102 lines
4.8 KiB
PHP
102 lines
4.8 KiB
PHP
<script>
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function validate() {
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var employer_contractor = $('#employer_contractor').val();
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if (employer_contractor == '') {
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BootstrapDialog.alert('Please Enter Employer/Contractor Name.!!!');
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return false;
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}
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// var remarks = $('#remarks').val();
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// if(remarks == ''){
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// BootstrapDialog.alert('Please Enter Remarks.!!!');
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// return false;
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// }
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save_employer_contractor();
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}
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</script>
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<style>
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#modal-add-patient {
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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="modal-add-employer-contractor" name="modal-add-employer-contractor" role="dialog"
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aria-hidden="true">
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<form role="form" id="employer-contractor_form" name="employer-contractor_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">Employer / Contractor 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="form-group">
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<label for="role">Employer / Contractor</label>
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<select class="form-control form-control-lg " name="employer_contractor" id="employer_contractor" required>
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<option value="">Select Agency Name.</option>
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<?php
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// Fetch employees from database
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$sql = "SELECT id, name FROM agencies";
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$result = mysqli_query($conn, $sql);
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if ($result && mysqli_num_rows($result) > 0) {
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while ($row = mysqli_fetch_assoc($result)) {
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echo "<option value='" . $row['name'] . "'>" . $row['name'] . "</option>";
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}
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}
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?>
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</select>
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</div>
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<div class="form-group">
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<label for="role">Code</label>
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<input type="text" class="form-control" name="employer_contractor_code"
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id="employer_contractor_code" maxlength="70" placeholder="Enter employer / Contractor Code"
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required />
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</div>
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<div class="form-group">
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<label for="role">Address</label>
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<input type="text" class="form-control" name="employer_contractor_address"
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id="employer_contractor_address" maxlength="70" placeholder="Enter Address details "
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required />
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</div>
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<div class="form-group">
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<label for="role">Contact</label>
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<input type="text" class="form-control" name="employer_contractor_contact"
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id="employer_contractor_contact" maxlength="70" placeholder="Enter Contact details"
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required />
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</div>
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<div class="form-group">
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<label for="role">Email</label>
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<input type="text" class="form-control" name="employer_contractor_email"
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id="employer_contractor_email" maxlength="70" placeholder="Enter Email details" required />
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</div>
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<div class="form-group">
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<label for="ailment">Remarks</label>
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<input type="text" class="form-control" name="remarks" id="remarks" maxlength="70"
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placeholder="Enter Remarks" required />
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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="validate();"><i
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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
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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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