<!DOCTYPE html>
    <html lang="en">
    

<head>
    <meta charset="UTF-8">

    <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script>

    <style>
    * {
        font-family: sans-serif;
    }

    table,
    tr,
    td {
        border: none !important;
    }

    .print {
        position: absolute;
        right: 11%;
    }

    @media print {
        #printPageButton {
            display: none;
        }

        .header {
            background-color: #ffeb3b !important;
            print-color-adjust: exact;
        }
    }

    /* .tbl1 {
            border-collapse: collapse;

        } */

    /* th {
            background-color: #e1e1e1;
            font-size: 10px;
            font-style: bold;
            vertical-align: top;
        }

        td {
            text-align: left;
            font-size: 10px;
            vertical-align: top;
            padding: 8px !important;
        } */

    /* tr {
            border: 1px solid black;
        } */
    </style>
    <?php

    // include autoloader;


    $checkup_id = 12;
$data=array();
    $unitMap = getKeyValueMap('unit_master', 'unit_id', 'unit_name');

    $query = "select  * from ohc_type where ohc_type_id = '" . $_SESSION['current_ohcttype'] . "'";

    error_log("query: 27: " . $query);
    // echo $query;

    $result = mysqli_query($conn, $query);

    $row_company = mysqli_fetch_array($result);

    @extract($row_company);
    //Code for loading the Check up Sections List for the given Checkup page case
    $sql_patient = "select * from checkup_form where checkup_id = '$checkup_id'";
    $result_p = mysqli_query($conn, $sql_patient);

    $row_p = mysqli_fetch_array($result_p);

    @extract($row_p);


    $queryc = "select * from company_profile ";

    $resultc = mysqli_query($conn, $queryc);

    $row_company = mysqli_fetch_array($resultc);

    @extract($row_company);


        $checkup_section_ids = $row_p['checkup_section_ids'];

    $param_present = (explode(',', $row_p['checkup_section_ids']));
    $param_present = array_unique($param_present);
    //for each Section enabled for the checkup case
    // print_r($param_present);
    foreach ($param_present as $x => $val) { 
        $sql_param = "select a.*,b.* from checkup_parameter a left join checkup_form_key_value b on a.column_name = b.checkup_form_key where  checkup_form_id = '$checkup_id' and checkup_form_section_id = '$val' order by column_order";

        error_log("//query to load fields for each section@@@@@@@!!!!" . $sql_param);

        $result_param = mysqli_query($conn, $sql_param);
        $param_name = array();
        $param_value = array();
        $param_unit ='';
        $param_ranges='';
        while ($row_param = mysqli_fetch_assoc($result_param)) {
            array_push($param_name, $row_param['parameter_name']);

if(empty(getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $row_param['checkup_form_value'])) && empty(getCommaSeperatedValuesForInClause("select parameter_value_name from checkup_parameter_value", 'parameter_value_id', $row_param['checkup_form_value'])) && empty($row_param['checkup_form_value'])){
    $param_unit='';
    
}else{

            $param_unit= getFieldFromTable('unit_name', 'checkup_parameter_unit_master', 'unit_id', $row_param['unit']);
}      
            

            if ($row_param['input_type'] == 'select') {
                array_push($param_value, getFieldFromTable('parameter_value_name', 'checkup_parameter_value', 'parameter_value_id', $row_param['checkup_form_value']).' &nbsp;'.$param_unit);
            } else if ($row_param['input_type'] == 'multiselect') {
                array_push($param_value, getCommaSeperatedValuesForInClause("select parameter_value_name from checkup_parameter_value", 'parameter_value_id', $row_param['checkup_form_value']).' '.$param_unit);
            } else {
                array_push($param_value, $row_param['checkup_form_value'].' '.$param_unit);
            }
        }    
        $sql_group_ids = "select count(distinct(a.group_id)) as field_value from checkup_parameter a left join checkup_form_key_value b on a.column_name = b.checkup_form_key where  checkup_form_id = '$checkup_id' and checkup_form_section_id = '$val' order by column_order";

                                        $result_grp = mysqli_query($conn, $sql_group_ids);
                                        $row_grp = mysqli_fetch_assoc($result_grp);
                                        $total_group_ids = $row_grp['field_value'];
                                        //echo 'hellooooooooooooooooooo';
                                        error_log("total group ids:" . $total_group_ids);

                                        $group_ids = array();

