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<?php
// session_start();
// require_once("../dbconnection.php");
// require_once('../DBManager.php');
// require_once('../LoginManager.php');
// $DisplayForm=True;
// $duty= "SELECT * FROM `dutydr` WHERE `AadhaarNumber`='$_GET[AadhaarNumber]'";
// $qduty = mysqli_query($con,$duty);
// if($rh = mysqli_fetch_array($qduty))
// {
// $DisplayForm=False;
// echo "<script>window.location='BasicProfile.php'</script>";
// }
// if($DisplayForm)
// {
?>
<?php
session_start();
require_once('../LoginManager.php');
require_once('../DBManager.php');
include('menu.php');
include('header.php');
include("dbconnection.php");
// RMO
if(isset($_POST['AddRMO'])){
$updated_at=date("F d, Y / h:i:s A");
$RMO=$con->query("UPDATE `dutydr` SET `FathersName`='$_POST[FathersName]',`Gender`='$_POST[Gender]',`EmailId`='$_POST[EmailId]',`DOB`='$_POST[DOB]',`BloodGroup`='$_POST[BloodGroup]',`Nationality`='$_POST[Nationality]',`MaritalStatus`='$_POST[MaritalStatus]',`Religion`='$_POST[Religion]',`AadhaarNumber`='$_POST[AadhaarNumber]',`Country`='$_POST[Country]',`State`='$_POST[State]',`Distict`='$_POST[Distict]',`PinCode`='$_POST[PinCode]',`Address`='$_POST[Address]' WHERE `rmoid`='$_POST[rmoid]'");
//echo $RMO;
if($RMO){
echo "<script>alert('RMO Update successfully');</script><script>window.location='ProfessionalProfile.php?userno=$_POST[rmoid]'</script>;</script>";
}
}
// Nurse
if(isset($_POST['AddNurse'])){
foreach($_FILES["Upload_Nurse"]["name"] as $key=>$val) {
$info=getimagesize($_FILES['Upload_Nurse']['tmp_name'][$key]);
if(isset($info['mime'])){
if($info['mime']=="image/jpeg"){
$img=imagecreatefromjpeg($_FILES['Upload_Nurse']['tmp_name'][$key]);
}
elseif($info['mime']=="image/png"){
$img=imagecreatefrompng($_FILES['Upload_Nurse']['tmp_name'][$key]);
}
elseif($info['mime']=="image/gif"){
$img=imagecreatefromgif($_FILES['Upload_Nurse']['tmp_name'][$key]);
}
elseif($info['mime']=="image/jpg"){
$img=imagecreatefromjpg($_FILES['Upload_Nurse']['tmp_name'][$key]);
}
else{
echo "Only select jpg or png image";
}
if(isset($img)){
$newFileName=$user_id.$email.$filename.$count.'.jpg';
$file = $newFileName.'_'.$val;
imagejpeg($img, "uploads/$file" ,20);
$updated_at=date("F d, Y / h:i:s A");
$nurse=$con->query("UPDATE `nurse` SET photo='$file', `FathersName`='$_POST[NurseFathersName]',`Gender`='$_POST[NurseGender]',`EmailId`='$_POST[userid]',`DOB`='$_POST[NurseDOB]',`BloodGroup`='$_POST[NurseBloodGroup]',`Nationality`='$_POST[NurseNationality]',`MaritalStatus`='$_POST[NurseMaritalStatus]',`Religion`='$_POST[NurseReligion]',`AadhaarNumber`='$_POST[NurseAadhaarNumber]',`Country`='$_POST[NurseCountry]',`State`='$_POST[NurseState]',`Distict`='$_POST[NurseDistict]',`PinCode`='$_POST[NursePinCode]',`Address`='$_POST[NurseAddress]' WHERE `Nurseid`='$_POST[Nurseid]'");
//echo $nurse;
if($nurse){
echo "<script>alert('Nurse Update successfully');</script>";
echo " <script>window.location='ProfessionalProfile.php?userno=$_POST[Nurseid]'</script>";
}
}
}
}
}
// Front Office
if(isset($_POST['AddFront'])){
foreach($_FILES["Upload_Consent"]["name"] as $key=>$val) {
$info=getimagesize($_FILES['Upload_Consent']['tmp_name'][$key]);
if(isset($info['mime'])){
if($info['mime']=="image/jpeg"){
$img=imagecreatefromjpeg($_FILES['Upload_Consent']['tmp_name'][$key]);
}
elseif($info['mime']=="image/png"){
$img=imagecreatefrompng($_FILES['Upload_Consent']['tmp_name'][$key]);
}
elseif($info['mime']=="image/gif"){
$img=imagecreatefromgif($_FILES['Upload_Consent']['tmp_name'][$key]);
}
elseif($info['mime']=="image/jpg"){
$img=imagecreatefromjpg($_FILES['Upload_Consent']['tmp_name'][$key]);
}
else{
echo "Only select jpg or png image";
}
if(isset($img)){
$newFileName=$user_id.$email.$filename.$count.'.jpg';
$file = $newFileName.'_'.$val;
imagejpeg($img, "uploads/$file" ,20);
$updated_at=date("F d, Y / h:i:s A");
$front=$con->query("UPDATE `front` SET `photo`='$file', `FathersName`='$_POST[FrontFathersName]',`Gender`='$_POST[FrontGender]',`EmailId`='$_POST[userid]',`DOB`='$_POST[FrontDOB]',`BloodGroup`='$_POST[FrontBloodGroup]',`Nationality`='$_POST[FrontNationality]',`MaritalStatus`='$_POST[FrontMaritalStatus]',`Religion`='$_POST[FrontReligion]',`AadhaarNumber`='$_POST[FrontAadhaarNumber]',`Country`='$_POST[FrontCountry]',`State`='$_POST[FrontState]',`Distict`='$_POST[FrontDistict]',`PinCode`='$_POST[FrontPinCode]',`Address`='$_POST[FrontAddress]' WHERE `frid`='$_POST[frid]'");
echo $front;
if($front){
echo "<script>alert('Front Office Update successfully');</script>";
echo " <script>window.location='ProfessionalProfile.php?userno=$_POST[frid]'</script>";
}
}
}
}
}
// HR
if(isset($_POST['AddHR'])){
$updated_at=date("F d, Y / h:i:s A");
$HR=$con->query("UPDATE `hr` SET `FathersName`='$_POST[HRFathersName]',`Gender`='$_POST[HRGender]',`EmailId`='$_POST[userid]',`DOB`='$_POST[HRDOB]',`BloodGroup`='$_POST[HRBloodGroup]',`Nationality`='$_POST[HRNationality]',`MaritalStatus`='$_POST[HRMaritalStatus]',`Religion`='$_POST[HRReligion]',`AadhaarNumber`='$_POST[HRAadhaarNumber]',`Country`='$_POST[HRCountry]',`State`='$_POST[HRState]',`Distict`='$_POST[HRDistict]',`PinCode`='$_POST[HRPinCode]',`Address`='$_POST[HRAddress]' WHERE `hrid`='$_POST[hrid]'");
