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
  26 include_once("../../globals.php");
  27 include_once("$srcdir/api.inc");
  28 require_once("$srcdir/patient.inc");
  29 require_once("$srcdir/options.inc.php");
  30 formHeader("Form:Transfer Summary");
  31 $returnurl = 'encounter_top.php';
  32 $formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
  33 $obj = $formid ? formFetch("form_transfer_summary", $formid) : array();
  34
  35 ?>
  36 <html>
  37 <head>
  38 <?php html_header_show();?>
  39
  40 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  41 <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-datetimepicker-2-5-4/build/jquery.datetimepicker.min.css">
  42
  43 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js?v=<?php echo $v_js_includes; ?>"></script>
  44 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dialog.js?v=<?php echo $v_js_includes; ?>"></script>
  45 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-min-3-1-1/index.js"></script>
  46 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-datetimepicker-2-5-4/build/jquery.datetimepicker.full.min.js"></script>
  47
  48 <script language="JavaScript">
  49  $(document).ready(function() {
  50   var win = top.printLogSetup ? top : opener.top;
  51   win.printLogSetup(document.getElementById('printbutton'));
  52
  53   $('.datepicker').datetimepicker({
  54     <?php $datetimepicker_timepicker = false; ?>
  55     <?php $datetimepicker_showseconds = false; ?>
  56     <?php $datetimepicker_formatInput = false; ?>
  57     <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
  58     <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
  59   });
  60  });
  61 </script>
  62
  63 </head>
  64
  65 <body class="body_top">
  66 <p><span class="forms-title"><?php echo xlt('Transfer Summary'); ?></span></p>
  67 </br>
  68 <?php
  69 echo "<form method='post' name='my_form' " .
  70   "action='$rootdir/forms/transfer_summary/save.php?id=" . attr($formid) ."'>\n";
  71 ?>
  72 <table  border="0">
  73 <tr>
  74 <td align="left" class="forms" class="forms"><?php echo xlt('Client Name'); ?>:</td>
  75         <td class="forms">
  76             <label class="forms-data"> <?php if (is_numeric($pid)) {
  77                 $result = getPatientData($pid, "fname,lname,squad");
  78                 echo text($result['fname'])." ".text($result['lname']);
  79 }
  80
  81    $patient_name=($result['fname'])." ".($result['lname']);
  82     ?>
  83    </label>
  84    <input type="hidden" name="client_name" value="<?php echo attr($patient_name);?>">
  85         </td>
  86         <td align="left"  class="forms"><?php echo xlt('DOB'); ?>:</td>
  87         <td class="forms">
  88         <label class="forms-data"> <?php if (is_numeric($pid)) {
  89             $result = getPatientData($pid, "*");
  90             echo text($result['DOB']);
  91 }
  92
  93    $dob=($result['DOB']);
  94     ?>
  95    </label>
  96      <input type="hidden" name="DOB" value="<?php echo attr($dob);?>">
  97         </td>
  98         </tr>
  99     <tr>
 100
 101     <td align="left" class="forms"><?php echo xlt('Transfer to'); ?>:</td>
 102
 103      <td class="forms">
 104          <input type="text" name="transfer_to" id="transfer_to"
 105         value="<?php echo text($obj{"transfer_to"});?>"></td>
 106
 107         <td align="left" class="forms"><?php echo xlt('Transfer date'); ?>:</td>
 108         <td class="forms">
 109                <input type='text' size='10' class='datepicker' name='transfer_date' id='transfer_date' <?php echo attr($disabled)?>;
 110        value='<?php echo attr($obj{"transfer_date"}); ?>'
 111        title='<?php echo xla('yyyy-mm-dd Date of service'); ?>' />
 112         </td>
 113
 114     </tr>
 115
 116     <tr>
 117         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 118     </tr>
 119
 120     <tr>
 121         <td align="left" class="forms"><b><?php echo xlt('Status Of Admission'); ?>:</b></td>
 122         <td colspan="3"><textarea name="status_of_admission" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"status_of_admission"});?></textarea></td>
 123         </tr>
 124         <tr>
 125         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 126     </tr>
 127     <tr>
 128         <td align="left" class="forms"><b><?php echo xlt('Diagnosis'); ?>:</b></td>
 129         <td colspan="3"><textarea name="diagnosis" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"diagnosis"});?></textarea></td>
 130             </tr>
 131             <tr>
 132         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 133     </tr>
 134     <tr>
 135         <td align="left" class="forms"><b><?php echo xlt('Intervention Provided'); ?>:</b></td>
 136         <td colspan="3"><textarea name="intervention_provided" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"intervention_provided"});?></textarea></td>
 137     </tr>
 138     <tr>
 139         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 140     </tr>
 141     <tr>
 142         <td align="left" class="forms"><b><?php echo xlt('Overall Status Of Discharge'); ?>:</b></td>
 143         <td colspan="3"><textarea name="overall_status_of_discharge" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"overall_status_of_discharge"});?></textarea></td>
 144     </tr>
 145
 146 <tr>
 147         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 148     </tr>
 149
 150     <tr>
 151         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 152     </tr>
 153     <tr>
 154         <td></td>
 155     <td><input type='submit'  value='<?php echo xlt('Save');?>' class="button-css">&nbsp;
 156     <input type='button' value='<?php echo xla('Print'); ?>' id='printbutton' />&nbsp;
 157     <input type='button' class="button-css" value='<?php echo xla('Cancel'); ?>'
 158  onclick="top.restoreSession();location='<?php echo "$rootdir/patient_file/encounter/$returnurl" ?>'" />
 159
 160  </td>
 161     </tr>
 162 </table>
 163 </form>
 164
 165 <?php
 166 formFooter();
 167 ?>