                                        for ($i = 1; $i <= $total_group_ids; $i++) {
                                            $group_id = "select count(group_id) from checkup_parameter where group_id = '$i' and enabled!='N' and checkup_form_section_id = '$val'";

                                            error_log("group id len query:" . $group_id);
                                            $result_group_id = mysqli_query($conn, $group_id);

                                            $row_group_id = mysqli_fetch_array($result_group_id);

                                            array_push($group_ids, $row_group_id['0']);
                                        }
                                        $max_len = max($group_ids);
                                        //    echo $max_len;
                                        //    print_r($group_ids);
                                        $k = 0;
                                        for ($i = 0; $i < $total_group_ids; $i++) {
                                            
                                        $value = $group_ids[$i];
                                        $value2 = $max_len - $value;
                                        while ($value != 0) {
                                            $para=array(
                                                
                                                $param_name[$k]=>$param_value[$k],
                                            );

                                            array_push($data,$para);
                                             $k++;
                                                $value--; 
                                          } while ($value2 != 0) {  $value2--;}}}
       
        

                                          function chekFromItem($arr, $keyToSearch) {
                                           
                                            foreach($arr as $key=>$para){
                                                foreach($para as $name=>$value)
                                            
                                                {
                                             if($name==$keyToSearch) return $value;
                                                }
                                            
                                        }}

    error_log("data".print_r($data,true));
        ?>








</head>

<body>

    <form name="checkup_form_employee" id="checkup_form_employee" method="POST">
        <div class="row" style="display:flex">
            <div id="preexam_form_div" style="width:50%;outline-style: solid;margin-right: 10px; ">





                <table width="100%" class='header' style="background-color:#ffeb3b;">
                    <tr>
                        <!-- <?php if( !empty($row_company['company_logo']) || $row_company['company_logo'] !=null || $row_company['company_logo'] !="" ){ ?>

                    <td width="20%"><img
                            src="data:<?php echo $row_company['image_type'] ?>;base64,<?php echo base64_encode($row_company['company_logo']) ?>"
                            style="width: 150px; height: 60px; margin: 0px; padding: 0px;background-color: #ffff0080;">
                    </td> <?php } ?> -->
                        <td width="60%" align="center">
                            <div style="margin-left: 20px;">
                                <strong style="margin-left: 50px ;font-size: 15px; text-align: center;">
                                    <?php echo $row_company['company_name'] ?>
                                </strong><br />
                                <strong
                                    style="margin-left: 50px ;font-size: 15px; text-align: center;"><?php echo $row_company['address'] ?>
                                </strong><br />
                                <strong style="margin-left:50px;color:green; font-size: 15px;">ANNUAL MEDICAL CHECK UP
                                    HEALTH
                                    CARD </strong>
                            </div>
                        </td>
                        <!-- <?php if (isset($row_company['right_com_logo']) && $row_company['right_com_logo'] != null) { ?>
                    <td width="20%" align="right"><img
                            src="data:<?php echo $row_company['right_image_type'] ?>;base64,<?php echo base64_encode($row_company['right_com_logo']) ?>"
                            style="width: 150px; height: 60px; margin:0px; padding: 0px;">
                    </td>
                    <?php } ?> -->
                    </tr>

                </table>

                <hr>


                <input type="hidden" id="checkup_section_ids" name="checkup_section_ids[]">
                <div class="mainPanel">
                    <div class="panel-group" id="accordion">
                        <div class="panel panel-default">
                            <div class="panel-heading" id="panel-heading1">


                            </div>
                            <div class="panel-body">
                                <div class="row">
                                    <?php

                                //  $emp_id ='5504';

                                $sql_employee = "select * from patient_master where id=(select emp_id from checkup_form where checkup_id='$checkup_id' )";

                                $result = mysqli_query($conn, $sql_employee);

                                //$checkup_id = $_REQUEST['flex_checkup_id'];
                                // $sql_checkup = "select * from checkup_form where checkup_id='$checkup_id'";
                                //echo $sql_checkup;
                                $checkup_result = mysqli_query($conn, $sql_employee);
                                $row_checkup = mysqli_fetch_assoc($checkup_result);
                                while ($row_employee = mysqli_fetch_assoc($result)) {
                                    $patient = $row_employee['patient_name'];
                                    $gender =  $row_employee['gender'] == 'm' || $row_employee['gender'] == 'M' ? 'MALE' : 'FEMALE';
                                    $age = "";
                                    if (!empty($row_employee['dob'])) {
                                        $dob = $row_employee['dob'];
                                        $age = (date('Y') - date('Y', strtotime($dob)));
                                    }
                                ?>

