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title	Example HTML code for Acute COPD Exacerbation Care Plan

<div class="form-inline">
<style media="screen">
.form-group {
width: 100%;
!important
}

Code Block

.cp_banner {
  background-color: #0B475D;
  color: #ffffff;
  font-size: 120%;
  font-weight: bold;
  width: 100%;
  padding: 10px;
  margin-bottom: 5px;
  margin-top: 5px;
}

.cp_whiteBox {
  background-color: #ffffff;
  padding: 15px;
  margin-bottom: 10px;
  margin-top: 10px;
  -moz-border-radius: 10px;
  -webkit-border-radius: 10px;
  -khtml-border-radius: 10px;
  border-radius: 10px;
}

</style>
<div class="cp_whiteBox" id="top">

Code Block

<h2>Introduction</h2>
<p> Chronic Obstructive Pulmonary Disease (COPD) is a slowly progressive condition affecting the lungs. It includes conditions or terms such as chronic bronchitis, chronic obstructive airways disease, emphysema and chronic asthma. It is usually
  smoking related but prolonged exposure to pollution, dusts or chemicals can also cause it.</p>
<p> COPD causes breathlessness when doing tasks such as shopping or bathing, and can also cause cough, phlegm and wheeze. Infections, or changes in outside temperature and pollution, can cause a flare-up or &quot;lung attack&quot;, these attacks
  are called &quot;exacerbations&quot;, and often need emergency treatment or assessment in hospital.</p>
<p>As part of your ongoing care, we would like you to use the Acute COPD exacerbation plan to record your symptoms and measurements at least daily for a 2 weeks, and then on a regular basis. To do this select the <b>Edit plan</b> button at the
  top of the page, select the <i>Symptoms and measurements to monitor</i> hyperlink, complete the relevant sections of the plan, and select <b>Save</b> to save the information you have added.</p>
<br></br>
<label for="monitor_exacerbation"><b style="font-size:20px"> My current exacerbation is being monitored by myself in conjunction with my</b></label>
<b style="font-size:20px">
  <select class="form-control" name="monitor_exacerbation" id="monitor_exacerbation" style="width: 100PX;">
    <option value="--">Select</option>
    <option value="hospital team">hospital team</option>
    <option value="community team">community team </option>
  </select></b>
<br></br>
<br></br>



<p> <u>The Acute COPD exacerbation plan is divided into the following sections:</u></p>

<ul>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#whatESD">What is Early Supported Discharge/Hospital at Home?</a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#whatnext">What happens next?</a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#homevisits">Follow up Visits at Home </a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#feelworse"> What do I do if I feel worse?</a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#contact">Contact numbers</a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#if_better">What happens when I am better?</a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#oxygen">Treatment with oxygen</a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#resources"> Resources (video and advice sheet links)</a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#mconcern">My main concerns and items I would like to ask my healthcare team</a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#feeling">How I feel today</a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#yournormal"> What is normal for you</a></li>
  <li style="list-style: inherit; margin-left: 15px;"><a href="#symp_measure">My symptoms and measurements </a></li>
</ul>
<br></br>
<p>Additional information about COPD and management of the condition can be found in the <a href="/library/manageLibrary.action" target="_blank" class="btn arrow btn-primary" title="Library section"
    alt="Click here to return to the Table of Contents">Library section</a></p>

</div>
<div class="cp_whiteBox" id="whatESD">
<h2>What is Early Supported Discharge/Hospital at Home?</h2>
<p> Following an assessment and treatment has been started in hospital, many patients with COPD can then be cared for safely and more comfortably at home. The 'Early Supported Discharge Hospital at Home Service' aims to provide care for
patients suffering from a COPD flare up in the most appropriate setting and it allow patients who have come into hospital with COPD to return home sooner than previously possible.
</p>

