<script> function validate() {/* var sbp = $('#sbp').val(); if(sbp == ''){ BootstrapDialog.alert('Please Enter SBP.!!!'); return false; } var dbp = $('#dbp').val(); if(dbp == ''){ BootstrapDialog.alert('Please Enter DBP.!!!'); return false; } var dvrt = $('#dvrt').val(); if(dvrt == ''){ BootstrapDialog.alert('Please Enter DVRT.!!!'); return false; } var nvrt = $('#nvrt').val(); if(nvrt == ''){ BootstrapDialog.alert('Please Enter NVRT.!!!'); return false; } var nvlt = $('#nvlt').val(); if(nvlt == ''){ BootstrapDialog.alert('Please Enter NVLT.!!!'); return false; } var cv = $('#cv').val(); if(cv == ''){ BootstrapDialog.alert('Please Enter CV.!!!'); return false; } var fundoscopy = $('#fundoscopy').val(); if(fundoscopy == ''){ BootstrapDialog.alert('Please Enter Fundoscopy.!!!'); return false; } var urine_albumin = $('#urine_albumin').val(); if(urine_albumin == ''){ BootstrapDialog.alert('Please Enter Urine Albumin.!!!'); return false; } var urine_sugar = $('#urine_sugar').val(); if(urine_sugar == ''){ BootstrapDialog.alert('Please Enter Urine Sugar.!!!'); return false; } var urine_bile_pigments = $('#urine_bile_pigments').val(); if(urine_bile_pigments == ''){ BootstrapDialog.alert('Please Enter Urine Bile Pigment.!!!'); return false; } var urine_ketones = $('#urine_ketones').val(); if(urine_ketones == ''){ BootstrapDialog.alert('Please Enter Urine ketones.!!!'); return false; } var urine_epithelial_cells = $('#urine_epithelial_cells').val(); if(urine_epithelial_cells == ''){ BootstrapDialog.alert('Please Enter Urine Epithelial Cells .!!!'); return false; } var hb = $('#hb').val(); if(hb == ''){ BootstrapDialog.alert('Please Enter HB%.!!!'); return false; } */ var emp_id=$("#emp_id").val(); if(emp_id=="" || emp_id==null){ BootstrapDialog.alert('Please Select Employee'); return false; } save_checkup(); } </script> <style> .modal-dialog { padding: 15px; width:55%; height:100%; } </style> <div class="modal fade" id="modal-add-checkup" name="modal-add-checkup" role="dialog" aria-hidden="true" > <form role="form" id="checkup_form" name="checkup_form" action="#" method="post"> <div class="modal-dialog modal-lg"> <div class="modal-content"> <div class="widget-header"> <h5 class="widget-title">Checkup 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-2"> <label for="role">Checkup Date</label> <div class="input-group"> <input class="form-control date-picker" style="width:70px;font-size:10px;height:25px;" name="checkup_date" id="checkup_date" type="text" data-date-format="dd/mm/yyyy" /> <span class="input-group-addon"> <i class="fa fa-calendar bigger-110"></i> </span> </div> </div> <div class="form-group col-sm-2"> <label for="role">SBP</label> <input type="hidden" class="form-control" name="checkup_id" id="checkup_id" value="" required/> <input type="text" class="form-control" name="sbp" style="font-size:10px;" id="sbp" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">DBP</label> <input type="text" class="form-control" name="dbp" style="font-size:10px;" id="dbp" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">DVRT</label> <input type="text" class="form-control" name="dvrt" style="font-size:10px;" id="dvrt" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">NVRT</label> <input type="text" class="form-control" name="nvrt" style="font-size:10px;" id="nvrt" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">NVLT</label> <input type="text" class="form-control" name="nvlt" style="font-size:10px;" id="nvlt" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">CV</label> <input type="text" class="form-control" name="cv" style="font-size:10px;" id="cv" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Fundoscopy</label> <input type="text" class="form-control" name="fundoscopy" style="font-size:10px;" id="fundoscopy" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Urine Albumin</label> <input type="text" class="form-control" name="urine_albumin" style="font-size:10px;" id="urine_albumin" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Urine Suagr</label> <input type="text" class="form-control" name="urine_sugar" style="font-size:10px;" id="urine_sugar" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Urine Biles</label> <input type="text" class="form-control" name="urine_bile_pigments" style="font-size:10px;" id="urine_bile_pigments" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Urine Kitones</label> <input type="text" class="form-control" name="urine_ketones" style="font-size:10px;" id="urine_ketones" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">Urine Pus Cells</label> <input