                                    <table border="0" width="100%" style="font-size:12px">
                                        <tr>
                                            <td width="25%" style="color:red;">

                                                <strong><?php echo $patient?></strong>
                                            </td>
                                            <td width="25%">
                                                <b style="color:red;">EMPLOYEE ID:</b>
                                                <?php echo $row_employee['emp_code'] ?>
                                            </td>

                                        </tr>
                                        <tr></tr>
                                        <tr></tr>
                                        <tr></tr>
                                        <tr>
                                            <td width="25%">
                                                <b style="color:red;"> Date:</b>
                                                <?php echo date_format(date_create($row_p['checkup_date']), "d-M-Y") ?>
                                            </td>
                                            <td width="25%">
                                                <b style="color:red;">AMC No.</b>
                                                <?php echo $row_p['ticket_no'] ?>
                                            </td>

                                        </tr>
                                        <tr>

                                            <td width="25%">
                                                <b style="color:red;">GENDER:</b>
                                                <?php echo $row_employee['gender'] == 'm' || $row_employee['gender'] == 'M' ? 'MALE' : 'FEMALE' ?>
                                            </td>
                                            <td width="25%">
                                                <b style="color:red;">DOJ:</b>

                                                <?php if($row_employee['doj']!='' || $row_employee['doj']!=null) echo date_format(date_create($row_employee['doj']), "d-M-Y") ?>
                                            </td>
                                        </tr>
                                        <tr>

                                            <td width="25%">
                                                <b style="color:red;">DOB:</b>
                                                <?= !empty($row_employee['dob']) ? date_format(date_create($row_employee['dob']), "d-M-Y") : '' ?>
                                            </td>
                                            <td width="25%">
                                                <b style="color:red;">Age</b>
                                                <?php echo $age ?>
                                            </td>
                                        </tr>
                                        <tr>
                                        <tr>
                                            <td width="25%">
                                                <b style="color:red;">DESIGNATION:</b>
                                                <?php echo getFieldFromTable('designation_name', 'designation', 'designation_id', $row_employee['designation_id']) ?>
                                            </td>
                                            <td width="25%">
                                                <b style="color:red;">MOBILE NO.:</b>
                                                <?php echo $row_employee['primary_phone'] ?>
                                            </td>
                                        </tr>

                                        <tr>


                                            <td width="25%">
                                                <b style="color:red;">DEPARTMENT:</b>
                                                <?php echo getFieldFromTable('dept_name', 'department', 'dept_id', $row_employee['dept_id']) ?>
                                            </td>
                                            <td width="25%">
                                                <b style="color:red;">DIVISION:</b>
                                                <?php echo getTableFieldValue('bussiness_unit', 'bu_name', 'bu_id', $row_employee['bu_id'], ''); ?>
                                            </td>
                                        </tr>
                                        <td width="25%">

                                        </td>
                                        </tr>


                                        <tr>
                                            <td width="25%">
                                                <b style="color:red;">HEIGHT:</b>
                                                <?php echo chekFromItem($data,"Height") ?>
                                                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                                <b style="color:red;">WEIGHT:</b>
                                                <?php echo chekFromItem($data,"Weight")?>
                                            </td>


                                            <td width="25%">
                                                <b style="color:red;">BMI:</b>
                                                <?php echo chekFromItem($data,"BMI")?>
                                            </td>

                                        </tr>
                                        <tr>
                                            <td width="25%">
                                                <b style="color:red;">IDENTIFICATION M.:</b>
                                                <?php echo $row_employee['identity'] ?>
                                            </td>
                                            <td width="25%">
                                                <b style="color:red;">B.group:</b>
                                                <?php echo $row_employee['blood_group'] ?>
                                            </td>

                                        </tr>


                                    </table>
                                    <?php  } ?>

                                    <table border="5" width="100%" style="font-size:12px;outline-style: solid;">
                                        <tr>
                                            <td align="center" style="outline-style: solid;">
                                                <b style="color:red;">ETE TEST</b>

                                            </td>
                                            <td align="center" style="outline-style: solid;">


                                            </td>
                                            <td width="25%" align="center" style="outline-style: solid;">
                                                <b>RT.EYE</b>

                                            </td>
                                            <td width="25%" align="center" style="outline-style: solid;">
                                                <b>LT.EYE</b>

