interface/forms/transfer_summary/new.php

   1 <?php
   2
   3 /**
   4  * transfer summary form.
   5  *
   6  * @package   OpenEMR
   7  * @link      http://www.open-emr.org
   8  * @author    Naina Mohamed <naina@capminds.com>
   9  * @author    Brady Miller <brady.g.miller@gmail.com>
  10  * @copyright Copyright (c) 2012-2013 Naina Mohamed <naina@capminds.com> CapMinds Technologies
  11  * @copyright Copyright (c) 2017-2019 Brady Miller <brady.g.miller@gmail.com>
  12  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  13  */
  14
  15 require_once(__DIR__ . "/../../globals.php");
  16 require_once("$srcdir/api.inc.php");
  17 require_once("$srcdir/patient.inc.php");
  18 require_once("$srcdir/options.inc.php");
  19
  20 use OpenEMR\Common\Csrf\CsrfUtils;
  21 use OpenEMR\Core\Header;
  22
  23 formHeader("Form:Transfer Summary");
  24 $returnurl = 'encounter_top.php';
  25 $formid = (int) (isset($_GET['id']) ? $_GET['id'] : 0);
  26 $obj = $formid ? formFetch("form_transfer_summary", $formid) : array();
  27
  28 ?>
  29 <html>
  30 <head>
  31
  32 <?php Header::setupHeader('datetime-picker'); ?>
  33
  34 <script>
  35  $(function () {
  36   var win = top.printLogSetup ? top : opener.top;
  37   win.printLogSetup(document.getElementById('printbutton'));
  38
  39   $('.datepicker').datetimepicker({
  40     <?php $datetimepicker_timepicker = false; ?>
  41     <?php $datetimepicker_showseconds = false; ?>
  42     <?php $datetimepicker_formatInput = false; ?>
  43     <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
  44     <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
  45   });
  46  });
  47 </script>
  48
  49 </head>
  50
  51 <body class="body_top">
  52 <p><span class="forms-title"><?php echo xlt('Transfer Summary'); ?></span></p>
  53 <br />
  54 <?php
  55 echo "<form method='post' name='my_form' " .
  56   "action='$rootdir/forms/transfer_summary/save.php?id=" . attr_url($formid) . "'>\n";
  57 ?>
  58 <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>" />
  59 <table  border="0">
  60 <tr>
  61 <td align="left" class="forms" class="forms"><?php echo xlt('Client Name'); ?>:</td>
  62         <td class="forms">
  63             <label class="forms-data"> <?php if (is_numeric($pid)) {
  64                 $result = getPatientData($pid, "fname,lname,squad");
  65                 echo text($result['fname']) . " " . text($result['lname']);
  66                                        }
  67
  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             $result = getPatientData($pid, "*");
  77             echo text($result['DOB']);
  78                                    }
  79
  80                                    $dob = ($result['DOB']);
  81                                     ?>
  82    </label>
  83      <input type="hidden" name="DOB" value="<?php echo attr($dob);?>">
  84         </td>
  85         </tr>
  86     <tr>
  87
  88     <td align="left" class="forms"><?php echo xlt('Transfer to'); ?>:</td>
  89
  90      <td class="forms">
  91          <input type="text" name="transfer_to" id="transfer_to"
  92         value="<?php echo text($obj["transfer_to"]);?>"></td>
  93
  94         <td align="left" class="forms"><?php echo xlt('Transfer date'); ?>:</td>
  95         <td class="forms">
  96                <input type='text' size='10' class='datepicker' name='transfer_date' id='transfer_date' <?php echo attr($disabled)?>;
  97        value='<?php echo attr($obj["transfer_date"]); ?>'
  98        title='<?php echo xla('yyyy-mm-dd Date of service'); ?>' />
  99         </td>
 100
 101     </tr>
 102
 103     <tr>
 104         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 105     </tr>
 106
 107     <tr>
 108         <td align="left" class="forms"><b><?php echo xlt('Status Of Admission'); ?>:</b></td>
 109         <td colspan="3"><textarea name="status_of_admission" rows="3" cols="60" wrap="virtual name"><?php echo text($obj["status_of_admission"]);?></textarea></td>
 110         </tr>
 111         <tr>
 112         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 113     </tr>
 114     <tr>
 115         <td align="left" class="forms"><b><?php echo xlt('Diagnosis'); ?>:</b></td>
 116         <td colspan="3"><textarea name="diagnosis" rows="3" cols="60" wrap="virtual name"><?php echo text($obj["diagnosis"]);?></textarea></td>
 117             </tr>
 118             <tr>
 119         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 120     </tr>
 121     <tr>
 122         <td align="left" class="forms"><b><?php echo xlt('Intervention Provided'); ?>:</b></td>
 123         <td colspan="3"><textarea name="intervention_provided" rows="3" cols="60" wrap="virtual name"><?php echo text($obj["intervention_provided"]);?></textarea></td>
 124     </tr>
 125     <tr>
 126         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 127     </tr>
 128     <tr>
 129         <td align="left" class="forms"><b><?php echo xlt('Overall Status Of Discharge'); ?>:</b></td>
 130         <td colspan="3"><textarea name="overall_status_of_discharge" rows="3" cols="60" wrap="virtual name"><?php echo text($obj["overall_status_of_discharge"]);?></textarea></td>
 131     </tr>
 132
 133 <tr>
 134         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 135     </tr>
 136
 137     <tr>
 138         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 139     </tr>
 140     <tr>
 141         <td></td>
 142     <td><input type='submit'  value='<?php echo xlt('Save');?>' class="button-css">&nbsp;
 143     <input type='button' value='<?php echo xla('Print'); ?>' id='printbutton' />&nbsp;
 144     <input type='button' class="button-css" value='<?php echo xla('Cancel'); ?>'
 145  onclick="parent.closeTab(window.name, false)" />
 146
 147  </td>
 148     </tr>
 149 </table>
 150 </form>
 151
 152 <?php
 153 formFooter();
 154 ?>