QuickOldCar

You can use something like this http://dev.maxmind.com/geoip/geoip2/javascript/tutorial/ Some people disable javascript, yes is a lot of sites that rely on javascript but they do it anyway. In that case can do it server side with php use curl/file_get_contents and a geo api , or have a local geo database use a switch or if/else to determine which site needed to load exclude the current site they are currently visiting perform a header redirect to your new location unless they are already at it I would set the location in a session or a cookie so don't have to keep doing the additional work each page load. Check if the session or cookie exists first, if not run the geoip code One thing you have to work out is if I was to visit from USA which site am I getting sent to. Your site isn't handling every possible location, if is not one of the 3 you mentioned make one the default.

Actually a priest in scranton pennsylvania invented wireless radio. Two towers to do his sermons both locations. https://en.wikipedia.org/wiki/Jozef_Murga%C5%A1 Isaac Newton and Gottfried Leibniz independently invented calculus in the mid-17th century. BTW, Leibniz invented binary, had one of the first mechanical computers using it. I researched a pile of patents long ago, would be amazed what is patented concerning coding and math, I would think can only patent very specific things by now and not the entire code except for as a complete package as is. Since the internet is everywhere, we are talking international patents, even then some countries do not abide by them.

You are telling the OP that right? Because the OP would not understand any of that.