echo $HR;
if($HR){
echo "<script>alert('Human resources Update successfully');</script>";
echo " <script>window.location='ProfessionalProfile.php?userno=$_POST[hrid]'</script>";
}
}
//OT
if(isset($_POST['AddOT'])){
$updated_at=date("F d, Y / h:i:s A");
$OT=$con->query("UPDATE `ot` SET `FathersName`='$_POST[OTFathersName]',`Gender`='$_POST[OTGender]',`EmailId`='$_POST[userid]',`DOB`='$_POST[OTDOB]',`BloodGroup`='$_POST[OTBloodGroup]',`Nationality`='$_POST[OTNationality]',`MaritalStatus`='$_POST[OTMaritalStatus]',`Religion`='$_POST[OTReligion]',`AadhaarNumber`='$_POST[OTAadhaarNumber]',`Country`='$_POST[OTCountry]',`State`='$_POST[OTState]',`Distict`='$_POST[OTDistict]',`PinCode`='$_POST[OTPinCode]',`Address`='$_POST[OTAddress]' WHERE `otid`='$_POST[otid]'");
echo $OT;
if($OT){
echo "<script>alert('OT Update successfully');</script>";
echo " <script>window.location='ProfessionalProfile.php?userno=$_POST[otid]'</script>";
}
}
//Lab
if(isset($_POST['AddLab'])){
$updated_at=date("F d, Y / h:i:s A");
$Lab=$con->query("UPDATE `addlab` SET `FathersName`='$_POST[LabFathersName]',`Gender`='$_POST[LabGender]',`EmailId`='$_POST[userid]',`DOB`='$_POST[LabDOB]',`BloodGroup`='$_POST[LabBloodGroup]',`Nationality`='$_POST[LabNationality]',`MaritalStatus`='$_POST[LabMaritalStatus]',`Religion`='$_POST[LabReligion]',`AadhaarNumber`='$_POST[LabAadhaarNumber]',`Country`='$_POST[LabCountry]',`State`='$_POST[LabState]',`Distict`='$_POST[LabDistict]',`PinCode`='$_POST[LabPinCode]',`Address`='$_POST[LabAddress]' WHERE `labid`='$_POST[labid]'");
echo $Lab;
if($Lab){
echo "<script>alert('Lab Update successfully');</script>";
echo " <script>window.location='ProfessionalProfile.php?userno=$_POST[labid]'</script>";
}
}
//Diagnostic
if(isset($_POST['AddDiagnostic'])){
foreach($_FILES["Upload_Diagnostic"]["name"] as $key=>$val) {
$info=getimagesize($_FILES['Upload_Diagnostic']['tmp_name'][$key]);
if(isset($info['mime'])){
if($info['mime']=="image/jpeg"){
$img=imagecreatefromjpeg($_FILES['Upload_Diagnostic']['tmp_name'][$key]);
}
elseif($info['mime']=="image/png"){
$img=imagecreatefrompng($_FILES['Upload_Diagnostic']['tmp_name'][$key]);
}
elseif($info['mime']=="image/gif"){
$img=imagecreatefromgif($_FILES['Upload_Diagnostic']['tmp_name'][$key]);
}
elseif($info['mime']=="image/jpg"){
$img=imagecreatefromjpg($_FILES['Upload_Diagnostic']['tmp_name'][$key]);
}
else{
echo "Only select jpg or png image";
}
if(isset($img)){
$newFileName=$user_id.$email.$filename.$count.'.jpg';
$file = $newFileName.'_'.$val;
imagejpeg($img, "uploads/$file" ,20);
$updated_at=date("F d, Y / h:i:s A");
$Diagnostic=$con->query("UPDATE `adddigno` SET `photo`='$file', `FathersName`='$_POST[DiagnosticFathersName]',`Gender`='$_POST[DiagnosticGender]',`EmailId`='$_POST[userid]',`DOB`='$_POST[DiagnosticDOB]',`BloodGroup`='$_POST[DiagnosticBloodGroup]',`Nationality`='$_POST[DiagnosticNationality]',`MaritalStatus`='$_POST[DiagnosticMaritalStatus]',`Religion`='$_POST[DiagnosticReligion]',`AadhaarNumber`='$_POST[DiagnosticAadhaarNumber]',`Country`='$_POST[DiagnosticCountry]',`State`='$_POST[DiagnosticState]',`Distict`='$_POST[DiagnosticDistict]',`PinCode`='$_POST[DiagnosticPinCode]',`Address`='$_POST[DiagnosticAddress]' WHERE `dignoid`='$_POST[dignoid]'");
echo $Diagnostic;
if($Diagnostic){
echo "<script>alert('Diagnostic Update successfully');</script>";
echo " <script>window.location='ProfessionalProfile.php?userno=$_POST[dignoid]'</script>";
}
}
}}}
if(isset($_POST['AddOptomatrix'])){
foreach($_FILES["Upload_Optomatrix"]["name"] as $key=>$val) {
$info=getimagesize($_FILES['Upload_Optomatrix']['tmp_name'][$key]);
if(isset($info['mime'])){
if($info['mime']=="image/jpeg"){
$img=imagecreatefromjpeg($_FILES['Upload_Optomatrix']['tmp_name'][$key]);
}
elseif($info['mime']=="image/png"){
$img=imagecreatefrompng($_FILES['Upload_Optomatrix']['tmp_name'][$key]);
}
elseif($info['mime']=="image/gif"){
$img=imagecreatefromgif($_FILES['Upload_Optomatrix']['tmp_name'][$key]);
}
elseif($info['mime']=="image/jpg"){
$img=imagecreatefromjpg($_FILES['Upload_Optomatrix']['tmp_name'][$key]);
}
else{
echo "Only select jpg or png image";
}
if(isset($img)){
$newFileName=$user_id.$email.$filename.$count.'.jpg';
$file = $newFileName.'_'.$val;
imagejpeg($img, "uploads/$file" ,20);
$updated_at=date("F d, Y / h:i:s A");
$Optomatrix=$con->query("UPDATE `optomatrix` SET `photo`='$file', `FathersName`='$_POST[OptomatrixFathersName]',`Gender`='$_POST[OptomatrixGender]',`EmailId`='$_POST[userid]',`DOB`='$_POST[OptomatrixDOB]',`BloodGroup`='$_POST[OptomatrixBloodGroup]',`Nationality`='$_POST[OptomatrixNationality]',`MaritalStatus`='$_POST[OptomatrixMaritalStatus]',`Religion`='$_POST[OptomatrixReligion]',`AadhaarNumber`='$_POST[OptomatrixAadhaarNumber]',`Country`='$_POST[OptomatrixCountry]',`State`='$_POST[OptomatrixState]',`Distict`='$_POST[OptomatrixDistict]',`PinCode`='$_POST[OptomatrixPinCode]',`Address`='$_POST[OptomatrixAddress]' WHERE `OptomatrixId`='38232'");
echo $Optomatrix;
if($Optomatrix){
echo "<script>alert('Optomatrix Update successfully');</script>";
