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<?php
session_start();
include('db/dbcon.php');
if(isset($_POST['immunization'])){
$sql ="INSERT INTO immunization(patientid,Vaccine,DateGiven,duedate,Note) values('$_POST[patientid]','$_POST[Vaccine]','$_POST[DateGiven]','$_POST[duedate]','$_POST[Note]')";
if($qsql = mysqli_query($conn,$sql))
{
echo "<script>alert('Immunization record inserted successfully...');</script><script>window.location='immunization.php?id=$_GET[id]';</script>;</script>";
}
else
{
echo mysqli_error($conn);
}
}
?>
<!DOCTYPE html>
<html lang="en">
<head>
<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1" />
<meta charset="utf-8" />
<title>Add Immunization</title>
<meta name="description" content="" />
<meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=1.0" />
<!-- bootstrap & fontawesome -->
<link rel="stylesheet" href="assets/css/bootstrap.min.css" />
<link rel="stylesheet" href="assets/font-awesome/4.5.0/css/font-awesome.min.css" />
<!-- page specific plugin styles -->
<!-- text fonts -->
<link rel="stylesheet" href="assets/css/fonts.googleapis.com.css" />
<!-- ace styles -->
<link rel="stylesheet" href="assets/css/ace.min.css" class="ace-main-stylesheet" id="main-ace-style" />
<!--[if lte IE 9]>
<link rel="stylesheet" href="assets/css/ace-part2.min.css" class="ace-main-stylesheet" />
<![endif]-->
<link rel="stylesheet" href="assets/css/ace-skins.min.css" />
<link rel="stylesheet" href="assets/css/ace-rtl.min.css" />
<!--[if lte IE 9]>
<link rel="stylesheet" href="assets/css/ace-ie.min.css" />
<![endif]-->
<!-- inline styles related to this page -->
<!-- ace settings handler -->
<script src="assets/js/ace-extra.min.js"></script>
<!-- HTML5shiv and Respond.js for IE8 to support HTML5 elements and media queries -->
<!--[if lte IE 8]>
<script src="assets/js/html5shiv.min.js"></script>
<script src="assets/js/respond.min.js"></script>
<![endif]-->
</head>
<body class="no-skin">
<?php include('includes/header.php'); ?>
<div class="main-container ace-save-state" id="main-container">
<script type="text/javascript">
try{ace.settings.loadState('main-container')}catch(e){}
</script>
<div id="sidebar" class="sidebar navbar-collapse collapse ace-save-state">
<script type="text/javascript">
try{ace.settings.loadState('sidebar')}catch(e){}
</script>
<div class="sidebar-shortcuts" id="sidebar-shortcuts">
<div class="sidebar-shortcuts-large" id="sidebar-shortcuts-large">
<button class="btn btn-success">
<i class="ace-icon fa fa-signal"></i>
</button>
<button class="btn btn-info">
<i class="ace-icon fa fa-pencil"></i>
</button>
<button class="btn btn-warning">
<i class="ace-icon fa fa-users"></i>
</button>
<button class="btn btn-danger">
<i class="ace-icon fa fa-cogs"></i>
</button>
</div>
<div class="sidebar-shortcuts-mini" id="sidebar-shortcuts-mini">
<span class="btn btn-success"></span>
<span class="btn btn-info"></span>
<span class="btn btn-warning"></span>
<span class="btn btn-danger"></span>
</div>
</div><!-- /.sidebar-shortcuts -->
<?php include('includes/sidebar.php'); ?>
<div class="sidebar-toggle sidebar-collapse" id="sidebar-collapse">
<i id="sidebar-toggle-icon" class="ace-icon fa fa-angle-double-left ace-save-state" data-icon1="ace-icon fa fa-angle-double-left" data-icon2="ace-icon fa fa-angle-double-right"></i>
</div>
</div>
<div class="main-content">
<div class="main-content-inner">
<div class="breadcrumbs ace-save-state" id="breadcrumbs">
<ul class="breadcrumb">
<li>
<i class="ace-icon fa fa-home home-icon"></i>
<a href="#">Home</a>
</li>
<li class="active">
<a href="#">Add Immunization</a>
</li>
</ul><!-- /.breadcrumb -->
<div class="nav-search" id="nav-search">
<form class="form-search">
<span class="input-icon">
<input type="text" placeholder="Search ..." class="nav-search-input" id="nav-search-input" autocomplete="off" />
<i class="ace-icon fa fa-search nav-search-icon"></i>
</span>
</form>
</div><!-- /.nav-search -->
</div>
<div class="page-content">
<div class="ace-settings-container" id="ace-settings-container">
<div class="btn btn-app btn-xs btn-warning ace-settings-btn" id="ace-settings-btn">
<i class="ace-icon fa fa-cog bigger-130"></i>
</div>
<div class="ace-settings-box clearfix" id="ace-settings-box">
<div class="pull-left width-50">
<div class="ace-settings-item">
<div class="pull-left">
<select id="skin-colorpicker" class="hide">