You were right about only within post, so added them up top. OP originally had them there although a wrong variable name for one. That's about all I'm willing to do with it, if you want to see something different be my guest and rewrite it for them. Of course that's what it does. What don't you get about the trim part? Is part of the checking process...not the actual checking process. The OP has no experience, not going to confuse them doing ternary operators or do additional work. <?php date_default_timezone_set('UTC'); $errors = array(); $firstname = $lastname = $middlename = $gender = $age = $email = $race = $homePhone = $cellPhone = $workPhone = $dateofdiagnosis = $FamilyHistory = $dateofbloodresults = $AbnormNET = $AbnormCGA = $AbnormPancrea = $AbnormSerotonin = $AbnormU5IAA = $AbnormOtherBiomarker = $PrimaryLocation = $cancerStatus = $cancerStage = $SecondaryLocation = $Histopathology = $HistopathologyLung = $HistopathologyGEPNET = $HistopathologyKi67 = $HistopathologyMitosesLUNG = $HistopathologyMitosesGEPNETS = $Ostreoscan = $OstreoscanDate = $OstreoscanPosNeg = $OstreoscanArea = $OstreoscanLiverLobe = $OstreoscanLesions = $OstreoscanUptake = $CTScan = $CTScanDate = $CTScanPosNeg = $CTScanArea = $CTScanLiverLobe = $CTScanLesions = $CTScanLesions = $CTScanSizeofMeta = $MRIScan = $MRIScanDate = $MRIScanPosNeg = $MRIScanArea = $MRIScanLiverLobe = $MRIScanLesions = $MRIScanSizeofMeta = $FDGScan = $FDGScanDate = $FDGScanPosNeg = $FDGScanArea = $FDGScanLiverLobe = $FDGScanLesions = $FDGScanL1 = $FDGScanL2 = $FDGScanL3 = $FDGScanL4 = $FDGScanL5 = $IstopeImaging = $IstopeImageDate = $IsotopeConjugad = $IsotopeL1 = $IsotopeL2 = $IsotopeL3 = $IsotopeL4 = $IsotopeL5 = $PrimarySurgery = $PrimarySurgeryDate = $PrimaryGISurgery = $PrimaryLungSurgery = $MetastasesSurgery = $MetastasesSurgeryDate = $MetastasesLiverSurgery = $MetastasesLungSurgery = $Staging = $StagingDate = $StagingNum = $Interventions = $InterventionDate = $TypeInter = $PRRT = $PRRTDate = $TypePRRT = $NumCycles = $PRRTDose = $SSasDate = $SSAsType = $SSAsAmount = $Everolimus = $EverolimusDate = $Sunitnib = $SunitnibDate = $Bevacizumab = $BevacizumabDate = $Chemotherapy = $ChemoDate = ""; $DiagnosisModality = $signs = $symptoms = $Hematology = $Hepatic = $Renal = $Biomarkers = $IsotopeConjugad = $ChemoTreatment = ''; if (isset($_POST["submit"])) { if (isset($_POST["lastname"]) && trim($_POST["lastname"]) != '') { $lastname = trim($_POST["lastname"]); } else { $errors['lastname'] = "Last Name is required"; } if (isset($_POST["firstname"]) && trim($_POST["firstname"]) != '') { $firstname = trim($_POST["firstname"]); } else { $errors['firstname'] = "First Name is required"; } if (isset($_POST["middlename"])) { $middlename = $_POST["middlename"]; } if (isset($_POST["age"]) && ctype_digit(trim($_POST["age"]))) { $age = trim($_POST["age"]); } else { $errors['age'] = "Age is required"; } if (isset($_POST["email"]) && filter_var(trim($_POST["email"]), FILTER_VALIDATE_EMAIL)) { $email = trim($_POST["email"]); } else { $errors['email'] = "Email is required"; } if (isset($_POST["race"]) && trim($_POST["race"]) != '') { $race = trim($_POST["race"]); } if (isset($_POST["gender"]) && trim($_POST["gender"]) != '') { $gender = trim($_POST["gender"]); } else { $errors['gender'] = "Gender is required"; } if (isset($_POST["homePhone"]) && trim($_POST["homePhone"]) != '') { $homePhone = $_POST["homePhone"]; } if (isset($_POST["cellPhone"]) && trim($_POST["cellPhone"]) != '') { $cellPhone = $_POST["cellPhone"]; } if (isset($_POST["workPhone"]) && trim($_POST["workPhone"]) != '') { $workPhone = $_POST["workPhone"]; } if (isset($_POST["dod"])) { $dateofdiagnosis = $_POST["dod"]; } if (isset($_POST["DiagnosisModality"])) { $DiagnosisModality = implode(",", $_POST["DiagnosisModality"]); } if (isset($_POST["signs"])) { $signs = implode(",", $_POST["signs"]); } if (isset($_POST["symptoms"])) { $symptoms = implode(",", $_POST["symptoms"]); } if (isset($_POST["FamilyHistory"])) { $FamilyHistory = $_POST["FamilyHistory"]; } if (isset($_POST["dobr"])) { $dateofbloodresults = $_POST["dobr"]; } if (isset($_POST["Hematology"])) { $Hematology = implode(",", $_POST["Hematology"]); } if (isset($_POST["Hepatic"])) { $Hepatic = implode(",", $_POST["Hepatic"]); } if (isset($_POST["Renal"])) { $Renal = implode(",", $_POST["Renal"]); } if (isset($_POST["Biomarkers"])) { $Biomarkers = implode(",", $_POST["Biomarkers"]); } if (isset($_POST["AbnormalElevatedNETest"])) { $AbnormNET = $_POST["AbnormalElevatedNETest"]; } if (isset($_POST["AbnormalElevatedCgA"])) { $AbnormCGA = $_POST["AbnormalElevatedCgA"]; } if (isset($_POST["AbnormalElevatedPancreastatin"])) { $AbnormPancrea = $_POST["AbnormalElevatedPancreastatin"]; } if (isset($_POST["AbnormalElevatedSerotonin"])) { $AbnormSerotonin = $_POST["AbnormalElevatedSerotonin"]; } if (isset($_POST["AbnormalElevatedU5HIAA"])) { $AbnormU5IAA = $_POST["AbnormalElevatedU5HIAA"]; } if (isset($_POST["AbnormalElevatedOtherBiomarker"])) { $AbnormOtherBiomarker = $_POST["AbnormalElevatedOtherBiomarker"]; } if (isset($_POST["PrimaryLocation"])) { $PrimaryLocation = $_POST["PrimaryLocation"]; } if (isset($_POST["cancerStatus"])) { $cancerStatus = $_POST["cancerStatus"]; } if (isset($_POST["cancerStage"])) { $cancerStage = $_POST["cancerStage"]; } if (isset($_POST["SecondaryLocation"])) { $SecondaryLocation = $_POST["SecondaryLocation"]; } if (isset($_POST["Histopathology"])) { $Histopathology = $_POST["Histopathology"]; } if (isset($_POST["HistopathologyLung"])) { $HistopathologyLung = $_POST["HistopathologyLung"]; } if (isset($_POST["HistopathologyGEPNET"])) { $HistopathologyGEPNET = $_POST["HistopathologyGEPNET"]; } if (isset($_POST["HistopathologyKi67"])) { $HistopathologyKi67 = $_POST["HistopathologyKi67"]; } if (isset($_POST["HistopathologyMitoses(Lung)"])) { $HistopathologyMitosesLUNG = $_POST["HistopathologyMitoses(Lung)"]; } $HistopathologyMitosesGEPNETS = $_POST["HistopathologyMitoses(GEP-NETs)"]; $Ostreoscan = $_POST["Ostreoscan"]; $OstreoscanDate = $_POST["OstreoscanDate"]; $OstreoscanPosNeg = $_POST["Ostreoscan+/-"]; $OstreoscanArea = $_POST["OstreoscanArea"]; $OstreoscanLiverLobe = $_POST["OstreoscanLiverLobe"]; $OstreoscanLesions = $_POST["OstreoscanLesions"]; $OstreoscanUptake = $_POST["OstreoscanUptake"]; $CTScan = $_POST["CTScan"]; $CTScanDate = $_POST["CTScanDate"]; $CTScanPosNeg = $_POST["CTScan+/-"]; $CTScanArea = $_POST["CTScanArea"]; $CTScanLiverLobe = $_POST["CTScanLiverLobe"]; $CTScanLesions = $_POST["CTScanLesions"]; $CTScanSizeofMeta = $_POST["CTScanSizeofMetastases"]; $MRIScan = $_POST["MRIScan"]; $MRIScanDate = $_POST["MRIScanDate"]; $MRIScanPosNeg = $_POST["MRIScan+/-"]; $MRIScanArea = $_POST["MRIScanArea"]; $MRIScanLiverLobe = $_POST["MRIScanLiverLobe"]; $MRIScanLesions = $_POST["MRIScanLesions"]; $MRIScanSizeofMeta = $_POST["MRIScanSizeofMetastases"]; $FDGScan = $_POST["FDGScan"]; $FDGScanDate = $_POST["FDGScanDate"]; $FDGScanPosNeg = $_POST["FDGScan+/-"]; $FDGScanArea = $_POST["FDGScanArea"]; $FDGScanLiverLobe = $_POST["FDGScanLiverLobe"]; $FDGScanLesions = $_POST["FDZGScanLesions"]; $FDGScanL1 = $_POST["FDGScanL1SUVmax"]; $FDGScanL2 = $_POST["FDGScanL2SUVmax"]; $FDGScanL3 = $_POST["FDGScanL3SUVmax"]; $FDGScanL4 = $_POST["FDGScanL4SUVmax"]; $FDGScanL5 = $_POST["FDGScanL5SUVmax"]; $IstopeImaging = $_POST["IstopeImaging"]; $IstopeImageDate = $_POST["IstopeImageDate"]; if (isset($_POST["IsotopeTracer"])) { $IstopeTracer = implode(",", $_POST["IsotopeTracer"]); } $IstopeTracerWorking = $_POST["IstopeTracerWorking"]; if (isset($_POST["IsotopeConjugad"])) { $IsotopeConjugad = implode(",", $_POST["IsotopeConjugad"]); } $IsotopeL1 = $_POST["IsotopeL1SUVmax"]; $IsotopeL2 = $_POST["IsotopeL2SUVmax"]; $IsotopeL3 = $_POST["IsotopeL3SUVmax"]; $IsotopeL4 = $_POST["IsotopeL4SUVmax"]; $IsotopeL5 = $_POST["IsotopeL5SUVmax"]; $PrimarySurgery = $_POST["PrimarySurgery"]; $PrimarySurgeryDate = $_POST["PrimarySurgeryDate"]; $PrimaryGISurgery = $_POST["PrimaryGITractSurgery"]; $PrimaryLungSurgery = $_POST["PrimaryLungSurgery"]; $MetastasesSurgery = $_POST["MetastasesSurgery"]; $MetastasesSurgeryDate = $_POST["MetastasesSurgeryDate"]; $MetastasesLiverSurgery = $_POST["MetastasesLiverSurgery"]; $MetastasesLungSurgery = $_POST["MetastasesLungSurgery"]; $Staging = $_POST["Staging"]; $StagingDate = $_POST["StagingDate"]; $StagingNum = $_POST["Staging#"]; $Interventions = $_POST["Interventions"]; $InterventionDate = $_POST["InterventionDate"]; $TypeInter = $_POST["TypeofInterventions"]; $PRRT = $_POST["PRRT"]; $PRRTDate = $_POST["PRRTDate"]; $TypePRRT = $_POST["TypeofPRRT"]; $NumCycles = $_POST["NumberofCycles"]; $PRRTDose = $_POST["PRRTDose"]; $SSAs = $_POST["SSAs"]; $SSAsDate = $_POST["SSAsDate"]; $SSAsType = $_POST["SSAsType"]; $SSAsAmount = $_POST["SSAsAmount"]; $Everolimus = $_POST["Everolimus"]; $EverolimusDate = $_POST["EverolimusDate"]; $Sunitnib = $_POST["Sunitnib"]; $SunitnibDate = $_POST["SunitnibDate"]; $Bevacizumab = $_POST["Bevacizumab"]; $BevacizumabDate = $_POST["BevacizumabDate"]; $Chemotherapy = $_POST["Chemotherapy"]; $ChemoDate = $_POST["ChemoDate"]; if (isset($_POST["ChemoTreatment"])) { $ChemoTreatment = implode(",", $_POST["ChemoTreatment"]); } $list = array( array( $lastname, $firstname, $middlename, $age, $email, $race, $gender, $homePhone, $cellPhone, $workPhone, $dateofdiagnosis, $DiagnosisModality, $signs, $symptoms, $FamilyHistory, $dateofbloodresults, $Hematology, $Hepatic, $Renal, $Biomarkers, $AbnormNET, $AbnormCGA, $AbnormPancrea, $AbnormSerotonin, $AbnormU5IAA, $AbnormBiomarker, $PrimaryLocation, $cancerStatus, $cancerStage, $SecondaryLocation, $Histopathology, $HistopathologyLung, $HistopathologyGEPNET, $HistopathologyKi67, $HistopathologyMitosesLUNG, $HistopathologyMitosesGEPNETS, $Ostreoscan, $OstreoscanDate, $OstreoscanPosNeg, $OstreoscanArea, $OstreoscanLiverLobe, $OstreoscanLesions, $OstreoscanUptake, $CTScan, $CTScanDate, $CTScanPosNeg, $CTScanArea, $CTScanLiverLobe, $CTScanLesions, $CTScanLesions, $CTScanSizeofMeta, $MRIScan, $MRIScanDate, $MRIScanPosNeg, $MRIScanArea, $MRIScanLiverLobe, $MRIScanLesions, $MRIScanSizeofMeta, $FDGScan, $FDGScanDate, $FDGScanPosNeg, $FDGScanArea, $FDGScanLiverLobe, $FDGScanLesions, $FDGScanL1, $FDGScanL2, $FDGScanL3, $FDGScanL4, $FDGScanL5, $IstopeImaging, $IstopeImageDate, $IsotopeConjugad, $IsotopeL1, $IsotopeL2, $IsotopeL3, $IsotopeL4, $IsotopeL5, $PrimarySurgery, $PrimarySurgeryDate, $PrimaryGISurgery, $PrimaryLungSurgery, $MetastasesSurgery, $MetastasesSurgeryDate, $MetastasesLiverSurgery, $MetastasesLungSurgery, $Staging, $StagingDate, $StagingNum, $Interventions, $InterventionDate, $TypeInter, $PRRT, $PRRTDate, $TypePRRT, $NumCycles, $PRRTDose, $SSasDate, $SSAsType, $SSAsAmount, $Everolimus, $EverolimusDate, $Sunitnib, $SunitnibDate, $Bevacizumab, $BevacizumabDate, $Chemotherapy, $ChemoDate, $ChemoTreatment, "\n" ) ); if (empty($errors)) { $filename = date("Y-m-d-g-i-a") . "-" . $lastname . "-" . $firstname . ".csv"; $fp = fopen($filename, 'a+'); foreach ($list as $fields) { fputcsv($fp, $fields); } fclose($fp); //header('Location: http://www.wrenlaboratories.com/'); header("refresh:5; url=http://www.wrenlaboratories.com/"); exit("Thank you for all your information, it is greatly appreciated and will help out our research."); } } ?> <!DOCTYPE html> <html> <head> <meta charset="UTF-8"> <title>Tumor Patient History Form</title> <style> .error {color: #FF0000;} </style> </head> <body class="patients"> <a name="top" id="top"></a> <div id="container"> <div id="header"> <div id="title"><font size=18> Neuroendocrine Tumor Patients</font> <!-- end #title --> </div> <!-- end #header --> </div> <h1><a name="Wren Patient Form" id="Wren Patient Form"></a>NEW PATIENT HISTORY FORM </h1> <p>* Denotes required</p> <form method="post" name="WrenForm" id="WrenForm"> <input name="subject" type="hidden" value="New Patient History Form" /> <p>Name (Last): * <input name="lastname" type="text" id="lastname" size="15" value="<?php echo $lastname;?>" /> <?php if($errors['lastname']){ echo "<span class='error'>".$errors['lastname']."</span>"; } ?> (First): * <input name="firstname" type="text" id="firstname" size="15" value="<?php echo $firstname;?>" /> <?php if($errors['firstname']){ echo "<span class='error'>".$errors['firstname']."</span>"; } ?> (Middle): <input name="middlename" type="text" id="middlename" size="15" value="<?php echo $middlename;?>" /> Age: * <input name="age" type="text" id="age" size="2" value="<?php echo $age;?>" /> <?php if($errors['age']){ echo "<span class='error'>".$errors['age']."</span>"; } ?> </p> <p> Email: * <input name="email" type="text" id="email" size="40" value="<?php echo $email;?>" /> <?php if($errors['email']){ echo "<span class='error'>".$errors['email']."</span>"; } ?> Race: <select name="race"> <option <?php if ($race == '' ) echo 'selected' ; ?> value=""></option> <option <?php if ($race == 'Caucsian' ) echo 'selected' ; ?> value="Caucsian">Caucasian</option> <option <?php if ($race == 'Black' ) echo 'selected' ; ?> value="Black">Black</option> <option <?php if ($race == 'Hispanic' ) echo 'selected' ; ?> value="Hispanic">Hispanic/Latino</option> <option <?php if ($race == 'Asian' ) echo 'selected' ; ?> value="Asian">Asian</option> <option <?php if ($race == 'OtherRace' ) echo 'selected' ; ?> value="OtherRace">Other</option> </select> Gender: * <select name="gender"> <option <?php if ($gender == '' ) echo 'selected' ; ?> value=""></option> <option <?php if ($gender == 'Male' ) echo 'selected' ; ?> value="Male">Male</option> <option <?php if ($gender == 'Female' ) echo 'selected' ; ?> value="Female">Female</option> </select> <?php if($errors['gender']){ echo "<span class='error'>".$errors['gender']."</span>"; } ?> </p> <p>Home Phone: <input name="homePhone" type="text" id="homePhone" size="14" value="<?php echo $homePhone;?>" /> Cell Phone: <input name="cellPhone" type="text" id="cellPhone" size="14" value="<?php echo $cellPhone;?>" /> Work Phone: <input name="workPhone" type="text" id="workPhone" size="14" value="<?php echo $workPhone;?>" /> </p> <p><strong><u><h2>Cancer Information:</h2></u></strong></p> <p> Diagnosis Date: <input name="dod" type="text" id="dod" size="8" value="<?php echo $dod;?>" /> <font size="2">(ex. 10/26/1985)</font> </p> <p>Diagnosis Modality:<br> <input name="DiagnosisModality[]" type="checkbox" id="DiagnosisModality[]" value=" Endoscopy" /> Endoscopy <input name="DiagnosisModality[]" type="checkbox" id="DiagnosisModality[]" value=" Imaging" /> Imaging <input name="DiagnosisModality[]" type="checkbox" id="DiagnosisModality[]" value=" Histology" /> Histology <input name="DiagnosisModality[]" type="checkbox" id="DiagnosisModality[]" value=" Biomaker" /> Biomaker </p> <p>Signs:<br> <input name="signs[]" type="checkbox" id="signs[]" value="Weight Gain" /> Weight Gain <input name="signs[]" type="checkbox" id="signs[]" value="Weight Loss" /> Weight Loss <input name="signs[]" type="checkbox" id="signs[]" value=" Lump" /> Lump <input name="signs[]" type="checkbox" id="signs[]" value=" Anemia" /> Anemia <input name="signs[]" type="checkbox" id="signs[]" value=" Flushing" /> Flushing </p> <p>Symptoms:<br> <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Flush" /> Flush <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Sweat" /> Sweat <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Diarrhea" /> Diarrhea <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Pain" /> Pain <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Palpitation" /> Palpitation <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Constipation" /> Constipation <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Glycemia" /> Glycemia <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" OtherSym" /> Other </p> <p> Family History Of NETs: <br> <input type="radio" name="FamilyHistory" id="FamilyHistory" value="Yes Father" /> Yes Father's Side <input type="radio" name="FamilyHistory" id="FamilyHistory" value="Yes Mother" /> Yes Mother's Side <input type="radio" name="FamilyHistory" id="FamilyHistory" value="No" /> No </p> <p><h2><strong><u>Blood Results: </u></strong></h2> Date of Results: <input name="dobr" type="text" id="dobr" size="8" /> <font size="2">(ex. 10/26/1985)</font> </p> <p>Abnormal Hematology:<br> <input name="Hematology[]" type="checkbox" id="Hematology[]" value=" Hb" /> Hb <input name="Hematology[]" type="checkbox" id="Hematology[]" value=" WCC" /> WCC <input name="Hemotology[]" type="checkbox" id="Hematology[]" value=" Platelets" /> Platelets </p> <p>Abnormal Hepatic Function:<br> <input name="Hepatic[]" type="checkbox" id="Hepatic[]" value=" Bilirubin" /> Bilirubin <input name="Hepatic[]" type="checkbox" id="Hepatic[]" value=" ALK P" /> ALK P <input name="Hepatic[]" type="checkbox" id="Hepatic[]" value=" ALT" /> ALT <input name="Hepatic[]" type="checkbox" id="Hepatic[]" value=" ATT" /> ATT <input name="Hepatic[]" type="checkbox" id="Hepatic[]" value=" Albumin" /> Albumin </p> <p>Abnormal Renal Function:<br> <input name="Renal[]" type="checkbox" id="Renal[]" value=" Urea" /> Urea <input name="Renal[]" type="checkbox" id="Renal[]" value=" Creatinine" /> Creatinine </p> <p>Biomarkers:<br> <input name="Biomarker[]" type="checkbox" id="Biomarker[]" value=" NETest" /> NETest <input name="Biomarker[]" type="checkbox" id="Biomarker[]" value=" Chromogranin A" /> Chromogranin A <input name="Biomarker[]" type="checkbox" id="Biomarker[]" value=" Pancreastatin" /> Pancreastatin <input name="Biomarker[]" type="checkbox" id="Biomarker[]" value=" Serotonin" /> Serotonin <input name="Biomarker[]" type="checkbox" id="Biomarker[]" value=" U-5HIAA" /> U-5HIAA <input name="Biomarker[]" type="text" id="Biomarker[]" size="10"/> Other </p> <p> Abnormal Elevated Biomarkers:<br> Yes : <input type="radio" name="AbnormalElevatedNETest" id="AbnormalElevatedNETest" value="Yes" /> <input type="radio" name="AbnormalElevatedCgA" id="AbnormalElevatedCgA" value="Yes" /> <input type="radio" name="AbnormalElevatedPancreastatin" id="AbnormalElevatedPancreastatin" value="Yes" /> <input type="radio" name="AbnormalElevatedSerotonin" id="AbnormalElevatedSerotonin" value="Yes" /> <input type="radio" name="AbnormalElevatedU5HIAA" id="AbnormalElevatedU5HIAA" value="Yes" /> <input type="radio" name="AbnormalElevatedOtherBiomarker" id="AbnormalElevatedOtherBiomarker" value="Yes" /> <br> No : <input type="radio" name="AbnormalElevatedNETest" id="AbnormalElevatedNETest" value="No" /> <input type="radio" name="AbnormalElevatedCgA" id="AbnormalElevatedCgA" value="No" /> <input type="radio" name="AbnormalElevatedPancreastatin" id="AbnormalElevatedPancreastatin" value="No" /> <input type="radio" name="AbnormalElevatedSerotonin" id="AbnormalElevatedSerotonin" value="No" /> <input type="radio" name="AbnormalElevatedU-5HIAA" id="AbnormalElevatedU-5HIAA" value="No" /> <input type="radio" name="AbnormalElevatedOtherBiomarker" id="AbnormalElevatedBiomarker" value="No" /> <br> NETest CgA Pancreastatin Serotonin U-5IAA Other Biomarkers </p> <p><h2><strong><u>Tumor Location:</u></strong></h2> Primary Location: <select name="PrimaryLocation"> <option value="SmallBowel">Small Bowel</option> <option value="Pancreas">Pancreas</option> <option value="Rectum">Rectum</option> <option value="Gastric">Gastric</option> <option value="Appendix">Appendix</option> <option value="Colon">Colon</option> <option value="Duodenum">Duodenum</option> <option value="Lung">Lung</option> <option value="Other">Other</option> </select> Current Status: <select name="cancerStatus"> <option value="Pre-Surgery">Pre-Surgery</option> <option value="Post Surgery">Post Surgery</option> <option value="Recurrence">Recurrence</option> </select> Current Stage: <select name="cancerStage"> <option value="0">Stage 0</option> <option value="1">Stage 1</option> <option value="2">Stage 2</option> <option value="3">Stage 3</option> <option value="4">Stage 4</option> </select> <br><br> Metastasis (Second Location): <select name="SecondaryLocation"> <option value="No Secondary">No Secondary Tumor</option> <option value="Liver">Liver</option> <option value="LymphNodes">Lymph Nodes</option> <option value="Peritoneum">Peritoneum</option> <option value="Lung">Lung</option> <option value="Bone">Bone</option> <option value="Brain">Brain</option> <option value="Other">Other</option> <option value="Multiple">Multiple Locations</option> </select> </p> <p><h2><strong><u>Histopathology:</u></strong></h2> <input type="radio" name="Histopathology" id="Histopathology" value="Yes" /> Yes <input type="radio" name="Histopathology" id="Histopathology" value="No" /> No Date of Hisopathology: <input name="dobr" type="text" id="dobr" size="8" /> <font size="2">(ex. 10/26/1985)</font> <br><br><font size="4"><u>Lungs:</u></font><br> <input type="radio" name="HistopathologyLung" id="HistopathologyLung" value="Typical Carinoid" /> Typical Carinoid <input type="radio" name="HistopathologyLung" id="HistopathologyLung" value="Atypical Carcinoid" /> Atypical Carcinoid <input type="radio" name="HistopathologyLung" id="HistopathologyLung" value="Large Cell NEC" /> Large Cell NEC <input type="radio" name="HistopathologyLung" id="HistopathologyLung" value="Small Cell NEC" /> Small Cell NEC <br><br><font size="4"><u>GEP-NET:</u></font><br> <input type="radio" name="HistopathologyGEPNET" id="HistopathologyGEPNET" value="Well Differentiated" /> Well Differentiated <input type="radio" name="HistopathologyGEPNET" id="HistopathologyGEPNET" value="Moderately Differentiated" /> Moderately Differentiated <input type="radio" name="HistopathologyGEPNET" id="HistopathologyGEPNET" value="Poorly Differentiated" /> Poorly Differentiated <br><br><font size="4"><u>Ki-67:</u></font><br> <input type="radio" name="HistopathologyKi67" id="HistopathologyKi67" value="< 2%" /> < 2% <input type="radio" name="HistopathologyKi67" id="HistopathologyKi67" value="2-5%" /> 2-5% <input type="radio" name="HistopathologyKi67" id="HistopathologyKi67" value="6-10%" /> 6-10% <input type="radio" name="HistopathologyKi67" id="HistopathologyKi67" value="11-20%" /> 11-20% <input type="radio" name="HistopathologyKi67" id="HistopathologyKi67" value="> 20%" /> > 20% <br><br><font size="4"><u>Mitoses (Lung):</u></font><br> <input type="radio" name="HistopathologyMitoses(Lung)" id="HistopathologyMitoses(Lung)" value="< 3 HPF" /> < 3 HPF <input type="radio" name="HistopathologyMitoses(Lung)" id="HistopathologyMitoses(Lung)" value="4-10 HPF" /> 4-10 HPF <input type="radio" name="HistopathologyMitoses(Lung)" id="HistopathologyMitoses(Lung)" value="> 10 HPF" /> > 10 HPF <br>No Necrosis Necrosis <br><br><font size="4"><u>Mitoses (GEP-NETs):</u></font><br> <input type="radio" name="HistopathologyMitoses(GEP-NETs)" id="HistopathologyMitoses(GEP-NETs)" value="< 2 HPF" /> < 2 /10HPF <input type="radio" name="HistopathologyMitoses(GEP-NETs)" id="Histopathology Mitoses(GEP-NETs)" value="2-20 HPF" /> 2-20HPF <input type="radio" name="HistopathologyMitoses(GEP-NETs)" id="HistopathologyMitoses(GEP-NETs)" value="> 20 HPF" /> > 20 HPF </p> <p><h2><strong><u>Imaging:</u></strong></h2> <h4><u>Ostreoscan</u></h4> <input type="radio" name="Ostreoscan" id="Ostreoscan" value="Yes" /> Yes <input type="radio" name="Ostreoscan" id="Ostreoscan" value="No" /> No Date of Scan: <input name="OstreoscanDate" type="text" id="OstreoscanDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Was your Osetreoscan results Positive or Negative?