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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($_POST['signup']))
{
PatientManager::patientreferral("$_GET[prescriptionid]","$_GET[patientid]","$_POST[hs_referral]","$_POST[location]","$_POST[Phone]","$_POST[Email]","$_POST[Accompanied]","$_POST[Primary_Diagnosis]","$_POST[Treatments_initiated]","$_POST[Types_Patient]","$_POST[Transportation_needs]","$_POST[Follow_up_requirements]","$_POST[Mobility]","$_POST[Self_care]","$_POST[Cognitive_impairment]","$_POST[Assistive_devices_provide]","$_POST[Assistive_required]","$_POST[Nurse_Name]","$_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";
}
}
function myFunction102() {
var checkBox = document.getElementById("myCheck102");
var text = document.getElementById("text102");
if (checkBox.checked == true){
text.style.display = "block";
} else {
text.style.display = "none";
}
}
</script>
<style>
.center {
border: 1px solid grey;
text-align:;
}
</style>
<div class='content-wrapper'>
<!-- Content Header (Page header) -->
<section class='content-header'>
<div class='center'>
<form name="signup" method="post">
<table id='example2' class='table table-bordered table-hover' width='100%'>
<h3 align='center'>Patient Referral</h3>
<tr>
<td width='50%'> Referral to: </td>
<td width='50%'>
<input onkeyup="this.value = this.value.toUpperCase();" placeholder='Name of facility or service' onchange="Referralload(this.value)" name='hs_referral' type='text' list='hs_referral'>
<datalist name='hs_referral' id='hs_referral'>
<?php
include("dbconnection.php");
$sqlpatient1 = "SELECT * FROM admin";
$qsqlpatient1 = mysqli_query($con,$sqlpatient1);
while($rsn = mysqli_fetch_array($qsqlpatient1))
{
echo "
<option value=''>Name of facility or service</option>
<option value='$rsn[hsname]'>$rsn[hsname]</option>";
}
?>
</td>
</datalist></td>
</tr>
</table>
<div id='divdr'>
<table id='example2' class='table table-bordered table-hover' width='100%'>
<tr>
<td width='50%'> Location: </td>
<td width='50%'><input type='text' name='location' placeholder='Location'>
</td>
</tr>
<tr>
<td width='50%'> Phone: </td>
<td width='50%'>
<input type='text' name='Phone' placeholder='Phone'>
</td>
</tr>
<tr>
<td width='50%'> Email: </td>
<td width='50%'>
<input type='text' name='Email' placeholder='Email'>
</td>
</tr>
</table>
</div>
<table id='example2' class='table table-bordered table-hover' width='100%'>
<?php
$narayan=LoginManager::currentUser();
$usertype=LoginManager::getUserTypeByuname("$narayan");
$sql ="SELECT * FROM site_users WHERE userno='$usertype'";
$qsql = mysqli_query($con,$sql);
if($rs = mysqli_fetch_array($qsql))
{
$sql ="SELECT * FROM hco WHERE adminid='$rs[entered_by]'";
$qsql = mysqli_query($con,$sql);
if($rs = mysqli_fetch_array($qsql))
{
$sql ="SELECT * FROM admin WHERE id='$rs[adminid]'";
$qsql = mysqli_query($con,$sql);
if($ra = mysqli_fetch_array($qsql))
{
echo"<tr>
<td width='50%'> Referring from: </td>
<td width='50%'> $ra[hsname]</td></tr>
<tr>
<td width='50%'> Location: </td>
<td width='50%'> $rs[Street] | $rs[Locality]</td></tr>
<tr>
<td width='50%'> Phone: </td>
<td width='50%'> $ra[numbers]</td></tr>
<tr>
<td width='50%'> Email Id: </td>
<td width='50%'> $ra[EmailID]</td></tr>
";
}
}
}
?>
</table>
<table id='example2' class='table table-bordered table-hover' width='100%'><tr>
<th>Patient Information</th></tr>
</table>
<table id='example2' class='table table-bordered table-hover' width='100%'>
<?php
$sql ="SELECT * FROM patient WHERE patientid='$_GET[patientid]'";
$qsql = mysqli_query($con,$sql);