                                            </td>
                                        </tr>
                                        <tr>
                                            <td align="center" width="25%" style="outline-style: solid;">
                                                <b style="color:red;">SPECTS </b>

                                            </td>
                                            <td align="center" width="25%" style="outline-style: solid;">
                                                <b>DIST</b>

                                            </td>
                                            <td width="25%" align="center" style="outline-style: solid;">
                                                <b><?php echo chekFromItem($data,"DISTANT VISION RT EYE")?></b>

                                            </td>
                                            <td width="25%" align="center" style="outline-style: solid;">
                                                <b><?php echo chekFromItem($data,"DISTANT VISION LT EYE")?></b>

                                            </td>
                                        </tr>
                                        <tr>
                                            <td align="center" width="25%" style="outline-style: solid;">
                                                <b style="color:red;">WITHOUT GLASS</b>

                                            </td>
                                            <td align="center" width="25%" style="outline-style: solid;">
                                                <b>NEAR</b>

                                            </td>
                                            <td width="25%" align="center" style="outline-style: solid;">
                                                <b><?php echo chekFromItem($data,"NEAR VISION RT EYE")?></b>

                                            </td>
                                            <td width="25%" align="center" style="outline-style: solid;">
                                                <b><?php echo chekFromItem($data,"NEAR VISION LT EYE")?></b>

                                            </td>
                                        </tr>
                                        <tr>
                                            <td align="center" style="outline-style: solid;">
                                                <b style="color:red;">COLOR VISION BY ISHIHARA CHART</b>

                                            </td>
                                            <td align="center" style="outline-style: solid;">


                                            </td>
                                            <td width="25%" colspan="2" align="center" style="outline-style: solid;">
                                                <b><?php echo chekFromItem($data,"COLOUR VISION ISHIHARA CHART")?></b>

                                            </td>
                                        </tr>
                                    </table>

                                    <table border="0" width="100%" style="font-size:12px">
                                        <tr>
                                            <td width="25%">
                                                <b style="color:red;">PULSE</b>

                                            </td>
                                            <td width="25%">
                                                <b><?php echo chekFromItem($data,"Pulse")?></b>

                                            </td>
                                            <!-- <td width="25%" colspan="2" align="center">

                                                <b style="color:red;">P/O/L/I/C/C</b>
                                            </td> -->
                                            <td width="25%">
                                                <b style="color:red;">BP</b>
                                                <b><?php echo chekFromItem($data,"Systolic BP")."/".chekFromItem($data,"DIASTOLIC BP")?></b>
                                            </td>

                                        </tr>
                                        <tr>
                                            <td width="25%">
                                                <b style="color:red;"> SYS EXAM</b>

                                            </td>
                                            <td width="25%">
                                                <b>NAD</b>

                                            </td>
                                            <td width="25%" colspan="2" align="center">


                                            </td>
                                        </tr>
                                        <tr>
                                            <td width="25%">
                                                <b style="color:red;">PAST H/O:</b>

                                            </td>
                                            <td width="25%" colspan="4">
                                                <b><?php echo "CAD: ".chekFromItem($data,"CAD").",  "?><?php echo "HYPERTENSION: ".chekFromItem($data,"Hypertension").",  "?><?php echo "DIABETES: ".chekFromItem($data,"Diabetes")?></b>



                                            </td>
                                        </tr>

                                        <tr>
                                            <td width="25%">
                                                <b style="color:red;">MEDICATION H/O:</b>

                                            </td>
                                            <td width="25%" colspan="4">
                                                <b>PRESENT
                                                    MEDICATION:<?="  ".chekFromItem($data,"PRESENT MEDICATION IF ANY")?></b>
                                            </td>
                                        </tr>



                                    </table>



                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
            <div id="preexam_form_div" style="width:50%;outline-style: solid;margin-right: 10px; ">

                <table border="0" width="100%" style="font-size:12px">
                    <tr>
                        <td width="25%">
                            <b style="color:red;">HB:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"Haemoglobin")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">
                            <b style="color:#0000ff8a;">M: 13-18 F:12-16</b>

                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">RBS:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"RBS")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">
                            <b style="color:#0000ff8a;">(70-140)</b>

                        </td>
                    </tr>

                    <tr>
                        <td width="25%">
                            <b style="color:red;">HBA1C:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"HBA1C")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">
                            <b style="color:#0000ff8a;">(4.0-6.5)</b>

