interface/de_identification_forms/de_identification_screen1.php

   1 <?php
   2 /********************************************************************************\
   3  * Copyright (C) ViCarePlus, Visolve (vicareplus_engg@visolve.com)              *
   4  *                                                                              *
   5  * This program is free software; you can redistribute it and/or                *
   6  * modify it under the terms of the GNU General Public License                  *
   7  * as published by the Free Software Foundation; either version 2               *
   8  * of the License, or (at your option) any later version.                       *
   9  *                                                                              *
  10  * This program is distributed in the hope that it will be useful,              *
  11  * but WITHOUT ANY WARRANTY; without even the implied warranty of               *
  12  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the                *
  13  * GNU General Public License for more details.                                 *
  14  *                                                                              *
  15  * You should have received a copy of the GNU General Public License            *
  16  * along with this program; if not, write to the Free Software                  *
  17  * Foundation, Inc., 59 Temple Place - Suite 330, Boston, MA  02111-1307, USA.  *
  18  \********************************************************************************/
  19 require_once("../globals.php");
  20 require_once("$srcdir/lists.inc");
  21 require_once("$srcdir/patient.inc");
  22 require_once("$srcdir/acl.inc");
  23 require_once("$srcdir/options.inc.php");
  24 require_once("$srcdir/translation.inc.php");
  25 ?>
  26
  27 <html>
  28 <head>
  29 <title><?php xl('De Identification','e'); ?></title>
  30 <link rel="stylesheet" href='<?php echo $css_header ?>' type='text/css'>
  31 <link rel="stylesheet" href='<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.css' type='text/css'>
  32 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dialog.js"></script>
  33 <style type="text/css">
  34 .style1 {
  35         text-align: center;
  36 }</style>
  37 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.js"></script>
  38 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar_en.js"></script>
  39 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar_setup.js"></script>
  40 <script language="JavaScript">
  41 //get value from popup window
  42 function set_related(s,type) {
  43  var list;
  44  if(type == "diagnosis")
  45         list = "diagnosis_list";
  46  else if(type == "drugs")
  47    list = "drug_list";
  48  else if(type == "immunizations")
  49    list = "immunization_list";
  50
  51  var p=s.split("#");
  52  var elSel = document.getElementById(list);
  53  var i,k;
  54  for (i=0;p[i]!=null;i++)
  55  {
  56   for(k=0;k<elSel.length;k++)
  57   {
  58    if((elSel.options[k].value)==p[i])
  59     p[i]= " ";
  60   }
  61   if(p[i]!= " ")
  62   {
  63   var elOptNew = document.createElement('option');
  64   elOptNew.text = p[i];
  65   elOptNew.value = p[i];
  66   try {
  67     elSel.add(elOptNew, null); // standards compliant; doesn't work in IE
  68   }
  69   catch(ex) {
  70     elSel.add(elOptNew); // IE only
  71   }
  72   }
  73  }
  74  show_value(type);
  75 }
  76
  77 function get_values(type)
  78 {
  79  if(type == "diagnosis")
  80         dlgopen('find_code_popup.php', '_blank', 500, 400);
  81  else if(type == "drugs")
  82    dlgopen('find_drug_popup.php', '_blank', 500, 400);
  83  else if(type == "immunizations")
  84    dlgopen('find_immunization_popup.php', '_blank', 500, 400);
  85 }
  86
  87 //remove item selected from list
  88 function remove_selected(type)
  89 {
  90   var list;
  91   if(type == "diagnosis")
  92         list = "diagnosis_list";
  93  else if(type == "drugs")
  94    list = "drug_list";
