interface/forms/aftercare_plan/new.php

   1 <?php
   2 /**
   3  *
   4  * Copyright (C) 2012-2013 Naina Mohamed <naina@capminds.com> CapMinds Technologies
   5  *
   6  * LICENSE: This program is free software; you can redistribute it and/or
   7  * modify it under the terms of the GNU General Public License
   8  * as published by the Free Software Foundation; either version 3
   9  * of the License, or (at your option) any later version.
  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  * You should have received a copy of the GNU General Public License
  15  * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
  16  *
  17  * @package OpenEMR
  18  * @author  Naina Mohamed <naina@capminds.com>
  19  * @link    http://www.open-emr.org
  20  */
  21
  22
  23 //SANITIZE ALL ESCAPES
  24 $sanitize_all_escapes=true;
  25
  26 //STOP FAKE REGISTER GLOBALS
  27 $fake_register_globals=false;
  28
  29 include_once("../../globals.php");
  30 include_once("$srcdir/api.inc");
  31 require_once("$srcdir/patient.inc");
  32 require_once("$srcdir/options.inc.php");
  33 require_once("$srcdir/htmlspecialchars.inc.php");
  34 formHeader("Form:AfterCare Planning");
  35 $returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
  36 $formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
  37 $obj = $formid ? formFetch("form_aftercare_plan", $formid) : array();
  38
  39 ?>
  40 <html>
  41 <head>
  42 <?php html_header_show();?>
  43 <script type="text/javascript" src="../../../library/dialog.js"></script>
  44 <!-- pop up calendar -->
  45 <style type="text/css">@import url(<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.css);</style>
  46 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.js"></script>
  47 <?php include_once("{$GLOBALS['srcdir']}/dynarch_calendar_en.inc.php"); ?>
  48 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar_setup.js"></script>
  49 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js"></script>
  50 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dialog.js"></script>
  51 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  52
  53 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/js/jquery-1.9.1.min.js"></script>
  54 <script language="JavaScript">
  55  $(document).ready(function() {
  56   var win = top.printLogSetup ? top : opener.top;
  57   win.printLogSetup(document.getElementById('printbutton'));
  58  });
  59 </script>
  60
  61 </head>
  62 <body class="body_top">
  63 <p><span class="forms-title"><?php echo xlt('AfterCare Planning'); ?></span></p>
  64 </br>
  65 <?php
  66 echo "<form method='post' name='my_form' " .
  67   "action='$rootdir/forms/aftercare_plan/save.php?id=" . attr($formid) ."'>\n";
  68 ?>
  69 <table  border="0">
  70 <tr>
  71 <td align="left" class="forms" class="forms"><?php echo xlt('Client Name' ); ?>:</td>
  72                 <td class="forms">
  73                         <label class="forms-data"> <?php if (is_numeric($pid)) {
  74
  75     $result = getPatientData($pid, "fname,lname,squad");
  76    echo htmlspecialchars(text($result['fname'])." ".text($result['lname']));}
  77    $patient_name=($result['fname'])." ".($result['lname']);
  78    ?>
  79    </label>
  80    <input type="hidden" name="client_name" value="<?php echo attr($patient_name);?>">
  81                 </td>
  82                 <td align="left"  class="forms"><?php echo xlt('DOB'); ?>:</td>
  83                 <td class="forms">
  84                 <label class="forms-data"> <?php if (is_numeric($pid)) {
  85
  86     $result = getPatientData($pid, "*");
  87    echo htmlspecialchars($result['DOB']);}
  88    $dob=($result['DOB']);
  89    ?>
  90    </label>
  91      <input type="hidden" name="DOB" value="<?php echo attr($dob);?>">
  92                 </td>
  93                 </tr>
  94 <tr>
  95
  96
  97   <td align="left" class="forms"><?php echo xlt('Admit Date'); ?>:</td>
  98                 <td class="forms">
  99                            <input type='text' size='10' name='admit_date' id='admission_date' <?php echo attr($disabled); ?>;
 100                            value='<?php echo attr($obj{"admit_date"}); ?>'
 101                            title='<?php echo xla('yyyy-mm-dd Date of service'); ?>'
 102        onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
 103         <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 104         id='img_admission_date' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
 105         title='<?php echo xla('Click here to choose a date'); ?>'>
 106                 </td>
 107
 108
 109
