interface/new/new.php

   1 <?php
   2 include_once("../globals.php");
   3
   4 // Determine if the registration date should be requested.
   5 $crow = sqlQuery("SELECT count(*) AS count FROM layout_options WHERE " .
   6   "form_id = 'DEM' AND field_id = 'regdate' AND uor > 0");
   7 $regstyle = $crow['count'] ? "" : " style='display:none'";
   8 ?>
   9 <html>
  10
  11 <head>
  12 <?php html_header_show();?>
  13 <link rel="stylesheet" href="<?php echo xl($css_header,'e');?>" type="text/css">
  14 <style type="text/css">@import url(../../library/dynarch_calendar.css);</style>
  15
  16 <script type="text/javascript" src="../../library/textformat.js"></script>
  17 <script type="text/javascript" src="../../library/dynarch_calendar.js"></script>
  18 <script type="text/javascript" src="../../library/dynarch_calendar_en.js"></script>
  19 <script type="text/javascript" src="../../library/dynarch_calendar_setup.js"></script>
  20
  21 <script LANGUAGE="JavaScript">
  22
  23  var mypcc = '1';
  24
  25  function validate() {
  26 <?php if ($GLOBALS['inhouse_pharmacy']) { ?>
  27   var f = document.forms[0];
  28   if (f.refsource.selectedIndex <= 0) {
  29    alert('Please select a referral source!');
  30    return false;
  31   }
  32 <?php } ?>
  33   top.restoreSession();
  34   return true;
  35  }
  36
  37 </script>
  38
  39 </head>
  40
  41 <body class="body_top" onload="javascript:document.new_patient.fname.focus();">
  42
  43 <?php if ($GLOBALS['concurrent_layout']) { ?>
  44 <form name='new_patient' method='post' action="new_patient_save.php"
  45  onsubmit='return validate()'>
  46 <span class='title'><?php xl('Add Patient Record','e');?></span>
  47 <?php } else { ?>
  48 <form name='new_patient' method='post' action="new_patient_save.php"
  49  target='_top' onsubmit='return validate()'>
  50 <a class="title" href="../main/main_screen.php" target="_top" onclick="top.restoreSession()">
  51 <?php xl('Add Patient Record','e');?></a>
  52 <?php } ?>
  53
  54 <br><br>
  55
  56 <center>
  57
  58 <?php if ($GLOBALS['omit_employers']) { ?>
  59    <input type='hidden' name='title' value='' />
  60 <?php } ?>
  61
  62 <table border='0'>
  63
  64 <?php if (!$GLOBALS['omit_employers']) { ?>
  65  <tr>
  66   <td>
  67    <span class='bold'><?php xl('Title','e');?>: </span>
  68   </td>
  69   <td>
  70    <select name='title'>
  71 <?php
  72 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
  73   "WHERE list_id = 'titles' ORDER BY seq");
  74 while ($orow = sqlFetchArray($ores)) {
  75   echo "    <option value='" . $orow['option_id'] . "'>" . $orow['title'] .
  76     "</option>\n";
  77 }
  78 ?>
  79    </select>
  80   </td>
  81  </tr>
  82 <?php } ?>
  83
  84  <tr>
  85   <td>
  86    <span class='bold'><?php xl('First Name','e');?>: </span>
  87   </td>
  88   <td>
  89    <input type='entry' size='15' name='fname'>
  90   </td>
  91  </tr>
  92
  93  <tr>
  94   <td>
  95    <span class='bold'><?php xl('Middle Name','e');?>: </span>
  96   </td>
  97   <td>
  98    <input type='entry' size='15' name='mname'>
  99   </td>
 100  </tr>
 101 <?php }  // EOS DBC ?>
 102
 103  <tr>
 104   <td>
 105    <span class='bold'><?php xl('Last Name','e');?>: </span>
 106   </td>
 107   <td>
 108    <input type='entry' size='15' name='lname'>
 109   </td>
 110  </tr>
 111
 112 <?php if ($GLOBALS['inhouse_pharmacy']) { ?>
 113  <tr>
 114   <td>
 115    <span class='bold'><?php xl('Referral Source','e'); ?>: </span>
 116   </td>
 117   <td>
 118    <select name='refsource'>
 119     <option value=''>Unassigned</option>
 120 <?php
 121 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
 122   "WHERE list_id = 'refsource' ORDER BY seq");
 123 while ($orow = sqlFetchArray($ores)) {
 124   echo "    <option value='" . $orow['option_id'] . "'>" . $orow['title'] .
 125     "</option>\n";
 126 }
 127 ?>
 128    </select>
 129   </td>
 130  </tr>
 131 <?php } ?>
 132
 133  <tr<?php echo $regstyle ?>>
 134   <td>
 135    <span class='bold'><?php xl('Registration Date','e');?>: </span>
 136   </td>
 137   <td>
 138    <input type='text' size='10' name='regdate' id='regdate'
 139     value='<?php echo date('Y-m-d') ?>'
 140     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)'
 141     title='yyyy-mm-dd' />
 142    <img src='../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 143     id='img_regdate' border='0' alt='[?]' style='cursor:pointer'
 144     title='Click here to choose a date'>
 145    <script LANGUAGE="JavaScript">
 146     Calendar.setup({inputField:"regdate", ifFormat:"%Y-%m-%d", button:"img_regdate"});
 147    </script>
 148   </td>
 149  </tr>
 150
 151  <tr>
 152   <td>
 153    <span class='bold'><?php xl('Patient Number','e');?>: </span>
 154   </td>
 155   <td>
 156    <input type='entry' size='5' name='pubpid'>
 157    <span class='text'><?php xl('omit to autoassign','e');?> &nbsp; &nbsp; </span>
 158   </td>
 159  </tr>
 160
 161  <tr>
 162   <td colspan='2'>
 163    &nbsp;<br>
 164    <input type='submit' name='form_create' value=<?php xl('Create New Patient','e'); ?> />
 165   </td>
 166   <td>
 167   </td>
 168  </tr>
 169
 170 </table>
 171 </center>
 172 </form>
 173
 174 </body>
 175 </html>