echo " <script>window.location='ProfessionalProfile.php?userno=$_POST[Optomatrixid]'</script>";
}
}
}}}
?>
<!DOCTYPE html>
<html lang="en">
<script src="https://code.jquery.com/jquery-2.1.1.min.js" type="text/javascript"></script>
<script>
function checkAvailability() {
$("#loaderIcon").show();
jQuery.ajax({
url: "rmo_check.php",
data:'uname='+$("#userid").val(),
type: "POST",
success:function(data){
$("#user-availability-status").html(data);
$("#loaderIcon").hide();
},
error:function (){}
});
}
</script>
<script>
function isNumber(evt) {
evt = (evt) ? evt : window.event;
var charCode = (evt.which) ? evt.which : evt.keyCode;
if (charCode > 31 && (charCode < 48 || charCode > 57)) {
alert("Please enter only Numbers.");
return false;
}
return true;
}
function ValidateNo() {
var phoneNo = document.getElementById('numbers');
if (phoneNo.value == "" || phoneNo.value == null) {
alert("Please enter your Mobile No.");
return false;
}
if (phoneNo.value.length < 10 || phoneNo.value.length > 10) {
alert("Mobile No. is not valid, Please Enter 10 Digit Mobile No.");
return false;
}
return true;
}
</script>
<script src="
https://cdn.jsdelivr.net/npm/sweetalert2@11.10.0/dist/sweetalert2.all.min.js
"></script>
<link href="
https://cdn.jsdelivr.net/npm/sweetalert2@11.10.0/dist/sweetalert2.min.css
" rel="stylesheet">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.1.1/jquery.min.js"></script>
<script type="text/javascript">
$(document).ready(function(){
$('#myForm').submit(function() {
$('#loaderImg').show();
return true;
});
});
</script>
<style>
#loaderImg {
position: absolute;
top: 0;
bottom: 0;
left: 0;
right: 0;
margin: auto;
border: 10px solid grey;
border-radius: 50%;
border-top: 10px solid black;
width: 100px;
height: 100px;
animation: spin 1s linear infinite;
z-index:1000000000;
}
@keyframes spin {
0% {
-webkit-transform: rotate(0deg);
transform: rotate(0deg);
}
100% {
-webkit-transform: rotate(360deg);
transform: rotate(360deg);
}
}
</style>
<meta http-equiv="content-type" content="text/html;charset=UTF-8" />
<title> Pt Signup</title>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="new2.css">
</head>
<body>
<div class="content-wrapper">
<section class="content-header">
<!-- Page Preloder -->
<?php
session_start();
require_once('../DBManager.php');
require_once('../LoginManager.php');
include("dbconnection.php");
$narayan=LoginManager::currentUser();
$harilal=LoginManager::getUserTypeByuname("$narayan");
$sql ="SELECT * FROM site_users WHERE userno='$harilal'";
$qsql = mysqli_query($con,$sql);
$re = mysqli_fetch_array($qsql);
if($re['usertype']=='RMO'){
$rmo=$con->query("SELECT * FROM `dutydr` WHERE rmoid='".$re['userno']."'");
}
if($re['usertype']=='Nurse'){
$rmo=$con->query("SELECT * FROM `nurse` WHERE Nurseid='".$re['userno']."'");
}
if($re['usertype']=='FrontOffice'){
$rmo=$con->query("SELECT * FROM `front` WHERE frid='".$re['userno']."'");
}
if($re['usertype']=='HR'){
$rmo=$con->query("SELECT * FROM `hr` WHERE hrid='".$re['userno']."'");
}
if($re['usertype']=='OT'){
$rmo=$con->query("SELECT * FROM `ot` WHERE otid='".$re['userno']."'");
}
if($re['usertype']=='Lab'){
$rmo=$con->query("SELECT * FROM `addlab` WHERE labid='".$re['userno']."'");
}
if($re['usertype']=='Diagnostic'){
$rmo=$con->query("SELECT * FROM `adddigno` WHERE dignoid='".$re['userno']."'");
}
if($re['usertype']=='Optometrist'){
$rmo=$con->query("SELECT * FROM `optomatrix` WHERE OptomatrixId='".$re['userno']."'");
}
$RowRMO=$rmo->fetch_assoc();
?>
<div style = "display:none;" id = "loaderImg"> <div class="loader"> </div> </div>
<?php
if($re['usertype']=='RMO'){
?>
<form method="post" enctype="multipart/form-data">
<h3><i class="fa fa-angle-right"></i> Basic Profile </h3>
<div class="row">
<div class="col-sm-12"> <div id="frmCheckUsername"></div></div>
<div class='col-sm-6'> <label for="item"> Name <span>*</span></label>
<input class="input100" type="text" name="Name" placeholder="Enter your Name" value="<?php echo $RowRMO['Name']; ?>" readonly />
<input type="hidden" name="rmoid" value="<?php echo $RowRMO['rmoid']; ?>" />
</div>
<div class='col-sm-6'><label for="item"> Email id<span>*</span></label>
<input class="input100" type="email" name="userid" value="<?php echo $re['uname']; ?>" readonly />
</div>
<div class='col-sm-6'><label for="item"> Mobile Number<span>*</span></label>
<input type="text" name="numbers" id="numbers" value="<?php echo $RowRMO['numbers']; ?>" readonly /></div>
<div class='col-sm-6'><label for="item"> Fathers Name<span>*</span></label>
<input type="text" name="FathersName" id="FathersName" required placeholder="Father's Name" value="<?php echo $RowRMO['FathersName']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Gender<span>*</span></label>
<div class="checkbox"><input onclick="ValidateNo();" type="radio" name="Gender" value="Male" required <?php echo ($RowRMO['Gender']=='Male')?'checked':'' ?>>
<span>Male </span></div><div class="checkbox">
<input type="radio" onclick="ValidateNo();" name="Gender" value="Female" <?php echo ($RowRMO['Gender']=='Female')?'checked':'' ?>>
<span>Female </span></div><div class="checkbox"><input type="radio" onclick="ValidateNo();" name="Gender" value="Other" <?php echo ($RowRMO['Gender']=='Other')?'checked':'' ?>>
