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<?php session_start(); require_once("../../patientmanager_Ptreg.php"); if(!isset($_SESSION['uname'])) { echo "<script>alert('Session Expired..');</script><script>window.location='../index.php';</script>"; } $narayan=LoginManager::currentUser(); $harilal=LoginManager::getUserTypeByuname("$narayan"); $sql ="SELECT * FROM site_users WHERE userno='$harilal'"; $qsql = mysqli_query($con,$sql); $rs = mysqli_fetch_array($qsql); $sql ="SELECT * FROM hco WHERE adminid='$rs[entered_by]'"; $qsql = mysqli_query($con,$sql); $rs1 = mysqli_fetch_array($qsql); $usertype=$rs1['adminid']; if(isset($_POST['Add_Pateint'])) { PatientManager::registerpatient("$_POST[familyid]","$_POST[headnumber]","$_POST[pic]","$_POST[fr]","$_POST[patientname]","$_POST[gendor]","$_POST[HusbandName]","$_POST[Email]","$_POST[numbers]","$_POST[dob]","$_POST[age_type]","$_POST[Weight]","$_POST[Height]","$_POST[bloodgroup]","$_POST[Nationality]","$_POST[Marital]","$_POST[Religion]","$_POST[Occupation]","$_POST[Familyinc]","$_POST[Education]","$_POST[Passportnm]","$_POST[AadharNu]","$_POST[Referred]","$_POST[Country]","$_POST[State]","$_POST[city]","$_POST[pincode]","$_POST[bloc]","$_POST[nameofinc]","$_POST[Policynm]","$_POST[entered_by]"); } ?> <!DOCTYPE html> <html lang="en"> <head> <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1" /> <meta charset="utf-8" /> <title>Add New Patient</title> <meta name="description" content="Common form elements and layouts" /> <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 --> <link rel="stylesheet" href="assets/css/jquery-ui.custom.min.css" /> <link rel="stylesheet" href="assets/css/chosen.min.css" /> <link rel="stylesheet" href="assets/css/bootstrap-datepicker3.min.css" /> <link rel="stylesheet" href="assets/css/bootstrap-timepicker.min.css" /> <link rel="stylesheet" href="assets/css/daterangepicker.min.css" /> <link rel="stylesheet" href="assets/css/bootstrap-datetimepicker.min.css" /> <link rel="stylesheet" href="assets/css/bootstrap-colorpicker.min.css" /> <!-- 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 responsive ace-save-state"> <script type="text/javascript"> try{ace.settings.loadState('sidebar')}catch(e){} </script> <?php include('includes/sidebar.php'); ?><!-- /.nav-list --> <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> <a href="#">Add</a> </li> <li class="active">New Patient</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="page-header"> <h1> Add <small> <i class="ace-icon fa fa-angle-double-right"></i> New Patient </small> </h1> </div><!-- /.page-header --> <div class="row"> <div class="col-xs-12"> <div id='divmb'></div> <!-- PAGE CONTENT BEGINS --> <form action='' method="POST"> <?php echo"<input type='hidden' name='familyid' value='$rs[entered_by]'> "; ?> <fieldset> <div class="row"> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'> Contact Number</span> <span style="color:red;">(Required)</span> <input type="text" onchange="mobile(this.value)" maxlength="10" name="numbers" class="form-control" placeholder="Contact Number" id="numbers" onkeypress="return isNumber(event)" required> </label></div> <div class="col-sm-4"> <label class="block clearfix"><span class='fontbold'> Name</span> <span style="color:red">(Required)</span> <input onclick="ValidateNo();" type="text" name="patientname" class="form-control" style="text-transform: capitalize;" placeholder="Name" onkeyup="this.value = this.value.toUpperCase();" required> </label></div> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'> Gender</span> <span style="color:red">(Required)</span><br> <span> Male </span><input type="radio" name="gendor" value="Male" required="required"> <span> Female </span><input type="radio" name="gendor" value="Female" required="required"> <span> Other </span><input type="radio" name="gendor" value="Other" required="required"> </label> </div></div> <div class="row"> <div class="col-sm-4"> <label class="block clearfix"><span class='fontbold'> Fathers/Husband Name</span> <span style="color:red">(Required)</span> <input class="form-control" type="text" name="HusbandName" onkeyup="this.value = this.value.toUpperCase();" placeholder="Enter your Fathers/Husband Name" required> </label></div> <div class="col-sm-4"><label class="block clearfix"> <span