<option data-skin="no-skin" value="#438EB9">#438EB9</option>
<option data-skin="skin-1" value="#222A2D">#222A2D</option>
<option data-skin="skin-2" value="#C6487E">#C6487E</option>
<option data-skin="skin-3" value="#D0D0D0">#D0D0D0</option>
</select>
</div>
<span> Choose Skin</span>
</div>
<div class="ace-settings-item">
<input type="checkbox" class="ace ace-checkbox-2 ace-save-state" id="ace-settings-navbar" autocomplete="off" />
<label class="lbl" for="ace-settings-navbar"> Fixed Navbar</label>
</div>
<div class="ace-settings-item">
<input type="checkbox" class="ace ace-checkbox-2 ace-save-state" id="ace-settings-sidebar" autocomplete="off" />
<label class="lbl" for="ace-settings-sidebar"> Fixed Sidebar</label>
</div>
<div class="ace-settings-item">
<input type="checkbox" class="ace ace-checkbox-2 ace-save-state" id="ace-settings-breadcrumbs" autocomplete="off" />
<label class="lbl" for="ace-settings-breadcrumbs"> Fixed Breadcrumbs</label>
</div>
<div class="ace-settings-item">
<input type="checkbox" class="ace ace-checkbox-2" id="ace-settings-rtl" autocomplete="off" />
<label class="lbl" for="ace-settings-rtl"> Right To Left (rtl)</label>
</div>
<div class="ace-settings-item">
<input type="checkbox" class="ace ace-checkbox-2 ace-save-state" id="ace-settings-add-container" autocomplete="off" />
<label class="lbl" for="ace-settings-add-container">
Inside
<b>.container</b>
</label>
</div>
</div><!-- /.pull-left -->
<div class="pull-left width-50">
<div class="ace-settings-item">
<input type="checkbox" class="ace ace-checkbox-2" id="ace-settings-hover" autocomplete="off" />
<label class="lbl" for="ace-settings-hover"> Submenu on Hover</label>
</div>
<div class="ace-settings-item">
<input type="checkbox" class="ace ace-checkbox-2" id="ace-settings-compact" autocomplete="off" />
<label class="lbl" for="ace-settings-compact"> Compact Sidebar</label>
</div>
<div class="ace-settings-item">
<input type="checkbox" class="ace ace-checkbox-2" id="ace-settings-highlight" autocomplete="off" />
<label class="lbl" for="ace-settings-highlight"> Alt. Active Item</label>
</div>
</div><!-- /.pull-left -->
</div><!-- /.ace-settings-box -->
</div><!-- /.ace-settings-container -->
<div class="page-header">
<h1>Add Immunization </h1>
</div><!-- /.page-header -->
<div class="row">
<div class="col-xs-12">
<!-- PAGE CONTENT BEGINS -->
<div class="row">
<div class="col-xs-12">
<form method="post" >
<table id="example2" class="table table-bordered table-hover">
<tbody>
<input type="hidden" name="patientid" id="patientid" value="<?php echo $_GET['id'] ?>">
<tr>
<td height="62">Vaccine</td>
<td><input type="text" name="Vaccine" id="Vaccine" class="form-control"></td>
</tr>
<tr>
<td height="62"> Given on</td>
<td><input type="date" name="DateGiven" class="form-control"></td>
</tr>
<tr>
<td height="62"> Due Date </td>
<td><input type="date" min="<?php echo date("Y-m-d"); ?>" name="duedate" id="duedate" class="form-control"></td>
</tr>
<tr><td>Note</td>
<td><textarea name="Note" rows="2" cols="50" id="Note" class="form-control"></textarea></td>
</tr>
<tr>
<td colspan="2" align="right"><input type="submit" class="btn btn-info" name="immunization" id="submit" value="Submit"></td>
</tr>
</tbody>
</table>
</form>
</div><!-- /.span -->
</div><!-- /.row -->
<div class="hr hr-18 dotted hr-double"></div>
<!-- PAGE CONTENT ENDS -->
</div><!-- /.col -->
</div>
<div class="hr hr32 hr-dotted"></div>
<!-- PAGE CONTENT ENDS -->
</div><!-- /.col -->
</div>
</div><!-- /.page-content -->
</div>
</div><!-- /.main-content -->
<?php include('includes/footer.php'); ?>
<a href="#" id="btn-scroll-up" class="btn-scroll-up btn btn-sm btn-inverse">
<i class="ace-icon fa fa-angle-double-up icon-only bigger-110"></i>
</a>
</div><!-- /.main-container -->
<!-- basic scripts -->
<!--[if !IE]> -->
<script src="assets/js/jquery-2.1.4.min.js"></script>
<!-- <![endif]-->
<!--[if IE]>
<script src="assets/js/jquery-1.11.3.min.js"></script>
<![endif]-->
<script type="text/javascript">
if('ontouchstart' in document.documentElement) document.write("<script src='assets/js/jquery.mobile.custom.min.js'>"+"<"+"/script>");
</script>
<script src="assets/js/bootstrap.min.js"></script>
<!-- page specific plugin scripts -->
<!-- ace scripts -->
<script src="assets/js/ace-elements.min.js"></script>
<script src="assets/js/ace.min.js"></script>
<!-- inline scripts related to this page -->
<!--[if lte IE 8]-->
</body>
</html>