<span>Other </span></div>
</div>
<div class='col-sm-6'><label for="item"> DOB<span>*</span></label>
<input type="date" name="DOB" id="DOB" placeholder="DOB" required value="<?php echo $RowRMO['DOB']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Blood Group<span>*</span></label>
<select name="BloodGroup" class="form-control" >
<option value="">Blood Group</option>
<option value='A+' <?php echo ($RowRMO['BloodGroup']=='A+')?'selected':'' ?>>A+</option>
<option value='A-' <?php echo ($RowRMO['BloodGroup']=='A-')?'selected':'' ?>>A-</option>
<option value='B+' <?php echo ($RowRMO['BloodGroup']=='B+')?'selected':'' ?>>B+</option>
<option value='B-' <?php echo ($RowRMO['BloodGroup']=='B-')?'selected':'' ?>>B-</option>
<option value='O+' <?php echo ($RowRMO['BloodGroup']=='O+')?'selected':'' ?>>O+</option>
<option value='O-' <?php echo ($RowRMO['BloodGroup']=='O-')?'selected':'' ?>>O-</option>
<option value='AB+' <?php echo ($RowRMO['BloodGroup']=='AB+')?'selected':'' ?>>AB+</option>
<option value='AB-' <?php echo ($RowRMO['BloodGroup']=='AB-')?'selected':'' ?>>AB-</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Nationality<span>*</span></label>
<select name="Nationality" class="form-control">
<option value="0">Nationality</option>
<option value="Indian" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Indian')?'selected':'' ?>>Indian</option>
<option value="Nepali" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Nepali')?'selected':'' ?>>Nepali</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Marital Status<span>*</span></label>
<select name="MaritalStatus" class="form-control">
<option value="" disabled selected>Marital status </option>
<option value="Single" label="Single" <?php echo ($RowRMO['MaritalStatus']=='Single')?'selected':'' ?>>Single</option>
<option value="Married" label="Married" <?php echo ($RowRMO['MaritalStatus']=='Married')?'selected':'' ?>>Married</option>
<option value="Widowed" <?php echo ($RowRMO['MaritalStatus']=='Widowed')?'selected':'' ?>>Widowed</option>
<option value="divorced" label="divorced" <?php echo ($RowRMO['MaritalStatus']=='divorced')?'selected':'' ?>>Divorced</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Religion<span>*</span></label>
<select name="Religion" class="form-control" >
<option value="" disabled selected>Religion </option>
<option value="Hindu" label="Hindu" <?php echo ($RowRMO['Religion']=='Hindu')?'selected':'' ?>>Hindu</option>
<option value="Muslim" label="Muslim" <?php echo ($RowRMO['Religion']=='Muslim')?'selected':'' ?>>Muslim</option>
<option value="Christian" label="Christian" <?php echo ($RowRMO['Religion']=='Christian')?'selected':'' ?>>Christian</option>
<option value="Sikh" label="Sikh" <?php echo ($RowRMO['Religion']=='Sikh')?'selected':'' ?>>Sikh</option>
<option value="Parsi" label="Parsi" <?php echo ($RowRMO['Religion']=='Parsi')?'selected':'' ?>>Parsi</option>
<option value="Jain" label="Jain" <?php echo ($RowRMO['Religion']=='Jain')?'selected':'' ?>>Jain</option>
<option value="Buddhist" label="Buddhist" <?php echo ($RowRMO['Religion']=='Buddhist')?'selected':'' ?>>Buddhist</option>
<option value="Jewish" label="Jewish" <?php echo ($RowRMO['Religion']=='Jewish')?'selected':'' ?>>Jewish</option>
<option value="No Religion" label="No Religion" <?php echo ($RowRMO['Religion']=='No Religion')?'selected':'' ?>>No Religion</option>
<option value="Spiritual - not religious" label="Spiritual" <?php echo ($RowRMO['Religion']=='Spiritual - not religious')?'selected':'' ?>>Spiritual</option>
<option value="Other" label="Other" <?php echo ($RowRMO['Religion']=='Other')?'selected':'' ?>>Other</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Aadhaar Number<span>*</span></label>
<input type="text" name="AadhaarNumber" id="AadhaarNumber" placeholder="Aadhaar Number" required value="<?php echo $RowRMO['AadhaarNumber']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Country<span>*</span></label>
<select class="form-control" name="Country" id="country" required>
<option value="" disabled selected>Country</option>
<?php
include("dbconnection.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>
</div>
<div class='col-sm-6'><label for="item"> State<span>*</span></label>
<select class="form-control" name="State" id="state" required>
<option value="">Select country first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Distict<span>*</span></label>
<select class="form-control" name="Distict" id="city" required>
<option value="">Select state first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> PinCode<span>*</span></label>
<input type="text" name="PinCode" id="PinCode" required placeholder="PinCode" value="<?php echo $RowRMO['PinCode']; ?>"></div>
<div class='col-sm-6'><label for="item"> Address<span>*</span></label>
<input type="text" name="Address" id="Address" required placeholder="Address" value="<?php echo $RowRMO['Address']; ?>"></div>
<div class='col-sm-6'><label>Profile Picture:</label>
<input name="Upload_RMO[]" type="file" multiple></div>
</div>
<input type="submit" id="clicknow" value="Submit" name="AddRMO">
</form>
