interface/new/new.php

   1 <?php
   2 include_once("../globals.php");
   3
   4 // Determine if the registration date should be requested.
   5 $crow = sqlQuery("SELECT count(*) AS count FROM layout_options WHERE " .
   6   "form_id = 'DEM' AND field_id = 'regdate' AND uor > 0");
   7 $regstyle = $crow['count'] ? "" : " style='display:none'";
   8 ?>
   9 <html>
  10
  11 <head>
  12 <?php html_header_show();?>
  13 <link rel="stylesheet" href="<?php echo xl($css_header,'e');?>" type="text/css">
  14 <style type="text/css">@import url(../../library/dynarch_calendar.css);</style>
  15
  16 <script type="text/javascript" src="../../library/textformat.js"></script>
  17 <script type="text/javascript" src="../../library/dynarch_calendar.js"></script>
  18 <script type="text/javascript" src="../../library/dynarch_calendar_en.js"></script>
  19 <script type="text/javascript" src="../../library/dynarch_calendar_setup.js"></script>
  20
  21 <script LANGUAGE="JavaScript">
  22
  23  var mypcc = '1';
  24
  25  function validate() {
  26 <?php if ($GLOBALS['inhouse_pharmacy']) { ?>
  27   var f = document.forms[0];
  28   if (f.refsource.selectedIndex <= 0) {
  29    alert('Please select a referral source!');
  30    return false;
  31   }
  32 <?php } ?>
  33   top.restoreSession();
  34   return true;
  35  }
  36
  37 </script>
  38
  39 </head>
  40
  41 <body class="body_top" onload="javascript:document.new_patient.fname.focus();">
  42
  43 <?php if ($GLOBALS['concurrent_layout']) { ?>
  44 <form name='new_patient' method='post' action="new_patient_save.php"
  45  onsubmit='return validate()'>
  46 <span class='title'><?php xl('Add Patient Record','e');?></span>
  47 <?php } else { ?>
  48 <form name='new_patient' method='post' action="new_patient_save.php"
  49  target='_top' onsubmit='return validate()'>
  50 <a class="title" href="../main/main_screen.php" target="_top" onclick="top.restoreSession()">
  51 <?php xl('Add Patient Record','e');?></a>
  52 <?php } ?>
  53
  54 <br><br>
  55
  56 <center>
  57
  58 <?php if ($GLOBALS['omit_employers']) { ?>
  59    <input type='hidden' name='title' value='' />
  60 <?php } ?>
  61
  62 <table border='0'>
  63
  64 <?php if (!$GLOBALS['omit_employers']) { ?>
  65  <tr>
  66   <td>
  67    <span class='bold'><?php xl('Title','e');?>: </span>
  68   </td>
  69   <td>
  70    <select name='title'>
  71     <option value="Mrs."><?php xl('Mrs.','e');?></option>
  72     <option value="Ms."><?php xl('Ms.','e');?></option>
  73     <option value="Mr."><?php xl('Mr.','e');?></option>
  74     <option value="Dr."><?php xl('Dr.','e');?></option>
  75    </select>
  76   </td>
  77  </tr>
  78 <?php } ?>
  79
  80  <tr>
  81   <td>
  82    <span class='bold'><?php xl('First Name','e');?>: </span>
  83   </td>
  84   <td>
  85    <input type='entry' size='15' name='fname'>
  86   </td>
  87  </tr>
  88
  89  <tr>
  90   <td>
  91    <span class='bold'><?php xl('Middle Name','e');?>: </span>
  92   </td>
  93   <td>
  94    <input type='entry' size='15' name='mname'>
  95   </td>
  96  </tr>
  97
  98  <tr>
  99   <td>
 100    <span class='bold'><?php xl('Last Name','e');?>: </span>
 101   </td>
 102   <td>
 103    <input type='entry' size='15' name='lname'>
 104   </td>
 105  </tr>
 106
 107 <?php if ($GLOBALS['inhouse_pharmacy']) { ?>
 108  <tr>
 109   <td>
 110    <span class='bold'><?php xl('Referral Source','e'); ?>: </span>
 111   </td>
 112   <td>
 113    <select name='refsource'>
 114 <?php
 115  foreach (array('', 'Patient', 'Employee', 'Walk-In', 'Newspaper', 'Radio',
 116   'T.V.', 'Direct Mail', 'Coupon', 'Referral Card', 'Other') as $rs)
 117  {
 118   echo "    <option value='$rs'>$rs</option>\n";
 119  }
 120 ?>
 121    </select>
 122   </td>
 123  </tr>
 124 <?php } ?>
 125
 126  <tr<?php echo $regstyle ?>>
 127   <td>
 128    <span class='bold'><?php xl('Registration Date','e');?>: </span>
 129   </td>
 130   <td>
 131    <input type='text' size='10' name='regdate' id='regdate'
 132     value='<?php echo date('Y-m-d') ?>'
 133     onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)'
 134     title='yyyy-mm-dd' />
 135    <img src='../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 136     id='img_regdate' border='0' alt='[?]' style='cursor:pointer'
 137     title='Click here to choose a date'>
 138    <script LANGUAGE="JavaScript">
 139     Calendar.setup({inputField:"regdate", ifFormat:"%Y-%m-%d", button:"img_regdate"});
 140    </script>
 141   </td>
 142  </tr>
 143
 144  <tr>
 145   <td>
 146    <span class='bold'><?php xl('Patient Number','e');?>: </span>
 147   </td>
 148   <td>
 149    <input type='entry' size='5' name='pubpid'>
 150    <span class='text'><?php xl('omit to autoassign','e');?> &nbsp; &nbsp; </span>
 151   </td>
 152  </tr>
 153
 154  <tr>
 155   <td colspan='2'>
 156    &nbsp;<br>
 157    <input type='submit' name='form_create' value=<?php xl('Create New Patient','e'); ?> />
 158   </td>
 159   <td>
 160   </td>
 161  </tr>
 162
 163 </table>
 164 </center>
 165 </form>
 166
 167 </body>
 168 </html>