<!-- bootstrap & fontawesome -->
<?php
error_reporting(E_ALL & ~E_NOTICE & ~E_DEPRECATED & ~E_WARNING);
include('includes/config/config.php');

?>
<link rel="stylesheet" href="assets/font-awesome/4.5.0/css/font-awesome.min.css" />

<!-- page specific plugin styles -->
<link rel="stylesheet" href="assets/css/jquery-ui.custom.min.css" />
<link rel="stylesheet" href="assets/css/chosen.min.css" />
<link rel="stylesheet" href="assets/css/bootstrap-datepicker3.min.css" />
<link rel="stylesheet" href="assets/css/bootstrap-timepicker.min.css" />
<link rel="stylesheet" href="assets/css/daterangepicker.min.css" />
<link rel="stylesheet" href="assets/css/bootstrap-datetimepicker.min.css" />
<link rel="stylesheet" href="assets/css/bootstrap-colorpicker.min.css" />
<link rel="stylesheet" href="adminlte/bower_components/bootstrap/less/type.less" />
<script src="assets/js/jquery-ui.custom.min.js"></script>
<script src="assets/js/jquery.ui.touch-punch.min.js"></script>
<script src="assets/js/chosen.jquery.min.js"></script>
<script src="assets/js/spinbox.min.js"></script>
<script src="assets/js/bootstrap-datepicker.min.js"></script>
<script src="assets/js/bootstrap-timepicker.min.js"></script>
<script src="assets/js/jquery.dataTables.min.js"></script>
<script src="assets/js/jquery.dataTables.bootstrap.min.js"></script>
<script src="assets/js/dataTables.buttons.min.js"></script>
<script src="assets/js/buttons.flash.min.js"></script>
<script src="assets/js/buttons.html5.min.js"></script>
<script src="assets/js/buttons.print.min.js"></script>
<script src="assets/js/buttons.colVis.min.js"></script>
<script src="assets/js/dataTables.select.min.js"></script>


<script src="assets/js/moment.min.js"></script>
<script src="assets/js/daterangepicker.min.js"></script>
<script src="assets/js/bootstrap-datetimepicker.min.js"></script>
<script src="assets/js/bootstrap-colorpicker.min.js"></script>
<script src="assets/js/jquery.knob.min.js"></script>
<script src="assets/js/autosize.min.js"></script>
<script src="assets/js/jquery.inputlimiter.min.js"></script>
<script src="assets/js/jquery.maskedinput.min.js"></script>
<script src="assets/js/bootstrap-tag.min.js"></script>
<script src="assets/js/ace-elements.min.js"></script>

<script type="text/javascript">
$(document).ready(function() {
    $(".glyphicon").css("top", "");

});

function open_treatments(appointment_id) {
    $('#modal-add-consultation').modal("show");

}
</script>

<form id="opd_form" method="post">
    <div class="widget-box box box-success" id="opd_form_pdf">
        <div class="widget-header" data-action="fullscreen">
            <h5 class="widget-title">Employee OPD Visit > &nbsp; <?php echo $patient_name ?> &nbsp;<a target="_blank"
                    href="emp_dashboard.php?flex_patient_id=<?php echo $row1['emp_id'] ?>"><i style="font-size: 17px;"
                        class="glyphicon glyphicon-user"></i></a>
            </h5>
            <div class="widget-toolbar" style="float: right">
                <div class="clearfix">
                    <div class="pull-right tableTools-container">
                        <div class="dt-buttons btn-overlap btn-group">


                            <a class="dt-button buttons-csv buttons-html5 btn btn-white btn-primary btn-bold"
                                id="forwardButton" tabindex="0" aria-controls="dynamic-table"
                                data-original-title="Send To Pharmacy" title="Save"><span><i
                                        class="fa fa-save bigger-110 blue"></i> <span
                                        class="hidden">Save</span></span></a>

                            <a id="hide" style="display:none"
                                class="dt-button buttons-print btn btn-white btn-primary btn-bold"
                                onclick="exporttopdf();" tabindex="0" aria-controls="dynamic-table"
                                data-original-title="Print" title="Print"><span><i
                                        class="fa fa-print bigger-110 grey"></i> <span
                                        class="hidden">Print</span></span></a>


                            <a class="dt-button buttons-print btn btn-white btn-primary btn-bold"
                                data-action="fullscreen" tabindex="0" aria-controls="dynamic-table"
                                data-original-title="Maximize" title="Maximize"><span><i
                                        class="fa fa fa-expand bigger-110 grey"></i> <span
                                        class="hidden">Maximize</span></span></a>
                            <input type="hidden" name="attendedStatus" id="attendedStatus"
                                value="<?php echo $__STATUS_RECEPTIONIST_ATTENDED ?>" />
                        </div>
                    </div>
                </div>
            </div>
        </div>
        <div class="widget-body">
            <div class="widget-main">
                <div class="row">
                    <div class="col-xs-9 table-responsive">
                        <div class="widget-box box box-warning">

                            <div class="widget-body">
                                <div class="widget-main">
                                    <div class="row">
                                        <div class="col-xs-12">
                                            <div class="row">

                                                <div class="col-sm-2">
                                                    <label class="control-label" for="appointment_id"><strong
                                                            style="font-size: 11px">Medical Record No:</strong></label>

                                                    <?php
                                                    //$ticket_no = getTableFieldValue('employee_appointment','max(appointment_id)');
                                                    $ticket_no = creatingTicketNoOPD();

                                                    ?>
                                                    <input id="ticket_no" type="hidden" name="ticket_no"
                                                        value="<?php echo $ticket_no; ?>" /> <input id="appointment_id"
                                                        type="hidden" name="appointment_id" />

                                                    <div class="input-group">


                                                        <?php echo $ticket_no; ?>
                                                    </div>

                                                </div>


                                                <div class="col-sm-3">
                                                    <label class="control-label" for="appointment_date"><strong
                                                            style="font-size: 11px">In Time</strong></label>

                                                    <div class="input-group">
                                                        <input id="emp_id" name="emp_id" type="hidden"
                                                            value="<?php echo ($_REQUEST['flex_opd_id'] != '' ? $_REQUEST['flex_opd_id'] : $_REQUEST['flex_patient_id']) ?>" />
                                                        <input id="appointment_type" name="appointment_type"
                                                            type="hidden" value="O" /> <input id="appointment_date"
                                                            type="text" style="height: 30px" class="form-control"
                                                            name="appointment_date" /> <span class="input-group-addon">
                                                            <i class="fa fa-clock-o bigger-110"
                                                                style="height: 5px; width: 30px"></i>
                                                        </span>
                                                    </div>

                                                </div>



                                                <div class=" col-sm-2">
                                                    <label class="control-label" for="followup_to_opd"><strong
                                                            style="font-size: 11px">Case Type</strong></label>


                                                    <select class="form-control" id="case_type" name="case_type">
                                                        <option value="">None</option>
                                                        <?php echo generateOption('case_type','case_name','case_code','','') ?>
                                                    </select>


                                                </div>

                                                <div class="col-sm-2">
                                                    <label class="control-label" for="shift_type">Shift
                                                    </label>

                                                    <select class="form-control select2" id="shift_type"
                                                        name="shift_type">
                                                        <option value="A">A</option>
                                                        <option value="B">B</option>
                                                        <option value="C">C</option>
                                                        <option value="G">G</option>
                                                    </select>


                                                </div>

                                                <div class=" col-sm-3">
                                                    <label class="control-label" for="followup_to_opd"><strong
                                                            style="font-size: 11px">Follow-up To(if
                                                            Applicable)</strong></label>

                                                    <div class="input-group">
                                                        <select id="followup_to_opd" name="followup_to_opd">
                                                            <option value="">None</option>
                                                            <?php echo generateOptionWithWhereClause('employee_appointment', "CONCAT(ticket_no,' ',DATE_FORMAT(appointment_date,'%d-%b-%Y %l:%i %p '))", 'appointment_id', '', '', 'emp_id', ($_REQUEST['flex_opd_id'] != '' ? $_REQUEST['flex_opd_id'] : $_REQUEST['flex_patient_id'])); ?>
                                                        </select>
                                                    </div>