<?php } ?>
<?php
if($re['usertype']=='Nurse'){
?>
<form method="post" enctype="multipart/form-data">
<h3><i class="fa fa-angle-right"></i> Basic Profile </h3>
<div class="row">
<div class="col-sm-12"> <div id="frmCheckUsername"></div></div>
<div class='col-sm-6'> <label for="item"> Name <span>*</span></label>
<input class="input100" type="text" name="Name" placeholder="Enter your Name" value="<?php echo $RowRMO['uname']; ?>" readonly />
<input type="hidden" name="Nurseid" value="<?php echo $RowRMO['Nurseid']; ?>" />
</div>
<div class='col-sm-6'><label for="item"> Email id<span>*</span></label>
<input class="input100" type="email" name="userid" value="<?php echo $RowRMO['user_id']; ?>" readonly />
</div>
<div class='col-sm-6'><label for="item"> Mobile Number<span>*</span></label>
<input type="text" name="numbers" id="numbers" value="<?php echo $RowRMO['numbers']; ?>" readonly /></div>
<div class='col-sm-6'><label for="item"> Fathers Name<span>*</span></label>
<input type="text" name="NurseFathersName" id="FathersName" required placeholder="Father's Name" value="<?php echo $RowRMO['FathersName']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Gender<span>*</span></label>
<div class="checkbox"><input onclick="ValidateNo();" type="radio" name="NurseGender" value="Male" required <?php echo ($RowRMO['Gender']=='Male')?'checked':'' ?>>
<span>Male </span></div><div class="checkbox">
<input type="radio" onclick="ValidateNo();" name="NurseGender" value="Female" <?php echo ($RowRMO['Gender']=='Female')?'checked':'' ?>>
<span>Female </span></div><div class="checkbox"><input type="radio" onclick="ValidateNo();" name="NurseGender" value="Other" <?php echo ($RowRMO['Gender']=='Other')?'checked':'' ?>>
<span>Other </span></div>
</div>
<div class='col-sm-6'><label for="item"> DOB<span>*</span></label>
<input type="date" name="NurseDOB" id="DOB" placeholder="DOB" required value="<?php echo $RowRMO['DOB']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Blood Group<span>*</span></label>
<select name="NurseBloodGroup" class="form-control" >
<option value="">Blood Group</option>
<option value='A+' <?php echo ($RowRMO['BloodGroup']=='A+')?'selected':'' ?>>A+</option>
<option value='A-' <?php echo ($RowRMO['BloodGroup']=='A-')?'selected':'' ?>>A-</option>
<option value='B+' <?php echo ($RowRMO['BloodGroup']=='B+')?'selected':'' ?>>B+</option>
<option value='B-' <?php echo ($RowRMO['BloodGroup']=='B-')?'selected':'' ?>>B-</option>
<option value='O+' <?php echo ($RowRMO['BloodGroup']=='O+')?'selected':'' ?>>O+</option>
<option value='O-' <?php echo ($RowRMO['BloodGroup']=='O-')?'selected':'' ?>>O-</option>
<option value='AB+' <?php echo ($RowRMO['BloodGroup']=='AB+')?'selected':'' ?>>AB+</option>
<option value='AB-' <?php echo ($RowRMO['BloodGroup']=='AB-')?'selected':'' ?>>AB-</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Nationality<span>*</span></label>
<select name="NurseNationality" class="form-control">
<option value="0">Nationality</option>
<option value="Indian" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Indian')?'selected':'' ?>>Indian</option>
<option value="Nepali" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Nepali')?'selected':'' ?>>Nepali</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Marital Status<span>*</span></label>
<select name="NurseMaritalStatus" class="form-control">
<option value="" disabled selected>Marital status </option>
<option value="Single" label="Single" <?php echo ($RowRMO['MaritalStatus']=='Single')?'selected':'' ?>>Single</option>
<option value="Married" label="Married" <?php echo ($RowRMO['MaritalStatus']=='Married')?'selected':'' ?>>Married</option>
<option value="Widowed" <?php echo ($RowRMO['MaritalStatus']=='Widowed')?'selected':'' ?>>Widowed</option>
<option value="divorced" label="divorced" <?php echo ($RowRMO['MaritalStatus']=='divorced')?'selected':'' ?>>Divorced</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Religion<span>*</span></label>
<select name="NurseReligion" class="form-control" >
<option value="" disabled selected>Religion </option>
<option value="Hindu" label="Hindu" <?php echo ($RowRMO['Religion']=='Hindu')?'selected':'' ?>>Hindu</option>
<option value="Muslim" label="Muslim" <?php echo ($RowRMO['Religion']=='Muslim')?'selected':'' ?>>Muslim</option>
<option value="Christian" label="Christian" <?php echo ($RowRMO['Religion']=='Christian')?'selected':'' ?>>Christian</option>
<option value="Sikh" label="Sikh" <?php echo ($RowRMO['Religion']=='Sikh')?'selected':'' ?>>Sikh</option>
<option value="Parsi" label="Parsi" <?php echo ($RowRMO['Religion']=='Parsi')?'selected':'' ?>>Parsi</option>
<option value="Jain" label="Jain" <?php echo ($RowRMO['Religion']=='Jain')?'selected':'' ?>>Jain</option>
<option value="Buddhist" label="Buddhist" <?php echo ($RowRMO['Religion']=='Buddhist')?'selected':'' ?>>Buddhist</option>
<option value="Jewish" label="Jewish" <?php echo ($RowRMO['Religion']=='Jewish')?'selected':'' ?>>Jewish</option>
<option value="No Religion" label="No Religion" <?php echo ($RowRMO['Religion']=='No Religion')?'selected':'' ?>>No Religion</option>