  95  else if(type == "immunizations")
  96    list = "immunization_list";
  97   var elSel = document.getElementById(list);
  98   var i;
  99   for (i = elSel.length - 1; i>=0; i--) {
 100     if (elSel.options[i].selected)
 101         {
 102       elSel.remove(i);
 103         }
 104   }
 105   show_value(type);
 106 }
 107
 108 function show_value(type)
 109 {
 110  var list,text,radio;
 111   if(type == "diagnosis")
 112         { radio = "diagnosis"; list = "diagnosis_list"; text="diagnosis_text"; }
 113  else if(type == "drugs")
 114   { radio = "drugs";  list = "drug_list"; text="drug_text"; }
 115  else if(type == "immunizations")
 116   { radio = "immunizations"; list = "immunization_list"; text="immunization_text"; }
 117  if(document.getElementById(radio) == "all")
 118  {
 119         document.getElementById(text).value="all";
 120  }
 121  else
 122 {
 123  var str;
 124  var elSel = document.getElementById(list);
 125   var i;
 126   for (i = elSel.length - 1; i>=0; i--)
 127   {
 128           if(!str)
 129            str = elSel.options[i].value;
 130           else
 131       str = str +"#"+elSel.options[i].value;
 132
 133     }
 134  document.getElementById(text).value=str;
 135  }
 136 }
 137
 138 //disable - enable other checkbox when all checkbox is clicked
 139 function disable_other_chkbox()
 140 {
 141  var value = document.forms[0].all.checked;
 142  if(value == 1)
 143  {
 144  document.forms[0].history_data.disabled = true;
 145  document.forms[0].prescriptions.disabled = true;
 146  document.forms[0].lists.disabled = true;
 147  document.forms[0].immunization.disabled = true;
 148  document.forms[0].transactions.disabled = true;
 149  document.forms[0].billing_data.disabled = true;
 150  document.forms[0].insurance_data.disabled = true;
 151  }
 152  else
 153  {
 154  document.forms[0].history_data.disabled = false;
 155  document.forms[0].prescriptions.disabled = false;
 156  document.forms[0].lists.disabled = false;
 157  document.forms[0].immunization.disabled = false;
 158  document.forms[0].transactions.disabled = false;
 159  document.forms[0].billing_data.disabled = false;
 160  document.forms[0].insurance_data.disabled = false;
 161  }
 162 }
 163
 164 //disable list,add button,remove button when all option is selected
 165 function disable_controls(type)
 166 {
 167  var list,button1,button2;
 168  if(type == "diagnosis")
 169  {      button1 = "add_diagnosis"; button2 = "remove_diagnosis"; list = "diagnosis_list"; text="diagnosis_text";  }
 170  else if(type == "drugs")
 171   { button1 = "add_drug";  button2 = "remove_drug"; list = "drug_list";  text="drug_text";}
 172  else if(type == "immunizations")
 173   { button1 = "add_immunization"; button2 = "remove_immunization"; list = "immunization_list"; text="immunization_text"; }
 174   document.getElementById(button1).disabled = true;
 175   document.getElementById(button2).disabled = true;
 176   document.getElementById(list).disabled = true;
 177   document.getElementById(text).value = "all";
 178 }
 179
 180 function enable_controls(type)
 181 {
 182  var list,button1,button2;
 183  if(type == "diagnosis")
 184  {      button1 = "add_diagnosis"; button2 = "remove_diagnosis"; list = "diagnosis_list";  }
 185  else if(type == "drugs")
 186   { button1 = "add_drug";  button2 = "remove_drug"; list = "drug_list";  }
 187  else if(type == "immunizations")
 188   { button1 = "add_immunization"; button2 = "remove_immunization"; list = "immunization_list";
 189  }
 190   document.getElementById(button1).disabled = false;
 191   document.getElementById(button2).disabled = false;
 192   document.getElementById(list).disabled = false;
 193   show_value(type);
 194 }
 195
 196
 197 function form_validate()
 198 {
 199  if(document.forms[0].begin_date.value >= document.forms[0].end_date.value)
 200  {
 201   alert("<?php echo xl('End date should be greater than Begin date');?>");
 202   return false;
 203  }
 204
