interface/new/new.php

   1 <?php
   2 include_once("../globals.php");
   3
   4 if ($GLOBALS['full_new_patient_form']) {
   5   require("new_comprehensive.php");
   6   exit;
   7 }
   8
   9 // For a layout field return 0=unused, 1=optional, 2=mandatory.
  10 function getLayoutUOR($form_id, $field_id) {
  11   $crow = sqlQuery("SELECT uor FROM layout_options WHERE " .
  12     "form_id = '$form_id' AND field_id = '$field_id' LIMIT 1");
  13   return 0 + $crow['uor'];
  14 }
  15
  16 // Determine if the registration date should be requested.
  17 $regstyle = getLayoutUOR('DEM','regdate') ? "" : " style='display:none'";
  18
  19 $form_pubpid    = $_POST['pubpid'   ] ? trim($_POST['pubpid'   ]) : '';
  20 $form_title     = $_POST['title'    ] ? trim($_POST['title'    ]) : '';
  21 $form_fname     = $_POST['fname'    ] ? trim($_POST['fname'    ]) : '';
  22 $form_mname     = $_POST['mname'    ] ? trim($_POST['mname'    ]) : '';
  23 $form_lname     = $_POST['lname'    ] ? trim($_POST['lname'    ]) : '';
  24 $form_refsource = $_POST['refsource'] ? trim($_POST['refsource']) : '';
  25 $form_sex       = $_POST['sex'      ] ? trim($_POST['sex'      ]) : '';
  26 $form_refsource = $_POST['refsource'] ? trim($_POST['refsource']) : '';
  27 $form_dob       = $_POST['DOB'      ] ? trim($_POST['DOB'      ]) : '';
  28 $form_regdate   = $_POST['regdate'  ] ? trim($_POST['regdate'  ]) : date('Y-m-d');
  29 ?>
  30 <html>
  31
  32 <head>
  33 <?php html_header_show(); ?>
  34 <link rel="stylesheet" href="<?php echo xl($css_header,'e');?>" type="text/css">
  35 <style type="text/css">@import url(../../library/dynarch_calendar.css);</style>
  36
  37 <script type="text/javascript" src="../../library/textformat.js"></script>
  38 <script type="text/javascript" src="../../library/dynarch_calendar.js"></script>
  39 <?php include_once("{$GLOBALS['srcdir']}/dynarch_calendar_en.inc.php"); ?>
  40 <script type="text/javascript" src="../../library/dynarch_calendar_setup.js"></script>
  41 <?php include_once("{$GLOBALS['srcdir']}/options.js.php"); ?>
  42
  43 <script LANGUAGE="JavaScript">
  44
  45  var mypcc = '1';
  46
  47  function validate() {
  48   var f = document.forms[0];
  49 <?php if ($GLOBALS['inhouse_pharmacy']) { ?>
  50   if (f.refsource.selectedIndex <= 0) {
  51    alert('Please select a referral source!');
  52    return false;
  53   }
  54 <?php } ?>
  55 <?php if (getLayoutUOR('DEM','sex') == 2) { ?>
  56   if (f.sex.selectedIndex <= 0) {
  57    alert('Please select a value for sex!');
  58    return false;
  59   }
  60 <?php } ?>
  61 <?php if (getLayoutUOR('DEM','DOB') == 2) { ?>
  62   if (f.DOB.value.length == 0) {
  63    alert('Please select a birth date!');
  64    return false;
  65   }
  66 <?php } ?>
  67   top.restoreSession();
  68   return true;
  69  }
  70
  71 </script>
  72
  73 </head>
  74
  75 <body class="body_top" onload="javascript:document.new_patient.fname.focus();">
  76
  77 <form name='new_patient' method='post' action="new_patient_save.php"
  78  onsubmit='return validate()'>
  79 <span class='title'><?php xl('Add Patient Record','e');?></span>
  80
  81 <br><br>
  82
  83 <center>
  84
  85 <?php if ($GLOBALS['omit_employers']) { ?>
  86    <input type='hidden' name='title' value='' />
  87 <?php } ?>
  88
  89 <table border='0'>
  90
  91 <?php if (!$GLOBALS['omit_employers']) { ?>
  92  <tr>
  93   <td>
  94    <span class='bold'><?php xl('Title','e');?>: </span>
  95   </td>
  96   <td>
  97    <select name='title'>
  98 <?php
  99 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
 100   "WHERE list_id = 'titles' AND activity = 1 ORDER BY seq");
 101 while ($orow = sqlFetchArray($ores)) {
 102   echo "    <option value='" . $orow['option_id'] . "'";
 103   if ($orow['option_id'] == $form_title) echo " selected";
 104   echo ">" . $orow['title'] . "</option>\n";
 105 }
 106 ?>
 107    </select>
 108   </td>
 109  </tr>
 110 <?php } ?>
 111
 112  <tr>
 113   <td>
 114    <span class='bold'><?php xl('First Name','e');?>: </span>
