interface/new/new_comprehensive.php

   1 <?php
   2
   3 /**
   4  * New patient or search patient.
   5  *
   6  * @package   OpenEMR
   7  * @link      http://www.open-emr.org
   8  * @author    Rod Roark <rod@sunsetsystems.com>
   9  * @author    Brady Miller <brady.g.miller@gmail.com>
  10  * @author    Tyler Wrenn <tyler@tylerwrenn.com>
  11  * @copyright Copyright (c) 2009-2021 Rod Roark <rod@sunsetsystems.com>
  12  * @copyright Copyright (c) 2017-2019 Brady Miller <brady.g.miller@gmail.com>
  13  * @copyright Copyright (c) 2020 Tyler Wrenn <tyler@tylerwrenn.com>
  14  * @license   https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  15  */
  16
  17 require_once("../globals.php");
  18 require_once("$srcdir/options.inc.php");
  19 require_once("$srcdir/patient.inc.php");
  20 require_once("$srcdir/validation/LBF_Validation.php");
  21 require_once("$srcdir/patientvalidation.inc.php");
  22
  23 use OpenEMR\Common\Acl\AclMain;
  24 use OpenEMR\Common\Csrf\CsrfUtils;
  25 use OpenEMR\Common\Twig\TwigContainer;
  26 use OpenEMR\Core\Header;
  27
  28 // Check authorization.
  29 if (!AclMain::aclCheckCore('patients', 'demo', '', array('write','addonly'))) {
  30     echo (new TwigContainer(null, $GLOBALS['kernel']))->getTwig()->render('core/unauthorized.html.twig', ['pageTitle' => xl("Search or Add Patient")]);
  31     exit;
  32 }
  33
  34 $CPR = 4; // cells per row
  35
  36 $searchcolor = empty($GLOBALS['layout_search_color']) ?
  37   'var(--yellow)' : $GLOBALS['layout_search_color'];
  38
  39 $WITH_SEARCH = ($GLOBALS['full_new_patient_form'] == '1' || $GLOBALS['full_new_patient_form'] == '2' );
  40 $SHORT_FORM  = ($GLOBALS['full_new_patient_form'] == '2' || $GLOBALS['full_new_patient_form'] == '3' || $GLOBALS['full_new_patient_form'] == '4');
  41
  42 $grparr = array();
  43 getLayoutProperties('DEM', $grparr, '*');
  44
  45 $TOPCPR = empty($grparr['']['grp_columns']) ? 4 : $grparr['']['grp_columns'];
  46
  47 function getLayoutRes()
  48 {
  49     global $SHORT_FORM;
  50     return sqlStatement("SELECT * FROM layout_options " .
  51     "WHERE form_id = 'DEM' AND uor > 0 AND field_id != '' " .
  52     ($SHORT_FORM ? "AND ( uor > 1 OR edit_options LIKE '%N%' ) " : "") .
  53     "ORDER BY group_id, seq");
  54 }
  55
  56 // Determine layout field search treatment from its data type:
  57 // 1 = text field
  58 // 2 = select list
  59 // 0 = not searchable
  60 //
  61 function getSearchClass($data_type)
  62 {
  63     switch ($data_type) {
  64         case 1: // single-selection list
  65         case 10: // local provider list
  66         case 11: // provider list
  67         case 12: // pharmacy list
  68         case 13: // squads
  69         case 14: // address book list
  70         case 26: // single-selection list with add
  71         case 35: // facilities
  72             return 2;
  73         case 2: // text field
  74         case 3: // textarea
  75         case 4: // date
  76             return 1;
  77     }
  78
  79     return 0;
  80 }
  81
  82 $fres = getLayoutRes();
  83 ?>
  84 <!DOCTYPE html>
  85 <html>
  86 <head>
  87 <?php Header::setupHeader(['common','datetime-picker','select2', 'erx']); ?>
  88 <title><?php echo xlt("Search or Add Patient"); ?></title>
  89 <style>
  90 .form-group {
  91     margin-bottom: 0.25rem;
  92 }
  93 </style>
  94
  95 <?php include_once("{$GLOBALS['srcdir']}/options.js.php"); ?>
  96
  97 <script><!--
  98 //Visolve - sync the radio buttons - Start
  99 if((top.window.parent) && (parent.window)){
 100         var wname = top.window.parent.left_nav;
 101         fname = (parent.window.name)?parent.window.name:window.name;
 102         wname.syncRadios();
 103 }//Visolve - sync the radio buttons - End
 104
 105 var mypcc = <?php echo js_escape($GLOBALS['phone_country_code']); ?>;
 106
 107 // This may be changed to true by the AJAX search script.
 108 var force_submit = false;
 109
 110 //code used from http://tech.irt.org/articles/js037/
 111 function replace(string,text,by) {
 112  // Replaces text with by in string
 113  var strLength = string.length, txtLength = text.length;
 114  if ((strLength == 0) || (txtLength == 0)) return string;
 115
 116  var i = string.indexOf(text);
 117  if ((!i) && (text != string.substring(0,txtLength))) return string;
 118  if (i == -1) return string;
 119
 120  var newstr = string.substring(0,i) + by;
 121
 122  if (i+txtLength < strLength)
 123   newstr += replace(string.substring(i+txtLength,strLength),text,by);
 124
 125  return newstr;
 126 }
 127
 128 <?php for ($i = 1; $i <= 3; $i++) { ?>
 129 function auto_populate_employer_address<?php echo $i ?>(){
 130  var f = document.demographics_form;
 131  if (f.form_i<?php echo $i?>subscriber_relationship.options[f.form_i<?php echo $i?>subscriber_relationship.selectedIndex].value == "self") {
 132   f.i<?php echo $i?>subscriber_fname.value=f.form_fname.value;
 133   f.i<?php echo $i?>subscriber_mname.value=f.form_mname.value;
 134   f.i<?php echo $i?>subscriber_lname.value=f.form_lname.value;
 135   f.i<?php echo $i?>subscriber_street.value=f.form_street.value;
 136   f.i<?php echo $i?>subscriber_street_line_2.value=f.form_street_line_2.value;
 137   f.i<?php echo $i?>subscriber_city.value=f.form_city.value;
 138   f.form_i<?php echo $i?>subscriber_state.value=f.form_state.value;
 139   f.i<?php echo $i?>subscriber_postal_code.value=f.form_postal_code.value;
 140   if (f.form_country_code)
 141     f.form_i<?php echo $i?>subscriber_country.value=f.form_country_code.value;
 142   f.i<?php echo $i?>subscriber_phone.value=f.form_phone_home.value;
 143   f.i<?php echo $i?>subscriber_DOB.value=f.form_DOB.value;
 144   f.i<?php echo $i?>subscriber_ss.value=f.form_ss.value;
 145   f.form_i<?php echo $i?>subscriber_sex.value = f.form_sex.value;
 146   f.i<?php echo $i?>subscriber_employer.value=f.form_em_name.value;
 147   f.i<?php echo $i?>subscriber_employer_street.value=f.form_em_street.value;
 148   f.i<?php echo $i?>subscriber_employer_city.value=f.form_em_city.value;
 149   f.form_i<?php echo $i?>subscriber_employer_state.value=f.form_em_state.value;
 150   f.i<?php echo $i?>subscriber_employer_postal_code.value=f.form_em_postal_code.value;
 151   if (f.form_em_country)
 152     f.form_i<?php echo $i?>subscriber_employer_country.value=f.form_em_country.value;
 153  }
 154 }
 155
 156 <?php } ?>
 157
 158 function upperFirst(string,text) {
 159  return replace(string,text,text.charAt(0).toUpperCase() + text.substring(1,text.length));
 160 }
 161
 162 // The ins_search.php window calls this to set the selected insurance.