                                                </div>
                                            </div>


                                            <div class="space-6"></div>

                                            <div class="row">

                                                <div class="col-sm-2">
                                                    <label class="control-label" for="form-field-8"><strong
                                                            style="font-size: 11px">Referred By</strong></label>
                                                    <br>



                                                    <select class="form-control" id="referred_by" name="referred_by">
                                                        <option value="" disabled selected>Please select an option
                                                        </option>
                                                        <?php echo generateOption('referred_by_master', 'referred_by', 'id', $row['referred_by'], '') ?>
                                                    </select>


                                                </div>

                                                <div class="col-sm-3">

                                                    <label class="control-label" for="form-field-8"><strong
                                                            style="font-size: 11px">Complaints</strong></label>
                                                    <br>


                                                    <div>
                                                        <select class="form-control chosen-select" name="complaints[]"
                                                            id="complaints" multiple value='<?=$row['complaints']?>'>
                                                            <?php echo generateOptionForMultiple('complaints', 'complaint', 'complaint_id',"" , '') ?>
                                                        </select>
                                                    </div>


                                                </div>
                                                <?php
                                               
                                                if ($_SESSION['RoleCode'] == $_SESSION['RoleCode']) {
                                                ?>

                                                <div class="col-sm-4">
                                                    <label class="control-label" for="ailment"><strong
                                                            style="font-size: 11px">Remarks/Follow-up Investigation
                                                            Details</strong></label>

                                                    <textarea name="remarks_rece" rows="3" cols="8" id="remarks_rece"
                                                        placeholder="Remaks" class="autosize-transition form-control"
                                                        style="overflow: hidden; overflow-wrap: break-word;"></textarea>


                                                </div>
                                                <input type="hidden" name="doctor_attended_flag"
                                                    id="doctor_attended_flag" value="N"> <input type="hidden"
                                                    name="medicine_disbursement" value="N">
                                            </div>

                                            <?php   } else { ?>
                                            <input type="hidden" name="doctor_attended_flag" id="doctor_attended_flag"
                                                value="Y">
                                            <div class="col-sm-3">
                                                <label class="control-label" for="form-field-8"><strong
                                                        style="font-size: 11px">Examination Findings</strong></label>

                                                <textarea rows="3" cols="8" class="autosize-transition form-control"
                                                    style="overflow: hidden; overflow-wrap: break-word;"
                                                    id="examination_remarks" name="examination_remarks"
                                                    placeholder="On Examination Symptoms" maxlength="500"></textarea>
                                            </div>
                                        </div>


                                        <div class="space-6"></div>

                                        <div class="row">
                                            <div class="col-sm-6">
                                                <label class="control-label" for="ailment"><strong
                                                        style="font-size: 11px">Diagnosis</strong></label>
                                                <div class="input-group">


                                                    <select multiple="" class="chosen-select form-control" id="ailment"
                                                        name="ailment[]" data-placeholder="Ailments">
                                                        <?php echo generateOption('ailment', 'ailment_name', 'ailment_id', '', ''); ?>
                                                    </select>
                                                    <div class="input-group-btn">
                                                        <button type="button" onclick="add_diagnosis();">
                                                            <font size="2">New</font>


                                                        </button>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="col-sm-6">
                                                <label class="control-label" for="ailment_system"><strong
                                                        style="font-size: 11px">Ailment System</strong></label>

                                                <div class="input-group">
                                                    <select multiple="" class="chosen-select form-control"
                                                        id="ailment_system" name="ailment_system[]"
                                                        data-placeholder="Choose a System...">
                                                        <?php echo generateOption('ailment_system', 'ailment_sys_name', 'ailment_sys_id', '', ''); ?>
                                                    </select>
                                                    <div class="input-group-btn">
                                                        <button type="button" onclick="add_Ailment_System();">
                                                            <font size="2">New</font>


                                                        </button>
                                                    </div>
                                                </div>
                                            </div>

                                        </div>


                                        <div class="space-6"></div>

                                        <div class="row">
                                            <div class="col-sm-12 table-responsive">
                                                <table id="treatmentTable<?php echo $row_history['appointment_id'] ?>"
                                                    class="table table-striped table-bordered ">
                                                    <thead>
                                                        <tr class="active" style="width: 100%">
                                                            <th style="font-size: 11px; text-align: center;"
                                                                style="width:25%">Medicine</th>
                                                            <th style="font-size: 11px; text-align: center;"
                                                                style="width:25%">Dosage</th>
                                                            <th style="font-size: 11px; text-align: center;"
                                                                style="width:20%">For Days</th>
                                                            <th style="font-size: 11px; text-align: center;"
                                                                style="width:5%">Qty</th>
                                                            <th style="font-size: 11px; text-align: center;"
                                                                style="width:5%">Price Per Unit</th>
                                                            <th style="font-size: 11px; text-align: center;"
                                                                style="width:5%">Stock</th>
                                                            <th style="font-size: 11px; text-align: center;"
                                                                style="width:5%">Issued</th>
                                                            <th style="font-size: 11px; text-align: center;"
                                                                style="width:5%">Total Price</th>
                                                            <th style="font-size: 11px; text-align: center;"
                                                                style="width:5%">
                                                                <button type="button"
                                                                    onclick="addRow('<?php echo $row_history['appointment_id'] ?>')"
                                                                    class="btn btn-info btn-sm"
                                                                    id="addrow<?php echo $row_history['appointment_id'] ?>">
                                                                    <span class="glyphicon glyphicon-plus"></span>

                                                                </button>

                                                            </th>
                                                        </tr>
                                                    </thead>
                                                    <tbody>

                                                        <tr style="width: 70%">
                                                            <td class="col-sm-2" style="width: 15%"><select
                                                                    style="width: 25%"
                                                                    class="chosen-select form-control"
                                                                    onchange="getItemDetails(this.value,'current_stock<?php echo $row_history['appointment_id'] ?>_0','current_stock<?php echo $row_history['appointment_id'] ?>0','current_rate<?php echo $row_history['appointment_id'] ?>_0','current_rate<?php echo $row_history['appointment_id'] ?>0','<?php echo $row_history['appointment_id'] ?>_0', '0');"
                                                                    id="treatment_item<?php echo $row_history['appointment_id'] ?>_0"
                                                                    name="treatment_item0"
                                                                    data-placeholder="Treatment...">
                                                                    <option value=""></option>
                                                                    <?php echo generateOption('tbl_items', 'item_name', 'item_id', '', ''); ?>";
                                                                </select></td>
                                                            <td class="col-sm-2" style="width: 15%"><select
                                                                    class="chosen-select form-control"
                                                                    id="treatment_item_dosage<?php echo $row_history['appointment_id'] ?>_0"
                                                                    name="treatment_item_dosage0"
                                                                    data-placeholder="Dosages..."
                                                                    onchange="getFrequenceyQty(this.value,'frequency_qty<?php echo $row_history['appointment_id'] ?>_0','dosage<?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></td>
                                                            <td class="col-sm-2" style="width: 5%"><input type="number"
                                                                    style="height: 25px; font-size: 12px"
                                                                    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','treatment_item_total_div0')" />
                                                            </td>

                                                            <td class="col-sm-1" style="width: 5%"><input type="hidden"
                                                                    name="frequency_qty0"
                                                                    id="frequency_qty<?php echo $row_history['appointment_id'] ?>_0" />
                                                                <input type="hidden" name="dosage0"
                                                                    id="dosage<?php echo $row_history['appointment_id'] ?>_0" />


                                                                <div style="text-align: center"
                                                                    id="treatment_item_total_div<?php echo $row_history['appointment_id'] ?>0">
                                                                </div> <input type="hidden"
                                                                    style="height: 25px; font-size: 12px"
                                                                    class="form-control" name="treatment_item_total0"
                                                                    id="treatment_item_total<?php echo $row_history['appointment_id'] ?>_0" />
                                                            </td>

                                                            <td class="col-sm-1" style="width: 5%">
                                                                <div style="text-align: center"
                                                                    id="current_rate<?php echo $row_history['appointment_id'] ?>0">
                                                                </div> <input type="hidden"
                                                                    style="height: 25px; font-size: 12px"
                                                                    class="form-control" name="current_rate0"
                                                                    id="current_rate<?php echo $row_history['appointment_id'] ?>_0" />
                                                            </td>
                                                            <td class="col-sm-1" style="width: 5%">
                                                                <div style="text-align: center"
                                                                    id="current_stock<?php echo $row_history['appointment_id'] ?>0">
                                                                </div> <input type="hidden" name="current_stock0"
                                                                    id="current_stock<?php echo $row_history['appointment_id'] ?>_0" />

