File manager - Edit - /home/autoph/public_html/portal/includes/phic/temp_new_patient.php
Back
<script type="text/javascript"> function addDateSeparator(e, control, format){ this.Format = format; var keycode = (e.which) ? e.which : event.keyCode if (keycode > 31 && (keycode < 48 || keycode > 57)){ return false; }else{ var DateFormatPattern = /^dd\/mm\/yyyy$|^mm\/dd\/yyyy$|^mm\/dd\/yyyy$|^yyyy\/mm\/dd$/; if ( DateFormatPattern.test(this.Format) ){ var SplitFormat = this.Format.split("/"); if ( control.value.length >= this.Format.length ){ if ( keycode !=8){ return false; } } if ( control.value.length == SplitFormat[0].length ){ if ( keycode !=8){ control.value += '/'; } } if ( control.value.length == (SplitFormat[1].length + SplitFormat[0].length +1) ){ if ( keycode !=8){ control.value += '/'; } } }else{ alert("Supplied date format parameter is incorrect."); } } }</script> <?php $logged_user = $user_data['u_name']; $comCode = $user_data['company_assignment']; if(isset($_POST['saverecord'])){ $regCity = $_POST['regCity']; $region = $_POST['region']; $assigneddoctor=$_POST['assigneddoctor']; $myDoctor = explode("-",$assigneddoctor); $doctor=$myDoctor[1]; $fname=$_POST['fname']; $mname=$_POST['mname']; $lname=$_POST['lname']; $bday=$_POST['bday']; $access=$_POST['access']; $age=$_POST['age']; $sex=$_POST['sex']; $status=$_POST['status']; $phicNumber=$_POST['phicNumber']; $access=$_POST['access']; $frequency=$_POST['frequency']; //============================= $ptPackage = $_POST['package']; $ptDialyzer = $_POST['dialyzer']; $exPackage =explode("---",$ptPackage); $myPackageCode = $exPackage[0]; $packageID = $exPackage[1]; $exDialyzer =explode("---",$ptDialyzer); $myDialyzerCode = $exDialyzer[1]; $epo = $_POST['epo']; $myEpo=explode("---",$epo); $myEpoCode=$myEpo[1]; //============================= $referral = $_POST['referral']; $taddress=$_POST['taddress']; $occupation=$_POST['occupation']; $paddress=$_POST['paddress']; $landline=$_POST['landline']; $mobile=$_POST['mobile']; $emergencycontat=$_POST['emergencycontat']; $emergencyaddress=$_POST['emergencyaddress']; $hpActive=$_POST['hpActive']; $hpType=$_POST['hpType']; $emergencymobile=$_POST['emergencymobile']; $emergencylandline=$_POST['emergencylandline']; $datediagnosed=$_POST['datediagnosed']; $datefirstdialysis=$_POST['datefirstdialysis']; $placeofdialysis=$_POST['placeofdialysis']; $tmember = $_POST['tmember']; $onPD = $_POST['onPD']; $HDReasons=$_POST['HDReasons']; $renaldiagnosis=$_POST['renaldiagnosis']; $comordities1=$_POST['comordities1']; $comordities2=$_POST['comordities2']; $comordities3=$_POST['comordities3']; $comordities4=$_POST['comordities4']; $comordities5=$_POST['comordities5']; $comordities6=$_POST['comordities6']; //check if first and lastname existing in the database to prevent duplicate entry $countName = mysql_result(mysql_query("SELECT COUNT('patient_id') FROM `patient_list` WHERE `patient_fname` LIKE '%$fname%' AND `patient_lname`= '$lname' AND `branch_code`='$comCode'"),0); if($countName > 0 ) { echo " <table style='background:#ffa27e '> <tr> <td align='center' width='500px'> <br> <font size = '3em' color='red'> WARNING!!! Possible duplicate entry. <b style='font-size:14px;color:blue'>".$fname." ".$lname." </b>. Please check your entry and try again. Thank you!</font> <br> <br> <a href='phic_claims.php?view=npt&subView=npt '><input style='background-color:#E5E4E2;border:1px black solid;border-radius:1px;width:120px;height:20px;color:black;font-size:12px;font-weight:normal;'type ='button' name ='edit' value = 'Close'> </a> <br><br> </td> </tr> </table>"; }else { //$attendingphysician=$_POST['attendingphysician']; $sql="INSERT INTO `patient_list` (`patient_id`, `patient_fname`, `patient_mname`, `patient_lname`, `patient_bday`, `patient_age`, `patient_sex`, `patient_status`,`phic_number`,`assigned_doctor`,`patient_occupation`, `patient_taddress`, `patient_paddress`, `patient_mobile`,`patient_line`,`patient_ername`,`patient_eraddress`,`patient_ermobile`,`patient_erline`,`patient_datefirstdiagnose`,`patient_datefirstdialysis`,`patient_placedialysis`,`patient_pd`,`patient_pdreason`,`patient_renal`,`patient_como1`,`patient_como2`,`patient_como3`,`patient_como4`,`patient_como5`,`patient_como6`,`patient_dateencoded`,`patient_timeencoded`,`patient_encodedby`,`status`,`isActive`,`branch_code`,`phic_member`,`hepa_class`,`hepa_type`,`entry_type`,`dialyzer`,`tx_package`,`access`,`epo`,`tx_frequency`,`region`,`reg_city`,`patient_package_code`) VALUES('','$fname','$mname','$lname','$bday','$age','$sex','$status','$phicNumber','$doctor','$occupation','$taddress','$paddress','$mobile','$landline','$emergencycontat','$emergencyaddress','$emergencymobile','$emergencylandline','$datediagnosed','$datefirstdialysis','$placeofdialysis','$onPD','$HDReasons','$renaldiagnosis','$comordities1','$comordities2','$comordities3','$comordities4','$comordities5','$comordities6','$toDate','$currentTime','$logged_user','Out','1','$comCode','$tmember','$hpActive','$hpType','$referral','$myDialyzerCode','$myPackageCode','$access','$myEpoCode','$frequency','$region','$regCity','$packageID')"; if(!mysql_query($sql)){ die('Error: ' . mysql_error()); }else{ echo " <table> <tr> <td align='center' width='500px'> <br> <font size = '3em' color='red'> New Record has been added successfully. Thank you!</font> <br> <br> <a href='phic_claims.php?view=npt&subView=npt'><input style='background-color:#E5E4E2;border:1px black solid;border-radius:1px;width:120px;height:20px;color:black;font-size:12px;font-weight:normal;'type ='button' name ='edit' value = 'Close'> </a> <br><br> </td> </tr> </table>"; } } } $checkAccess = $user_data['add_new_patient']; if($checkAccess == '0'){ secalert(); }else{ ?> <div STYLE=" height: 550px; width: 100%; font-size: 12px; overflow: auto;border:1px solid gray"> <table style="border-collapse:collapse;background:gray:border:none;height:100%;width:100%"> <?php //Check if search is initiated by user elase load patient information form if(isset($_POST['plookup'])){ $searchtext=$_POST['searchpatient']; echo "<tr>"; echo "<td colspan ='3' valign='TOP' style='border:1px solid white;font-size:14px;weight:bold;color:gray;height:400px;background:white'>"; $q=mysql_query("SELECT * FROM `patient_list` WHERE `isActive`='1' AND `branch_code`='$comCode' AND `patient_lname` LIKE '%$searchtext%'"); $row=mysql_fetch_array($q); $total=mysql_num_rows($q); $dis=10; $total_page=ceil($total/$dis); $page_cur=(isset($_GET['page']))?$_GET['page']:1; $k=($page_cur-1)*$dis; $page_cur = mysql_real_escape_string($page_cur); $qq=mysql_query("SELECT * FROM `patient_list` WHERE `isActive`='1' AND `branch_code`='$comCode' AND `patient_lname` LIKE '%$searchtext%' ORDER by `patient_lname` ASC"); echo "<table style='width:100%; height:95% border:1px solid white; border-collapse:collapse;'>"; echo "<tr> <th class='Gradient' style='text-align:center;width:50px;background:#f5f5f5;border:1px solid gray;font-size:13px;height:25px'>Record I.D</th> <th class='Gradient' align='left' style='width:150px;background:#f5f5f5;border:1px solid gray;font-size:13px'>First Name</th> <th class='Gradient' align='left' style='width:150px;background:#f5f5f5;border:1px solid gray;font-size:13px'>Last Name</th> <th class='Gradient' align='left' style='width:200px;background:#f5f5f5;border:1px solid gray;font-size:13px'>Assigned Doctor</th> <th class='Gradient' align='left' style='width:80px;background:#f5f5f5;border:1px solid gray;font-size:13px'>Referral</th> <th class='Gradient' align='left' style='width:50px;background:#f5f5f5;border:1px solid gray;font-size:13px'>Gender</th> <th class='Gradient' align='left' style='width:300px;background:#f5f5f5;border:1px solid gray;font-size:13px'>Address</th> <th