 163 function set_insurance(ins_id, ins_name) {
 164  var thesel = document.forms[0]['i' + insurance_index + 'provider'];
 165  var theopts = thesel.options; // the array of Option objects
 166  var i = 0;
 167  for (; i < theopts.length; ++i) {
 168   if (theopts[i].value == ins_id) {
 169    theopts[i].selected = true;
 170    return;
 171   }
 172  }
 173  // no matching option was found so create one, append it to the
 174  // end of the list, and select it.
 175  theopts[i] = new Option(ins_name, ins_id, false, true);
 176 }
 177
 178 // Indicates which insurance slot is being updated.
 179 var insurance_index = 0;
 180
 181 // The OnClick handler for searching/adding the insurance company.
 182 function ins_search(ins) {
 183  insurance_index = ins;
 184  return false;
 185 }
 186
 187 function checkNum () {
 188  var re= new RegExp();
 189  re = /^\d*\.?\d*$/;
 190  str=document.forms[0].monthly_income.value;
 191  if(re.exec(str))
 192  {
 193  }else{
 194   alert(<?php echo xlj("Please enter a dollar amount using only numbers and a decimal point."); ?>);
 195  }
 196 }
 197
 198 // This capitalizes the first letter of each word in the passed input
 199 // element.  It also strips out extraneous spaces.
 200 function capitalizeMe(elem) {
 201  var a = elem.value.split(' ');
 202  var s = '';
 203  for(var i = 0; i < a.length; ++i) {
 204   if (a[i].length > 0) {
 205    if (s.length > 0) s += ' ';
 206    s += a[i].charAt(0).toUpperCase() + a[i].substring(1);
 207   }
 208  }
 209  elem.value = s;
 210 }
 211
 212 function divclick(cb, divid) {
 213  var divstyle = document.getElementById(divid).style;
 214  if (cb.checked) {
 215   divstyle.display = 'block';
 216  } else {
 217   divstyle.display = 'none';
 218  }
 219  return true;
 220 }
 221
 222 // Compute the length of a string without leading and trailing spaces.
 223 function trimlen(s) {
 224  var i = 0;
 225  var j = s.length - 1;
 226  for (; i <= j && s.charAt(i) == ' '; ++i);
 227  for (; i <= j && s.charAt(j) == ' '; --j);
 228  if (i > j) return 0;
 229  return j + 1 - i;
 230 }
 231
 232 function validate(f) {
 233   var errMsgs = new Array();
 234     <?php generate_layout_validation('DEM'); ?>
 235     <?php if ($GLOBALS['erx_enable']) { ?>
 236   alertMsg='';
 237   for(i=0;i<f.length;i++){
 238     if(f[i].type=='text' && f[i].value)
 239     {
 240       if(f[i].name == 'form_fname' || f[i].name == 'form_mname' || f[i].name == 'form_lname')
 241       {
 242         alertMsg += checkLength(f[i].name,f[i].value,35);
 243         alertMsg += checkUsername(f[i].name,f[i].value);
 244       }
 245       else if(f[i].name == 'form_street' || f[i].name == 'form_city')
 246       {
 247         alertMsg += checkLength(f[i].name,f[i].value,35);
 248         alertMsg += checkAlphaNumericExtended(f[i].name,f[i].value);
 249       }
 250       else if(f[i].name == 'form_phone_home')
 251       {
 252        alertMsg += checkPhone(f[i].name,f[i].value);
 253       }
 254     }
 255   }
 256   if(alertMsg)
 257   {
 258     alert(alertMsg);
 259     return false;
 260   }
 261     <?php } ?>
 262   var msg = "";
 263   msg += <?php echo xlj('The following fields are required'); ?> + ":\n\n";
 264   for ( var i = 0; i < errMsgs.length; i++ ) {
 265          msg += errMsgs[i] + "\n";
 266   }
 267   msg += "\n" + <?php echo xlj('Please fill them in before continuing.'); ?>;
 268
 269
 270 //Misc  Deceased Date Validation for Future Date
 271 var dateVal = document.getElementById("form_deceased_date").value;
 272 var currentDate;
 273 var d = new Date();
 274 month = '' + (d.getMonth() + 1),
 275 day = '' + d.getDate(),
 276 year = d.getFullYear();
 277 if (month.length < 2) month = '0' + month;
 278 if (day.length < 2) day = '0' + day;
 279 currentDate = year+'-'+month+'-'+day;
 280 if(errMsgs.length > 0 || dateVal > currentDate) {
 281   if(errMsgs.length > 0) {
 282     alert(msg);
 283   }
 284   if(dateVal > currentDate) {
 285     alert(<?php echo xlj("Deceased Date should not be greater than Today"); ?>);
 286     return false;
 287   }
 288 }
 289  return true;
 290 }
 291
 292 function toggleSearch(elem) {
 293  var f = document.forms[0];
 294 <?php if ($WITH_SEARCH) { ?>
 295  // Toggle background color.
