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  * sherwingaddis@gmail.com added bootstrap 2023
  14  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  15  */
  16
  17
  18 require_once dirname(__FILE__, 3) . "/globals.php";
  19 require_once("$srcdir/api.inc.php");
  20
  21 use OpenEMR\Common\Csrf\CsrfUtils;
  22 use OpenEMR\Core\Header;
  23
  24 formHeader("Form: note");
  25 $returnurl = 'encounter_top.php';
  26 $provider_results = sqlQuery("select fname, lname from users where username=?", array($_SESSION["authUser"]));
  27 /* name of this form */
  28 $form_name = "note";
  29 ?>
  30 <html>
  31 <head>
  32     <?php Header::setupHeader('datetime-picker'); ?>
  33     <script>
  34         // required for textbox date verification
  35         const mypcc = <?php echo js_escape($GLOBALS['phone_country_code']); ?>;
  36
  37         $(function () {
  38             $('.datepicker').datetimepicker({
  39                 <?php $datetimepicker_timepicker = false; ?>
  40                 <?php $datetimepicker_showseconds = false; ?>
  41                 <?php $datetimepicker_formatInput = true; ?>
  42                 <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
  43                 <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
  44             });
  45         });
  46     </script>
  47 </head>
  48 <body>
  49 <div class="container">
  50     <div class="row">
  51         <div class="col-sm-12 mt-5">
  52             <h1><?php echo xlt('Work/School Note'); ?></h1>
  53             <?php echo text(date("F d, Y", time())); ?>
  54         </div>
  55         <div class="row">
  56             <div class="col-sm-12">
  57                 <form class="form" method=post action="<?php echo $rootdir . "/forms/" . $form_name . "/save.php?mode=new";?>" name="my_form" id="my_form">
  58                     <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>" />
  59
  60                     <div style="margin: 10px;">
  61                         <input type="button" class="btn btn-primary save" value="    <?php echo xla('Save'); ?>    "> &nbsp;
  62                         <input type="button" class="btn btn-warning dontsave" value="<?php echo xla('Don\'t Save'); ?>"> &nbsp;
  63                     </div>
  64
  65                     <select class="form-control" name="note_type">
  66                         <option value="WORK NOTE"><?php echo xlt('WORK NOTE'); ?></option>
  67                         <option value="SCHOOL NOTE"><?php echo xlt('SCHOOL NOTE'); ?></option>
  68                     </select>
  69                     <br />
  70                     <b><?php echo xlt('MESSAGE:'); ?></b>
  71                     <br />
  72                     <textarea class="form-control" name="message" id="message" rows="7" cols="47"></textarea>
  73                     <br />
  74
  75                     <br />
  76                     <b><?php echo xlt('Signature:'); ?></b>
  77                     <br />
  78                     <table class="table">
  79                         <tr><td>
  80                                 <?php echo xlt('Doctor:'); ?>
  81                                 <input class="form-control" type="text" name="doctor" id="doctor" value="<?php echo attr($provider_results["fname"]) . ' ' . attr($provider_results["lname"]); ?>">
  82                             </td>
  83
  84                             <td>
  85                                 <span class="text"><?php echo xlt('Date'); ?></span>
  86                                 <input class='datepicker form-control' type='text' size='16' name='date_of_signature' id='date_of_signature' autocomplete='off'
  87                                        value='<?php echo attr(oeFormatShortDate(date('Y-m-d'))); ?>'
  88                                        title='<?php echo xla('Date of Signature'); ?>' />
  89                             </td>
  90                         </tr>
  91                     </table>
  92                     <div style="margin: 10px;">
  93                         <input type="button" class="btn btn-primary save" value="    <?php echo xla('Save'); ?>    "> &nbsp;
  94                         <input type="button" class="btn btn-warning dontsave" value="<?php echo xla('Don\'t Save'); ?>"> &nbsp;
  95                     </div>
  96                 </form>
  97             </div>
  98         </div>
  99     </div>
 100 </body>
 101 <script>
 102     // jQuery stuff to make the page a little easier to use
 103     $(function () {
 104         $(".save").click(function() { top.restoreSession(); $('#my_form').submit(); });
 105         $(".dontsave").click(function() { parent.closeTab(window.name, false); });
 106     });
 107 </script>
 108 </html>