class='Gradient' align='center' style='width:120px;background:#f5f5f5;border:1px solid gray;font-size:13px'>Date Registered</th> <th class='Gradient' align='center' style='width:50px;background:#f5f5f5;border:1px solid gray;font-size:13px'>-</th> <th class='Gradient' align='center' style='width:50px;background:#f5f5f5;border:1px solid gray;font-size:13px'>-</th> </tr>"; while($row = mysql_fetch_array($qq)){ echo "<tr>"; echo "<td style='font-size:10px;border:1px solid gray;text-align:center;height:25px'>" . $row['patient_id'] . "</td>"; echo "<td style='font-size:10px;border:1px solid gray;text-align:left;height:25px'>" . $row['patient_fname'] . "</td>"; echo "<td style='font-size:10px;border:1px solid gray;text-align:left;height:25px'>" . $row['patient_lname'] . "</td>"; echo "<td style='font-size:10px;border:1px solid gray;text-align:left;height:25px'>"; $docID = $row['assigned_doctor']; $docFname = mysql_result(mysql_query("SELECT `doc_fname` FROM `doctors_profile` WHERE `doc_id`='$docID'"),0); $docLname = mysql_result(mysql_query("SELECT `doc_lname` FROM `doctors_profile` WHERE `doc_id`='$docID'"),0); echo $docFname ." ".$docLname; echo "</td>"; echo "<td style='font-size:10px;border:1px solid gray;text-align:left;height:25px'>" . $row['entry_type'] . "</td>"; echo "<td style='font-size:10px;border:1px solid gray;text-align:left;height:25px'>" . $row['patient_sex'] . "</td>"; echo "<td style='font-size:10px;border:1px solid gray;text-align:left;height:25px'>" . $row['patient_taddress'] . "</td>"; echo "<td style='font-size:10px;border:1px solid gray;text-align:center;height:25px'>" . $row['patient_dateencoded'] . "</td>"; echo "<td style='font-size:10px;border:1px solid gray;text-align:center;height:25px'><a href='mainindex.php?view=pupdate&id=".$row['patient_id']."'>Update</a></td>"; echo "<td style='font-size:10px;border:1px solid gray;text-align:center;height:25px'><a href='mainindex.php?view=expired&id=".$row['patient_id']."&fname=".$row['patient_fname']."&lname=".$row['patient_lname']."'>Expired</a></td>"; } echo "</tr>"; echo "</table>"; echo "</td>"; echo "</tr>"; }else{ ?> <tr> <td colspan ="3" valign="TOP" style="border:1px solid white;font-size:14px;weight:bold;color:gray;height:400px;background:gray"> <form action="" method="POST"> <center><table style='width:100%;background:white;border:1px solid gray'> <tr> <td colspan="6" style='background:lightgray;border:none;font-size:14px;border-bottom:1px solid gray;font-weight:normal;color:gray'>Patient's Information:</td> </tr> <tr> <td style='background:lightgray;border:none;font-size:11px'>Last Name:<br><input type="text" name="lname" style="font-size:14px;color:blue;width:250px;border:1px solid gray;background:#F2F5A9;border-top:1px solid white;text-align:center" required placeholder=""></td> <td style='background:lightgray;border:none;font-size:11px'>First Name:<br><input type="text" name="fname" style="font-size:14px;color:blue;width:250px;border:1px solid gray;background:#F2F5A9;border-top:1px solid white;text-align:center" required placeholder=""></td> <td style='background:lightgray;border:none;font-size:11px'>Middle Name:<br><input type="text" name="mname" value='N/A' style="font-size:14px;color:blue;width:200px;border:1px solid gray;background:#fff;border-top:1px solid white;text-align:center" placeholder=""></td> <td style='background:lightgray;border:none;font-size:11px'>Age:<br><input type="text" name="age" style="font-size:14px;color:blue;width:40px;border:1px solid gray;background:#fff;border-top:1px solid white;text-align:center" placeholder=""></td> <td style='background:lightgray;border:none;font-size:11px'>Sex:<br> <select name="sex" style="width:70px;height:25px;font-size:14px;color:blue;border:1px solid gray;background:#fff;text-align:left" required> <option>Male</option> <option>Female</option> </select> </td> <td