interface/forms/transfer_summary/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 //SANITIZE ALL ESCAPES
  23  $sanitize_all_escapes=true;
  24
  25  //STOP FAKE REGISTER GLOBALS
  26  $fake_register_globals=false;
  27
  28 include_once("../../globals.php");
  29 include_once("$srcdir/api.inc");
  30 require_once("$srcdir/patient.inc");
  31 require_once("$srcdir/options.inc.php");
  32 formHeader("Form:Transfer Summary");
  33 $returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
  34 $formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
  35 $obj = $formid ? formFetch("form_transfer_summary", $formid) : array();
  36
  37 ?>
  38 <html>
  39 <head>
  40 <?php html_header_show();?>
  41 <script type="text/javascript" src="../../../library/dialog.js"></script>
  42 <!-- pop up calendar -->
  43 <style type="text/css">@import url(<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.css);</style>
  44 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.js"></script>
  45 <?php include_once("{$GLOBALS['srcdir']}/dynarch_calendar_en.inc.php"); ?>
  46 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar_setup.js"></script>
  47 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js"></script>
  48 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dialog.js"></script>
  49 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  50 </head>
  51
  52 <body class="body_top">
  53 <p><span class="forms-title"><?php echo xlt('Transfer Summary'); ?></span></p>
  54 </br>
  55 <?php
  56 echo "<form method='post' name='my_form' " .
  57   "action='$rootdir/forms/transfer_summary/save.php?id=" . attr($formid) ."'>\n";
  58 ?>
  59 <table  border="0">
  60 <tr>
  61 <td align="left" class="forms" class="forms"><?php echo xlt('Client Name' ); ?>:</td>
  62                 <td class="forms">
  63                         <label class="forms-data"> <?php if (is_numeric($pid)) {
  64
  65     $result = getPatientData($pid, "fname,lname,squad");
  66    echo htmlspecialchars(xl('','','','').text($result['fname'])." ".text($result['lname']));}
  67    $patient_name=($result['fname'])." ".($result['lname']);
  68    ?>
  69    </label>
  70    <input type="hidden" name="client_name" value="<?php echo attr($patient_name);?>">
  71                 </td>
  72                 <td align="left"  class="forms"><?php echo xlt('DOB'); ?>:</td>
  73                 <td class="forms">
  74                 <label class="forms-data"> <?php if (is_numeric($pid)) {
  75
  76     $result = getPatientData($pid, "*");
  77    echo htmlspecialchars(($result['DOB']));}
  78    $dob=($result['DOB']);
  79    ?>
  80    </label>
  81      <input type="hidden" name="DOB" value="<?php echo attr($dob);?>">
  82                 </td>
  83                 </tr>
  84         <tr>
  85
  86         <td align="left" class="forms"><?php echo xlt('Transfer to'); ?>:</td>
  87
  88          <td class="forms">
  89                  <input type="text" name="transfer_to" id="transfer_to"
  90                 value="<?php echo text($obj{"transfer_to"});?>"></td>
  91
  92                 <td align="left" class="forms"><?php echo xlt('Transfer date'); ?>:</td>
  93                 <td class="forms">
  94                            <input type='text' size='10' name='transfer_date' id='transfer_date' <?php echo attr ($disabled)?>;
  95        value='<?php echo attr($obj{"transfer_date"}); ?>'
  96        title='<?php echo xla('yyyy-mm-dd Date of service'); ?>'
  97        onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
  98         <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
  99         id='img_transfer_date' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
 100         title='<?php echo xla('Click here to choose a date'); ?>'>
 101                 </td>
 102
 103         </tr>
 104
 105         <tr>
 106                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 107         </tr>
 108
 109         <tr>
 110                 <td align="left" class="forms"><b><?php echo xlt('Status Of Admission'); ?>:</b></td>
 111                 <td colspan="3"><textarea name="status_of_admission" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"status_of_admission"});?></textarea></td>
 112                 </tr>
 113                 <tr>
 114                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 115         </tr>
 116         <tr>
 117                 <td align="left" class="forms"><b><?php echo xlt('Diagnosis'); ?>:</b></td>
 118                 <td colspan="3"><textarea name="diagnosis" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"diagnosis"});?></textarea></td>
 119                         </tr>
 120                         <tr>
 121                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 122         </tr>
 123         <tr>
 124                 <td align="left" class="forms"><b><?php echo xlt('Intervention Provided'); ?>:</b></td>
 125                 <td colspan="3"><textarea name="intervention_provided" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"intervention_provided"});?></textarea></td>
 126         </tr>
 127         <tr>
 128                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 129         </tr>
 130         <tr>
 131                 <td align="left" class="forms"><b><?php echo xlt('Overall Status Of Discharge'); ?>:</b></td>
 132                 <td colspan="3"><textarea name="overall_status_of_discharge" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"overall_status_of_discharge"});?></textarea></td>
 133         </tr>
 134
 135 <tr>
 136                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 137         </tr>
 138
 139         <tr>
 140                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 141         </tr>
 142         <tr>
 143                 <td></td>
 144     <td><input type='submit'  value='<?php echo xlt('Save');?>' class="button-css">&nbsp;
 145          <input type='button'  value="Print" onclick="window.print()" class="button-css">&nbsp;
 146         <input type='button' class="button-css" value='<?php echo xlt('Cancel');?>'
 147  onclick="top.restoreSession();location='<?php echo "$rootdir/patient_file/encounter/$returnurl" ?>'" />
 148
 149  </td>
 150         </tr>
 151 </table>
 152 </form>
 153
 154 <script language="javascript">
 155 /* required for popup calendar */
 156 Calendar.setup({inputField:"transfer_date", ifFormat:"%Y-%m-%d", button:"img_transfer_date"});
 157
 158 </script>
 159 <?php
 160 formFooter();
 161 ?>