                                                            </td>

                                                            <td class="col-sm-1" style="width: 5%"><input type="hidden"
                                                                    name="treatment_id0" id="treatment_id_0" /><input
                                                                    type="text" style="height: 25px; font-size: 12px"
                                                                    class="form-control" name="treatment_item_qtygvn0"
                                                                    id="treatment_item_qtygvn<?php echo $row_history['appointment_id'] ?>_0"
                                                                    disabled
                                                                    onchange="itemLevelTotol('treatment_item_qtygvn<?php echo $row_history['appointment_id'] ?>_0','current_rate<?php echo $row_history['appointment_id'] ?>_0','treatment_item_total_amount<?php echo $row_history['appointment_id'] ?>_0','treatment_item_total_amount<?php echo $row_history['appointment_id'] ?>0');checkQty()   " />
                                                            </td>

                                                            <td class="col-sm-1" style="width: 5%">
                                                                <div style="text-align: center"
                                                                    id="treatment_item_total_amount<?php echo $row_history['appointment_id'] ?>0">
                                                                </div>
                                                                <input type="hidden"
                                                                    style="height: 25px; font-size: 12px"
                                                                    class="form-control"
                                                                    name="treatment_item_total_amount0"
                                                                    id="treatment_item_total_amount<?php echo $row_history['appointment_id'] ?>_0" />

                                                            <td class="col-sm-1" style="width: 5%"><a
                                                                    class="deleteRow"></a></td>
                                                        </tr>

                                                    </tbody>
                                                    <tfoot>
                                                        <tr>
                                                            <td colspan="7" style="text-align: right;"><strong
                                                                    style="font-size: 11px"> Total Amount :<strong></td>
                                                            <td colspan="2"><input type="hidden"
                                                                    name="count_treatment_item"
                                                                    id="count_treatment_item" value="1" /><input
                                                                    type="hidden" name="count_treatment_item_new"
                                                                    id="count_treatment_item_new" value="1" /> <input
                                                                    type="hidden"
                                                                    style="height: 25px; font-size: 12px; width: 60px; align: center"
                                                                    class="form-control" name="order_level_total"
                                                                    id="order_level_total" />
                                                                <div id="order_level_total_div"
                                                                    style="margin-left: 30px"></div>
                                                            </td>
                                                        </tr>
                                                        <tr>
                                                        </tr>
                                                    </tfoot>
                                                </table>
                                            </div>
                                        </div>







                                        <div class="row">
                                            <div class="col-sm-3">
                                                <label class=" control-label " for="form-field-8"><strong
                                                        style="font-size: 11px">Medicine Disbursement</strong> </label>
                                            </div>
                                            <div class="col-sm-1">
                                                <input type="radio" name="medicine_disbursement" value="Y"
                                                    onchange="setFieldDisableOrEnable(this.value)">
                                                Yes<br>
                                            </div>
                                            <div class="col-sm-1">
                                                <input type="radio" name="medicine_disbursement" value="N" checked
                                                    onchange="setFieldDisableOrEnable(this.value)">
                                                No
                                            </div>

                                        </div>

                                        <div class="row">
                                            <div class="col-sm-6">
                                                <label class="control-label" for="referral"><strong
                                                        style="font-size: 11px">Referral</strong></label>
                                                <textarea name="referral" rows="4" cols="8" id="referral"
                                                    placeholder="Referral" class="autosize-transition form-control"
                                                    style="overflow: hidden; overflow-wrap: break-word;"></textarea>
                                            </div>

                                            <div class="col-sm-6">
                                                <label class="control-label" for="followup"><strong
                                                        style="font-size: 11px">Follow-up</strong></label>
                                                <textarea id="followup" rows="4" cols="8" name="followup"
                                                    placeholder="Follow Up" class="autosize-transition form-control"
                                                    style="overflow: hidden; overflow-wrap: break-word;"></textarea>
                                            </div>

                                        </div>
                                        <?php  } ?>
                                    </div>
                                    <!-- /.col-xs-12 -->
                                </div>
                                <!--row end-->

                            </div>
                            <!--end of widget-main-->
                        </div>
                        <!--end of widget-body-->
                    </div>
                    <!--end of widget-box-->
                </div>




                <div class="col-xs-3 table-responsive">
                    <div class="widget-box box box-danger">

                        <div class="widget-body">
                            <div class="widget-main">
                                <div class="row">
                                    <div class="col-sm-6">
                                        <label class="control-label" for="form-field-select-1"><strong
                                                style="font-size: 11px">Emergency?</strong></label> <select
                                            class="form-control" style="height: 30px;" id="isEmergency"
                                            name="isEmergency">
                                            <option value="0" selected>No</option>
                                            <option value="1">Yes</option>
                                        </select>
                                    </div>
                                    <div class="col-sm-6">
                                        <label class="control-label" for="form-field-select-1"><strong
                                                style="font-size: 11px">Chargeable?</strong></label> <select
                                            class="form-control" style="height: 30px;" id="isChargeable"
                                            name="isChargeable">
                                            <option value="0">No</option>
                                            <option value="1" selected>Yes</option>
                                        </select>
                                    </div>
                                </div>
                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">

                                        <div class="col-xs-4" style="margin-left: -12px">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">Weight</strong></label>
                                            <input type="number" style="height: 30px;" min="0" max="1000"
                                                placeholder="WEIGHT(kg)" id="weight" name="weight"
                                                onchange="calculateBMI()">
                                        </div>
                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">Height</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;" id="height"
                                                name="height" placeholder="HEIGHT (cms)" min="0" max="1000"
                                                onchange="calculateBMI()">
                                        </div>
                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">BMI</strong></label>
                                            <input type="number" style="height: 30px;width: 85px" id="bmi" name="bmi"
                                                placeholder="BMI(KG/m2)" min="0" max="200">
                                        </div>


                                    </div>
                                </div>
                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">

                                        <div class="col-xs-4" style="margin-left: -12px">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">SBP</strong></label>
                                            <input type="number" style="height: 30px;" min="0" max="1000"
                                                placeholder="SBP" id="sbp" name="sbp">
                                        </div>

                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">DBP</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;" id="DBP"
                                                name="dbp" placeholder="DBP" min="0" max="1000">
                                        </div>

                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">Temperature</strong></label>
                                            <input type="number" style="height: 30px;width: 85px" min="0" max="1000"
                                                placeholder="Temp.(F)" id="temperature" name="temperature"
                                                value="<?php echo $row['temperature'] ?>" maxlength="10">
                                        </div>


                                    </div>
                                </div>
                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">

                                        <div class="col-xs-4" style="margin-left: -12px">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">Respiratory Rate</strong></label>
                                            <input type="number" style="height: 30px;" min="0" max="1000"
                                                placeholder="Respiratory rate" id="resp_rate" name="resp_rate">
                                        </div>

                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">Heart Rate</strong></label>
                                            <input type="number" style="height: 30px;" id="heart_rate" name="heart_rate"
                                                placeholder="Heart Rate(BPM)" min="0" max="200">
                                        </div>

                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">Urine Output</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;width: 85px"
                                                id="urine_output" name="urine_output" placeholder="Urine Output">
                                        </div>


                                    </div>
                                </div>
                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">

                                        <div class="col-xs-4" style="margin-left: -12px">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">FBS</strong></label>
                                            <input type="number" style="height: 30px;" min="0" max="1000"
                                                placeholder="FBS" id="fbs" name="fbs">
                                        </div>

                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">RBS</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;" id="rbs"
                                                name="rbs" placeholder="RBS">
                                        </div>

                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">PPBS</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;width: 85px"
                                                id="ppbs" name="ppbs" placeholder="PPBS">
                                        </div>


                                    </div>
                                </div>
                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">

                                        <div class="col-xs-4" style="margin-left: -12px">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">SPO2</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;"
                                                id="spo2_percent" name="spoc2_percent" placeholder="SPO2"
                                                value="<?php echo $row['spo2_percent'] ?>" maxlength="10">
                                        </div>