<br> <input type="radio" name="Ostreoscan+/-" id="Ostreoscan+/-" value="Positive" /> Positive <input type="radio" name="Ostreoscan+/-" id="Ostreoscan+/-" value="Negative" /> Negative<br><br> What area did you have Scanned?<br> <input type="radio" name="OstreoscanArea" id="OstreoscanArea" value="Primary" /> Primary <input type="radio" name="OstreoscanArea" id="OstreoscanArea" value="Lymph Node" /> Lymph Node <input type="radio" name="OstreoscanArea" id="OstreoscanArea" value="Peritoneum" /> Peritoneum <input type="radio" name="OstreoscanArea" id="OstreoscanArea" value="Bone" /> Bone <input type="radio" name="OstreoscanArea" id="OstreoscanArea" value="Liver" /> Liver Other: <input name="OstreoscanArea" type="text" id="OstreoscanArea" size="10" /> <br><br>If you had the liver scanned what area showed activity?<br> <input type="radio" name="OstreoscanLiverLobe" id="OstreoscanLiverLobe" value="Left" /> Left <input type="radio" name="OstreoscanLiverLobe" id="OstreoscanLiverLobe" value="Right" /> Right <input type="radio" name="OstreoscanLiverLobe" id="OstreoscanLiverLobe" value="Both" /> Both<br><br> <input type="radio" name="OstreoscanLesions" id="OstreoscanLesions" value="<2" /> <2 <input type="radio" name="OstreoscanLesions" id="OstreoscanLesions" value="2-5" /> 2-5 <input type="radio" name="OstreoscanLesions" id="OstreoscanLesions" value="5-10" /> 5-10 <input type="radio" name="OstreoscanLesions" id="OstreoscanLesions" value=">10" /> >10 <input type="radio" name="OstreoscanUptake" id="OstreoscanUptake" value="1" /> 1 <input type="radio" name="OstreoscanUptake" id="OstreoscanUptake" value="2" /> 2 <input type="radio" name="OstreoscanUptake" id="OstreoscanUptake" value="3" /> 3 <input type="radio" name="OstreoscanUptake" id="OstreoscanUptake" value="4" /> 4 <br> Number of Lesions Uptake (Krenning Scale) <h4><u>CT Scan</u></h4> <input type="radio" name="CTScan" id="CTScan" value="Yes" /> Yes <input type="radio" name="CTScan" id="CTScan" value="No" /> No Date of Scan: <input name="CTScanDate" type="text" id="CTScanDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Was your CT Scan results Positive or Negative?<br> <input type="radio" name="CTScan+/-" id="CTScan+/-" value="Positive" /> Positive <input type="radio" name="CTScan+/-" id="CTScan+/-" value="Negative" /> Negative<br><br> What area did you have Scanned?<br> <input type="radio" name="CTScanArea" id="CTScanArea" value="Primary" /> Primary <input type="radio" name="CTScanArea" id="CTScanArea" value="Lymph Node" /> Lymph Node <input type="radio" name="CTScanArea" id="CTScanArea" value="Peritoneum" /> Peritoneum <input type="radio" name="CTScanArea" id="CTScanArea" value="Bone" /> Bone <input type="radio" name="CTScanArea" id="CTScanArea" value="Liver" /> Liver Other: <input name="CT Scan Area" type="text" id="CT Scan Area" size="10" /> <br><br>If you had the liver scanned what area showed activity?<br> <input type="radio" name="CTScanLiverLobe" id="CTScanLiverLobe" value="Left" /> Left <input type="radio" name="CTScanLiverLobe" id="CTScanLiverLobe" value="Right" /> Right <input type="radio" name="CTScanLiverLobe" id="CTScanLiverLobe" value="Both" /> Both<br><br> <input type="radio" name="CTScanLesions" id="CTScanLesions" value="<2" /> <2 <input type="radio" name="CTScanLesions" id="CTScanLesions" value="2-5" /> 2-5 <input type="radio" name="CTScanLesions" id="CTScanLesions" value="5-10" /> 5-10 <input type="radio" name="CTScanLesions" id="CTScanLesions" value=">10" /> >10 <input type="radio" name="CTScanSizeofMetastases" id="CTScanSizeofMetastases" value="<1/2" /> <1/2 <input type="radio" name="CTScanSizeofMetastases" id="CTScanSizeofMetastases" value="1" /> 1 <input type="radio" name="CTScanSizeofMetastases" id="CTScanSizeofMetastases" value="1-2" /> 1-2 <input type="radio" name="CTScanSizeofMetastases" id="CTScanSizeofMetastases" value="2-3" /> 2-3 <input type="radio" name="CTScanSizeofMetastases" id="CTScanSizeofMetastases" value=">3" /> >3 <br> Number of Lesions Size of Metastases (cm) <h4><u>MRI Scan</u></h4> <input type="radio" name="MRIScan" id="MRIScan" value="Yes" /> Yes <input type="radio" name="MRIScan" id="MRIScan" value="No" /> No Date of Scan: <input name="MRIScanDate" type="text" id="MRIScanDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Was your MRI Scan results Positive or Negative?<br> <input type="radio" name="MRIScan+/-" id="MRIScan+/-" value="Positive" /> Positive <input type="radio" name="MRIScan+/-" id="MRIScan+/-" value="Negative" /> Negative<br><br> What area did you have Scanned?<br> <input type="radio" name="MRIScanArea" id="MRIScanArea" value="Primary" /> Primary <input type="radio" name="MRIScanArea" id="MRIScanArea" value="Lymph Node" /> Lymph Node <input type="radio" name="MRIScanArea" id="MRIScanArea" value="Peritoneum" /> Peritoneum <input type="radio" name="MRIScanArea" id="MRIScanArea" value="Bone" /> Bone <input type="radio" name="MRIScanArea" id="MRIScanArea" value="Liver" /> Liver Other: <input name="MRIScanArea" type="text" id="MRIScanArea" size="10" /> <br><br>If you had the liver scanned what area showed activity?<br> <input type="radio" name="MRIScanLiverLobe" id="MRIScanLiverLobe" value="Left" /> Left <input type="radio" name="MRIScanLiverLobe" id="MRIScanLiverLobe" value="Right" /> Right <input type="radio" name="MRIScanLiverLobe" id="MRIScanLiverLobe" value="Both" /> Both<br><br> <input type="radio" name="MRIScanLesions" id="MRIScanLesions" value="<2" /> <2 <input type="radio" name="MRIScanLesions" id="MRIScanLesions" value="2-5" /> 2-5 <input type="radio" name="MRIScanLesions" id="MRIScanLesions" value="5-10" /> 5-10 <input type="radio" name="MRIScanLesions" id="MRIScanLesions" value=">10" /> >10 <input type="radio" name="MRIScanSizeofMetastases" id="MRIScanSizeofMetastases" value="<1/2" /> <1/2 <input type="radio" name="MRIScanSizeofMetastases" id="MRIScanSizeofMetastases" value="1" /> 1 <input type="radio" name="MRIScanSizeofMetastases" id="MRIScanSizeofMetastases" value="1-2" /> 1-2 <input type="radio" name="MRIScanSizeofMetastases" id="MRIScanSizeofMetastases" value="2-3" /> 2-3 <input type="radio" name="MRIScanSizeofMetastases" id="MRIScanSizeofMetastases" value=">3" /> >3 <br> Number of Lesions Size of Metastases (cm) <h4><u>FDG Scan</u></h4> <input type="radio" name="FDGScan" id="FDGScan" value="Yes" /> Yes <input type="radio" name="FDGScan" id="FDGScan" value="No" /> No Date of Scan: <input name="FDGScanDate" type="text" id="FDGScanDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Was your FDG Scan results Positive or Negative?<br> <input type="radio" name="FDGScan+/-" id="FDGScan+/-" value="Positive" /> Positive <input type="radio" name="FDGScan+/-" id="FDGScan+/-" value="Negative" /> Negative<br><br> What area did you have Scanned?<br> <input type="radio" name="FDGScanArea" id="FDGScanArea" value="Primary" /> Primary <input type="radio" name="FDGScanArea" id="FDGScanArea" value="Lymph Node" /> Lymph Node <input type="radio" name="FDGScanArea" id="FDGScanArea" value="Peritoneum" /> Peritoneum <input type="radio" name="FDGScanArea" id="FDGScanArea" value="Bone" /> Bone <input type="radio" name="FDGScanArea" id="FDGScanArea" value="Liver" /> Liver Other: <input name="FDGScanArea" type="text" id="FDGScanArea" size="10" /> <br><br>If you had the liver scanned what area showed activity?<br> <input type="radio" name="FDGScanLiverLobe" id="FDGScanLiverLobe" value="Left" /> Left <input type="radio" name="FDGScanLiverLobe" id="FDGScanLiverLobe" value="Right" /> Right <input type="radio" name="FDGScanLiverLobe" id="FDGScanLiverLobe" value="Both" /> Both<br><br> <input type="radio" name="FDGScanLesions" id="FDGScanLesions" value="<2" /> <2 <input type="radio" name="FDGScanLesions" id="FDGScanLesions" value="2-5" /> 2-5 <input type="radio" name="FDGScanLesions" id="FDGScanLesions" value="5-10" /> 5-10 <input type="radio" name="FDGScanLesions" id="FDGScanLesions" value=">10" /> >10 L1: <input name="FDGScanL1SUVmax" type="text" id="FDGScanL1SUVmax" size="1" /> L2: <input name="FDGScanL2SUVmax" type="text" id="FDGScanL2SUVmax" size="1" /> L3: <input name="FDGScanL3SUVmax" type="text" id="FDGScanL3SUVmax" size="1" /> L4: <input name="FDGScanL4SUVmax" type="text" id="FDGScanL4SUVmax" size="1" /> L5: <input name="FDGScanL5SUVmax" type="text" id="FDGScanL5SUVmax" size="1" /> KBq/ml <br> Number of Lesions SUVmax (<font size="2">Kilobecquerel/ per Millileter)</font> <h4><u>Isotope Imaging</u></h4> <input type="radio" name="IsotopeImaging" id="IsotopeImaging" value="Yes" /> Yes <input type="radio" name="IsotopeImaging" id="IsotopeImaging" value="No" /> No Date of Scan: <input name="IsotopeImageDate" type="text" id="IsotopeImageDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Type of Tracer:<br> <input name="IsotopeTracer[]" type="checkbox" id="IsotopeTracer[]" value="Ga" /> Ga <input name="IsotopeTracer[]" type="checkbox" id="IsotopeTracer[]" value="Fluro-DOPA" /> Fluro-DOPA <input name="IsotopeTracer[]" type="checkbox" id="IsotopeTracer[]" value="C-HTP" /> C-HTP <input name="IsotopeTracer[]" type="checkbox" id="IsotopeTracer[]" value="Tc-OCT" /> Tc-OCT Other: <input name="IsotopeTracer[]" type="text" id="IsotopeTracer[]" size="10" /> <br><br> Did the Tracer Work?<br> <input type="radio" name="IsotopeTracerWorking" id="IsotopeTracerWorking" value="Yes" /> Yes <input type="radio" name="IsotopeTracerWorking" id="IsotopeTracerWorking" value="No" /> No<br><br> Type of Conjugand:<br> <input name="IsotopeConjugand[]" type="checkbox" id="IsotopeConjugand[]" value="TATE" /> TATE <input name="IsotopeConjugand[]" type="checkbox" id="IsotopeConjugand[]" value="TOC" /> TOC <input name="IsotopeConjugand[]" type="checkbox" id="IsotopeConjugand[]" value="NOC" /> NOC<br><br> SUVmax:<br> Lesion 1: <input name="IsotopeL1SUVmax" type="text" id="IsotopeL1SUVmax" size="1" /> KBq/ml<br> Lesion 2: <input name="IsotopeL2SUVmax" type="text" id="IsotopeL2SUVmax" size="1" /> KBq/ml<br> Lesion 3: <input name="IsotopeL3SUVmax" type="text" id="IsotopeL3SUVmax" size="1" /> KBq/ml<br> Lesion 4: <input name="IsotopeL4SUVmax" type="text" id="IsotopeL4SUVmax" size="1" /> KBq/ml<br> Lesion 5: <input name="IsotopeL5SUVmax" type="text" id="IsotopeL5SUVmax" size="1" /> KBq/ml </p> <p> <h2><strong><u>Surgery:</u></strong></h2> <h4><u>Primary:</u></h4> <input type="radio" name="PrimarySurgery" id="PrimarySurgery" value="Yes" /> Yes <input type="radio" name="PrimarySurgery" id="PrimarySurgery" value="No" /> No Date of Surgery: <input name="PrimarySurgeryDate" type="text" id="PrimarySurgeryDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> <u>GI Tract</u><br> <input type="radio" name="PrimaryGITractSurgery" id="PrimaryGITractSurgery" value="Small Bowel Resection" /> Small Bowel Resection <input type="radio" name="PrimaryGITractSurgery" id="PrimaryGITractSurgery" value="Right Hemicolectomy" /> Right Hemicolectomy <input type="radio" name="PrimaryGITractSurgery" id="PrimaryGITractSurgery" value="Whipple Resection" /> Whipple Resection <input type="radio" name="PrimaryGITractSurgery" id="PrimaryGITractSurgery" value="Enucleation" /> Enucleation <input type="radio" name="PrimaryGITractSurgery" id="PrimaryGITractSurgery" value="Tail Resection" /> Tail Resection Other: <input name="PrmaryGITractSurgery" type="text" id="PrimaryGITractSurgery" size="10" /><br><br> <u>Lung</u><br> <input type="radio" name="PrimaryLungSurgery" id="PrimaryLungSurgery" value="Lobectomy Resection" /> Lobectomy Resection <input type="radio" name="PrimaryLungSurgery" id="PrimaryLungSurgery" value="Sleeve Resection" /> Sleeve Resection <br><br><h4><u>Metastases:</u></h4> <input type="radio" name="MetastasesSurgery" id="MetastasesSurgery" value="Yes" /> Yes <input type="radio" name="MetastasesSurgery" id="MetastasesSurgery" value="No" /> No Date of Surgery: <input name="MetastasesSurgeryDate" type="text" id="MetastasesSurgeryDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> <u>Liver</u><br> <input type="radio" name="MetastasesLiverSurgery" id="MetastasesLiver Surgery" value="Right Lobectomy" /> Right Lobectomy <input type="radio" name="MetastasesLiverSurgery" id="MetastasesLiver Surgery" value="Left Lobectomy" /> Left Lobectomy <input type="radio" name="MetastasesLiverSurgery" id="MetastasesLiver Surgery" value="Wedge Resection" /> Wedge Resection <input type="radio" name="MetastasesLiverSurgery" id="MetastasesLiver Surgery" value="Cherry Picking" /> Cherry Picking Other: <input name="MetastasesLiverSurgery" type="text" id="MetastasesLiverSurgery" size="10" /><br><br> <u> Lung</u><br> <input type="radio" name="MetastasesLungSurgery" id="MetastasesLungSurgery" value="Right Lobectomy" /> Right Lobectomy <input type="radio" name="MetastasesLungSurgery" id="MetastasesLungSurgery" value="Left Lobectomy" /> Left Lobectomy <input type="radio" name="MetastasesLungSurgery" id="MetastasesLungSurgery" value="Wedge Resection" /> Wedge Resection Other: <input name="MetastasesLungSurgery" type="text" id="MetastasesLungSurgery" size="10" /><br> <br><h4><u>Staging:</u></h4> <input type="radio" name="Staging" id="Staging" value="Yes" /> Yes <input type="radio" name="Staging" id="Staging" value="No" /> No Date of Surgery: <input name="StagingDate" type="text" id="StagingDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Primary Tumor(T) Regional Lymph Nodes (N) Distant Metastasisx (M)<br> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="T1" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="T2" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="T3" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="T4" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="N0" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="N1" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="M0" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="M1" /> <br> T1 T2 T3 T4 N0 N1 M0 M1 </p> <p><h2><strong><u>Interventions:</u></strong></h2> <input type="radio" name="Interventions" id="Interventions" value="Yes" /> Yes <input type="radio" name="Interventions" id="Interventions" value="No" /> No Date of Intervention: <input name="Intervention Date" type="text" id="Intervention Date" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <input type="checkbox" name="TypeofInterventions[]" id="TypeofInterventions[]" value="Bland Embolization"> Bland Embolization<br> <input type="checkbox" name="TypeofInterventions[]" id="TypeofInterventions[]" value="Chemo Embolization"> Chemo Embolization<br> <input type="checkbox" name="TypeofInterventions[]" id="TypeofInterventions[]" value="SIRT"> SIRT<br> <input type="checkbox" name="TypeofInterventions[]" id="TypeofInterventions[]" value="Thera Spheres"> Thera Spheres<br> <input type="checkbox" name="TypeofInterventions[]" id="TypeofInterventions[]" value="RFA"> RFA<br> Other: <input name="TypeofInterventions" type="text" id="TypeofInterventions" size="10" /><br> <h4><u>PRRT:</u></h4> <input type="radio" name="PRRT" id="PRRT" value="Yes" /> Yes <input type="radio" name="PRRT" id="PRRT" value="No" /> No Date of PRRT: <input name="PRRTDate" type="text" id="PRRTDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <br>Drug for intervention:<br><input type="checkbox" name="TypeofPRRT[]" id="TypeofPRRT[]" value="Lutetium">Lutetium <input type="checkbox" name="TypeofPRRT[]" id="TypeofPRRT[]" value="Yttrium">Yttrium<br><br> Number of Cycles: <select name="Number of Cylces"> <option value="0">No PRRT</option> <option value="1">1 Cycle</option> <option value="2">2 Cycles</option> <option value="3">3 Cycles</option> <option value="4">4 Cycles</option> <option value="5">5 Cycles</option> </select><br><br> Dosage: <input name="PRRT Dose" type="text" id="PRRT Dose" size="8" />MBq/per cycle <font size="2">(Megabecquerel per cycle)</font> </p> <p><h2><strong><u>Medication:</u></strong></h2> <h4><u>SSAs:</u></h4> <input type="radio" name="SSAs" id="SSAs" value="Yes" />Yes <input type="radio" name="SSAs" id="SSAs" value="No" />No Date: <input name="SSAsDate" type="text" id="SSAsDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> SSAs given medication:<br> <input type="radio" name="SSAsType" id="SSAsType" value="Sandostatin" />Sandostatin <input type="radio" name="SSAsType" id="SSAsType" value="Lanreotide" />Lanreotide <br><br> Amount of SSAs medication taken daily:<br> <input type="radio" name="SSAsAmount" id="SSAsAmount" value="10mg" />10mg <input type="radio" name="SSAsAmount" id="SSAsAmount" value="20mg" />20mg <input type="radio" name="SSAsAmount" id="SSAsAmount" value="30mg" />30mg <input type="radio" name="SSAsAmount" id="SSAsAmount" value="40mg" />40mg Other Amounts: <input name="SSAsAmount" type="text" id="SSAsAmount" size="1" />mg<br><br> Duration of SSA Medication:<br><input name="SSAs Durration (Months) " type="text" id="SSAs Durration (Months)" size="2" /> Months <font size="2">(ex. 34 is 2 years and 10 months)</font> <br><h4><u>Everolimus:</u></h4> <input type="radio" name="Everolimus" id="Everolimus" value="Yes" />Yes <input type="radio" name="Everolimus" id="Everolimus" value="No" />No Date: <input name="EverolimusDate" type="text" id="EverolimusDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <h4><u>Sunitnib:</u></h4> <input type="radio" name="Sunitnib" id="Sunitnib" value="Yes" />Yes <input type="radio" name="Sunitnib" id="Sunitnib" value="No" />No Date: <input name="SunitnibDate" type="text" id="SunitnibDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <h4><u>Bevacizumab:</u></h4> <input type="radio" name="Bevacizumab" id="Bevacizumab" value="Yes" />Yes <input type="radio" name="Bevacizumab" id="Bevacizumab" value="No" />No Date: <input name="BevacizumabDate" type="text" id="BevacizumabDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <h4><u>Chemotherapy:</u></h4> <input type="radio" name="Chemotherapy" id="Chemotherapy" value="Yes" />Yes <input type="radio" name="Chemotherapy" id="Chemotherapy" value="No" />No Date: <input name="ChemoDate" type="text" id="ChemoDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <br>Type of Chemotherapy:<br><input name="ChemoTreatment[]" type="checkbox" id="ChemoTreatment[]" value="Temozolomide" /> Temozolomide <input name="ChemoTreatment[]" type="checkbox" id="ChemoTreatment[]" value="5-FU" /> 5-FU <input name="ChemoTreatment[]" type="checkbox" id="ChemoTreatment[]" value="Streptozotozin" /> Streptozotozin <input name="ChemoTreatment[]" type="checkbox" id="ChemoTreatment[]" value="Cisplatin" /> Cisplatin Other: <input name="ChemoTreatment[]" type="text" id="ChemoTreatment[]" size="8" /> </p> <input type="submit" name="submit" id="submit" value="Submit" /> <input type="reset" name="clear" value="Clear"> </p> </form> <!-- end #mainContent --> </div> <div id="footer"> <!-- end #footer --> </div> <!-- end #container --> </div> </body> </html>

