interface/forms/aftercare_plan/new.php

   1 <?php
   2 /**
   3  *
   4  * Copyright (C) 2012-2013 Naina Mohamed <naina@capminds.com> CapMinds Technologies
   5  * Copyright (C) 2017 Brady Miller <brady.g.miller@gmail.com>
   6  *
   7  * LICENSE: This program is free software; you can redistribute it and/or
   8  * modify it under the terms of the GNU General Public License
   9  * as published by the Free Software Foundation; either version 3
  10  * of the License, or (at your option) any later version.
  11  * This program is distributed in the hope that it will be useful,
  12  * but WITHOUT ANY WARRANTY; without even the implied warranty of
  13  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
  14  * GNU General Public License for more details.
  15  * You should have received a copy of the GNU General Public License
  16  * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
  17  *
  18  * @package OpenEMR
  19  * @author  Naina Mohamed <naina@capminds.com>
  20  * @author  Brady Miller <brady.g.miller@gmail.com>
  21  * @link    http://www.open-emr.org
  22  */
  23
  24
  25 //SANITIZE ALL ESCAPES
  26 $sanitize_all_escapes=true;
  27
  28 //STOP FAKE REGISTER GLOBALS
  29 $fake_register_globals=false;
  30
  31 include_once("../../globals.php");
  32 include_once("$srcdir/api.inc");
  33 require_once("$srcdir/patient.inc");
  34 require_once("$srcdir/options.inc.php");
  35 formHeader("Form:AfterCare Planning");
  36 $returnurl = 'encounter_top.php';
  37 $formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
  38 $obj = $formid ? formFetch("form_aftercare_plan", $formid) : array();
  39
  40 ?>
  41 <html>
  42 <head>
  43 <?php html_header_show();?>
  44
  45 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  46 <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-datetimepicker-2-5-4/build/jquery.datetimepicker.min.css">
  47
  48 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js?v=<?php echo $v_js_includes; ?>"></script>
  49 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dialog.js?v=<?php echo $v_js_includes; ?>"></script>
  50 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-min-3-1-1/index.js"></script>
  51 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-datetimepicker-2-5-4/build/jquery.datetimepicker.full.min.js"></script>
  52
  53 <script language="JavaScript">
  54  $(document).ready(function() {
  55   var win = top.printLogSetup ? top : opener.top;
  56   win.printLogSetup(document.getElementById('printbutton'));
  57
  58   $('.datepicker').datetimepicker({
  59    <?php $datetimepicker_timepicker = false; ?>
  60    <?php $datetimepicker_showseconds = false; ?>
  61    <?php $datetimepicker_formatInput = false; ?>
  62    <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
  63    <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
  64   });
  65  });
  66 </script>
  67
  68 </head>
  69 <body class="body_top">
  70 <p><span class="forms-title"><?php echo xlt('AfterCare Planning'); ?></span></p>
  71 </br>
  72 <?php
  73 echo "<form method='post' name='my_form' " .