while($rs = mysqli_fetch_array($qsql))
{
echo "
<tr>
<td width='50%'> Full Name : </td>
<td width='50%'>$rs[patientname]</td>
</tr>
<tr>
<td width='50%'> Phone : </td>
<td width='50%'>$rs[numbers]</td>
</tr>
<tr>
<td width='50%'> DOB: </td>
<td width='50%'>$rs[dob]</td>
</tr>
<tr>
<td width='50%'> Sex : </td>
<td width='50%'>$rs[gendor]</td>
</tr>
";
echo "</td></tr>"; }
?>
<tr>
<td width='50%'> Accompanied by care provider : </td>
<td width='50%'><label class='switch'>
<input name='Accompanied' type='checkbox'>
<span class='slider'></span>
</label>
</td>
</tr>
<tr>
<td width='50%'> Primary Diagnosis : </td>
<td width='50%'><textarea name="Primary_Diagnosis" rows="3" cols="50">
</textarea>
</td>
</tr>
<tr>
<td width='50%'> Treatments initiated : </td>
<td width='50%'><textarea name="Treatments_initiated" rows="3" cols="50">
</textarea>
</td>
</tr>
<tr>
<td width='50%'> Types of Patient : </td>
<td width='50%'><select name='Types_Patient'>
<option value='Admission Consent' disabled selected>Types of Patient</option>
<option value='Inpatient'>Inpatient</option>
<option value='Outpatient'>Outpatient </option>
<option value='Community'>Community</option>
</select></td>
</tr>
<tr>
<td width='50%'> Transportation needs : </td>
<td width='50%'><select name='Transportation_needs'>
<option value='Admission Consent' disabled selected>Transportation needs</option>
<option value='Yes'>Yes</option>
<option value='No'>No </option>
</select></td>
</tr>
<tr>
<td width='50%'> Follow_up_requirements : </td>
<td width='50%'><input type='text' name='Follow_up_requirements' Placeholder='Follow-up requirements'>
</td>
</tr>
</table>
<table id='example2' class='table table-bordered table-hover' width='100%'><tr>
<th>Functional Status</th></tr>
</table>
<table id='example2' class='table table-bordered table-hover' width='100%'>
<tr>
<td width='50%'> Mobility : </td>
<td width='50%'><select name='Mobility'>
<option disabled selected>Mobility</option>
<option value='Bed bound'>Bed bound</option>
<option value='Wheelchair'>Wheelchair</option>
<option value='Crutches'>Crutches</option>
<option value='Walking frame'>Walking frame</option>
<option value='Requires assistance'>Requires assistance</option>
<option value='Independent'>Independent</option>
</select></td>
</tr>
<tr>
<td width='50%'> Self-care : </td>
<td width='50%'><select name='Self_care'>
<option disabled selected>Self-care</option>
<option value='Carer dependent'>Carer dependent</option>
<option value='Requires commode'>Requires commode</option>
<option value='Requires modified latrine/washroom'>Requires modified latrine/washroom</option>
<option value='Independent'>Independent</option>
</select></td>
</tr>
<tr>
<td width='50%'> Cognitive impairment : </td>
<td width='50%'><label class='switch'>
<input name='Cognitive_impairment' type='checkbox'>
<span class='slider'></span>
</label>
</td>
</tr>
<tr>
<td width='50%'> Assistive devices(s) provided : </td>
<td width='50%'><textarea name="Assistive_devices_provide" rows="2" cols="50">
</textarea>
</td>
</tr>
<tr>
<td width='50%'> Assistive device(s) required:
</td>
<td width='50%'><textarea name="Assistive_required" rows="2" cols="50">
</textarea>
</td>
</tr>
</table>
</td><td></td><input type="hidden" name='Nurse_Name' placeholder='Created By'>
<br><br>
<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>
<script>
function Referralload(drid)
{
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("divdr").innerHTML = this.responseText;
}
};
xmlhttp.open("GET","loadReferral.php?drid="+drid,true);
xmlhttp.send();
}
</script>