                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">AVPU</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;" id="avpu"
                                                name="avpu" placeholder="AVPU" value="<?php echo $row['avpu'] ?>"
                                                maxlength="10">
                                        </div>

                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">TRAMA</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;width: 85px"
                                                id="trama" name="trama" placeholder="Trama"
                                                value="<?php echo $row['trama'] ?>" maxlength="10">
                                        </div>




                                    </div>
                                </div>
                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">



                                        <div class="col-xs-4" style="margin-left: -12px">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 9px">oxygen supplementation</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;"
                                                id="oxygen_supply" name="oxygen_supply"
                                                placeholder="Oxygen supplementation"
                                                value="<?php echo $row['oxygen_supply'] ?>" maxlength="10">
                                        </div>

                                        <div class="col-xs-4">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 9px">glasgow coma scale</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;"
                                                id="glasgow_coma_scale" name="glasgow_coma_scale"
                                                placeholder="Glasgow coma scale"
                                                value="<?php echo $row['glasgow_coma_scale'] ?>" maxlength="10">
                                        </div>

                                        <div class="col-xs-4">
                                            <br>
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 9px">Mobility</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 31px;width: 85px"
                                                id="mobility" name="mobility" placeholder="Mobility"
                                                value="<?php echo $row['mobility'] ?>" maxlength="10">
                                        </div>




                                    </div>
                                </div>


                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">
                                        <div class="col-xs-4" style="margin-left: -12px">
                                            <label class="control-label" for="form-field-select-1"><strong
                                                    style="font-size: 11px">Total Cholesterol</strong></label>
                                            <input type="number" min="0" max="1000" style="height: 30px;"
                                                id="total_cholesterol" name="total_cholesterol"
                                                placeholder="Cholesterol"
                                                value="<?php echo $row['total_cholesterol'] ?>" maxlength="10">
                                        </div>
                                    </div>
                                </div>
                                <?php


                                // echo "equality:"	($rolecode != "RCP");
                                if ($_SESSION['RoleCode'] != $_SESSION['RoleCode']) {
                                ?>
                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">
                                        <label class="control-label" for="injury_part"><strong
                                                style="font-size: 11px">Affected Body Parts</strong></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>
                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">
                                        <label class="control-label" for="health_advice_name"><strong
                                                style="font-size: 11px">Health Advices</strong></label> <select
                                            multiple="" class="chosen-select form-control" id="health_advice_name"
                                            name="health_advice_name[]" data-placeholder="Health Advices..">
                                            <?php echo generateOption('health_advice', 'health_advice_name', 'health_advice_id', '', ''); ?>
                                        </select>
                                    </div>
                                </div>
                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">
                                        <label class="control-label" for="additional_advices"><strong
                                                style="font-size:11px"> Recommended Tests For Checkup</strong></label>
                                        <select multiple="" class="chosen-select form-control" id="recommended_test"
                                            name="recommended_test[]" data-placeholder="Doctor Recommended Tests..">
                                            <?php echo generateOptionForMultiple('checkup_form_section', 'section_name', 'section_id', $row['tests'], ''); ?>
                                        </select>
                                    </div>
                                </div>
                                <div class="space-6"></div>
                                <div class="row">
                                    <div class="col-sm-12">
                                        <label class="control-label" for="additional_advices"><strong
                                                style="font-size: 11px">Additional Precautions</strong></label>
                                        <textarea name="remarks" placeholder="Additional Precautions.." rows="3"
                                            cols="8" id="remarks" class="autosize-transition form-control"
                                            style="overflow: hidden; overflow-wrap: break-word;"></textarea>

                                    </div>
                                </div>
                                <?php  } ?>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    </div>
</form>

<form id="pdfform" target="_blank">
    <input type="hidden" id="appointment_id_pdf" name="appointment_id_pdf">
</form>
<script>
$(document).ready(function() {

    $("#hide").hide();
});

function itemLevelTotol(treatment_item_qtygvn_field, current_rate_field, treatment_item_total_amount_field,
    treatment_item_total_amount_field_div) {
    var count = $("#count_treatment_item").val();
    //alert(count);
    var price = $("#" + current_rate_field).val();
    var qty = $("#" + treatment_item_qtygvn_field).val();
    var totalValue = price * qty;
    ///alert(totalValue);
    $("#" + treatment_item_total_amount_field).val(totalValue);
    document.getElementById(treatment_item_total_amount_field_div + "").innerText = totalValue;

    orderLevelTotal(count);
}

function orderLevelTotal(count) {
    var totalAmount = 0;
    //totalAmount=totalAmount+parseInt(treatment_item_total_amount_field_value);
    for (var i = 0; i < count; i++) {
        if ($("#treatment_item_total_amount_" + i).val() == "" || $("#treatment_item_total_amount_" + i).val() ==
            null) {
            $("#treatment_item_total_amount_" + i).val(0);
        }
        totalAmount = totalAmount + parseInt($("#treatment_item_total_amount_" + i).val());
    }

    //alert(totalAmount);
    $("#order_level_total").val(totalAmount);

    document.getElementById("order_level_total_div").innerText = totalAmount;



}

function getBMI(height, weight) {
    //var height=$("#"+heightField).val();
    //var weight=$("#"+WeightField).val();
    if (height != null && height != '' && weight != null && weight != '') {
        height = parseFloat(height);
        weight = parseFloat(weight);
        if (height != 0.0)
            var bmi = (weight / (height / 100 * height / 100));
        return bmi.toFixed(1);
    }
    return "";
}

function calculateBMI() {
    var height = $("#height").val();
    var weight = $("#weight").val();
    $("#bmi").val(getBMI(height, weight));
}

function save_appointment() {
    // var comp= $("#complaints").val();
    // alert(comp)
    $.ajax({
        url: 'save_opd.php',
        type: "POST",
        data: $("#opd_form").serialize(),
        success: function(data) {
            var data = $.parseJSON(data);
            //alert(data);
            if ($("#appointment_id").val() == "") {
                var history_record = $("#history_record").text();

                $('#history_record').text(parseInt(history_record) + 1);
            }
            if (data[0].appointment_id != null) {
                $("#appointment_id").val(data[0].appointment_id);
                $("#appointment_id_pdf").val(data[0].appointment_id);
            }
            if (data[1] != null && data[1] != "") {
                for (var i = 0; i < data[1].length; i++) {
                    $("#treatment_id_" + i).val(data[1][i]);
                }

            }
            $('#flex1').flexReload();
            BootstrapDialog.alert('Details Saved Successfully.');



            //loadAppointmentHistory('<?php echo $_REQUEST['flex_opd_id'] ?>');
            //return;
        },
        error: function(data) {
            BootstrapDialog.alert('Error Saving Details');
            //return;
        }
    });
}

function getFrequenceyQty(frequency_id, qty_value_field_id, dosage_desc_field_id, appointment_id, counter) {

    $.ajax({
        url: 'select_frequency.php?frequency_id=' + frequency_id,
        type: "GET",
        //data : $("#"+formId).serialize(),
        async: false,
        success: function(data) {
            var data = $.parseJSON(data);
            //alert(data);
            if (data.qty != null) {
                $("#" + qty_value_field_id).val(data.qty);
                $("#" + dosage_desc_field_id).val(data.frequency_description);

            }

            //BootstrapDialog.alert('Injury Details Updated Successfully.');
            //location.reload();
            //return;
        },
        error: function(data) {
            BootstrapDialog.alert('Error pulling frequency qty');
            return;
        }

    });
    updateTotalMedicineQty('frequency_qty' + '_' + counter, 'treatment_item_days' + '_' + counter,
        'treatment_item_total' + '_' + counter, 'treatment_item_total_div' + counter)
}

function setFieldDisableOrEnable(value) {
    var count = $("#count_treatment_item").val();
    if (value == 'Y') {
        //  $("[name='field07']").prop("disabled", false);
        for (var i = 0; i < count; i++) {
            $("#treatment_item_qtygvn_" + i).prop("disabled", false);
        }
    } else if (value == 'N') {

        for (var i = 0; i < count; i++) {
            $("#treatment_item_qtygvn_" + i).prop("disabled", true);
        }
    }