That's what I meant.

first trim is just checking, the next actually using it Is defining variable as blank to use in the form, otherwise would never be defined, is not in that huge list above. Action removed in the posted form

I have never used someone elses code unless was some sort of public/opensource. I will agree that someone may have coded it similar in the past or will in the future, it's coding...only so many ways can write it. It's actually best to talk to a lawyer that specializes in this stuff. To be blunt, is not much can do and is a waste of time unless you actually get a patent on said code. Even then is not easy to prove it. Most people are not willing to spend the thousands to do this. Edit: You may also discover that someone before you holds patents on what you have.

That's an extremely long form. I fixed most the errors and also many other items. Retaining the post values in form and mark the selected. Just top area though, you can look at that and do similar the rest your form. The radio in forms uses checked versus the dropdown using selected. Moving all html below and doing a delay on the header with a message. It's going to be hard for you to determine those optional and imploded post arrays, I usually push new values to an array and name them with an associative array, then again I also use a database. In this code the csv filename is the date,time,lastname,firstname Make a folder and save them all one location, shouldn't get duplicates or overwritten now. <?php date_default_timezone_set('UTC'); $errors = array(); $middlename = $race = $homePhone = $cellPhone = $workPhone = $dateofdiagnosis = $FamilyHistory = $dateofbloodresults = $AbnormNET = $AbnormCGA = $AbnormPancrea = $AbnormSerotonin = $AbnormU5IAA = $AbnormOtherBiomarker = $PrimaryLocation = $cancerStatus = $cancerStage = $SecondaryLocation = $Histopathology = $HistopathologyLung = $HistopathologyGEPNET = $HistopathologyKi67 = $HistopathologyMitosesLUNG = $HistopathologyMitosesGEPNETS = $Ostreoscan = $OstreoscanDate = $OstreoscanPosNeg = $OstreoscanArea = $OstreoscanLiverLobe = $OstreoscanLesions = $OstreoscanUptake = $CTScan = $CTScanDate = $CTScanPosNeg = $CTScanArea = $CTScanLiverLobe = $CTScanLesions = $CTScanLesions = $CTScanSizeofMeta = $MRIScan = $MRIScanDate = $MRIScanPosNeg = $MRIScanArea = $MRIScanLiverLobe = $MRIScanLesions = $MRIScanSizeofMeta = $FDGScan = $FDGScanDate = $FDGScanPosNeg = $FDGScanArea = $FDGScanLiverLobe = $FDGScanLesions = $FDGScanL1 = $FDGScanL2 = $FDGScanL3 = $FDGScanL4 = $FDGScanL5 = $IstopeImaging = $IstopeImageDate = $IsotopeConjugad = $IsotopeL1 = $IsotopeL2 = $IsotopeL3 = $IsotopeL4 = $IsotopeL5 = $PrimarySurgery = $PrimarySurgeryDate = $PrimaryGISurgery = $PrimaryLungSurgery = $MetastasesSurgery = $MetastasesSurgeryDate = $MetastasesLiverSurgery = $MetastasesLungSurgery = $Staging = $StagingDate = $StagingNum = $Interventions = $InterventionDate = $TypeInter = $PRRT = $PRRTDate = $TypePRRT = $NumCycles = $PRRTDose = $SSasDate = $SSAsType = $SSAsAmount = $Everolimus = $EverolimusDate = $Sunitnib = $SunitnibDate = $Bevacizumab = $BevacizumabDate = $Chemotherapy = $ChemoDate = ""; $DiagnosisModality = $signs = $symptoms = $Hematology = $Hepatic = $Renal = $Biomarkers = $IsotopeConjugad = $ChemoTreatment = ''; if (isset($_POST["submit"])) { if (isset($_POST["lastname"]) && trim($_POST["lastname"]) != '') { $lastname = trim($_POST["lastname"]); } else { $lastname = ''; $errors['lastname'] = "Last Name is required"; } if (isset($_POST["firstname"]) && trim($_POST["firstname"]) != '') { $firstname = trim($_POST["firstname"]); } else { $firstname = ''; $errors['firstname'] = "First Name is required"; } if (isset($_POST["middlename"])) { $middlename = $_POST["middlename"]; } else { $middlename = ''; } if (isset($_POST["age"]) && ctype_digit(trim($_POST["age"]))) { $age = trim($_POST["age"]); } else { $age = ''; $errors['age'] = "Age is required"; } if (isset($_POST["email"]) && filter_var(trim($_POST["email"]), FILTER_VALIDATE_EMAIL)) { $email = trim($_POST["email"]); } else { $email = ''; $errors['email'] = "Email is required"; } if (isset($_POST["race"]) && trim($_POST["race"]) != '') { $race = trim($_POST["race"]); } else { $race = ''; } if (isset($_POST["gender"]) && trim($_POST["gender"]) != '') { $gender = trim($_POST["gender"]); } else { $gender = ''; $errors['gender'] = "Gender is required"; } if (isset($_POST["homePhone"]) && trim($_POST["homePhone"]) != '') { $homePhone = $_POST["homePhone"]; } if (isset($_POST["cellPhone"]) && trim($_POST["cellPhone"]) != '') { $cellPhone = $_POST["cellPhone"]; } if (isset($_POST["workPhone"]) && trim($_POST["workPhone"]) != '') { $workPhone = $_POST["workPhone"]; } if (isset($_POST["dod"])) { $dateofdiagnosis = $_POST["dod"]; } if (isset($_POST["DiagnosisModality"])) { $DiagnosisModality = implode(",", $_POST["DiagnosisModality"]); } if (isset($_POST["signs"])) { $signs = implode(",", $_POST["signs"]); } if (isset($_POST["symptoms"])) { $symptoms = implode(",", $_POST["symptoms"]); } if (isset($_POST["FamilyHistory"])) { $FamilyHistory = $_POST["FamilyHistory"]; } if (isset($_POST["dobr"])) { $dateofbloodresults = $_POST["dobr"]; } if (isset($_POST["Hematology"])) { $Hematology = implode(",", $_POST["Hematology"]); } if (isset($_POST["Hepatic"])) { $Hepatic = implode(",", $_POST["Hepatic"]); } if (isset($_POST["Renal"])) { $Renal = implode(",", $_POST["Renal"]); } if (isset($_POST["Biomarkers"])) { $Biomarkers = implode(",", $_POST["Biomarkers"]); } if (isset($_POST["AbnormalElevatedNETest"])) { $AbnormNET = $_POST["AbnormalElevatedNETest"]; } if (isset($_POST["AbnormalElevatedCgA"])) { $AbnormCGA = $_POST["AbnormalElevatedCgA"]; } if (isset($_POST["AbnormalElevatedPancreastatin"])) { $AbnormPancrea = $_POST["AbnormalElevatedPancreastatin"]; } if (isset($_POST["AbnormalElevatedSerotonin"])) { $AbnormSerotonin = $_POST["AbnormalElevatedSerotonin"]; } if (isset($_POST["AbnormalElevatedU5HIAA"])) { $AbnormU5IAA = $_POST["AbnormalElevatedU5HIAA"]; } if (isset($_POST["AbnormalElevatedOtherBiomarker"])) { $AbnormOtherBiomarker = $_POST["AbnormalElevatedOtherBiomarker"]; } if (isset($_POST["PrimaryLocation"])) { $PrimaryLocation = $_POST["PrimaryLocation"]; } if (isset($_POST["cancerStatus"])) { $cancerStatus = $_POST["cancerStatus"]; } if (isset($_POST["cancerStage"])) { $cancerStage = $_POST["cancerStage"]; } if (isset($_POST["SecondaryLocation"])) { $SecondaryLocation = $_POST["SecondaryLocation"]; } if (isset($_POST["Histopathology"])) { $Histopathology = $_POST["Histopathology"]; } if (isset($_POST["HistopathologyLung"])) { $HistopathologyLung = $_POST["HistopathologyLung"]; } if (isset($_POST["HistopathologyGEPNET"])) { $HistopathologyGEPNET = $_POST["HistopathologyGEPNET"]; } if (isset($_POST["HistopathologyKi67"])) { $HistopathologyKi67 = $_POST["HistopathologyKi67"]; } if (isset($_POST["HistopathologyMitoses(Lung)"])) { $HistopathologyMitosesLUNG = $_POST["HistopathologyMitoses(Lung)"]; } $HistopathologyMitosesGEPNETS = $_POST["HistopathologyMitoses(GEP-NETs)"]; $Ostreoscan = $_POST["Ostreoscan"]; $OstreoscanDate = $_POST["OstreoscanDate"]; $OstreoscanPosNeg = $_POST["Ostreoscan+/-"]; $OstreoscanArea = $_POST["OstreoscanArea"]; $OstreoscanLiverLobe = $_POST["OstreoscanLiverLobe"]; $OstreoscanLesions = $_POST["OstreoscanLesions"]; $OstreoscanUptake = $_POST["OstreoscanUptake"]; $CTScan = $_POST["CTScan"]; $CTScanDate = $_POST["CTScanDate"]; $CTScanPosNeg = $_POST["CTScan+/-"]; $CTScanArea = $_POST["CTScanArea"]; $CTScanLiverLobe = $_POST["CTScanLiverLobe"]; $CTScanLesions = $_POST["CTScanLesions"]; $CTScanSizeofMeta = $_POST["CTScanSizeofMetastases"]; $MRIScan = $_POST["MRIScan"]; $MRIScanDate = $_POST["MRIScanDate"]; $MRIScanPosNeg = $_POST["MRIScan+/-"]; $MRIScanArea = $_POST["MRIScanArea"]; $MRIScanLiverLobe = $_POST["MRIScanLiverLobe"]; $MRIScanLesions = $_POST["MRIScanLesions"]; $MRIScanSizeofMeta = $_POST["MRIScanSizeofMetastases"]; $FDGScan = $_POST["FDGScan"]; $FDGScanDate = $_POST["FDGScanDate"]; $FDGScanPosNeg = $_POST["FDGScan+/-"]; $FDGScanArea = $_POST["FDGScanArea"]; $FDGScanLiverLobe = $_POST["FDGScanLiverLobe"]; $FDGScanLesions = $_POST["FDZGScanLesions"]; $FDGScanL1 = $_POST["FDGScanL1SUVmax"]; $FDGScanL2 = $_POST["FDGScanL2SUVmax"]; $FDGScanL3 = $_POST["FDGScanL3SUVmax"]; $FDGScanL4 = $_POST["FDGScanL4SUVmax"]; $FDGScanL5 = $_POST["FDGScanL5SUVmax"]; $IstopeImaging = $_POST["IstopeImaging"]; $IstopeImageDate = $_POST["IstopeImageDate"]; if (isset($_POST["IsotopeTracer"])) { $IstopeTracer = implode(",", $_POST["IsotopeTracer"]); } $IstopeTracerWorking = $_POST["IstopeTracerWorking"]; if (isset($_POST["IsotopeConjugad"])) { $IsotopeConjugad = implode(",", $_POST["IsotopeConjugad"]); } $IsotopeL1 = $_POST["IsotopeL1SUVmax"]; $IsotopeL2 = $_POST["IsotopeL2SUVmax"]; $IsotopeL3 = $_POST["IsotopeL3SUVmax"]; $IsotopeL4 = $_POST["IsotopeL4SUVmax"]; $IsotopeL5 = $_POST["IsotopeL5SUVmax"]; $PrimarySurgery = $_POST["PrimarySurgery"]; $PrimarySurgeryDate = $_POST["PrimarySurgeryDate"]; $PrimaryGISurgery = $_POST["PrimaryGITractSurgery"]; $PrimaryLungSurgery = $_POST["PrimaryLungSurgery"]; $MetastasesSurgery = $_POST["MetastasesSurgery"]; $MetastasesSurgeryDate = $_POST["MetastasesSurgeryDate"]; $MetastasesLiverSurgery = $_POST["MetastasesLiverSurgery"]; $MetastasesLungSurgery = $_POST["MetastasesLungSurgery"]; $Staging = $_POST["Staging"]; $StagingDate = $_POST["StagingDate"]; $StagingNum = $_POST["Staging#"]; $Interventions = $_POST["Interventions"]; $InterventionDate = $_POST["InterventionDate"]; $TypeInter = $_POST["TypeofInterventions"]; $PRRT = $_POST["PRRT"]; $PRRTDate = $_POST["PRRTDate"]; $TypePRRT = $_POST["TypeofPRRT"]; $NumCycles = $_POST["NumberofCycles"]; $PRRTDose = $_POST["PRRTDose"]; $SSAs = $_POST["SSAs"]; $SSAsDate = $_POST["SSAsDate"]; $SSAsType = $_POST["SSAsType"]; $SSAsAmount = $_POST["SSAsAmount"]; $Everolimus = $_POST["Everolimus"]; $EverolimusDate = $_POST["EverolimusDate"]; $Sunitnib = $_POST["Sunitnib"]; $SunitnibDate = $_POST["SunitnibDate"]; $Bevacizumab = $_POST["Bevacizumab"]; $BevacizumabDate = $_POST["BevacizumabDate"]; $Chemotherapy = $_POST["Chemotherapy"]; $ChemoDate = $_POST["ChemoDate"]; if (isset($_POST["ChemoTreatment"])) { $ChemoTreatment = implode(",", $_POST["ChemoTreatment"]); } $list = array( array( $lastname, $firstname, $middlename, $age, $email, $race, $gender, $homePhone, $cellPhone, $workPhone, $dateofdiagnosis, $DiagnosisModality, $signs, $symptoms, $FamilyHistory, $dateofbloodresults, $Hematology, $Hepatic, $Renal, $Biomarkers, $AbnormNET, $AbnormCGA, $AbnormPancrea, $AbnormSerotonin, $AbnormU5IAA, $AbnormBiomarker, $PrimaryLocation, $cancerStatus, $cancerStage, $SecondaryLocation, $Histopathology, $HistopathologyLung, $HistopathologyGEPNET, $HistopathologyKi67, $HistopathologyMitosesLUNG, $HistopathologyMitosesGEPNETS, $Ostreoscan, $OstreoscanDate, $OstreoscanPosNeg, $OstreoscanArea, $OstreoscanLiverLobe, $OstreoscanLesions, $OstreoscanUptake, $CTScan, $CTScanDate, $CTScanPosNeg, $CTScanArea, $CTScanLiverLobe, $CTScanLesions, $CTScanLesions, $CTScanSizeofMeta, $MRIScan, $MRIScanDate, $MRIScanPosNeg, $MRIScanArea, $MRIScanLiverLobe, $MRIScanLesions, $MRIScanSizeofMeta, $FDGScan, $FDGScanDate, $FDGScanPosNeg, $FDGScanArea, $FDGScanLiverLobe, $FDGScanLesions, $FDGScanL1, $FDGScanL2, $FDGScanL3, $FDGScanL4, $FDGScanL5, $IstopeImaging, $IstopeImageDate, $IsotopeConjugad, $IsotopeL1, $IsotopeL2, $IsotopeL3, $IsotopeL4, $IsotopeL5, $PrimarySurgery, $PrimarySurgeryDate, $PrimaryGISurgery, $PrimaryLungSurgery, $MetastasesSurgery, $MetastasesSurgeryDate, $MetastasesLiverSurgery, $MetastasesLungSurgery, $Staging, $StagingDate, $StagingNum, $Interventions, $InterventionDate, $TypeInter, $PRRT, $PRRTDate, $TypePRRT, $NumCycles, $PRRTDose, $SSasDate, $SSAsType, $SSAsAmount, $Everolimus, $EverolimusDate, $Sunitnib, $SunitnibDate, $Bevacizumab, $BevacizumabDate, $Chemotherapy, $ChemoDate, $ChemoTreatment, "\n" ) ); if (empty($errors)) { $filename = date("Y-m-d-g-i-a") . "-" . $lastname . "-" . $firstname . ".csv"; $fp = fopen($filename, 'a+'); foreach ($list as $fields) { fputcsv($fp, $fields); } fclose($fp); //header('Location: http://www.wrenlaboratories.com/'); header("refresh:5; url=http://www.wrenlaboratories.com/"); exit("Thank you for all your information, it is greatly appreciated and will help out our research."); } } ?> <!DOCTYPE html> <html> <head> <meta charset="UTF-8"> <title>Tumor Patient History Form</title> <style> .error {color: #FF0000;} </style> </head> <body class="patients"> <a name="top" id="top"></a> <div id="container"> <div id="header"> <div id="title"><font size=18> Neuroendocrine Tumor Patients</font> <!-- end #title --> </div> <!-- end #header --> </div> <h1><a name="Wren Patient Form" id="Wren Patient Form"></a>NEW PATIENT HISTORY FORM </h1> <p>* Denotes required</p> <form method="post" name="WrenForm" id="WrenForm"> <input name="subject" type="hidden" value="New Patient History Form" /> <p>Name (Last): * <input name="lastname" type="text" id="lastname" size="15" value="<?php echo $lastname;?>" /> <?php if($errors['lastname']){ echo "<span class='error'>".$errors['lastname']."</span>"; } ?> (First): * <input name="firstname" type="text" id="firstname" size="15" value="<?php echo $firstname;?>" /> <?php if($errors['firstname']){ echo "<span class='error'>".$errors['firstname']."</span>"; } ?> (Middle): <input name="middlename" type="text" id="middlename" size="15" value="<?php echo $middlename;?>" /> Age: * <input name="age" type="text" id="age" size="2" value="<?php echo $age;?>" /> <?php if($errors['age']){ echo "<span class='error'>".$errors['age']."</span>"; } ?> </p> <p> Email: * <input name="email" type="text" id="email" size="40" value="<?php echo $email;?>" /> <?php if($errors['email']){ echo "<span class='error'>".$errors['email']."</span>"; } ?> Race: <select name="race"> <option <?php if ($race == '' ) echo 'selected' ; ?> value=""></option> <option <?php if ($race == 'Caucsian' ) echo 'selected' ; ?> value="Caucsian">Caucasian</option> <option <?php if ($race == 'Black' ) echo 'selected' ; ?> value="Black">Black</option> <option <?php if ($race == 'Hispanic' ) echo 'selected' ; ?> value="Hispanic">Hispanic/Latino</option> <option <?php if ($race == 'Asian' ) echo 'selected' ; ?> value="Asian">Asian</option> <option <?php if ($race == 'OtherRace' ) echo 'selected' ; ?> value="OtherRace">Other</option> </select> Gender: * <select name="gender"> <option <?php if ($gender == '' ) echo 'selected' ; ?