167 lines
8.0 KiB
PHP
167 lines
8.0 KiB
PHP
<style>
|
|
#modal-add-ailment{
|
|
overflow-y:scroll;
|
|
}
|
|
</style>
|
|
<div class="modal fade" id="modal-add-guestAppointment" name="modal-add-guestAppointment" role="dialog" aria-hidden="true">
|
|
<form role="form" id="guest_appointment_form" name="guest_appointment_form" enctype="multipart/form-data" action="#" method="post">
|
|
<div class="modal-dialog">
|
|
<div class="modal-content">
|
|
<div class="widget-header">
|
|
<h5 class="widget-title">Guest OPD Form</h5>
|
|
<div class="widget-toolbar">
|
|
<div class="widget-menu">
|
|
<a href="#" class="close" data-action="close" data-dismiss="modal">
|
|
<i class="ace-icon fa fa-times"></i>
|
|
</a>
|
|
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="modal-body">
|
|
<div class="row">
|
|
<div class="form-group col-sm-6">
|
|
<label for="appointment_date">Visit Date</label>
|
|
|
|
|
|
<div class="input-group">
|
|
<input id="guest_id" name="guest_id" type="hidden" value=<?php echo $_REQUEST['flex_opd_id']?>/>
|
|
|
|
<input id="appointment_date1" type="text" class="form-control" name="appointment_date1" />
|
|
<span class="input-group-addon">
|
|
<i class="fa fa-clock-o bigger-110"></i>
|
|
</span>
|
|
</div>
|
|
</div>
|
|
<div class="form-group col-sm-6">
|
|
<label for="role">Complaints</label>
|
|
<input type="text" class="form-control" name="complaints_appointment"
|
|
id="complaints_appointment" placeholder="Complaints" required/>
|
|
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-sm-6">
|
|
<label for="examination_remarks">Examination Findings</label>
|
|
<input type="text" class="form-control" name="examination_remarks_appointment"
|
|
id="examination_remarks_appointment" placeholder="On Examination Symptoms" required/>
|
|
</div>
|
|
|
|
<div class="form-group col-sm-6">
|
|
<label for="IsEmergency">Emergency</label><br>
|
|
<select class="form-control" id="isEmergency_appointment" name="isEmergency_appointment">
|
|
<option value="0" selected>No</option>
|
|
<option value="1">Yes</option>
|
|
</select>
|
|
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-sm-6">
|
|
<label for="ailment">Diagnosis</label>
|
|
|
|
<select multiple="" class="chosen-select form-control" id="ailment_appointment" name="ailment[]" data-placeholder="Ailments" style="display: none;">
|
|
<?php echo generateOption('ailment','ailment_name','ailment_id',''); ?>
|
|
</select>
|
|
</div>
|
|
|
|
<div class="form-group col-sm-6">
|
|
<label for="ailment_system">Ailment System</label>
|
|
|
|
|
|
<select multiple="" class="chosen-select form-control" id="ailment_system" name="ailment_system[]" data-placeholder="Choose a System..." style="display: none;">
|
|
<?php echo generateOption('ailment_system','ailment_sys_name','ailment_sys_id',''); ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-sm-6">
|
|
<label for="ailment">Medicine</label>
|
|
<select class="chosen-select form-control" id="treatment_item<?php echo $row_history['appointment_id']?>_0" name="treatment_item[]" data-placeholder="Treatment..." style="display: none;">
|
|
<option value=""> </option>
|
|
<?php echo generateOption('tbl_items','item_name','item_id',$row_history_treatment['item_id'],''); ?>
|
|
</select>
|
|
</div>
|
|
<div class="form-group col-sm-6">
|
|
<label for="ailment">Dosage </label>
|
|
<select class="chosen-select form-control" id="treatment_item_dosage<?php echo $row_history['appointment_id']?>_0"name="treatment_item_dosage0" data-placeholder="Dosages..." style="display: none;" onchange="getFrequenceyQty(this.value,'frequency_qty<?php echo $row_history['appointment_id']?>_0','<?php echo $row_history['appointment_id']?>','0');">
|
|
<option value=""> </option>
|
|
