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Backend Service

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This commit is contained in:
Olusesan Ameye
2019-03-11 15:39:10 +00:00
parent 7257a86f16
commit 878d34fb36
11 changed files with 152 additions and 20 deletions
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providerwww/application/views/provider/patient/newpatient.php
+15 -15
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@@ -30,15 +30,15 @@
<div class="card-body">
<form>
<div class="form-row">
<form method="POST" action="/patient/addnew">
<div class="form-row">
<div class="form-group col-md-6">
<label for="inputEmail4">Firstname</label>
<input type="text" class="form-control" id="firstname" placeholder="Firstname">
<input type="text" class="form-control" id="firstname" name="firstname" value="<?=$firstname?>" placeholder="Firstname">
</div>
<div class="form-group col-md-6">
<label for="inputPassword4">Lastname</label>
<input type="text" class="form-control" id="lastname" placeholder="Lastname">
<input type="text" class="form-control" id="lastname" name="lastname" value="<?=$lastname?>" placeholder="Lastname">
</div>
</div>
@@ -49,40 +49,40 @@
</div>
<div class="form-group col-md-6">
<label for="inputPassword4">Password</label>
<input type="password" class="form-control" id="inputPassword4" placeholder="Password">
<input type="password" class="form-control" id="password" value="<?=$password?>" placeholder="Password">
</div>
</div>
<div class="form-group">
<label for="inputAddress">Address</label>
<input type="text" class="form-control" id="inputAddress" placeholder="1234 Main St">
<input type="text" class="form-control" id="street1" name="street1" value="<?=$street1?>" placeholder="1234 Main St">
</div>
<div class="form-group">
<label for="inputAddress2">Address 2</label>
<input type="text" class="form-control" id="inputAddress2" placeholder="Apartment, studio, or floor">
<input type="text" class="form-control" id="street2" name="street2" value=<?=$street2?> placeholder="Apartment, studio, or floor">
</div>
<div class="form-row">
<div class="form-group col-md-6">
<label for="inputCity">City</label>
<input type="text" class="form-control" id="inputCity">
<input type="text" class="form-control" id="city" name="city" value="<?=$city?>">
</div>
<div class="form-group col-md-4">
<label for="inputState">State</label>
<select id="inputState" class="form-control">
<select id="inputState" class="form-control" name="state">
<option selected>Select State</option>
<option>Ontario</option>
<option>Toronto</option>
<option value="OGUN">Ogun</option>
<option value="OYO">Oyo</option>
<option value="OSUN" selected>Osun</option>
</select>
</div>
<div class="form-group col-md-2">
<label for="inputZip">Zip</label>
<input type="text" class="form-control" id="inputZip">
<input type="text" class="form-control" id="zipcode" name="zipcode" value="<?=$zipcode?>">
</div>
</div>
<div class="form-group">
<div class="form-check">
<input class="form-check-input" type="checkbox" id="gridCheck">
<label class="form-check-label" for="gridCheck">
Check me out
<label class="form-check-label">
<?=$account_message?>
</label>
</div>
</div>