109 lines
4.6 KiB
PHP
109 lines
4.6 KiB
PHP
<script>
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function validate(){
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save_medicine();
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}
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</script>
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<style>
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#modal-add-medicine{
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overflow-y:scroll;
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}
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</style>
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<div class="modal fade" id="model-checkup-parameter" role="dialog" aria-hidden="true">
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<form role="form" id="checkup_parameter_form" name="checkup_parameter_form" action="#" method="post">
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<div class="modal-dialog">
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<div class="modal-content">
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<div class="widget-header">
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<h5 class="widget-title"> Checkup Parameter Form</h5>
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<div class="widget-toolbar">
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<div class="widget-menu">
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<a href="#" class="close" data-action="close" data-dismiss="modal">
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<i class="ace-icon fa fa-times"></i>
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</a>
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</div>
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</div>
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</div>
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<div class="modal-body">
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<div class="row">
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<div class="form-group col-sm-12">
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<label for="firm_code">Checkup Parameter Name</label>
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<input type="text" class="form-control" name="checkup_parameter_name"
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id="checkup_parameter_name" autofocus="autofocus" value="" placeholder="Enter CheckUp Parameter Name" required/>
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</div>
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</div>
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<div class="row">
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<div class="form-group col-sm-12">
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<label for="firm_code">Select Section Name</label>
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<select name="checkup_section_id" id="checkup_section_id" class="form-control" >
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<?php echo generateOption('checkup_form_section','section_name','section_id','','');
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?>
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</select>
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<!--
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<input type="text" class="form-control" name="checkup_section_name"
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id="checkup_section_name" autofocus="autofocus" value="" placeholder="Enter CheckUp Section Name" required/>
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-->
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</div>
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</div>
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<div class="row">
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<div class="form-group col-sm-6">
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<label for="firm_code">Starting Range</label>
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<input type="number" class="form-control" name="checkup_starting_range"
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id="checkup_starting_range" autofocus="autofocus" value="" placeholder="Enter Starting Range" required/>
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</div>
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<div class="form-group col-sm-6">
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<label for="firm_code">Ending Range</label>
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<input type="number" class="form-control" name="checkup_ending_range"
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id="checkup_ending_range" autofocus="autofocus" value="" placeholder="Enter Ending Range" required/>
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</div>
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</div>
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<div class="row">
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<div class="form-group col-sm-6">
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<label for="firm_code">Less Risk</label>
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<select multiple="" style="" class="chosen-select form-control" id="checkup_less_risk" name="checkup_less_risk[]" data-placeholder="" >
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<?php echo generateOption('health_risk','health_risk_name','health_risk_id','',''); ?>
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</select>
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</div>
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<div class="form-group col-sm-6">
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<label for="firm_code">More Risk</label>
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<select multiple="" style="" class="chosen-select form-control" id="checkup_more_risk" name="checkup_more_risk[]" data-placeholder="" >
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<?php echo generateOption('health_risk','health_risk_name','health_risk_id','',''); ?>
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</select>
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</div>
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</div>
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<div class="row">
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<div class="col-sm-6">
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<label class="control-label" for="health_advice_name">Less Advice</label>
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<select multiple="" style="" class="chosen-select form-control" id="checkup_less_advice" name="checkup_less_advice[]" data-placeholder="" >
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<?php echo generateOption('health_advice','health_advice_name','health_advice_id','',''); ?>
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</select>
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</div>
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<div class="col-sm-6">
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<label class="control-label" for="health_advice_name">More Advice</label>
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<select multiple="" style="" class="chosen-select form-control" id="checkup_more_advice" name="checkup_more_advice[]" data-placeholder="" >
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<?php echo generateOption('health_advice','health_advice_name','health_advice_id','',''); ?>
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</select>
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</div>
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</div>
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</div>
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<div class="widget-toolbox padding-8 clearfix" >
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<button type="button" class="btn btn-info btn-sm save_button" onclick="save_checkup_parameter();"><i class="ace-icon fa fa-floppy-o bigger-110"></i>Save </button>
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<button type="button" class="btn btn-danger btn-sm" data-dismiss="modal"><i class="ace-icon fa fa-times bigger-110"></i>Cancel</button>
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</div>
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</div>
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</div>
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</form>
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</div>
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