class='fontbold'>Email</span> (Optional) <input class="form-control" type="text" name="Email" placeholder="Enter your email addess"> </label></div> <div class="col-sm-4"> <label class="block clearfix"><span class='fontbold'> Age</span> <span style="color:red">(Required)</span> <div class='row'> <div class='col-sm-6'><input type='number' name='dob' id='select' required class="form-control"></div> <div class='col-sm-6'><select name='age_type' id='select' class="form-control"> <option>Years</option> <option>Month</option> <option>Days</option> </select></div> </div> </label></div> </div> <div class="row"> <div class="col-sm-4"><label class="block clearfix"> <span class='fontbold'>Weight</span> (Suggested) <span class="block input-icon input-icon-right"> <input class="form-control" type="text" name="Weight" placeholder="Weight in Kilogram" > </span> </label> </div> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'> Height</span> (Suggested) <span class="block input-icon input-icon-right"> <select class="form-control" name="Height" > <option>Select Height</option> <option value="Below" > Below </option> <option value='39'>1ft 3in / 39 cms </option> <option value='41'>1ft 4in / 41 cms </option> <option value='45'>1ft 6in / 45 cms </option> <option value='47'>1ft 7in / 47 cms </option> <option value='51'>1ft 8in / 51 cms </option> <option value='55'>1ft 9in / 55 cms </option> <option value='57'>1ft 10in / 57 cms </option> <option value='59'>1ft 11in / 59 cms </option> <option value='61'>2ft 61 cms </option> <option value='65'>2ft 1in / 65 cms </option> <option value='67'>2ft 2in / 67 cms </option> <option value='69'>2ft 3in / 69 cms </option> <option value='73'>2ft 4in / 73 cms </option> <option value='75'>2ft 5in / 75 cms </option> <option value='77'>2ft 6in / 77 cms </option> <option value='79'>2ft 7in / 79 cms </option> <option value='83'>2ft 8in / 83 cms </option> <option value='85'>2ft 9in / 85 cms </option> <option value='87'>2ft 10in / 87 cms </option> <option value='89'>2ft 11in / 89 cms </option> <option value='93'>3ft 93 cms </option> <option value='95'>3ft 1in / 95 cms </option> <option value='97'>3ft 2in / 97 cms </option> <option value='101'>3ft 31in / 101 cms </option> <option value='103'>3ft 4in / 103 cms </option> <option value='105'>3ft 5in / 105 cms </option> <option value='107'>3ft 6in / 107 cms </option> <option value='111'>3ft 7in / 111 cms </option> <option value='113'>3ft 8in / 113 cms </option> <option value='115'>3ft 9in / 115 cms </option> <option value='117'>3ft 10in / 117 cms </option> <option value='121'>3ft 11in / 121 cms </option> <option value='123'>4ft 123 cms </option> <option value='125'>4ft 1in / 125 cms </option> <option value='127'>4ft 2in / 127 cms </option> <option value='131'>4ft 3in / 131 cms </option> <option value='133'>4ft 4in / 133 cms </option> <option value='135'>4ft 5in / 135 cms </option> <option value='137' > >4ft 6in / 137 cms</option> <option value='139' >4ft 7in / 139 cms</option> <option value='142' >4ft 8in / 142 cms</option> <option value='144' >4ft 9in / 144 cms</option> <option value='147' >4ft 10in / 147 cms</option> <option value='149' >4ft 11in / 149 cms</option> <option value='152' >5ft / 152 cms</option> <option value='154' >5ft 1in / 154 cms</option> <option value='157' >5ft 2in / 157 cms</option> <option value='160' >5ft 3in / 160 cms</option> <option value='162' >5ft 4in / 162 cms</option> <option value='165' >5ft 5in / 165 cms</option> <option value='167' >5ft 6in / 167 cms</option> <option value='170' >5ft 7in / 170 cms</option> <option value='172' >5ft 8in / 172 cms</option> <option value='175' >5ft 9in / 175 cms</option> <option value='177' >5ft 10in / 177 cms</option> <option value='180' >5ft 11in / 180 cms</option> <option value='182' >6ft / 182 cms</option> <option value='185' >6ft 1in / 185 cms</option> <option value='187' >6ft 2in / 187 cms</option> <option value='190' >6ft 3in / 190 cms</option> <option value='193' >6ft 4in / 193 cms</option> <option value='195' >6ft 5in / 195 cms</option> <option value='198' >6ft 6in / 198 cms</option> <option value='200' >6ft 7in / 200 cms</option> <option value='203' >6ft 8in / 203 cms</option> <option value='205' >6ft 9in / 205 cms</option> <option value='208' >6ft 10in / 208 cms</option> <option value='210' >6ft 11in / 210 