<option value="Spiritual - not religious" label="Spiritual" <?php echo ($RowRMO['Religion']=='Spiritual - not religious')?'selected':'' ?>>Spiritual</option>
<option value="Other" label="Other" <?php echo ($RowRMO['Religion']=='Other')?'selected':'' ?>>Other</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Aadhaar Number<span>*</span></label>
<input type="text" name="NurseAadhaarNumber" id="AadhaarNumber" placeholder="Aadhaar Number" required value="<?php echo $RowRMO['AadhaarNumber']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Country<span>*</span></label>
<select class="form-control" name="NurseCountry" id="country" required>
<option value="" disabled selected>Country</option>
<?php
include("dbconnection.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>
</div>
<div class='col-sm-6'><label for="item"> State<span>*</span></label>
<select class="form-control" name="NurseState" id="state" required>
<option value="">Select country first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Distict<span>*</span></label>
<select class="form-control" name="NurseDistict" id="city" required>
<option value="">Select state first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> PinCode<span>*</span></label>
<input type="text" name="NursePinCode" id="PinCode" required placeholder="PinCode" value="<?php echo $RowRMO['PinCode']; ?>"></div>
<div class='col-sm-6'><label for="item"> Address<span>*</span></label>
<input type="text" name="NurseAddress" id="Address" required placeholder="Address" value="<?php echo $RowRMO['Address']; ?>"></div>
<div class='col-sm-6'><label>Select Image File:</label>
<input name="Upload_Nurse[]" type="file" multiple></div>
</div>
<input type="submit" id="clicknow" value="Submit" name="AddNurse">
</form>
<?php } ?>
<?php if($re['usertype']=='FrontOffice'){
?>
<form id="myForm" method="post" enctype="multipart/form-data">
<h3><i class="fa fa-angle-right"></i> Basic Profile </h3>
<div class="row">
<div class="col-sm-12"> <div id="frmCheckUsername"></div></div>
<div class='col-sm-6'> <label for="item"> Name <span>*</span></label>
<input class="input100" type="text" name="Name" placeholder="Enter your Name" value="<?php echo $RowRMO['Name']; ?>" readonly />
<input type="hidden" name="frid" value="<?php echo $RowRMO['frid']; ?>" />
</div>
<div class='col-sm-6'><label for="item"> Email id<span>*</span></label>
<input class="input100" type="email" name="userid" value="<?php echo $RowRMO['user_id']; ?>" readonly />
</div>
<div class='col-sm-6'><label for="item"> Mobile Number<span>*</span></label>
<input type="text" name="numbers" id="numbers" value="<?php echo $RowRMO['numbers']; ?>" readonly /></div>
<div class='col-sm-6'><label for="item"> Fathers Name<span>*</span></label>
<input type="text" name="FrontFathersName" id="FathersName" required placeholder="Father's Name" value="<?php echo $RowRMO['FathersName']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Gender<span>*</span></label>
<div class="checkbox"><input onclick="ValidateNo();" type="radio" name="FrontGender" value="Male" required <?php echo ($RowRMO['Gender']=='Male')?'checked':'' ?>>
<span>Male </span></div><div class="checkbox">
<input type="radio" onclick="ValidateNo();" name="FrontGender" value="Female" <?php echo ($RowRMO['Gender']=='Female')?'checked':'' ?>>
<span>Female </span></div><div class="checkbox"><input type="radio" onclick="ValidateNo();" name="FrontGender" value="Other" <?php echo ($RowRMO['Gender']=='Other')?'checked':'' ?>>
<span>Other </span></div>
</div>
<div class='col-sm-6'><label for="item"> DOB<span>*</span></label>
<input type="date" name="FrontDOB" id="DOB" placeholder="DOB" required value="<?php echo $RowRMO['DOB']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Blood Group<span>*</span></label>
<select name="FrontBloodGroup" class="form-control" >
<option value="">Blood Group</option>
<option value='A+' <?php echo ($RowRMO['BloodGroup']=='A+')?'selected':'' ?>>A+</option>
<option value='A-' <?php echo ($RowRMO['BloodGroup']=='A-')?'selected':'' ?>>A-</option>
<option value='B+' <?php echo ($RowRMO['BloodGroup']=='B+')?'selected':'' ?>>B+</option>
<option value='B-' <?php echo ($RowRMO['BloodGroup']=='B-')?'selected':'' ?>>B-</option>
<option value='O+' <?php echo ($RowRMO['BloodGroup']=='O+')?'selected':'' ?>>O+</option>
<option value='O-' <?php echo ($RowRMO['BloodGroup']=='O-')?'selected':'' ?>>O-</option>
<option value='AB+' <?php echo ($RowRMO['BloodGroup']=='AB+')?'selected':'' ?>>AB+</option>
<option value='AB-' <?php echo ($RowRMO['BloodGroup']=='AB-')?'selected':'' ?>>AB-</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Nationality<span>*</span></label>
<select name="FrontNationality" class="form-control">
<option value="0">Nationality</option>
<option value="Indian" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Indian')?'selected':'' ?>>Indian</option>
<option value="Nepali" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Nepali')?'selected':'' ?>>Nepali</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Marital Status<span>*</span></label>
<select name="FrontMaritalStatus" class="form-control">
<option value="" disabled selected>Marital status </option>
