templates/pharmacies/general_edit.html

   1 {**
   2  * Pharmacy edit
   3  *
   4  * @package   OpenEMR
   5  * @link      http://www.open-emr.org
   6  * @author    Brady Miller <brady.g.miller@gmail.com>
   7  * @copyright Copyright (c) 2017 Brady Miller <brady.g.miller@gmail.com>
   8  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
   9  *}
  10 <form name="pharmacy" method="post" action="{$FORM_ACTION}"  class='form-horizontal' onsubmit="return top.restoreSession()">
  11 <!-- it is important that the hidden form_id field be listed first, when it is called is populates any old information attached with the id, this allows for partial edits
  12         if it were called last, the settings from the form would be overwritten with the old information-->
  13     <input type="hidden" name="form_id" value="{$pharmacy->id|escape:'html'}" />
  14     <div class="form-group">
  15         <label for="name" class="control-label col-sm-2">{xl t='Name'|escape:'html'}</label>
  16         <div class="col-sm-8">
  17             <input type="text" id="name" name="name" class="form-control" aria-describedby="nameHelpBox" value="{$pharmacy->name|escape:'html'}" onKeyDown="PreventIt(event)">
  18             <span id="nameHelpBox" class="help-block">({xl t='Required'|escape:'html'})</span>
  19         </div>
  20     </div>
  21     <div class="form-group">
  22         <label for="address_line1" class="control-label col-sm-2">{xl t='Address'|escape:'html'}</label>
  23         <div class="col-sm-8">
  24             <input type="text" id="address_line1" name="address_line1" class="form-control" value="{$pharmacy->address->line1|escape:'html'}" onKeyDown="PreventIt(event)">
  25         </div>
  26     </div>
  27     <div class="form-group">
  28         <label for="address_line2" class="control-label col-sm-2">{xl t='Address'|escape:'html'}</label>
  29         <div class="col-sm-8">
  30             <input type="text" id="address_line2" name="address_line2" class="form-control" value="{$pharmacy->address->line2|escape:'html'}" onKeyDown="PreventIt(event)">
  31         </div>
  32     </div>
  33     <div class="form-group">
  34         <label for="city" class="control-label col-sm-2">{xl t='City'|escape:'html'}</label>
  35         <div class="col-sm-8">
  36             <input type="text" id="city" name="city" class="form-control" value="{$pharmacy->address->city|escape:'html'}" onKeyDown="PreventIt(event)">
  37         </div>
  38     </div>
  39     <div class="form-group">
  40         <label for="state" class="control-label col-sm-2">{xl t='State'|escape:'html'}</label>
  41         <div class="col-sm-8">
  42             <input type="text" maxlength="2" id="state" name="state" class="form-control" value="{$pharmacy->address->state|escape:'html'}" onKeyDown="PreventIt(event)">
  43         </div>
  44     </div>
  45     <div class="form-group">
  46         <label for="city" class="control-label col-sm-2">{xl t='Zip Code'|escape:'html'}</label>
  47         <div class="col-sm-8">
  48             <input type="text" id="zip" name="zip" class="form-control" value="{$pharmacy->address->zip|escape:'html'}" onKeyDown="PreventIt(event)">
  49         </div>
  50     </div>
  51     <div class="form-group">
  52         <label for="email" class="control-label col-sm-2">{xl t='Email'|escape:'html'}</label>
  53         <div class="col-sm-8">
  54             <input type="text" id="email" name="email" class="form-control" value="{$pharmacy->email|escape:'html'}" onKeyDown="PreventIt(event)">
  55         </div>
  56     </div>
  57     <div class="form-group">
  58         <label for="phone" class="control-label col-sm-2">{xl t='Phone'|escape:'html'}</label>
  59         <div class="col-sm-8">
  60             <input type="text" id="phone" name="phone" class="form-control" value="{$pharmacy->get_phone()|escape:'html'}" onKeyDown="PreventIt(event)">
  61         </div>
  62     </div>
  63     <div class="form-group">
  64         <label for="fax" class="control-label col-sm-2">{xl t='Fax'|escape:'html'}</label>
  65         <div class="col-sm-8">
  66             <input type="text" id="fax" name="fax" class="form-control" value="{$pharmacy->get_fax()|escape:'html'}" onKeyDown="PreventIt(event)">
  67         </div>
  68     </div>
  69     <div class="form-group">
  70         <label for="npi" class="control-label col-sm-2">{xl t='NPI'|escape:'html'}</label>
  71         <div class="col-sm-8">
  72             <input type="text" id="npi" name="npi" class="form-control" value="{$pharmacy->get_npi()|escape:'html'}" onKeyDown="PreventIt(event)">
  73         </div>
  74     </div>
  75     <div class="form-group">
  76         <label for="ncpdp" class="control-label col-sm-2">{xl t='NCPDP'|escape:'html'}</label>
  77         <div class="col-sm-8">
  78             <input type="text" id="ncpdp" name="ncpdp" class="form-control" value="{$pharmacy->get_ncpdp()|escape:'html'}" onKeyDown="PreventIt(event)">
  79         </div>
  80     </div>
  81     <div class="form-group">
  82         <label for="transmit_method" class="control-label col-sm-2">{xl t='Default Method'|escape:'html'}</label>
  83         <div class="col-sm-8">
  84             <select id="transmit_method" name="transmit_method" class="form-control">
  85                 {html_options options=$pharmacy->transmit_method_array selected=$pharmacy->transmit_method}
  86             </select>
  87         </div>
  88     </div>
  89     <div class="btn-group col-sm-offset-2">
  90         <a href="javascript:submit_pharmacy();" class="btn btn-default btn-save" onclick="top.restoreSession()">
  91             {xl t='Save'|escape:'html'}
  92         </a>
  93         <a href="controller.php?practice_settings&pharmacy&action=list" class="btn btn-link btn-cancel" onclick="top.restoreSession()">
  94             {xl t='Cancel'|escape:'html'}
  95         </a>
  96     </div>
  97     <input type="hidden" name="id" value="{$pharmacy->id|escape:'html'}">
  98     <input type="hidden" name="process" value="{$PROCESS|escape:'html'}">
  99 </form>
 100
 101 {literal}
 102 <script language="javascript">
 103 function submit_pharmacy()
 104 {
 105     if(document.pharmacy.name.value.length>0)
 106     {
 107         top.restoreSession();
 108         document.pharmacy.submit();
 109         //Z&H Removed redirection
 110     }
 111     else
 112     {
 113         document.pharmacy.name.style.backgroundColor="red";
 114         document.pharmacy.name.focus();
 115     }
 116 }
 117
 118  function Waittoredirect(delaymsec) {
 119      var st = new Date();
 120      var et = null;
 121      do {
 122      et = new Date();
 123      } while ((et - st) < delaymsec);
 124  }
 125 </script>
 126 {/literal}