interface/new/new_comprehensive.php

   1 <?php
   2 // Copyright (C) 2009-2010 Rod Roark <rod@sunsetsystems.com>
   3 //
   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.
   8
   9 require_once("../globals.php");
  10 require_once("$srcdir/acl.inc");
  11 require_once("$srcdir/options.inc.php");
  12 require_once("$srcdir/patient.inc");
  13
  14 // Check authorization.
  15 $thisauth = acl_check('patients', 'demo');
  16 if ($thisauth != 'write' && $thisauth != 'addonly')
  17   die("Adding demographics is not authorized.");
  18
  19 $CPR = 4; // cells per row
  20
  21 $searchcolor = empty($GLOBALS['layout_search_color']) ?
  22   '#ffff55' : $GLOBALS['layout_search_color'];
  23
  24 $WITH_SEARCH = ($GLOBALS['full_new_patient_form'] == '1' || $GLOBALS['full_new_patient_form'] == '2');
  25 $SHORT_FORM  = ($GLOBALS['full_new_patient_form'] == '2' || $GLOBALS['full_new_patient_form'] == '3');
  26
  27 function getLayoutRes() {
  28   global $SHORT_FORM;
  29   return sqlStatement("SELECT * FROM layout_options " .
  30     "WHERE form_id = 'DEM' AND uor > 0 AND field_id != '' " .
  31     ($SHORT_FORM ? "AND ( uor > 1 OR edit_options LIKE '%N%' ) " : "") .
  32     "ORDER BY group_name, seq");
  33 }
  34
  35 // Determine layout field search treatment from its data type:
  36 // 1 = text field
  37 // 2 = select list
  38 // 0 = not searchable
  39 //
  40 function getSearchClass($data_type) {
  41   switch($data_type) {
  42     case  1: // single-selection list
  43     case 10: // local provider list
  44     case 11: // provider list
  45     case 12: // pharmacy list
  46     case 13: // squads
  47     case 14: // address book list
  48     case 26: // single-selection list with add
  49       return 2;
  50     case  2: // text field
  51     case  3: // textarea
  52     case  4: // date
  53       return 1;
  54   }
  55   return 0;
  56 }
  57
  58 $fres = getLayoutRes();
  59 ?>
  60 <html>
  61 <head>
  62 <?php html_header_show(); ?>
  63
  64 <link rel="stylesheet" href="<?php echo $css_header; ?>" type="text/css">
  65
  66 <style>
  67 body, td, input, select, textarea {
  68  font-family: Arial, Helvetica, sans-serif;
  69  font-size: 10pt;
  70 }
  71
  72 body {
  73  padding: 5pt 5pt 5pt 5pt;
  74 }
  75
  76 div.section {
  77  border: solid;
  78  border-width: 1px;
  79  border-color: #0000ff;
  80  margin: 0 0 0 10pt;
  81  padding: 5pt;
  82 }
  83
  84 </style>
  85
  86 <style type="text/css">@import url(../../library/dynarch_calendar.css);</style>
  87
  88 <script type="text/javascript" src="../../library/dialog.js"></script>
  89 <script type="text/javascript" src="../../library/textformat.js"></script>
  90 <script type="text/javascript" src="../../library/dynarch_calendar.js"></script>
  91 <?php include_once("{$GLOBALS['srcdir']}/dynarch_calendar_en.inc.php"); ?>
  92 <script type="text/javascript" src="../../library/dynarch_calendar_setup.js"></script>
  93 <script type="text/javascript" src="<?php echo $GLOBALS['webroot']; ?>/library/js/jquery.js"></script>
  94
  95 <SCRIPT LANGUAGE="JavaScript"><!--
  96 //Visolve - sync the radio buttons - Start
  97 if((top.window.parent) && (parent.window)){
  98         var wname = top.window.parent.left_nav;
  99         fname = (parent.window.name)?parent.window.name:window.name;
 100         wname.syncRadios();
 101         wname.setRadio(fname, "new");
 102 }//Visolve - sync the radio buttons - End
 103
 104 var mypcc = '<?php echo $GLOBALS['phone_country_code'] ?>';
 105
 106 // This may be changed to true by the AJAX search script.
