interface/patient_file/encounter/other.php

   1 <?php
   2 include_once("../../globals.php");
   3 include_once("$srcdir/sql.inc");
   4
   5 //the number of rows to display before resetting and starting a new column:
   6 $N=10
   7 ?>
   8
   9 <html>
  10 <head>
  11 <?php html_header_show();?>
  12
  13 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  14
  15 </head>
  16 <body class="body_bottom">
  17
  18 <table border=0 cellspacing=0 cellpadding=0 height=100%>
  19 <tr>
  20
  21 <td valign=top>
  22
  23 <dl>
  24
  25 <form method='post' name='other_form' action="diagnosis.php?mode=add&type=OTHER"
  26  target='Diagnosis' onsubmit='return top.restoreSession()'>
  27
  28 <dt><span class=title><?php xl('Other','e'); ?></span></dt>
  29
  30 <br>
  31 <table>
  32 <tr>
  33 <td class="text"><?php xl('code','e'); ?></td>
  34 <td class="text"><?php xl('description','e'); ?></td>
  35 <td class="text">&nbsp;&nbsp;&nbsp;<?php xl('fee','e'); ?></td>
  36 <td></td>
  37 </tr>
  38 <tr>
  39   <td class="text"><input type=entry name=code size=4>&nbsp;&nbsp;</td>
  40   <td class="text"><input type=entry name=text size=15>&nbsp;&nbsp;</td>
  41   <td class="text"><?php xl('$','e'); ?> </span><input type=entry name=fee size=5></td>
  42   <td>&nbsp;<a class='text' href="javascript:top.restoreSession();document.other_form.submit();">
  43    <?php xl('Save','e'); ?></a>
  44   </td>
  45 </tr>
  46 </table>
  47
  48 </form>
  49
  50 </dl>
  51
  52 </td>
  53 </tr>
  54 </table>
  55
  56 </body>
  57 </html>