> value=""></option> <option <?php if ($gender == 'Male' ) echo 'selected' ; ?> value="Male">Male</option> <option <?php if ($gender == 'Female' ) echo 'selected' ; ?> value="Female">Female</option> </select> <?php if($errors['gender']){ echo "<span class='error'>".$errors['gender']."</span>"; } ?> </p> <p>Home Phone: <input name="homePhone" type="text" id="homePhone" size="14" value="<?php echo $homePhone;?>" /> Cell Phone: <input name="cellPhone" type="text" id="cellPhone" size="14" value="<?php echo $cellPhone;?>" /> Work Phone: <input name="workPhone" type="text" id="workPhone" size="14" value="<?php echo $workPhone;?>" /> </p> <p><strong><u><h2>Cancer Information:</h2></u></strong></p> <p> Diagnosis Date: <input name="dod" type="text" id="dod" size="8" value="<?php echo $dod;?>" /> <font size="2">(ex. 10/26/1985)</font> </p> <p>Diagnosis Modality:<br> <input name="DiagnosisModality[]" type="checkbox" id="DiagnosisModality[]" value=" Endoscopy" /> Endoscopy <input name="DiagnosisModality[]" type="checkbox" id="DiagnosisModality[]" value=" Imaging" /> Imaging <input name="DiagnosisModality[]" type="checkbox" id="DiagnosisModality[]" value=" Histology" /> Histology <input name="DiagnosisModality[]" type="checkbox" id="DiagnosisModality[]" value=" Biomaker" /> Biomaker </p> <p>Signs:<br> <input name="signs[]" type="checkbox" id="signs[]" value="Weight Gain" /> Weight Gain <input name="signs[]" type="checkbox" id="signs[]" value="Weight Loss" /> Weight Loss <input name="signs[]" type="checkbox" id="signs[]" value=" Lump" /> Lump <input name="signs[]" type="checkbox" id="signs[]" value=" Anemia" /> Anemia <input name="signs[]" type="checkbox" id="signs[]" value=" Flushing" /> Flushing </p> <p>Symptoms:<br> <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Flush" /> Flush <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Sweat" /> Sweat <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Diarrhea" /> Diarrhea <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Pain" /> Pain <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Palpitation" /> Palpitation <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Constipation" /> Constipation <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" Glycemia" /> Glycemia <input name="symptoms[]" type="checkbox" id="symptoms[]" value=" OtherSym" /> Other </p> <p> Family History Of NETs: <br> <input type="radio" name="FamilyHistory" id="FamilyHistory" value="Yes Father" /> Yes Father's Side <input type="radio" name="FamilyHistory" id="FamilyHistory" value="Yes Mother" /> Yes Mother's Side <input type="radio" name="FamilyHistory" id="FamilyHistory" value="No" /> No </p> <p><h2><strong><u>Blood Results: </u></strong></h2> Date of Results: <input name="dobr" type="text" id="dobr" size="8" /> <font size="2">(ex. 10/26/1985)</font> </p> <p>Abnormal Hematology:<br> <input name="Hematology[]" type="checkbox" id="Hematology[]" value=" Hb" /> Hb <input name="Hematology[]" type="checkbox" id="Hematology[]" value=" WCC" /> WCC <input name="Hemotology[]" type="checkbox" id="Hematology[]" value=" Platelets" /> Platelets </p> <p>Abnormal Hepatic Function:<br> <input name="Hepatic[]" type="checkbox" id="Hepatic[]" value=" Bilirubin" /> Bilirubin <input name="Hepatic[]" type="checkbox" id="Hepatic[]" value=" ALK P" /> ALK P <input name="Hepatic[]" type="checkbox" id="Hepatic[]" value=" ALT" /> ALT <input name="Hepatic[]" type="checkbox" id="Hepatic[]" value=" ATT" /> ATT <input name="Hepatic[]" type="checkbox" id="Hepatic[]" value=" Albumin" /> Albumin </p> <p>Abnormal Renal Function:<br> <input name="Renal[]" type="checkbox" id="Renal[]" value=" Urea" /> Urea <input name="Renal[]" type="checkbox" id="Renal[]" value=" Creatinine" /> Creatinine </p> <p>Biomarkers:<br> <input name="Biomarker[]" type="checkbox" id="Biomarker[]" value=" NETest" /> NETest <input name="Biomarker[]" type="checkbox" id="Biomarker[]" value=" Chromogranin A" /> Chromogranin A <input name="Biomarker[]" type="checkbox" id="Biomarker[]" value=" Pancreastatin" /> Pancreastatin <input name="Biomarker[]" type="checkbox" id="Biomarker[]" value=" Serotonin" /> Serotonin <input name="Biomarker[]" type="checkbox" id="Biomarker[]" value=" U-5HIAA" /> U-5HIAA <input name="Biomarker[]" type="text" id="Biomarker[]" size="10"/> Other </p> <p> Abnormal Elevated Biomarkers:<br> Yes : <input type="radio" name="AbnormalElevatedNETest" id="AbnormalElevatedNETest" value="Yes" /> <input type="radio" name="AbnormalElevatedCgA" id="AbnormalElevatedCgA" value="Yes" /> <input type="radio" name="AbnormalElevatedPancreastatin" id="AbnormalElevatedPancreastatin" value="Yes" /> <input type="radio" name="AbnormalElevatedSerotonin" id="AbnormalElevatedSerotonin" value="Yes" /> <input type="radio" name="AbnormalElevatedU5HIAA" id="AbnormalElevatedU5HIAA" value="Yes" /> <input type="radio" name="AbnormalElevatedOtherBiomarker" id="AbnormalElevatedOtherBiomarker" value="Yes" /> <br> No : <input type="radio" name="AbnormalElevatedNETest" id="AbnormalElevatedNETest" value="No" /> <input type="radio" name="AbnormalElevatedCgA" id="AbnormalElevatedCgA" value="No" /> <input type="radio" name="AbnormalElevatedPancreastatin" id="AbnormalElevatedPancreastatin" value="No" /> <input type="radio" name="AbnormalElevatedSerotonin" id="AbnormalElevatedSerotonin" value="No" /> <input type="radio" name="AbnormalElevatedU-5HIAA" id="AbnormalElevatedU-5HIAA" value="No" /> <input type="radio" name="AbnormalElevatedOtherBiomarker" id="AbnormalElevatedBiomarker" value="No" /> <br> NETest CgA Pancreastatin Serotonin U-5IAA Other Biomarkers </p> <p><h2><strong><u>Tumor Location:</u></strong></h2> Primary Location: <select name="PrimaryLocation"> <option value="SmallBowel">Small Bowel</option> <option value="Pancreas">Pancreas</option> <option value="Rectum">Rectum</option> <option value="Gastric">Gastric</option> <option value="Appendix">Appendix</option> <option value="Colon">Colon</option> <option value="Duodenum">Duodenum</option> <option value="Lung">Lung</option> <option value="Other">Other</option> </select> Current Status: <select name="cancerStatus"> <option value="Pre-Surgery">Pre-Surgery</option> <option value="Post Surgery">Post Surgery</option> <option value="Recurrence">Recurrence</option> </select> Current Stage: <select name="cancerStage"> <option value="0">Stage 0</option> <option value="1">Stage 1</option> <option value="2">Stage 2</option> <option value="3">Stage 3</option> <option value="4">Stage 4</option> </select> <br><br> Metastasis (Second Location): <select name="SecondaryLocation"> <option value="No Secondary">No Secondary Tumor</option> <option value="Liver">Liver</option> <option value="LymphNodes">Lymph Nodes</option> <option value="Peritoneum">Peritoneum</option> <option value="Lung">Lung</option> <option value="Bone">Bone</option> <option value="Brain">Brain</option> <option value="Other">Other</option> <option value="Multiple">Multiple Locations</option> </select> </p> <p><h2><strong><u>Histopathology:</u></strong></h2> <input type="radio" name="Histopathology" id="Histopathology" value="Yes" /> Yes <input type="radio" name="Histopathology" id="Histopathology" value="No" /> No Date of Hisopathology: <input name="dobr" type="text" id="dobr" size="8" /> <font size="2">(ex. 10/26/1985)</font> <br><br><font size="4"><u>Lungs:</u></font><br> <input type="radio" name="HistopathologyLung" id="HistopathologyLung" value="Typical Carinoid" /> Typical Carinoid <input type="radio" name="HistopathologyLung" id="HistopathologyLung" value="Atypical Carcinoid" /> Atypical Carcinoid <input type="radio" name="HistopathologyLung" id="HistopathologyLung" value="Large Cell NEC" /> Large Cell NEC <input type="radio" name="HistopathologyLung" id="HistopathologyLung" value="Small Cell NEC" /> Small Cell NEC <br><br><font size="4"><u>GEP-NET:</u></font><br> <input type="radio" name="HistopathologyGEPNET" id="HistopathologyGEPNET" value="Well Differentiated" /> Well Differentiated <input type="radio" name="HistopathologyGEPNET" id="HistopathologyGEPNET" value="Moderately Differentiated" /> Moderately Differentiated <input type="radio" name="HistopathologyGEPNET" id="HistopathologyGEPNET" value="Poorly Differentiated" /> Poorly Differentiated <br><br><font size="4"><u>Ki-67:</u></font><br> <input type="radio" name="HistopathologyKi67" id="HistopathologyKi67" value="< 2%" /> < 2% <input type="radio" name="HistopathologyKi67" id="HistopathologyKi67" value="2-5%" /> 2-5% <input type="radio" name="HistopathologyKi67" id="HistopathologyKi67" value="6-10%" /> 6-10% <input type="radio" name="HistopathologyKi67" id="HistopathologyKi67" value="11-20%" /> 11-20% <input type="radio" name="HistopathologyKi67" id="HistopathologyKi67" value="> 20%" /> > 20% <br><br><font size="4"><u>Mitoses (Lung):</u></font><br> <input type="radio" name="HistopathologyMitoses(Lung)" id="HistopathologyMitoses(Lung)" value="< 3 HPF" /> < 3 HPF <input type="radio" name="HistopathologyMitoses(Lung)" id="HistopathologyMitoses(Lung)" value="4-10 HPF" /> 4-10 HPF <input type="radio" name="HistopathologyMitoses(Lung)" id="HistopathologyMitoses(Lung)" value="> 10 HPF" /> > 10 HPF <br>No Necrosis Necrosis <br><br><font size="4"><u>Mitoses (GEP-NETs):</u></font><br> <input type="radio" name="HistopathologyMitoses(GEP-NETs)" id="HistopathologyMitoses(GEP-NETs)" value="< 2 HPF" /> < 2 /10HPF <input type="radio" name="HistopathologyMitoses(GEP-NETs)" id="Histopathology Mitoses(GEP-NETs)" value="2-20 HPF" /> 2-20HPF <input type="radio" name="HistopathologyMitoses(GEP-NETs)" id="HistopathologyMitoses(GEP-NETs)" value="> 20 HPF" /> > 20 HPF </p> <p><h2><strong><u>Imaging:</u></strong></h2> <h4><u>Ostreoscan</u></h4> <input type="radio" name="Ostreoscan" id="Ostreoscan" value="Yes" /> Yes <input type="radio" name="Ostreoscan" id="Ostreoscan" value="No" /> No Date of Scan: <input name="OstreoscanDate" type="text" id="OstreoscanDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Was your Osetreoscan results Positive or Negative?<br> <input type="radio" name="Ostreoscan+/-" id="Ostreoscan+/-" value="Positive" /> Positive <input type="radio" name="Ostreoscan+/-" id="Ostreoscan+/-" value="Negative" /> Negative<br><br> What area did you have Scanned?<br> <input type="radio" name="OstreoscanArea" id="OstreoscanArea" value="Primary" /> Primary <input type="radio" name="OstreoscanArea" id="OstreoscanArea" value="Lymph Node" /> Lymph Node <input type="radio" name="OstreoscanArea" id="OstreoscanArea" value="Peritoneum" /> Peritoneum <input type="radio" name="OstreoscanArea" id="OstreoscanArea" value="Bone" /> Bone <input type="radio" name="OstreoscanArea" id="OstreoscanArea" value="Liver" /> Liver Other: <input name="OstreoscanArea" type="text" id="OstreoscanArea" size="10" /> <br><br>If you had the liver scanned what area showed activity?<br> <input type="radio" name="OstreoscanLiverLobe" id="OstreoscanLiverLobe" value="Left" /> Left <input type="radio" name="OstreoscanLiverLobe" id="OstreoscanLiverLobe" value="Right" /> Right <input type="radio" name="OstreoscanLiverLobe" id="OstreoscanLiverLobe" value="Both" /> Both<br><br> <input type="radio" name="OstreoscanLesions" id="OstreoscanLesions" value="<2" /> <2 <input type="radio" name="OstreoscanLesions" id="OstreoscanLesions" value="2-5" /> 2-5 <input type="radio" name="OstreoscanLesions" id="OstreoscanLesions" value="5-10" /> 5-10 <input type="radio" name="OstreoscanLesions" id="OstreoscanLesions" value=">10" /> >10 <input type="radio" name="OstreoscanUptake" id="OstreoscanUptake" value="1" /> 1 <input type="radio" name="OstreoscanUptake" id="OstreoscanUptake" value="2" /> 2 <input type="radio" name="OstreoscanUptake" id="OstreoscanUptake" value="3" /> 3 <input type="radio" name="OstreoscanUptake" id="OstreoscanUptake" value="4" /> 4 <br> Number of Lesions Uptake (Krenning Scale) <h4><u>CT Scan</u></h4> <input type="radio" name="CTScan" id="CTScan" value="Yes" /> Yes <input type="radio" name="CTScan" id="CTScan" value="No" /> No Date of Scan: <input name="CTScanDate" type="text" id="CTScanDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Was your CT Scan results Positive or Negative?<br> <input type="radio" name="CTScan+/-" id="CTScan+/-" value="Positive" /> Positive <input type="radio" name="CTScan+/-" id="CTScan+/-" value="Negative" /> Negative<br><br> What area did you have Scanned?<br> <input type="radio" name="CTScanArea" id="CTScanArea" value="Primary" /> Primary <input type="radio" name="CTScanArea" id="CTScanArea" value="Lymph Node" /> Lymph Node <input type="radio" name="CTScanArea" id="CTScanArea" value="Peritoneum" /> Peritoneum <input type="radio" name="CTScanArea" id="CTScanArea" value="Bone" /> Bone <input type="radio" name="CTScanArea" id="CTScanArea" value="Liver" /> Liver Other: <input name="CT Scan Area" type="text" id="CT Scan Area" size="10" /> <br><br>If you had the liver scanned what area showed activity?<br> <input type="radio" name="CTScanLiverLobe" id="CTScanLiverLobe" value="Left" /> Left <input type="radio" name="CTScanLiverLobe" id="CTScanLiverLobe" value="Right" /> Right <input type="radio" name="CTScanLiverLobe" id="CTScanLiverLobe" value="Both" /> Both<br><br> <input type="radio" name="CTScanLesions" id="CTScanLesions" value="<2" /> <2 <input type="radio" name="CTScanLesions" id="CTScanLesions" value="2-5" /> 2-5 <input type="radio" name="CTScanLesions" id="CTScanLesions" value="5-10" /> 5-10 <input type="radio" name="CTScanLesions" id="CTScanLesions" value=">10" /> >10 <input type="radio" name="CTScanSizeofMetastases" id="CTScanSizeofMetastases" value="<1/2" /> <1/2 <input type="radio" name="CTScanSizeofMetastases" id="CTScanSizeofMetastases" value="1" /> 1 <input type="radio" name="CTScanSizeofMetastases" id="CTScanSizeofMetastases" value="1-2" /> 1-2 <input type="radio" name="CTScanSizeofMetastases" id="CTScanSizeofMetastases" value="2-3" /> 2-3 <input type="radio" name="CTScanSizeofMetastases" id="CTScanSizeofMetastases" value=">3" /> >3 <br> Number of Lesions Size of Metastases (cm) <h4><u>MRI Scan</u></h4> <input type="radio" name="MRIScan" id="MRIScan" value="Yes" /> Yes <input type="radio" name="MRIScan" id="MRIScan" value="No" /> No Date of Scan: <input name="MRIScanDate" type="text" id="MRIScanDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Was your MRI Scan results Positive or Negative?