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<?php
session_start();
require_once("../DBManager.php");
require_once("../patientmanager.php");
require_once("../LoginManager.php");
include('db/dbcon.php');
if(isset($_POST['Add_Pateint']))
{
$userkey=LoginManager::getRandomkey();
$password=rand(1000, 9999);
$user_otp = rand(100000, 999999);
$patientuser = rand(1000, 9999);
$user_activation_code = md5(rand());
$updated_at=date("F d, Y / h:i:s A");
$created_at=date("F d, Y / h:i:s A");
$sql="INSERT INTO site_users(userno,uname,name,numbers,email,usertype,status,password,userkey,user_otp,user_activation_code,entered_by,created_at,updated_at) VALUES (NULL, 'Patien$patientuser', '$_POST[patientname]', '$_POST[numbers]','$_POST[Email]', 'Patient', 'Active','$password', '$userkey','$user_otp','$user_activation_code','$_POST[entered_by]', '$created_at', '$updated_at');";
//echo $sql;
$result=mysqli_query($conn,$sql);
if(!$result)
return false;
$sql ="select last_insert_id() from site_users";
$result=mysqli_query($conn,$sql);
if(!$result)
return false;
$row=mysqli_fetch_row($result);
$userno=$row[0];
$dob=$_POST['dob'];
$year = (date('Y') - date('Y',strtotime($dob)));
//echo $userno;
$sql="INSERT INTO patient(srno,patientid,familyid,headnumber,pic,fr,patientname,gendor,HusbandName,Email,numbers,dob,age_type,Weight,Height,bloodgroup,Nationality,Marital,Religion,Occupation,Familyinc,Education, Passportnm,AadharNu,Referred,Country,State,city,pincode,bloc,nameofinc,Policynm,user_otp,numbers_status,user_activation_code,entered_by, created_at,updated_at) VALUES (NULL, '$userno','$_POST[familyid]','$_POST[headnumber]','$_POST[pic]','$_POST[fr]','$_POST[patientname]','$_POST[gendor]','$_POST[HusbandName]','$_POST[Email]','$_POST[numbers]','$year','Year','$_POST[Weight]','$_POST[Height]','$_POST[bloodgroup]','$_POST[Nationality]','$_POST[Marital]','$_POST[Religion]','$_POST[Occupation]','$_POST[Familyinc]','$_POST[Education]','$_POST[Passportnm]','$_POST[AadharNu]','$_POST[entered_by]','$_POST[Country]','$_POST[State]','$_POST[city]','$_POST[pincode]','$_POST[bloc]','$_POST[nameofinc]','$_POST[Policynm]','$user_otp','Not Verified','$user_activation_code','$_POST[entered_by]','$created_at','$updated_at')";
//echo $sql;
$result=mysqli_query($conn,$sql);
if($result){
//echo "<script>alert('Member Add successfully');</script><script>window.location='signin.php?family=$_POST[familyid]'</script>;</script>";
echo "<script>alert('Member Add successfully');</script><script>window.location='medical-condition.php?id=$userno'</script>;</script>";
}else {
echo "Fail";
}
}
?>
<!DOCTYPE html>
<html lang="en">
<head>
<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1" />
<meta charset="utf-8" />
<title>Add Pateint</title>
<meta name="description" content="User login page" />
<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" />
<!-- text fonts -->
<link rel="stylesheet" href="assets/css/fonts.googleapis.com.css" />
<!-- ace styles -->
<link rel="stylesheet" href="assets/css/ace.min.css" />
<!--[if lte IE 9]>
<link rel="stylesheet" href="assets/css/ace-part2.min.css" />
<![endif]-->
<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]-->
<!-- 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>
<style>
.fontbold{
font-weight:bold;
}
</style>
<body class="login-layout">
<div class="main-container">
<div class="main-content">
<div class="row">
<div class="col-sm-10 col-sm-offset-1">
<div class="">
<div class="center">
<div class="row">
<div class="col-sm-4"></div>
<div class="col-sm-4"><h1>
<img src='assets/images/logo/logo.png' class='img-responsive' alt='logo' >
</h1></div>
<div class="col-sm-4"></div>
</div>
</div>
<div class="space-6"></div>
<div class="position-relative">
<div id="login-box" class="login-box visible widget-box no-border">
<div class="widget-body">
<div class="widget-main">
<h4 class="header blue lighter bigger">
<i class="ace-icon fa fa-user-md green"></i>
Please Enter Patient Information
<a href="family.php?id=<?php echo $_GET['id'] ?>" class="btn btn-sm" style='float:right;margin:5px;'>
<i class="ace-icon fa fa-arrow-left"></i> Back
</a>
</h4>
<div class="space-6">
</div>
<form action='' method="POST">
<?php
$site_users ="SELECT * FROM site_users WHERE userno='$_GET[id]'";
$qsite_users = mysqli_query($conn,$site_users);
$rsite_users = mysqli_fetch_array($qsite_users);
echo "<input type='hidden' name='headnumber' value='$rsite_users[numbers]'>";
echo "<input type='hidden' name='familyid' value='$rsite_users[userno]''>";
echo "<input type='hidden' name='entered_by' value='$rsite_users[entered_by]''>";
?>
<fieldset>
<div class="row">
<div class="col-sm-4"><label class="block clearfix"><span class='fontbold'> Profile For</span>
<span style="color:red;">(Required)</span>
<select class="form-control" name="fr" required>
<option value="" disabled selected>Profile For</option>
<option value="Self">Self</option>
<option value="Spouse">Spouse</option>
<option value="Son">Son</option>
<option value="Daughter">Daughter</option>
<option value="Sibling">Sibling</option>
<option value="Parent">Parent</option>
