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<div id="app">
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<el-form label-width="200px" :model="form" size="mini" :rules="rules" ref="ruleForm">
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<div class="copd-data-para-item">
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<div class="copd-d-p-i-title" id="copdBaseInfo">基本信息</div>
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<div class="diver-line"></div>
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<div class="copd-d-p-i-content">
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<div class="copd-d-p-i-content_inner">
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<el-form-item label="患者姓名:" class="copd-form-item" required>
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<el-input class="copd-form-input" v-model="form.sickName"></el-input>
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</el-form-item>
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<el-form-item label="年龄:" class="copd-form-item">
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<el-input class="copd-form-input" v-model="form.age"></el-input>
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</el-form-item>
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<el-form-item label="民族:" class="copd-form-item">
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<el-radio-group v-model="form.nation" direction="horizontal">
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<el-radio label="1">汉族</el-radio>
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<el-radio label="2">其他</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="其他民族:" class="copd-form-item" v-if="form.nation == 2">
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<el-input class="copd-form-input" v-model="form.nationName" placeholder="请输入其他民族"></el-input>
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</el-form-item>
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<el-form-item label="出生日期:" class="copd-form-item">
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<el-date-picker class="copd-edit-datepicker" v-model="form.birthday" value-format="yyyy-MM-dd" placeholder="选择日期时间"></el-date-picker>
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</el-form-item>
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<el-form-item label="本人联系电话:" prop="phone" class="copd-form-item">
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<el-input class="copd-form-input" type="tel" maxlength="11" v-model="form.phone" placeholder="请输入本人联系电话"></el-input>
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</el-form-item>
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<el-form-item label="现住址:" class="copd-form-item">
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<div class="copd-form-input">
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<el-cascader
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v-model="selAddress"
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:options="areaOptions"
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:props="cascaderProps"
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clearable
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ref="areaCascader"
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@change="function(val){handleItemChange(val, 1)}"
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style="width: 100%"
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></el-cascader>
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</div>
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</el-form-item>
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<el-form-item label="所在街道:" class="copd-form-item">
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<div class="copd-form-input">
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<el-cascader
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clearable
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width="100%"
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placeholder="请选择地址"
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ref="cascader"
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:options="addressOptions1"
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@active-item-change="function(val){handleItemChange(val, 1)}"
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:props="props"
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v-model="addressVal"></el-cascader>
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</div>
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</el-form-item>
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<el-form-item label="详细地址:" class="copd-form-item">
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<el-input class="copd-form-input" v-model="form.address" placeholder="请输入详细地址"></el-input>
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</el-form-item>
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<el-form-item label="医保类型:" class="copd-form-item">
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<el-radio-group v-model="form.womenCategory" direction="horizontal">
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<el-radio label="1">女职工</el-radio>
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<el-radio label="2">居民医保</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="个人医保账户年度体检费用:" class="copd-form-item">
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<el-radio-group v-model="form.accountFeeType" direction="horizontal">
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<el-radio label="1">医保账户内有年度体检费用</el-radio>
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<el-radio label="2">医保账户内无年度体检费用</el-radio>
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</el-radio-group>
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</el-form-item>
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<div id="" style="font-size: 12px; color: #808080; padding: 12px">