 205  if(document.forms[0].all.checked == false &&
 206  document.forms[0].history_data.checked == false &&
 207  document.forms[0].prescriptions.checked == false &&
 208  document.forms[0].immunization.checked == false &&
 209  document.forms[0].lists.checked == false &&
 210  document.forms[0].transactions.checked == false &&
 211  document.forms[0].billing_data.checked == false &&
 212  document.forms[0].insurance_data.checked == false)
 213  {
 214   alert("<?php echo xl('Select Data Required for De Identification');?>");
 215   return false;
 216  }
 217
 218  if(document.forms[0].diagnosis_text.value == "undefined" || document.forms[0].diagnosis_text.value == "")
 219  {
 220   alert("<?php echo xl('Select Diagnosis for De Identification request');?>");
 221   return false;
 222  }
 223  if(document.forms[0].drug_text.value == "undefined" || document.forms[0].drug_text.value == "")
 224  {
 225   alert("<?php echo xl('Select Drugs for De Identification request');?>");
 226   return false;
 227  }
 228  if(document.forms[0].immunization_text.value == "undefined" || document.forms[0].immunization_text.value == "")
 229  {
 230   alert("<?php echo xl('Select Immunizations for De Identification request');?>");
 231   return false;
 232  }
 233  alert("<?php echo xl('De Identification process is started and running in background'); echo '\n'; echo xl('Please visit the screen after some time');?>");
 234  top.restoreSession();
 235  return true;
 236 }
 237
 238 function download_file()
 239 {
 240  alert("<?php echo xl('De-identification files will be saved in'); echo ' `'.$GLOBALS['temporary_files_dir'].'` '; echo xl('location of the openemr machine and may contain sensitive data, so it is recommended to manually delete the files after its use');?>");
 241  document.de_identification.submit();
 242 }
 243
 244 </script>
 245 </head>
 246 <body class="body_top">
 247 <form name="de_identification" id="de_identification" action="de_identification_screen2.php" method="post" onsubmit="return form_validate();">
 248 <strong><?php xl('De Identification','e'); ?></strong>
 249 <?php
 250  $row = sqlQuery("SHOW TABLES LIKE 'de_identification_status'");
 251  if (empty($row))
 252  {
 253    ?>
 254    <table>  <tr>        <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 255               <tr>  <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 256  </table>
 257  <table class="de_identification_status_message" align="center" >
 258         <tr valign="top">
 259                 <td>&nbsp;</td>
 260                 <td rowspan="3">
 261                 <br>
 262         <?php echo xl('Please upgrade OpenEMR Database to include De Identification procedures, function, tables'); ?>
 263         </br></br><a  target="Blank" href="../../contrib/util/de_identification_upgrade.php"><?php echo xl('Click here');?></a>
 264         <?php echo xl('to run');
 265         echo " de_identification_upgrade.php</br>";?><br>
 266                 </td>
 267                 <td>&nbsp;</td>
 268         </tr>
 269         <tr>
 270                 <td>&nbsp;</td>
 271                 <td>&nbsp;</td>
 272         </tr>
 273         <tr>
 274                 <td>&nbsp;</td>
 275                 <td>&nbsp;</td>
 276         </tr>
 277         </table>
 278   <?php
 279   }
 280  else {
 281  $query = "select status from de_identification_status";
 282  $res = sqlStatement($query);
 283  if ($row = sqlFetchArray($res))
 284  {
 285    $deIdentificationStatus = addslashes($row['status']);
 286  /* $deIdentificationStatus:
 287  *  0 - There is no De Identification in progress. (start new De Identification process)
 288  *  1 - A De Identification process is currently in progress.
 289  *  2 - The De Identification process completed and xls file is ready to download
 290  *  3 - The De Identification process completed with error
 291  */
 292  }
 293  if($deIdentificationStatus == 1)
 294  {
 295   //1 - A De Identification process is currently in progress.