 107 var force_submit = false;
 108
 109 //code used from http://tech.irt.org/articles/js037/
 110 function replace(string,text,by) {
 111  // Replaces text with by in string
 112  var strLength = string.length, txtLength = text.length;
 113  if ((strLength == 0) || (txtLength == 0)) return string;
 114
 115  var i = string.indexOf(text);
 116  if ((!i) && (text != string.substring(0,txtLength))) return string;
 117  if (i == -1) return string;
 118
 119  var newstr = string.substring(0,i) + by;
 120
 121  if (i+txtLength < strLength)
 122   newstr += replace(string.substring(i+txtLength,strLength),text,by);
 123
 124  return newstr;
 125 }
 126
 127 <?php for ($i=1;$i<=3;$i++) { ?>
 128 function auto_populate_employer_address<?php echo $i ?>(){
 129  var f = document.demographics_form;
 130  if (f.form_i<?php echo $i?>subscriber_relationship.options[f.form_i<?php echo $i?>subscriber_relationship.selectedIndex].value == "self") {
 131   f.i<?php echo $i?>subscriber_fname.value=f.form_fname.value;
 132   f.i<?php echo $i?>subscriber_mname.value=f.form_mname.value;
 133   f.i<?php echo $i?>subscriber_lname.value=f.form_lname.value;
 134   f.i<?php echo $i?>subscriber_street.value=f.form_street.value;
 135   f.i<?php echo $i?>subscriber_city.value=f.form_city.value;
 136   f.form_i<?php echo $i?>subscriber_state.value=f.form_state.value;
 137   f.i<?php echo $i?>subscriber_postal_code.value=f.form_postal_code.value;
 138   if (f.form_country_code)
 139     f.form_i<?php echo $i?>subscriber_country.value=f.form_country_code.value;
 140   f.i<?php echo $i?>subscriber_phone.value=f.form_phone_home.value;
 141   f.i<?php echo $i?>subscriber_DOB.value=f.form_DOB.value;
 142   f.i<?php echo $i?>subscriber_ss.value=f.form_ss.value;
 143   f.form_i<?php echo $i?>subscriber_sex.value = f.form_sex.value;
 144   f.i<?php echo $i?>subscriber_employer.value=f.form_em_name.value;
 145   f.i<?php echo $i?>subscriber_employer_street.value=f.form_em_street.value;
 146   f.i<?php echo $i?>subscriber_employer_city.value=f.form_em_city.value;
 147   f.form_i<?php echo $i?>subscriber_employer_state.value=f.form_em_state.value;
 148   f.i<?php echo $i?>subscriber_employer_postal_code.value=f.form_em_postal_code.value;
 149   if (f.form_em_country)
 150     f.form_i<?php echo $i?>subscriber_employer_country.value=f.form_em_country.value;
 151  }
 152 }
 153
 154 <?php } ?>
 155
 156 function upperFirst(string,text) {
 157  return replace(string,text,text.charAt(0).toUpperCase() + text.substring(1,text.length));
 158 }
 159
 160 // The ins_search.php window calls this to set the selected insurance.
 161 function set_insurance(ins_id, ins_name) {
 162  var thesel = document.forms[0]['i' + insurance_index + 'provider'];
 163  var theopts = thesel.options; // the array of Option objects
 164  var i = 0;
 165  for (; i < theopts.length; ++i) {
 166   if (theopts[i].value == ins_id) {
 167    theopts[i].selected = true;
 168    return;
 169   }
 170  }
 171  // no matching option was found so create one, append it to the
 172  // end of the list, and select it.
 173  theopts[i] = new Option(ins_name, ins_id, false, true);
 174 }
 175
 176 // Indicates which insurance slot is being updated.
 177 var insurance_index = 0;
 178
 179 // The OnClick handler for searching/adding the insurance company.
 180 function ins_search(ins) {
 181  insurance_index = ins;
 182  dlgopen('../../interface/practice/ins_search.php', '_blank', 550, 400);
 183  return false;
 184 }
 185
 186 function checkNum () {
 187  var re= new RegExp();
 188  re = /^\d*\.?\d*$/;
 189  str=document.forms[0].monthly_income.value;
 190  if(re.exec(str))
 191  {
 192  }else{
 193   alert("Please enter a dollar amount using only numbers and a decimal point.");
 194  }
 195 }
 196
 197 // This capitalizes the first letter of each word in the passed input
 198 // element.  It also strips out extraneous spaces.