style='background:lightgray;border:none;font-size:11px'>Status:<br> <select name="status" style="width:80px;height:25px;font-size:14px;color:blue;border:1px solid gray;background:#fff;text-align:left"> <option>Single</option> <option>Married</option> <option>Widow</option> <option>Separated</option> </select> </td> </tr> <tr> <td style='background:lightgray;border:none;font-size:11px'>Occupation:<br><input type="text" name="occupation" value='N/A' style="font-size:14px;color:blue;width:100%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left" placeholder="Occupation"></td> <td colspan="1" style='background:lightgray;border:none;font-size:11px'>Landline Number:<br><input type="text" value='N/A' name="landline" style="font-size:14px;color:blue;width:100%;border:1px solid gray;background:white;border-top:1px solid white;text-align:center" placeholder="Landline No."></td> <td colspan="1" style='background:lightgray;border:none;font-size:11px'>Mobile Number:<br><input type="text" value='N/A' name="mobile" style="font-size:14px;color:blue;width:100%;border:1px solid gray;background:white;border-top:1px solid white;text-align:center" placeholder="Mobile No."></td> <td colspan="3" style='background:lightgray;border:none;font-size:11px'> Birthdate: Access: Frequency:<br> <input type="text" name="bday" style="font-size:14px;font-weight:normal;color:blue;width:80px;height:25px;border:1px solid gray;text-align:center;background:white" onkeyup="addDateSeparator(event,this,'dd/mm/yyyy')" placeholder="mm/dd/yyyy"> <select name='access' style="font-size:12px;font-weight:normal;color:blue;width:120px;height:25px;border:1px solid lightgray;text-align:center;background:white" placeholder="Frequency"> <option>N/A</option> <option>AVF</option> <option>AVG</option> <option>FEMORAL</option> <option>INTRAJUGULAR</option> <option>SUBCLAVIAN</option> </select> <select name='frequency' style="font-size:12px;font-weight:normal;color:blue;width:60px;height:25px;border:1px solid lightgray;text-align:center;background:white" placeholder="Frequency"> <option>NA</option> <option>1x</option> <option>2x</option> <option>3x</option> <option>4x</option> <option>2x|3x</option> </select> </td> </tr> <tr> <td colspan="2" style='background:lightgray;border:none;font-size:11px'>Present Address:<br> <input type="text" name="taddress" value='N/A' style="font-size:14px;color:blue;width:68%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left" placeholder="Present Address"> <select name="regCity" style="font-size:14px;color:blue;width:30%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left"> <option> NA </option> <?php $getCityName=''; $getreg = mysql_query("SELECT * FROM `region` WHERE `reg_status`= '1' ORDER by `reg_city` ASC"); while($myReg = mysql_fetch_array($getreg)){ if($myReg['reg_city'] === $getCityName){ }else{ echo "<option style='font-size:12px;color:gray'>". $myReg['reg_city']."</option>"; $getCityName=$myReg['reg_city']; // remove duplicate region name } } ?> </select></td> <td style='background:lightgray;border:none;font-size:11px'>PhilHealth Number:<br><input type="text" value='N/A' name="phicNumber" style="font-size:14px;color:blue;width:100%;border:1px solid gray;background:white;border-top:1px solid white;text-align:center" placeholder="Philhealth Number"></td> <td colspan="3" style='background:lightgray;border:none;font-size:11px'>PhilHealth Member:<br><input type="text" value='N/A' name="tmember" style="font-size:14px;color:blue;width:100%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left" placeholder="Name of PhilHealth Member"></td> </tr> <tr> <td colspan="2" style='background:lightgray;border:none;font-size:11px'>Permanent Address<br> <input type="text" value='N/A' name="paddress" style="font-size:14px;color:blue;width:68%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left" placeholder="Permanent Address"> <select name="region" style="font-size:14px;color:blue;width:30%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left" required> <option> NA </option> <?php $getRegName=''; $getregion = mysql_query("SELECT * FROM `region` WHERE `reg_status`= '1' ORDER by `reg_name` ASC"); while($myRegion = mysql_fetch_array($getregion)){ if($myRegion['reg_name'] === $getRegName){ }else{ echo "<option style='font-size:12px;color:gray'>". $myRegion['reg_name']."