<html>
<head>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script>
<div id="opd_form_div" style="display:none">
<form id="opd_form" name="opd_form">
<?php
//include autoloader;
include('includes/config/config.php');
include_once("includes/functions.php");
error_reporting(E_ERROR | E_PARSE);
error_log("id:" . $_REQUEST['appointment_idpdf']);
$sql_employee_appointment = "select a.*,p.patient_name, p.dept_id, p.emp_code, p.father_name, p.designation_id,employer_contractor_id, patient_cat_id, gender,blood_group,emp_cadre from employee_appointment a, patient_master p where a.emp_id=p.id and appointment_id='" . $_REQUEST['appointment_idpdf'] . "'";
error_log("sql injury pres:" . $sql_employee_appointment);
$res_emp_appoint = mysqli_query($conn, $sql_employee_appointment);
$rows_emp_appoint = mysqli_fetch_array($res_emp_appoint);
@extract($rows_emp_appoint);
$patient_name = $rows_emp_appoint['patient_name'];
//echo $query;
$doc_user_id = ($rows_emp_appoint['doctor_last_attended'] != null || 0 || "") ? $rows_emp_appoint['doctor_last_attended'] : $rows_emp_appoint['modified_by'];
$doc_emp_id = getTableFieldValue('tbl_users', 'emp_id', 'user_id', $doc_user_id, '');
$doc_name = getTableFieldValue('patient_master', 'patient_name', 'id', $doc_emp_id, '');
$result = mysqli_query($conn, $query);
$row = mysqli_fetch_array($result);
@extract($row);
$sql_doc_details = "select * from employee_signature where emp_id='$doc_emp_id'";
$result_doc_details = mysqli_query($conn, $sql_doc_details);
$row_doc_details = mysqli_fetch_array($result_doc_details);
$employee_code = $rows_emp_appoint['emp_code'];
$father_name = $rows_emp_appoint['father_name'];
if ($rows_emp_appoint['IsEmergency'] == 1) {
$ans = "Yes";
} else {
$ans = "No";
}
date_default_timezone_set('Asia/Kolkata');
$date = date('Y-m-d H:i:s');
$currentDate = date_format(date_create($date), "d-M-Y h:i:sa ");
$ailment_names = $rows_emp_appoint['ailments_new'];
$ailment_system_name = $rows_emp_appoint['ailment_systems_new'];
$injury_part_names = $rows_emp_appoint['injury_parts_new'];
$health_advices = $rows_emp_appoint['health_advices_new']; //getCommaSeperatedValuesForInClause("select health_advice_name from health_advice ","health_advice_id",$rows_emp_appoint['health_advices']);
$tests = $rows_emp_appoint['recommended_tests_new']; //getCommaSeperatedValuesForInClause("select section_name from checkup_form_section ","section_id",$rows_emp_appoint['tests']);
?>
<style>
.tbl1 {
width: 100%;
}
th {
background-color: #e1e1e1;
font-size: 12px;
font-style: bold;
vertical-align: top;
}
td {
text-align: left;
font-size: 12px;
vertical-align: top;
}
</style>
</head>
<table border="1" cellspacing="0" width="100%">
<tr>
<td colspan="6" width="100%" ><center><strong>FORM 6</strong></center></td>
</tr>
<tr>
<td colspan="6" width="100%" align="center"><center><strong>CERTIFICATE OF FITNESS</strong></center></td>
</tr>
<tr>
<td colspan="2"><strong>Serial No</strong></td>
<td colspan="4"></td>
</tr>
<tr>
<td colspan="2"><strong>Date</strong></td>
<td colspan="4"></td>
</tr>
<tr>
<td colspan="2"><strong>Name</strong></td>
<td colspan="4"></td>
</tr>
<tr>
<td colspan="2"><strong>Father's Name</strong></td>
<td colspan="4"></td>
</tr>
<tr>
<td colspan="1" width="25%"><strong>Sex</strong></td>
<td colspan="1" width="25%"></td>
<td colspan="1" width="25%"><strong>Age</strong></td>
<td colspan="1" width="25%"></td>
<td colspan="1" width="25%"><strong>Date of Birth</strong></td>
<td colspan="1" width="25%"></td>
</tr>
<tr>
<td colspan="2" height="4%"><strong>Permanent Address</strong></td>
<td colspan="4" height="4%"></td>
</tr>
<tr>
<td colspan="2" height="4%"><strong>Present Address</strong></td>
<td colspan="4" height="4%"></td>
</tr>
<tr>
<td colspan="2" rowspan="2"><strong>Identification mark</strong></td>
<td colspan="4">1)</td>
</tr>
<tr>
<td colspan="4">2)</td>
</tr>
<tr>
<td colspan="6" height="5%">
I herby certify that I have personally examined ___________________________________ son/daughter of ___________________________________ who is desirous of being employed in factory, and that his/her age as nearly as can be ascertained from my examination is _______ years and that he/she is fit for employment in factory as an adult.
