interface/new/new.php

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