</option>"; $getRegName=$myRegion['reg_name']; // remove duplicate region name } } ?> </select> </td> <td colspan="1" style='background:lightgray;border:none;font-size:11px'>Referral:<br> <select name="referral" style="width:100%;font-size:14px;color:blue;border;1px solid lightgry;border:1px solid gray;background:white" required> <option> NA </option> <?php $pID = $_GET['id']; $getDeck = mysql_result(mysql_query("SELECT `entry_type` FROM `patient_list` WHERE `patient_id`= '$pID'"),0); echo " <option style='font-size:14px'>".$getDeck."</option>"; ?> <option id="0" style="font-size:14px">Referred</option> <option id="0" style="font-size:14px">Deck</option> </select> </td> <td colspan="3" style='background:lightgray;border:none;font-size:11px'>Assigned Doctor:<br> <select name="assigneddoctor" style="width:100%;font-size:14px;color:blue;border;1px solid lightgry;border:1px solid gray;background:white"> <option id="0" style="font-size:18px">NA</option> <?php $getdoctor = mysql_query("SELECT * FROM `doctors_profile` WHERE `doc_status`= '1'"); while($myMT = mysql_fetch_array($getdoctor)){ ?> <option id = "<?php echo $myMT['doc_id'];?>" style="font-size:14px;color:blue;"> <?php echo $myMT['doc_lname'];?> <?php echo $myMT['doc_fname'];?> - <?php echo $myMT['doc_id'];?></option> <?php }?> </select> </td> </tr> <tr> <td colspan="6" style='background:lightgray;border:none;font-size:14px;border-bottom:1px solid gray;font-weight:normal;color:gray'><br>Nearest Relative (to notify in case of emergency): </td> </tr> <tr> <td colspan="4" style='background:lightgray;border:none;font-size:11px'>Contact Person: (Full Name)<br> <input type="text" value='N/A' name="emergencycontat" style="font-size:14px;color:blue;width:80%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left" placeholder="Name"> </td> <td colspan="4" style='background:lightgray;border:none;font-size:11px'>Contact Number:<br> <input type="text" value='N/A' name="emergencylandline" style="font-size:14px;color:blue;width:80%;border:1px solid gray;background:white;border-top:1px solid white;text-align:center" placeholder="Landline"> </td> </tr> <tr> <td colspan="4" style='background:lightgray;border:none;font-size:11px'>Complete Address:<br> <input type="text" value='N/A' name="emergencyaddress" style="font-size:14px;color:blue;width:80%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left" placeholder="Address"> </td> <td colspan="2" style='background:lightgray;border:none;font-size:11px'>Mobile Number:<br> <input type="text" value='N/A' name="emergencymobile" style="font-size:14px;color:blue;min-width:80%;border:1px solid gray;background:white;border-top:1px solid white;text-align:center" placeholder="Mobile"></td> </tr> <tr> <td style='background:lightgray;border:none;font-size:14px;border-bottom:1px solid gray;font-weight:bold;color:gray;width:200px'> <br>Date first diagnosed with kidney disease (mm-dd-yyyy)</td> <td style='width:150px;background:lightgray;border:none;font-size:14px;border-bottom:1px solid gray;font-weight:bold;color:gray;width:200px'> <br>Date of first dialysis (mm-dd-yyyy)</td> <td colspan="2" style='background:lightgray;border:none;font-size:14px;border-bottom:1px solid gray;font-weight:bold;color:gray;width:200px'> <br>Place where first dialysis done</td> <td style='background:lightgray;border:none;font-size:14px;border-bottom:1px solid gray;font-weight:bold;color:gray'>Hepatitis (HP)</td> <td