interface/new/new.php

   1 <?php
   2 include_once("../globals.php");
   3
   4 if ($GLOBALS['full_new_patient_form']) {
   5   require("new_comprehensive.php");
   6   exit;
   7 }
   8
   9 // For a layout field return 0=unused, 1=optional, 2=mandatory.
  10 function getLayoutUOR($form_id, $field_id) {
  11   $crow = sqlQuery("SELECT uor FROM layout_options WHERE " .
  12     "form_id = '$form_id' AND field_id = '$field_id' LIMIT 1");
  13   return 0 + $crow['uor'];
  14 }
  15
  16 // Determine if the registration date should be requested.
  17 $regstyle = getLayoutUOR('DEM','regdate') ? "" : " style='display:none'";
  18
  19 $form_pubpid    = $_POST['pubpid'   ] ? trim($_POST['pubpid'   ]) : '';
  20 $form_title     = $_POST['title'    ] ? trim($_POST['title'    ]) : '';
  21 $form_fname     = $_POST['fname'    ] ? trim($_POST['fname'    ]) : '';
  22 $form_mname     = $_POST['mname'    ] ? trim($_POST['mname'    ]) : '';
  23 $form_lname     = $_POST['lname'    ] ? trim($_POST['lname'    ]) : '';
  24 $form_refsource = $_POST['refsource'] ? trim($_POST['refsource']) : '';
  25 $form_sex       = $_POST['sex'      ] ? trim($_POST['sex'      ]) : '';
  26 $form_refsource = $_POST['refsource'] ? trim($_POST['refsource']) : '';
  27 $form_dob       = $_POST['DOB'      ] ? trim($_POST['DOB'      ]) : '';
  28 $form_regdate   = $_POST['regdate'  ] ? trim($_POST['regdate'  ]) : date('Y-m-d');
  29 ?>
  30 <html>
  31
  32 <head>
  33 <?php html_header_show(); ?>
  34 <link rel="stylesheet" href="<?php echo xl($css_header,'e');?>" type="text/css">
  35 <style type="text/css">@import url(../../library/dynarch_calendar.css);</style>
  36
  37 <script type="text/javascript" src="../../library/textformat.js"></script>
  38 <script type="text/javascript" src="../../library/dynarch_calendar.js"></script>
  39 <?php include_once("{$GLOBALS['srcdir']}/dynarch_calendar_en.inc.php"); ?>
  40 <script type="text/javascript" src="../../library/dynarch_calendar_setup.js"></script>
  41
  42 <script LANGUAGE="JavaScript">
  43
  44  var mypcc = '1';
  45
  46  function validate() {
  47   var f = document.forms[0];
  48 <?php if ($GLOBALS['inhouse_pharmacy']) { ?>
  49   if (f.refsource.selectedIndex <= 0) {
  50    alert('Please select a referral source!');
  51    return false;
  52   }
  53 <?php } ?>
  54 <?php if (getLayoutUOR('DEM','sex') == 2) { ?>
  55   if (f.sex.selectedIndex <= 0) {
  56    alert('Please select a value for sex!');
  57    return false;
  58   }
  59 <?php } ?>
  60 <?php if (getLayoutUOR('DEM','DOB') == 2) { ?>
  61   if (f.DOB.value.length == 0) {
  62    alert('Please select a birth date!');
  63    return false;
  64   }
  65 <?php } ?>
  66   top.restoreSession();
  67   return true;
  68  }
  69
  70 </script>
  71
  72 </head>
  73
  74 <body class="body_top" onload="javascript:document.new_patient.fname.focus();">
  75
  76 <?php if ($GLOBALS['concurrent_layout']) { ?>
  77 <form name='new_patient' method='post' action="new_patient_save.php"
  78  onsubmit='return validate()'>
  79 <span class='title'><?php xl('Add Patient Record','e');?></span>
  80 <?php } else { ?>
  81 <form name='new_patient' method='post' action="new_patient_save.php"
  82  target='_top' onsubmit='return validate()'>
  83 <a class="title" href="../main/main_screen.php" target="_top" onclick="top.restoreSession()">
  84 <?php xl('Add Patient Record','e');?></a>
  85 <?php } ?>
  86
  87 <br><br>
  88
  89 <center>
  90
  91 <?php if ($GLOBALS['omit_employers']) { ?>
  92    <input type='hidden' name='title' value='' />
  93 <?php } ?>
  94
  95 <table border='0'>
  96
  97 <?php if (!$GLOBALS['omit_employers']) { ?>
  98  <tr>
  99   <td>
 100    <span class='bold'><?php xl('Title','e');?>: </span>
 101   </td>
 102   <td>
 103    <select name='title'>
 104 <?php
 105 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
 106   "WHERE list_id = 'titles' ORDER BY seq");
 107 while ($orow = sqlFetchArray($ores)) {
 108   echo "    <option value='" . $orow['option_id'] . "'";
 109   if ($orow['option_id'] == $form_title) echo " selected";
 110   echo ">" . $orow['title'] . "</option>\n";
 111 }
 112 ?>
