templates/prescription/general_edit.html

   1 <html>
   2 <head>
   3 {literal}
   4  <style type="text/css" title="mystyles" media="all">
   5 <!--
   6 td {
   7         font-size:8pt;
   8         font-family:helvetica;
   9 }
  10 input {
  11         font-size:8pt;
  12         font-family:helvetica;
  13 }
  14 select {
  15         font-size:8pt;
  16         font-family:helvetica;
  17 }
  18 textarea {
  19         font-size:8pt;
  20         font-family:helvetica;
  21 }
  22 -->
  23 </style>
  24 <script type="text/javascript" src="library/dialog.js"></script>
  25 <script language='JavaScript'>
  26  function dispense() {
  27   var f = document.forms[0];
  28   dlgopen('interface/drugs/dispense_drug.php' +
  29    '?drug_id=' + f.drug_id.value +
  30    '&prescription=' + f.id.value +
  31    '&quantity=' + f.disp_quantity.value +
  32    '&fee=' + f.disp_fee.value,
  33    '_blank', 400, 200);
  34  }
  35 </script>
  36 {/literal}
  37 </head>
  38 <body {$STYLE.BOTTOM_BG_LINE}>
  39 <form name="prescribe" method="post" action="{$FORM_ACTION}">
  40 <table CELLSPACING="0" CELLPADDING="3">
  41 <tr>
  42         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Starting Date</td>
  43         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  44                 {html_select_date start_year="-10" end_year="+5" time=$prescription->start_date prefix="start_date_"}
  45         </td>
  46 </tr>
  47 <tr>
  48         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Provider</td>
  49         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  50                 {html_options name="provider_id" options=$prescription->provider->utility_provider_array() selected=$prescription->provider->get_id()}
  51                 <input type="hidden" name="patient_id" value="{$prescription->patient->id}" />
  52         </td>
  53 </tr>
  54 <!--
  55 <tr>
  56         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Patient Name</td>
  57         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >{$prescription->patient->get_name_display()}</td>
  58 </tr>
  59 -->
  60 <tr>
  61         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Drug</td>
  62         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  63                 <input type="input" size="20" name="drug" value="{$prescription->drug}"/><input class="button" type="BUTTON" onClick="drugPopup=window.open('controller.php?prescription&lookup', 'drugPopup', 'width=400,height=50,menubar=no,titlebar=no,left = 825,top = 400'); drugPopup.opener=self; return true;" value="Drug Lookup"/>
  64         </td>
  65 </tr>
  66
  67 {if $DRUG_ARRAY}
  68 <tr>
  69         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >&nbsp; in-house</td>
  70         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  71                 {html_options name="drug_id" options=$DRUG_ARRAY selected=$prescription->get_drug_id()}
  72         </td>
  73 </tr>
  74 {/if}
  75
  76 <tr>
  77         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Quantity</td>
  78         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  79                 <input TYPE="TEXT" NAME="quantity" SIZE="2" MAXLENGTH="10" VALUE="{$prescription->quantity}"/>
  80         </td>
  81 </tr>
  82 <tr>
  83         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Medicine Units</td>
  84         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  85                 <input TYPE="TEXT" NAME="size" SIZE="11" MAXLENGTH="10" VALUE="{$prescription->size}"/>
  86                 <select name="unit">{html_options options=$prescription->unit_array selected=$prescription->unit}</select>
  87         </td>
  88 </tr>
  89 <tr>
  90         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Take</td>
  91         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  92                 <input TYPE="TEXT" NAME="dosage" SIZE="2" MAXLENGTH="10" VALUE="{$prescription->dosage}"/> in
  93                 <select name="form">{html_options options=$prescription->form_array selected=$prescription->form}</select>
  94                 <select name="route">{html_options options=$prescription->route_array selected=$prescription->route}</select>
  95                 <select name="interval">{html_options options=$prescription->interval_array selected=$prescription->interval}</select>
  96         </td>
  97 </tr>
  98 <tr>
  99         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Refill</td>
 100         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
 101                 {html_options name="refills" options=$prescription->refills_array selected=$prescription->refills}
 102                 <input TYPE="TEXT" NAME="per_refill" SIZE="2" MAXLENGTH="10" VALUE="{$prescription->per_refill}"/> units</td>
 103 </tr>
 104 <tr>
 105         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Substitution</td>
 106         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
 107         {html_options name="substitute" options=$prescription->substitute_array selected=$prescription->substitute}
 108         </td>
 109 </tr>
 110 <tr>
 111         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Notes</td>
 112         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
 113         <textarea name="note" cols="30" rows="2" wrap="virtual">{$prescription->note}</textarea>
 114         </td>
 115 </tr>
 116 <tr>
 117         <td colspan="3">
 118                 <input type="submit" value="Prescribe" />
 119                 {if $DRUG_ARRAY}{if $prescription->id}
 120                 &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
 121                 <input type="button" value="Dispense" onclick="dispense()" />
 122                 <input type="text" name="disp_quantity" size="2" maxlength="10" value="{$prescription->quantity}" />
 123                 units, $
 124                 <input type="text" name="disp_fee" size="5" maxlength="10" />
 125                 {/if}{/if}
 126         </td>
 127 </tr>
 128 </table>
 129 <input type="hidden" name="id" value="{$prescription->id}" />
 130 <input type="hidden" name="process" value="{$PROCESS}" />
 131 </form>
 132 </body>
 133 </html>