 296  ?>
 297  <table>  <tr>  <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 298               <tr>  <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 299  </table>
 300  <table class="de_identification_status_message" align="center" >
 301         <tr valign="top">
 302                 <td>&nbsp;</td>
 303                 <td rowspan="3">
 304                 <br>
 305         <?php echo xl('De Identification Process is ongoing');
 306         echo "</br></br>";
 307         echo xl('Please visit De Identification screen after some time');
 308         echo "</br>";   ?>      <br>
 309                 </td>
 310                 <td>&nbsp;</td>
 311         </tr>
 312         <tr>
 313                 <td>&nbsp;</td>
 314                 <td>&nbsp;</td>
 315         </tr>
 316         <tr>
 317                 <td>&nbsp;</td>
 318                 <td>&nbsp;</td>
 319         </tr>
 320         </table>
 321  <?php
 322  }
 323  else if($deIdentificationStatus == 2)
 324  {
 325   //2 - The De Identification process completed and xls file is ready to download
 326   $query = "SELECT count(*) as count FROM de_identified_data ";
 327      $res = sqlStatement($query);
 328      if ($row = sqlFetchArray($res))
 329      {
 330       $no_of_items = addslashes($row['count']);
 331           }
 332       if($no_of_items <= 1)
 333       {
 334          //start new search - no patient record fount
 335          $query = "update de_identification_status set status = 0";
 336  $res = sqlStatement($query);
 337          ?>
 338          <table>  <tr>  <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 339               <tr>  <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 340  </table>
 341  <table class="de_identification_status_message" align="center" >
 342             <tr valign="top">
 343
 344                 <td>&nbsp;</td>
 345                 <td rowspan="3">
 346                 <br>
 347        <?php echo xl('No Patient record found for given Selection criteria');
 348         echo "</br></br>";
 349         echo xl('Please start new De Identification process');
 350     echo "</br>";       ?> </br>
 351                 </td>
 352                 <td>&nbsp;</td>
 353         </tr>
 354         <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 355
 356         <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 357         </table>
 358
 359         <table align="center">
 360         <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 361       </table>
 362          <?php
 363       }
 364      else {
 365  ?>
 366  <table>  <tr>  <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 367               <tr>  <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 368  </table>
 369  <table class="de_identification_status_message" align="center" >
 370             <tr valign="top">
 371                 <td>&nbsp;</td>
 372                 <td rowspan="3">
 373                 <br>
 374         <?php echo xl('De Identification Process is completed');
 375         echo "</br></br>";
 376         echo xl('Please Click download button to download the De Identified data');
 377     echo "</br>";       ?>      <br>
 378                 </td>
 379                 <td>&nbsp;</td>
 380         </tr>
 381         <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 382         <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 383         </table>
 384         <table align="center">
 385         <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 386    <tr>
 387    <td colspan="2" class="style1">
 388                 <input type="button" name="Download" value=<?php echo xl("Download");?> onclick="download_file()" ></td>
 389    </tr>
 390    </table>
 391  <?php
 392         }
 393  }
 394  else if($deIdentificationStatus == 3)
 395  {
 396   //3 - The De Identification process completed with error
 397   ?>
 398    <table>  <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 399                 <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 400    </table>
 401  <table class="de_identification_status_message" align="center" >
 402             <tr valign="top">
 403                 <td>&nbsp;</td>
 404                 <td rowspan="3">
 405                 <br>
 406         <?php echo xl('Some error has occured during De Identification Process');
 407         echo "</br></br>";
 408         echo xl('De Identified data may not be complete');
 409     echo "</br></br>";
 410    ?><span class="text"><?php echo xl('Please view De Identification error log table for more details');
 411     echo "</br>";       ?></span>       <br>
 412                 </td>
 413                 <td>&nbsp;</td>
 414         </tr>
 415         <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 416         <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 417         </table>
