<?php 
if(isset($_POST['sigrequest'])) 
{
   PatientManager::RequestTransport("$_GET[prescriptionid]","$_GET[patientid]","$_POST[Type_Ambulance]","$_POST[Departure]","$_POST[Expected_Arrival]","$_POST[EN_Route]","$_POST[Loading_Startup]","$_POST[Duration]","$_POST[Inspection_Report]","$_POST[Duration2]","$_POST[entered_by]");
}
?>

    <form name="sigrequest" method="post" >
               <h2 align="center">Request Transport</h2>
    
               <br>
      
	
      <table id="dynamic-table" class="table table-striped table-bordered table-hover dataTable no-footer"> 

                  <tr>
                      
          
                  
            <tr><td ><lable>Type of Ambulance : </lable> </td>
            <td  ><select name='Type_Ambulance' class='form-control'>
        <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></td></tr>
           
           
<td><lable>Scheduled Departure : </lable> </td><td><input name="Departure" type="datetime-local" class='form-control'></td></tr>

<tr><td><lable>EN Route: </lable> </td><td><input placeholder="EN Route" name="EN_Route" type="text" class='form-control'></td></tr>

<tr><td><lable> Expected Drop At : </lable> </td><td><input placeholder="Loading Time/Startup" name="Loading_Startup" type="datetime-local" class='form-control'></td></tr>






<tr><td><lable>Inspection Report    : </lable> </td><td><select name='Inspection_Report' class='form-control'>
        <option value='' >Inspection Report</option>
       <option value='Self Inspected'>Self Inspected</option>
    <option value='Third Party Inspection Report'>Third Party Inspection Report</option>
     <option value='Missing'>Missing</option>
           </select></td></tr>





             

      <tr>
          <td colspan='2'><input type="submit" name="sigrequest" value="Save" class='btn btn-success'></td>
      </tr>
       
        </table>   
        


</form>