 199 function capitalizeMe(elem) {
 200  var a = elem.value.split(' ');
 201  var s = '';
 202  for(var i = 0; i < a.length; ++i) {
 203   if (a[i].length > 0) {
 204    if (s.length > 0) s += ' ';
 205    s += a[i].charAt(0).toUpperCase() + a[i].substring(1);
 206   }
 207  }
 208  elem.value = s;
 209 }
 210
 211 function divclick(cb, divid) {
 212  var divstyle = document.getElementById(divid).style;
 213  if (cb.checked) {
 214   divstyle.display = 'block';
 215  } else {
 216   divstyle.display = 'none';
 217  }
 218  return true;
 219 }
 220
 221 // Compute the length of a string without leading and trailing spaces.
 222 function trimlen(s) {
 223  var i = 0;
 224  var j = s.length - 1;
 225  for (; i <= j && s.charAt(i) == ' '; ++i);
 226  for (; i <= j && s.charAt(j) == ' '; --j);
 227  if (i > j) return 0;
 228  return j + 1 - i;
 229 }
 230
 231 function validate(f) {
 232 <?php generate_layout_validation('DEM'); ?>
 233  return true;
 234 }
 235
 236 function toggleSearch(elem) {
 237  var f = document.forms[0];
 238 <?php if ($WITH_SEARCH) { ?>
 239  // Toggle background color.
 240  if (elem.style.backgroundColor == '')
 241   elem.style.backgroundColor = '<?php echo $searchcolor; ?>';
 242  else
 243   elem.style.backgroundColor = '';
 244 <?php } ?>
 245  if (force_submit) {
 246   force_submit = false;
 247   f.create.value = '<?php xl('Create New Patient','e'); ?>';
 248  }
 249  return true;
 250 }
 251
 252 // If a <select> list is dropped down, this is its name.
 253 var open_sel_name = '';
 254
 255 function selClick(elem) {
 256  if (open_sel_name == elem.name) {
 257   open_sel_name = '';
 258  }
 259  else {
 260   open_sel_name = elem.name;
 261   toggleSearch(elem);
 262  }
 263  return true;
 264 }
 265
 266 function selBlur(elem) {
 267  if (open_sel_name == elem.name) {
 268   open_sel_name = '';
 269  }
 270  return true;
 271 }
 272
 273 // This invokes the patient search dialog.
 274 function searchme() {
 275  var f = document.forms[0];
 276  var url = '../main/finder/patient_select.php?popup=1';
 277
 278 <?php
 279 $lres = getLayoutRes();
 280
 281 while ($lrow = sqlFetchArray($lres)) {
 282   $field_id  = $lrow['field_id'];
 283   if (strpos($field_id, 'em_') === 0) continue;
 284   $data_type = $lrow['data_type'];
 285   $fldname = "form_$field_id";
 286   switch(getSearchClass($data_type)) {
 287     case  1:
 288       echo
 289       " if (f.$fldname.style.backgroundColor != '' && trimlen(f.$fldname.value) > 0) {\n" .
 290       "  url += '&$field_id=' + encodeURIComponent(f.$fldname.value);\n" .
 291       " }\n";
 292       break;
 293     case 2:
 294       echo
 295       " if (f.$fldname.style.backgroundColor != '' && f.$fldname.selectedIndex > 0) {\n" .
 296       "  url += '&$field_id=' + encodeURIComponent(f.$fldname.options[f.$fldname.selectedIndex].value);\n" .
