

<?php $__env->startSection('content'); ?>
<div class="container py-4">
    <!-- Main Header with Right-Aligned Button -->
    <div class="main-header mb-4 d-flex justify-content-between align-items-center">
        <h1 class="h2">Vanderbilt ADHD Assessment Scales</h1>
        <button type="button" class="btn btn-sm btn-outline-secondary show-view" data-view="dashboard">
            <i class="bi bi-arrow-left"></i> Back to Dashboard
        </button>
    </div>

    <!-- Instructions Section -->
    <h2 class="h5">Instructions</h2>
    <p>
    Each rating should be considered in the context of what is appropriate for the age of your child. Please think about your child's behaviors since the beginning of the school year when rating the frequency questions.
     <br><span>Frequency Code:  </span>0 = Never, 1 = Occasionally, 2 = Often, 3 = Very Often</p>
</div>
<form id="questionForm" onsubmit="submitForm(event)" class="ajax-form forms-sample" method="post" action="<?php echo e(route('mentalHealth.vnderbiltStore')); ?>" data-redirect="<?php echo e(route('mentalHealth.dashboard')); ?>">     
<!-- Centered Content with Card and Progress Bar --> 
<div class="d-flex justify-content-center min-vh-75 align-items-center">
    <div class="col-sm-12 col-xl-6">

        <!-- Progress Bar -->
        <div class="progress mb-4">
  <div class="progress-bar bg-primary" id="progress-bar" role="progressbar" style="width: 0%;" 
       aria-valuenow="0" aria-valuemin="0" aria-valuemax="100">0%</div>
</div>
    

 <!-- Question 1 -->
 <div class="bg-secondary border border-white rounded h-100 p-4 question" data-question="1">
        <h2>Inattention</h2>
            <h6 class="mb-4 text-white">Fails to give attention to details or makes careless mistakes in schoolwork</h6>
            <input type="hidden" name="question" value="Fails to give attention to details or makes careless mistakes in schoolwork">
            <?php for($i = 0; $i <= 3; $i++): ?> <div class="form-check form-check-inline">
                <input class="form-check-input" type="radio" name="question1" id="question1_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                <label class="form-check-label text-white"
                    for="question1_<?php echo e($i); ?>"><?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?></label>
        </div>
        <hr> 
        <?php endfor; ?>  

        <!-- Buttons -->
        <div class="d-flex justify-content-between mt-4">
            <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)" id="prevBtn">Previous</button>
            <button class="btn btn-primary" id="nextBtn" onclick="navigateQuestion(1, event)">Next</button>

        </div>
    </div>



    <!-- Question 2 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="2">
    <h2>Inattention</h2>
    <h6 class="mb-4 text-white">Has difficulty sustaining attention in tasks or play activities</h6>
    <input type="hidden" name="question" value="Has difficulty sustaining attention in tasks or play activities">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question2" id="question2_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question2_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 3 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="3">
    <h2>Inattention</h2>
    <h6 class="mb-4 text-white">Does not seem to listen when spoken to directly</h6>
    <input type="hidden" name="question" value="Does not seem to listen when spoken to directly">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question3" id="question3_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question3_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 4 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="4">
    <h2>Inattention</h2>
    <h6 class="mb-4 text-white">Does not follow through on instructions and fails to finish schoolwork (not due to oppositional behavior or failure to understand)</h6>
    <input type="hidden" name="question" value="Does not follow through on instructions and fails to finish schoolwork (not due to oppositional behavior or failure to understand)">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question4" id="question4_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question4_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 5 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="5">
    <h2>Inattention</h2>
    <h6 class="mb-4 text-white">Has difficulty organizing tasks and activities</h6>
    <input type="hidden" name="question" value="Has difficulty organizing tasks and activities">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question5" id="question5_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question5_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 6 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="6">
    <h2>Inattention</h2>
    <h6 class="mb-4 text-white">Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort</h6>
    <input type="hidden" name="question" value="Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question6" id="question6_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question6_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



<!-- Question 7 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="7">
    <h2>Inattention</h2>
    <h6 class="mb-4 text-white">Loses things necessary for tasks or activities (school assignments, pencils, books)</h6>
    <input type="hidden" name="question" value="Loses things necessary for tasks or activities (school assignments, pencils, books)">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question7" id="question7_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question7_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 8 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="8">
    <h2>Inattention</h2>
    <h6 class="mb-4 text-white">Is easily distracted by extraneous stimuli</h6>
    <input type="hidden" name="question" value="Is easily distracted by extraneous stimuli">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question8" id="question8_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question8_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 9 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="9">
    <h2>Inattention</h2>
    <h6 class="mb-4 text-white">Is forgetful in daily activities</h6>
    <input type="hidden" name="question" value="Is forgetful in daily activities">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question9" id="question9_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question9_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 10 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="10">
    <h2>Hyperactivity/Impulsivity</h2>
    <h6 class="mb-4 text-white">Fidgets with hands or feet or squirms in seat</h6>
    <input type="hidden" name="question" value="Fidgets with hands or feet or squirms in seat">