<br> <input type="radio" name="MRIScan+/-" id="MRIScan+/-" value="Positive" /> Positive <input type="radio" name="MRIScan+/-" id="MRIScan+/-" value="Negative" /> Negative<br><br> What area did you have Scanned?<br> <input type="radio" name="MRIScanArea" id="MRIScanArea" value="Primary" /> Primary <input type="radio" name="MRIScanArea" id="MRIScanArea" value="Lymph Node" /> Lymph Node <input type="radio" name="MRIScanArea" id="MRIScanArea" value="Peritoneum" /> Peritoneum <input type="radio" name="MRIScanArea" id="MRIScanArea" value="Bone" /> Bone <input type="radio" name="MRIScanArea" id="MRIScanArea" value="Liver" /> Liver Other: <input name="MRIScanArea" type="text" id="MRIScanArea" size="10" /> <br><br>If you had the liver scanned what area showed activity?<br> <input type="radio" name="MRIScanLiverLobe" id="MRIScanLiverLobe" value="Left" /> Left <input type="radio" name="MRIScanLiverLobe" id="MRIScanLiverLobe" value="Right" /> Right <input type="radio" name="MRIScanLiverLobe" id="MRIScanLiverLobe" value="Both" /> Both<br><br> <input type="radio" name="MRIScanLesions" id="MRIScanLesions" value="<2" /> <2 <input type="radio" name="MRIScanLesions" id="MRIScanLesions" value="2-5" /> 2-5 <input type="radio" name="MRIScanLesions" id="MRIScanLesions" value="5-10" /> 5-10 <input type="radio" name="MRIScanLesions" id="MRIScanLesions" value=">10" /> >10 <input type="radio" name="MRIScanSizeofMetastases" id="MRIScanSizeofMetastases" value="<1/2" /> <1/2 <input type="radio" name="MRIScanSizeofMetastases" id="MRIScanSizeofMetastases" value="1" /> 1 <input type="radio" name="MRIScanSizeofMetastases" id="MRIScanSizeofMetastases" value="1-2" /> 1-2 <input type="radio" name="MRIScanSizeofMetastases" id="MRIScanSizeofMetastases" value="2-3" /> 2-3 <input type="radio" name="MRIScanSizeofMetastases" id="MRIScanSizeofMetastases" value=">3" /> >3 <br> Number of Lesions Size of Metastases (cm) <h4><u>FDG Scan</u></h4> <input type="radio" name="FDGScan" id="FDGScan" value="Yes" /> Yes <input type="radio" name="FDGScan" id="FDGScan" value="No" /> No Date of Scan: <input name="FDGScanDate" type="text" id="FDGScanDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Was your FDG Scan results Positive or Negative?<br> <input type="radio" name="FDGScan+/-" id="FDGScan+/-" value="Positive" /> Positive <input type="radio" name="FDGScan+/-" id="FDGScan+/-" value="Negative" /> Negative<br><br> What area did you have Scanned?<br> <input type="radio" name="FDGScanArea" id="FDGScanArea" value="Primary" /> Primary <input type="radio" name="FDGScanArea" id="FDGScanArea" value="Lymph Node" /> Lymph Node <input type="radio" name="FDGScanArea" id="FDGScanArea" value="Peritoneum" /> Peritoneum <input type="radio" name="FDGScanArea" id="FDGScanArea" value="Bone" /> Bone <input type="radio" name="FDGScanArea" id="FDGScanArea" value="Liver" /> Liver Other: <input name="FDGScanArea" type="text" id="FDGScanArea" size="10" /> <br><br>If you had the liver scanned what area showed activity?<br> <input type="radio" name="FDGScanLiverLobe" id="FDGScanLiverLobe" value="Left" /> Left <input type="radio" name="FDGScanLiverLobe" id="FDGScanLiverLobe" value="Right" /> Right <input type="radio" name="FDGScanLiverLobe" id="FDGScanLiverLobe" value="Both" /> Both<br><br> <input type="radio" name="FDGScanLesions" id="FDGScanLesions" value="<2" /> <2 <input type="radio" name="FDGScanLesions" id="FDGScanLesions" value="2-5" /> 2-5 <input type="radio" name="FDGScanLesions" id="FDGScanLesions" value="5-10" /> 5-10 <input type="radio" name="FDGScanLesions" id="FDGScanLesions" value=">10" /> >10 L1: <input name="FDGScanL1SUVmax" type="text" id="FDGScanL1SUVmax" size="1" /> L2: <input name="FDGScanL2SUVmax" type="text" id="FDGScanL2SUVmax" size="1" /> L3: <input name="FDGScanL3SUVmax" type="text" id="FDGScanL3SUVmax" size="1" /> L4: <input name="FDGScanL4SUVmax" type="text" id="FDGScanL4SUVmax" size="1" /> L5: <input name="FDGScanL5SUVmax" type="text" id="FDGScanL5SUVmax" size="1" /> KBq/ml <br> Number of Lesions SUVmax (<font size="2">Kilobecquerel/ per Millileter)</font> <h4><u>Isotope Imaging</u></h4> <input type="radio" name="IsotopeImaging" id="IsotopeImaging" value="Yes" /> Yes <input type="radio" name="IsotopeImaging" id="IsotopeImaging" value="No" /> No Date of Scan: <input name="IsotopeImageDate" type="text" id="IsotopeImageDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Type of Tracer:<br> <input name="IsotopeTracer[]" type="checkbox" id="IsotopeTracer[]" value="Ga" /> Ga <input name="IsotopeTracer[]" type="checkbox" id="IsotopeTracer[]" value="Fluro-DOPA" /> Fluro-DOPA <input name="IsotopeTracer[]" type="checkbox" id="IsotopeTracer[]" value="C-HTP" /> C-HTP <input name="IsotopeTracer[]" type="checkbox" id="IsotopeTracer[]" value="Tc-OCT" /> Tc-OCT Other: <input name="IsotopeTracer[]" type="text" id="IsotopeTracer[]" size="10" /> <br><br> Did the Tracer Work?<br> <input type="radio" name="IsotopeTracerWorking" id="IsotopeTracerWorking" value="Yes" /> Yes <input type="radio" name="IsotopeTracerWorking" id="IsotopeTracerWorking" value="No" /> No<br><br> Type of Conjugand:<br> <input name="IsotopeConjugand[]" type="checkbox" id="IsotopeConjugand[]" value="TATE" /> TATE <input name="IsotopeConjugand[]" type="checkbox" id="IsotopeConjugand[]" value="TOC" /> TOC <input name="IsotopeConjugand[]" type="checkbox" id="IsotopeConjugand[]" value="NOC" /> NOC<br><br> SUVmax:<br> Lesion 1: <input name="IsotopeL1SUVmax" type="text" id="IsotopeL1SUVmax" size="1" /> KBq/ml<br> Lesion 2: <input name="IsotopeL2SUVmax" type="text" id="IsotopeL2SUVmax" size="1" /> KBq/ml<br> Lesion 3: <input name="IsotopeL3SUVmax" type="text" id="IsotopeL3SUVmax" size="1" /> KBq/ml<br> Lesion 4: <input name="IsotopeL4SUVmax" type="text" id="IsotopeL4SUVmax" size="1" /> KBq/ml<br> Lesion 5: <input name="IsotopeL5SUVmax" type="text" id="IsotopeL5SUVmax" size="1" /> KBq/ml </p> <p> <h2><strong><u>Surgery:</u></strong></h2> <h4><u>Primary:</u></h4> <input type="radio" name="PrimarySurgery" id="PrimarySurgery" value="Yes" /> Yes <input type="radio" name="PrimarySurgery" id="PrimarySurgery" value="No" /> No Date of Surgery: <input name="PrimarySurgeryDate" type="text" id="PrimarySurgeryDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> <u>GI Tract</u><br> <input type="radio" name="PrimaryGITractSurgery" id="PrimaryGITractSurgery" value="Small Bowel Resection" /> Small Bowel Resection <input type="radio" name="PrimaryGITractSurgery" id="PrimaryGITractSurgery" value="Right Hemicolectomy" /> Right Hemicolectomy <input type="radio" name="PrimaryGITractSurgery" id="PrimaryGITractSurgery" value="Whipple Resection" /> Whipple Resection <input type="radio" name="PrimaryGITractSurgery" id="PrimaryGITractSurgery" value="Enucleation" /> Enucleation <input type="radio" name="PrimaryGITractSurgery" id="PrimaryGITractSurgery" value="Tail Resection" /> Tail Resection Other: <input name="PrmaryGITractSurgery" type="text" id="PrimaryGITractSurgery" size="10" /><br><br> <u>Lung</u><br> <input type="radio" name="PrimaryLungSurgery" id="PrimaryLungSurgery" value="Lobectomy Resection" /> Lobectomy Resection <input type="radio" name="PrimaryLungSurgery" id="PrimaryLungSurgery" value="Sleeve Resection" /> Sleeve Resection <br><br><h4><u>Metastases:</u></h4> <input type="radio" name="MetastasesSurgery" id="MetastasesSurgery" value="Yes" /> Yes <input type="radio" name="MetastasesSurgery" id="MetastasesSurgery" value="No" /> No Date of Surgery: <input name="MetastasesSurgeryDate" type="text" id="MetastasesSurgeryDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> <u>Liver</u><br> <input type="radio" name="MetastasesLiverSurgery" id="MetastasesLiver Surgery" value="Right Lobectomy" /> Right Lobectomy <input type="radio" name="MetastasesLiverSurgery" id="MetastasesLiver Surgery" value="Left Lobectomy" /> Left Lobectomy <input type="radio" name="MetastasesLiverSurgery" id="MetastasesLiver Surgery" value="Wedge Resection" /> Wedge Resection <input type="radio" name="MetastasesLiverSurgery" id="MetastasesLiver Surgery" value="Cherry Picking" /> Cherry Picking Other: <input name="MetastasesLiverSurgery" type="text" id="MetastasesLiverSurgery" size="10" /><br><br> <u> Lung</u><br> <input type="radio" name="MetastasesLungSurgery" id="MetastasesLungSurgery" value="Right Lobectomy" /> Right Lobectomy <input type="radio" name="MetastasesLungSurgery" id="MetastasesLungSurgery" value="Left Lobectomy" /> Left Lobectomy <input type="radio" name="MetastasesLungSurgery" id="MetastasesLungSurgery" value="Wedge Resection" /> Wedge Resection Other: <input name="MetastasesLungSurgery" type="text" id="MetastasesLungSurgery" size="10" /><br> <br><h4><u>Staging:</u></h4> <input type="radio" name="Staging" id="Staging" value="Yes" /> Yes <input type="radio" name="Staging" id="Staging" value="No" /> No Date of Surgery: <input name="StagingDate" type="text" id="StagingDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> Primary Tumor(T) Regional Lymph Nodes (N) Distant Metastasisx (M)<br> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="T1" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="T2" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="T3" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="T4" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="N0" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="N1" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="M0" /> <input type="checkbox" name="Staging#[]" id="Staging#[]" value="M1" /> <br> T1 T2 T3 T4 N0 N1 M0 M1 </p> <p><h2><strong><u>Interventions:</u></strong></h2> <input type="radio" name="Interventions" id="Interventions" value="Yes" /> Yes <input type="radio" name="Interventions" id="Interventions" value="No" /> No Date of Intervention: <input name="Intervention Date" type="text" id="Intervention Date" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <input type="checkbox" name="TypeofInterventions[]" id="TypeofInterventions[]" value="Bland Embolization"> Bland Embolization<br> <input type="checkbox" name="TypeofInterventions[]" id="TypeofInterventions[]" value="Chemo Embolization"> Chemo Embolization<br> <input type="checkbox" name="TypeofInterventions[]" id="TypeofInterventions[]" value="SIRT"> SIRT<br> <input type="checkbox" name="TypeofInterventions[]" id="TypeofInterventions[]" value="Thera Spheres"> Thera Spheres<br> <input type="checkbox" name="TypeofInterventions[]" id="TypeofInterventions[]" value="RFA"> RFA<br> Other: <input name="TypeofInterventions" type="text" id="TypeofInterventions" size="10" /><br> <h4><u>PRRT:</u></h4> <input type="radio" name="PRRT" id="PRRT" value="Yes" /> Yes <input type="radio" name="PRRT" id="PRRT" value="No" /> No Date of PRRT: <input name="PRRTDate" type="text" id="PRRTDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <br>Drug for intervention:<br><input type="checkbox" name="TypeofPRRT[]" id="TypeofPRRT[]" value="Lutetium">Lutetium <input type="checkbox" name="TypeofPRRT[]" id="TypeofPRRT[]" value="Yttrium">Yttrium<br><br> Number of Cycles: <select name="Number of Cylces"> <option value="0">No PRRT</option> <option value="1">1 Cycle</option> <option value="2">2 Cycles</option> <option value="3">3 Cycles</option> <option value="4">4 Cycles</option> <option value="5">5 Cycles</option> </select><br><br> Dosage: <input name="PRRT Dose" type="text" id="PRRT Dose" size="8" />MBq/per cycle <font size="2">(Megabecquerel per cycle)</font> </p> <p><h2><strong><u>Medication:</u></strong></h2> <h4><u>SSAs:</u></h4> <input type="radio" name="SSAs" id="SSAs" value="Yes" />Yes <input type="radio" name="SSAs" id="SSAs" value="No" />No Date: <input name="SSAsDate" type="text" id="SSAsDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br><br> SSAs given medication:<br> <input type="radio" name="SSAsType" id="SSAsType" value="Sandostatin" />Sandostatin <input type="radio" name="SSAsType" id="SSAsType" value="Lanreotide" />Lanreotide <br><br> Amount of SSAs medication taken daily:<br> <input type="radio" name="SSAsAmount" id="SSAsAmount" value="10mg" />10mg <input type="radio" name="SSAsAmount" id="SSAsAmount" value="20mg" />20mg <input type="radio" name="SSAsAmount" id="SSAsAmount" value="30mg" />30mg <input type="radio" name="SSAsAmount" id="SSAsAmount" value="40mg" />40mg Other Amounts: <input name="SSAsAmount" type="text" id="SSAsAmount" size="1" />mg<br><br> Duration of SSA Medication:<br><input name="SSAs Durration (Months) " type="text" id="SSAs Durration (Months)" size="2" /> Months <font size="2">(ex. 34 is 2 years and 10 months)</font> <br><h4><u>Everolimus:</u></h4> <input type="radio" name="Everolimus" id="Everolimus" value="Yes" />Yes <input type="radio" name="Everolimus" id="Everolimus" value="No" />No Date: <input name="EverolimusDate" type="text" id="EverolimusDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <h4><u>Sunitnib:</u></h4> <input type="radio" name="Sunitnib" id="Sunitnib" value="Yes" />Yes <input type="radio" name="Sunitnib" id="Sunitnib" value="No" />No Date: <input name="SunitnibDate" type="text" id="SunitnibDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <h4><u>Bevacizumab:</u></h4> <input type="radio" name="Bevacizumab" id="Bevacizumab" value="Yes" />Yes <input type="radio" name="Bevacizumab" id="Bevacizumab" value="No" />No Date: <input name="BevacizumabDate" type="text" id="BevacizumabDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <h4><u>Chemotherapy:</u></h4> <input type="radio" name="Chemotherapy" id="Chemotherapy" value="Yes" />Yes <input type="radio" name="Chemotherapy" id="Chemotherapy" value="No" />No Date: <input name="ChemoDate" type="text" id="ChemoDate" size="8" /> <font size="2">(ex. 10/26/1985)</font><br> <br>Type of Chemotherapy:<br><input name="ChemoTreatment[]" type="checkbox" id="ChemoTreatment[]" value="Temozolomide" /> Temozolomide <input name="ChemoTreatment[]" type="checkbox" id="ChemoTreatment[]" value="5-FU" /> 5-FU <input name="ChemoTreatment[]" type="checkbox" id="ChemoTreatment[]" value="Streptozotozin" /> Streptozotozin <input name="ChemoTreatment[]" type="checkbox" id="ChemoTreatment[]" value="Cisplatin" /> Cisplatin Other: <input name="ChemoTreatment[]" type="text" id="ChemoTreatment[]" size="8" /> </p> <input type="submit" name="submit" id="submit" value="Submit" /> <input type="reset" name="clear" value="Clear"> </p> </form> <!-- end #mainContent --> </div> <div id="footer"> <!-- end #footer --> </div> <!-- end #container --> </div> </body> </html>

