CS202 ASSIGNMENT 1 SOLUTION Fall 2021 || CS202 Assignment No. 01 Solution 100% Correct
CS202 ASSIGNMENT 1 SOLUTION Fall 2021 || CS202 Assignment No. 01 Solution 100% Correct
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<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>CS202 Assignment 1 Fall 2021</title>
</head>
<body style="color: white;background: #262626;">
<h1 style="text-align: center;">Centers For Disease Control Survey Form For Dengue Control</h1>
<table style="width: 100%; margin-top: 50px;" cellspacing="15">
<tr>
<td>First Name</td>
<td><input type="text"></td>
</tr>
<tr>
<td>Last Name</td>
<td><input type="text"></td>
</tr>
<tr>
<td>Father/Husband Name</td>
<td><input type="text"></td>
</tr>
<tr>
<td>Area Name</td>
<td><input type="text"></td>
</tr>
<tr>
<td>Permanent Address</td>
<td><textarea rows="5" cols="20"></textarea></td>
</tr>
<tr>
<td>Gender</td>
<td>
<input type="radio" name="gen" value="1"> Male <br>
<input type="radio" name="gen" value="2"> Female
</td>
</tr>
<tr>
<td>Age</td>
<td><input type="number"></td>
</tr>
<tr>
<td>Mobile Number</td>
<td><input type="text"></td>
</tr>
<tr>
<td>Are you experiencing Headache from last few days?</td>
<td>
<input type="radio" name="ex" value="1"> Yes <br>
<input type="radio" name="ex" value="2"> No
</td>
</tr>
<tr>
<td>Are you experiencing Muscle Pain from last few days?</td>
<td>
<input type="radio" name="pain" value="1"> Yes <br>
<input type="radio" name="pain" value="2"> No
</td>
</tr>
<tr>
<td>Please Select Suitable Option from given below<br> (if thier are more than one places check multiple option)</td>
<td>
<input type="checkbox" name="mul" value="1">
I am experiencing Muscla Pain, Bone & Join Pain<br>
<input type="checkbox" name="mul" value="2">
I am experiencing Vomting from last few days<br>
<input type="checkbox" name="mul" value="3">
I am experiencing the Pain behind the eyes from last few days<br>
<input type="checkbox" name="mul" value="4">
I am experiencing Swollen Glands from last few days<br>
<input type="text"> (Mention Other Feelings)
</td>
</tr>
<tr>
<td></td>
<td><input type="submit" style="width: 250px;height: 40px;"></td>
</tr>
</table>
<p style="text-align: center;">Sana Ismail</p>
</body>
</html>
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