interface/forms/aftercare_plan/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
  23 //SANITIZE ALL ESCAPES
  24 $sanitize_all_escapes=true;
  25
  26 //STOP FAKE REGISTER GLOBALS
  27 $fake_register_globals=false;
  28
  29 include_once("../../globals.php");
  30 include_once("$srcdir/api.inc");
  31 require_once("$srcdir/patient.inc");
  32 require_once("$srcdir/options.inc.php");
  33 formHeader("Form:AfterCare Planning");
  34 $returnurl = 'encounter_top.php';
  35 $formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
  36 $obj = $formid ? formFetch("form_aftercare_plan", $formid) : array();
  37
  38 ?>
  39 <html>
  40 <head>
  41 <?php html_header_show();?>
  42 <script type="text/javascript" src="../../../library/dialog.js?v=<?php echo $v_js_includes; ?>"></script>
  43 <!-- pop up calendar -->
  44 <style type="text/css">@import url(<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.css);</style>
  45 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.js"></script>
  46 <?php include_once("{$GLOBALS['srcdir']}/dynarch_calendar_en.inc.php"); ?>
  47 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar_setup.js"></script>
  48 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js"></script>
  49 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dialog.js?v=<?php echo $v_js_includes; ?>"></script>
  50 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  51
  52 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-min-1-9-1/index.js"></script>
  53 <script language="JavaScript">
  54  $(document).ready(function() {
  55   var win = top.printLogSetup ? top : opener.top;
  56   win.printLogSetup(document.getElementById('printbutton'));
  57  });
  58 </script>
  59
  60 </head>
  61 <body class="body_top">
  62 <p><span class="forms-title"><?php echo xlt('AfterCare Planning'); ?></span></p>
  63 </br>
  64 <?php
  65 echo "<form method='post' name='my_form' " .
  66   "action='$rootdir/forms/aftercare_plan/save.php?id=" . attr($formid) ."'>\n";
  67 ?>
  68 <table  border="0">
  69 <tr>
  70 <td align="left" class="forms" class="forms"><?php echo xlt('Client Name' ); ?>:</td>
  71                 <td class="forms">
  72                         <label class="forms-data"> <?php if (is_numeric($pid)) {
  73
  74     $result = getPatientData($pid, "fname,lname,squad");
  75    echo htmlspecialchars(text($result['fname'])." ".text($result['lname']));}
  76    $patient_name=($result['fname'])." ".($result['lname']);
  77    ?>
  78    </label>
  79    <input type="hidden" name="client_name" value="<?php echo attr($patient_name);?>">
  80                 </td>
  81                 <td align="left"  class="forms"><?php echo xlt('DOB'); ?>:</td>
  82                 <td class="forms">
  83                 <label class="forms-data"> <?php if (is_numeric($pid)) {
  84
  85     $result = getPatientData($pid, "*");
  86    echo htmlspecialchars($result['DOB']);}
  87    $dob=($result['DOB']);
  88    ?>
  89    </label>
  90      <input type="hidden" name="DOB" value="<?php echo attr($dob);?>">
  91                 </td>
  92                 </tr>
  93 <tr>
  94
  95
  96   <td align="left" class="forms"><?php echo xlt('Admit Date'); ?>:</td>
  97                 <td class="forms">
  98                            <input type='text' size='10' name='admit_date' id='admission_date' <?php echo attr($disabled); ?>;
  99                            value='<?php echo attr($obj{"admit_date"}); ?>'
 100                            title='<?php echo xla('yyyy-mm-dd Date of service'); ?>'
 101        onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
 102         <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 103         id='img_admission_date' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
 104         title='<?php echo xla('Click here to choose a date'); ?>'>
 105                 </td>
 106
 107
 108
 109                 <td align="left" class="forms"><?php echo xlt('Discharged'); ?>:</td>
 110                 <td class="forms">
 111                            <input type='text' size='10' name='discharged' id='discharge_date' <?php echo attr($disabled); ?>;
 112       value='<?php echo attr($obj{"discharged"}); ?>'
 113        title='<?php echo xla('yyyy-mm-dd Date of service'); ?>'
 114        onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
 115         <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 116         id='img_discharge_date' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
 117         title='<?php echo xla('Click here to choose a date'); ?>'>
 118                 </td>
 119         </tr>
 120         <tr>
 121                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 122         </tr>
 123                 <tr>
 124
 125                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal and Methods');?></B></td>
 126
 127         </tr>
 128         <tr>
 129                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 130         </tr>
 131         <tr>
 132
 133                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal A');?>:</B>&nbsp;<?php echo xlt('Acute Intoxication/Withdrawal'); ?></td>
 134
 135         </tr>
 136         <tr>
 137                 <td align="right" class="forms">1.</td>
 138                 <td colspan="3"><textarea name="goal_a_acute_intoxication" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication"});?></textarea></td>
 139
 140         </tr>
 141         <tr>
 142                 <td align="right" class="forms">2.</td>
 143                 <td colspan="3"><textarea name="goal_a_acute_intoxication_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication_I"});?></textarea></td>
 144
 145         </tr>
 146         <tr>
 147                 <td align="right" class="forms">3.</td>
 148                 <td colspan="3"><textarea name="goal_a_acute_intoxication_II" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication_II"});?></textarea></td>
 149
 150
 151         <tr>
 152
 153                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal B');?>:</B>&nbsp;<?php  echo xlt('Emotional / Behavioral Conditions & Complications'); ?></td>
 154
 155         </tr>
 156         <tr>
 157                 <td align="right" class="forms">1.</td>
 158                 <td colspan="3"><textarea name="goal_b_emotional_behavioral_conditions" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_b_emotional_behavioral_conditions"});?></textarea></td>
 159
 160         </tr>
 161         <tr>
 162                 <td align="right" class="forms">2.</td>
 163                 <td colspan="3"><textarea name="goal_b_emotional_behavioral_conditions_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_b_emotional_behavioral_conditions_I"});?></textarea></td>
 164
 165         </tr>
 166
 167
 168                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal C');?>:</B>&nbsp;<?php  echo xlt('Relapse Potential'); ?></td>
 169
 170         </tr>
 171         <tr>
 172                 <td align="right" class="forms">1.</td>
 173                 <td colspan="3"><textarea name="goal_c_relapse_potential" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_c_relapse_potential"});?></textarea></td>
 174
 175         </tr>
 176         <tr>
 177                 <td align="right" class="forms">2.</td>
 178                 <td colspan="3"><textarea name="goal_c_relapse_potential_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_c_relapse_potential_I"});?></textarea></td>
 179
 180         </tr>
 181
 182         <tr>
 183                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 184         </tr>
 185         <tr>
 186                 <td></td>
 187     <td><input type='submit' value='<?php echo xla('Save'); ?>' class='button-css' />&nbsp;
 188     <input type='button' value='<?php echo xla('Print'); ?>' id='printbutton' class='button-css' />&nbsp;
 189     <input type='button' class='button-css' value='<?php echo xla('Cancel'); ?>'
 190  onclick="top.restoreSession();location='<?php echo "$rootdir/patient_file/encounter/$returnurl" ?>'" /></td>
 191         </tr>
 192 </table>
 193 </form>
 194 <script language="javascript">
 195 /* required for popup calendar */
 196 Calendar.setup({inputField:"admission_date", ifFormat:"%Y-%m-%d", button:"img_admission_date"});
 197 Calendar.setup({inputField:"discharge_date", ifFormat:"%Y-%m-%d", button:"img_discharge_date"});
 198 </script>
 199 <?php
 200 formFooter();
 201 ?>