    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question10" id="question10_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question10_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



<!-- Question 11 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="11">
    <h2>Hyperactivity/Impulsivity</h2>
    <h6 class="mb-4 text-white">Leaves seat in classroom or in other situations when remaining seated is expected</h6>
    <input type="hidden" name="question" value="Leaves seat in classroom or in other situations when remaining seated is expected">

    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question11" id="question11_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question11_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 12 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="12">
    <h2>Hyperactivity/Impulsivity</h2>
    <h6 class="mb-4 text-white">Runs about or climbs excessively in situations when remaining seated is expected</h6>
    <input type="hidden" name="question" value="Runs about or climbs excessively in situations when remaining seated is expected">

    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question12" id="question12_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question12_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 13 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="13">
    <h2>Hyperactivity/Impulsivity</h2>
    <h6 class="mb-4 text-white">Has difficulty playing or engaging in leisure activities quietly</h6>
    <input type="hidden" name="question" value="Has difficulty playing or engaging in leisure activities quietly">

    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question13" id="question13_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question13_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



<!-- Question 14 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="14">
    <h2>Hyperactivity/Impulsivity</h2>
    <h6 class="mb-4 text-white">Is "on the go" or acts as if "driven by a motor"</h6>
    <input type="hidden" name="question" value="Is 'on the go' or acts as if 'driven by a motor'">

    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question14" id="question14_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question14_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



<!-- Question 15 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="15">
    <h2>Hyperactivity/Impulsivity</h2>
    <h6 class="mb-4 text-white">Talks excessively</h6>
    <input type="hidden" name="question" value="Talks excessively">

    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question15" id="question15_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question15_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



<!-- Question 16 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="16">
    <h2>Hyperactivity/Impulsivity</h2>
    <h6 class="mb-4 text-white">Blurts out answers before questions have been completed</h6>
    <input type="hidden" name="question" value="Blurts out answers before questions have been completed">

    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question16" id="question16_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question16_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



<!-- Question 17 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="17">
    <h2>Hyperactivity/Impulsivity</h2>
    <h6 class="mb-4 text-white">Has difficulty waiting in line</h6>
    <input type="hidden" name="question" value="Has difficulty waiting in line">

    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question17" id="question17_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question17_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 18 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="18">
    <h2>Hyperactivity/Impulsivity</h2>
    <h6 class="mb-4 text-white">Interrupts or intrudes on others (butts into conversations or games)</h6>
    <input type="hidden" name="question" value="Interrupts or intrudes on others (butts into conversations or games)">

    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question18" id="question18_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question18_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



<!-- Question 19 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="19">
    <h2>Oppositional-Defiant Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Argues with adults</h6>
    <input type="hidden" name="question" value="Argues with adults">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question19" id="question19_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question19_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>




<!-- Question 20 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="20">
    <h2>Oppositional-Defiant Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Loses temper</h6>
    <input type="hidden" name="question" value="Loses temper">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question20" id="question20_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question20_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>




<!-- Question 21 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="21">
    <h2>Oppositional-Defiant Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Actively defies or refuses to comply with adults' requests or rules</h6>
    <input type="hidden" name="question" value="Actively defies or refuses to comply with adults' requests or rules">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question21" id="question21_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question21_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
    <hr>
    <?php endfor; ?>  

