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import gradio as gr
def display_form(
first_name, last_name, middle_initial, dob, age, sex, address, city, state, zip_code,
doctor_first_name, doctor_last_name, doctor_middle_initial, hospital_name, doctor_address,
doctor_city, doctor_state, doctor_zip,
admission_date, referral_source, admission_method, discharge_date, discharge_reason, date_of_death,
diagnosis, procedures, medications, preparer_name, preparer_job_title
):
form = f"""
**Patient Discharge Form**
**Patient Details:**
- Name: {first_name} {middle_initial} {last_name}
- Date of Birth: {dob}, Age: {age}, Sex: {sex}
- Address: {address}, {city}, {state}, {zip_code}
**Primary Healthcare Professional Details:**
- Name: {doctor_first_name} {doctor_middle_initial} {doctor_last_name}
- Hospital/Clinic: {hospital_name}
- Address: {doctor_address}, {doctor_city}, {doctor_state}, {doctor_zip}
**Admission and Discharge Details:**
- Date of Admission: {admission_date}
- Source of Referral: {referral_source}
- Method of Admission: {admission_method}
- Date of Discharge: {discharge_date}
- Discharge Reason: {discharge_reason}
- Date of Death (if applicable): {date_of_death}
**Diagnosis & Procedures:**
- Diagnosis: {diagnosis}
- Procedures: {procedures}
**Medication Details:**
- Medications on Discharge: {medications}
**Prepared By:**
- Name: {preparer_name}, Job Title: {preparer_job_title}
"""
return form
with gr.Blocks() as demo:
gr.Markdown("# Patient Discharge Form")
with gr.Row():
first_name = gr.Textbox(label="First Name")
last_name = gr.Textbox(label="Last Name")
middle_initial = gr.Textbox(label="Middle Initial")
with gr.Row():
dob = gr.Textbox(label="Date of Birth")
age = gr.Textbox(label="Age")
sex = gr.Textbox(label="Sex")
address = gr.Textbox(label="Address")
with gr.Row():
city = gr.Textbox(label="City")
state = gr.Textbox(label="State")
zip_code = gr.Textbox(label="Zip Code")
gr.Markdown("## Primary Healthcare Professional Details")
with gr.Row():
doctor_first_name = gr.Textbox(label="Doctor's First Name")
doctor_last_name = gr.Textbox(label="Doctor's Last Name")
doctor_middle_initial = gr.Textbox(label="Middle Initial")
hospital_name = gr.Textbox(label="Hospital/Clinic Name")
doctor_address = gr.Textbox(label="Address")
with gr.Row():
doctor_city = gr.Textbox(label="City")
doctor_state = gr.Textbox(label="State")
doctor_zip = gr.Textbox(label="Zip Code")
gr.Markdown("## Admission and Discharge Details")
with gr.Row():
admission_date = gr.Textbox(label="Date of Admission")
referral_source = gr.Textbox(label="Source of Referral")
admission_method = gr.Textbox(label="Method of Admission")
with gr.Row():
discharge_date = gr.Textbox(label="Date of Discharge")
discharge_reason = gr.Radio(["Treated", "Transferred", "Discharge Against Advice", "Patient Died"], label="Discharge Reason")
date_of_death = gr.Textbox(label="Date of Death (if applicable)")
gr.Markdown("## Diagnosis & Procedures")
diagnosis = gr.Textbox(label="Diagnosis")
procedures = gr.Textbox(label="Operation & Procedures")
gr.Markdown("## Medication Details")
medications = gr.Textbox(label="Medication on Discharge")
gr.Markdown("## Prepared By")
with gr.Row():
preparer_name = gr.Textbox(label="Name")
preparer_job_title = gr.Textbox(label="Job Title")
submit = gr.Button("Generate Form")
output = gr.Markdown()
submit.click(
display_form,
inputs=[
first_name, last_name, middle_initial, dob, age, sex, address, city, state, zip_code,
doctor_first_name, doctor_last_name, doctor_middle_initial, hospital_name, doctor_address,
doctor_city, doctor_state, doctor_zip,
admission_date, referral_source, admission_method, discharge_date, discharge_reason, date_of_death,
diagnosis, procedures, medications, preparer_name, preparer_job_title
],
outputs=output
)
demo.launch()
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