59 lines
1.7 KiB
PHP
59 lines
1.7 KiB
PHP
<div class="modal fade" id="display_existing_medical" role="dialog" aria-hidden="true">
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<div class="modal-dialog modal-lg">
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<div class="modal-content">
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<div class="modal-header">
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<strong style="font-size:15px"><br>A recent Medical Examination Record for the Patient Already exists. Do you still want to continue creating a new entry?. Click No to Cancel. Yes to add New Entry </strong>
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</div>
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<form role="form" id="item_form" name="item_form" action="#" method="post">
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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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<table class="table table-bordered order-list" id="table">
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<tr>
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<th>PATIENT NAME
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</th>
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<th>EXAM TYPE
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</th>
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<th>MEDICAL ENTRY DATE
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</th>
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</tr>
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<tr>
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<td>
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<input readonly type="text" class="form-control" style="height: 29px" name="name" style="text-transform:uppercase" id="name" />
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</td>
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<td>
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<input readonly type="text" class="form-control" style="height: 29px" name="type" style="text-transform:uppercase" id="type" />
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</td>
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<td>
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<input readonly type="text" class="form-control" style="height: 29px" name="med_date" style="text-transform:uppercase" id="med_date" />
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</td>
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</tr>
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</table>
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</div>
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</div>
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</div>
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<div class="modal-footer">
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<button type="button" class="btn btn-info btn-sm save_button" onclick="navigateReceptionist()">
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YES
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</button>
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<button type="button" class="btn btn-danger btn-sm" data-dismiss="modal">
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<i class="ace-icon fa fa-times bigger-110"></i>NO
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</button>
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</div>
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</form>
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</div>
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</div>
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</div> |