type="text" class="form-control" name="urine_pus_cells" style="font-size:10px;" id="urine_pus_cells" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Urine Epithelial </label> <input type="text" class="form-control" name="urine_epithelial_cells" style="font-size:10px;" id="urine_epithelial_cells" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Hb%</label> <input type="text" class="form-control" name="Hb%" style="font-size:10px;" id="Hb%" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">WBC</label> <input type="text" class="form-control" name="wbc" style="font-size:10px;" id="wbc" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">R B C</label> <input type="text" class="form-control" name="rbc" style="font-size:10px;" id="rbc" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">P C V</label> <input type="text" class="form-control" name="pcv" style="font-size:10px;" id="pcv" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">M C V</label> <input type="text" class="form-control" name="mcv" style="font-size:10px;" id="mcv" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">M C H</label> <input type="text" class="form-control" name="mch" style="font-size:10px;" id="mch" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">M C H C</label> <input type="text" class="form-control" name="mchc" style="font-size:10px;" id="mchc" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Neutrophils</label> <input type="text" class="form-control" name="Neutrophils" style="font-size:10px;" id="Neutrophils" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Lymphocytes</label> <input type="text" class="form-control" name="lymphocytes" style="font-size:10px;" id="lymphocytes" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Eosinophils</label> <input type="text" class="form-control" name="eosinophils" style="font-size:10px;" id="eosinophils" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">Monocytes</label> <input type="text" class="form-control" name="monocytes" style="font-size:10px;" id="monocytes" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Basophils</label> <input type="text" class="form-control" name="basophils" style="font-size:10px;" id="basophils" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Platelets</label> <input type="text" class="form-control" name="platelets" style="font-size:10px;" id="platelets" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">E S R</label> <input type="text" class="form-control" name="esr" style="font-size:10px;" id="esr" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">RBS</label> <input type="text" class="form-control" name="rbs" style="font-size:10px;" id="rbs" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Blood Urea</label> <input type="text" class="form-control" name="bloodurea" style="font-size:10px;" id="bloodurea" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">Sr. Creatinine</label> <input type="text" class="form-control" name="creatinine" style="font-size:10px;" id="creatinine" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Uric Acid</label> <input type="text" class="form-control" name="uric_acid" style="font-size:10px;" id="uric_acid" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Total Cholesterol</label> <input type="text" class="form-control" name="total_cholesterol" style="font-size:10px;" id="total_cholesterol" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">HDL</label> <input type="text" class="form-control" name="hdl" style="font-size:10px;" id="hdl" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">LDL</label> <input type="text" class="form-control" name="ldl" style="font-size:10px;" id="ldl" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Triglycerides</label> <input type="text" class="form-control" name="triglycerides" style="font-size:10px;" id="triglycerides" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">Total Bilirubin</label> <input type="text" class="form-control" name="total_bilirubin" style="font-size:10px;" id="total_bilirubin" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Direct Bilirubin</label> <input type="text" class="form-control" name="direct_bilirubin" style="font-size:10px;" id="direct_bilirubin" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Indirect Bilirubin</label> <input type="text" class="form-control" name="indirect_bilirubin" style="font-size:10px;" id="indirect_bilirubin" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">SGOT</label> <input type="text" class="form-control" name="sgot" style="font-size:10px;" id="sgot" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">SGPT</label> <input