 115   </td>
 116   <td>
 117    <input type='entry' size='15' name='fname' value='<?php echo $form_fname; ?>'>
 118   </td>
 119  </tr>
 120
 121  <tr>
 122   <td>
 123    <span class='bold'><?php xl('Middle Name','e');?>: </span>
 124   </td>
 125   <td>
 126    <input type='entry' size='15' name='mname' value='<?php echo $form_mname; ?>'>
 127   </td>
 128  </tr>
 129
 130  <tr>
 131   <td>
 132    <span class='bold'><?php xl('Last Name','e');?>: </span>
 133   </td>
 134   <td>
 135    <input type='entry' size='15' name='lname' value='<?php echo $form_lname; ?>'>
 136   </td>
 137  </tr>
 138
 139  <tr>
 140   <td>
 141    <span class='bold'><?php xl('Sex','e'); ?>: </span>
 142   </td>
 143   <td>
 144    <select name='sex'>
 145     <option value=''>Unassigned</option>
 146 <?php
 147 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
 148   "WHERE list_id = 'sex' AND activity = 1 ORDER BY seq");
 149 while ($orow = sqlFetchArray($ores)) {
 150   echo "    <option value='" . $orow['option_id'] . "'";
 151   if ($orow['option_id'] == $form_sex) echo " selected";
 152   echo ">" . $orow['title'] . "</option>\n";
 153 }
 154 ?>
 155    </select>
 156   </td>
 157  </tr>
 158
 159 <?php if ($GLOBALS['inhouse_pharmacy']) { ?>
 160  <tr>
 161   <td>
 162    <span class='bold'><?php xl('Referral Source','e'); ?>: </span>
 163   </td>
 164   <td>
 165    <select name='refsource'>
 166     <option value=''>Unassigned</option>
 167 <?php
 168 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
 169   "WHERE list_id = 'refsource' AND activity = 1 ORDER BY seq");
 170 while ($orow = sqlFetchArray($ores)) {
 171   echo "    <option value='" . $orow['option_id'] . "'";
 172   if ($orow['option_id'] == $form_refsource) echo " selected";
 173   echo ">" . $orow['title'] . "</option>\n";
 174 }
 175 ?>
 176    </select>
 177   </td>
 178  </tr>
 179 <?php } ?>
 180
 181  <tr>
 182   <td>
 183    <span class='bold'><?php xl('Birth Date','e');?>: </span>
 184   </td>
 185   <td>
 186    <input type='text' size='10' name='DOB' id='DOB'
 187     value='<?php echo $form_dob; ?>'
 188     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)'
 189     title='yyyy-mm-dd' />
 190    <img src='../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 191     id='img_dob' border='0' alt='[?]' style='cursor:pointer'
 192     title='Click here to choose a date'>
 193    <script LANGUAGE="JavaScript">
 194     Calendar.setup({inputField:"DOB", ifFormat:"%Y-%m-%d", button:"img_dob"});
 195    </script>
 196   </td>
 197  </tr>
 198
 199  <tr<?php echo $regstyle ?>>
 200   <td>
 201    <span class='bold'><?php xl('Registration Date','e');?>: </span>
 202   </td>
 203   <td>
 204    <input type='text' size='10' name='regdate' id='regdate'
 205     value='<?php echo $form_regdate; ?>'
 206     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)'
 207     title='yyyy-mm-dd' />
 208    <img src='../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 209     id='img_regdate' border='0' alt='[?]' style='cursor:pointer'
 210     title='Click here to choose a date'>
 211    <script LANGUAGE="JavaScript">
 212     Calendar.setup({inputField:"regdate", ifFormat:"%Y-%m-%d", button:"img_regdate"});
 213    </script>
 214   </td>
 215  </tr>
 216
 217  <tr>
 218   <td>
 219    <span class='bold'><?php xl('Patient Number','e');?>: </span>
 220   </td>
 221   <td>
 222    <input type='entry' size='5' name='pubpid' value='<?php echo $form_pubpid; ?>'>
 223    <span class='text'><?php xl('omit to autoassign','e');?> &nbsp; &nbsp; </span>
 224   </td>
 225  </tr>
 226
 227  <tr>
 228   <td colspan='2'>
 229    &nbsp;<br>
 230    <input type='submit' name='form_create' value=<?php xl('Create New Patient','e'); ?> />
 231   </td>
 232   <td>
 233   </td>
 234  </tr>
 235
 236 </table>
 237 </center>
 238 </form>
 239 <script language="Javascript">
 240 <?php
 241 if ($form_pubpid) {
 242   echo "alert('" . xl('This patient ID is already in use!') . "');\n";
 243 }
 244 ?>
 245 </script>
 246
 247 </body>
 248 </html>