<option value="Grand Parent">Grand Parent</option>
<option value="Grand Child">Grand Child</option>
</select>
</label></div>
<div class="col-sm-4">
<label class="block clearfix"><span class='fontbold'> Name</span>
<span style="color:red">(Required)</span>
<input type="text" name="patientname" placeholder="Enter your name" class="form-control" 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">
<?php
$sql ="SELECT * FROM site_users WHERE userno='$_GET[id]'";
$qsql = mysqli_query($conn,$sql);
while($rs = mysqli_fetch_array($qsql))
{
echo"
<input type='hidden' value='$rs[numbers]' name='numbers' >
";
}
?>
<label class="block clearfix"><span class='fontbold'> Date of birth</span>
<span style="color:red">(Required)</span>
<input class="form-control" type="date" name="dob" placeholder="Date of birth" required>
</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="4-6" > >4ft 6in / 137 cms</option>
<option value="4-6" >4ft 6in / 137 cms</option>
<option value="4-7" >4ft 7in / 139 cms</option>
<option value="4-8" >4ft 8in / 142 cms</option>
<option value="4-9" >4ft 9in / 144 cms</option>
<option value="4-10" >4ft 10in / 147 cms</option>
<option value="4-11" >4ft 11in / 149 cms</option>
<option value="5" >5ft / 152 cms</option>
<option value="5-1" >5ft 1in / 154 cms</option>
<option value="5-2" >5ft 2in / 157 cms</option>
<option value="5-3" >5ft 3in / 160 cms</option>
<option value="5-4" >5ft 4in / 162 cms</option>
<option value="5-5" >5ft 5in / 165 cms</option>
<option value="5-6" >5ft 6in / 167 cms</option>
<option value="5-7" >5ft 7in / 170 cms</option>
<option value="5-8" >5ft 8in / 172 cms</option>
<option value="5-9" >5ft 9in / 175 cms</option>
<option value="5-10" >5ft 10in / 177 cms</option>
<option value="5-11" >5ft 11in / 180 cms</option>
<option value="6" >6ft / 182 cms</option>
<option value="6-1" >6ft 1in / 185 cms</option>
<option value="6-2" >6ft 2in / 187 cms</option>
<option value="6-3" >6ft 3in / 190 cms</option>
<option value="6-4" >6ft 4in / 193 cms</option>
<option value="6-5" >6ft 5in / 195 cms</option>
<option value="6-6" >6ft 6in / 198 cms</option>
<option value="6-7" >6ft 7in / 200 cms</option>
<option value="6-8" >6ft 8in / 203 cms</option>
<option value="6-9" >6ft 9in / 205 cms</option>
<option value="6-10" >6ft 10in / 208 cms</option>
<option value="6-11" >6ft 11in / 210 cms</option>
<option value="7" >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" 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 = $conn->query($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]'>$rsn[Name]</option>";
}
?>
</td>
</select>
</span>
</label>
</div>
<div class="col-sm-4"><label class="block clearfix"><span class='fontbold'>Policy Number </span>(Optional)
<span class="block input-icon input-icon-right">
<input class="form-control" type="text" name="Policynm" placeholder="Enter your Policy Number" >
</span>
</label></div>
</div>
<div class="row">
<div class="col-sm-4"><div class="clearfix">
</div></div>
<div class="col-sm-4"></div>
<div class="col-sm-4"><div class="space-24"></div>
<div class="clearfix">
<button type="reset" class="width-30 pull-left btn btn-sm">
<i class="ace-icon fa fa-refresh"></i>
<span class="bigger-110">Reset</span>
</button>
<button type="submit" name="Add_Pateint" class="width-65 pull-right btn btn-sm btn-success">
<span class="bigger-110">Add</span>
<i class="ace-icon fa fa-arrow-right icon-on-right"></i>
</button>
</div></div>
</div>
</fieldset>
</form>
<?php
// Show any error or success message
if(isset($_SESSION['msg'])) {
echo $_SESSION['msg'];
//session_unset($_SESSION['msg']);
}
?>
<div class="space-6"></div>
</div><!-- /.widget-main -->
<div class="toolbar clearfix">
</div>
</div><!-- /.widget-body -->
</div><!-- /.login-box -->
</div><!-- /.position-relative -->
</div>
</div><!-- /.col -->
</div><!-- /.row -->
</div><!-- /.main-content -->
</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>
<!-- inline scripts related to this page -->
<script type="text/javascript">
jQuery(function($) {
$(document).on('click', '.toolbar a[data-target]', function(e) {
e.preventDefault();
var target = $(this).data('target');
$('.widget-box.visible').removeClass('visible');//hide others
$(target).addClass('visible');//show target
});
});
//you don't need this, just used for changing background
jQuery(function($) {
$('#btn-login-dark').on('click', function(e) {
$('body').attr('class', 'login-layout');
$('#id-text2').attr('class', 'white');
$('#id-company-text').attr('class', 'blue');
e.preventDefault();
});
$('#btn-login-light').on('click', function(e) {
$('body').attr('class', 'login-layout light-login');
$('#id-text2').attr('class', 'grey');
$('#id-company-text').attr('class', 'blue');
e.preventDefault();
});
$('#btn-login-blur').on('click', function(e) {
$('body').attr('class', 'login-layout blur-login');
$('#id-text2').attr('class', 'white');
$('#id-company-text').attr('class', 'light-blue');
e.preventDefault();
});
});
</script>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.7.0/jquery.min.js"></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>');
}
});
});
</script>
</body>
</html>