type="text" class="form-control" name="total_cholesterol" style="font-size:10px;" id="total_cholesterol" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">ALP</label> <input type="text" class="form-control" name="alp" style="font-size:10px;" id="alp" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">FVC</label> <input type="text" class="form-control" name="total_cholesterol" style="font-size:10px;" id="total_cholesterol" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">FEV1</label> <input type="text" class="form-control" name="fev1" style="font-size:10px;" id="fev1" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">FEV1/FVC</label> <input type="text" class="form-control" name="fev1_fvc" style="font-size:10px;" id="fev1_fvc" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">FEF 25-75</label> <input type="text" class="form-control" name="FEF_25_75" style="font-size:10px;" id="FEF_25_75" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">PFT Result</label> <input type="text" class="form-control" name="PFT_result" style="font-size:10px;" id="PFT_result" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Chest X-ray</label> <input type="text" class="form-control" name="Chest_X_ray" style="font-size:10px;" id="Chest_X_ray" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">ECG</label> <input type="text" class="form-control" name="ECG" style="font-size:10px;" id="ECG" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">HBsAg</label> <input type="text" class="form-control" name="HBsAg" style="font-size:10px;" id="HBsAg" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Widal Test</label> <input type="text" class="form-control" name="Widal_test" style="font-size:10px;" id="Widal_test" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Mantoux Test</label> <input type="text" class="form-control" name="Mantoux_test" style="font-size:10px;" id="Mantoux_test" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Notes</label> <input type="text" class="form-control" name="Notes" style="font-size:10px;" id="Notes" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 500 Hz</label> <input type="text" class="form-control" name="ACRt500Hz" style="font-size:10px;" id="ACRt500Hz" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 1000 Hz</label> <input type="text" class="form-control" name="ACRt1000Hz" style="font-size:10px;" id="ACRt1000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 2000 Hz</label> <input type="text" class="form-control" name="ACRt2000Hz" style="font-size:10px;" id="ACRt2000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 500 Hz</label> <input type="text" class="form-control" name="ACRt500Hz" style="font-size:10px;" id="ACRt500Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 1000 Hz</label> <input type="text" class="form-control" name="ACRt1000Hz" style="font-size:10px;" id="ACRt1000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 2000 Hz</label> <input type="text" class="form-control" name="ACRt2000Hz" style="font-size:10px;" id="ACRt2000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 500 Hz</label> <input type="text" class="form-control" name="ACRt500Hz" style="font-size:10px;" id="ACRt500Hz" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 1000 Hz</label> <input type="text" class="form-control" name="ACRt1000Hz" style="font-size:10px;" id="ACRt1000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 2000 Hz</label> <input type="text" class="form-control" name="ACRt2000Hz" style="font-size:10px;" id="ACRt2000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 4000 Hz</label> <input type="text" class="form-control" name="ACRt4000Hz" style="font-size:10px;" id="ACRt4000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Rt 8000 Hz</label> <input type="text" class="form-control" name="ACRt8000Hz" style="font-size:10px;" id="ACRt8000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Lt 500 Hz</label> <input type="text" class="form-control" name="ACLt500Hz" style="font-size:10px;" id="ACLt500Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Lt 1000 Hz</label> <input type="text" class="form-control" name="ACLt1000Hz" style="font-size:10px;" id="ACLt1000Hz" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">AC Lt 2000 Hz</label> <input type="text" class="form-control" name="ACLt2000Hz" style="font-size:10px;" id="ACLt2000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Lt 4000 Hz</label> <input type="text" class="form-control" name="ACLt4000Hz" style="font-size:10px;" id="ACLt4000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">AC Lt 8000 Hz</label> <input