 418         <table align="center">
 419         <tr> <td>&nbsp;</td> <td>&nbsp;</td> </tr>
 420    <tr>
 421    <td colspan="2" class="style1">
 422                 <input type="button" name="Download" value=<?php echo xl("Download Anyway");?>  onclick="download_file()"></td>
 423    </tr>
 424    </table>
 425  </tr>
 426  </table>
 427
 428   <?php
 429   }
 430   if($deIdentificationStatus == 0 )
 431   {
 432   //0 - There is no De Identification in progress. (start new De Identification process)
 433  ?>
 434 <div id="overDiv" style="position: absolute; visibility: hidden; z-index: 1000;">
 435 </div>
 436 <table style="width: 74%" border=0>
 437         <tr rowspan=2>
 438                 <td>&nbsp;</td>
 439                 <td><span class="text"><?php xl('Begin Date','e'); ?></span>
 440                 <input type="text" size="10" name="begin_date" id="begin_date" value="<?php echo $viewmode ? substr($result['date'], 0, 10) : date('Y-m-d'); ?>" title="<?php xl('yyyy-mm-dd Date of service','e'); ?>" onkeyup="datekeyup(this,mypcc)" onblur="dateblur(this,mypcc)" />
 441                 <img src="../pic/show_calendar.gif" align="absbottom" width="24" height="22" id="img_begin_date" border="0" alt="[?]" style="cursor: pointer; cursor: hand" title="<?php xl('Click here to choose a date','e'); ?>">&nbsp;
 442                 </td>
 443                 <td><span class="text"><?php xl('End Date','e'); ?></span>
 444                 <input type="text" size="10" name="end_date" id="end_date" value="<?php echo $viewmode ? substr($result['date'], 0, 10) : date('Y-m-d'); ?>" title="<?php xl('yyyy-mm-dd Date of service','e'); ?>" onkeyup="datekeyup(this,mypcc)" onblur="dateblur(this,mypcc)" />
 445                 <img src="../pic/show_calendar.gif" align="absbottom" width="24" height="22" id="img_end_date" border="0" alt="[?]" style="cursor: pointer; cursor: hand" title="<?php xl('Click here to choose a date','e'); ?>">
 446                 </td>
 447                 <td>&nbsp;</td>
 448                 <td>&nbsp;</td>
 449                 </tr>
 450                 <tr>
 451                 <td>&nbsp;</td> </tr>
 452                 <tr><td>&nbsp;</td>
 453                 <td colspan=2 class="de_identification_input_controls_box"><input type="checkbox" name="unstructured" id="unstructured" value=<?php echo xl("unstructured");?>><span class="text"><?php xl('Include Unstructured data','e'); ?></span></td>
 454                 <td>&nbsp;</td></tr>
 455                 <tr>
 456                 <td>&nbsp;</td>
 457                 <td colspan="2">
 458                 <table class="de_identification_input_controls_box">
 459                         <tr>
 460                                 <td><span class="text"><?php xl('Select data to be included in De Identified data','e'); ?></span>                              <br />
 461                                 <input type="checkbox" name="all" id ="all" value='all' onclick="disable_other_chkbox()"><span class="text"><?php xl('All','e'); ?> </span><br />
 462                                 <input type="checkbox" name="history_data" id="history_data" value='history_data'><span class="text"><?php xl('History Data','e'); ?></span> <br />
 463                                 <input type="checkbox" name="immunization" id="immunization" value="immunizations"><span class="text"><?php xl('Immunizations','e'); ?></span>
 464                                 <br />
 465                                 <input type="checkbox" name="prescriptions" id="prescriptions" value="prescriptions"><span class="text"><?php xl('Prescriptions','e'); ?></span>
 466
 467 &nbsp;</td>             <br />
 468                                 <td><br>
 469                                 <input type="checkbox" name="lists" id="lists" value="lists"><span class="text"><?php xl('Issues','e'); ?> </span><br />
 470                                 <input type="checkbox" name="transactions" id="transactions" value="transactions"><span class="text"><?php xl('Transactions','e'); ?></span>
 471                                 <br />
 472                                 <input type="checkbox" name="insurance_data" id="insurance_data" value="insurance_data"><span class="text"><?php xl('Insurance Data','e'); ?> </span><br />
 473                                 <input type="checkbox" name="billing_data" id="billing_data" value="billing_data"><span class="text"><?php xl('Billing Data','e'); ?></span> <br />
 474
 475 &nbsp;</td>
 476                         </tr>
 477                 </table>
 478                 </td>
 479                 <td>&nbsp;</td>
 480         </tr>
 481         <tr>
 482                 <td>&nbsp;</td>
 483                 <td colspan="2"><br>
 484                 </td>
 485                 <td>&nbsp;</td>
 486         </tr>
 487         <tr>
 488                 <td>&nbsp;</td>