cms</option> <option value='213' >7ft / 213 cms</option> </select> </span> </label> </div> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Blood Group</span> (Suggested) <span class="block input-icon input-icon-right"> <select class="form-control" name="bloodgroup" > <option value="">Blood Group</option> <option value='A+'>A+</option> <option value='A-'>A-</option> <option value='B+'>B+</option> <option value='B-'>B-</option> <option value='O+'>O+</option> <option value='O-'>O-</option> <option value='AB+'>AB+</option> <option value='AB-'>AB-</option> </select> </span> </label></div> </div> <div class="row"> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Nationality</span> (Optional) <span class="block input-icon input-icon-right"> <select class="form-control" name="Nationality"> <option value="0">Nationality</option><option value="Indian" style="color:#004F00">Indian</option><option value="222" style="color:#004F00">United States of America</option><option value="220" style="color:#004F00">United Arab Emirates</option><option value="221" style="color:#004F00">United Kingdom</option><option value="13" style="color:#004F00">Australia</option><option value="189" style="color:#004F00">Singapore</option><option value="39" style="color:#004F00">Canada</option><option value="173" style="color:#004F00">Qatar</option><option value="114" style="color:#004F00">Kuwait</option><option value="161" style="color:#004F00">Oman</option><option value="17" style="color:#004F00">Bahrain</option><option value="185" style="color:#004F00">Saudi Arabia</option><option value="129" style="color:#004F00">Malaysia</option><option value="80" style="color:#004F00">Germany</option><option value="153" style="color:#004F00">New Zealand</option><option value="73" style="color:#004F00">France</option><option value="102" style="color:#004F00">Ireland</option><option value="203" style="color:#004F00">Switzerland</option><option value="193" style="color:#004F00">South Africa</option><option value="195" style="color:#004F00">Sri Lanka</option><option value="99" style="color:#004F00">Indonesia</option><option value="149" style="color:#004F00">Nepal</option><option value="162" style="color:#004F00">Pakistan</option><option value="18" style="color:#004F00">Bangladesh</option><option value="1" style="color:#004F00">Afghanistan</option> </select> </span> </label></div> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Marital status </span>(Optional) <span class="block input-icon input-icon-right"> <select class="form-control" name="Marital"> <option value="" disabled selected>Marital status </option> <option value="Single" label="Single">Single</option> <option value="Married" label="Married">Married</option> <option value="Widowed">Widowed</option> <option value="Sivorced" label="Divorced">Divorced</option> </select> </span> </label> </div> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Religion</span> (Optional) <span class="block input-icon input-icon-right"> <select class="form-control" name="Religion"> <option value="" disabled selected>Religion </option> <option value="Hindu" label="Hindu">Hindu</option> <option value="Muslim" label="Muslim">Muslim</option> <option value="Christian" label="Christian">Christian</option> <option value="Sikh" label="Sikh">Sikh</option> <option value="Parsi" label="Parsi">Parsi</option> <option value="Jain" label="Jain">Jain</option> <option value="Buddhist" label="Buddhist">Buddhist</option> <option value="Jewish" label="Jewish">Jewish</option> <option value="No Religion" label="No Religion">No Religion</option> <option value="Spiritual - not religious" label="Spiritual">Spiritual</option> <option value="Other" label="Other">Other</option> </select> </span> </label></div> </div> <div class="row"> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Occupation</span> (Optional) <span class="block input-icon input-icon-right"> <select class="form-control" name="Occupation"> <option value="" disabled selected>Occupation </option> <option value="Chief Executive and senior officers">Chief Executive and senior officers</option> <option value="IT">IT</option> <option value="Medical professionals">Medical professionals</option> <option value="Services and sales">Services and sales</option> <option value="Agricultural workers">Agricultural