 296  if (elem.style.backgroundColor == '')
 297   elem.style.backgroundColor = <?php echo js_escape($searchcolor); ?>;
 298  else
 299   elem.style.backgroundColor = '';
 300
 301  if (!elem.classList.contains("is-invalid") && $.trim($(elem).val()) == '') {
 302   elem.classList.add("is-invalid");
 303 } else {
 304   if($.trim($(elem).val()) != '') {
 305     elem.classList.remove("is-invalid");
 306     elem.classList.remove("is-valid");
 307   }
 308 }
 309 <?php } ?>
 310  if (force_submit) {
 311   force_submit = false;
 312   f.create.value = <?php echo xlj('Create New Patient'); ?>;
 313  }
 314  return true;
 315 }
 316
 317 // If a <select> list is dropped down, this is its name.
 318 var open_sel_name = '';
 319
 320 function selClick(elem) {
 321  if (open_sel_name == elem.name) {
 322   open_sel_name = '';
 323  }
 324  else {
 325   open_sel_name = elem.name;
 326   toggleSearch(elem);
 327  }
 328  return true;
 329 }
 330
 331 function selBlur(elem) {
 332  if (open_sel_name == elem.name) {
 333   open_sel_name = '';
 334  }
 335  return true;
 336 }
 337
 338 // This invokes the patient search dialog.
 339 function searchme() {
 340  var f = document.forms[0];
 341  var url = '../main/finder/patient_select.php?popup=1&csrf_token_form=<?php echo attr_url(CsrfUtils::collectCsrfToken()); ?>';
 342
 343 <?php
 344 $lres = getLayoutRes();
 345
 346 while ($lrow = sqlFetchArray($lres)) {
 347     $field_id  = $lrow['field_id'];
 348     if (strpos($field_id, 'em_') === 0) {
 349         continue;
 350     }
 351
 352     $data_type = $lrow['data_type'];
 353     $fldname = "form_$field_id";
 354     switch (getSearchClass($data_type)) {
 355         case 1:
 356             echo
 357             " if (f." . attr($fldname) . ".style.backgroundColor != '' && trimlen(f." . attr($fldname) . ".value) > 0) {\n" .
 358             "  url += '&" . attr($field_id) . "=' + encodeURIComponent(f." . attr($fldname) . ".value);\n" .
 359             " }\n";
 360             break;
 361         case 2:
 362             echo
 363             " if (f." . attr($fldname) . ".style.backgroundColor != '' && f." . attr($fldname) . ".selectedIndex > 0) {\n" .
 364             "  url += '&" . attr($field_id) . "=' + encodeURIComponent(f." . attr($fldname) . ".options[f." . attr($fldname) . ".selectedIndex].value);\n" .
 365             " }\n";
 366             break;
 367     }
 368 }
 369 ?>
 370
 371  dlgopen(url, '_blank', 700, 500);
 372 }
 373 function srchDone(pid){
 374     top.restoreSession();
 375     document.location.href = "./../../patient_file/summary/demographics.php?set_pid=" + encodeURIComponent(pid);
 376 }
 377 //-->
 378
 379 </script>
 380 </head>
 381
 382 <body class="body_top">
 383
 384 <?php
 385 /*Get the constraint from the DB-> LBF forms accordinf the form_id*/
 386 $constraints = LBF_Validation::generate_validate_constraints("DEM");
 387 ?>
 388 <script> var constraints = <?php echo $constraints; ?>; </script>
 389     <div class="container-xl">
 390         <div class="row">
 391             <div class="col-md-12">
 392                 <h2><?php echo xlt('Search or Add Patient');?></h2>
 393             </div>
 394         </div>
 395         <div class="row">
 396             <div class="<?php echo $BS_COL_CLASS; ?>-12">
 397                 <div class="accordion" id="dem_according">
 398                 <form action='new_comprehensive_save.php' name='demographics_form' id='DEM'
 399                       method='post'
 400                       onsubmit='return submitme(<?php echo $GLOBALS['new_validate'] ? 1 : 0;?>,event,"DEM",constraints)'>
 401                     <!--  Was: class='form-inline' -->
 402                     <input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>" />
 403
 404                     <table class='table table-sm w-100' cellspacing='8'>
 405                     <tr>
 406                       <td class="text-left align-top">
 407                     <?php
 408                     if ($SHORT_FORM) {
 409                         echo "<div class='mx-auto'>";
 410                     } ?>
 411                     <?php
 412
 413                     function end_cell()
 414                     {
 415                         global $item_count;
 416                         if ($item_count > 0) {
 417                             echo "</div>"; // end BS column
 418                             $item_count = 0;
 419                         }
 420                     }
 421
 422                     function end_row()
 423                     {
 424                         global $cell_count, $CPR, $BS_COL_CLASS;
 425                         end_cell();
 426                         if ($cell_count > 0 && $cell_count < $CPR) {
 427                             // Create a cell occupying the remaining bootstrap columns.
 428                             // BS columns will be less than 12 if $CPR is not 2, 3, 4, 6 or 12.
 429                             $bs_cols_remaining = ($CPR - $cell_count) * intval(12 / $CPR);
 430                             echo "<div class='$BS_COL_CLASS-$bs_cols_remaining'></div>";
 431                         }
 432                         if ($cell_count > 0) {
 433                             echo "</div><!-- End BS row -->\n";
 434                         }
 435                         $cell_count = 0;
 436                     }
 437
 438                     function end_group()
 439                     {
 440                         global $last_group, $SHORT_FORM;
 441                         if (strlen($last_group) > 0) {
 442                             end_row();
 443                             echo "</div>\n"; // end BS container
 444                             if (!$SHORT_FORM) {
 445                                 echo "</div>\n";
 446                             }
 447                         }
 448                         echo "</div>";
 449                     }
 450
 451                     $last_group    = '';
 452                     $cell_count    = 0;
 453                     $item_count    = 0;
 454                     $display_style = 'block';
 455                     $group_seq     = 0; // this gives the DIV blocks unique IDs
 456                     $condition_str = '';
 457
 458                     while ($frow = sqlFetchArray($fres)) {
 459                         $this_group = $frow['group_id'];
 460                         $titlecols  = $frow['titlecols'];
 461                         $datacols   = $frow['datacols'];
 462                         $data_type  = $frow['data_type'];
 463                         $field_id   = $frow['field_id'];
 464                         $list_id    = $frow['list_id'];
 465                         $currvalue  = '';
 466
 467                         // Accumulate action conditions into a JSON expression for the browser side.