</div>
<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents">Back to Top</a>
<div class="cp_whiteBox" id="whatnext">
<h2>What happens next?</h2>
<p> Firstly, you will be assessed by the COPD Specialist team to see whether you are suitable for this support. Once you are considered suitable, a care plan will be agreed between COPD specialist Team, hospital consultant and you. The COPD
specialist team will recommend what is to be provided for you when you go home and will get an agreement from you before discharge.</p>
<p>These recommendations will consist of:</p>
<ol>
<li style="list-style:inherit; margin-left: 15px;">Medication such as antibiotics or steroids</li>
<li style="list-style:inherit; margin-left: 15px;">Treatment with Oxygen or nebulised medicines as necessary</li>
<li style="list-style:inherit; margin-left: 15px;">Contact telephone numbers for you contact for advice about your breathing</li>
</ol>
</div>
<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents">Back to Top</a>
<div class="cp_whiteBox" id="homevisits">
<h2>Follow up Visits at Home </h2>
<p>If you do not feel better or need to go back to hospital then this will be arranged.</p>
<p> Some patients will be asked to wear a remote monitoring device to check their observations regularly. If you have been asked to do this, the specialist team will help set this up for you and show how to use this device, including maintenance.</p>
<p> As part of your ongoing care, we would like you to use the Acute COPD Exacerbation Care Plan to record your symptoms and measurements at least daily for a 2 weeks using the 'Care Information Exchange'. To do this select the <b>Edit
plan</b> button at the top of the page, complete the relevant sections of the plan, and select <b>Save</b> to save the information you have added.</p>
</div>
<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents">Back to Top</a>
<div class="cp_whiteBox" id="feelworse">
<h2>What do I do if I feel worse?</h2>
<p> While you are under the care of the community respiratory team, you can speak to one of the nurses if you have any questions or problems. They are available between 9am and 5pm. After 5pm the Out of Hours GP service will be available to help
you if needed. At times rapid response teams may be involved in your care.</p>
<p> Whilst you are under the care of the community respiratory team, you will remain under the care of the Hospital Consultant.</p>
<p style="color:red; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px; border: 2px solid red;"><b> Please ring for ambulance on 999, If you
feel any of the following symptoms - Very Short of breath, not able to speak in sentences, chest pain, high fever, confusion, drowsiness.</b></p>
</div>

<div class="cp_whiteBox" id="contact">
<h2>Contact numbers</h2>
<p> If you or your family/carers have any concerns of questions regarding your current health please contact:</p>
<p><b> The Kensington Chelsea & Westminster (KCW) Community Respiratory Team from 9am-5pm: 07506609186 or 02033127661</b></p>
<p><b> The Hammersmith & Fulham (H&F) Community Respiratory Team from 9am-5pm: 07957 629 023</b></p>
<p><b>West Middlesex Community Respiratory Team from 9am-5pm: 07500 572232</b></p>
<p><b> The Out of Hours Service after 5pm: 0208 969 0808</b></p>
<p style="color:red; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px; border: 2px solid red;"><b> If are not improving please discuss this
with your nurse however if you feel Very Short of breath, not able to speak in sentences, chest pain, high fever, confusion, drowsiness. Please ring for ambulance on 999.</b></p>
<p> Please try to remember to take the medical notes and documents that you have at home with you to hospital.</p>

</div>

<div class="cp_whiteBox" id="if_better">
<h2> What happens when I am better?</h2>
<p> When you are well, you will be discharged from the community respiratory team to the care of your GP. An outpatient appointment will be made for you with the community respiratory consultant. You will also be given a COPD management plan
which explains how to recognise the early warning signs of a 'flare up' and how best for you to manage it. You will be given the telephone number of the team to ring them in the future if you have problems with your breathing.</p>
</div>
<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents">Back to Top</a>

<div class="cp_whiteBox" id="oxygen">
<h2>Treatment with oxygen</h2>
<H3> You may have been given temporary oxygen to use at home? </H3>
<p> While you have been in hospital, we have agreed that you need some oxygen to use at home to help you recover. This is because you have low oxygen levels in your blood. The nurses or physiotherapists who visit you at home will continue to
monitor your oxygen levels.</p>

