2 include_once("../globals.php");
7 <?php
html_header_show();?
>
8 <link rel
="stylesheet" href
="<?php echo xl($css_header,'e');?>" type
="text/css">
10 <script LANGUAGE
="JavaScript">
13 <?php
if ($GLOBALS['inhouse_pharmacy']) { ?
>
14 var f
= document
.forms
[0];
15 if (f
.refsource
.selectedIndex
<= 0) {
16 alert('Please select a referral source!');
28 <body
class="body_top" onload
="javascript:document.new_patient.fname.focus();">
30 <?php
if ($GLOBALS['concurrent_layout']) { ?
>
31 <form name
='new_patient' method
='post' action
="new_patient_save.php"
32 onsubmit
='return validate()'>
33 <span
class='title'><?php
xl('New Patient','e');?
></span
>
35 <form name
='new_patient' method
='post' action
="new_patient_save.php"
36 target
='_top' onsubmit
='return validate()'>
37 <a
class="title" href
="../main/main_screen.php" target
="_top" onclick
="top.restoreSession()">
38 <?php
xl('New Patient','e');?
></a
>
45 <?php
if ($GLOBALS['omit_employers']) { ?
>
46 <input type
='hidden' name
='title' value
='' />
51 <?php
if (!$GLOBALS['omit_employers']) { ?
>
54 <span
class='bold'><?php
xl('Title','e');?
>: </span
>
58 <option value
="Mrs."><?php
xl('Mrs.','e');?
></option
>
59 <option value
="Ms."><?php
xl('Ms.','e');?
></option
>
60 <option value
="Mr."><?php
xl('Mr.','e');?
></option
>
61 <option value
="Dr."><?php
xl('Dr.','e');?
></option
>
69 <span
class='bold'><?php
xl('First Name','e');?
>: </span
>
72 <input type
='entry' size
='15' name
='fname'>
78 <span
class='bold'><?php
xl('Middle Name','e');?
>: </span
>
81 <input type
='entry' size
='15' name
='mname'>
87 <span
class='bold'><?php
xl('Last Name','e');?
>: </span
>
90 <input type
='entry' size
='15' name
='lname'>
94 <?php
if ($GLOBALS['inhouse_pharmacy']) { ?
>
97 <span
class='bold'><?php
xl('Referral Source','e'); ?
>: </span
>
100 <select name
='refsource'>
102 foreach (array('', 'Patient', 'Employee', 'Walk-In', 'Newspaper', 'Radio',
103 'T.V.', 'Direct Mail', 'Coupon', 'Referral Card', 'Other') as $rs)
105 echo " <option value='$rs'>$rs</option>\n";
115 <span
class='bold'><?php
xl('Patient Number','e');?
>: </span
>
118 <input type
='entry' size
='5' name
='pubpid'>
119 <span
class='text'><?php
xl('omit to autoassign','e');?
>  
;  
; </span
>
126 <input type
='submit' name
='form_create' value
=<?php
xl('Create New Patient','e'); ?
> />