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<!-- Question 22 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="22">
    <h2>Oppositional-Defiant Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Deliberately annoys people</h6>
    <input type="hidden" name="question" value="Deliberately annoys people">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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<!-- Question 23 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="23">
    <h2>Oppositional-Defiant Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Blames others for his or her mistakes or misbehaviors</h6>
    <input type="hidden" name="question" value="Blames others for his or her mistakes or misbehaviors">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question23" id="question23_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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<!-- Question 24 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="24">
    <h2>Oppositional-Defiant Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Is touchy or easily annoyed by others</h6>
    <input type="hidden" name="question" value="Is touchy or easily annoyed by others">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question24" id="question24_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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<!-- Question 25 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="25">
    <h2>Oppositional-Defiant Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Is angry or resentful</h6>
    <input type="hidden" name="question" value="Is angry or resentful">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question25" id="question25_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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<!-- Question 26 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="26">
    <h2>Oppositional-Defiant Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Is spiteful and vindictive</h6>
    <input type="hidden" name="question" value="Is spiteful and vindictive">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question26" id="question26_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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<!-- Question 27 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="27">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Bullies, threatens, or intimidates others</h6>
    <input type="hidden" name="question" value="Bullies, threatens, or intimidates others">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question27" id="question27_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question27_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 28 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="28">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Initiates physical fights</h6>
    <input type="hidden" name="question" value="Initiates physical fights">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question28" id="question28_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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<!-- Question 29 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="29">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Lies to obtain goods for favors or to avoid obligations (i.e., "cons" others)</h6>
    <input type="hidden" name="question" value="Lies to obtain goods for favors or to avoid obligations (i.e., 'cons' others)">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question29" id="question29_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question29_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 30 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="30">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Is truant from school (skips school) without permission</h6>
    <input type="hidden" name="question" value="Is truant from school (skips school) without permission">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question30" id="question30_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question30_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 31 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="31">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Is physically cruel to people</h6>
    <input type="hidden" name="question" value="Is physically cruel to people">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question31" id="question31_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question31_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 32 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="32">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Has stolen items of nontrivial value</h6>
    <input type="hidden" name="question" value="Has stolen items of nontrivial value">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question32" id="question32_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question32_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 33 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="33">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Deliberately destroys others' property</h6>
    <input type="hidden" name="question" value="Deliberately destroys others' property">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question33" id="question33_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 34 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="34">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Has used a weapon that can cause serious harm (bat, knife, brick, gun)</h6>
    <input type="hidden" name="question" value="Has used a weapon that can cause serious harm (bat, knife, brick, gun)">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question34" id="question34_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question34_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 35 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="35">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Is physically cruel to animals</h6>
    <input type="hidden" name="question" value="Is physically cruel to animals">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question35" id="question35_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question35_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 36 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="36">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Has deliberately set fires to cause damage</h6>
    <input type="hidden" name="question" value="Has deliberately set fires to cause damage">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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        <input class="form-check-input" type="radio" name="question36" id="question36_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question36_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 37 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="37">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Has broken into someone else's home, business, or car</h6>
    <input type="hidden" name="question" value="Has broken into someone else's home, business, or car">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question37" id="question37_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question37_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 38 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="38">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Has stayed out at night without permission</h6>
    <input type="hidden" name="question" value="Has stayed out at night without permission">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question38" id="question38_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question38_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 39 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="39">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Has run away from home overnight</h6>
    <input type="hidden" name="question" value="Has run away from home overnight">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question39" id="question39_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question39_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 40 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="40">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Has forced someone into sexual activity</h6>
    <input type="hidden" name="question" value="Has forced someone into sexual activity">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question40" id="question40_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question40_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 41 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="41">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Is fearful, anxious, or worried</h6>
    <input type="hidden" name="question" value="Is fearful, anxious, or worried">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question41" id="question41_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question41_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

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<!-- Question 42 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="42">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Is afraid to try new things for fear of making mistakes</h6>
    <input type="hidden" name="question" value="Is afraid to try new things for fear of making mistakes">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question42" id="question42_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question42_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
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<!-- Question 43 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="43">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Feels worthless or inferior</h6>
    <input type="hidden" name="question" value="Feels worthless or inferior">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question43" id="question43_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
        <label class="form-check-label text-white" for="question43_<?php echo e($i); ?>">
            <?php echo e(['Never', 'Occasionally', 'Often', 'Very Often'][$i]); ?>

        </label>
    </div>
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    <?php endfor; ?>

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<!-- Question 44 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="44">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Blames self for problems, feels guilty</h6>
    <input type="hidden" name="question" value="Blames self for problems, feels guilty">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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<!-- Question 45 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="45">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Feels lonely, unwanted, or unloved; complains that "no one loves him/her"</h6>
    <input type="hidden" name="question" value="Feels lonely, unwanted, or unloved; complains that 'no one loves him/her'">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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<!-- Question 46 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="46">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Is sad, unhappy, or depressed</h6>
    <input type="hidden" name="question" value="Is sad, unhappy, or depressed">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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<!-- Question 47 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="47">
    <h2>Conduct Disorder Symptoms</h2>
    <h6 class="mb-4 text-white">Is self-conscious or easily embarrassed</h6>
    <input type="hidden" name="question" value="Is self-conscious or easily embarrassed">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
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<!-- Question 48 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="48">
    <h2>Performance</h2>
    <h6 class="mb-4 text-white">Overall academic performance</h6>
    <input type="hidden" name="question" value="Overall academic performance">
    
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<!-- Question 49 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="49">
    <h2>Performance</h2>
    <h6 class="mb-4 text-white">Reading</h6>
    <input type="hidden" name="question" value="Reading">
    
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        <input class="form-check-input" type="radio" name="question49" id="question49_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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            <?php echo e(['Excellent', 'Above Average', 'Average', 'Somewhat of a Problem', 'Problematic'][$i-1]); ?>