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我市适龄女性免费“两癌”筛查保障对象为参加本市医保35-64岁妇女中城镇居民医保及职工医保无年度体检费用的女性。
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个人账户内有无年度体检费用可通过微信小程序“厦门医疗保障查询”,具体路径:微信搜索“厦门医疗保障”→点击进入“厦门医疗保障查询”小程序进入“我的医保”页面→点击“参保信息查询”进入“个人医保”界面即可查询,若可见相关账户(不包括个人账户),则为医保账户内有年度体检费用。
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</div>
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<el-form-item label="单位名称:" class="copd-form-item">
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<el-input class="copd-form-input" v-model="form.unitName" placeholder="请输入单位名称"></el-input>
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</el-form-item>
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<el-form-item label="身高:" class="copd-form-item">
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<el-input class="copd-form-input" v-model="form.height" placeholder="请输入身高(CM)"></el-input>
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</el-form-item>
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<el-form-item label="体重:" class="copd-form-item">
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<el-input class="copd-form-input" v-model="form.weight" placeholder="请输入体重(KG)"></el-input>
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</el-form-item>
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<el-form-item label="学历:" class="copd-form-item">
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<el-radio-group v-model="form.edu" direction="horizontal">
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<el-radio label="1">小学以下</el-radio>
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<el-radio label="2">初中/高中</el-radio>
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<el-radio label="3">大学及以上</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="家庭月收入:" class="copd-form-item">
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<el-radio-group v-model="form.monthlyIncome" direction="horizontal">
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<el-radio label="1">0-5000元</el-radio>
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<el-radio label="2">5001-10000元</el-radio>
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<el-radio label="3">10001-15000元</el-radio>
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<el-radio label="4">15001-20000元</el-radio>
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<el-radio label="5">20001元以上</el-radio>
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<el-radio label="6">拒绝提供</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="HPV疫苗接种情况:" class="copd-form-item">
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<el-radio-group v-model="form.vaccinationHpv" direction="horizontal">
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<el-radio label="1">是</el-radio>
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<el-radio label="2">否</el-radio>
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</el-form-item>
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<el-form-item label="接种的HPV疫苗是几价疫苗:" class="copd-form-item">
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<el-radio-group v-model="form.vaccinationHpv" direction="horizontal">
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<el-radio label="1">二价</el-radio>
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<el-radio label="2">四价</el-radio>
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<el-radio label="3">九价</el-radio>
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</el-form-item>
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</div>
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</div>
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</div>
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<div class="copd-data-para-item">
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<div class="copd-d-p-i-title" id="copdBaseInfo">生理和生育情况</div>
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<div class="diver-line"></div>
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<div class="copd-d-p-i-content">
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<div class="copd-d-p-i-content_inner">
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<el-form-item label="月经初潮(周岁):" class="copd-form-item">
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<el-select v-model="form.menophaniaAge" placeholder="请选择" style="width: 100%;">
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<el-option
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v-for="item in menophaniaAgeList"
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:key="item"
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:label="item"
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:value="item">
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</el-option>
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</el-select>
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</el-form-item>
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<el-form-item label="是否已绝闭经:" class="copd-form-item">
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<el-radio-group v-model="form.menopause" direction="horizontal">
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<el-radio label="1">是</el-radio>
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<el-radio label="0">否</el-radio>
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<el-radio label="2">不清楚</el-radio>
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</el-form-item>
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<el-form-item label="绝经年龄(周岁):" class="copd-form-item" v-if='form.menopause ==1'>
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<el-input class="copd-form-input" v-model="form.menopauseAge" placeholder="请输入绝经年龄(周岁)"></el-input>
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</el-form-item>
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<el-form-item label="末次月经:" class="copd-form-item" v-if='form.menopause===0||form.menopause ==2' >
