interface/forms/treatment_plan/new.php

   1 <?php
   2
   3 /**
   4  * treatment plan form.
   5  *
   6  * @package   OpenEMR
   7  * @link      http://www.open-emr.org
   8  * @author    Naina Mohamed <naina@capminds.com>
   9  * @author    Brady Miller <brady.g.miller@gmail.com>
  10  * @copyright Copyright (c) 2012-2013 Naina Mohamed <naina@capminds.com> CapMinds Technologies
  11  * @copyright Copyright (c) 2017-2019 Brady Miller <brady.g.miller@gmail.com>
  12  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  13  */
  14
  15 require_once(__DIR__ . "/../../globals.php");
  16 require_once("$srcdir/api.inc.php");
  17 require_once("$srcdir/patient.inc.php");
  18 require_once("$srcdir/options.inc.php");
  19
  20 use OpenEMR\Common\Csrf\CsrfUtils;
  21 use OpenEMR\Core\Header;
  22
  23 formHeader("Form:Treatment Planning");
  24 $returnurl = 'encounter_top.php';
  25 $formid = (int) (isset($_GET['id']) ? $_GET['id'] : 0);
  26 $obj = $formid ? formFetch("form_treatment_plan", $formid) : array();
  27
  28 // Get the providers list.
  29  $ures = sqlStatement("SELECT id, username, fname, lname FROM users WHERE " .
  30   "authorized != 0 AND active = 1 ORDER BY lname, fname");
  31     ?>
  32 <html><head>
  33
  34 <?php Header::setupHeader('datetime-picker'); ?>
  35
  36 <script>
  37  $(function () {
  38   var win = top.printLogSetup ? top : opener.top;
  39   win.printLogSetup(document.getElementById('printbutton'));
  40
  41   $('.datepicker').datetimepicker({
  42     <?php $datetimepicker_timepicker = false; ?>
  43     <?php $datetimepicker_showseconds = false; ?>
  44     <?php $datetimepicker_formatInput = false; ?>
  45     <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
  46     <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
  47   });
  48  });
  49 </script>
  50
  51 </head>
  52 <body class="body_top">
  53 <p><span class="forms-title"><?php echo xlt('Treatment Planning'); ?></span></p>
  54 <br />
  55 <?php
  56 echo "<form method='post' name='my_form' " .
  57   "action='$rootdir/forms/treatment_plan/save.php?id=" . attr_url($formid) . "'>\n";
  58 ?>
  59 <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>" />
  60 <table  border="0">
  61
  62 <tr>
  63 <td align="left" class="forms" class="forms"><?php echo xlt('Client Name'); ?>:</td>
  64         <td class="forms">
  65             <label class="forms-data"> <?php if (is_numeric($pid)) {
  66                 $result = getPatientData($pid, "fname,lname,squad");
  67                 echo text($result['fname']) . " " . text($result['lname']);
  68                                        }
  69
  70                                        $patient_name = ($result['fname']) . " " . ($result['lname']);
  71                                         ?>
  72    </label>
  73    <input type="hidden" name="client_name" value="<?php echo attr($patient_name);?>">
  74         </td>
  75         <td align="left"  class="forms"><?php echo xlt('DOB'); ?>:</td>
  76         <td class="forms">
  77         <label class="forms-data"> <?php if (is_numeric($pid)) {
  78             $result = getPatientData($pid, "*");
  79             echo text($result['DOB']);
  80                                    }
  81
  82                                    $dob = ($result['DOB']);
  83                                     ?>
  84    </label>
  85      <input type="hidden" name="DOB" value="<?php echo attr($dob);?>">
  86         </td>
  87         </tr>
  88     <tr>
  89       <td align="left"  class="forms"><?php echo xlt('Client Number'); ?>:</td>
  90         <td class="forms">
  91             <label class="forms-data" > <?php if (is_numeric($pid)) {
  92                 $result = getPatientData($pid, "*");
  93                 echo text($result['pid']);
  94                                         }
  95
  96                                         $patient_id = $result['pid'];
  97                                         ?>
  98    </label>
  99     <input type="hidden" name="client_number" value="<?php echo attr($patient_id);?>">
