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<?php session_start(); include 'dbconnection.php'; require_once("../patientmanager.php"); require_once("../DBManager.php"); if(isset($_POST['sigrequest'])) { PatientManager::RequestTransport("$_GET[prescriptionid]","$_GET[patientid]","$_POST[Type_Ambulance]","$_POST[Departure]","$_POST[Arrival]","$_POST[EN_Route]","$_POST[Loading_Startup]","$_POST[Duration]","$_POST[Inspection_Report]","$_POST[Duration2]","$_POST[entered_by]"); } ?> <!DOCTYPE html> <html lang="en"> <head><meta charset="ibm866"> <style> .switch { position: relative; display: inline-block; width: 90px; height: 34px; } .switch input {display:none;} .slider { position: absolute; cursor: pointer; top: 0; left: 0; right: 0; bottom: 0; background-color: #ca2222; -webkit-transition: .4s; transition: .4s; border-radius: 34px; } .slider:before { position: absolute; content: ""; height: 26px; width: 26px; left: 4px; bottom: 4px; background-color: white; -webkit-transition: .4s; transition: .4s; border-radius: 50%; } input:checked + .slider { background-color: #2ab934; } input:focus + .slider { box-shadow: 0 0 1px #2196F3; } input:checked + .slider:before { -webkit-transform: translateX(26px); -ms-transform: translateX(26px); transform: translateX(55px); } /*------ ADDED CSS ---------*/ .slider:after { content:'No'; color: white; display: block; position: absolute; transform: translate(-50%,-50%); top: 50%; left: 50%; font-size: 10px; font-family: Verdana, sans-serif; } input:checked + .slider:after { content:'Yes'; } .center { border: 1px solid grey; text-align:; } </style> <meta name="viewport" content="width=device-width, initial-scale=1"> <link rel="stylesheet" href="https://www.w3schools.com/w3css/4/w3.css"> <title>Document</title> <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"; } } </script> <style> .center { border: 1px solid grey; text-align:; } </style> </head> <body> <form name="sigrequest" method="post" > <h2 align="center">Request Transport</h2> <br> <div class="center"> <table id="example2" class="table table-bordered table-hover"> <thead> <tr> <div class='account-details'> <tr><td style="width:29%"><div><h5>Type of Ambulance : </h5> </td></div><td style="width:46%"><div><select name='Type_Ambulance'> <option value='' >Type of Ambulance</option> <option value='Basic Life Support Ambulance'>Basic Life Support Ambulance</option> <option value='Advanced Life Support Ambulance'>Advanced Life Support Ambulance</option> <option value='Air Ambulance'>Air Ambulance</option> </select></div></td></tr> <td><div><h5>Departure from Source : </h5> </td></div><td><div><input name="Departure" type="time"></div></td></tr> <tr><td><div><h5>Arrival : </h5> </td></div><td><div><input name="Arrival" type="time"></div></td></tr> <tr><td><div><h5>EN Route: </h5> </td></div><td><div><input placeholder="EN Route" name="EN_Route" type="text"></div></td></tr> <tr><td><div><h5>Alternate: </h5> </td></div><td><div><input placeholder="Alternate" name="Alternate" type="text"></div></td></tr> <tr><td><div><h5>Loading Time/Startup: </h5> </td></div><td><div><input placeholder="Loading Time/Startup" name="Loading_Startup" type="time"></div></td></tr> </div> </tr> <tr><td><div><h5>Expected Departure with Patient: </h5> </td></div><td><div><input placeholder="Expected Arrival at" name="Expected_Arrival" type="time"></div></td></tr> </div> </tr> <tr><td><div><h5>Inspection Report : </h5> </td></div><td><div><select name='Inspection_Report'> <option value='' >Inspection Report</option> <option value='Self Inspection Checklist'>Self Inspection Checklist</option> <option value='Upload Inspection Report'>Upload Inspection Report </option> </select></div></td></tr> </div> </tr> <tr><td><div><h5>Duration : </h5> </td></div><td><div><input placeholder="Duration" name="Duration" type="time"></div></td></tr> </div> </tr> </thead> </tbody> <tfoot> </tfoot> </table> </div> <input type="submit" name="sigrequest" value="Save"> </form> </body> </html>