</td>
</tr>
<tr>
<td colspan="2"><strong>Reason for</strong></td>
<td colspan="4"></td>
</tr>
<tr>
<td colspan="6" height="5%">1) Refusal of Certificate:</td>
</tr>
<tr>
<td colspan="6">OR</td>
</tr>
<tr>
<td colspan="6" height="5%">2) Certificate being revoked</td>
</tr>
<tr><td colspan="6" height="1%"></td></tr>
<tr>
<td colspan="3" height="6%"></td>
<td colspan="3" height="6%"></td>
</tr>
<tr>
<td colspan="3"><strong>Left Hand Thumb Impression</strong></td>
<td colspan="3"><strong>Factory Medical Officer's Stamp & Signature</strong></td>
</tr>
</table>
<br>
<table border="1" width="100%" cellspacing="0">
<tr>
<td colspan="4"><center>FORM 23</center></td>
</tr>
<tr>
<td colspan="4"><center>Special Certificate of Fitness</center></td>
</tr>
<tr>
<td colspan="4"><center>(In respect of persons employed in occupation involving use of * compounds)</center></td>
</tr>
<tr>
<td colspan="1" width="25%">Serial No</td>
<td colspan="1" width="25%"></td>
<td colspan="1" width="25%">Dated</td>
<td colspan="1" width="25%"></td>
</tr>
<tr>
<td colspan="1">Shri</td>
<td colspan="3"></td>
</tr>
<tr>
<td colspan="1">Residing at</td>
<td colspan="3"></td>
</tr>
<tr>
<td colspan="4" height="4%">who is desirous of being employed as in the <br> and that his age, as nearly as can be ascertained from my examination is years and that he is in my opinion fit for employment in operation of</td>
</tr>
<tr>
<td colspan="2"></td>
<td colspan="2">*Chromium Compounds</td>
</tr>
<tr>
<td colspan="2"></td>
<td colspan="2">*Glass Manufacturing</td>
</tr>
<tr>
<td colspan="2"></td>
<td colspan="2">*Nitro amino compound</td>
</tr>
<tr>
<td colspan="2"></td>
<td colspan="2">*Hydrogen sulphide</td>
</tr>
<tr>
<td colspan="2"></td>
<td colspan="2">*Manganese & it's compounds</td>
</tr>
<tr>
<td colspan="2"></td>
<td colspan="2">*Benzene</td>
</tr>
<tr>
<td colspan="2" rowspan="2">Identification mark</td>
<td colspan="2">1)</td>
</tr>
<tr>
<td colspan="2">2)</td>
</tr>
<tr>
<td colspan="2" height="6%"></td>
<td colspan="2" height="6%"></td>
</tr>
<tr>
<td colspan="2"><strong>Left Hand Thumb Impression</strong></td>
<td colspan="2"><strong>Factory Medical Officer's Stamp & Signature</strong></td>
</tr>
</table>
</form>
<form id="employeeDetailsFormPdf" action="" method="POST">
<input type="hidden" name="htmlText" id="htmlText" />
</form>
</div>
<script>
formSubmit();
function formSubmit() {
$("#htmlText").val($("#opd_form").html());
document.forms['employeeDetailsFormPdf'].action = "pdf_dynamic.php";
document.forms['employeeDetailsFormPdf'].method = "post";
document.forms['employeeDetailsFormPdf'].submit();
}
</script>