 468                         accumActionConditions($frow, $condition_str);
 469
 470                         if (strpos($field_id, 'em_') === 0) {
 471                             $tmp = substr($field_id, 3);
 472                             if (isset($result2[$tmp])) {
 473                                 $currvalue = $result2[$tmp];
 474                             }
 475                         } else {
 476                             if (isset($result[$field_id])) {
 477                                 $currvalue = $result[$field_id];
 478                             }
 479                         }
 480
 481                         // Handle a data category (group) change.
 482                         if (strcmp($this_group, $last_group) != 0) {
 483                             if (!$SHORT_FORM) {
 484                                 end_group();
 485                                 $group_seq++;    // ID for DIV tags
 486                                 $group_name = $grparr[$this_group]['grp_title'];
 487
 488                                 $group_seq_attr = attr($group_seq);
 489                                 $checked = ($display_style == 'block') ? "show" : "";
 490                                 $group_name_xl = text(xl_layout_label($group_name));
 491                                 $onclick = attr_js("div_" . $group_seq);
 492                                 $init_open = $grparr[$this_group]['grp_init_open'];
 493                                 if ($checked != "show") {
 494                                     $checked = ($init_open == 1) ? $checked . " show" : $checked;
 495                                 }
 496                                 echo <<<HTML
 497                                 <div class="card">
 498                                     <div class="card-header p-0 bg-secondary" id="header_{$group_seq_attr}">
 499                                         <h2 class="mb-0">
 500                                             <button class="btn btn-link btn-block text-light text-left" type="button" data-toggle="collapse" data-target="#div_{$group_seq_attr}" aria-expanded="true" aria-controls="{$group_seq_attr}">$group_name_xl</button>
 501                                         </h2>
 502                                     </div>
 503                                     <div id="div_{$group_seq_attr}" class="bg-light collapse {$checked}" aria-labelledby="header_{$group_seq_attr}" >
 504                                         <div class="container-xl card-body">
 505                                 HTML;
 506                                 $display_style = 'none';
 507                             } elseif (strlen($last_group) == 0) {
 508                                 echo " <div class='container-xl'>\n";
 509                             }
 510                             $CPR = empty($grparr[$this_group]['grp_columns']) ? $TOPCPR : $grparr[$this_group]['grp_columns'];
 511                             $last_group = $this_group;
 512                         }
 513
 514                       // Handle starting of a new row.
 515                         if (($titlecols > 0 && $cell_count >= $CPR) || $cell_count == 0) {
 516                             end_row();
 517                             echo "<div class='form-group row'>";
 518                         }
 519
 520                         if ($item_count == 0 && $titlecols == 0) {
 521                             $titlecols = 1;
 522                         }
 523
 524                         $field_id_label = 'label_' . $frow['field_id'];
 525
 526                         // Handle starting of a new label cell.
 527                         if ($titlecols > 0) {
 528                             end_cell();
 529                             $bs_cols = $titlecols * intval(12 / $CPR);
 530                             echo "<div class='$BS_COL_CLASS-$bs_cols ";
 531                             echo ($frow['uor'] == 2) ? "required" : "";
 532                             echo "' id='" . attr($field_id_label) . "'";
 533                             echo ">";
 534                             $cell_count += $titlecols;
 535                         }
 536
 537                         // $item_count is the number of title and data items in the current cell.
 538                         ++$item_count;
 539
 540                         if ($datacols == 0) {
 541                             // Data will be in the same cell, so prevent wrapping between title and data.
 542                             echo "<span class='text-nowrap mr-2'>"; // mb-2 doesn't work here
 543                         }
 544
 545
 546                         // Modified 6-09 by BM - Translate if applicable
 547                         if ($frow['title']) {
 548                             echo (text(xl_layout_label($frow['title'])) . ":");
 549                         }
 550
 551                         // Handle starting of a new data cell.
 552                         if ($datacols > 0) {
 553                             $id_field_text = "text_" . $frow['field_id'];
 554                             end_cell();
 555                             $bs_cols = $datacols * intval(12 / $CPR);
 556                             echo "<div class='$BS_COL_CLASS-$bs_cols'";
 557                             echo " id='" . attr($id_field_text) . "'";
 558                             echo ">";
 559                             $cell_count += $datacols;
 560                         }
 561
 562                         ++$item_count;
 563
 564                         if ($item_count > 1) {
 565                             echo "&nbsp;";
 566                         }
 567
 568                         // 'smallform' can be used to add arbitrary CSS classes. Note the leading space.