style='background:lightgray;border:none;font-size:14px;border-bottom:1px solid gray;font-weight:bold;color:gray'>Hepatitis (Type)</td> </tr> <tr> <td style='background:lightgray;border:none;font-size:11px'>Date Diagnosed:<br><input type="text" name="datediagnosed" value='N/A' style="font-size:14px;font-weight:normal;color:blue;width:;width:100%;height:25px;border:1px solid gray;text-align:center;background:white" onkeyup="addDateSeparator(event,this,'dd/mm/yyyy')" placeholder="mm/dd/yyyy" maxlength="10"></td> <td style='background:lightgray;border:none;font-size:11px'>Date of First Dialysis:<br><input type="text" value='N/A' name="datefirstdialysis" style="font-size:14px;font-weight:normal;color:blue;width:100%;height:25px;border:1px solid gray;text-align:center;background:white" onkeyup="addDateSeparator(event,this,'dd/mm/yyyy')" placeholder="mm/dd/yyyy" maxlength="10"></td> <td colspan="2" style='background:lightgray;border:none;font-size:11px'>Place Diagnosed:<br><input type="text" value='N/A' name="placeofdialysis" style="font-size:14px;color:blue;width:100%;border:1px solid gray;background:white;border-top:1px solid white;text-align:center" placeholder="Place done"></td> <td style='background:lightgray;border:none;font-size:11px'>Hepatitis Info:<br> <select name="hpActive" style="font-size:14px;color:blue;width:120px;border:1px solid gray;background:white;border-top:1px solid white;text-align:left"> <option style='font-size:12px'>None</option> <option style='font-size:12px'>Non-Reactive</option> <option style='font-size:12px'>Reactive</option> </select> </td> <td style='background:lightgray;border:none;font-size:11px;width:150px'>Hepatitis Type:<br> <select name="hpType" style="font-size:14px;color:blue;width:100%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left"> <option style='font-size:12px'>None</option> <option style='font-size:12px'>Type A</option> <option style='font-size:12px'>Type B</option> <option style='font-size:12px'>Type C</option> </select> </td> </tr> <tr> <td style='background:lightgray;border:none;font-size:14px;border-bottom:1px solid gray;font-weight:bold;color:gray'><br>Previously on PD?</td> <td colspan="5" style='background:lightgray;border:none;font-size:14px;border-bottom:1px solid gray;font-weight:bold;color:gray'><br>If yes, what was the reason for shifting to HD?</td> </tr> <tr> <td style='background:lightgray;border:none;font-size:14px'> <center><select name="onPD" style="width:100px;height:30px;font-size:14px;color:blue;border:1px solid gray;background:#fff;text-align:center"> <option>No</option> <option>Yes</option> </select></center> </td> <td colspan="5" style='background:lightgray;border:none;font-size:14px'> <textarea rows="2" name="HDReasons" style="color:blue;width:100%;border:1px solid gray;border-radius:5px;background:white">NA</textarea> </td> </tr> <tr> <td colspan="2" style='background:lightgray;border:none;font-size:14px'> <b style="font-size:11px;color:black">Renal Diagnoses:</b><br><textarea rows="2" name="renaldiagnosis" style="color:blue;width:100%;border:1px solid gray;border-radius:5px;background:white">NA</textarea> </td> <td colspan="4" style='background:lightgray;border:none;font-size:14px'> <table style='background:lightgray;border:none;width:100%'> <tr> <td style='width:35%;border:none;background:lightgray'><b style="font-size:11px;color:black">Dialyzer:</b></td> <td style='width:35%;border:none;background:lightgray'><b style="font-size:11px;color:black">EPO:</b></td> <td style='width:30%;border:none;background:lightgray'><b style="font-size:11px;color:black">Package:</b></td> </tr> <tr> <td style='width:35%;border:none;background:white'> <select name="dialyzer" style="width:100%;font-size:14px;color:blue;border;1px solid lightgry;border:1px solid gray;background:white"> <option id="0" style="font-size:18px">NA</option> <?php $getMed = mysql_query("SELECT * FROM `medicines` WHERE `type`= 'Dialyzer'"); while($myMT = mysql_fetch_array($getMed)){ ?