<option value="Single" label="Single" <?php echo ($RowRMO['MaritalStatus']=='Single')?'selected':'' ?>>Single</option>
<option value="Married" label="Married" <?php echo ($RowRMO['MaritalStatus']=='Married')?'selected':'' ?>>Married</option>
<option value="Widowed" <?php echo ($RowRMO['MaritalStatus']=='Widowed')?'selected':'' ?>>Widowed</option>
<option value="divorced" label="divorced" <?php echo ($RowRMO['MaritalStatus']=='divorced')?'selected':'' ?>>Divorced</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Religion<span>*</span></label>
<select name="FrontReligion" class="form-control" >
<option value="" disabled selected>Religion </option>
<option value="Hindu" label="Hindu" <?php echo ($RowRMO['Religion']=='Hindu')?'selected':'' ?>>Hindu</option>
<option value="Muslim" label="Muslim" <?php echo ($RowRMO['Religion']=='Muslim')?'selected':'' ?>>Muslim</option>
<option value="Christian" label="Christian" <?php echo ($RowRMO['Religion']=='Christian')?'selected':'' ?>>Christian</option>
<option value="Sikh" label="Sikh" <?php echo ($RowRMO['Religion']=='Sikh')?'selected':'' ?>>Sikh</option>
<option value="Parsi" label="Parsi" <?php echo ($RowRMO['Religion']=='Parsi')?'selected':'' ?>>Parsi</option>
<option value="Jain" label="Jain" <?php echo ($RowRMO['Religion']=='Jain')?'selected':'' ?>>Jain</option>
<option value="Buddhist" label="Buddhist" <?php echo ($RowRMO['Religion']=='Buddhist')?'selected':'' ?>>Buddhist</option>
<option value="Jewish" label="Jewish" <?php echo ($RowRMO['Religion']=='Jewish')?'selected':'' ?>>Jewish</option>
<option value="No Religion" label="No Religion" <?php echo ($RowRMO['Religion']=='No Religion')?'selected':'' ?>>No Religion</option>
<option value="Spiritual - not religious" label="Spiritual" <?php echo ($RowRMO['Religion']=='Spiritual - not religious')?'selected':'' ?>>Spiritual</option>
<option value="Other" label="Other" <?php echo ($RowRMO['Religion']=='Other')?'selected':'' ?>>Other</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Aadhaar Number<span>*</span></label>
<input type="text" name="FrontAadhaarNumber" id="AadhaarNumber" placeholder="Aadhaar Number" required value="<?php echo $RowRMO['AadhaarNumber']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Country<span>*</span></label>
<select class="form-control" name="FrontCountry" id="country" required>
<option value="" disabled selected>Country</option>
<?php
include("dbconnection.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>
</div>
<div class='col-sm-6'><label for="item"> State<span>*</span></label>
<select class="form-control" name="FrontState" id="state" required>
<option value="">Select country first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Distict<span>*</span></label>
<select class="form-control" name="FrontDistict" id="city" required>
<option value="">Select state first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> PinCode<span>*</span></label>
<input type="text" name="FrontPinCode" id="PinCode" required placeholder="PinCode" value="<?php echo $RowRMO['PinCode']; ?>"></div>
<div class='col-sm-6'><label for="item"> Address<span>*</span></label>
<input type="text" name="FrontAddress" id="Address" required placeholder="Address" value="<?php echo $RowRMO['Address']; ?>"></div>
<div class='col-sm-6'><label>Select Image File:</label>
<input name="Upload_Consent[]" type="file" multiple></div>
</div>
<input type="submit" id="clicknow" value="Submit" name="AddFront">
</form>
<?php } ?>
<?php if($re['usertype']=='HR'){
?>
<form method="post" enctype="multipart/form-data">
<h3><i class="fa fa-angle-right"></i> Basic Profile </h3>
<div class="row">
<div class="col-sm-12"> <div id="frmCheckUsername"></div></div>
<div class='col-sm-6'> <label for="item"> Name <span>*</span></label>
<input class="input100" type="text" name="Name" placeholder="Enter your Name" value="<?php echo $RowRMO['Name']; ?>" readonly />
<input type="hidden" name="hrid" value="<?php echo $RowRMO['hrid']; ?>" />
</div>
<div class='col-sm-6'><label for="item"> Email id<span>*</span></label>
<input class="input100" type="email" name="userid" value="<?php echo $RowRMO['user_id']; ?>" readonly />
</div>
<div class='col-sm-6'><label for="item"> Mobile Number<span>*</span></label>
<input type="text" name="numbers" id="numbers" value="<?php echo $RowRMO['numbers']; ?>" readonly /></div>
<div class='col-sm-6'><label for="item"> Fathers Name<span>*</span></label>
<input type="text" name="HRFathersName" id="FathersName" required placeholder="Father's Name" value="<?php echo $RowRMO['FathersName']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Gender<span>*</span></label>
<div class="checkbox"><input onclick="ValidateNo();" type="radio" name="HRGender" value="Male" required <?php echo ($RowRMO['Gender']=='Male')?'checked':'' ?>>
<span>Male </span></div><div class="checkbox">
<input type="radio" onclick="ValidateNo();" name="HRGender" value="Female" <?php echo ($RowRMO['Gender']=='Female')?'checked':'' ?>>
<span>Female </span></div><div class="checkbox"><input type="radio" onclick="ValidateNo();" name="HRGender" value="Other" <?php echo ($RowRMO['Gender']=='Other')?'checked':'' ?>>
