interface/forms/example/view.php

   1 <?php
   2 /*
   3  * Sports Physical Form created by Jason Morrill: January 2009
   4  */
   5
   6 include_once("../../globals.php");
   7 include_once("$srcdir/api.inc");
   8
   9 /** CHANGE THIS - name of the database table associated with this form **/
  10 $table_name = "form_example";
  11
  12 /** CHANGE THIS name to the name of your form **/
  13 $form_name = "My Example Form";
  14
  15 /** CHANGE THIS to match the folder you created for this form **/
  16 $form_folder = "example";
  17
  18 formHeader("Form: ".$form_name);
  19 $returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
  20
  21 /* load the saved record */
  22 $record = formFetch($table_name, $_GET["id"]);
  23
  24 /* remove the time-of-day from the date fields */
  25 if ($record['form_date'] != "") {
  26     $dateparts = split(" ", $record['form_date']);
  27     $record['form_date'] = $dateparts[0];
  28 }
  29 if ($record['dob'] != "") {
  30     $dateparts = split(" ", $record['dob']);
  31     $record['dob'] = $dateparts[0];
  32 }
  33 if ($record['sig_date'] != "") {
  34     $dateparts = split(" ", $record['sig_date']);
  35     $record['sig_date'] = $dateparts[0];
  36 }
  37 ?>
  38
  39 <html><head>
  40 <?php html_header_show();?>
  41
  42 <!-- supporting javascript code -->
  43 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/js/jquery.js"></script>
  44 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js"></script>
  45
  46 <!-- page styles -->
  47 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  48 <link rel="stylesheet" href="../../forms/<?php echo $form_folder; ?>/style.css" type="text/css">
  49
  50 <!-- pop up calendar -->
  51 <style type="text/css">@import url(<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.css);</style>
  52 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.js"></script>
  53 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar_en.js"></script>
  54 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar_setup.js"></script>
  55
  56 <script language="JavaScript">
  57 // this line is to assist the calendar text boxes
  58 var mypcc = '<?php echo $GLOBALS['phone_country_code'] ?>';
  59
  60 function PrintForm() {
  61     newwin = window.open("<?php echo "http://".$_SERVER['SERVER_NAME'].$rootdir."/forms/".$form_folder."/print.php?id=".$_GET["id"]; ?>","mywin");
  62 }
  63 </script>
  64
  65 </head>
  66
  67 <body class="body_top">
  68
  69 <?php echo date("F d, Y", time()); ?>
  70
  71 <form method=post action="<?php echo $rootdir;?>/forms/<?php echo $form_folder; ?>/save.php?mode=update&id=<?php echo $_GET["id"];?>" name="my_form">
  72 <span class="title"><?php xl($form_name,'e'); ?></span><br>
  73
  74 <!-- Save/Cancel links -->
  75 <input type="button" class="save" value="<?php xl('Save Changes','e'); ?>"> &nbsp;
  76 <input type="button" class="dontsave" value="<?php xl('Don\'t Save Changes','e'); ?>"> &nbsp;
  77 <input type="button" class="printform" value="<?php xl('Print','e'); ?>"> &nbsp;
  78
  79 <!-- container for the main body of the form -->
  80 <div id="form_container">
  81
  82 <div id="general">
  83 <table>
  84 <tr><td>
  85 Date:
  86    <input type='text' size='10' name='form_date' id='form_date'
  87     value='<?php echo stripslashes($record['form_date']);?>'
  88     title='<?php xl('yyyy-mm-dd','e'); ?>'
  89     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
  90    <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
  91     id='img_form_date' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
  92     title='<?php xl('Click here to choose a date','e'); ?>'>
  93 </td></tr>
  94 <tr><td>
  95 Name: <input id="name" name="name" type="text" size="50" maxlength="250" value="<?php echo stripslashes($record['name']);?>">
  96 Date of Birth:
  97    <input type='text' size='10' name='dob' id='dob'
  98     value='<?php echo stripslashes($record['dob']);?>'
  99     title='<?php xl('yyyy-mm-dd Date of Birth','e'); ?>'
 100     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc);'
 101     />
 102    <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 103     id='img_dob' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
 104     title='<?php xl('Click here to choose a date','e'); ?>'>
 105 </td></tr>
 106 <tr><td>
 107 Phone: <input name="phone" id="phone" type="text" size="15" maxlength="15" value="<?php echo stripslashes($record['phone']);?>">
 108 </td></tr>
 109 <tr><td>
 110 Address: <input name="address" id="address" type="text" size="80" maxlength="250" value="<?php echo stripslashes($record['address']);?>">
 111 </td></tr>
 112 </table>
 113 </div>
 114
 115 <div id="bottom">
 116 Use this space to express notes <br>
 117 <textarea name="notes" id="notes" cols="80" rows="4"><?php echo stripslashes($record['notes']);?></textarea>
 118 <br><br>
 119 <div style="text-align:right;">
 120 Signature?
 121 <input type="radio" id="sig" name="sig" value="y" <?php if ($record["sig"] == 'y') echo "CHECKED"; ?>>Yes
 122 /
 123 <input type="radio" id="sig" name="sig" value="n" <?php if ($record["sig"] == 'n') echo "CHECKED"; ?>>No
 124 &nbsp;&nbsp;
 125 Date of signature:
 126    <input type='text' size='10' name='sig_date' id='sig_date'
 127     value='<?php echo stripslashes($record['sig_date']);?>'
 128     title='<?php xl('yyyy-mm-dd','e'); ?>'
 129     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
 130    <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 131     id='img_sig_date' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
 132     title='<?php xl('Click here to choose a date','e'); ?>'>
 133 </div>
 134 </div>
 135
 136 </div> <!-- end form_container -->
 137
 138 <input type="button" class="save" value="<?php xl('Save Changes','e'); ?>"> &nbsp;
 139 <input type="button" class="dontsave" value="<?php xl('Don\'t Save Changes','e'); ?>"> &nbsp;
 140 <input type="button" class="printform" value="<?php xl('Print','e'); ?>"> &nbsp;
 141
 142 </form>
 143
 144 </body>
 145
 146 <script language="javascript">
 147 /* required for popup calendar */
 148 Calendar.setup({inputField:"dob", ifFormat:"%Y-%m-%d", button:"img_dob"});
 149 Calendar.setup({inputField:"form_date", ifFormat:"%Y-%m-%d", button:"img_form_date"});
 150 Calendar.setup({inputField:"sig_date", ifFormat:"%Y-%m-%d", button:"img_sig_date"});
 151
 152 // jQuery stuff to make the page a little easier to use
 153
 154 $(document).ready(function(){
 155     $(".save").click(function() { top.restoreSession(); document.my_form.submit(); });
 156     $(".dontsave").click(function() { location.href='<?php echo "$rootdir/patient_file/encounter/$returnurl";?>'; });
 157     $(".printform").click(function() { PrintForm(); });
 158 });
 159
 160 </script>
 161
 162 </html>