 569                         $frow['smallform'] = ' form-control-sm mw-100' . ($datacols ? '' : ' mb-1');
 570
 571                         // set flag so we don't bring in session pid data for a new pt form
 572                         $frow['blank_form'] = false;
 573                         if (
 574                             $frow['data_type'] == "52"
 575                             || $frow['data_type'] == "53"
 576                             || $frow['data_type'] == "54"
 577                         ) {
 578                             $frow['blank_form'] = true;
 579                         }
 580                         generate_form_field($frow, $currvalue);
 581
 582                         if ($datacols == 0) {
 583                             // End nowrap
 584                             echo "</span> "; // space to allow wrap between spans
 585                         }
 586                     }
 587
 588                     end_group();
 589                     ?>
 590
 591                     <?php
 592                     if (!$GLOBALS['simplified_demographics']) {
 593                         $insurancei = getInsuranceProviders();
 594                         $pid = 0;
 595                         if ($GLOBALS['insurance_only_one']) {
 596                             $insurance_headings = array(xl("Primary Insurance Provider"));
 597                             $insurance_info = array();
 598                             $insurance_info[1] = getInsuranceData($pid, "primary");
 599                         } else {
 600                             $insurance_headings = array(xl("Primary Insurance Provider"), xl("Secondary Insurance Provider"), xl("Tertiary Insurance provider"));
 601                             $insurance_info = array();
 602                             $insurance_info[1] = getInsuranceData($pid, "primary");
 603                             $insurance_info[2] = getInsuranceData($pid, "secondary");
 604                             $insurance_info[3] = getInsuranceData($pid, "tertiary");
 605                         }
 606                         $insuranceTitle = xlt("Insurance");
 607                         echo <<<HTML
 608                         <div class="card">
 609                             <div class="card-header p-0 bg-secondary" id="header_ins">
 610                                 <h2 class="mb-0">
 611                                     <button class="btn btn-link btn-block text-light text-left" type="button" data-toggle="collapse" data-target="#div_ins" aria-expanded="true" aria-controls="ins">$insuranceTitle</button>
 612                                 </h2>
 613                             </div>
 614                             <div id="div_ins" class="bg-light collapse" aria-labelledby="header_ins" >
 615                                 <div class="container-xl card-body">
 616                         HTML;
 617
 618                         for ($i = 1; $i <= sizeof($insurance_info); $i++) {
 619                             $result3 = $insurance_info[$i];
 620                             ?>
 621                         <div class="row p-3">
 622                           <div class="col-md-12 mb-2">
 623                             <div class="input-group">
 624                               <label class='col-form-label mr-2 required'><?php echo text($insurance_headings[$i - 1]) . ":"?></label>
 625                               <select name="i<?php echo attr($i); ?>provider" class="form-control">
 626                                   <option value=""><?php echo xlt('Unassigned'); ?></option>
 627                                   <?php
 628                                     foreach ($insurancei as $iid => $iname) {
 629                                         echo "<option value='" . attr($iid) . "'";
 630                                         if (!empty($result3["provider"]) && (strtolower($iid) == strtolower($result3["provider"]))) {
 631                                             echo " selected";
 632                                         }
 633                                         echo ">" . text($iname) . "</option>\n";
 634                                     }
 635                                     ?>
 636                               </select>
 637                               <div class="input-group-append">
 638                                 <a class='btn btn-primary text-white medium_modal' href='../practice/ins_search.php' onclick='ins_search(<?php echo attr_js($i); ?>)'><?php echo xlt('Search/Add Insurer'); ?></a>
 639                               </div>
 640                             </div>
 641                           </div>
 642                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('Plan Name'); ?>:</label>
 643                           <div class="col-md-5 mb-2">
 644                             <input type='entry' class='form-control' size='20' name='i<?php echo attr($i); ?>plan_name' value="<?php echo attr($result3["plan_name"] ?? ''); ?>" onchange="capitalizeMe(this);" />
 645                           </div>
 646                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('Subscriber'); ?>:</label>
 647                           <div class="col-md-5 mb-2 form-inline">
 648                             <input type='entry' class='form-control' size='10' name='i<?php echo attr($i); ?>subscriber_fname' value="<?php echo attr($result3["subscriber_fname"] ?? ''); ?>" onchange="capitalizeMe(this);" />
 649                             <input type='entry' class='form-control' size='3' name='i<?php echo attr($i); ?>subscriber_mname' value="<?php echo attr($result3["subscriber_mname"] ?? ''); ?>" onchange="capitalizeMe(this);" />
 650                             <input type='entry' class='form-control' size='10' name='i<?php echo attr($i); ?>subscriber_lname' value="<?php echo attr($result3["subscriber_lname"] ?? ''); ?>" onchange="capitalizeMe(this);" />
 651                           </div>
 652                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('Effective Date'); ?>: </label>
 653                           <div class="col-md-5 mb-2">
 654                             <input type='entry' size='11' class='datepicker form-control' name='i<?php echo attr($i); ?>effective_date' id='i<?php echo attr($i); ?>effective_date' value='<?php echo attr($result3['date'] ?? ''); ?>' />
 655                           </div>
 656                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('Relationship'); ?>:</label>
 657                           <div class="col-md-5 mb-2">
 658                             <?php
 659                             generate_form_field(array('data_type' => 1,'field_id' => ('i' . $i . 'subscriber_relationship'),'list_id' => 'sub_relation','empty_title' => ' ', 'smallform' => 'true'), ($result3['subscriber_relationship'] ?? ''));
 660                             ?>
 661                             <a href="javascript:popUp('../../interface/patient_file/summary/browse.php?browsenum=<?php echo attr_url($i); ?>')" class='text'>(<?php echo xlt('Browse'); ?>)</a>
 662                           </div>
 663                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('Policy Number'); ?>:</label>
 664                           <div class="col-md-5 mb-2">
 665                             <input type='entry' class='form-control' size='16' name='i<?php echo attr($i); ?>policy_number' value="<?php echo attr($result3["policy_number"] ?? ''); ?>" onkeyup='policykeyup(this)' />
 666                           </div>
 667                           <label class='col-form-label col-md-1 mb-2'><?php echo xlt('D.O.B.'); ?>:</label>
 668                           <div class="col-md-5 mb-2">
 669                             <input type='entry' size='11' class='datepicker-past form-control' name='i<?php echo attr($i); ?>subscriber_DOB' id='i<?php echo attr($i); ?>subscriber_DOB' value='<?php echo attr($result3['subscriber_DOB'] ?? ''); ?>' />
 670                           </div>
 671                           <label class='col-form-label col-md-1 required'><?php echo xlt('Group Number'); ?>:</label>
 672                           <div class="col-md-5 mb-2">
 673                             <input type='entry' class='form-control' size='16' name='i<?php echo attr($i); ?>group_number' value="<?php echo attr($result3["group_number"] ?? ''); ?>" onkeyup='policykeyup(this)' />
 674                           </div>
 675                           <label class='col-form-label col-md-1 mb-2'><?php echo xlt('S.S.'); ?>:</label>
 676                           <div class="col-md-5 mb-2">
 677                             <input type='entry' class='form-control' size='11' name='i<?php echo attr($i); ?>subscriber_ss' value="<?php echo attr($result3["subscriber_ss"] ?? ''); ?>" />
 678                           </div>
 679                             <?php echo ($GLOBALS['omit_employers']) ? "<div class='d-none'>" : ""; ?>
 680                             <label class="col-form-label col-md-1 mb-2 required"><?php echo xlt('Subscriber Employer (SE)'); ?>:</label>
 681                             <div class="col-md-5 mb-2">
 682                               <input type='entry' class='form-control' aria-describedby="seHelpBlock" size='25' name='i<?php echo attr($i); ?>subscriber_employer' value="<?php echo attr($result3["subscriber_employer"] ?? ''); ?>" onchange="capitalizeMe(this);" />
 683                               <small id="seHelpBlock" class="form-text text-muted">
 684                                 <?php echo xlt('if unemployed enter Student'); ?>, <?php echo xlt('PT Student, or leave blank'); ?>.
