interface/forms/transfer_summary/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  *
   8  * LICENSE: This program is free software; you can redistribute it and/or
   9  * modify it under the terms of the GNU General Public License
  10  * as published by the Free Software Foundation; either version 3
  11  * of the License, or (at your option) any later version.
  12  * This program is distributed in the hope that it will be useful,
  13  * but WITHOUT ANY WARRANTY; without even the implied warranty of
  14  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
  15  * GNU General Public License for more details.
  16  * You should have received a copy of the GNU General Public License
  17  * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
  18  *
  19  * @package OpenEMR
  20  * @author  Naina Mohamed <naina@capminds.com>
  21  * @author  Brady Miller <brady.g.miller@gmail.com>
  22  * @link    http://www.open-emr.org
  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:Transfer Summary");
  36 $returnurl = 'encounter_top.php';
  37 $formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
  38 $obj = $formid ? formFetch("form_transfer_summary", $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
  70 <body class="body_top">
  71 <p><span class="forms-title"><?php echo xlt('Transfer Summary'); ?></span></p>
  72 </br>
  73 <?php
  74 echo "<form method='post' name='my_form' " .
  75   "action='$rootdir/forms/transfer_summary/save.php?id=" . attr($formid) ."'>\n";
  76 ?>
  77 <table  border="0">
  78 <tr>
  79 <td align="left" class="forms" class="forms"><?php echo xlt('Client Name' ); ?>:</td>
  80                 <td class="forms">
  81                         <label class="forms-data"> <?php if (is_numeric($pid)) {
  82
  83     $result = getPatientData($pid, "fname,lname,squad");
  84    echo text($result['fname'])." ".text($result['lname']);}
  85    $patient_name=($result['fname'])." ".($result['lname']);
  86    ?>
  87    </label>
  88    <input type="hidden" name="client_name" value="<?php echo attr($patient_name);?>">
  89                 </td>
  90                 <td align="left"  class="forms"><?php echo xlt('DOB'); ?>:</td>
  91                 <td class="forms">
  92                 <label class="forms-data"> <?php if (is_numeric($pid)) {
  93
  94     $result = getPatientData($pid, "*");
  95    echo text($result['DOB']);}
  96    $dob=($result['DOB']);
  97    ?>
  98    </label>
  99      <input type="hidden" name="DOB" value="<?php echo attr($dob);?>">
 100                 </td>
 101                 </tr>
 102         <tr>
 103
 104         <td align="left" class="forms"><?php echo xlt('Transfer to'); ?>:</td>
 105
 106          <td class="forms">
 107                  <input type="text" name="transfer_to" id="transfer_to"
 108                 value="<?php echo text($obj{"transfer_to"});?>"></td>
 109
 110                 <td align="left" class="forms"><?php echo xlt('Transfer date'); ?>:</td>
 111                 <td class="forms">
 112                            <input type='text' size='10' class='datepicker' name='transfer_date' id='transfer_date' <?php echo attr ($disabled)?>;
 113        value='<?php echo attr($obj{"transfer_date"}); ?>'
 114        title='<?php echo xla('yyyy-mm-dd Date of service'); ?>' />
 115                 </td>
 116
 117         </tr>
 118
 119         <tr>
 120                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 121         </tr>
 122
 123         <tr>
 124                 <td align="left" class="forms"><b><?php echo xlt('Status Of Admission'); ?>:</b></td>
 125                 <td colspan="3"><textarea name="status_of_admission" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"status_of_admission"});?></textarea></td>
 126                 </tr>
 127                 <tr>
 128                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 129         </tr>
 130         <tr>
 131                 <td align="left" class="forms"><b><?php echo xlt('Diagnosis'); ?>:</b></td>
 132                 <td colspan="3"><textarea name="diagnosis" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"diagnosis"});?></textarea></td>
 133                         </tr>
 134                         <tr>
 135                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 136         </tr>
 137         <tr>
 138                 <td align="left" class="forms"><b><?php echo xlt('Intervention Provided'); ?>:</b></td>
 139                 <td colspan="3"><textarea name="intervention_provided" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"intervention_provided"});?></textarea></td>
 140         </tr>
 141         <tr>
 142                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 143         </tr>
 144         <tr>
 145                 <td align="left" class="forms"><b><?php echo xlt('Overall Status Of Discharge'); ?>:</b></td>
 146                 <td colspan="3"><textarea name="overall_status_of_discharge" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"overall_status_of_discharge"});?></textarea></td>
 147         </tr>
 148
 149 <tr>
 150                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 151         </tr>
 152
 153         <tr>
 154                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 155         </tr>
 156         <tr>
 157                 <td></td>
 158     <td><input type='submit'  value='<?php echo xlt('Save');?>' class="button-css">&nbsp;
 159     <input type='button' value='<?php echo xla('Print'); ?>' id='printbutton' />&nbsp;
 160     <input type='button' class="button-css" value='<?php echo xla('Cancel'); ?>'
 161  onclick="top.restoreSession();location='<?php echo "$rootdir/patient_file/encounter/$returnurl" ?>'" />
 162
 163  </td>
 164         </tr>
 165 </table>
 166 </form>
 167
 168 <?php
 169 formFooter();
 170 ?>