interface/forms/newpatient/view.php

   1 <?
   2 include_once("../../globals.php");
   3
   4 $disabled = "disabled";
   5
   6 // Uncomment this if you want to allow changing encounter dates.
   7 // Eventually this needs to be subject to access control:
   8 //
   9 //$disabled = "";
  10
  11 $months = array("01","02","03","04","05","06","07","08","09","10","11","12");
  12 $days = array("01","02","03","04","05","06","07","08","09","10","11","12","13","14","15","16","17",
  13         "18","19","20","21","22","23","24","25","26","27","28","29","30","31");
  14 $years = array("2004","2005","2006","2007");
  15
  16 $result = sqlQuery("select * from form_encounter where id='$id'");
  17
  18 $enc_year  = substr($result{'date'}, 0, 4);
  19 $enc_month = substr($result{'date'}, 5, 2);
  20 $enc_day   = substr($result{'date'}, 8, 2);
  21 $ons_year  = substr($result{'onset_date'}, 0, 4);
  22 $ons_month = substr($result{'onset_date'}, 5, 2);
  23 $ons_day   = substr($result{'onset_date'}, 8, 2);
  24 ?>
  25
  26 <link rel=stylesheet href="<?echo $css_header;?>" type="text/css">
  27
  28 <html>
  29 <head>
  30 <title>New Patient Encounter</title>
  31
  32 </head>
  33 <body <?echo $top_bg_line;?> topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
  34
  35 <form method=post action="<?echo $rootdir?>/forms/newpatient/save.php" name=new_encounter target=Main>
  36 <input type=hidden name=mode value='update'>
  37 <input type=hidden name=id value='<?echo $_GET["id"];?>'>
  38 <span class=title>New Patient Encounter Form</span>
  39 <br>
  40
  41 <table>
  42
  43 <tr><td><select name='facility'>
  44 <?
  45 $fres = sqlStatement("select * from facility order by name");
  46 if ($fres) {
  47 for ($iter = 0; $frow = sqlFetchArray($fres); $iter++)
  48                 $result[$iter] = $frow;
  49 foreach($result as $iter) {
  50 ?>
  51 <option <?if ($iter{name} == $result{facility}) {echo "selected";};?> value="<?echo $iter{name};?>"><?echo $iter{name};?></option>
  52 <?
  53 }
  54 }
  55 ?>
  56 </select></td><td></td></tr>
  57
  58 <tr><td><span class=text>Chief Complaint:</span></td><td></td></tr>
  59 <tr><td><textarea name=reason cols=40 rows=6 wrap=virtual><?
  60 echo $result{"reason"};
  61 ?></textarea>
  62 </td></td></tr>
  63
  64 <tr><td><span class='text'>Date Of Service:</span></td>
  65 <td><select name='month' <? echo $disabled ?>>
  66 <?
  67 foreach($months as $month){
  68 ?>
  69 <option value="<?echo $month;?>" <?if($month == $enc_month) echo "selected";?>><?echo $month?></option>
  70 <?
  71 }
  72 ?>
  73 </select>
  74 <select name='day' <? echo $disabled ?>>
  75 <?
  76 foreach($days as $day){
  77 ?>
  78 <option value="<?echo $day;?>" <?if($day == $enc_day) echo "selected";?>><?echo $day?></option>
  79 <?
  80 }
  81 ?>
  82 </select>
  83 <select name='year' <? echo $disabled ?>>
  84 <?
  85 foreach($years as $year){
  86 ?>
  87 <option value="<?echo $year;?>" <?if($year == $enc_year) echo "selected";?>><?echo $year?></option>
  88 <?
  89 }
  90 ?>
  91 </select></td></tr>
  92
  93 <tr><td><span class='text'>Date of onset or hospitalization:</span></td>
  94 <td><select name='onset_month'>
  95 <?
  96 foreach($months as $month){
  97 ?>
  98 <option value="<?echo $month;?>" <?if($month == $ons_month) echo "selected";?>><?echo $month?></option>
  99 <?
 100 }
 101 ?>
 102 </select>
 103 <select name='onset_day'>
 104 <?
 105 foreach($days as $day){
 106 ?>
 107 <option value="<?echo $day;?>" <?if($day == $ons_day) echo "selected";?>><?echo $day?></option>
 108 <?
 109 }
 110 ?>
 111 </select>
 112 <select name='onset_year'>
 113 <?
 114 foreach($years as $year){
 115 ?>
 116 <option value="<?echo $year;?>" <?if($year == $ons_year) echo "selected";?>><?echo $year?></option>
 117 <?
 118 }
 119 ?>
 120 </select></td></tr>
 121
 122 </table>
 123
 124 <a href="javascript:document.new_encounter.submit();" class="link_submit">[Save]</a>
 125 &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
 126 <a href="<?echo "$rootdir/patient_file/encounter/patient_encounter.php";?>" class="link" target=Main>[Don't Save Changes]</a>
 127
 128 </form>
 129
 130 </body>
 131 </html>