 685                               </small>
 686                             </div>
 687                             <?php echo ($GLOBALS['omit_employers']) ? "</div>" : ""; ?>
 688                           <label class='col-form-label col-md-1 mb-2'><?php echo xlt('Sex'); ?>:</label>
 689                           <div class="col-md-5 mb-2">
 690                             <?php
 691                             generate_form_field(array('data_type' => 1,'field_id' => ('i' . $i . 'subscriber_sex'),'list_id' => 'sex', 'smallform' => 'true'), $result3['subscriber_sex'] ?? '');
 692                             ?>
 693                           </div>
 694                             <?php echo ($GLOBALS['omit_employers']) ? "<div class='d-none'>" : ""; ?>
 695                             <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('SE Address'); ?>:</label>
 696                             <div class="col-md-5 mb-2">
 697                               <input type='entry' class='form-control' size='25' name='i<?php echo attr($i); ?>subscriber_employer_street' value="<?php echo attr($result3["subscriber_employer_street"] ?? ''); ?>" onchange="capitalizeMe(this);" />
 698                             </div>
 699                             <?php echo ($GLOBALS['omit_employers']) ? "</div>" : ""; ?>
 700                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('Subscriber Address Line 1'); ?>:</label>
 701                           <div class="col-md-5 mb-2">
 702                             <input type='entry' class='form-control' size='25' name='i<?php echo attr($i); ?>subscriber_street' value="<?php echo attr($result3["subscriber_street"] ?? ''); ?>" onchange="capitalizeMe(this);" />
 703                           </div>
 704                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('Subscriber Address Line 2'); ?>:</label>
 705                           <div class="col-md-5 mb-2">
 706                             <input type='entry' class='form-control' size='25' name='i<?php echo attr($i); ?>subscriber_street_line_2' value="<?php echo attr($result3["subscriber_street_line_2"] ?? ''); ?>" onchange="capitalizeMe(this);" />
 707                           </div>
 708                             <?php echo ($GLOBALS['omit_employers']) ? "<div class='d-none'>" : ""; ?>
 709                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('SE City'); ?>:</label>
 710                           <div class="col-md-5 mb-2">
 711                             <input type='entry' class='form-control' size='15' name='i<?php echo attr($i); ?>subscriber_employer_city' value="<?php echo attr($result3["subscriber_employer_city"] ?? ''); ?>" onchange="capitalizeMe(this);" />
 712                           </div>
 713                             <?php echo ($GLOBALS['omit_employers']) ? "</div>" : ""; ?>
 714                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('City'); ?>:</label>
 715                           <div class="col-md-5 mb-2">
 716                             <input type='entry' class='form-control' size='15' name='i<?php echo attr($i); ?>subscriber_city' value="<?php echo attr($result3["subscriber_city"] ?? ''); ?>" onchange="capitalizeMe(this);" />
 717                           </div>
 718                             <?php echo ($GLOBALS['omit_employers']) ? "<div class='d-none'>" : ""; ?>
 719                           <label class='col-form-label col-md-1 mb-2 required'><?php echo ($GLOBALS['phone_country_code'] == '1') ? xlt('SE State') : xlt('SE Locality') ?>:</label>
 720                           <div class="col-md-5 mb-2">
 721                             <?php
 722                             generate_form_field(array('data_type' => $GLOBALS['state_data_type'],'field_id' => ('i' . $i . 'subscriber_employer_state'),'list_id' => $GLOBALS['state_list'],'fld_length' => '15','max_length' => '63','edit_options' => 'C', 'smallform' => 'true'), ($result3['subscriber_employer_state'] ?? ''));
 723                             ?>
 724                           </div>
 725                             <?php echo ($GLOBALS['omit_employers']) ? "</div>" : ""; ?>
 726                           <label class='col-form-label col-md-1 mb-2 required'><?php echo ($GLOBALS['phone_country_code'] == '1') ? xlt('State') : xlt('Locality') ?>:</label>
 727                           <div class="col-md-5 mb-2">
 728                             <?php
 729                             generate_form_field(array('data_type' => $GLOBALS['state_data_type'], 'field_id' => ('i' . $i . 'subscriber_state'),'list_id' => $GLOBALS['state_list'],'fld_length' => '15','max_length' => '63','edit_options' => 'C', 'smallform' => 'true'), ($result3['subscriber_state'] ?? ''));
 730                             ?>
 731                           </div>
 732                             <?php echo ($GLOBALS['omit_employers']) ? "<div class='d-none'>" : ""; ?>
 733                           <label class='col-form-label col-md-1 mb-2 required'><?php echo ($GLOBALS['phone_country_code'] == '1') ? xlt('SE Zip Code') : xlt('SE Postal Code') ?>: </label>
 734                           <div class="col-md-5 mb-2">
 735                             <input type='entry' class='form-control' size='10' name='i<?php echo $i?>subscriber_employer_postal_code' value="<?php echo attr($result3["subscriber_employer_postal_code"] ?? ''); ?>" />
 736                           </div>
 737                             <?php echo ($GLOBALS['omit_employers']) ? "</div>" : ""; ?>
 738                           <label class='col-form-label col-md-1 mb-2 required'><?php echo ($GLOBALS['phone_country_code'] == '1') ? xlt('Zip Code') : xlt('Postal Code') ?>: </label>
 739                           <div class="col-md-5 mb-2">
 740                             <input type='entry' class='form-control' size='10' name='i<?php echo attr($i); ?>subscriber_postal_code' value="<?php echo attr($result3["subscriber_postal_code"] ?? ''); ?>" />
 741                           </div>
 742                             <?php echo ($GLOBALS['omit_employers']) ? "<div class='d-none'>" : ""; ?>
 743                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('SE Country'); ?>:</label>
 744                           <div class="col-md-5 mb-2">
 745                             <?php
 746                             generate_form_field(array('data_type' => $GLOBALS['country_data_type'],'field_id' => ('i' . $i . 'subscriber_employer_country'),'list_id' => $GLOBALS['country_list'],'fld_length' => '10','max_length' => '63','edit_options' => 'C', 'smallform' => 'true'), ($result3['subscriber_employer_country'] ?? ''));
 747                             ?>
 748                           </div>
 749                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('Country'); ?>:</label>