Code Block

<H3>How long will I have oxygen for?</H3>
<p> Most people who need oxygen when they are not well only need it for a short while, until their oxygen levels recover. Others may need it longer and may be referred for an assessment about six to eight weeks after you leave hospital.</p>
<H3>How do I stay safe?</H3>
<p>As long as it is used correctly, oxygen is safe.</p>
<p>Follow these simple rules to stay safe.</p>
<ul>

  <li style="list-style: inherit; margin-left: 15px; font-size: 20px; font-weight: bold;"> Your oxygen prescription is: <b>
      <input type="text" name="cp_oxygenprescription" id="cp_oxygenprescription" class="form-control"></input>
    </b>
  </li>

  <li style="list-style: inherit; margin-left: 15px;">Never adjust the flow rate of your oxygen. It has been specifically assessed for you, and too much oxygen could harm you.</li>
  <li style="list-style: inherit; margin-left: 15px;"> Do not smoke or let anyone smoke near you or the oxygen.</li>
  <li style="list-style: inherit; margin-left: 15px;"> Keep it away from naked flames and from heat.</li>
  <li style="list-style: inherit; margin-left: 15px;"> Keep the tubing free.</li>
  <li style="list-style: inherit; margin-left: 15px;"> If you have a power cut your oxygen concentrator will not work. Use your back-up oxygen cylinder until the power comes back on and call Air Liquide on 080 8143 9991 to order a replacement
    straight away.</li>
</ul>
<H3>Where can I get help if I have problems with the equipment?</H3>
<p>If you have problems with the equipment, please contact the oxygen supplier Air Liquide on 080 8143 9991 at any time, night or day.</p>

</div>

<div class="cp_whiteBox" id="resources">
<h2>Resources (video and advice sheet links)</h2>
<div class="row">
<div class="col-sm-4">
<ul>
<li style="list-style: inherit; margin-left: 15px;">COPD Self-management plan</li>
</ul>
</div>
<div class="col-sm-8">
<ul>
<li style="list-style:circle; margin-left: 15px;">please refer to your COPD Self-management plan</li>
</ul>
</div>
</div>

Code Block

<div class="row">
  <div class="col-sm-4">
    <ul>
      <li style="list-style: inherit; margin-left: 15px;">Airway clearance</li>
    </ul>
  </div>
  <div class="col-sm-8">
    <ul>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.acprc.org.uk/Data/Publication_Downloads/GL-05ACBT.pdfpdf>"> target="_blank"><https://www.acprc.org.uk/Data/Publication_Downloads/GL-05ACBT.pdf</a><a>></li>>li>
    </ul>
  </div>
</div>