  74   "action='$rootdir/forms/aftercare_plan/save.php?id=" . attr($formid) ."'>\n";
  75 ?>
  76 <table  border="0">
  77 <tr>
  78 <td align="left" class="forms" class="forms"><?php echo xlt('Client Name' ); ?>:</td>
  79                 <td class="forms">
  80                         <label class="forms-data"> <?php if (is_numeric($pid)) {
  81
  82     $result = getPatientData($pid, "fname,lname,squad");
  83    echo htmlspecialchars(text($result['fname'])." ".text($result['lname']));}
  84    $patient_name=($result['fname'])." ".($result['lname']);
  85    ?>
  86    </label>
  87    <input type="hidden" name="client_name" value="<?php echo attr($patient_name);?>">
  88                 </td>
  89                 <td align="left"  class="forms"><?php echo xlt('DOB'); ?>:</td>
  90                 <td class="forms">
  91                 <label class="forms-data"> <?php if (is_numeric($pid)) {
  92
  93     $result = getPatientData($pid, "*");
  94    echo htmlspecialchars($result['DOB']);}
  95    $dob=($result['DOB']);
  96    ?>
  97    </label>
  98      <input type="hidden" name="DOB" value="<?php echo attr($dob);?>">
  99                 </td>
 100                 </tr>
 101 <tr>
 102
 103
 104   <td align="left" class="forms"><?php echo xlt('Admit Date'); ?>:</td>
 105                 <td class="forms">
 106                            <input type='text' size='10' class='datepicker' name='admit_date' id='admission_date' <?php echo attr($disabled); ?>;
 107                            value='<?php echo attr($obj{"admit_date"}); ?>'
 108                            title='<?php echo xla('yyyy-mm-dd Date of service'); ?>' />
 109                 </td>
 110                 <td align="left" class="forms"><?php echo xlt('Discharged'); ?>:</td>
 111                 <td class="forms">
 112                            <input type='text' size='10' class='datepicker' name='discharged' id='discharge_date' <?php echo attr($disabled); ?>;
 113       value='<?php echo attr($obj{"discharged"}); ?>'
 114        title='<?php echo xla('yyyy-mm-dd Date of service'); ?>' />
 115                 </td>
 116         </tr>
 117         <tr>
 118                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 119         </tr>
 120                 <tr>
 121
 122                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal and Methods');?></B></td>
 123
 124         </tr>
 125         <tr>
 126                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 127         </tr>
 128         <tr>
 129
 130                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal A');?>:</B>&nbsp;<?php echo xlt('Acute Intoxication/Withdrawal'); ?></td>
 131
 132         </tr>
 133         <tr>
 134                 <td align="right" class="forms">1.</td>
 135                 <td colspan="3"><textarea name="goal_a_acute_intoxication" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication"});?></textarea></td>
 136
 137         </tr>
 138         <tr>
 139                 <td align="right" class="forms">2.</td>
 140                 <td colspan="3"><textarea name="goal_a_acute_intoxication_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication_I"});?></textarea></td>
 141
 142         </tr>
 143         <tr>
 144                 <td align="right" class="forms">3.</td>
 145                 <td colspan="3"><textarea name="goal_a_acute_intoxication_II" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication_II"});?></textarea></td>
 146
 147
 148         <tr>
 149
 150                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal B');?>:</B>&nbsp;<?php  echo xlt('Emotional / Behavioral Conditions & Complications'); ?></td>
 151
 152         </tr>
 153         <tr>
 154                 <td align="right" class="forms">1.</td>
 155                 <td colspan="3"><textarea name="goal_b_emotional_behavioral_conditions" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_b_emotional_behavioral_conditions"});?></textarea></td>
 156
 157         </tr>
 158         <tr>
 159                 <td align="right" class="forms">2.</td>
 160                 <td colspan="3"><textarea name="goal_b_emotional_behavioral_conditions_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_b_emotional_behavioral_conditions_I"});?></textarea></td>
 161
 162         </tr>
 163
 164
 165                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal C');?>:</B>&nbsp;<?php  echo xlt('Relapse Potential'); ?></td>
 166
 167         </tr>
 168         <tr>
 169                 <td align="right" class="forms">1.</td>
 170                 <td colspan="3"><textarea name="goal_c_relapse_potential" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_c_relapse_potential"});?></textarea></td>
 171
 172         </tr>
 173         <tr>
 174                 <td align="right" class="forms">2.</td>
 175                 <td colspan="3"><textarea name="goal_c_relapse_potential_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_c_relapse_potential_I"});?></textarea></td>
 176
 177         </tr>
 178
 179         <tr>
 180                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 181         </tr>
 182         <tr>
 183                 <td></td>
 184     <td><input type='submit' value='<?php echo xla('Save'); ?>' class='button-css' />&nbsp;
 185     <input type='button' value='<?php echo xla('Print'); ?>' id='printbutton' class='button-css' />&nbsp;
 186     <input type='button' class='button-css' value='<?php echo xla('Cancel'); ?>'
 187  onclick="top.restoreSession();location='<?php echo "$rootdir/patient_file/encounter/$returnurl" ?>'" /></td>
 188         </tr>
 189 </table>
 190 </form>
 191 <?php
 192 formFooter();
 193 ?>