 297       " }\n";
 298       break;
 299   }
 300 }
 301 ?>
 302
 303  dlgopen(url, '_blank', 700, 500);
 304 }
 305
 306 //-->
 307
 308 </script>
 309 </head>
 310
 311 <body class="body_top">
 312
 313 <form action='new_comprehensive_save.php' name='demographics_form' method='post' onsubmit='return validate(this)'>
 314
 315 <span class='title'><?php xl('Search or Add Patient','e'); ?></span>
 316
 317 <table width='100%' cellpadding='0' cellspacing='8'>
 318  <tr>
 319   <td align='left' valign='top'>
 320 <?php if ($SHORT_FORM) echo "  <center>\n"; ?>
 321 <?php
 322
 323 function end_cell() {
 324   global $item_count, $cell_count;
 325   if ($item_count > 0) {
 326     echo "</td>";
 327     $item_count = 0;
 328   }
 329 }
 330
 331 function end_row() {
 332   global $cell_count, $CPR;
 333   end_cell();
 334   if ($cell_count > 0) {
 335     for (; $cell_count < $CPR; ++$cell_count) echo "<td></td>";
 336     echo "</tr>\n";
 337     $cell_count = 0;
 338   }
 339 }
 340
 341 function end_group() {
 342   global $last_group, $SHORT_FORM;
 343   if (strlen($last_group) > 0) {
 344     end_row();
 345     echo " </table>\n";
 346     if (!$SHORT_FORM) echo "</div>\n";
 347   }
 348 }
 349
 350 $last_group    = '';
 351 $cell_count    = 0;
 352 $item_count    = 0;
 353 $display_style = 'block';
 354 $group_seq     = 0; // this gives the DIV blocks unique IDs
 355
 356 while ($frow = sqlFetchArray($fres)) {
 357   $this_group = $frow['group_name'];
 358   $titlecols  = $frow['titlecols'];
 359   $datacols   = $frow['datacols'];
 360   $data_type  = $frow['data_type'];
 361   $field_id   = $frow['field_id'];
 362   $list_id    = $frow['list_id'];
 363   $currvalue  = '';
 364
 365   if (strpos($field_id, 'em_') === 0) {
 366     $tmp = substr($field_id, 3);
 367     if (isset($result2[$tmp])) $currvalue = $result2[$tmp];
 368   }
 369   else {
 370     if (isset($result[$field_id])) $currvalue = $result[$field_id];
 371   }
 372
 373   // Handle a data category (group) change.
 374   if (strcmp($this_group, $last_group) != 0) {
 375     if (!$SHORT_FORM) {
 376       end_group();
 377       $group_seq++;    // ID for DIV tags
 378       $group_name = substr($this_group, 1);
 379       if (strlen($last_group) > 0) echo "<br />";
 380       echo "<span class='bold'><input type='checkbox' name='form_cb_$group_seq' id='form_cb_$group_seq' value='1' " .
 381         "onclick='return divclick(this,\"div_$group_seq\");'";
 382       if ($display_style == 'block') echo " checked";
 383
 384       // Modified 6-09 by BM - Translate if applicable
 385       echo " /><b>" . xl_layout_label($group_name) . "</b></span>\n";
 386
 387       echo "<div id='div_$group_seq' class='section' style='display:$display_style;'>\n";
 388       echo " <table border='0' cellpadding='0'>\n";
 389       $display_style = 'none';
 390     }
 391     else if (strlen($last_group) == 0) {
 392       echo " <table border='0' cellpadding='0'>\n";
 393     }
 394     $last_group = $this_group;
 395   }
 396
 397   // Handle starting of a new row.
 398   if (($titlecols > 0 && $cell_count >= $CPR) || $cell_count == 0) {
 399     end_row();
 400     echo "  <tr>";
 401   }
 402
 403   if ($item_count == 0 && $titlecols == 0) $titlecols = 1;
 404
 405   // Handle starting of a new label cell.
 406   if ($titlecols > 0) {
 407     end_cell();
 408     echo "<td colspan='$titlecols'";
 409     echo ($frow['uor'] == 2) ? " class='required'" : " class='bold'";
 410     if ($cell_count == 2) echo " style='padding-left:10pt'";
 411     echo ">";
 412     $cell_count += $titlecols;
 413   }
 414   ++$item_count;
 415
 416   echo "<b>";
 417
 418   // Modified 6-09 by BM - Translate if applicable
 419   if ($frow['title']) echo (xl_layout_label($frow['title']).":"); else echo "&nbsp;";
 420
 421   echo "</b>";
 422
 423   // Handle starting of a new data cell.
 424   if ($datacols > 0) {
 425     end_cell();
 426     echo "<td colspan='$datacols' class='text'";
 427     if ($cell_count > 0) echo " style='padding-left:5pt'";
 428     echo ">";
 429     $cell_count += $datacols;
 430   }
 431
 432   ++$item_count;
 433   generate_form_field($frow, $currvalue);
 434 }
 435
 436 end_group();
 437 ?>
 438
 439 <?php
 440 if (! $GLOBALS['simplified_demographics']) {
 441   $insurancei = getInsuranceProviders();
 442   $pid = 0;
 443   $insurance_headings = array(xl("Primary Insurance Provider"), xl("Secondary Insurance Provider"), xl("Tertiary Insurance provider"));
 444   $insurance_info = array();
 445   $insurance_info[1] = getInsuranceData($pid,"primary");
 446   $insurance_info[2] = getInsuranceData($pid,"secondary");
 447   $insurance_info[3] = getInsuranceData($pid,"tertiary");
 448
 449   echo "<br /><span class='bold'><input type='checkbox' name='form_cb_ins' value='1' " .