                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">FBS:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"FBS")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">

                            <b style="color:#0000ff8a;">(70-110)</b>
                        </td>
                    </tr>

                    <tr>
                        <td width="25%">
                            <b style="color:red;">TOTAL CHOLESTEROL:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"Total Cholesterol")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">

                            <b style="color:#0000ff8a;">(< 200)</b>
                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">SERUM TRIGLYCERIDES:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"Serum Triglyceride")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">

                            <b style="color:#0000ff8a;">(< 150)</b>
                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">SERUM HDL:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"SERUM HDL")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">

                            <b style="color:#0000ff8a;">(> 40)</b>
                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">SERUM LDL:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"Serum LDL")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">

                            <b style="color:#0000ff8a;">(< 100)</b>
                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">SERUM VLDL:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"Serum VLDL")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">

                            <b style="color:#0000ff8a;">(< 30)</b>
                        </td>
                    </tr>

                    <tr>
                        <td width="25%">
                            <b style="color:red;">SERUM BILIRUBIN TOTAL:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"Serum Bilirubin Total")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">

                            <b style="color:#0000ff8a;">(0.5-1.2)</b>
                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">SERUM CREATININE:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"Serum Creatinine")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">
                            <b style="color:#0000ff8a;">(M:0.6-1.4 F:0.5-1.2)</b>

                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">SGPT:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"SGPT")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">

                            <b style="color:#0000ff8a;">(< 40)</b>
                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">SGOT:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"SGOT ")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">

                            <b style="color:#0000ff8a;">(< 40)</b>
                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">BUN:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"BUN")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">


                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">URINE SUGAR:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"Sugar")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">


                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">AUDIO:</b>

                        </td>
                        <td width="25%">
                            <b><?php if(chekFromItem($data,"Audiometry RT Ear")!=null || chekFromItem($data,"Audiometry RT Ear")!=''){ echo " R: ".chekFromItem($data,"Audiometry RT Ear");}?><?php if(chekFromItem($data,"Audiometry LT Ear")!=null || chekFromItem($data,"Audiometry LT Ear")!=''){echo " L: ".chekFromItem($data,"Audiometry LT Ear");}?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">
                            <b style="color:#0000ff8a;">-</b>

                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">PFT:</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"SPIROMETRY (PFT)")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">
                            <b style="color:#0000ff8a;">-</b>

                        </td>
                    </tr>
                    <tr>
                        <td width="25%">
                            <b style="color:red;">X RAY CHEST (PA VIEW)</b>

                        </td>
                        <td width="25%">
                            <b><?php echo chekFromItem($data,"X Ray Chest (PA View)")?></b>

                        </td>
                        <td width="25%" colspan="2" align="center">
                            <b style="color:#0000ff8a;">- </b>

                        </td>
                    </tr>

                </table>




                <hr>


                <table width="100%" class='header' style="background-color:#ffeb3b;height:150px">
                    <tr>
                        <td width="60%" align="center" style="color:BLUE;">
                            <div style="margin-left: 20px;">
                                <strong style="margin-left: 50px ;font-size: 15px; text-align: center;">
                                    <?php echo getTableFieldValue("patient_master","patient_name",'id',$row_p['doc_attend'])  ?>
                                </strong><br />
                                <strong style="margin-left: 50px ;font-size: 15px; text-align: center;">CHIF MEDICAL
                                    OFFICER</strong><br />

                                <strong style="margin-left: 50px ;font-size: 15px; text-align: center;">OCCUPATIONAL
                                    HEALTH CENTRE</strong><br />

                                <strong
                                    style="margin-left: 50px ;font-size: 15px; text-align: center;"><?php echo $row_company['address'] ?>
                                </strong><br />
                                <strong style="margin-left: 50px ;font-size: 15px; text-align: center;">
                                    CONTACT NO. 9099093222,9099061549,02876-

                                </strong><br />
                                <strong style="margin-left: 50px ;font-size: 15px; text-align: center;">
                                    265302/3/4

                                </strong><br />

                            </div>
                        </td>
                    </tr>

                </table>



            </div>
        </div>
        </div>
        </div>
        </div>
        </div>
        </div>
    </form>

    <form id="employeeDetailsFormPdf" action="" method="POST">

        <input type="hidden" name="htmlText" id="htmlText" />

    </form>
    <button id="printPageButton" class="btn btn-success print" onClick="window.print();">Print</button>



</body>
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