interface/forms/transfer_summary/new.php

   1 <?php
   2 /**
   3  *
   4  * Copyright (C) 2012-2013 Naina Mohamed <naina@capminds.com> CapMinds Technologies
   5  *
   6  * LICENSE: This program is free software; you can redistribute it and/or
   7  * modify it under the terms of the GNU General Public License
   8  * as published by the Free Software Foundation; either version 3
   9  * of the License, or (at your option) any later version.
  10  * This program is distributed in the hope that it will be useful,
  11  * but WITHOUT ANY WARRANTY; without even the implied warranty of
  12  * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
  13  * GNU General Public License for more details.
  14  * You should have received a copy of the GNU General Public License
  15  * along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
  16  *
  17  * @package OpenEMR
  18  * @author  Naina Mohamed <naina@capminds.com>
  19  * @link    http://www.open-emr.org
  20  */
  21
  22 //SANITIZE ALL ESCAPES
  23  $sanitize_all_escapes=true;
  24
  25  //STOP FAKE REGISTER GLOBALS
  26  $fake_register_globals=false;
  27
  28 include_once("../../globals.php");
  29 include_once("$srcdir/api.inc");
  30 require_once("$srcdir/patient.inc");
  31 require_once("$srcdir/options.inc.php");
  32 formHeader("Form:Transfer Summary");
  33 $returnurl = 'encounter_top.php';
  34 $formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
  35 $obj = $formid ? formFetch("form_transfer_summary", $formid) : array();
  36
  37 ?>
  38 <html>
  39 <head>
  40 <?php html_header_show();?>
  41 <script type="text/javascript" src="../../../library/dialog.js?v=<?php echo $v_js_includes; ?>"></script>
  42 <!-- pop up calendar -->
  43 <style type="text/css">@import url(<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.css);</style>
  44 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar.js"></script>
  45 <?php include_once("{$GLOBALS['srcdir']}/dynarch_calendar_en.inc.php"); ?>
  46 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dynarch_calendar_setup.js"></script>
  47 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js"></script>
  48 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/dialog.js?v=<?php echo $v_js_includes; ?>"></script>
  49 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
  50
  51 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-min-1-9-1/index.js"></script>
  52 <script language="JavaScript">
  53  $(document).ready(function() {
  54   var win = top.printLogSetup ? top : opener.top;
  55   win.printLogSetup(document.getElementById('printbutton'));
  56  });
  57 </script>
  58
  59 </head>
  60
  61 <body class="body_top">
  62 <p><span class="forms-title"><?php echo xlt('Transfer Summary'); ?></span></p>
  63 </br>
  64 <?php
  65 echo "<form method='post' name='my_form' " .
  66   "action='$rootdir/forms/transfer_summary/save.php?id=" . attr($formid) ."'>\n";
  67 ?>
  68 <table  border="0">
  69 <tr>
  70 <td align="left" class="forms" class="forms"><?php echo xlt('Client Name' ); ?>:</td>
  71                 <td class="forms">
  72                         <label class="forms-data"> <?php if (is_numeric($pid)) {
  73
  74     $result = getPatientData($pid, "fname,lname,squad");
  75    echo text($result['fname'])." ".text($result['lname']);}
  76    $patient_name=($result['fname'])." ".($result['lname']);
  77    ?>
  78    </label>
  79    <input type="hidden" name="client_name" value="<?php echo attr($patient_name);?>">
  80                 </td>
  81                 <td align="left"  class="forms"><?php echo xlt('DOB'); ?>:</td>
  82                 <td class="forms">
  83                 <label class="forms-data"> <?php if (is_numeric($pid)) {
  84
  85     $result = getPatientData($pid, "*");
  86    echo text($result['DOB']);}
  87    $dob=($result['DOB']);
  88    ?>
  89    </label>
  90      <input type="hidden" name="DOB" value="<?php echo attr($dob);?>">
  91                 </td>
  92                 </tr>
  93         <tr>
  94
  95         <td align="left" class="forms"><?php echo xlt('Transfer to'); ?>:</td>
  96
  97          <td class="forms">
  98                  <input type="text" name="transfer_to" id="transfer_to"
  99                 value="<?php echo text($obj{"transfer_to"});?>"></td>
 100
 101                 <td align="left" class="forms"><?php echo xlt('Transfer date'); ?>:</td>
 102                 <td class="forms">
 103                            <input type='text' size='10' name='transfer_date' id='transfer_date' <?php echo attr ($disabled)?>;
 104        value='<?php echo attr($obj{"transfer_date"}); ?>'
 105        title='<?php echo xla('yyyy-mm-dd Date of service'); ?>'
 106        onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />
 107         <img src='../../pic/show_calendar.gif' align='absbottom' width='24' height='22'
 108         id='img_transfer_date' border='0' alt='[?]' style='cursor:pointer;cursor:hand'
 109         title='<?php echo xla('Click here to choose a date'); ?>'>
 110                 </td>
 111
 112         </tr>
 113
 114         <tr>
 115                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 116         </tr>
 117
 118         <tr>
 119                 <td align="left" class="forms"><b><?php echo xlt('Status Of Admission'); ?>:</b></td>
 120                 <td colspan="3"><textarea name="status_of_admission" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"status_of_admission"});?></textarea></td>
 121                 </tr>
 122                 <tr>
 123                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 124         </tr>
 125         <tr>
 126                 <td align="left" class="forms"><b><?php echo xlt('Diagnosis'); ?>:</b></td>
 127                 <td colspan="3"><textarea name="diagnosis" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"diagnosis"});?></textarea></td>
 128                         </tr>
 129                         <tr>
 130                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 131         </tr>
 132         <tr>
 133                 <td align="left" class="forms"><b><?php echo xlt('Intervention Provided'); ?>:</b></td>
 134                 <td colspan="3"><textarea name="intervention_provided" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"intervention_provided"});?></textarea></td>
 135         </tr>
 136         <tr>
 137                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 138         </tr>
 139         <tr>
 140                 <td align="left" class="forms"><b><?php echo xlt('Overall Status Of Discharge'); ?>:</b></td>
 141                 <td colspan="3"><textarea name="overall_status_of_discharge" rows="3" cols="60" wrap="virtual name"><?php echo text($obj{"overall_status_of_discharge"});?></textarea></td>
 142         </tr>
 143
 144 <tr>
 145                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 146         </tr>
 147
 148         <tr>
 149                 <td align="left colspan="3" style="padding-bottom:7px;"></td>
 150         </tr>
 151         <tr>
 152                 <td></td>
 153     <td><input type='submit'  value='<?php echo xlt('Save');?>' class="button-css">&nbsp;
 154     <input type='button' value='<?php echo xla('Print'); ?>' id='printbutton' />&nbsp;
 155     <input type='button' class="button-css" value='<?php echo xla('Cancel'); ?>'
 156  onclick="top.restoreSession();location='<?php echo "$rootdir/patient_file/encounter/$returnurl" ?>'" />
 157
 158  </td>
 159         </tr>
 160 </table>
 161 </form>
 162
 163 <script language="javascript">
 164 /* required for popup calendar */
 165 Calendar.setup({inputField:"transfer_date", ifFormat:"%Y-%m-%d", button:"img_transfer_date"});
 166
 167 </script>
 168 <?php
 169 formFooter();
 170 ?>