 450     "onclick='return divclick(this,\"div_ins\");'";
 451   if ($display_style == 'block') echo " checked";
 452   echo " /><b>" . xl('Insurance') . "</b></span>\n";
 453   echo "<div id='div_ins' class='section' style='display:$display_style;'>\n";
 454
 455   for($i=1;$i<=3;$i++) {
 456    $result3 = $insurance_info[$i];
 457 ?>
 458 <table border="0">
 459  <tr>
 460   <td valign='top' colspan='2'>
 461    <span class='required'><?php echo $insurance_headings[$i -1].":"?></span>
 462    <select name="i<?php echo $i?>provider">
 463     <option value=""><?php xl('Unassigned','e'); ?></option>
 464 <?php
 465  foreach ($insurancei as $iid => $iname) {
 466   echo "<option value='" . $iid . "'";
 467   if (strtolower($iid) == strtolower($result3{"provider"}))
 468    echo " selected";
 469   echo ">" . $iname . "</option>\n";
 470  }
 471 ?>
 472    </select>&nbsp;<a href='' onclick='return ins_search(<?php echo $i?>)'>
 473    <?php xl('Search/Add Insurer','e'); ?></a>
 474   </td>
 475  </tr>
 476  <tr>
 477   <td valign=top>
 478    <table border="0">
 479
 480     <tr>
 481      <td>
 482       <span class='required'><?php xl('Plan Name','e'); ?>: </span>
 483      </td>
 484      <td>
 485       <input type='entry' size='20' name='i<?php echo $i?>plan_name' value="<?php echo $result3{"plan_name"} ?>"
 486        onchange="capitalizeMe(this);" />&nbsp;&nbsp;
 487      </td>
 488     </tr>
 489
 490     <tr>
 491      <td>
 492       <span class='required'><?php xl('Effective Date','e'); ?>: </span>
 493      </td>
 494      <td>
 495       <input type='entry' size='11' name='i<?php echo $i ?>effective_date'
 496        id='i<?php echo $i ?>effective_date'
 497        value='<?php echo $result3['date'] ?>'
 498        onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)'
 499        title='yyyy-mm-dd' />
 500
 501       <img src='../../interface/pic/show_calendar.gif' align='absbottom' width='24' height='22'
 502       id='img_i<?php echo $i ?>effective_date' border='0' alt='[?]' style='cursor:pointer'
 503       title='<?php xl('Click here to choose a date','e'); ?>'>
 504
 505       <script LANGUAGE="JavaScript">
 506       Calendar.setup({inputField:"i<?php echo $i ?>effective_date", ifFormat:"%Y-%m-%d", button:"img_i<?php echo $i; ?>effective_date"});
 507       </script>
 508
 509
 510      </td>
 511     </tr>
 512
 513     <tr>
 514      <td><span class=required><?php xl('Policy Number','e'); ?>: </span></td>
 515      <td><input type='entry' size='16' name='i<?php echo $i?>policy_number' value="<?php echo $result3{"policy_number"}?>"
 516       onkeyup='policykeyup(this)'></td>
 517     </tr>
 518
 519     <tr>
 520      <td><span class=required><?php xl('Group Number','e'); ?>: </span></td><td><input type=entry size=16 name=i<?php echo $i?>group_number value="<?php echo $result3{"group_number"}?>"></td>
 521     </tr>
 522
 523     <tr<?php if ($GLOBALS['omit_employers']) echo " style='display:none'"; ?>>
 524      <td class='required'><?php xl('Subscriber Employer (SE)','e'); ?><br><span style='font-weight:normal'>
 525       (<?php xl('if unemployed enter Student','e'); ?>,<br><?php xl('PT Student, or leave blank','e'); ?>): </span></td>
 526      <td><input type=entry size=25 name=i<?php echo $i?>subscriber_employer
 527       value="<?php echo $result3{"subscriber_employer"}?>"
 528        onchange="capitalizeMe(this);" /></td>
 529     </tr>
 530
 531     <tr<?php if ($GLOBALS['omit_employers']) echo " style='display:none'"; ?>>
 532      <td><span class=required><?php xl('SE Address','e'); ?>: </span></td>
 533      <td><input type=entry size=25 name=i<?php echo $i?>subscriber_employer_street
 534       value="<?php echo $result3{"subscriber_employer_street"}?>"
 535        onchange="capitalizeMe(this);" /></td>