type="text" class="form-control" name="ACLt8000Hz" style="font-size:10px;" id="ACLt8000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">BC Rt 500 Hz</label> <input type="text" class="form-control" name="BCRt500Hz" style="font-size:10px;" id="BCRt500Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">BC Rt 1000 Hz</label> <input type="text" class="form-control" name="BCRt1000Hz" style="font-size:10px;" id="BCRt1000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">BC Rt 2000 Hz</label> <input type="text" class="form-control" name="BCRt2000Hz" style="font-size:10px;" id="BCRt2000Hz" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">BC Rt 4000 Hz</label> <input type="text" class="form-control" name="BCRt4000Hz" style="font-size:10px;" id="BCRt4000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">BC Rt 8000 Hz</label> <input type="text" class="form-control" name="BCRt8000Hz" style="font-size:10px;" id="BCRt8000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">BC Lt 500 Hz</label> <input type="text" class="form-control" name="BCLt500Hz" style="font-size:10px;" id="BCLt500Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">BC Lt 1000 Hz</label> <input type="text" class="form-control" name="BCLt1000Hz" style="font-size:10px;" id="BCLt1000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">BC Lt 2000 Hz</label> <input type="text" class="form-control" name="BCLt2000Hz" style="font-size:10px;" id="BCLt2000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">BC Lt 4000 Hz</label> <input type="text" class="form-control" name="BCLt4000Hz" style="font-size:10px;" id="BCLt4000Hz" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">BC Lt 8000 Hz</label> <input type="text" class="form-control" name="BCLt8000Hz" style="font-size:10px;" id="BCLt8000Hz" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Audiometry Result</label> <input type="text" class="form-control" name="Audiometry_result" style="font-size:10px;" id="Audiometry_result" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">ECHO</label> <input type="text" class="form-control" name="ECHO" style="font-size:10px;" id="ECHO" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Ultrasound</label> <input type="text" class="form-control" name="Ultrasound" style="font-size:10px;" id="Ultrasound" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">PAP Smear/PSA</label> <input type="text" class="form-control" name="PAP_Smear" style="font-size:10px;" id="PAP_Smear" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Mammogram</label> <input type="text" class="form-control" name="Mammogram" style="font-size:10px;" id="Mammogram" placeholder="" required/> </div> </div> <div class="row"> <div class="form-group col-sm-2"> <label for="checkup">Vitamin B12</label> <input type="text" class="form-control" name="Vitamin_B12" style="font-size:10px;" id="Vitamin_B12" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Vitamin D</label> <input type="text" class="form-control" name="Vitamin_D" style="font-size:10px;" id="Vitamin_D" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">HbA1C</label> <input type="text" class="form-control" name="HbA1C" style="font-size:10px;" id="HbA1C" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Bone Density</label> <input type="text" class="form-control" name="Bone_density" style="font-size:10px;" id="Bone_density" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">CT Scan</label> <input type="text" class="form-control" name="CT_Scan" style="font-size:10px;" id="CT_Scan" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">MRI</label> <input type="text" class="form-control" name="MRI" style="font-size:10px;" id="MRI" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Other Tests</label> <input type="text" class="form-control" name="Other_tests" style="font-size:10px;" id="Other_tests" placeholder="" required/> </div> <div class="form-group col-sm-2"> <label for="checkup">Select Employee</label> <select class="form-control" name="emp_id" style="font-size:10px;width:150px" id="emp_id" placeholder="" required> </select> </div> </div> </div> <div class="widget-toolbox padding-8 clearfix" > <button type="button" class="btn btn-info btn-sm save_button" onclick="validate();"><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> </form> </div> <script> $('#checkup_date').datepicker({ autoclose:true, format: 'dd/mm/yyyy', startDate: '1d/1m/1970y', }).next().on(ace.click_event, function(){ $(this).prev().focus(); }); </script> <style> .input-group-addon { height:25px; width:30px; padding: 0px 0px; } label{ font-size: 10px; } .form-control{ width:80px; height:25px; } </style>