<div class="row">
  <div class="col-sm-4">
    <ul>
      <li style="list-style: inherit; margin-left: 15px;">Breathlessness</li>
    </ul>
  </div>
  <div class="col-sm-8">
    <ul>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.blf.org.uk/support-for-you/keep-active/exercise-video/breathing-techniquestechniques>"> target="_blank">
          <https://www.blf.org.uk/support-for-you/keep-active/exercise-video/breathing-techniques</a><a>></li>>li>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.blf.org.uk/support-for-you/breathlessness/how-to-manage-breathlessnessbreathlessness>"> target="_blank">
          <https://www.blf.org.uk/support-for-you/breathlessness/how-to-manage-breathlessness</a><a>></li>>li>
    </ul>
  </div>
</div>
<div class="row">
  <div class="col-sm-4">
    <ul>
      <li style="list-style: inherit; margin-left: 15px;">Positioning, pacing and energy conservation</li>
    </ul>
  </div>
  <div class="col-sm-8">
    <ul>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.acprc.org.uk/Data/Publication_Downloads/GL-03EnergyConservation(1).pdf?date=24/12/2020%2011:34:1313>">
          target="_blank"><https://www.acprc.org.uk/Data/Publication_Downloads/GL-03EnergyConservation(1).pdf?date=24/12/2020%2011:34:13</a><a>></li>>li>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.acprc.org.uk/Data/Publication_Downloads/GL-01HowtocopewithbeingSOB-positions(1).pdf?date=24/12/2020%2011:34:1313>"> target="_blank">
          <https://www.acprc.org.uk/Data/Publication_Downloads/GL-01HowtocopewithbeingSOB-positions(1).pdf?date=24/12/2020%2011:34:13</a><a>></li>>li>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.acprc.org.uk/Data/Publication_Downloads/GL-02HowtocopewithbeingSOB-breathingex(1).pdf?date=24/12/2020%2011:34:1313>"> target="_blank">
          <https://www.acprc.org.uk/Data/Publication_Downloads/GL-02HowtocopewithbeingSOB-breathingex(1).pdf?date=24/12/2020%2011:34:13</a><a>></li>>li>
    </ul>
  </div>
</div>
<div class="row">
  <div class="col-sm-4">
    <ul>
      <li style="list-style: inherit; margin-left: 15px;">Smoking cessation</li>
    </ul>
  </div>
  <div class="col-sm-8">
    <ul>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.blf.org.uk/support-for-you/smoking/why-is-smoking-bad-for-meme>"> target="_blank">
          <https://www.blf.org.uk/support-for-you/smoking/why-is-smoking-bad-for-me</a><a>></li>>li>
    </ul>
  </div>
</div>
<div class="row">
  <div class="col-sm-4">
    <ul>
      <li style="list-style: inherit; margin-left: 15px;">Inhaler technique</li>
    </ul>
  </div>
  <div class="col-sm-8">
    <ul>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.asthma.org.uk/advice/inhaler-videos/>"> target="_blank"><https://www.asthma.org.uk/advice/inhaler-videos/</a><a>></li>>li>
    </ul>
  </div>
</div>
<div class="row">
  <div class="col-sm-4">
    <ul>
      <li style="list-style: inherit; margin-left: 15px;">Nebuliser</li>
    </ul>
  </div>
  <div class="col-sm-8">
    <ul>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.youtube.com/watch?v=75KlL-U__YYYY>"> target="_blank"><https://www.youtube.com/watch?v=75KlL-U__YY</a><a>></li>>li>
    </ul>
  </div>
</div>
<div class="row">
  <div class="col-sm-4">
    <ul>
      <li style="list-style: inherit; margin-left: 15px;">Oxygen</li>
    </ul>
  </div>
  <div class="col-sm-8">
    <ul>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.nhs.uk/conditions/home-oxygen-treatment/>"> target="_blank"> <https://www.nhs.uk/conditions/home-oxygen-treatment/</a><a>></li>>li>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.blf.org.uk/support-for-you/oxygen/what-is-itit>"> target="_blank"> <https://www.blf.org.uk/support-for-you/oxygen/what-is-it</a><a>></li>>li>

    </ul>
  </div>
</div>
<div class="row">
  <div class="col-sm-4">
    <ul>
      <li style="list-style: inherit; margin-left: 15px;">Diet</li>
    </ul>
  </div>
  <div class="col-sm-8">
    <ul>
      <li style="list-style:circle; margin-left: 15px;"><a href="<https://www.blf.org.uk/support-for-you/eating-wellwell>"> target="_blank"> <https://www.blf.org.uk/support-for-you/eating-well</a><a>></li>>li>
    </ul>
  </div>
</div>
<br></br>
<p> You can access additional information from resources available in the <a href="/library/manageLibrary.action" target="_blank" class="btn arrow btn-primary" title="Library section" alt="Click here to return to the Table of Contents">Library
    section</a></p>

</div>
<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents">Back to Top</a>

<div class="cp_whiteBox" id="mconcern">
<h2>My main concerns and items I would like to ask my healthcare team</h2>
<p> Please use this section to tell us about things that are troubling you and what you would like to discuss with us.</p>

Code Block

<H3>My main concerns:</H3>
<p>
  <textarea name="concerns" class="form-control" rows="3" style="width: 100%;"> </textarea>
</p>
<H3>What I would like to discuss with my healthcare professional:</H3>
<p>
  <textarea name="discuss" class="form-control" rows="3" style="width: 100%;"> </textarea>
</p>