 536     </tr>
 537
 538     <tr<?php if ($GLOBALS['omit_employers']) echo " style='display:none'"; ?>>
 539      <td colspan="2">
 540       <table>
 541        <tr>
 542         <td><span class=required><?php xl('SE City','e'); ?>: </span></td>
 543         <td><input type=entry size=15 name=i<?php echo $i?>subscriber_employer_city
 544          value="<?php echo $result3{"subscriber_employer_city"}?>"
 545           onchange="capitalizeMe(this);" /></td>
 546         <td><span class=required><?php echo ($GLOBALS['phone_country_code'] == '1') ? xl('SE State','e') : xl('SE Locality','e') ?>: </span></td>
 547         <td>
 548          <?php
 549           // Modified 7/2009 by BM to incorporate data types
 550           generate_form_field(array('data_type'=>$GLOBALS['state_data_type'],'field_id'=>('i'.$i.'subscriber_employer_state'),'list_id'=>$GLOBALS['state_list'],'fld_length'=>'15','max_length'=>'63','edit_options'=>'C'), $result3['subscriber_employer_state']);
 551          ?>
 552         </td>
 553        </tr>
 554        <tr>
 555         <td><span class=required><?php echo ($GLOBALS['phone_country_code'] == '1') ? xl('SE Zip Code','e') : xl('SE Postal Code','e') ?>: </span></td>
 556         <td><input type=entry size=10 name=i<?php echo $i?>subscriber_employer_postal_code value="<?php echo $result3{"subscriber_employer_postal_code"}?>"></td>
 557         <td><span class=required><?php xl('SE Country','e'); ?>: </span></td>
 558         <td>
 559          <?php
 560           // Modified 7/2009 by BM to incorporate data types
 561           generate_form_field(array('data_type'=>$GLOBALS['country_data_type'],'field_id'=>('i'.$i.'subscriber_employer_country'),'list_id'=>$GLOBALS['country_list'],'fld_length'=>'10','max_length'=>'63','edit_options'=>'C'), $result3['subscriber_employer_country']);
 562          ?>
 563         </td>
 564        </tr>
 565       </table>
 566      </td>
 567     </tr>
 568
 569    </table>
 570   </td>
 571
 572   <td valign=top>
 573    <span class=required><?php xl('Subscriber','e'); ?>: </span>
 574    <input type=entry size=10 name=i<?php echo $i?>subscriber_fname
 575     value="<?php echo $result3{"subscriber_fname"}?>"
 576     onchange="capitalizeMe(this);" />
 577    <input type=entry size=3 name=i<?php echo $i?>subscriber_mname
 578     value="<?php echo $result3{"subscriber_mname"}?>"
 579     onchange="capitalizeMe(this);" />
 580    <input type=entry size=10 name=i<?php echo $i?>subscriber_lname
 581     value="<?php echo $result3{"subscriber_lname"}?>"
 582     onchange="capitalizeMe(this);" />
 583    <br>
 584    <span class=required><?php xl('Relationship','e'); ?>: </span>
 585    <?php
 586     // Modified 6/2009 by BM to use list_options and function
 587     generate_form_field(array('data_type'=>1,'field_id'=>('i'.$i.'subscriber_relationship'),'list_id'=>'sub_relation','empty_title'=>' '), $result3['subscriber_relationship']);
 588    ?>
 589    <a href="javascript:popUp('../../interface/patient_file/summary/browse.php?browsenum=<?php echo $i?>')" class=text>(<?php xl('Browse','e'); ?>)</a><br />
 590
 591    <span class=bold><?php xl('D.O.B.','e'); ?>: </span>
 592    <input type='entry' size='11' name='i<?php echo $i?>subscriber_DOB'
 593     id='i<?php echo $i?>subscriber_DOB'
 594     value='<?php echo $result3['subscriber_DOB'] ?>'
 595     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)'
 596     title='yyyy-mm-dd' />
 597
 598    <img src='../../interface/pic/show_calendar.gif' align='absbottom' width='24' height='22'
 599     id='img_i<?php echo $i; ?>dob_date' border='0' alt='[?]' style='cursor:pointer'
 600     title='<?php xl('Click here to choose a date','e'); ?>'>
 601
 602     <script LANGUAGE="JavaScript">