 110                 <td align="left" class="forms"><?php echo xlt('Discharged'); ?>:</td>
 111                 <td class="forms">
 112                            <input type='text' size='10' name='discharged' id='discharge_date' <?php echo attr($disabled); ?>;
 113       value='<?php echo attr($obj{"discharged"}); ?>'
 114        title='<?php echo xla('yyyy-mm-dd Date of service'); ?>'
 115        onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
 116         <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 117         id='img_discharge_date' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
 118         title='<?php echo xla('Click here to choose a date'); ?>'>
 119                 </td>
 120         </tr>
 121         <tr>
 122                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 123         </tr>
 124                 <tr>
 125
 126                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal and Methods');?></B></td>
 127
 128         </tr>
 129         <tr>
 130                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 131         </tr>
 132         <tr>
 133
 134                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal A');?>:</B>&nbsp;<?php echo xlt('Acute Intoxication/Withdrawal'); ?></td>
 135
 136         </tr>
 137         <tr>
 138                 <td align="right" class="forms">1.</td>
 139                 <td colspan="3"><textarea name="goal_a_acute_intoxication" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication"});?></textarea></td>
 140
 141         </tr>
 142         <tr>
 143                 <td align="right" class="forms">2.</td>
 144                 <td colspan="3"><textarea name="goal_a_acute_intoxication_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication_I"});?></textarea></td>
 145
 146         </tr>
 147         <tr>
 148                 <td align="right" class="forms">3.</td>
 149                 <td colspan="3"><textarea name="goal_a_acute_intoxication_II" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_a_acute_intoxication_II"});?></textarea></td>
 150
 151
 152         <tr>
 153
 154                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal B');?>:</B>&nbsp;<?php  echo xlt('Emotional / Behavioral Conditions & Complications'); ?></td>
 155
 156         </tr>
 157         <tr>
 158                 <td align="right" class="forms">1.</td>
 159                 <td colspan="3"><textarea name="goal_b_emotional_behavioral_conditions" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_b_emotional_behavioral_conditions"});?></textarea></td>
 160
 161         </tr>
 162         <tr>
 163                 <td align="right" class="forms">2.</td>
 164                 <td colspan="3"><textarea name="goal_b_emotional_behavioral_conditions_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_b_emotional_behavioral_conditions_I"});?></textarea></td>
 165
 166         </tr>
 167
 168
 169                 <td class="forms-subtitle" colspan="4"><B><?php echo xlt('Goal C');?>:</B>&nbsp;<?php  echo xlt('Relapse Potential'); ?></td>
 170
 171         </tr>
 172         <tr>
 173                 <td align="right" class="forms">1.</td>
 174                 <td colspan="3"><textarea name="goal_c_relapse_potential" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_c_relapse_potential"});?></textarea></td>
 175
 176         </tr>
 177         <tr>
 178                 <td align="right" class="forms">2.</td>
 179                 <td colspan="3"><textarea name="goal_c_relapse_potential_I" rows="2" cols="80" wrap="virtual name"><?php echo text($obj{"goal_c_relapse_potential_I"});?></textarea></td>
 180
 181         </tr>
 182
 183         <tr>
 184                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 185         </tr>
 186         <tr>
 187                 <td></td>
 188     <td><input type='submit' value='<?php echo xla('Save'); ?>' class='button-css' />&nbsp;
 189     <input type='button' value='<?php echo xla('Print'); ?>' id='printbutton' class='button-css' />&nbsp;
 190     <input type='button' class='button-css' value='<?php echo xla('Cancel'); ?>'
 191  onclick="top.restoreSession();location='<?php echo "$rootdir/patient_file/encounter/$returnurl" ?>'" /></td>
 192         </tr>
 193 </table>
 194 </form>
 195 <script language="javascript">
 196 /* required for popup calendar */
 197 Calendar.setup({inputField:"admission_date", ifFormat:"%Y-%m-%d", button:"img_admission_date"});
 198 Calendar.setup({inputField:"discharge_date", ifFormat:"%Y-%m-%d", button:"img_discharge_date"});
 199 </script>
 200 <?php
 201 formFooter();
 202 ?>