CHIEFSOFT\ameye
213 lines
11 KiB
PHP
213 lines
11 KiB
PHP
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<!-- end app-header -->
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<!-- begin app-container -->
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<div class="app-container">
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<!-- begin app-nabar -->
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<aside class="app-navbar">
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<? include "application/views/template/menu/sidemain.php"; ?>
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</aside>
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<!-- end app-navbar -->
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<!-- begin app-main -->
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<div class="app-main" id="main">
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<!-- begin container-fluid -->
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<div class="container-fluid">
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<? include "application/views/template/topstrip.php"; ?>
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<!-- begin row -->
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<div class="row">
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<div class="col-lg-6 col-xxl-4 m-b-30">
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<div class="card card-statistics h-100 mb-0">
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<div class="card-header d-flex justify-content-between">
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<div class="card-heading">
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<h4 class="card-title">New Patient - <?= $account_message ?> </h4>
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</div>
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<div class="dropdown">
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<!-- a class="btn btn-round btn-inverse-primary btn-xs" href="#">View all </a -->
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</div>
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</div>
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<div class="card-body">
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<div class="card-body">
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<form method="POST" action="/patient/addnew">
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<div class="form-row">
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<div class="form-group col-md-6">
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<label for="inputEmail4">Firstname</label>
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<input type="text" class="form-control" id="firstname" name="firstname" value="<?= $firstname ?>" placeholder="Firstname">
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</div>
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<div class="form-group col-md-6">
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<label for="inputPassword4">Lastname</label>
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<input type="text" class="form-control" id="lastname" name="lastname" value="<?= $lastname ?>" placeholder="Lastname">
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</div>
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</div>
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<div class="form-row">
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<div class="form-group col-md-6">
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<label for="inputEmail4">DOB</label>
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<input type="text" class="form-control date-picker-default" value="" name="dob">
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</div>
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<div class="form-group col-md-6">
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<label for="inputPassword4">Gender</label>
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<select class="form-control" aria-label="Select Gender" name ="gender">
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<option selected>Select</option>
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<option value="M">Male</option>
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<option value="F">Female</option>
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<option value="U">Unknown</option>
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</select>
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</div>
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</div>
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<!-- div class="form-row">
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<div class="form-group col-md-6">
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<label for="inputEmail4">Email</label>
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<input type="email" class="form-control" id="inputEmail4" placeholder="Email">
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</div>
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<div class="form-group col-md-6">
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<label for="inputPassword4">Password</label>
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<input type="password" class="form-control" id="password" value="<?= $password ?>" placeholder="Password">
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</div>
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</div -->
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<div class="form-group">
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<label for="inputAddress">Email</label>
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<input type="email" class="form-control" id="inputEmail4" name ="email" placeholder="Email">
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</div>
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<div class="form-group">
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<label for="inputAddress">Address</label>
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<input type="text" class="form-control" id="street1" name="street1" value="<?= $street1 ?>" placeholder="1234 Main St">
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</div>
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<div class="form-group">
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<label for="inputAddress2">Address 2</label>
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<input type="text" class="form-control" id="street2" name="street2" value="<?= $street2 ?>" placeholder="Apartment, studio, or floor">
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</div>
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<div class="form-row">
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<div class="form-group col-md-6">
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<label for="inputCity">City</label>
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<input type="text" class="form-control" id="city" name="city" value="<?= $city ?>">
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</div>
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<div class="form-group col-md-4">
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<label for="inputState">State</label>
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<select id="inputState" class="form-control" name="state">
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<option selected>Select State</option>
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<option value="OGUN">Ogun</option>
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<option value="OYO">Oyo</option>
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<option value="OSUN" selected>Osun</option>
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</select>
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</div>
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<div class="form-group col-md-2">
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<label for="inputZip">Zip</label>
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<input type="text" class="form-control" id="zipcode" name="zipcode" value="<?= $zipcode ?>">
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</div>
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</div>
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<!-- div class="form-group">
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<div class="form-check">
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<label class="form-check-label">
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<?= $account_message ?>
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</label>
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</div>
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</!-->
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<div class="form-row">
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<div class="form-group col-md-9">
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</div>
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<div class="form-group col-md-3">
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<button type="submit" class="btn btn-primary btn-sm">Add Patient</button>
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</div>
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</div>
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</form>
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</div>
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</div>
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</div>
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</div>
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<div class="col-xxl-3 m-b-30">
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<div class="card card-statistics h-40 mb-0">
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<div class="card-header d-flex justify-content-between">
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<div class="card-heading">
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<h4 class="card-title">New Patient Link ID</h4>
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</div>
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<div class="dropdown">
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<!-- a class="btn btn-round btn-inverse-primary btn-xs" href="#">View all </a -->
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</div>
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</div>
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<div class="card-body">
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<div class="card-body">
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<form name="linkform">
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<div class="form-row">
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<div class="form-group col-md-12">
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<label for="inputLinkID">Enter Link ID</label>
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<input type="text" class="form-control" id="patient_link_id" name="patient_link_id" value="<?= isset($patient_link_id) ? $patient_link_id : '' ?>" placeholder="Link ID : WE34RTH587">
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</div>
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</div>
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<div class="form-row">
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<div class="form-group col-md-6">
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<div id="link_result">[]</div>
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</div>
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<div class="form-group col-md-6">
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<button type="submit" id="link_submit" class="btn btn-primary btn-block btn-sm" onclick="return connectLinkID()">Link Patient</button>
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</div>
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</div>
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</form>
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</div>
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</div>
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</div>
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</div>
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<div class="col-xxl-5 m-b-30">
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<? include 'application/views/provider/components/patient_listing.php'; ?>
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</div>
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</div>
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</div>
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<!-- end container-fluid -->
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</div>
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<!-- end app-main -->
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</div>
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<!-- end app-container -->
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<!-- begin footer -->
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<script type="text/javascript">
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<!--
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function connectLinkID() {
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var patient_link_id = document.linkform.patient_link_id.value;
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// alert(patient_link_id);
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if (patient_link_id === '') {
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alert('You must enter valid linkID to continue!');
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return false;
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}
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// alert(job_description);
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$('#link_result').html('Processing...');
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$('#link_submit').prop('disabled', true);
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$.ajax({
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url: "/patient/linkpatient?patient_link_id=" + patient_link_id
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}).done(function (data) {
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$('#link_result').html(data);
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document.linkform.patient_link_id.value = '';
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$('#link_submit').prop('disabled', false);
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});
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return false;
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}
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// -->
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</script>
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