interface/patient_file/encounter/other.php

   1 <?
   2 include_once("../../globals.php");
   3 include_once("$srcdir/sql.inc");
   4
   5 //the number of rows to display before resetting and starting a new column:
   6 $N=10
   7
   8 ?>
   9
  10 <html>
  11 <head>
  12
  13
  14 <link rel=stylesheet href="<?echo $css_header;?>" type="text/css">
  15
  16 </head>
  17 <body <?echo $bottom_bg_line;?> topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
  18
  19
  20 <table border=0 cellspacing=0 cellpadding=0 height=100%>
  21 <tr>
  22 <td background="<?echo $linepic;?>" width=7 height=100%>
  23 &nbsp;
  24 </td>
  25 <td valign=top>
  26
  27 <dl>
  28
  29 <form method=post name=other_form action="diagnosis.php?mode=add&type=OTHER" target=Diagnosis>
  30
  31 <dt><span class=title>Other</span></dt>
  32
  33 <br>
  34 <table>
  35 <tr>
  36 <td class="text">code</td>
  37 <td class="text">description</td>
  38 <td class="text">&nbsp;&nbsp;&nbsp;fee</td>
  39 <td></td>
  40 </tr>
  41 <tr>
  42   <td class="text"><input type=entry name=code size=4>&nbsp;&nbsp;</td>
  43   <td class="text"><input type=entry name=text size=15>&nbsp;&nbsp;</td>
  44   <td class="text">$ </span><input type=entry name=fee size=5></td>
  45   <td>&nbsp;<a class=text href="javascript:document.other_form.submit();">Save</a>
  46   </td>
  47 </tr>
  48 </table>
  49
  50
  51
  52
  53 </form>
  54
  55
  56
  57 </dl>
  58
  59
  60 </td>
  61 </tr>
  62 </table>
  63
  64
  65
  66
  67 </body>
  68 </html>