interface/forms/aftercare_plan/new.php

   1 <?php
   2 /**
   3  *
   4  * Copyright (C) 2012-2013 Naina Mohamed <naina@capminds.com> CapMinds Technologies
   5  *
   6  * LICENSE: This program is free software; you can redistribute it and/or
   7  * modify it under the terms of the GNU General Public License
   8  * as published by the Free Software Foundation; either version 3
   9  * of the License, or (at your option) any later version.
  10  * This program is distributed in the hope that it will be useful,
  11  * but WITHOUT ANY WARRANTY; without even the implied warranty of
  12  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
  13  * GNU General Public License for more details.
  14  * You should have received a copy of the GNU General Public License
  15  * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
  16  *
  17  * @package OpenEMR
  18  * @author  Naina Mohamed <naina@capminds.com>
  19  * @link    http://www.open-emr.org
  20  */
  21
  22
  23 //SANITIZE ALL ESCAPES
  24 $sanitize_all_escapes=true;
  25
  26 //STOP FAKE REGISTER GLOBALS
  27 $fake_register_globals=false;
  28
  29 include_once("../../globals.php");
  30 include_once("$srcdir/api.inc");
  31 require_once("$srcdir/patient.inc");
  32 require_once("$srcdir/options.inc.php");
  33 require_once("$srcdir/htmlspecialchars.inc.php");
  34 formHeader("Form:AfterCare Planning");
  35 $returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
  36 $formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
  37 $obj = $formid ? formFetch("form_aftercare_plan", $formid) : array();
  38
  39 ?>
  40 <html>
  41 <head>
  42 <?php html_header_show();?>
  43 <script type="text/javascript" src="../../../library/dialog.js"></script>
  44 <!-- pop up calendar -->
  45 <style type="text/css">@import url(<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.css);</style>
  46 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.js"></script>
  47 <?php include_once("{$GLOBALS['srcdir']}/dynarch_calendar_en.inc.php"); ?>
  48 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar_setup.js"></script>
  49 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js"></script>
  50 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dialog.js"></script>
  51 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  52 </head>
  53 <body class="body_top">
  54 <p><span class="forms-title"><?php echo xlt('AfterCare Planning'); ?></span></p>
  55 </br>
  56 <?php
  57 echo "<form method='post' name='my_form' " .
  58   "action='$rootdir/forms/aftercare_plan/save.php?id=" . attr($formid) ."'>\n";
  59 ?>
  60 <table  border="0">
  61 <tr>
  62 <td align="left" class="forms" class="forms"><?php echo xlt('Client Name' ); ?>:</td>
  63                 <td class="forms">
  64                         <label class="forms-data"> <?php if (is_numeric($pid)) {
  65
  66     $result = getPatientData($pid, "fname,lname,squad");
  67    echo htmlspecialchars(text($result['fname'])." ".text($result['lname']));}
  68    $patient_name=($result['fname'])." ".($result['lname']);
  69    ?>
  70    </label>
  71    <input type="hidden" name="client_name" value="<?php echo attr($patient_name);?>">
  72                 </td>
  73                 <td align="left"  class="forms"><?php echo xlt('DOB'); ?>:</td>
  74                 <td class="forms">
  75                 <label class="forms-data"> <?php if (is_numeric($pid)) {
  76
  77     $result = getPatientData($pid, "*");
  78    echo htmlspecialchars($result['DOB']);}
  79    $dob=($result['DOB']);
  80    ?>
  81    </label>
  82      <input type="hidden" name="DOB" value="<?php echo attr($dob);?>">
  83                 </td>
  84                 </tr>
  85 <tr>
  86
  87
  88   <td align="left" class="forms"><?php echo xlt('Admit Date'); ?>:</td>
  89                 <td class="forms">
  90                            <input type='text' size='10' name='admit_date' id='admission_date' <?php echo attr($disabled); ?>;
  91                            value='<?php echo attr($obj{"admit_date"}); ?>'
  92                            title='<?php echo xla('yyyy-mm-dd Date of service'); ?>'
  93        onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
  94         <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
  95         id='img_admission_date' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
  96         title='<?php echo xla('Click here to choose a date'); ?>'>
  97                 </td>
  98
  99
 100