</div>
<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents">Back to Top</a>

<div class="cp_whiteBox" id="feeling">
<h2>How I feel today</h2>
<p>We would like you to tell us more about how you are feeling by recording your symptoms on a regular basis. To do this select the <b>Edit plan</b> button at the top of the page, enter your symptoms and weight in the relevant sections of the
plan and select <b>Save</b> to save the information you have added.</p>

Code Block

<h2>Symptoms</h2>
<p><u>Symptoms to look out for:</u></p>
<ul>
  <li style="list-style: inherit; margin-left: 15px;"> Shortness of breath at rest </li>
  <li style="list-style: inherit; margin-left: 15px;"> Shortness of breath on activity </li>
  <li style="list-style: inherit; margin-left: 15px;"> Cough </li>
  <li style="list-style: inherit; margin-left: 15px;"> Chest pain</li>
  <li style="list-style: inherit; margin-left: 15px;"> Wheeze</li>
  <li style="list-style: inherit; margin-left: 15px;"> Tired (fatigue)</li>
  <li style="list-style: inherit; margin-left: 15px;"> Palpitations</li>
  <li style="list-style: inherit; margin-left: 15px;"> Sputum (phlegm)</li>
  <li style="list-style: inherit; margin-left: 15px;"> Difficulty walking (weakness)</li>
  <li style="list-style: inherit; margin-left: 15px;"> Difficulty expectoration (bring out phlegm)</li>
  <li style="list-style: inherit; margin-left: 15px;"> Loss of appetite </li>
  <li style="list-style: inherit; margin-left: 15px;"> Feeling anxious </li>
  <li style="list-style: inherit; margin-left: 15px;"> Feeling down </li>
  <li style="list-style: inherit; margin-left: 15px;"> Leg/ankle swelling </li>
  <li style="list-style: inherit; margin-left: 15px;"> Orthopnea (breathlessness on lying flat) </li>
</ul>
<p> To record your symptoms, select the <b>Edit plan</b> button at the top of the page, select the <i>Symptoms and measurements to monitor</i> hyperlink, record your symptoms in the relevant sections of the plan and select <b>Save</b> to save the
  information you have added.</p>
<h2>Measurements</h2>
<p><u>We would like you to provide the following measurements:</u></p>
<ul>
  <li style="list-style: inherit; margin-left: 15px;"> Pulse </li>
  <li style="list-style: inherit; margin-left: 15px;"> SpO2</li>
  <li style="list-style: inherit; margin-left: 15px;">Respiratory rate</li>
  <li style="list-style: inherit; margin-left: 15px;">Blood pressure</li>
  <li style="list-style: inherit; margin-left: 15px;">Temperature</li>
  <li style="list-style: inherit; margin-left: 15px;">Weight</li>
</ul>
<p> To record your measurements, select the <b>Edit plan</b> button at the top of the page, select the <i>Symptoms and measurements to monitor</i> hyperlink, enter your measurements in the relevant sections of the plan and select <b>Save</b> to
  save the information you have added.</p>

</div>
<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents">Back to Top</a>

<div class="cp_whiteBox" id="yournormal">
<h2>What is normal for you</h2>
<label for="cp_todaybreathless"><b style="font-size:20px"> Breathlessness: </b></label>

Code Block

<input type="text" name="cp_todaybreathless" id="cp_todaybreathless" class="form-control"></input>
<br></br>
<label for="cp_todayexercise"><b style="font-size:20px"> Exercise tolerance: </b></label>
<input type="text" name="cp_todayexsercise" id="cp_todayexercise" class="form-control"></input>

<br></br>
<label for="cp_todaywheeze"><b style="font-size:20px"> Wheeze: </b></label>

<input type="text" name="cp_todaywheeze" id="cp_todaywheeze" class="form-control"></input>