}

function exporttopdf() {


    document.forms['pdfform'].action = "opd_form_pdf.php";
    document.forms['pdfform'].method = "post";
    document.forms['pdfform'].submit();
}

function add_diagnosis() {
    //$("#aligment-model").model("show");
    $("#ailment_id").val("");
    $("#ailment_name").val("");
    $("#ailment_description").val("");
    $("#ailment_code").val("");

    $('#modal-add-ailment').modal({
        show: 'true'
    });

}

function add_Ailment_System() {

    $("#ailment_system_name").val("");
    $("#ailment_system_description").val("");
    $("#ailment_system_code").val("");
    $("#ailment_system_id").val("");




    $('#modal-add-ailment-system').modal({
        show: 'true'
    });

}
addRow('<?php echo $row_history['appointment_id'] ?>');
addRow('<?php echo $row_history['appointment_id'] ?>');
var flag = 0;

function addRow(appointment_id) {
    var counter = $("#count_treatment_item" + appointment_id).val();
    var itemOptions = "<?php echo generateOption('tbl_items', 'item_name', 'item_id', '', ''); ?>";
    var itemDosages =
        "<?php echo generateOption('medicine_frequency', 'medicine_frequency', 'frequency_id', '', ''); ?>";

    var newRow = $("<tr>");
    var cols = "";
    var select_treatment = "";
    select_treatment +=
        "<select class=\"chosen-select form-control\" size=\"5\" onchange=\"getItemDetails(this.value,'current_stock" +
        appointment_id + "_" + counter + "','current_stock" + counter + "','current_rate" + appointment_id + "_" +
        counter + "','current_rate" + counter + "','" + appointment_id + "', '" + counter + "');\" ";
    select_treatment += "id=\"treatment_item" + appointment_id + "_" + counter + "\"name=\"treatment_item" + counter +
        "\"data-placeholder=\"Treatment...\"";
    //select_treatment+="style=\"display: none;\"";
    select_treatment += ">";

    select_treatment += "<option value=\"\">  </option>";
    select_treatment += itemOptions
    select_treatment += "</select>";

    cols += '<td>' + select_treatment + '</td>';
    var select_dosage = "";
    select_dosage += "<select  onchange=\"getFrequenceyQty(this.value,'frequency_qty" + appointment_id + "_" + counter +
        "','dosage" + appointment_id + "_" + counter + "','" + appointment_id + "', '" + counter +
        "');\" class='chosen-select form-control'";
    select_dosage += "id=\"treatment_item_dosage" + appointment_id + "_" + counter + "\"name=\"treatment_item_dosage" +
        counter + "\"data-placeholder=\"Dosage...\"";
    //select_dosage+="style=\"display: none;\"";
    select_dosage += ">";

    select_dosage += "<option value=\"\">  </option>";
    select_dosage += itemDosages
    select_dosage += "</select>";

    cols += '<td>' + select_dosage + '</td>';
    cols += '<td><input type=\"hidden\" name=\"treatment_id' + counter + '" id=\"treatment_id' + '_' + counter +
        '" ><input type="number" style="height:25px;font-size:12px"  class="form-control"id ="treatment_item_days' +
        appointment_id + '_' + counter + '" value="1"  onblur="updateTotalMedicineQty(\'frequency_qty' +
        appointment_id + '_' + counter + '\',\'treatment_item_days' + appointment_id + '_' + counter +
        '\',\'treatment_item_total' + appointment_id + '_' + counter + '\',\'treatment_item_total_div' + counter +
        '\')" name="treatment_item_days' + counter + '"/></td>';
    cols += '<td><div style="text-align:center" id="treatment_item_total_div' + appointment_id + counter +
        '""></div><input type="hidden" style="height:25px;font-size:12px"  class="form-control"id="treatment_item_total' +
        appointment_id + '_' + counter + '" name="treatment_item_total' + counter + '" readonly/></td>';
    cols += '<td><input type="hidden"  name="frequency_qty' + counter + '" id="frequency_qty' + appointment_id + '_' +
        counter + '" /><input type="hidden" name="dosage' + counter + '" id="dosage' + appointment_id + '_' + counter +
        '" /> <div style="text-align:center" id="current_rate' + appointment_id + counter +
        '" "></div><input type="hidden" style="height:25px;font-size:12px"  class="form-control" id="current_rate' +
        appointment_id + '_' + counter + '"  name="current_rate' + counter +
        '" onblur="updatePrice(\'treatment_item_qtygvn' + appointment_id + '_' + counter + '\',\'treatment_item' +
        appointment_id + '_' + counter + '\',\'current_rate' + appointment_id + '_' + counter + '\',\'current_stock' +
        appointment_id + '_' + counter + '\',\'price' + appointment_id + '_' + counter + '\')"  /></td>';
    cols += '<td><div style="text-align:center" id="current_stock' + counter +
        '" ></div><input type="hidden"   style="height:25px;font-size:12px" class="form-control" id="current_stock' +
        appointment_id + '_' + counter + '" name="current_stock' + counter + '"  /></td>';
    cols +=
        '<td><input type="text"   style="height:25px;font-size:12px" class="form-control"  id="treatment_item_qtygvn' +
        appointment_id + '_' + counter + '" name="treatment_item_qtygvn' + counter +
        '"    onchange="itemLevelTotol(\'treatment_item_qtygvn' + appointment_id + '_' + counter + '\',\'current_rate' +
        appointment_id + '_' + counter + '\',\'treatment_item_total_amount' + appointment_id + '_' + counter +
        '\',\'treatment_item_total_amount' + counter + '\');checkQty()"  /></td>';

    cols += '<td><div style="text-align:center" id="treatment_item_total_amount' + counter +
        '"></div><input type="hidden"  style="height:25px;font-size:12px" class="form-control" id="treatment_item_total_amount' +
        appointment_id + '_' + counter + '" name="treatment_item_total_amount' + counter + '"/></td>';
    cols += '<td><a href="#"><i class="ace-icon fa fa-trash-o bigger-130"></i></a></td>';
    newRow.append(cols);

    $("#treatmentTable" + appointment_id).append(newRow);
    if (parseInt(counter) > 2) {
        // $('.chosen-select').chosen({allow_single_deselect:true}); 
        //$('.chosen-select').next().css({'width': $('#treatment_item'+counter).parent().width()});
        $('#treatment_item_dosage' + "_" + counter).chosen({
            allow_single_deselect: true
        });
        $('#treatment_item_dosage' + "_" + counter).next().css({
            'width': '100%'
        });

        $('#treatment_item' + "_" + counter).chosen({
            allow_single_deselect: true
        });
        $('#treatment_item' + "_" + counter).next().css({
            'width': '100%'
        });

    }
    if (parseInt($("#count_treatment_item_new").val()) > parseInt($("#count_treatment_item").val())) {
        $('#treatment_item_dosage' + "_" + counter).chosen({
            allow_single_deselect: true
        });
        $('#treatment_item_dosage' + "_" + counter).next().css({
            'width': '100%'
        });

        $('#treatment_item' + "_" + counter).chosen({
            allow_single_deselect: true
        });
        $('#treatment_item' + "_" + counter).next().css({
            'width': '100%'
        });
        flag = 1;
    } else if (flag == 1 && parseInt(counter) == 2) {
        $('#treatment_item_dosage' + "_" + counter).chosen({
            allow_single_deselect: true
        });
        $('#treatment_item_dosage' + "_" + counter).next().css({
            'width': '100%'
        });

        $('#treatment_item' + "_" + counter).chosen({
            allow_single_deselect: true
        });
        $('#treatment_item' + "_" + counter).next().css({
            'width': '100%'
        });


    }



    counter++;
    $("#count_treatment_item" + appointment_id).val(counter);
    $("#count_treatment_item_new").val(counter);