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<el-date-picker class="copd-edit-datepicker" v-model="form.lmp" value-format="yyyy-MM-dd" placeholder="选择末次月经时间"></el-date-picker>
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</el-form-item>
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<el-form-item label="流产次数(含自然流产和人工流产):" class="copd-form-item" v-if='form.menopause ==1'>
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<el-input class="copd-form-input" v-model="form.miscarriage" placeholder="请输入流产次数(含自然流产和人工流产)"></el-input>
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</el-form-item>
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<el-form-item label="是否有生育史:" class="copd-form-item">
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<el-radio-group v-model="form.reproductiveHistory" direction="horizontal">
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<el-radio label="1">是</el-radio>
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<el-radio label="0">否</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="足月产胎次:" class="copd-form-item" v-if='form.reproductiveHistory ==1'>
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<el-input class="copd-form-input" v-model="form.partusMaturus" placeholder="请输入足月产胎次"></el-input>
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</el-form-item>
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<el-form-item label="早产胎次:" class="copd-form-item" v-if='form.reproductiveHistory ==1'>
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<el-input class="copd-form-input" v-model="form.prematureDelivery" placeholder="请输入早产胎次"></el-input>
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</el-form-item>
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<el-form-item label="第一次分娩年龄(周岁):" class="copd-form-item" v-if='form.reproductiveHistory ==1'>
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<el-input class="copd-form-input" v-model="form.firstDeliveryAge" placeholder="请输入第一次分娩年龄(周岁)"></el-input>
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</el-form-item>
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<el-form-item label="哺乳史:" class="copd-form-item" v-if='form.reproductiveHistory ==1'>
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<el-radio-group v-model="form.reproductiveHistory" >
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<el-radio label="1">无或<4个月</el-radio>
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<el-radio label="2">4个月及以上</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="是否有一级亲属(母亲、姐妹及女儿)曾患乳腺癌:" class="copd-form-item1" >
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<el-radio-group v-model="form.breastCancerFir" >
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<el-radio label="1">是</el-radio>
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<el-radio label="0">否</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="是否有二级亲属(祖母、外祖母及姑姨)50岁前曾患乳腺癌:" class="copd-form-item1" >
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<el-radio-group v-model="form.breastCancerSec" >
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<el-radio label="1">是</el-radio>
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<el-radio label="0">否</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="二级亲属(祖母、外祖母及姑姨)50岁前曾患乳腺癌人数:" class="copd-form-item1" v-if='form.breastCancerSec == 1'>
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<el-input class="copd-form-input" v-model="form.breastCancerSecNum" placeholder="二级亲属(祖母、外祖母及姑姨)50 岁前曾患乳腺癌人数"></el-input>
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</el-form-item>
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<el-form-item v-if='form.oophoromaSec == 1' label="是否有二级亲属(祖母、外祖母及姑姨)50岁前曾患卵巢癌人数:" class="copd-form-item1" v-if='form.reproductiveHistory ==1'>
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<el-input class="copd-form-input" v-model="form.oophoromaNum" placeholder="是否有二级亲属(祖母、外祖母及姑姨)50 岁前曾患卵巢癌人数"></el-input>
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</el-form-item>
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<el-form-item label="您是否有一级亲属(母亲、姐妹及女儿)曾患宫颈癌:" class="copd-form-item1" >
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<el-radio-group v-model="form.cervicalCancerFir" >
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<el-radio label="1">是</el-radio>
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<el-radio label="0">否</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="您是否曾进行过BRCA基因检测,结果显示携带有BRCA1/2基因致病性遗传突变:" class="copd-form-item1" >
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<el-radio-group v-model="form.brcaGeneticTesting" >
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<el-radio label="1">是</el-radio>
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<el-radio label="0">否</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="30岁前接受胸部放疗:" class="copd-form-item" >
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<el-radio-group v-model="form.chestRadiotherapy" >
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<el-radio label="1">是</el-radio>
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<el-radio label="0">否</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="外源性激素使用:" class="copd-form-item" >
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<el-radio-group v-model="form.chestRadiotherapy" flex-direction="column">
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<el-radio label="1" style="display: block;">是,仅雌激素(如:更宝芬、补佳乐、协坤、<br>维尼安、更乐、倍美力、得美素、欧适可、松奇、康美华、<br>尼尔雌醇等)</el-radio>
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<el-radio label="2" style="display: block;">是,雌孕激素联合(如:诺康律、诺更宁、<br>克龄蒙、倍美安、倍美盈等)</el-radio>
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<el-radio label="3" style="display: block;">否</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="外源性激素使用时间:" class="copd-form-item" v-if='form.hormoneUse == 1 || form.hormoneUse == 2' >
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<el-radio-group v-model="form.hormoneUseMonth" >
