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PHP Version : 7.2.34
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Current File : /home/btiyawmy/.trash/vendor/venders_Empanelment.php
<?php session_start();
require_once('dbconnection.php');

//Code for Registration 
if(isset($_POST['signup']))
{

  $Accreditationlevel=$_POST['Accreditationlevel'];
  $Validupto=$_POST['Validupto'];
  $identificationnumber=$_POST['identificationnumber'];
  $accreditationboard=$_POST['accreditationboard'];
  $othervalidupto=$_POST['othervalidupto'];
  $otheridentificationnumber=$_POST['otheridentificationnumber'];
  $Numberofemp=$_POST['Numberofemp'];
  $Nameofempanelled=$_POST['Nameofempanelled'];
  $Identificationno=$_POST['Identificationno'];
  	$msg=mysqli_query($con,"insert into emp(Accreditationlevel,Validupto,identificationnumber,accreditationboard,othervalidupto,otheridentificationnumber,Numberofemp,Nameofempanelled,Identificationno) values('$Accreditationlevel','$Validupto','$identificationnumber','$accreditationboard','$othervalidupto','$otheridentificationnumber','$Numberofemp','$Nameofempanelled','$Identificationno')");
if($msg)
{
	echo "<script>alert('Register successfully');</script>";
}
}
?>

<!DOCTYPE html>
<html>
<title>Testing new </title>
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="https://www.w3schools.com/w3css/4/w3.css">
<script>
function myFunction() {
  var checkBox = document.getElementById("myCheck");
  var text = document.getElementById("text");
  if (checkBox.checked == true){
    text.style.display = "block";
  } else {
     text.style.display = "none";
  }
}
function myFunction2() {
  var checkBox = document.getElementById("myCheck2");
  var text = document.getElementById("text2");
  if (checkBox.checked == true){
    text.style.display = "block";
  } else {
     text.style.display = "none";
  }
}
function myFunction3() {
  var checkBox = document.getElementById("myCheck3");
  var text = document.getElementById("text3");
  if (checkBox.checked == true){
    text.style.display = "block";
  } else {
     text.style.display = "none";
  }
}
function myFunction4() {
  var checkBox = document.getElementById("myCheck4");
  var text = document.getElementById("text4");
  if (checkBox.checked == true){
    text.style.display = "block";
  } else {
     text.style.display = "none";
  }
}
function myFunction5() {
  var checkBox = document.getElementById("myCheck5");
  var text = document.getElementById("text5");
  if (checkBox.checked == true){
    text.style.display = "block";
  } else {
     text.style.display = "none";
  }
}
function myFunction6() {
  var checkBox = document.getElementById("myCheck6");
  var text = document.getElementById("text6");
  if (checkBox.checked == true){
    text.style.display = "block";
  } else {
     text.style.display = "none";
  }
}
function myFunction7() {
  var checkBox = document.getElementById("myCheck7");
  var text = document.getElementById("text7");
  if (checkBox.checked == true){
    text.style.display = "block";
  } else {
     text.style.display = "none";
  }
}


</script>
<body>
<?php include 'menu.php';?>
<div class="content">
<form name="new2" method="post" class="w3-container w3-card-4 w3-light-grey w3-text-blue w3-margin">
<h2 class="w3-center">Empanelment and accreditation details</h2>
<input type="checkbox" name="NABH" id="myCheck2" onclick="myFunction2()">
<label>NABH Accreditation  </label>
<div id="text2" style="display:none" class="w3-row-padding">
<div class="w3-half">
    <div class="w3-rest">
    <label>Accreditation level</label>
    <select class="w3-select w3-border" name="Accreditationlevel">
    <option value="" disabled selected>Accreditation level</option>
    <option value="Entry-level">Entry-level</option>
    <option value="Progressive-level">Progressive level</option>
    <option value="Final-level">Final-level</option>
  </select>
    </div>
</div>
<div class="w3-half">
    <div class="w3-rest">
    <label>Valid upto</label>
      <input class="w3-input w3-border" name="Validupto" type="date" placeholder="Valid upto">
    </div>
</div>
<div class="w3-half">
  <div class="w3-rest">
  <label>Identification number</label>
      <input class="w3-input w3-border" name="identificationnumber" type="text" placeholder="Identification number">
    </div>
</div>
</div>
</br>
<div class="w3-rest">
<input type="checkbox"  id="myCheck" onclick="myFunction()">
<label for="Blood">Other accreditation Board details</label>
<div id="text" style="display:none" class="w3-row-padding">
<div class="w3-half">
    <div class="w3-rest">
    <label>Accreditation </label>
      <input class="w3-input w3-border" name="accreditationboard" type="text" placeholder="Name of accreditation">
    </div>
</div>
<div class="w3-half">
    <div class="w3-rest">
    <label>Accreditation level</label>
      <input class="w3-input w3-border" name="othervalidupto" type="text" placeholder="Accreditation level">
    </div>
  </div>
<div class="w3-half">
      <div class="w3-rest">
      <label> Identification Number</label>
      <input class="w3-input w3-border" name="otheridentificationnumber" type="text" placeholder="identification number">
    </div>
</div>
<div class="w3-half">
    <div class="w3-rest">
    <label>upto</label>
      <input class="w3-input w3-border" name="othervalidupto" type="date" value="level-valid upto">
    </div>
  </div>
  </div>
<div class="w3-row-padding">
<input type="checkbox"  id="myCheck7" onclick="myFunction7()">
<label for="Blood">Empanelled  details</label>
<div id="text7" style="display:none" class="w3-row-padding">
<div class="w3-half">
  <div class="w3-rest">
  <input class="w3-input w3-border"  name="Nameofempanelled" placeholder="Name of empanelled body ">
    </div>
    </div>
<div class="w3-half">
    <div class="w3-rest">
      <input class="w3-input w3-border" name="Identificationno" type="text" placeholder="Identification number">
    </div>
</div>
</div>
</br>
<div class=w3-row-padding>
<div class="w3-half">
<input type="checkbox" name="NABH" id="myCheck3" onclick="myFunction3()">
<label>CGHS Registration Number  </label>
<div id="text3" style="display:none" class="w3-row-padding">
      <input class="w3-input w3-border" name="Accreditationlevel" type="text" placeholder="Registration Number">
    </div>
</div>
<div class="w3-half">
<input type="checkbox" name="NABH" id="myCheck4" onclick="myFunction4()">
<label>RSBY Registration Number   </label>
<div id="text4" style="display:none" class="w3-row-padding">
      <input class="w3-input w3-border" name="Accreditationlevel" type="text" placeholder="Registration Number">
    </div>
</div>
<div class="w3-half">
<input type="checkbox" name="NABH" id="myCheck5" onclick="myFunction5()">
<label>ESIC Registration Number </label>
<div id="text5" style="display:none" class="w3-row-padding">
      <input class="w3-input w3-border" name="Accreditationlevel" type="text" placeholder="Registration Number">
    </div>
</div>
<div class="w3-half">
<input type="checkbox" name="NABH" id="myCheck6" onclick="myFunction6()">
<label>AB-PMJAY Registration Number  </label>
<div id="text6" style="display:none" class="w3-row-padding">
      <input class="w3-input w3-border" name="Accreditationlevel" type="text" placeholder="Registration Number">
    </div>
</div>
</div>

<p class="w3-center">
<button name="signup"class="w3-button w3-section w3-blue w3-ripple"> Submit</button>
</p>

</div>
</div>
</form>
</body>
</html>
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AnonSec Team