workers</option> <option value="Agricultural workers">Homemaker</option> <option value="Student">Student</option> <option value="Other">Other</option> </select> </span> </label></div> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Family income</span> (Optional) <span class="block input-icon input-icon-right"> <select class="form-control" name="Familyinc"> <option value="0">- Family Income -</option> <option value="0 - 1 Lakh">0 - 1 Lakh</option><option value="1 - 2 Lakhs">1 - 2 Lakhs</option><option value="2 - 3 Lakhs">2 - 3 Lakhs</option><option value="3 - 4 Lakhs">3 - 4 Lakhs</option><option value="4 - 5 Lakhs">4 - 5 Lakhs</option><option value="5 - 6 Lakhs">5 - 6 Lakhs</option><option value="6 - 7 Lakhs">6 - 7 Lakhs</option><option value="7 - 8 Lakhs">7 - 8 Lakhs</option><option value="8 - 9 Lakhs">8 - 9 Lakhs</option><option value="9 - 10 Lakhs">9 - 10 Lakhs</option><option value="10 - 12 Lakhs">10 - 12 Lakhs</option><option value="12 - 14 Lakhs">12 - 14 Lakhs</option><option value="14 - 16 Lakhs">14 - 16 Lakhs</option><option value="16 - 18 Lakhs">16 - 18 Lakhs</option><option value="18 - 20 Lakhs">18 - 20 Lakhs</option><option value="20 - 25 Lakhs">20 - 25 Lakhs</option><option value="19">25 - 30 Lakhs</option><option value="25 - 30 Lakhs">30 - 35 Lakhs</option><option value="35 - 40 Lakhs">35 - 40 Lakhs</option><option value="40 - 45 Lakhs">40 - 45 Lakhs</option><option value="45 - 50 Lakhs">45 - 50 Lakhs</option><option value="50 - 60 Lakhs">50 - 60 Lakhs</option><option value="60 - 70 Lakhs">60 - 70 Lakhs</option><option value="70 - 80 Lakhs">70 - 80 Lakhs</option><option value="80 - 90 Lakhs">80 - 90 Lakhs</option><option value="90 Lakhs - 1 Crore">90 Lakhs - 1 Crore</option><option value="1 Crore & Above">1 Crore & Above</option> </select> </span> </label></div> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Education Qualification </span>(Optional) <span class="block input-icon input-icon-right"> <select class="form-control" name="Education"> <option>Select Budget</option> <option value="" disabled selected> Education Qualification</option> <option value='Doctrate'>Doctorate</option> <option value='Post Graduation'>Post Graduation</option> <option value='Bachelor'>Graduation</option> <option value='Diploma'>Diploma</option> <option value='Higher Secondary School / High School'>Higher Secondary School / High School</option> <option value='None Of Above'>None Of Above</option> </select> </span> </label></div> </div> <div class="row"> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'> Passport Number </span>(Optional) <span class="block input-icon input-icon-right"> <input class="form-control" type="text" name="Passportnm" placeholder="Passport Number"> </span> </label> </div> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Aadhar Number </span>(Optional) <span class="block input-icon input-icon-right"> <input class="form-control" type="text" maxlength="16" name="AadharNu" placeholder="Aadhar Number"> </span> </label> </div> <div class="col-sm-4"> <label class="block clearfix"><span class='fontbold'>Country</span> <span style="color:red">(Required)</span> <select class="form-control" name="Country" id="country" required> <option value="" disabled selected>Country</option> <?php $query = "SELECT * FROM countries WHERE status = 1 AND country_name ='India'"; $result = $con->query($query); if($result->num_rows > 0){ while($row = $result->fetch_assoc()){ echo '<option value="'.$row['country_id'].'">'.$row['country_name'].'</option>'; } }else{ echo '<option value="">Country not available</option>'; } ?> </select> </span></label></div> </div> <div class="row"> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>State</span> <span style="color:red">(Required)</span> <select class="form-control" name="State" id="state" required > <option value="">Select country first</option> </select> </label> </div> <div class="col-sm-4"> <label class="block clearfix"><span class='fontbold'>Districts</span> <span style="color:red">(Required)</span> <select class="form-control" name="city" id="city" required> <option value="">Select state first</option> </select> </label></div> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Pincode</span> <span style="color:red">(Required)</span> <span class="block input-icon input-icon-right"> <input class="form-control" type="text" name="pincode" placeholder="Pincode" required> </span> </label></div> </div> <div class="row"> <div class="col-sm-4"> <label class="block clearfix"><span class='fontbold'>Address </span>(Optional) <span class="block input-icon input-icon-right"> <textarea class="form-control" name="bloc" placeholder="Your Address here..."