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<?php session_start(); require_once('../DBManager.php'); require_once('../LoginManager.php'); require_once('../patientmanager.php'); include 'dashboarddocument.php'; include 'header.php'; if(isset($_POST['signup'])) { PatientManager::bloodrequisition("$_POST[prescriptionid]","$_POST[patientid]","$_POST[abo_rh]","$_POST[units]","$_POST[blgroup]","$_POST[Address]","$_POST[Ref_Dr]","$_POST[entered_by]"); } ?> <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 charset="UTF-8"> <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> <?php $sql ="SELECT * FROM patient WHERE patientid='12704'"; $qsql = mysqli_query($con,$sql); while($rs = mysqli_fetch_array($qsql)) { echo " <div class='content-wrapper'> <!-- Content Header (Page header) --> <section class='content-header'> <div class='center'> <table id='example2' class='table table-bordered table-hover' width='100%'> <h3 align='center'>Blood Requisition Form</h3> <tr> <td width='50%'> Pt. Name: </td> <td width='50%'>$rs[patientname]</td> </tr> <tr> <td width='50%'> W/O,D/O,S/O. : </td> <td width='50%'>$rs[HusbandName]</td> </tr> <tr> <td width='50%'> DOB: </td> <td width='50%'>$rs[dob]</td> </tr> <tr> <td width='50%'> Sex : </td> <td width='50%'>$rs[gendor]</td> </tr> "; echo "</td></tr>"; } ?> <form name="signup" method="post"> <tr> <td width='50%'> ABO & Rh: </td> <td width='50%'><input type="text" placeholder="ABO & Rh" name="abo_rh"></td> </tr> <tr> <td width='50%'> Advice: </td> <td width='50%'>Please provide <input type='text' name='units'> Units <input type='text' name='group'> After grouping and cross matching </td> </tr> <tr> <td width='50%'> Address: </td> <td width='50%'><input type='text' placeholder='Address' name='address'></td> </tr> <tr> <td width='50%'> Ref.by Dr: </td> <td width='50%'><input type='text' placeholder='Ref.by Dr' name='Ref_Dr'></td> </tr> <?php $sql ="SELECT * FROM addaspatient WHERE prescriptionid='$_GET[prescriptionid]' AND patientid='$_GET[patientid]'"; $qsql = mysqli_query($con,$sql); while($rs = mysqli_fetch_array($qsql)) { echo " <input type='hidden' name='prescriptionid' value='$rs[prescriptionid]'> <input type='hidden' name='patientid' value='$rs[patientid]'> "; } ?> <br> </table> <label>Nurse Name</label></td><td></td><input type="text" name='Nurse_Name' placeholder='Nurse Name'> <br> <br> <tr> <td width='50%'> Blood Bag Number: </td> <td width='50%'><input type='text' placeholder='Blood Bag Number' name='Blood_Bag_Number'></td> </tr> <tr> <td width='50%'> Product's Blood Group: </td> <td width='50%'><input type='text' placeholder='Product Blood Group' name='Products_Blood_Group'></td> </tr> <tr> <td width='50%'> Product's Name(PL. encircle): </td> <td width='50%'><select name="product_name"> <option value="Whole Blood">Whole Blood</option> <option value="RBC">RBC</option> <option value="PRC">PRC</option> <option value="FFP">FFP</option> <option value="CPP">CPP</option> <option value="Cryoprecipitate">Cryoprecipitate</option> </select></td> </tr> <tr> <td width='50%'> Name of the Blood Bank: </td> <td width='50%'><input type='text' placeholder='Name of the Blood Bank' name='blood_bank_name'></td> </tr> <tr> <td width='50%'> Date of expiry: </td> <td width='50%'><input type='date' placeholder='Date of expiry' name='date_of_expiry'></td> </tr> <tr> <td width='50%'> Blood Checked by the Doctor: </td> <td width='50%'><input type='text' placeholder='Blood Checked by the Doctor' name='Blood_Checked_Doctor'></td> </tr> <tr> <td width='50%'> Doctor ID No.: </td> <td width='50%'><input type='text' placeholder='Doctor ID No.' name='doctor_id_no'></td> </tr> <input type="submit" name="signup" value="Submit"> </form> <script> n = new Date(); y = n.getFullYear(); m = n.getMonth() + 1; d = n.getDate(); document.getElementById("date").innerHTML = m + "/" + d + "/" + y; </script>