interface/forms/CAMOS/print.php

   1 <?php
   2 include_once("../../globals.php");
   3 include_once("../../../library/api.inc");
   4 formHeader("Form: CAMOS");
   5 $returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
   6 ?>
   7 <html><head>
   8 <link rel=stylesheet href="<?echo $css_header;?>" type="text/css">
   9 </head>
  10 <body <?echo $top_bg_line;?> topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
  11 <form method=post action="<?echo $rootdir;?>/forms/CAMOS/save.php?mode=new" name="my_form">
  12 <h1><php xl ('CAMOS','e'); ?> </h1>
  13 <hr>
  14 <input type="submit" name="submit form" value="<?php xl('submit form','e'); ?>" /><?
  15 echo "<a href='".$GLOBALS['webroot'] . "/interface/patient_file/encounter/$returnurl'>[" . xl('do not save') ."]</a>";
  16 ?>
  17 <table></table><h3><php xl ('Computer Aided Medical Ordering System','e'); ?></h3>
  18 <table><tr><td><php xl ('category','e'); ?></td> <td><input type="text" name="category"  /></td></tr>
  19 <tr><td><php xl ('subcategory','e'); ?></td> <td><input type="text" name="subcategory"  /></td></tr>
  20 <tr><td><php xl ('item','e'); ?></td> <td><input type="text" name="item"  /></td></tr>
  21 <tr><td><php xl ('content','e'); ?></td> <td><input type="text" name="content"  /></td></tr>
  22 </table><input type="submit" name="submit form" value="submit form" /><?
  23 echo "<a href='".$GLOBALS['webroot'] . "/interface/patient_file/encounter/$returnurl'>[" .xl('do not save') ."]</a>";
  24 ?>
  25
  26 </form>
  27 <?php
  28 formFooter();
  29 ?>