<?php echo generateOption('medicine_frequency','medicine_frequency','frequency_id','',''); ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-sm-6">
|
|
<label for="section_head">For Days</label>
|
|
<input type="number" class="form-control"name="treatment_item_days0" id="treatment_item_days<?php echo $row_history['appointment_id']?>_0" value="1" onblur="updateTotalMedicineQty('frequency_qty<?php echo $row_history['appointment_id']?>_0','treatment_item_days<?php echo $row_history['appointment_id']?>_0','treatment_item_total<?php echo $row_history['appointment_id']?>_0')";/>
|
|
</div>
|
|
<div class="form-group col-sm-6">
|
|
<label for="section_head">Qty</label>
|
|
<input type="hidden" name="frequency_qty0" id="frequency_qty<?php echo $row_history['appointment_id']?>_0" />
|
|
<input type="number" class="form-control"name="treatment_item_total0" id="treatment_item_total<?php echo $row_history['appointment_id']?>_0" />
|
|
</div>
|
|
</div>
|
|
<div class= "row">
|
|
<div class="form-group col-sm-6">
|
|
<label for="section_head">Issued </label>
|
|
<input type="number"class="form-control"name="treatment_item_qtygvn0" id="treatment_item_qtygvn<?php echo $row_history['appointment_id']?>_0" />
|
|
</div>
|
|
<div class="form-group col-sm-6">
|
|
<label for="section_head">Procedure</label>
|
|
<input type="text" class="form-control"name="treatment_item_remarks0" id="treatment_item_remarks<?php echo $row_history['appointment_id']?>_0" />
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-sm-6">
|
|
<label class="control-label" for="Referral">Referral</label>
|
|
<input type="text" class="form-control" name="referral_appointment"
|
|
id="referral_appointment" placeholder="Referral" required/>
|
|
</div>
|
|
<div class="form-group col-sm-6">
|
|
<label class="control-label" for="followup">Follow-up</label>
|
|
<input type="text" class="form-control" name="followup_appointment"
|
|
id="followup_appointment" placeholder="Follow-up" required/>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-sm-6">
|
|
<label class="control-label" for="injury_part">Affected Body Parts</label>
|
|
<select multiple="" class="chosen-select form-control" id="injury_part" name="injury_part[]" data-placeholder="Affected Body Parts..">
|
|
<?php echo generateOption('injury_part','inj_name','inj_id','',''); ?>
|
|
</select>
|
|
</div>
|
|
<div class="form-group col-sm-6">
|
|
<label class="control-label" for="health_advice_name">Health Advices</label>
|
|
<select multiple="" class="chosen-select form-control" id="health_advice" name="health_advice[]" data-placeholder="Health Advices.." >
|
|
<?php echo generateOption('health_advice','health_advice_name','health_advice_id','',''); ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="form-group col-sm-6">
|
|
<label class="control-label" for="additional_advices">Additional Precautions</label>
|
|
<textarea name="remarks_appointment" placeholder="Additional Precautions.." rows="5" cols="10" id="remarks_appointment" class="autosize-transition form-control" style="overflow: hidden; overflow-wrap: break-word; "></textarea>
|
|
|
|
<div class="form-group col-sm-6">
|
|
|
|
<input type="hidden" class="form-control" name="appointment_id"
|
|
id="appointment_id" placeholder="Enter First Name" required/>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
<div>
|
|
|
|
</div>
|
|
|
|
<div class="widget-toolbox padding-8 clearfix" >
|
|
<button type="button" class="btn btn-info btn-sm save_button" onclick="validate_employee();"><i class="ace-icon fa fa-floppy-o bigger-110"></i>Save </button>
|
|
<button type="button" class="btn btn-danger btn-sm" data-dismiss="modal"><i class="ace-icon fa fa-times bigger-110"></i>Cancel</button>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</form>
|
|
</div>
|