library/ESign/views/form/esign_form.php

   1 <?php
   2 /**
   3  * Signature form view script for form module
   4  *
   5  * Copyright (C) 2013 OEMR 501c3 www.oemr.org
   6  *
   7  * LICENSE: This program is free software; you can redistribute it and/or
   8  * modify it under the terms of the GNU General Public License
   9  * as published by the Free Software Foundation; either version 3
  10  * of the License, or (at your option) any later version.
  11  * This program is distributed in the hope that it will be useful,
  12  * but WITHOUT ANY WARRANTY; without even the implied warranty of
  13  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
  14  * GNU General Public License for more details.
  15  * You should have received a copy of the GNU General Public License
  16  * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
  17  *
  18  * @package OpenEMR
  19  * @author  Ken Chapple <ken@mi-squared.com>
  20  * @author  Medical Information Integration, LLC
  21  * @link    http://www.open-emr.org
  22  **/
  23 ?>
  24 <div id='esign-form-container'>
  25         <form id='esign-signature-form' method='post' action='<?php echo attr( $this->form->action ); ?>'>
  26
  27         <div class="esign-signature-form-element">
  28                       <span id='esign-signature-form-prompt'><?php echo xlt("Your password is your signature" ); ?></span>
  29                 </div>
  30
  31                 <div class="esign-signature-form-element">
  32                       <label for='password'><?php echo xlt('Password');?></label>
  33                       <input type='password' id='password' name='password' size='10' />
  34                 </div>
  35
  36                 <?php if ( $this->form->showLock ) { ?>
  37                 <div class="esign-signature-form-element">
  38                       <label for='lock'><?php echo xlt('Lock?');?></label>
  39                       <input type="checkbox" id="lock" name="lock" />
  40                 </div>
  41                 <?php } ?>
  42
  43                 <div class="esign-signature-form-element">
  44                       <textarea name='amendment' id='amendment' placeholder='<?php echo xlt("Enter an amendment..."); ?>'></textarea>
  45                 </div>
  46
  47                 <div class="esign-signature-form-element">
  48                       <input type='submit' value='<?php echo xla('Back'); ?>' id='esign-back-button' />
  49                   <input type='button' value='<?php echo xla('Sign'); ?>' id='esign-sign-button-form' />
  50             </div>
  51
  52             <input type='hidden' id='formId' name='formId' value='<?php echo attr( $this->form->formId ); ?>' />
  53                 <input type='hidden' id='table' name='table' value='<?php echo attr( $this->form->table ); ?>' />
  54                 <input type='hidden' id='formDir' name='formDir' value='<?php echo attr( $this->form->formDir ); ?>' />
  55                 <input type='hidden' id='encounterId' name='encounterId' value='<?php echo attr( $this->form->encounterId ); ?>' />
  56                 <input type='hidden' id='userId' name='userId' value='<?php echo attr( $this->form->userId ); ?>' />
  57
  58         </form>
  59 </div>