2 include_once("../globals.php");
4 // Determine if the registration date should be requested.
5 $crow = sqlQuery("SELECT count(*) AS count FROM layout_options WHERE " .
6 "form_id = 'DEM' AND field_id = 'regdate' AND uor > 0");
7 $regstyle = $crow['count'] ?
"" : " style='display:none'";
9 $form_pubpid = $_POST['pubpid' ] ?
trim($_POST['pubpid' ]) : '';
10 $form_title = $_POST['title' ] ?
trim($_POST['title' ]) : '';
11 $form_fname = $_POST['fname' ] ?
trim($_POST['fname' ]) : '';
12 $form_mname = $_POST['mname' ] ?
trim($_POST['mname' ]) : '';
13 $form_lname = $_POST['lname' ] ?
trim($_POST['lname' ]) : '';
14 $form_refsource = $_POST['refsource'] ?
trim($_POST['refsource']) : '';
15 $form_regdate = $_POST['regdate' ] ?
trim($_POST['regdate' ]) : date('Y-m-d');
20 <?php
html_header_show(); ?
>
21 <link rel
="stylesheet" href
="<?php echo xl($css_header,'e');?>" type
="text/css">
22 <style type
="text/css">@import
url(../../library
/dynarch_calendar
.css
);</style
>
24 <script type
="text/javascript" src
="../../library/textformat.js"></script
>
25 <script type
="text/javascript" src
="../../library/dynarch_calendar.js"></script
>
26 <script type
="text/javascript" src
="../../library/dynarch_calendar_en.js"></script
>
27 <script type
="text/javascript" src
="../../library/dynarch_calendar_setup.js"></script
>
29 <script LANGUAGE
="JavaScript">
34 <?php
if ($GLOBALS['inhouse_pharmacy']) { ?
>
35 var f
= document
.forms
[0];
36 if (f
.refsource
.selectedIndex
<= 0) {
37 alert('Please select a referral source!');
49 <body
class="body_top" onload
="javascript:document.new_patient.fname.focus();">
51 <?php
if ($GLOBALS['concurrent_layout']) { ?
>
52 <form name
='new_patient' method
='post' action
="new_patient_save.php"
53 onsubmit
='return validate()'>
54 <span
class='title'><?php
xl('Add Patient Record','e');?
></span
>
56 <form name
='new_patient' method
='post' action
="new_patient_save.php"
57 target
='_top' onsubmit
='return validate()'>
58 <a
class="title" href
="../main/main_screen.php" target
="_top" onclick
="top.restoreSession()">
59 <?php
xl('Add Patient Record','e');?
></a
>
66 <?php
if ($GLOBALS['omit_employers']) { ?
>
67 <input type
='hidden' name
='title' value
='' />
72 <?php
if (!$GLOBALS['omit_employers']) { ?
>
75 <span
class='bold'><?php
xl('Title','e');?
>: </span
>
80 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
81 "WHERE list_id = 'titles' ORDER BY seq");
82 while ($orow = sqlFetchArray($ores)) {
83 echo " <option value='" . $orow['option_id'] . "'";
84 if ($orow['option_id'] == $form_title) echo " selected";
85 echo ">" . $orow['title'] . "</option>\n";
95 <span
class='bold'><?php
xl('First Name','e');?
>: </span
>
98 <input type
='entry' size
='15' name
='fname' value
='<?php echo $form_fname; ?>'>
104 <span
class='bold'><?php
xl('Middle Name','e');?
>: </span
>
107 <input type
='entry' size
='15' name
='mname' value
='<?php echo $form_mname; ?>'>
113 <span
class='bold'><?php
xl('Last Name','e');?
>: </span
>
116 <input type
='entry' size
='15' name
='lname' value
='<?php echo $form_lname; ?>'>
120 <?php
if ($GLOBALS['inhouse_pharmacy']) { ?
>
123 <span
class='bold'><?php
xl('Referral Source','e'); ?
>: </span
>
126 <select name
='refsource'>
127 <option value
=''>Unassigned
</option
>
129 $ores = sqlStatement("SELECT option_id, title FROM list_options " .
130 "WHERE list_id = 'refsource' ORDER BY seq");
131 while ($orow = sqlFetchArray($ores)) {
132 echo " <option value='" . $orow['option_id'] . "'";
133 if ($orow['option_id'] == $form_refsource) echo " selected";
134 echo ">" . $orow['title'] . "</option>\n";
142 <tr
<?php
echo $regstyle ?
>>
144 <span
class='bold'><?php
xl('Registration Date','e');?
>: </span
>
147 <input type
='text' size
='10' name
='regdate' id
='regdate'
148 value
='<?php echo $form_regdate; ?>'
149 onkeyup
='datekeyup(this,mypcc)' onblur
='dateblur(this,mypcc)'
150 title
='yyyy-mm-dd' />
151 <img src
='../pic/show_calendar.gif' align
='absbottom' width
='24' height
='22'
152 id
='img_regdate' border
='0' alt
='[?]' style
='cursor:pointer'
153 title
='Click here to choose a date'>
154 <script LANGUAGE
="JavaScript">
155 Calendar
.setup({inputField
:"regdate", ifFormat
:"%Y-%m-%d", button
:"img_regdate"});
162 <span
class='bold'><?php
xl('Patient Number','e');?
>: </span
>
165 <input type
='entry' size
='5' name
='pubpid' value
='<?php echo $form_pubpid; ?>'>
166 <span
class='text'><?php
xl('omit to autoassign','e');?
>  
;  
; </span
>
173 <input type
='submit' name
='form_create' value
=<?php
xl('Create New Patient','e'); ?
> />
182 <script language
="Javascript">
185 echo "alert('" . xl('This patient ID is already in use!') . "');\n";