 750                           <div class="col-md-5 mb-2">
 751                             <?php
 752                             generate_form_field(array('data_type' => $GLOBALS['country_data_type'],'field_id' => ('i' . $i . 'subscriber_country'),'list_id' => $GLOBALS['country_list'],'fld_length' => '10','max_length' => '63','edit_options' => 'C', 'smallform' => 'true'), ($result3['subscriber_country'] ?? ''));
 753                             ?>
 754                           </div>
 755                             <?php echo ($GLOBALS['omit_employers']) ? "</div>" : ""; ?>
 756                           <label class='col-form-label col-md-1 mb-2'><?php echo xlt('Subscriber Phone'); ?>:</label>
 757                           <div class="col-md-5 mb-2">
 758                             <input type='text' class='form-control' size='20' name='i<?php echo attr($i); ?>subscriber_phone' value='<?php echo attr($result3["subscriber_phone"] ?? ''); ?>' onkeyup='phonekeyup(this,mypcc)' />
 759                           </div>
 760                           <label class='col-form-label col-md-1 mb-2'><?php echo xlt('Co-Pay'); ?>:</label>
 761                           <div class="col-md-5 mb-2">
 762                             <input type='text' class='form-control' size="6" name='i<?php echo attr($i); ?>copay' value="<?php echo attr($result3["copay"] ?? ''); ?>" />
 763                           </div>
 764                           <label class='col-form-label col-md-1 mb-2 required'><?php echo xlt('Accept Assignment'); ?>:</label>
 765                           <div class="col-md-5 mb-2">
 766                             <select class='form-control' name='i<?php echo attr($i); ?>accept_assignment'>
 767                                 <option value="TRUE" <?php echo (strtoupper($result3["accept_assignment"] ?? '') == "TRUE") ? "selected" : ""; ?>><?php echo xlt('YES'); ?></option>
 768                                 <option value="FALSE" <?php echo (strtoupper($result3["accept_assignment"] ?? '') == "FALSE") ? "selected" : ""; ?>><?php echo xlt('NO'); ?></option>
 769                             </select>
 770                           </div>
 771                         </div>
 772                         <hr />
 773                             <?php
 774                         }
 775
 776                         echo "</div>\n";
 777                     } // end of "if not simplified_demographics"
 778                     ?>
 779
 780                     <?php
 781                     if ($SHORT_FORM) {
 782                         echo "  </div>\n";
 783                     } ?>
 784
 785                             </td>
 786                             <td class="text-right align-top text-nowrap" width='1%'>
 787                             <!-- Image upload stuff was here but got moved. -->
 788                             </td>
 789                         </tr>
 790                     </table>
 791                 </form>
 792                 </div>
 793             </div>
 794         </div>
 795         <div class="row">
 796             <div class="col-md-12">
 797                 <div class="btn-group">
 798                     <?php if ($WITH_SEARCH) { ?>
 799                         <button type="button" class="btn btn-secondary btn-search" id="search" value="<?php echo xla('Search'); ?>">
 800                             <?php echo xlt('Search'); ?>
 801                         </button>
 802                     <?php } ?>
 803                     <button type="button" class="btn btn-primary btn-save" name='create' id="create" value="<?php echo xla('Create New Patient'); ?>">
 804                         <?php echo xlt('Create New Patient'); ?>
 805                     </button>
 806                 </div>
 807             </div>
 808         </div>
 809     </div> <!--end of container div -->
 810 <!-- include support for the list-add selectbox feature -->
 811 <?php require($GLOBALS['fileroot'] . "/library/options_listadd.inc.php"); ?>
 812 <script>
 813
 814 // hard code validation for old validation, in the new validation possible to add match rules
 815 <?php if ($GLOBALS['new_validate'] == 0) { ?>
 816 // fix inconsistently formatted phone numbers from the database
 817 var f = document.forms[0];
 818 if (f.form_phone_contact) phonekeyup(f.form_phone_contact,mypcc);
 819 if (f.form_phone_home   ) phonekeyup(f.form_phone_home   ,mypcc);
 820 if (f.form_phone_biz    ) phonekeyup(f.form_phone_biz    ,mypcc);
 821 if (f.form_phone_cell   ) phonekeyup(f.form_phone_cell   ,mypcc);
 822
 823 <?php }?>
 824
 825 <?php echo $date_init; ?>
 826
 827 // -=- jQuery makes life easier -=-
 828
 829 // var matches = 0; // number of patients that match the demographic information being entered
 830 // var override = false; // flag that overrides the duplication warning
 831
 832 $(function () {
 833     $(".medium_modal").on('click', function(e) {
 834         e.preventDefault();e.stopPropagation();
 835         dlgopen('', '', 650, 460, '', '', {
 836             buttons: [
 837                 {text: <?php echo xlj('Close'); ?>, close: true, style: 'default btn-sm'}
 838             ],
 839             //onClosed: 'refreshme',
 840             allowResize: false,
 841             allowDrag: true,
 842             dialogId: '',
 843             type: 'iframe',
 844             url: $(this).attr('href')
 845         });
 846     });
 847     // added to integrate insurance stuff
 848     <?php for ($i = 1; $i <= 3; $i++) { ?>
 849     $("#form_i<?php echo $i?>subscriber_relationship").change(function() { auto_populate_employer_address<?php echo $i?>(); });
 850     <?php } ?>
 851
 852     $('#search').click(function() { searchme(); });
 853     $('#create').click(function() { check()});
 854
 855     var check = function(e) {
 856         var f = document.forms[0];
 857         <?php if ($GLOBALS['new_validate']) {?>
 858             var valid = submitme(<?php echo $GLOBALS['new_validate'] ? 1 : 0;?>, e, "DEM", constraints);
 859         <?php } else {?>
 860             top.restoreSession();
 861             var valid = validate(f);
 862         <?php }?>
 863         if (valid) {
 864             if (force_submit) {
 865                 // In this case dups were shown already and Save should just save.
 866                 top.restoreSession();
 867                 f.submit();
 868                 return;
 869             }
 870
 871         <?php
 872         // D in edit_options indicates the field is used in duplication checking.
 873         // This constructs a list of the names of those fields.
 874         $mflist = "";
 875         $mfres = sqlStatement("SELECT * FROM layout_options " .
 876             "WHERE form_id = 'DEM' AND uor > 0 AND field_id != '' AND " .
 877             "(edit_options LIKE '%D%' OR  edit_options LIKE '%W%' )" .