></textarea> </span> </label> </div> <div class="col-sm-4"> <label class="block clearfix"><span class='fontbold'>Insurance Policy </span>(Optional) <span class="block input-icon input-icon-right"> <select name="nameofinc" class="form-control"> <option value="">Insurance Company</option> <?php $sqlpatient1 = "SELECT * FROM tpa_insurance"; $qsqlpatient1 = mysqli_query($con,$sqlpatient1); while($rsn = mysqli_fetch_array($qsqlpatient1)) { echo "<option value='$rsn[id]'>$rsn[Name]</option>"; } ?> </td> </select> </span> </label> </div> <div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Policy Number </span>(Optional) <span class="block input-icon input-icon-right"> <input class="form-control" type="text" name="Policynm" placeholder="Enter your Policy Number" > </span> </label></div> </div> <div class="row"> <div class="col-sm-4"><div class="clearfix"> </div></div> <div class="col-sm-4"></div> <div class="col-sm-4"><div class="space-24"></div> <div class="clearfix"> <button type="reset" class="width-30 pull-left btn btn-sm"> <i class="ace-icon fa fa-refresh"></i> <span class="bigger-110">Reset</span> </button> <button type="submit" name="Add_Pateint" class="width-65 pull-right btn btn-sm btn-success"> <span class="bigger-110">Add</span> <i class="ace-icon fa fa-arrow-right icon-on-right"></i> </button> </div></div> </div> </fieldset> </form> </div><!-- /.col --> </div><!-- /.row --> </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 --> <!--[if lte IE 8]> <script src="assets/js/excanvas.min.js"></script> <![endif]--> <script src="assets/js/jquery-ui.custom.min.js"></script> <script src="assets/js/jquery.ui.touch-punch.min.js"></script> <script src="assets/js/chosen.jquery.min.js"></script> <script src="assets/js/spinbox.min.js"></script> <script src="assets/js/bootstrap-datepicker.min.js"></script> <script src="assets/js/bootstrap-timepicker.min.js"></script> <script src="assets/js/moment.min.js"></script> <script src="assets/js/daterangepicker.min.js"></script> <script src="assets/js/bootstrap-datetimepicker.min.js"></script> <script src="assets/js/bootstrap-colorpicker.min.js"></script> <script src="assets/js/jquery.knob.min.js"></script> <script src="assets/js/autosize.min.js"></script> <script src="assets/js/jquery.inputlimiter.min.js"></script> <script src="assets/js/jquery.maskedinput.min.js"></script> <script src="assets/js/bootstrap-tag.min.js"></script> <!-- 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 --> <script> document.getElementById('btn').addEventListener("click", function(){ this.classList.add("loading"); this.innerHTML = "Loading..."; }); </script> <script> function mobile(mbid) { if (window.XMLHttpRequest) { // code for IE7+, Firefox, Chrome, Opera, Safari xmlhttp = new XMLHttpRequest(); } else { // code for IE6, IE5 xmlhttp = new ActiveXObject("Microsoft.XMLHTTP"); } xmlhttp.onreadystatechange = function() { if (this.readyState == 4 && this.status == 200) { document.getElementById("divmb").innerHTML = this.responseText; } }; xmlhttp.open("GET","loadmobile.php?mbid="+mbid,true); xmlhttp.send(); } </script> <script> $(document).ready(function(){ $('#country').on('change', function(){ var countryID = $(this).val(); if(countryID){ $.ajax({ type:'POST', url:'../ajaxData.php', data:'country_id='+countryID, success:function(html){ $('#state').html(html); $('#city').html('<option value="">Select state first</option>'); } }); }else{ $('#state').html('<option value="">Select country first</option>'); $('#city').html('<option value="">Select state first</option>'); } }); $('#state').on('change', function(){ var stateID = $(this).val(); if(stateID){ $.ajax({ type:'POST', url:'../ajaxData.php', data:'state_id='+stateID, success:function(html){ $('#city').html(html); } }); }else{ $('#city').html('<option value="">Select state first</option>'); } }); }); $(document).ready(function () { $('select').selectize({ sortField: 'text' }); }); </script> </body> </html>