    $("#treatmentTable" + appointment_id).on("click", ".fa-trash-o", function(event) {
        $(this).closest("tr").remove();
        counter -= 1
        $("#count_treatment_item" + appointment_id).val(counter);
    });

    var valueChecked = $('input[name=medicine_disbursement]:checked').val();

    setFieldDisableOrEnable(valueChecked)
}

function checkQty() {


    var counter = $("#count_treatment_item").val();
    for (var i = 0; i < counter; i++) {
        var treatment_qty = $("#treatment_item_total_" + i).val();
        var issued_qty = $("#treatment_item_qtygvn_" + i).val();
        if (issued_qty == null || issued_qty == '') {
            issued_qty = 0;
        }
        if (issued_qty > treatment_qty) {
            BootstrapDialog.alert(' Issue Qty should be less than or equal to Treatment Qty .!!!');

            return false;
        }
    }

}


function ailment_validate() {
    var ailment_name = $('#ailment_name').val();
    if (ailment_name == '') {
        BootstrapDialog.alert('Please Enter Ailment Name.!!!');
        return false;
    }
    var ailment_desc = $('#ailment_description').val();
    if (ailment_desc == '') {
        BootstrapDialog.alert('Please Enter Ailment Description.!!!');
        return false;
    }
    var ailment_code = $('#ailment_code').val();
    if (ailment_code == '') {
        BootstrapDialog.alert('Please Enter Ailment Code.!!!');
        return false;
    }
    save_ailment();
}

function save_ailment() {

    $.ajax({
        url: 'save_ailment.php',
        type: "POST",
        data: $("#ailment_form").serialize(),
        success: function(data) {
            var data = $.parseJSON(data);
            BootstrapDialog.alert('Ailment Saved Successfully.');
            var content = "<option value=" + data.ailment_id + ">" + data.ailment_name + "</option>"

            $("#ailment").append(content);


            $('#ailment').trigger('chosen:updated');




        },
        error: function(data) {
            BootstrapDialog.alert('Error Saving ailment');
            return;
        }
    });
    //  $("#hide").show();
    $('.close').click();

}

function ailment_system_save() {

    $.ajax({
        url: 'save_ailment_system.php? ',
        type: "POST",
        data: $("#ailment_system_form").serialize(),
        success: function(data) {
            var data = $.parseJSON(data);
            BootstrapDialog.alert('Ailment System Saved Successfully.');
            var content = "<option value=" + data.ailment_sys_id + ">" + data.ailment_sys_name + "</option>"

            $("#ailment_system").append(content);


            $('#ailment_system').trigger('chosen:updated');
        },
        error: function(data) {
            BootstrapDialog.alert('Error Saving Ailment System');
            return;
        }
    });
    $('.close').click();
}

function ailment_system_validate() {
    var ailment_name = $('#ailment_system_name').val();
    if (ailment_name == '') {
        BootstrapDialog.alert('Please Enter Ailment Name.!!!');
        return false;
    }
    var ailment_desc = $('#ailment_system_description').val();
    if (ailment_desc == '') {
        BootstrapDialog.alert('Please Enter Ailment Description.!!!');
        return false;
    }
    var ailment_code = $('#ailment_system_code').val();
    if (ailment_code == '') {
        BootstrapDialog.alert('Please Enter Ailment Code.!!!');
        return false;
    }
    ailment_system_save();
}
</script>

<div class="modal fade" id="modal-add-ailment" name="modal-add-ailment" role="dialog" aria-hidden="true">
    <form role="form" id="ailment_form" name="ailment_form" action="#" method="post">
        <div class="modal-dialog">
            <div class="modal-content">
                <div class="modal-header">
                    <button type="button" class="close" data-dismiss="modal">&times;</button>
                    <h4 class="modal-title">Add Ailment</h4>
                </div>

                <div class="modal-body">

                    <div class="row">
                        <div class="col-sm-6">
                            <div class="form-group">
                                <label for="role">Ailment Name</label> <input type="hidden" class="form-control"
                                    name="ailment_id" id="ailment_id" value="" required /> <input type="text"
                                    autofocus="autofocus" class="form-control" name="ailment_name" id="ailment_name"
                                    placeholder="Enter Ailment Name" required />
                            </div>
                        </div>
                        <div class="col-sm-6">
                            <div class="form-group">
                                <label for="ailment">Ailment Description</label> <input type="text" class="form-control"
                                    name="ailment_description" id="ailment_description"
                                    placeholder="Enter Ailment Description" required />
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-sm-6">
                            <div class="form-group">
                                <label for="ailment">Ailment code</label> <input type="text" class="form-control"
                                    name="ailment_code" id="ailment_code" placeholder="Enter Ailment code" required />
                            </div>
                        </div>
                    </div>
                </div>
                <div class="modal-footer">
                    <button type="button" class="btn btn-info btn-sm save_button" onclick="ailment_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>

<div class="modal fade" id="modal-add-ailment-system" name="modal-add-ailment-system" role="dialog" aria-hidden="true">
    <form role="form" id="ailment_system_form" name="ailment_system_form" action="#" method="post">
        <div class="modal-dialog">
            <div class="modal-content">
                <div class="modal-header">
                    <button type="button" class="close" data-dismiss="modal">&times;</button>
                    <h4 class="modal-title">Add Ailment System</h4>
                </div>

                <div class="modal-body">
                    <div class="row">
                        <div class="col-sm-6">
                            <div class="form-group">
                                <label for="role">Ailment System Name</label> <input type="hidden"
                                    id="ailment_system_id" name="ailment_system_id" vaule="" /> <input type="text"
                                    autofocus="autofocus" class="form-control" name="ailment_system_name"
                                    id="ailment_system_name" placeholder="Enter ailment Name" required />
                            </div>
                        </div>
                        <div class="col-sm-6">
                            <div class="form-group">
                                <label for="ailment">Ailment System Description</label> <input type="text"
                                    class="form-control" name="ailment_system_description"
                                    id="ailment_system_description" placeholder="Enter Ailment Description" required />
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-sm-6">
                            <div class="form-group">
                                <label for="ailment">Ailment System Code</label> <input type="text" class="form-control"
                                    name="ailment_system_code" id="ailment_system_code" placeholder="Enter Ailment Code"
                                    required />
                            </div>
                        </div>
                    </div>
                </div>
                <div class="modal-footer">
                    <button type="button" class="btn btn-info btn-sm save_button" onclick="ailment_system_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>
jQuery(function($) {
    //alert("rolecode:<?php echo $_SESSION['RoleCode'] ?>");
    <?php
        if ($_SESSION['RoleCode'] == $_SESSION['RoleCode']) {    ?>
    $("#forwardButton").on("click", function() {

        BootstrapDialog.show({
            // type: BootstrapDialog.TYPE_DEFAULT,
            title: 'Save & Forward',

            message: '<select class="form-control"  id="forward_status" >' +
                '<option value="<?php echo $__STATUS_PHARMACY_PENDING ?>">Forward To Dispensary</option>' +
                '<option value="<?php echo $__STATUS_DOCTOR_PENDING ?>">Forward To Doctor</option>' +
                '</select>',

            buttons: [{
                label: 'Save & Submit',
                icon: 'fa fa-save',
                cssClass: 'btn-info',
                action: function() {
                    $("#attendedStatus").val($("#forward_status").val());
                    validate($("#forward_status").val())
                    $(".close").click();
                }
            }]
        });
    });
    <?php  } else { ?>
    validate($("#forward_status").val())
    <?php  } ?>


    $('#id-disable-check').on('click', function() {
        var inp = $('#form-input-readonly').get(0);
        if (inp.hasAttribute('disabled')) {
            inp.setAttribute('readonly', 'true');
            inp.removeAttribute('disabled');
            inp.value = "This text field is readonly!";
        } else {
            inp.setAttribute('disabled', 'disabled');
            inp.removeAttribute('readonly');
            inp.value = "This text field is disabled!";
        }
    });


    if (!ace.vars['touch']) {
        $('.chosen-select').chosen({
            allow_single_deselect: true
        });
        //resize the chosen on window resize

        $(window)
            .off('resize.chosen')
            .on('resize.chosen', function() {
                $('.chosen-select').each(function() {
                    var $this = $(this);
                    $this.next().css({
                        'width': $this.parent().width()
                    });
                })
            }).trigger('resize.chosen');
        //resize chosen on sidebar collapse/expand
        $(document).on('settings.ace.chosen', function(e, event_name, event_val) {
            if (event_name != 'sidebar_collapsed') return;
            $('.chosen-select').each(function() {
                var $this = $(this);
                $this.next().css({
                    'width': $this.parent().width()
                });
            })
        });