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LOAD DATA LOCAL INFILE '/tmp/airports.dat' REPLACE INTO TABLE airports FIELDS ESCAPED BY '\"' TERMINATED BY ',' OPTIONALLY ENCLOSED BY '\"' LINES TERMINATED BY '\r\n' (`apid`, `name`, `city`, `country`, `iata`, `icao`, `y`, `x`, `elevation`, `timezone`, `dst`, `tz_id`) Remove the double quotes in the last record after insert or add an empty line at the end of dat file

Rewrites are not for multiple user modes, it's for using the same values each time, modifying the url address versus the actual location. Your best bet is to include different scripts or permission rights with code. Use a session to see if that person has at least a certain permission level User permissions 1-9 stored in database Always use session_start(); top your scripts Upon successful login when you do a query set the permission in the session $_SESSION['permission'] = $row['permission']; Now in your script can check if a permission is higher than a certain amount. if($_SESSION['permission'] && $_SESSION['permission'] >= { //allow something a superadmin can do } You can also do some functions to make it simpler writing throughout your code. Can expand upon this with specific roles hard coded or saved database <?php session_start(); //set session with login query $_SESSION['permission'] = 9; //1-9 //permissions based on at least a certain number function isUberAdmin() { if ($_SESSION['permission'] && $_SESSION['permission'] == 9) { return true; } else { return false; } } function isSuperAdmin() { if ($_SESSION['permission'] && $_SESSION['permission'] >= { return true; } else { return false; } } function isAdmin() { if ($_SESSION['permission'] && $_SESSION['permission'] >= 7) { return true; } else { return false; } } function isUberModerator() { if ($_SESSION['permission'] && $_SESSION['permission'] >= 6) { return true; } else { return false; } } function isSuperModerator() { if ($_SESSION['permission'] && $_SESSION['permission'] >= 5) { return true; } else { return false; } } function isModerator() { if ($_SESSION['permission'] && $_SESSION['permission'] >= 4) { return true; } else { return false; } } function isUberUser() { if ($_SESSION['permission'] && $_SESSION['permission'] >= 3) { return true; } else { return false; } } function isSuperUser() { if ($_SESSION['permission'] && $_SESSION['permission'] >= 2) { return true; } else { return false; } } function isUser() { if ($_SESSION['permission'] && $_SESSION['permission'] >= 1) { return true; } else { return false; } } function isLoggedIn() { if ($_SESSION['permission'] && $_SESSION['permission'] != "") { return true; } else { return false; } } //simple usage if (isAdmin()) { echo " are admin"; } else { echo " not admin"; } if (isLoggedIn()) { echo " are logged in"; } else { echo " not logged in"; } if (isUser()) { echo " are at least a user"; } else { echo " not even a user"; } ?>