 113    </select>
 114   </td>
 115  </tr>
 116 <?php } ?>
 117
 118  <tr>
 119   <td>
 120    <span class='bold'><?php xl('First Name','e');?>: </span>
 121   </td>
 122   <td>
 123    <input type='entry' size='15' name='fname' value='<?php echo $form_fname; ?>'>
 124   </td>
 125  </tr>
 126
 127  <tr>
 128   <td>
 129    <span class='bold'><?php xl('Middle Name','e');?>: </span>
 130   </td>
 131   <td>
 132    <input type='entry' size='15' name='mname' value='<?php echo $form_mname; ?>'>
 133   </td>
 134  </tr>
 135
 136  <tr>
 137   <td>
 138    <span class='bold'><?php xl('Last Name','e');?>: </span>
 139   </td>
 140   <td>
 141    <input type='entry' size='15' name='lname' value='<?php echo $form_lname; ?>'>
 142   </td>
 143  </tr>
 144
 145  <tr>
 146   <td>
 147    <span class='bold'><?php xl('Sex','e'); ?>: </span>
 148   </td>
 149   <td>
 150    <select name='sex'>
 151     <option value=''>Unassigned</option>
 152 <?php
 153 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
 154   "WHERE list_id = 'sex' ORDER BY seq");
 155 while ($orow = sqlFetchArray($ores)) {
 156   echo "    <option value='" . $orow['option_id'] . "'";
 157   if ($orow['option_id'] == $form_sex) echo " selected";
 158   echo ">" . $orow['title'] . "</option>\n";
 159 }
 160 ?>
 161    </select>
 162   </td>
 163  </tr>
 164
 165 <?php if ($GLOBALS['inhouse_pharmacy']) { ?>
 166  <tr>
 167   <td>
 168    <span class='bold'><?php xl('Referral Source','e'); ?>: </span>
 169   </td>
 170   <td>
 171    <select name='refsource'>
 172     <option value=''>Unassigned</option>
 173 <?php
 174 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
 175   "WHERE list_id = 'refsource' ORDER BY seq");
 176 while ($orow = sqlFetchArray($ores)) {
 177   echo "    <option value='" . $orow['option_id'] . "'";
 178   if ($orow['option_id'] == $form_refsource) echo " selected";
 179   echo ">" . $orow['title'] . "</option>\n";
 180 }
 181 ?>
 182    </select>
 183   </td>
 184  </tr>
 185 <?php } ?>
 186
 187  <tr>
 188   <td>
 189    <span class='bold'><?php xl('Birth Date','e');?>: </span>
 190   </td>
 191   <td>
 192    <input type='text' size='10' name='DOB' id='DOB'
 193     value='<?php echo $form_dob; ?>'
 194     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)'
 195     title='yyyy-mm-dd' />
 196    <img src='../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 197     id='img_dob' border='0' alt='[?]' style='cursor:pointer'
 198     title='Click here to choose a date'>
 199    <script LANGUAGE="JavaScript">
 200     Calendar.setup({inputField:"DOB", ifFormat:"%Y-%m-%d", button:"img_dob"});
 201    </script>
 202   </td>
 203  </tr>
 204
 205  <tr<?php echo $regstyle ?>>
 206   <td>
 207    <span class='bold'><?php xl('Registration Date','e');?>: </span>
 208   </td>
 209   <td>
 210    <input type='text' size='10' name='regdate' id='regdate'
 211     value='<?php echo $form_regdate; ?>'
 212     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)'
 213     title='yyyy-mm-dd' />
 214    <img src='../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 215     id='img_regdate' border='0' alt='[?]' style='cursor:pointer'
 216     title='Click here to choose a date'>
 217    <script LANGUAGE="JavaScript">
 218     Calendar.setup({inputField:"regdate", ifFormat:"%Y-%m-%d", button:"img_regdate"});
 219    </script>
 220   </td>
 221  </tr>
 222
 223  <tr>
 224   <td>
 225    <span class='bold'><?php xl('Patient Number','e');?>: </span>
 226   </td>
 227   <td>
 228    <input type='entry' size='5' name='pubpid' value='<?php echo $form_pubpid; ?>'>
 229    <span class='text'><?php xl('omit to autoassign','e');?> &nbsp; &nbsp; </span>
 230   </td>
 231  </tr>
 232
 233  <tr>
 234   <td colspan='2'>
 235    &nbsp;<br>
 236    <input type='submit' name='form_create' value=<?php xl('Create New Patient','e'); ?> />
 237   </td>
 238   <td>
 239   </td>
 240  </tr>
 241
 242 </table>
 243 </center>
 244 </form>
 245 <script language="Javascript">
 246 <?php
 247 if ($form_pubpid) {
 248   echo "alert('" . xl('This patient ID is already in use!') . "');\n";
 249 }
 250 ?>
 251 </script>
 252
 253 </body>
 254 </html>