        $('#chosen-multiple-style .btn').on('click', function(e) {
            var target = $(this).find('input[type=radio]');
            var which = parseInt(target.val());
            if (which == 2) $('#form-field-select-4').addClass('tag-input-style');
            else $('#form-field-select-4').removeClass('tag-input-style');
        });
    }


    $('[data-rel=tooltip]').tooltip({
        container: 'body'
    });
    $('[data-rel=popover]').popover({
        container: 'body'
    });

    autosize($('textarea[class*=autosize]'));

    $('textarea.limited').inputlimiter({
        remText: '%n character%s remaining...',
        limitText: 'max allowed : %n.'
    });

    $.mask.definitions['~'] = '[+-]';
    $('.input-mask-date').mask('99/99/9999');
    $('.input-mask-phone').mask('(999) 999-9999');
    $('.input-mask-eyescript').mask('~9.99 ~9.99 999');
    $(".input-mask-product").mask("a*-999-a999", {
        placeholder: " ",
        completed: function() {
            alert("You typed the following: " + this.val());
        }
    });



    $("#input-size-slider").css('width', '200px').slider({
        value: 1,
        range: "min",
        min: 1,
        max: 8,
        step: 1,
        slide: function(event, ui) {
            var sizing = ['', 'input-sm', 'input-lg', 'input-mini', 'input-small', 'input-medium',
                'input-large', 'input-xlarge', 'input-xxlarge'
            ];
            var val = parseInt(ui.value);
            $('#form-field-4').attr('class', sizing[val]).attr('placeholder', '.' + sizing[val]);
        }
    });

    $("#input-span-slider").slider({
        value: 1,
        range: "min",
        min: 1,
        max: 12,
        step: 1,
        slide: function(event, ui) {
            var val = parseInt(ui.value);
            $('#form-field-5').attr('class', 'col-xs-' + val).val('.col-xs-' + val);
        }
    });



    //"jQuery UI Slider"
    //range slider tooltip example
    $("#slider-range").css('height', '200px').slider({
        orientation: "vertical",
        range: true,
        min: 0,
        max: 100,
        values: [17, 67],
        slide: function(event, ui) {
            var val = ui.values[$(ui.handle).index() - 1] + "";

            if (!ui.handle.firstChild) {
                $("<div class='tooltip right in' style='display:none;left:16px;top:-6px;'><div class='tooltip-arrow'></div><div class='tooltip-inner'></div></div>")
                    .prependTo(ui.handle);
            }
            $(ui.handle.firstChild).show().children().eq(1).text(val);
        }
    }).find('span.ui-slider-handle').on('blur', function() {
        $(this.firstChild).hide();
    });


    $("#slider-range-max").slider({
        range: "max",
        min: 1,
        max: 10,
        value: 2
    });

    $("#slider-eq > span").css({
        width: '90%',
        'float': 'left',
        margin: '15px'
    }).each(function() {
        // read initial values from markup and remove that
        var value = parseInt($(this).text(), 10);
        $(this).empty().slider({
            value: value,
            range: "min",
            animate: true

        });
    });

    $("#slider-eq > span.ui-slider-purple").slider('disable'); //disable third item


    $('#id-input-file-1 , #id-input-file-2').ace_file_input({
        no_file: 'No File ...',
        btn_choose: 'Choose',
        btn_change: 'Change',
        droppable: false,
        onchange: null,
        thumbnail: false //| true | large
        //whitelist:'gif|png|jpg|jpeg'
        //blacklist:'exe|php'
        //onchange:''
        //
    });
    //pre-show a file name, for example a previously selected file
    //$('#id-input-file-1').ace_file_input('show_file_list', ['myfile.txt'])


    $('#id-input-file-3').ace_file_input({
        style: 'well',
        btn_choose: 'Drop files here or click to choose',
        btn_change: null,
        no_icon: 'ace-icon fa fa-cloud-upload',
        droppable: true,
        thumbnail: 'small' //large | fit
            //,icon_remove:null//set null, to hide remove/reset button
            /**,before_change:function(files, dropped) {
            	//Check an example below
            	//or examples/file-upload.html
            	return true;
            }*/
            /**,before_remove : function() {
            	return true;
            }*/
            ,
        preview_error: function(filename, error_code) {
            //name of the file that failed
            //error_code values
            //1 = 'FILE_LOAD_FAILED',
            //2 = 'IMAGE_LOAD_FAILED',
            //3 = 'THUMBNAIL_FAILED'
            //alert(error_code);
        }

    }).on('change', function() {
        //console.log($(this).data('ace_input_files'));
        //console.log($(this).data('ace_input_method'));
    });


    //$('#id-input-file-3')
    //.ace_file_input('show_file_list', [
    //{type: 'image', name: 'name of image', path: 'http://path/to/image/for/preview'},
    //{type: 'file', name: 'hello.txt'}
    //]);




    //dynamically change allowed formats by changing allowExt && allowMime function
    $('#id-file-format').removeAttr('checked').on('change', function() {
        var whitelist_ext, whitelist_mime;
        var btn_choose
        var no_icon
        if (this.checked) {
            btn_choose = "Drop images here or click to choose";
            no_icon = "ace-icon fa fa-picture-o";

            whitelist_ext = ["jpeg", "jpg", "png", "gif", "bmp"];
            whitelist_mime = ["image/jpg", "image/jpeg", "image/png", "image/gif", "image/bmp"];
        } else {
            btn_choose = "Drop files here or click to choose";
            no_icon = "ace-icon fa fa-cloud-upload";

            whitelist_ext = null; //all extensions are acceptable
            whitelist_mime = null; //all mimes are acceptable
        }
        var file_input = $('#id-input-file-3');
        file_input
            .ace_file_input('update_settings', {
                'btn_choose': btn_choose,
                'no_icon': no_icon,
                'allowExt': whitelist_ext,
                'allowMime': whitelist_mime
            })
        file_input.ace_file_input('reset_input');

        file_input
            .off('file.error.ace')
            .on('file.error.ace', function(e, info) {
                //console.log(info.file_count);//number of selected files
                //console.log(info.invalid_count);//number of invalid files
                //console.log(info.error_list);//a list of errors in the following format

                //info.error_count['ext']
                //info.error_count['mime']
                //info.error_count['size']

                //info.error_list['ext']  = [list of file names with invalid extension]
                //info.error_list['mime'] = [list of file names with invalid mimetype]
                //info.error_list['size'] = [list of file names with invalid size]


                /**
                if( !info.dropped ) {
                	//perhapse reset file field if files have been selected, and there are invalid files among them
                	//when files are dropped, only valid files will be added to our file array
                	e.preventDefault();//it will rest input
                }
                */


                //if files have been selected (not dropped), you can choose to reset input
                //because browser keeps all selected files anyway and this cannot be changed
                //we can only reset file field to become empty again
                //on any case you still should check files with your server side script
                //because any arbitrary file can be uploaded by user and it's not safe to rely on browser-side measures
            });


        /**
        file_input
        .off('file.preview.ace')
        .on('file.preview.ace', function(e, info) {
        	console.log(info.file.width);
        	console.log(info.file.height);
        	e.preventDefault();//to prevent preview
        });
        */

    });

    $('#spinner1').ace_spinner({
            value: 0,
            min: 0,
            max: 200,
            step: 10,
            btn_up_class: 'btn-info',
            btn_down_class: 'btn-info'
        })
        .closest('.ace-spinner')
        .on('changed.fu.spinbox', function() {
            //console.log($('#spinner1').val())
        });
    $('#spinner2').ace_spinner({
        value: 0,
        min: 0,
        max: 10000,
        step: 100,
        touch_spinner: true,
        icon_up: 'ace-icon fa fa-caret-up bigger-110',
        icon_down: 'ace-icon fa fa-caret-down bigger-110'
    });
    $('#spinner3').ace_spinner({
        value: 0,
        min: -100,
        max: 100,
        step: 10,
        on_sides: true,
        icon_up: 'ace-icon fa fa-plus bigger-110',
        icon_down: 'ace-icon fa fa-minus bigger-110',
        btn_up_class: 'btn-success',
        btn_down_class: 'btn-danger'
    });
    $('#spinner4').ace_spinner({
        value: 0,
        min: -100,
        max: 100,
        step: 10,
        on_sides: true,
        icon_up: 'ace-icon fa fa-plus',
        icon_down: 'ace-icon fa fa-minus',
        btn_up_class: 'btn-purple',
        btn_down_class: 'btn-purple'
    });

