<input type='text' id='patientname' class='form-control usertextbox'>,<input type='text' id='address' class='form-control usertextbox'>,<input type='text' id='age' class='form-control usertextbox'>,<input type='text' id='disease' class='form-control usertextbox'>,<input type='text' id='healthcondition' class='form-control usertextbox'>