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<!-- Question 50 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="50">
    <h2>Performance</h2>
    <h6 class="mb-4 text-white">Writing</h6>
    <input type="hidden" name="question" value="Writing">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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        <input class="form-check-input" type="radio" name="question50" id="question50_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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            <?php echo e(['Excellent', 'Above Average', 'Average', 'Somewhat of a Problem', 'Problematic'][$i-1]); ?>

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<!-- Question 51 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="51">
    <h2>Performance</h2>
    <h6 class="mb-4 text-white">Mathematics</h6>
    <input type="hidden" name="question" value="Mathematics">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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        <input class="form-check-input" type="radio" name="question51" id="question51_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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            <?php echo e(['Excellent', 'Above Average', 'Average', 'Somewhat of a Problem', 'Problematic'][$i-1]); ?>

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<!-- Question 52 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="52">
    <h2>Performance</h2>
    <h6 class="mb-4 text-white">Relationship with parents</h6>
    <input type="hidden" name="question" value="Relationship with parents">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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        <input class="form-check-input" type="radio" name="question52" id="question52_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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            <?php echo e(['Excellent', 'Above Average', 'Average', 'Somewhat of a Problem', 'Problematic'][$i-1]); ?>

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<!-- Question 53 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="53">
    <h2>Performance</h2>
    <h6 class="mb-4 text-white">Relationship with siblings</h6>
    <input type="hidden" name="question" value="Relationship with siblings">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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        <input class="form-check-input" type="radio" name="question53" id="question53_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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<!-- Question 54 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="54">
    <h2>Performance</h2>
    <h6 class="mb-4 text-white">Relationship with peers</h6>
    <input type="hidden" name="question" value="Relationship with peers">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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        <input class="form-check-input" type="radio" name="question54" id="question54_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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            <?php echo e(['Excellent', 'Above Average', 'Average', 'Somewhat of a Problem', 'Problematic'][$i-1]); ?>

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<!-- Question 55 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="55">
    <h2>Performance</h2>
    <h6 class="mb-4 text-white">Participation in organized activities (e.g., teams)</h6>
    <input type="hidden" name="question" value="Participation in organized activities (e.g., teams)">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
    <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="question55" id="question55_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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            <?php echo e(['Excellent', 'Above Average', 'Average', 'Somewhat of a Problem', 'Problematic'][$i-1]); ?>

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<!-- Question 56 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="56">
    <h2>Academic Performance</h2>
    <h6 class="mb-4 text-white">Reading</h6>
    <input type="hidden" name="question" value="Reading">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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            <?php echo e(['Excellent', 'Above Average', 'Average', 'Somewhat of a Problem', 'Problematic'][$i-1]); ?>

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<!-- Question 57 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="57">
    <h2>Academic Performance</h2>
    <h6 class="mb-4 text-white">Mathematics</h6>
    <input type="hidden" name="question" value="Mathematics">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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        <input class="form-check-input" type="radio" name="question57" id="question57_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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            <?php echo e(['Excellent', 'Above Average', 'Average', 'Somewhat of a Problem', 'Problematic'][$i-1]); ?>

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<!-- Question 58 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="58">
    <h2>Academic Performance</h2>
    <h6 class="mb-4 text-white">Written expression</h6>
    <input type="hidden" name="question" value="Written expression">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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<!-- Question 59 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="59">
    <h2>Classroom Behavioral Performance</h2>
    <h6 class="mb-4 text-white">Relationship with peers</h6>
    <input type="hidden" name="question" value="Relationship with peers">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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        <input class="form-check-input" type="radio" name="question59" id="question59_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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<!-- Question 60 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="60">
    <h2>Classroom Behavioral Performance</h2>
    <h6 class="mb-4 text-white">Following directions/rules</h6>
    <input type="hidden" name="question" value="Following directions/rules">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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<!-- Question 61 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="61">
    <h2>Classroom Behavioral Performance</h2>
    <h6 class="mb-4 text-white">Disrupting class</h6>
    <input type="hidden" name="question" value="Disrupting class">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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        <input class="form-check-input" type="radio" name="question61" id="question61_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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<!-- Question 62 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="62">
    <h2>Classroom Behavioral Performance</h2>
    <h6 class="mb-4 text-white">Assignment completion</h6>
    <input type="hidden" name="question" value="Assignment completion">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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        <input class="form-check-input" type="radio" name="question62" id="question62_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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            <?php echo e(['Excellent', 'Above Average', 'Average', 'Somewhat of a Problem', 'Problematic'][$i-1]); ?>

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<!-- Question 63 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="63">
    <h2>Classroom Behavioral Performance</h2>
    <h6 class="mb-4 text-white">Organizational skills</h6>
    <input type="hidden" name="question" value="Organizational skills">
    
    <?php for($i = 1; $i <= 5; $i++): ?>
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        <input class="form-check-input" type="radio" name="question63" id="question63_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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