    //$('#spinner1').ace_spinner('disable').ace_spinner('value', 11);
    //or
    //$('#spinner1').closest('.ace-spinner').spinner('disable').spinner('enable').spinner('value', 11);//disable, enable or change value
    //$('#spinner1').closest('.ace-spinner').spinner('value', 0);//reset to 0


    //datepicker plugin
    //link
    $('.date-picker').datepicker({
            autoclose: true,
            todayHighlight: true
        })
        //show datepicker when clicking on the icon
        .next().on(ace.click_event, function() {
            $(this).prev().focus();
        });

    //or change it into a date range picker
    $('.input-daterange').datepicker({
        autoclose: true
    });


    //to translate the daterange picker, please copy the "examples/daterange-fr.js" contents here before initialization
    $('input[name=date-range-picker]').daterangepicker({
            'applyClass': 'btn-sm btn-success',
            'cancelClass': 'btn-sm btn-default',
            locale: {
                applyLabel: 'Apply',
                cancelLabel: 'Cancel',
            }
        })
        .prev().on(ace.click_event, function() {
            $(this).next().focus();
        });


    $('#timepicker1').timepicker({
        minuteStep: 1,
        showSeconds: true,
        showMeridian: false,
        disableFocus: true,
        icons: {
            up: 'fa fa-chevron-up',
            down: 'fa fa-chevron-down'
        }
    }).on('focus', function() {
        $('#timepicker1').timepicker('showWidget');
    }).next().on(ace.click_event, function() {
        $(this).prev().focus();
    });




    if (!ace.vars['old_ie']) $('#appointment_date').datetimepicker({
        format: 'DD/MM/YYYY h:mm A', //use this option to display seconds
        defaultDate: new Date(),
        maxDate: new Date(),
        icons: {
            time: 'fa fa-clock-o',
            date: 'fa fa-calendar',
            up: 'fa fa-chevron-up',
            down: 'fa fa-chevron-down',
            previous: 'fa fa-chevron-left',
            next: 'fa fa-chevron-right',
            today: 'fa fa-arrows ',
            clear: 'fa fa-trash',
            close: 'fa fa-times'
        }
    }).next().on(ace.click_event, function() {
        $(this).prev().focus();
    });

    if (!ace.vars['old_ie']) $('#out_time').datetimepicker({
        format: 'DD/MM/YYYY h:mm A', //use this option to display seconds
        // defaultDate: new Date(),
        maxDate: new Date(),
        icons: {
            time: 'fa fa-clock-o',
            date: 'fa fa-calendar',
            up: 'fa fa-chevron-up',
            down: 'fa fa-chevron-down',
            previous: 'fa fa-chevron-left',
            next: 'fa fa-chevron-right',
            today: 'fa fa-arrows ',
            clear: 'fa fa-trash',
            close: 'fa fa-times'
        }
    }).next().on(ace.click_event, function() {
        $(this).prev().focus();
    });


    $('#colorpicker1').colorpicker();
    //$('.colorpicker').last().css('z-index', 2000);//if colorpicker is inside a modal, its z-index should be higher than modal'safe

    $('#simple-colorpicker-1').ace_colorpicker();
    //$('#simple-colorpicker-1').ace_colorpicker('pick', 2);//select 2nd color
    //$('#simple-colorpicker-1').ace_colorpicker('pick', '#fbe983');//select #fbe983 color
    //var picker = $('#simple-colorpicker-1').data('ace_colorpicker')
    //picker.pick('red', true);//insert the color if it doesn't exist


    $(".knob").knob();


    var tag_input = $('#form-field-tags');
    try {
        tag_input.tag({
            placeholder: tag_input.attr('placeholder'),
            //enable typeahead by specifying the source array
            source: ailments, //defined in ace.js >> ace.enable_search_ahead
            /**
            //or fetch data from database, fetch those that match "query"
            source: function(query, process) {
              $.ajax({url: 'remote_source.php?q='+encodeURIComponent(query)})
              .done(function(result_items){
            	process(result_items);
              });
            }
            */
        })

        //programmatically add/remove a tag
        var $tag_obj = $('#form-field-tags').data('tag');
        $tag_obj.add('Programmatically Added');

        var index = $tag_obj.inValues('some tag');
        $tag_obj.remove(index);
    } catch (e) {
        //display a textarea for old IE, because it doesn't support this plugin or another one I tried!
        tag_input.after('<textarea id="' + tag_input.attr('id') + '" name="' + tag_input.attr('name') +
            '" rows="3">' + tag_input.val() + '</textarea>').remove();
        //autosize($('#form-field-tags'));
    }


    /////////
    $('#modal-form input[type=file]').ace_file_input({
        style: 'well',
        btn_choose: 'Drop files here or click to choose',
        btn_change: null,
        no_icon: 'ace-icon fa fa-cloud-upload',
        droppable: true,
        thumbnail: 'large'
    })

    //chosen plugin inside a modal will have a zero width because the select element is originally hidden
    //and its width cannot be determined.
    //so we set the width after modal is show
    $('#modal-form').on('shown.bs.modal', function() {
        if (!ace.vars['touch']) {
            $(this).find('.chosen-container').each(function() {
                $(this).find('a:first-child').css('width', '210px');
                $(this).find('.chosen-drop').css('width', '210px');
                $(this).find('.chosen-search input').css('width', '200px');
            });
        }
    })
    /**
    //or you can activate the chosen plugin after modal is shown
    //this way select element becomes visible with dimensions and chosen works as expected
    $('#modal-form').on('shown', function () {
    	$(this).find('.modal-chosen').chosen();
    })
    */



    $(document).one('ajaxloadstart.page', function(e) {
        autosize.destroy('textarea[class*=autosize]')

        $('.limiterBox,.autosizejs').remove();
        $('.daterangepicker.dropdown-menu,.colorpicker.dropdown-menu,.bootstrap-datetimepicker-widget.dropdown-menu')
            .remove();
    });

});

<?php if (!strcmp(strtolower($complaint_config), "true")) { ?>

if ($('#complaints')) {

    var complaints = new Array();
    getComplaints();

    function getComplaints() {
        $.ajax({
            url: 'select_complaints.php',
            type: "GET",
            success: function(data) {
                complaints = $.parseJSON(data);

            },
            error: function(data) {
                BootstrapDialog.alert('Error pulling Complaints!!');
                return;
            }
        });
    }
}
<?php  } ?>

<?php if (!strcmp(strtolower($complaint_config), "true")) { ?>

if ($('#complaints')) {
    setTimeout(function() {

        var tag_input_complaints = $('#complaints');
        try {
            tag_input_complaints.tag({
                placeholder: tag_input_complaints.attr('placeholder'),

                source: complaints

            })

            //programmatically add/remove a tag
            var $tag_obj = $('#complaints').data('tag');
            //$tag_obj.add('Programmatically Added');
            var existingComplaints = "<?php echo $row['complaints'] ?>"
            if (existingComplaints != undefined && existingComplaints != null && existingComplaints != '') {
                var existingComplaintsArr = existingComplaints.split(",");
                jQuery.each(existingComplaintsArr, function(i, val) {
                    $tag_obj.add(val.toUpperCase());
                });
            }
            //var index = $tag_obj.inValues('some tag');
            //	$tag_obj.remove(index);
        } catch (e) {
            //display a textarea for old IE, because it doesn't support this plugin or another one I tried!
            tag_input_complaints.after('<textarea id="' + tag_input_complaints.attr('id') + '" name="' +
                tag_input_complaints.attr('name') + '" rows="3">' + tag_input_complaints.val() +
                '</textarea>').remove();
            //autosize($('#form-field-tags'));
        }
        var y = $('#complaints').parents(".col-sm-3").width();
        $('#complaints').siblings().css('width', y - 5);
    }, 2000);
}
<?php } ?>
</script>

<style>
.modal-dialog {
    padding: 15px;
    width: 45%;
}

.form-control {
    height: 30px;
}

.close {
    font-size: 12px;
    font-weight: 900;
}

.input-group-addon {
    padding: unset;
}
</style>