 603     Calendar.setup({inputField:"i<?php echo $i?>subscriber_DOB", ifFormat:"%Y-%m-%d", button:"img_i<?php echo $i; ?>dob_date"});
 604     </script>
 605
 606
 607    <span class=bold><?php xl('S.S.','e'); ?>: </span><input type=entry size=11 name=i<?php echo $i?>subscriber_ss value="<?php echo $result3{"subscriber_ss"}?>">&nbsp;
 608    <span class=bold><?php xl('Sex','e'); ?>: </span>
 609    <?php
 610     // Modified 6/2009 by BM to use list_options and function
 611     generate_form_field(array('data_type'=>1,'field_id'=>('i'.$i.'subscriber_sex'),'list_id'=>'sex'), $result3['subscriber_sex']);
 612    ?>
 613    <br>
 614    <span class=required><?php xl('Subscriber Address','e'); ?>: </span>
 615    <input type=entry size=25 name=i<?php echo $i?>subscriber_street
 616     value="<?php echo $result3{"subscriber_street"}?>"
 617     onchange="capitalizeMe(this);" /><br>
 618    <span class=required><?php xl('City','e'); ?>: </span>
 619    <input type=entry size=15 name=i<?php echo $i?>subscriber_city
 620     value="<?php echo $result3{"subscriber_city"}?>"
 621     onchange="capitalizeMe(this);" />
 622    <span class=required><?php echo ($GLOBALS['phone_country_code'] == '1') ? xl('State','e') : xl('Locality','e') ?>: </span>
 623    <?php
 624     // Modified 7/2009 by BM to incorporate data types
 625     generate_form_field(array('data_type'=>$GLOBALS['state_data_type'],'field_id'=>('i'.$i.'subscriber_state'),'list_id'=>$GLOBALS['state_list'],'fld_length'=>'15','max_length'=>'63','edit_options'=>'C'), $result3['subscriber_state']);
 626    ?>
 627    <br />
 628    <span class=required><?php echo ($GLOBALS['phone_country_code'] == '1') ? xl('Zip Code','e') : xl('Postal Code','e') ?>: </span><input type=entry size=10 name=i<?php echo $i?>subscriber_postal_code value="<?php echo $result3{"subscriber_postal_code"}?>">
 629    <span class='required'<?php if ($GLOBALS['omit_employers']) echo " style='display:none'"; ?>>
 630    <?php xl('Country','e'); ?>: </span>
 631    <?php
 632     // Modified 7/2009 by BM to incorporate data types
 633     generate_form_field(array('data_type'=>$GLOBALS['country_data_type'],'field_id'=>('i'.$i.'subscriber_country'),'list_id'=>$GLOBALS['country_list'],'fld_length'=>'10','max_length'=>'63','edit_options'=>'C'), $result3['subscriber_country']);
 634    ?>
 635    <br />
 636    <span class=bold><?php xl('Subscriber Phone','e'); ?>:
 637    <input type='text' size='20' name='i<?php echo $i?>subscriber_phone' value='<?php echo $result3["subscriber_phone"] ?>' onkeyup='phonekeyup(this,mypcc)' />
 638    </span><br />
 639    <span class=bold><?php xl('CoPay','e'); ?>: <input type=text size="6" name=i<?php echo $i?>copay value="<?php echo $result3{"copay"}?>">
 640    </span><br />
 641    <span class='required'><?php xl('Accept Assignment','e'); ?>: </span>
 642    <select name=i<?php echo $i?>accept_assignment>
 643      <option value="TRUE" <?php if (strtoupper($result3{"accept_assignment"}) == "TRUE") echo "selected"?>><?php xl('YES','e'); ?></option>
 644      <option value="FALSE" <?php if (strtoupper($result3{"accept_assignment"}) == "FALSE") echo "selected"?>><?php xl('NO','e'); ?></option>
 645    </select>
 646   </td>
 647  </tr>
 648
 649 </table>
 650 <hr />
 651 <?php
 652   }
 653   echo "</div>\n";
 654  } // end of "if not simplified_demographics"
 655 ?>
 656
 657 <?php if (!$SHORT_FORM) echo "  <center>\n"; ?>
 658 <br />
 659 <?php if ($WITH_SEARCH) { ?>
 660 <input type="button" id="search" value=<?php xl('Search','e','\'','\''); ?>
 661  style='background-color:<?php echo $searchcolor; ?>' />
 662 &nbsp;&nbsp;
 663 <?php } ?>
 664 <input type="button" name='create' id="create" value=<?php xl('Create New Patient','e','\'','\''); ?> />
 665
 666 </center>
 667