 100         </td>
 101
 102
 103         <td align="left" class="forms"><?php echo xlt('Admit Date'); ?>:</td>
 104         <td class="forms">
 105                <input type='text' size='10' class='datepicker' name='admit_date' id='admission_date' <?php echo attr($disabled) ?>;
 106                value='<?php echo attr($obj["admit_date"]); ?>'
 107                title='<?php echo xla('yyyy-mm-dd Date of service'); ?>' />
 108         </td>
 109
 110         </tr>
 111         <tr>
 112         <td align="left" class="forms"><?php echo xlt('Provider'); ?>:</td>
 113          <td class="forms" width="280px">
 114     <?php
 115
 116     echo "<select name='provider' style='width:60%' />";
 117     while ($urow = sqlFetchArray($ures)) {
 118         echo "    <option value='" . attr($urow['lname']) . "'";
 119         if ($urow['lname'] == attr($obj["provider"])) {
 120             echo " selected";
 121         }
 122
 123         echo ">" . text($urow['lname']);
 124         if ($urow['fname']) {
 125             echo ", " . text($urow['fname']);
 126         }
 127
 128         echo "</option>\n";
 129     }
 130
 131     echo "</select>";
 132     ?>
 133         </td>
 134
 135         </tr>
 136
 137     <tr>
 138
 139   <td colspan='3' nowrap style='font-size:8pt'>
 140    &nbsp;
 141     </td>
 142     </tr>
 143
 144     <tr>
 145         <td align="left" class="forms"><?php echo xlt('Presenting Issue(s)'); ?>:</td>
 146         <td colspan="3"><textarea name="presenting_issues" rows="2" cols="60" wrap="virtual name"><?php echo text($obj["presenting_issues"]);?></textarea></td>
 147
 148     </tr>
 149     <tr>
 150         <td align="left" class="forms"><?php echo xlt('Patient History'); ?>:</td>
 151         <td colspan="3"><textarea name="patient_history" rows="2" cols="60" wrap="virtual name"><?php echo text($obj["patient_history"]);?></textarea></td>
 152
 153     </tr>
 154     <tr>
 155
 156         <td align="left" class="forms"><?php echo xlt('Medications'); ?>:</td>
 157         <td colspan="3"><textarea name="medications" rows="2" cols="60" wrap="virtual name"><?php echo text($obj["medications"]);?></textarea></td>
 158
 159
 160     </tr>
 161     <tr>
 162         <td align="left" class="forms"><?php echo xlt('Anyother Relevant Information'); ?>:</td>
 163         <td colspan="3"><textarea name="anyother_relevant_information" rows="2" cols="60" wrap="virtual name"><?php echo text($obj["anyother_relevant_information"]);?></textarea></td>
 164
 165     </tr>
 166     <tr>
 167         <td align="left" class="forms"><?php echo xlt('Diagnosis'); ?>:</td>
 168         <td colspan="3"><textarea name="diagnosis" rows="2" cols="60" wrap="virtual name"><?php echo text($obj["diagnosis"]);?></textarea></td>
 169
 170     </tr>
 171     <tr>
 172         <td align="left" class="forms"><?php echo xlt('Treatment Received'); ?>:</td>
 173         <td colspan="3"><textarea name="treatment_received" rows="2" cols="60" wrap="virtual name"><?php echo text($obj["treatment_received"]);?></textarea></td>
 174
 175     </tr>
 176     <tr>
 177         <td align="left" class="forms"><?php echo xlt('Recommendation For Follow Up'); ?>:</td>
 178         <td colspan="3"><textarea name="recommendation_for_follow_up" rows="2" cols="60" wrap="virtual name"><?php echo text($obj["recommendation_for_follow_up"]);?></textarea></td>
 179
 180     </tr>
 181     <tr>
 182         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 183     </tr>
 184     <tr>
 185         <td align="left colspan="3" style="padding-bottom:7px;"></td>
 186     </tr>
 187     <tr>
 188         <td></td>
 189     <td><input type='submit'  value='<?php echo xla('Save');?>' class="button-css">&nbsp;
 190   <input type='button' value='<?php echo xla('Print'); ?>' id='printbutton' />&nbsp;
 191
 192     <input type='button' class="button-css" value='<?php echo xla('Cancel');?>'
 193  onclick="parent.closeTab(window.name, false)" /></td>
 194     </tr>
 195 </table>
 196 </form>
 197 <?php
 198 formFooter();
 199 ?>