Proposed launch commit for new themes and bootstrap conversion.
[openemr.git] / interface / forms / soap / templates / general_new.html
blobad47ebc5236191fed9bb046a7354a021dc92d86b
1 <html>
2 <head>
3 <title>{xl t='SOAP'|escape:'html'}</title>
4 {headerTemplate}
5 </head>
6 <body class="body_top">
7 <div class="container">
8 <div class="row">
9 <div class="col-xs-12">
10 <div class="page-header">
11 <h2>{xl t='SOAP'|escape:'html'}</h2>
12 </div>
13 </div>
14 </div>
15 <div class="row">
16 <div class="col-xs-12">
17 <form name="soap" method="post" action="{$FORM_ACTION}/interface/forms/soap/save.php" onsubmit="return top.restoreSession()">
18 <fieldset>
19 <legend>{xl t='Subjective'|escape:'html'}</legend>
20 <div class="form-group" >
21 <div class="col-sm-10 col-sm-offset-1">
22 <textarea name="subjective" class="form-control" cols="60" rows="6">{$data->get_subjective()|escape:'html'}</textarea>
23 </div>
24 </div>
25 </fieldset>
26 <fieldset>
27 <legend>{xl t='Objective'|escape:'html'}</legend>
28 <div class="form-group">
29 <div class="col-sm-10 col-sm-offset-1">
30 <textarea name="objective" class="form-control" cols="60" rows="6">{$data->get_objective()|escape:'html'}</textarea>
31 </div>
32 </div>
33 </fieldset>
34 <fieldset>
35 <legend>{xl t='Assessment'|escape:'html'}</legend>
36 <div class="form-group">
37 <div class="col-sm-10 col-sm-offset-1">
38 <textarea name="assessment" class="form-control" cols="60" rows="6">{$data->get_assessment()|escape:'html'}</textarea>
39 </div>
40 </div>
41 </fieldset>
42 <fieldset>
43 <legend>{xl t='Plan'|escape:'html'}</legend>
44 <div class="form-group">
45 <div class="col-sm-10 col-sm-offset-1">
46 <textarea name="plan" class="form-control" cols="60" rows="6">{$data->get_plan()|escape:'html'}</textarea>
47 </div>
48 </div>
49 </fieldset>
50 <div class="form-group clearfix">
51 <div class="col-sm-10 col-sm-offset-1 position-override">
52 <div class="btn-group oe-opt-btn-group-pinch" role="group">
53 <button type="submit" class="btn btn-default btn-save" name="Submit">{xl t='Save'|escape:'html'}</button>
54 <button type="button" class="btn btn-link btn-cancel oe-opt-btn-separate-left" onclick="top.restoreSession(); location.href='{$DONT_SAVE_LINK}';">{xl t='Cancel'|escape:'html'}</button>
55 </div>
56 <input type="hidden" name="id" value="{$data->get_id()|escape:'html'}" />
57 <input type="hidden" name="activity" value="{$data->get_activity()|escape:'html'}">
58 <input type="hidden" name="pid" value="{$data->get_pid()|escape:'html'}">
59 <input type="hidden" name="process" value="true">
60 </div>
61 </div>
62 </form>
63 </div>
64 </div>
65 </div>
66 </body>
67 </html>