 489                 <td colspan="3">
 490                 <table style="width: 100%">
 491                         <tr valign="top">
 492                                 <!--diagnosis--><td style="width:50%;" class="style1"><span class="text"><?php xl('Enter Diagnosis','e'); ?></span>
 493                                 <input type="radio" id="diagnosis" name="diagnosis" value="all" onclick="disable_controls('diagnosis');" /><span class="text"> <?php xl('All','e'); ?></span>
 494                                 <input type="radio" id="diagnosis" name="diagnosis" value="select_diagnosis" onclick="enable_controls('diagnosis');"    />
 495                                 <span class="text"><?php xl('Select Diagnosis','e'); ?></span>
 496                                 <select id="diagnosis_list" name="diagnosis_list" size="10" style="width: 60%">
 497                                 </select>
 498
 499                                 </td>
 500                                 <td style="width:50%;" class="style1">
 501                                 <!--drugs--><span class="text"><?php xl('Enter Drugs','e'); ?></span>
 502                                 <input type="radio" id="drugs" name="drugs" value="all"); onclick="disable_controls('drugs')"/><span class="text"> <?php xl('All','e'); ?></span>
 503                                 <input type="radio" id="drugs" name="drugs" value="select_drug" onclick="enable_controls('drugs')" />
 504                                 <span class="text"><?php xl('Select Drugs','e'); ?> <br></span>
 505                                 <select id="drug_list" name="drug_list" size="10" style="width: 60%">
 506                                 </select>
 507
 508                                 </td>
 509                         </tr>
 510                         <tr> <td class="style1">
 511                                 <input type="button" name="add_diagnosis" id = "add_diagnosis" value=<?php echo xl("Add Diagnosis"); ?> onclick="get_values('diagnosis')">
 512                                 <input type="button" name="remove_diagnosis" id="remove_diagnosis"value=<?php echo xl("Remove"); ?> onclick="remove_selected('diagnosis')">&nbsp; </td> <td class="style1">
 513                                 <input type="button" name="add_drug" id="add_drug" value=<?php echo xl("Add Drug"); ?> onclick="get_values('drugs')">
 514                                 <input type="button" name="remove_drug" id="remove_drug" value=<?php echo xl("Remove"); ?> onclick="remove_selected('drugs')">
 515                         </td> </tr>
 516                 </table>
 517                 </td>
 518                 <td>&nbsp;</td>
 519         </tr>
 520         <tr>
 521                 <td>&nbsp;</td>
 522                 <td colspan="2" class="style1">
 523                 <!--immunizations--><br>
 524                 <span class="text"><?php xl('Enter Immunizations','e'); ?></span>
 525                 <input type="radio" id="immunizations" name="immunizations" value="all" onclick="disable_controls('immunizations')"/><span class="text"> <?php xl('All','e'); ?></span>
 526                 <input type="radio" id="immunizations" name="immunizations" value="select_immunization" onclick="enable_controls('immunizations')" />
 527                 <span class="text"><?php xl('Select Immunizations','e'); ?></span> <br>
 528                 <select id="immunization_list" name="immunization_list" size="10" width="300" style="width: 30%">
 529                 </select> <br>
 530                 <input type="button" name="add_immunization" id="add_immunization" value=<?php echo xl("Add Immunization"); ?> onclick="get_values('immunizations')">
 531                 <input type="button" name="remove_immunization" id="remove_immunization" value=<?php echo xl("Remove"); ?> onclick="remove_selected('immunizations')">
 532                 <br>
 533 &nbsp;</td>
 534                 <td>&nbsp;</td>
 535         </tr>
 536         <tr>
 537                 <td>&nbsp;</td>
 538                 <td colspan="2" class="style1">
 539                 <input type="submit" name="Submit" value=<?php echo xl("Submit"); ?> ></td>
 540                 <td>&nbsp;</td>
 541         </tr>
 542
 543         <input type="hidden" name="diagnosis_text" id="diagnosis_text"><br>
 544                 <input type="hidden" name="drug_text" id="drug_text"><br>
 545                 <input type="hidden" name="immunization_text" id="immunization_text">
 546 </table>
 547 <script language='JavaScript'>
 548 /* required for popup calendar */
 549 Calendar.setup({inputField:"begin_date", ifFormat:"%Y-%m-%d", button:"img_begin_date"});
 550 Calendar.setup({inputField:"end_date", ifFormat:"%Y-%m-%d", button:"img_end_date"});
 551 </script>
 552         <?php
 553         }
 554        }
 555
 556    ?>
 557 </form>
 558 </body>
 559 </html>