 668   </td>
 669   <td align='right' valign='top' width='1%' nowrap>
 670    <!-- Image upload stuff was here but got moved. -->
 671   </td>
 672  </tr>
 673 </table>
 674
 675 </form>
 676
 677 <!-- include support for the list-add selectbox feature -->
 678 <?php include($GLOBALS['fileroot']."/library/options_listadd.inc"); ?>
 679
 680 </body>
 681
 682 <script language="JavaScript">
 683
 684 // fix inconsistently formatted phone numbers from the database
 685 var f = document.forms[0];
 686 if (f.form_phone_contact) phonekeyup(f.form_phone_contact,mypcc);
 687 if (f.form_phone_home   ) phonekeyup(f.form_phone_home   ,mypcc);
 688 if (f.form_phone_biz    ) phonekeyup(f.form_phone_biz    ,mypcc);
 689 if (f.form_phone_cell   ) phonekeyup(f.form_phone_cell   ,mypcc);
 690
 691 <?php echo $date_init; ?>
 692
 693 // -=- jQuery makes life easier -=-
 694
 695 // var matches = 0; // number of patients that match the demographic information being entered
 696 // var override = false; // flag that overrides the duplication warning
 697
 698 $(document).ready(function() {
 699
 700     // added to integrate insurance stuff
 701     <?php for ($i=1;$i<=3;$i++) { ?>
 702     $("#form_i<?php echo $i?>subscriber_relationship").change(function() { auto_populate_employer_address<?php echo $i?>(); });
 703     <?php } ?>
 704
 705     $('#search').click(function() { searchme(); });
 706     $('#create').click(function() { submitme(); });
 707
 708     var submitme = function() {
 709       top.restoreSession();
 710       var f = document.forms[0];
 711
 712       if (validate(f)) {
 713         if (force_submit) {
 714           // In this case dups were shown already and Save should just save.
 715           f.submit();
 716           return;
 717         }
 718 <?php
 719 // D in edit_options indicates the field is used in duplication checking.
 720 // This constructs a list of the names of those fields.
 721 $mflist = "";
 722 $mfres = sqlStatement("SELECT * FROM layout_options " .
 723   "WHERE form_id = 'DEM' AND uor > 0 AND field_id != '' AND " .
 724   "edit_options LIKE '%D%' " .
 725   "ORDER BY group_name, seq");
 726 while ($mfrow = sqlFetchArray($mfres)) {
 727   $field_id  = $mfrow['field_id'];
 728   if (strpos($field_id, 'em_') === 0) continue;
 729   if (!empty($mflist)) $mflist .= ",";
 730   $mflist .= "'" . htmlentities($field_id) . "'";
 731 }
 732 ?>
 733         // Build and invoke the URL to create the dup-checker dialog.
 734         var url = 'new_search_popup.php';
 735         var flds = new Array(<?php echo $mflist; ?>);
 736         var separator = '?';
 737         for (var i = 0; i < flds.length; ++i) {
 738           var fval = $('#form_' + flds[i]).val();
 739           if (fval && fval != '') {
 740             url += separator;
 741             separator = '&';
 742             url += 'mf_' + flds[i] + '=' + encodeURIComponent(fval);
 743           }
 744         }
 745         dlgopen(url, '_blank', 700, 500);
 746
 747       } // end if validate
 748     } // end function
 749
 750 // Set onclick/onfocus handlers for toggling background color.
 751 <?php
 752 $lres = getLayoutRes();
 753 while ($lrow = sqlFetchArray($lres)) {
 754   $field_id  = $lrow['field_id'];
 755   if (strpos($field_id, 'em_') === 0) continue;
 756   switch(getSearchClass($lrow['data_type'])) {
 757     case 1:
 758       echo "    \$('#form_$field_id').click(function() { toggleSearch(this); });\n";
 759       break;
 760     case 2:
 761       echo "    \$('#form_$field_id').click(function() { selClick(this); });\n";
 762       echo "    \$('#form_$field_id').blur(function() { selBlur(this); });\n";
 763       break;
 764   }
 765 }
 766 ?>
 767
 768 }); // end document.ready
 769
 770 </script>
 771
 772 </html>
 773