 878             "ORDER BY group_id, seq");
 879         while ($mfrow = sqlFetchArray($mfres)) {
 880             $field_id  = $mfrow['field_id'];
 881             if (strpos($field_id, 'em_') === 0) {
 882                 continue;
 883             }
 884
 885             if (!empty($mflist)) {
 886                 $mflist .= ",";
 887             }
 888
 889             $mflist .= js_escape($field_id);
 890         }
 891         ?>
 892         <?php if (($GLOBALS['full_new_patient_form'] == '4') && (checkIfPatientValidationHookIsActive())) :?>
 893             // Use zend module patient validation hook to open the controller and send the dup-checker fields.
 894             var url ='<?php echo $GLOBALS['web_root'] . "/interface/modules/zend_modules/public/patientvalidation"; ?>';
 895         <?php else :?>
 896             // Build and invoke the URL to create the dup-checker dialog.
 897             var url = 'new_search_popup.php';
 898         <?php endif;?>
 899
 900         var flds = new Array(<?php echo $mflist; ?>);
 901         var separator = '?';
 902         for (var i = 0; i < flds.length; ++i) {
 903             var fval = $('#form_' + flds[i]).val();
 904             if (fval && fval != '') {
 905                 url += separator;
 906                 separator = '&';
 907                 url += 'mf_' + flds[i] + '=' + encodeURIComponent(fval);
 908             }
 909         }
 910         if (flds == '') {
 911             url += "?close";
 912         } else {
 913             url+="&close";
 914         }
 915         dlgopen(url, '_blank', 875, 500);
 916         } // end function
 917     } // end function
 918
 919 // Set onclick/onfocus handlers for toggling background color.
 920 <?php
 921 $lres = getLayoutRes();
 922 while ($lrow = sqlFetchArray($lres)) {
 923     $field_id  = $lrow['field_id'];
 924     if (strpos($field_id, 'em_') === 0) {
 925         continue;
 926     }
 927
 928     switch (getSearchClass($lrow['data_type'])) {
 929         case 1:
 930             echo "    \$(" . js_escape("#form_" . $field_id) . ").click(function() { toggleSearch(this); });\n";
 931             break;
 932         case 2:
 933             echo "    \$(" . js_escape("#form_" . $field_id) . ").click(function() { selClick(this); });\n";
 934             echo "    \$(" . js_escape("#form_" . $field_id) . ").blur(function() { selBlur(this); });\n";
 935             break;
 936     }
 937 }
 938 ?>
 939
 940     $(".select-dropdown").select2({
 941         theme: "bootstrap4",
 942         dropdownAutoWidth: true,
 943         width: 'resolve',
 944         <?php require($GLOBALS['srcdir'] . '/js/xl/select2.js.php'); ?>
 945     });
 946     if (typeof error !== 'undefined') {
 947         if (error) {
 948             alertMsg(error);
 949         }
 950     }
 951
 952   $('.datepicker').datetimepicker({
 953     <?php $datetimepicker_timepicker = false; ?>
 954     <?php $datetimepicker_showseconds = false; ?>
 955     <?php $datetimepicker_formatInput = true; ?>
 956     <?php $datetimepicker_minDate = false; ?>
 957     <?php $datetimepicker_maxDate = false; ?>
 958     <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 959     <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 960   });
 961   $('.datetimepicker').datetimepicker({
 962     <?php $datetimepicker_timepicker = true; ?>
 963     <?php $datetimepicker_showseconds = false; ?>
 964     <?php $datetimepicker_formatInput = true; ?>
 965     <?php $datetimepicker_minDate = false; ?>
 966     <?php $datetimepicker_maxDate = false; ?>
 967     <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 968     <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 969   });
 970   $('.datepicker-past').datetimepicker({
 971     <?php $datetimepicker_timepicker = false; ?>
 972     <?php $datetimepicker_showseconds = false; ?>
 973     <?php $datetimepicker_formatInput = true; ?>
 974     <?php $datetimepicker_minDate = false; ?>
 975     <?php $datetimepicker_maxDate = '+1970/01/01'; ?>
 976     <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 977     <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 978   });
 979   $('.datetimepicker-past').datetimepicker({
 980     <?php $datetimepicker_timepicker = true; ?>
 981     <?php $datetimepicker_showseconds = false; ?>
 982     <?php $datetimepicker_formatInput = true; ?>
 983     <?php $datetimepicker_minDate = false; ?>
 984     <?php $datetimepicker_maxDate = '+1970/01/01'; ?>
 985     <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 986     <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 987   });
 988   $('.datepicker-future').datetimepicker({
 989     <?php $datetimepicker_timepicker = false; ?>
 990     <?php $datetimepicker_showseconds = false; ?>
 991     <?php $datetimepicker_formatInput = true; ?>
 992     <?php $datetimepicker_minDate = '-1970/01/01'; ?>
 993     <?php $datetimepicker_maxDate = false; ?>
 994     <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
 995     <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
 996   });
 997   $('.datetimepicker-future').datetimepicker({
 998     <?php $datetimepicker_timepicker = true; ?>
 999     <?php $datetimepicker_showseconds = false; ?>
1000     <?php $datetimepicker_formatInput = true; ?>
1001     <?php $datetimepicker_minDate = '-1970/01/01'; ?>
1002     <?php $datetimepicker_maxDate = false; ?>
1003     <?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
1004     <?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
1005   });
1006
1007
1008 }); // end document.ready
1009
1010 // callback for new patient save confirm from new_search_popup.php
1011 // note that dlgclose() callbacks mostly need to init outside dom.
1012 function srcConfirmSave() {
1013     document.forms[0].submit();
1014 }
1015
1016 </script>
1017 <?php /*Include the validation script and rules for this form*/
1018 $form_id = "DEM";
1019 ?>
1020
1021 <?php
1022 //LBF forms use the new validation depending on the global value
1023 $use_validate_js = $GLOBALS['new_validate'];
1024 include_once("$srcdir/validation/validation_script.js.php");?>
1025 <script>
1026     // Array of skip conditions for the checkSkipConditions() function.
1027     var skipArray = [
1028         <?php echo $condition_str; ?>
1029     ];
1030     checkSkipConditions();
1031     $("input").change(function() {
1032         checkSkipConditions();
1033     });
1034     $("select").change(function() {
1035         checkSkipConditions();
1036     });
1037 </script>
1038 </body>
1039 </html>