 style="text-align:center; color:red;"><b>Hospital Survey Form</b></h1>
<h2 style="text-align:center; color:green;"><b>Provided by VU Answer</b></h2>
<h3 style="text-align:left; color:green;"><b>Student ID: ------</b></h3>
<h3 style="text-align:left; color:green;"><b>Student Name: -----</b></h3>
Patient's First Name: <input type="text" style="margin-Left:6; width: 20;" > Patient Second Name:
<input type="text" style="width: 20;"><br><br>
Patient's Father /Husband Name: <input type="text" style="width: 20%; margin-Left: 5%;"><br><br>
Permanent Address: <input type="text" style="margin-Left:15%; width: 35 %;height: 30px;"><br> <br>
What is Your Gender:<input type="radio" style="margin-Left:9.5%;"> Male <br>
<input type="radio" style="margin-Left: 26.6%;"> Female <br><br>
Patient's Age: <input type="text" style="margin-Left:9% ;width: 20%;"><br><br> Enter Mobile No: <input type="text" style="margin-Left:10% ;width: 20%;"><br><br>
Have You Been Diagnosed As COVID-19 Postive Patient?<input type="radio" style="margin- Left: 2%;">Yes<input type="radio"style="margin-Left: 15 ;">N0<br><br >
<h2 style="coLor: rgb(206, 121, 138);">Please select suitable option from Given below:</h2><br>
<input type="checkbox"style="margin-Left: 18%;">i'm still have a covid -19 symptoms.<br>
<input type="checkbox"style="margin-Left: 18%;">i have a no other symptoms but dry cough.<br>
<input type="checkbox"style="margin-Left: 18%;">i just feel very tired.<br>
<input type="checkbox"style="margin-Left: 18%;">i'm having a trouble deep breeth .<br>
<input type="checkbox"style="margin-Left: 18%;">i'm feeling like I am having tight band wrape around my chest. <br>
<input type="checkbox"style="margin-Left: 18%;">i'm having loss of smell and taste. <br>
<input type="text" style="margin-Left: 18%;">Mention Other feelings
<h2 style="color: rgb(206, 121, 145);">Please select suitable option from Given below:</h2>
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<input type="checkbox"style="margin-Left: 18%;">i'm not having COVID-19 symptoms. <br>
<input type="checkbox"style="margin-Left: 18%;">i'm having headache all the time..<br>
<input type="checkbox"style="margin-Left: 18%;">i have developed muscles aches.<br>
<input type="checkbox"style="margin-Left: 18%;">i'm having fever inspite of havig COVID-19 negtive test result.<br>
<input type="text" style="margin-Left:18%;">Mention Other feelings<br><br>
<button style="margin-Left: 30; color: darkgreen;">Submit</button>
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