interface/patient_file/encounter/copay.php

   1 <?
   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
  10 <html>
  11 <head>
  12
  13
  14 <link rel=stylesheet href="<?echo $css_header;?>" type="text/css">
  15
  16 </head>
  17 <body <?echo $bottom_bg_line;?> topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
  18
  19
  20 <table border=0 cellspacing=0 cellpadding=0 height=100%>
  21 <tr>
  22
  23 <!--
  24 <td background="<?echo $linepic;?>" width=7 height=100%>
  25 &nbsp;
  26 </td>
  27 -->
  28
  29 <td valign=top>
  30
  31 <dl>
  32
  33 <form method=post name=copay_form action="diagnosis.php?mode=add&type=COPAY&text=copay" target=Diagnosis>
  34
  35 <dt><span class=title>Copay</span></dt>
  36
  37 <br>
  38
  39 <span class=text>$ </span><input type=entry name=code size=5>
  40
  41
  42 <a class=text href="javascript:document.copay_form.submit();">Save</a>
  43
  44
  45
  46 </form>
  47
  48
  49
  50 </dl>
  51
  52
  53 </td>
  54 </tr>
  55 </table>
  56
  57
  58
  59
  60 </body>
  61 </html>