interface/forms/note/new.php

   1 <!-- Work/School Note Form created by Nikolai Vitsyn: 2004/02/13 and update 2005/03/30
   2      Copyright (C) Open Source Medical Software
   3
   4      This program is free software; you can redistribute it and/or
   5      modify it under the terms of the GNU General Public License
   6      as published by the Free Software Foundation; either version 2
   7      of the License, or (at your option) any later version.
   8
   9      This program is distributed in the hope that it will be useful,
  10      but WITHOUT ANY WARRANTY; without even the implied warranty of
  11      MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  12      GNU General Public License for more details.
  13
  14     You should have received a copy of the GNU General Public License
  15     along with this program; if not, write to the Free Software
  16     Foundation, Inc., 59 Temple Place - Suite 330, Boston, MA  02111-1307, USA. -->
  17
  18 <?php
  19 include_once("../../globals.php");
  20 include_once("$srcdir/api.inc");
  21 formHeader("Form: note");
  22 ?>
  23
  24 <html><head>
  25 <SCRIPT language="JavaScript"><!--
  26 /******************************************
  27    Today's Date
  28 *******************************************/
  29
  30 Style = 1; //pick a style from below
  31
  32 /*------------------------------
  33 Style 1: March 17, 2000
  34 Style 2: Mar 17, 2000
  35 Style 3: Saturday March 17, 2000
  36 Style 4: Sat Mar 17, 2000
  37 Style 5: Sat March 17, 2000
  38 Style 6: 17 March 2000
  39 Style 7: 17 Mar 2000
  40 Style 8: 17 Mar 00
  41 Style 9: 3/17/00
  42 Style 10: 3-17-00
  43 Style 11: Saturday March 17
  44 --------------------------------*/
  45
  46 months = new Array();
  47 months[1] = "January";  months[7] = "July";
  48 months[2] = "February"; months[8] = "August";
  49 months[3] = "March";    months[9] = "September";
  50 months[4] = "April";    months[10] = "October";
  51 months[5] = "May";      months[11] = "November";
  52 months[6] = "June";     months[12] = "December";
  53
  54 months2 = new Array();
  55 months2[1] = "Jan"; months2[7] = "Jul";
  56 months2[2] = "Feb"; months2[8] = "Aug";
  57 months2[3] = "Mar"; months2[9] = "Sep";
  58 months2[4] = "Apr"; months2[10] = "Oct";
  59 months2[5] = "May"; months2[11] = "Nov";
  60 months2[6] = "Jun"; months2[12] = "Dec";
  61
  62 days = new Array();
  63 days[1] = "Sunday";    days[5] = "Thursday";
  64 days[2] = "Monday";    days[6] = "Friday";
  65 days[3] = "Tuesday";   days[7] = "Saturday";
  66 days[4] = "Wednesday";
  67
  68 days2 = new Array();
  69 days2[1] = "Sun"; days2[5] = "Thu";
  70 days2[2] = "Mon"; days2[6] = "Fri";
  71 days2[3] = "Tue"; days2[7] = "Sat";
  72 days2[4] = "Wed";
  73
  74 todaysdate = new Date();
  75 date  = todaysdate.getDate();
  76 day  = todaysdate.getDay() + 1;
  77 month = todaysdate.getMonth() + 1;
  78 yy = todaysdate.getYear();
  79 year = (yy < 1000) ? yy + 1900 : yy;
  80 year2 = 2000 - year; year2 = (year2 < 10) ? "0" + year2 : year2;
  81
  82 dateline = new Array();
  83 dateline[1] = months[month] + " " + date + ", " + year;
  84 dateline[2] = months2[month] + " " + date + ", " + year;
  85 dateline[3] = days[day] + " " + months[month] + " " + date + ", " + year;
  86 dateline[4] = days2[day] + " " + months2[month] + " " + date + ", " + year;
  87 dateline[5] = days2[day] + " " + months[month] + " " + date + ", " + year;
  88 dateline[6] = date + " " + months[month] + " " + year;
  89 dateline[7] = date + " " + months2[month] + " " + year;
  90 dateline[8] = date + " " + months2[month] + " " + year2;
  91 dateline[9] = month + "/" + date + "/" + year2;
  92 dateline[10] = month + "-" + date + "-" + year2;
  93 dateline[11] = days[day] + " " + months[month] + " " + date;
  94 document.write(dateline[Style]);
  95
  96 //--></SCRIPT>
  97
  98
  99 <link rel=stylesheet href="<?echo $css_header;?>" type="text/css">
 100 </head>
 101
 102
 103 <body <?echo $top_bg_line;?>
 104 topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
 105 <form method=post action="<?echo $rootdir;?>/forms/note/save.php?mode=new" name="my_form">
 106 <span class="title">Work/School Note</span><br></br>
 107
 108 <a href="javascript:document.my_form.submit();" class="link_submit">[Save]</a>
 109 <br>
 110 <a href="<?echo "$rootdir/patient_file/encounter/patient_encounter.php";?>" class="link" style="color: #483D8B">[Don't Save]</a>
 111 <br></br>
 112
 113 <?
 114 //print "$name";
 115 //print "Date:<input type=entry name=$date value=".date("Y-m-d")."> ";
 116 ?>
 117
 118 <tr>
 119   <td>
 120    <select name="note_type">
 121      <option value="WORK NOTE">WORK NOTE</option>
 122      <option value="SCHOOL NOTE">SCHOOL NOTE</option>
 123    <br></select>
 124    </td>
 125 </tr>
 126
 127 <tr>
 128 <td colspan="2" bgcolor="#ffffff"></td>
 129 </tr>
 130 <tr align="left" valign="top">
 131 <td colspan="2" bgcolor="#e0e0e0"><b>MESSAGE:</b>
 132 </td>
 133 </tr>
 134 <br>
 135 <tr><td align="right"></td>
 136 <td><textarea name="message" rows="7" cols="47" wrap="virtual name"></textarea></td>
 137 </tr>
 138 <br></br>
 139
 140 <tr>
 141 <td colspan="2" bgcolor="#ffffff"></td>
 142 </tr>
 143 <tr align="left" valign="top">
 144 <td colspan="2" bgcolor="#e0e0e0"><b>Signature:</b>
 145 </td>
 146 </tr>
 147 <br>
 148
 149 <tr>
 150  <td align="right">Doctor:</td>
 151  <td>
 152    <select name="doctor">
 153       <option value="Dr. #1">Dr. #1</option>
 154       <option value="Dr. #2">Dr. #2</option>
 155       <option value="Dr. #3">Dr. #3</option>
 156     <br><br>
 157    </select>
 158   </td>
 159 </tr>
 160 <br><br>
 161
 162 <?
 163 //global $date;
 164 //$date = date("Y-m-d");
 165 //print "Date:$encounter";
 166 //print "Date:<input type=entry name=$date value=".date("Y-m-d")."> ";
 167 ?>
 168
 169
 170 <span class="text">Date</span><input type="entry" name="date_of_signature"
 171 value="<?php echo date("Y-m-d") ?>">
 172 </input>
 173 <br></br>
 174
 175 <a href="javascript:document.my_form.submit();" class="link_submit">[Save]</a>
 176 <br>
 177 <a href="<?echo "$rootdir/patient_file/encounter/patient_encounter.php";?>" class="link" style="color: #483D8B">[Don't Save]</a>
 178 </form>
 179 <?php
 180 formFooter();
 181 ?>