1 <!-- Work
/School Note Form created by Nikolai Vitsyn
: 2004/02/13 and update
2005/03/30
2 Copyright (C
) Open Source Medical Software
4 This program is free software
; you can redistribute it
and/or
5 modify it under the terms of the GNU General
Public License
6 as published by the Free Software Foundation
; either version
2
7 of the License
, or (at your option
) any later version
.
9 This program is distributed in the hope that it will be useful
,
10 but WITHOUT ANY WARRANTY
; without even the implied warranty of
11 MERCHANTABILITY
or FITNESS
FOR A PARTICULAR PURPOSE
. See the
12 GNU General
Public License
for more details
.
14 You should have received a copy of the GNU General
Public License
15 along with this program
; if not
, write to the Free Software
16 Foundation
, Inc
., 59 Temple Place
- Suite
330, Boston
, MA
02111-1307, USA
. -->
19 include_once("../../globals.php");
20 include_once("$srcdir/api.inc");
21 formHeader("Form: note");
22 $returnurl = $GLOBALS['concurrent_layout'] ?
'encounter_top.php' : 'patient_encounter.php';
26 <SCRIPT language
="JavaScript"><!--
27 /******************************************
29 *******************************************/
31 Style
= 1; //pick a style from below
33 /*------------------------------
34 Style 1: March 17, 2000
36 Style 3: Saturday March 17, 2000
37 Style 4: Sat Mar 17, 2000
38 Style 5: Sat March 17, 2000
39 Style 6: 17 March 2000
44 Style 11: Saturday March 17
45 --------------------------------*/
48 months
[1] = "January"; months
[7] = "July";
49 months
[2] = "February"; months
[8] = "August";
50 months
[3] = "March"; months
[9] = "September";
51 months
[4] = "April"; months
[10] = "October";
52 months
[5] = "May"; months
[11] = "November";
53 months
[6] = "June"; months
[12] = "December";
55 months2
= new Array();
56 months2
[1] = "Jan"; months2
[7] = "Jul";
57 months2
[2] = "Feb"; months2
[8] = "Aug";
58 months2
[3] = "Mar"; months2
[9] = "Sep";
59 months2
[4] = "Apr"; months2
[10] = "Oct";
60 months2
[5] = "May"; months2
[11] = "Nov";
61 months2
[6] = "Jun"; months2
[12] = "Dec";
64 days
[1] = "Sunday"; days
[5] = "Thursday";
65 days
[2] = "Monday"; days
[6] = "Friday";
66 days
[3] = "Tuesday"; days
[7] = "Saturday";
67 days
[4] = "Wednesday";
70 days2
[1] = "Sun"; days2
[5] = "Thu";
71 days2
[2] = "Mon"; days2
[6] = "Fri";
72 days2
[3] = "Tue"; days2
[7] = "Sat";
75 todaysdate
= new Date();
76 date
= todaysdate
.getDate();
77 day
= todaysdate
.getDay() +
1;
78 month
= todaysdate
.getMonth() +
1;
79 yy
= todaysdate
.getYear();
80 year
= (yy
< 1000) ? yy +
1900 : yy
;
81 year2
= 2000 - year
; year2
= (year2
< 10) ?
"0" + year2
: year2
;
83 dateline
= new Array();
84 dateline
[1] = months
[month
] +
" " + date +
", " + year
;
85 dateline
[2] = months2
[month
] +
" " + date +
", " + year
;
86 dateline
[3] = days
[day
] +
" " + months
[month
] +
" " + date +
", " + year
;
87 dateline
[4] = days2
[day
] +
" " + months2
[month
] +
" " + date +
", " + year
;
88 dateline
[5] = days2
[day
] +
" " + months
[month
] +
" " + date +
", " + year
;
89 dateline
[6] = date +
" " + months
[month
] +
" " + year
;
90 dateline
[7] = date +
" " + months2
[month
] +
" " + year
;
91 dateline
[8] = date +
" " + months2
[month
] +
" " + year2
;
92 dateline
[9] = month +
"/" + date +
"/" + year2
;
93 dateline
[10] = month +
"-" + date +
"-" + year2
;
94 dateline
[11] = days
[day
] +
" " + months
[month
] +
" " + date
;
95 document
.write(dateline
[Style
]);
100 <link rel
=stylesheet href
="<?echo $css_header;?>" type
="text/css">
104 <body
<?
echo $top_bg_line;?
>
105 topmargin
=0 rightmargin
=0 leftmargin
=2 bottommargin
=0 marginwidth
=2 marginheight
=0>
106 <form method
=post action
="<?echo $rootdir;?>/forms/note/save.php?mode=new" name
="my_form">
107 <span
class="title"><?php
xl('Work/School Note','e'); ?
></span
><br
></br
>
109 <a href
="javascript:document.my_form.submit();" class="link_submit">[<?php
xl('Save','e'); ?
>]</a
>
111 <a href
="<?echo "$rootdir/patient_file
/encounter
/$returnurl";?>" class="link" style
="color: #483D8B">[<?php
xl('Don\'t Save','e'); ?
>]</a
>
116 //print "Date:<input type=entry name=$date value=".date("Y-m-d")."> ";
121 <select name
="note_type">
122 <option value
="WORK NOTE"><?php
xl('WORK NOTE','e'); ?
></option
>
123 <option value
="SCHOOL NOTE"><?php
xl('SCHOOL NOTE','e'); ?
></option
>
129 <td colspan
="2" bgcolor
="#ffffff"></td
>
131 <tr align
="left" valign
="top">
132 <td colspan
="2" bgcolor
="#e0e0e0"><b
><?php
xl('MESSAGE:','e'); ?
></b
>
136 <tr
><td align
="right"></td
>
137 <td
><textarea name
="message" rows
="7" cols
="47" wrap
="virtual name"></textarea
></td
>
142 <td colspan
="2" bgcolor
="#ffffff"></td
>
144 <tr align
="left" valign
="top">
145 <td colspan
="2" bgcolor
="#e0e0e0"><b
><?php
xl('Signature:','e'); ?
></b
>
151 <td align
="right"><?php
xl('Doctor:','e'); ?
></td
>
153 <select name
="doctor">
154 <option value
="Dr. #1">Dr
. #1</option>
155 <option value
="Dr. #2">Dr
. #2</option>
156 <option value
="Dr. #3">Dr
. #3</option>
165 //$date = date("Y-m-d");
166 //print "Date:$encounter";
167 //print "Date:<input type=entry name=$date value=".date("Y-m-d")."> ";
171 <span
class="text"><?php
xl('Date','e'); ?
></span
><input type
="entry" name
="date_of_signature"
172 value
="<?php echo date("Y
-m
-d
") ?>">
176 <a href
="javascript:document.my_form.submit();" class="link_submit">[<?php
xl('Save','e'); ?
>]</a
>
178 <a href
="<?echo "$rootdir/patient_file
/encounter
/$returnurl";?>" class="link" style
="color: #483D8B">[<?php
xl('Don\'t Save','e'); ?
>]</a
>