<br></br>
<label for="cp_todaycough"><b style="font-size:20px"> Cough: </b></label>
<input type="text" name="cp_todaycough" id="cp_todaycough" class="form-control"></input>

<br></br>
<label for="cp_todaysputumcolour"><b style="font-size:20px"> Sputum colour: </b></label>
<select class="form-control" name="cp_todaysputumcolour" id="cp_todaysputumcolour" style="width: 100PX;">
  <option value="--">Select</option>
  <option value="Usual colour"> Usual colour</option>
  <option value="White"> White </option>
  <option value="Green"> Green </option>
  <option value="Yellow">Yellow </option>
  <option value="Blood stained ">Blood stained </option>

</select>


<br></br>
<label for="cp_todaysputumvol"><b style="font-size:20px"> Sputum volume: </b></label>
<input type="text" name="cp_todaysputumvol" id="cp_todaysputumvol" class="form-control"></input>

<br></br>
<label for="cp_todayinhaler"><b style="font-size:20px"> How often I use my blue inhaler: </b></label>

<input type="text" name="cp_todayinhaler" id="cp_todayinhaler" class="form-control"></input>

</div>
<a href="#top" class="btn arrow btn-primary" title="Back to Top" alt="Click here to return to the Table of Contents">Back to Top</a>

<div class="cp_whiteBox" id="symp_measure">
<h2>My symptoms and measurements</h2>
<p> We would like you to tell us more about how you are feeling by recording your symptoms on a regular basis.</p>
<p>On a scale of 0 to 10 where 0 is extremely poor and 10 is normal for you, please let us know how you are feeling today.</p>
<label for="general_health">How is your general health today?</label>
<select class="form-control" name="general_health" id="general_health" style="width: 100PX;">
<option value="--">Select</option>
<option value="0 "> 0 (Extremely poor)</option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3">3 </option>
<option value="4 ">4 </option>
<option value="5 ">5 </option>
<option value="6 ">6 </option>
<option value="7 ">7 </option>
<option value="8 ">8 </option>
<option value="9 ">9 </option>
<option value="10 "> 10 (Normal for you)</option>
</select>
<br></br>
<label for="activity">How able are you to manage your usual daily activities? (e.g washing, dressing, cleaning)</label>
<select class="form-control" name="activity" id="activity" style="width: 100PX;">
<option value="--">Select</option>
<option value="0 "> 0 (Extremely poor)</option>
<option value="1"> 1 </option>
<option value="2"> 2 </option>
<option value="3">3 </option>
<option value="4 ">4 </option>
<option value="5 ">5 </option>
<option value="6 ">6 </option>
<option value="7 ">7 </option>
<option value="8 ">8 </option>
<option value="9 ">9 </option>
<option value="10"> 10 (Normal for you)</option>
</select>
<br></br>

Code Block

<label for="sputum">How is your sputum amount?</label>
<select class="form-control" name="sputum" id="sputum" style="width: 100PX;">
  <option value="--">Select</option>
  <option value="0 "> 0 (Extremely poor)</option>
  <option value="1"> 1 </option>
  <option value="2"> 2 </option>
  <option value="3">3 </option>
  <option value="4 ">4 </option>
  <option value="5 ">5 </option>
  <option value="6 ">6 </option>
  <option value="7 ">7 </option>
  <option value="8 ">8 </option>
  <option value="9 ">9 </option>
  <option value="10 "> 10 (Normal for you)</option>
</select>
<br></br>
<label for="sputum_colour">What is your sputum colour today?</label>
<select class="form-control" name="sputum_colour" id="sputum_colour" style="width: 100PX;">
  <option value="--">Select</option>
  <option value="Usual colour"> Usual colour</option>
  <option value="White"> White </option>
  <option value="Green"> Green </option>
  <option value="Yellow">Yellow </option>
  <option value="Blood stained ">Blood stained </option>

</select>
<br></br>
<H2>Please record your symptoms and measurements above in the <a href="#symptoms">Monitoring section</a>.</H2>

</div>
</div>

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