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<el-radio label="1">小于6个月</el-radio>
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<el-radio label="2">大于等于6个月</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="是否曾有乳腺手术史:" class="copd-form-item" >
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<el-radio-group v-model="form.breastBiopsySurgery" >
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<el-radio label="1">有</el-radio>
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<el-radio label="0">无</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item v-if='form.oophoromaSec == 1' label="乳腺手术次数:" class="copd-form-item1" v-if='form.reproductiveHistory ==1'>
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<el-input class="copd-form-input" v-model="form.breastSurgeryNum" placeholder="乳腺手术次数"></el-input>
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</el-form-item>
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<el-form-item label="乳腺手术病理结果:" class="copd-form-item" v-if='form.breastBiopsySurgery == 1' >
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<el-radio-group v-model="form.breastSurgeryResult" >
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<el-radio label="0">良性</el-radio>
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<el-radio label="1">恶性</el-radio>
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<el-radio label="2">不确定</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="双侧卵巢切除手术:" class="copd-form-item" >
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<el-radio-group v-model="form.accessoryExcision" >
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<el-radio label="1">有</el-radio>
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<el-radio label="0">无</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="子宫切除手术:" class="copd-form-item" >
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<el-radio-group v-model="form.hysterectomy" >
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<el-radio label="1">有</el-radio>
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<el-radio label="0">无</el-radio>
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</el-radio-group>
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</el-form-item>
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<el-form-item label="子宫切除手术年龄:" class="copd-form-item1" v-if='form.hysterectomy ==1'>
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<el-input class="copd-form-input" v-model="form.hysterectomyAge" placeholder="子宫切除手术年龄"></el-input>
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</el-form-item>
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<el-form-item label="目前使用避孕方法:" class="copd-form-item" >
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<el-radio-group v-model="form.accessoryExcision" >
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<el-radio label="1">未避孕</el-radio>
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<el-radio label="2">避孕套</el-radio>
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<el-radio label="3">避孕药(年)</el-radio>
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<el-radio label="4">宫内节育器</el-radio>
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<el-radio label="5">其他避孕方法</el-radio>
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</el-radio-group>
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</el-form-item>
|
|
|
|
|
|
<el-form-item label="其他避孕方法:" class="copd-form-item1" v-if='form.contraceptiveMethod ==5'>
|
|
|
<el-input class="copd-form-input" v-model="form.contraceptiveOtherMethod" placeholder="其他避孕方法"></el-input>
|
|
|
</el-form-item>
|
|
|
|
|
|
<el-form-item label="白带异常:" class="copd-form-item" >
|
|
|
<el-radio-group v-model="form.accessoryExcision" >
|
|
|
<el-radio label="1">有</el-radio>
|
|
|
<el-radio label="0">无</el-radio>
|
|
|
|
|
|
</el-radio-group>
|
|
|
</el-form-item>
|
|
|
<el-form-item label="接触性出血:" class="copd-form-item" >
|
|
|
<el-radio-group v-model="form.contactBleeding" >
|
|
|
<el-radio label="1">有</el-radio>
|
|
|
<el-radio label="0">无</el-radio>
|
|
|
|
|
|
</el-radio-group>
|
|
|
</el-form-item>
|
|
|
<el-form-item label="阴道不规则出血:" class="copd-form-item" >
|
|
|
<el-radio-group v-model="form.irregularVaginalBleeding" >
|
|
|
<el-radio label="1">有</el-radio>
|
|
|
<el-radio label="0">无</el-radio>
|
|
|
</el-radio-group>
|
|
|
</el-form-item>
|
|
|
</div>
|
|
|
</div>
|
|
|
</div>
|
|
|
|
|
|
<div class="copd-data-para-item">
|
|
|
<div class="copd-d-p-i-title" id="copdBaseInfo">个人相关病史</div>
|
|
|
<div class="diver-line"></div>
|
|
|
<div class="copd-d-p-i-content">
|
|
|
<div class="copd-d-p-i-content_inner">
|
|
|
|
|
|
<el-form-item label="是否有过宫颈癌检查:" class="copd-form-item">
|
|
|
<el-radio-group v-model="form.cervicalCancerExamination" direction="horizontal">
|
|
|
<el-radio label="1">三年内</el-radio>
|
|
|
<el-radio label="2">三年以上</el-radio>
|
|
|
<el-radio label="0">否</el-radio>
|
|
|
</el-form-item>
|
|
|
|
|
|
|
|
|
<el-form-item label="宫颈细胞学结果异常:" class="copd-form-item" >
|
|
|
<el-radio-group v-model="form.cervicalCellsAbnormal" >
|
|
|
<el-radio label="1">有</el-radio>
|
|
|
<el-radio label="0">无</el-radio>
|
|
|
</el-radio-group>
|
|
|
</el-form-item>
|
|
|
|
|
|
<el-form-item label="HPV检查阳性:" class="copd-form-item" >
|
|
|
<el-radio-group v-model="form.hysterectomy" >
|
|
|
<el-radio label="1">有</el-radio>
|
|
|
<el-radio label="0">无</el-radio>
|
|
|
</el-radio-group>
|
|
|
</el-form-item>
|
|
|
<el-form-item label="CIN(宫颈上皮内瘤变):" class="copd-form-item" >
|
|
|
<el-radio-group v-model="form.hysterectomy" >
|
|
|
<el-radio label="1">有</el-radio>
|
|
|
<el-radio label="0">无</el-radio>
|
|
|
</el-radio-group>
|
|
|
</el-form-item>
|
|
|
<el-form-item label="宫颈癌:" class="copd-form-item" >
|
|
|
<el-radio-group v-model="form.hysterectomy" >
|
|
|
<el-radio label="1">有</el-radio>
|
|
|
<el-radio label="0">无</el-radio>
|
|
|
</el-radio-group>
|
|
|
</el-form-item>
|
|
|
|
|
|
</div>
|
|
|
</div>
|
|
|
</div>
|
|
|
</el-form>
|
|
|
</div>
|