interface/forms/note/new.php

   1 <?php
   2
   3 /*
   4  * Work/School Note Form new.php
   5  *
   6  * @package   OpenEMR
   7  * @link      http://www.open-emr.org
   8  * @author    Nikolai Vitsyn
   9  * @author    Brady Miller <brady.g.miller@gmail.com>
  10  * @copyright Copyright (c) 2004-2005 Nikolai Vitsyn
  11  * @copyright Copyright (c) Open Source Medical Software
  12  * @copyright Copyright (c) 2019 Brady Miller <brady.g.miller@gmail.com>
  13  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  14  */
  15
  16
  17 require_once(__DIR__ . "/../../globals.php");
  18 require_once("$srcdir/api.inc.php");
  19
  20 use OpenEMR\Common\Csrf\CsrfUtils;
  21 use OpenEMR\Core\Header;
  22
  23 formHeader("Form: note");
  24 $returnurl = 'encounter_top.php';
  25 $provider_results = sqlQuery("select fname, lname from users where username=?", array($_SESSION["authUser"]));
  26 /* name of this form */
  27 $form_name = "note";
  28 ?>
  29
  30 <html><head>
  31
  32 <?php Header::setupHeader('datetime-picker'); ?>
  33
  34 <script>
  35 // required for textbox date verification
  36 var mypcc = <?php echo js_escape($GLOBALS['phone_country_code']); ?>;
  37 </script>
  38
  39 </head>
  40
  41 <body class="body_top">
  42 <?php echo text(date("F d, Y", time())); ?>
  43
  44 <form method=post action="<?php echo $rootdir . "/forms/" . $form_name . "/save.php?mode=new";?>" name="my_form" id="my_form">
  45 <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>" />
  46
  47 <span class="title"><?php echo xlt('Work/School Note'); ?></span><br /><br />
  48
  49 <div style="margin: 10px;">
  50 <input type="button" class="save" value="    <?php echo xla('Save'); ?>    "> &nbsp;
  51 <input type="button" class="dontsave" value="<?php echo xla('Don\'t Save'); ?>"> &nbsp;
  52 </div>
  53
  54 <select name="note_type">
  55 <option value="WORK NOTE"><?php echo xlt('WORK NOTE'); ?></option>
  56 <option value="SCHOOL NOTE"><?php echo xlt('SCHOOL NOTE'); ?></option>
  57 </select>
  58 <br />
  59 <b><?php echo xlt('MESSAGE:'); ?></b>
  60 <br />
  61 <textarea name="message" id="message" rows="7" cols="47"></textarea>
  62 <br />
  63
  64 <?php
  65 // commented out below private field, because no field in database, and causes error.
  66 ?>
  67 <!--
  68 <input type="checkbox" name="private" id="private"><label for="private">This note is private</label>
  69 <br />
  70 -->
  71
  72 <br />
  73 <b><?php echo xlt('Signature:'); ?></b>
  74 <br />
  75
  76 <table>
  77 <tr><td>
  78 <?php echo xlt('Doctor:'); ?>
  79 <input type="text" name="doctor" id="doctor" value="<?php echo attr($provider_results["fname"]) . ' ' . attr($provider_results["lname"]); ?>">
  80 </td>
  81
  82 <td>
  83 <span class="text"><?php echo xlt('Date'); ?></span>
  84    <input type='text' size='10' class='datepicker' name='date_of_signature' id='date_of_signature'
  85     value='<?php echo attr(date('Y-m-d', time())); ?>'
  86     title='<?php echo xla('yyyy-mm-dd'); ?>' />
  87 </td>
  88 </tr>
  89 </table>
  90
  91 <div style="margin: 10px;">
  92 <input type="button" class="save" value="    <?php echo xla('Save'); ?>    "> &nbsp;
  93 <input type="button" class="dontsave" value="<?php echo xla('Don\'t Save'); ?>"> &nbsp;
  94 </div>
  95
  96 </form>
  97
  98 </body>
  99
 100 <script>
 101
 102 // jQuery stuff to make the page a little easier to use
 103
 104 $(function () {
 105     $(".save").click(function() { top.restoreSession(); $('#my_form').submit(); });
 106     $(".dontsave").click(function() { parent.closeTab(window.name, false); });
 107     //$("#printform").click(function() { PrintForm(); });
 108
 109     $('.datepicker').datetimepicker({
 110         <?php $datetimepicker_timepicker = false; ?>
 111         <?php $datetimepicker_showseconds = false; ?>
 112         <?php $datetimepicker_formatInput = false; ?>
 113         <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 114         <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 115     });
 116 });
 117
 118 </script>
 119
 120 </html>