You can create a custom page template and use your themes header, footer, sidebar and replace just the content area with what you want. <?php /* Template Name: CustomPage */ ?> <?php get_header(); ?> <style> <!-- div.newcontent { width: 80%; background:#000000; color:#DF0101; text-decoration: none; text-align:center; margin-top:0px; margin-bottom:0px; margin-right: auto; margin-left: auto; padding:0px; } --> </style> <?php echo "<div class='newcontent'>"; echo "Any code gets added this area"; echo "</div>"; ?> <?php get_footer(); ?> Save that as custompage.php inside your current themes directory Go to your dashboard Create a new page and name it what you desire At the bottom right under "Page Attributes" select the "CustomPage" under "Template" Publish your page

I'll vouch for benanamen knows what saying and not trying to build posts.

preg_replace using regex for url patterns

I see you are using pdo, my question is how would you make an accurate comparison if changed it now. Rewrite it and do it the more secure way, email your users to make a new password.

Updated mine I use a different password every site, this stuff happens.

What you should do instead is use pdo with prepared statements, password_hash() and password_verify()

The reason for the api is to integrate it into a site for payments, then check if payment was actually made. Paypal has a few different payment types. You would want the integrated paypal pro/business. Create a developer account at https://developer.paypal.com/ Once you make that account click "application" then "sandbox accounts", use that for testing. https://developer.paypal.com/webapps/developer/docs/classic/lifecycle/ug_sandbox/ If you have multiple domains and the accounts are someone elses, they should each have their own paypal accounts and you supply a way they can insert their credentials(api key) and ability to set each IPN URL in your script.

I've made a pile of feed parsers and aggregators over the years. I search for document types and then also specific tags within the content, also if they are populated, that script doesn't. Atom is a different structure and the script never looks for it, use a script that can handle all the feed formats like simplepie

opengraph data will do you more good, that's the summarized content of the page.

Query like this failed? SELECT * FROM zamjene_brojeva WHERE glavni_broj='966 45 19-68' GROUP BY glavni_broj HAVING COUNT(glavni_broj) > 1

Is a lot of checking you should be doing but you can get to that later. One thing is these results should be saving to one line and using a delimiter fwrite($file, $q1."||".$q2."||".$q3."||".$q4."||".$q5."||".$q6."\r\n"); When you go to read the file the array will be each line, then you explode by the delimiter to get each value.

It's not id, it's Itemid in the url

You already have a field with the content, I wouldn't make another in the database or even make another query. You can use post_content() with preg_match and some regex or a string replace afterwards, then limit the words. There also exists the_excerpt() wordpress function which uses the first 55 words. The best option is to make a plugin or a function in the themes function.php file. add_filter( 'the_excerpt', 'remove_tab_excerpt' ); function remove_tab_excerpt( $excerpt ) { return preg_replace ('/\[tab[^\]]*\](.*)\[\/tab\]/', '$1', $excerpt); } If you want to do this just posts and not on single pages. if(!is_single($post)) { add_filter( 'the_excerpt', 'remove_tab_excerpt' ); function remove_tab_excerpt( $excerpt ) { return preg_replace ('/\[tab[^\]]*\](.*)\[\/tab\]/', '$1', $excerpt); } } Usually when modifying wordpress is best to make a plugin or a custom theme with functions, when you update anything in wordpress can lose your changes.