 101                 <td align="left" class="forms"><?php echo xlt('Discharged'); ?>:</td>
 102                 <td class="forms">
 103                            <input type='text' size='10' name='discharged' id='discharge_date' <?php echo attr($disabled); ?>;
 104       value='<?php echo attr($obj{"discharged"}); ?>'
 105        title='<?php echo xla('yyyy-mm-dd Date of service'); ?>'
 106        onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
 107         <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 108         id='img_discharge_date' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
 109         title='<?php echo xla('Click here to choose a date'); ?>'>
 110                 </td>
 111         </tr>
 112         <tr>
 113                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 114         </tr>
 115                 <tr>
 116
 117                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal and Methods');?></B></td>
 118
 119         </tr>
 120         <tr>
 121                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 122         </tr>
 123         <tr>
 124
 125                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal A');?>:</B>&nbsp;<?php echo xlt('Acute Intoxication/Withdrawal'); ?></td>
 126
 127         </tr>
 128         <tr>
 129                 <td align="right" class="forms">1.</td>
 130                 <td colspan="3"><textarea name="goal_a_acute_intoxication" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication"});?></textarea></td>
 131
 132         </tr>
 133         <tr>
 134                 <td align="right" class="forms">2.</td>
 135                 <td colspan="3"><textarea name="goal_a_acute_intoxication_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication_I"});?></textarea></td>
 136
 137         </tr>
 138         <tr>
 139                 <td align="right" class="forms">3.</td>
 140                 <td colspan="3"><textarea name="goal_a_acute_intoxication_II" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication_II"});?></textarea></td>
 141
 142
 143         <tr>
 144
 145                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal B');?>:</B>&nbsp;<?php  echo xlt('Emotional / Behavioral Conditions & Complications'); ?></td>
 146
 147         </tr>
 148         <tr>
 149                 <td align="right" class="forms">1.</td>
 150                 <td colspan="3"><textarea name="goal_b_emotional_behavioral_conditions" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_b_emotional_behavioral_conditions"});?></textarea></td>
 151
 152         </tr>
 153         <tr>
 154                 <td align="right" class="forms">2.</td>
 155                 <td colspan="3"><textarea name="goal_b_emotional_behavioral_conditions_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_b_emotional_behavioral_conditions_I"});?></textarea></td>
 156
 157         </tr>
 158
 159
 160                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal C');?>:</B>&nbsp;<?php  echo xlt('Relapse Potential'); ?></td>
 161
 162         </tr>
 163         <tr>
 164                 <td align="right" class="forms">1.</td>
 165                 <td colspan="3"><textarea name="goal_c_relapse_potential" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_c_relapse_potential"});?></textarea></td>
 166
 167         </tr>
 168         <tr>
 169                 <td align="right" class="forms">2.</td>
 170                 <td colspan="3"><textarea name="goal_c_relapse_potential_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_c_relapse_potential_I"});?></textarea></td>
 171
 172         </tr>
 173
 174         <tr>
 175                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 176         </tr>
 177         <tr>
 178                 <td></td>
 179     <td><input type='submit'  value='<?php echo xlt('Save');?>' class="button-css">&nbsp;
 180 <input type='button'  value="Print" onclick="window.print()" class="button-css">&nbsp;
 181         <input type='button' class="button-css" value='<?php echo xlt('Cancel');?>'
 182  onclick="top.restoreSession();location='<?php echo "$rootdir/patient_file/encounter/$returnurl" ?>'" /></td>
 183         </tr>
 184 </table>
 185 </form>
 186 <script language="javascript">
 187 /* required for popup calendar */
 188 Calendar.setup({inputField:"admission_date", ifFormat:"%Y-%m-%d", button:"img_admission_date"});
 189 Calendar.setup({inputField:"discharge_date", ifFormat:"%Y-%m-%d", button:"img_discharge_date"});
 190 </script>
 191 <?php
 192 formFooter();
 193 ?>