> <option id = "<?php echo $myMT['medicine_id'];?>" style="font-size:14px;color:blue;"> <?php echo $myMT['medicine_desc'];?>---<?php echo $myMT['medicine_id'];?></option> <?php }?> </select> </td> <td style='width:35%;border:none;background:white'> <select name="epo" style="width:100%;font-size:12px;color:blue;border;1px solid lightgry;border:1px solid lightgray;height:25px;background:#ffc3c3"> <option>NA</option> <?php $getEPO = mysql_query("SELECT * FROM `medicines` WHERE `medicine_desc` LIKE '%Eryth%' ORDER BY `medicine_desc` ASC "); while($myEPO= mysql_fetch_array($getEPO)){ ?> <option id = "<?php echo $myMT['medicine_id'];?>" style="font-size:12px;color:blue;"> <?php echo $myEPO['medicine_desc'];?>---<?php echo $myEPO['medicine_id'];?></option> <?php }?> </select> </td> <td style='width:30%;border:none;background:white'> <select name="package" style="width:100%;font-size:14px;color:blue;border;1px solid lightgry;border:1px solid gray;background:white"> <option id="0" style="font-size:18px">NA</option> <?php $getPackage = mysql_query("SELECT * FROM `package_header` WHERE `active`= '1' ORDER BY `package_code` ASC"); while($mypack = mysql_fetch_array($getPackage)){ ?> <option id = "<?php echo $mypack['package_hdr_id'];?>" style="font-size:14px;color:blue;"> <?php echo $mypack['package_code'];?>---<?php echo $mypack['package_hdr_id'];?></option> <?php }?> </select> </td> </tr> </table> </td> </tr> <tr> <td colspan="6" style='background:lightgray;border:none;font-size:11px;border-bottom:1px solid gray;font-weight:bold;color:black'><br>Co-morbidities:</td> </tr> <tr> <td colspan="2" style='background:lightgray;border:none;font-size:14px;font-size:14px;color:gray'>1. <input value='N/A' type="text" name="comordities1" style="font-size:14px;color:blue;width:90%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left" ></td> <td colspan="4" style='background:lightgray;border:none;font-size:14px;font-size:14px;color:gray'>2. <input value='N/A' type="text" name="comordities2" style="font-size:14px;color:blue;width:95%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left"></td> </tr> <tr> <td colspan="2" style='background:lightgray;border:none;font-size:14px;font-size:14px;color:gray'>3. <input value='N/A' type="text" name="comordities3" style="font-size:14px;color:blue;width:90%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left"></td> <td colspan="4" style='background:lightgray;border:none;font-size:14px;font-size:14px;color:gray'>4. <input value='N/A' type="text" name="comordities4" style="font-size:14px;color:blue;width:95%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left"></td> </tr> <tr> <td colspan="2" style='background:lightgray;border:none;font-size:14px;font-size:14px;color:gray'>5. <input value='N/A' type="text" name="comordities5" style="font-size:14px;color:blue;width:90%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left"></td> <td colspan="4" style='background:lightgray;border:none;font-size:14px;font-size:14px;color:gray'>6. <input value='N/A' type="text" name="comordities6" style="font-size:14px;color:blue;width:95%;border:1px solid gray;background:white;border-top:1px solid white;text-align:left"></td> </tr> <tr> <td colspan="6" style='background:lightgray;border:none;font-size:14px'> <center> <br><input type="submit" name="saverecord" value="Save" style="width:100px;height:30px;border:1px solid gray;border-radius:5px;font-size:16px;font-weight:bold"> <input type="reset" name="resetrecord" value="Reset" style="width:100px;height:30px;border:1px solid gray;border-radius:5px;font-size:16px;font-weight:bold"><br><br> </center></td> </tr> </table></center> </form> </td> </tr> <?php } } ?> </table></div>
| ver. 1.4 |
.
| PHP 7.3.33 | Generation time: 0 |
proxy
|
phpinfo
|
Settings