<span>Other </span></div>
</div>
<div class='col-sm-6'><label for="item"> DOB<span>*</span></label>
<input type="date" name="HRDOB" id="DOB" placeholder="DOB" required value="<?php echo $RowRMO['DOB']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Blood Group<span>*</span></label>
<select name="HRBloodGroup" class="form-control" >
<option value="">Blood Group</option>
<option value='A+' <?php echo ($RowRMO['BloodGroup']=='A+')?'selected':'' ?>>A+</option>
<option value='A-' <?php echo ($RowRMO['BloodGroup']=='A-')?'selected':'' ?>>A-</option>
<option value='B+' <?php echo ($RowRMO['BloodGroup']=='B+')?'selected':'' ?>>B+</option>
<option value='B-' <?php echo ($RowRMO['BloodGroup']=='B-')?'selected':'' ?>>B-</option>
<option value='O+' <?php echo ($RowRMO['BloodGroup']=='O+')?'selected':'' ?>>O+</option>
<option value='O-' <?php echo ($RowRMO['BloodGroup']=='O-')?'selected':'' ?>>O-</option>
<option value='AB+' <?php echo ($RowRMO['BloodGroup']=='AB+')?'selected':'' ?>>AB+</option>
<option value='AB-' <?php echo ($RowRMO['BloodGroup']=='AB-')?'selected':'' ?>>AB-</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Nationality<span>*</span></label>
<select name="HRNationality" class="form-control">
<option value="0">Nationality</option>
<option value="Indian" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Indian')?'selected':'' ?>>Indian</option>
<option value="Nepali" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Nepali')?'selected':'' ?>>Nepali</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Marital Status<span>*</span></label>
<select name="HRMaritalStatus" class="form-control">
<option value="" disabled selected>Marital status </option>
<option value="Single" label="Single" <?php echo ($RowRMO['MaritalStatus']=='Single')?'selected':'' ?>>Single</option>
<option value="Married" label="Married" <?php echo ($RowRMO['MaritalStatus']=='Married')?'selected':'' ?>>Married</option>
<option value="Widowed" <?php echo ($RowRMO['MaritalStatus']=='Widowed')?'selected':'' ?>>Widowed</option>
<option value="divorced" label="divorced" <?php echo ($RowRMO['MaritalStatus']=='divorced')?'selected':'' ?>>Divorced</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Religion<span>*</span></label>
<select name="HRReligion" class="form-control" >
<option value="" disabled selected>Religion </option>
<option value="Hindu" label="Hindu" <?php echo ($RowRMO['Religion']=='Hindu')?'selected':'' ?>>Hindu</option>
<option value="Muslim" label="Muslim" <?php echo ($RowRMO['Religion']=='Muslim')?'selected':'' ?>>Muslim</option>
<option value="Christian" label="Christian" <?php echo ($RowRMO['Religion']=='Christian')?'selected':'' ?>>Christian</option>
<option value="Sikh" label="Sikh" <?php echo ($RowRMO['Religion']=='Sikh')?'selected':'' ?>>Sikh</option>
<option value="Parsi" label="Parsi" <?php echo ($RowRMO['Religion']=='Parsi')?'selected':'' ?>>Parsi</option>
<option value="Jain" label="Jain" <?php echo ($RowRMO['Religion']=='Jain')?'selected':'' ?>>Jain</option>
<option value="Buddhist" label="Buddhist" <?php echo ($RowRMO['Religion']=='Buddhist')?'selected':'' ?>>Buddhist</option>
<option value="Jewish" label="Jewish" <?php echo ($RowRMO['Religion']=='Jewish')?'selected':'' ?>>Jewish</option>
<option value="No Religion" label="No Religion" <?php echo ($RowRMO['Religion']=='No Religion')?'selected':'' ?>>No Religion</option>
<option value="Spiritual - not religious" label="Spiritual" <?php echo ($RowRMO['Religion']=='Spiritual - not religious')?'selected':'' ?>>Spiritual</option>
<option value="Other" label="Other" <?php echo ($RowRMO['Religion']=='Other')?'selected':'' ?>>Other</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Aadhaar Number<span>*</span></label>
<input type="text" name="HRAadhaarNumber" id="AadhaarNumber" placeholder="Aadhaar Number" required value="<?php echo $RowRMO['AadhaarNumber']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Country<span>*</span></label>
<select class="form-control" name="HRCountry" id="country" required>
<option value="" disabled selected>Country</option>
<?php
include("dbconnection.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>
</div>
<div class='col-sm-6'><label for="item"> State<span>*</span></label>
<select class="form-control" name="HRState" id="state" required>
<option value="">Select country first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Distict<span>*</span></label>
<select class="form-control" name="HRDistict" id="city" required>
<option value="">Select state first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> PinCode<span>*</span></label>
<input type="text" name="HRPinCode" id="PinCode" required placeholder="PinCode" value="<?php echo $RowRMO['PinCode']; ?>"></div>
<div class='col-sm-6'><label for="item"> Address<span>*</span></label>
<input type="text" name="HRAddress" id="Address" required placeholder="Address" value="<?php echo $RowRMO['Address']; ?>"></div>
<div class='col-sm-6'><label>Select Image File:</label>
<input name="Upload_HR[]" type="file" multiple></div>
</div>
<input type="submit" id="clicknow" value="Submit" name="AddHR">
</form>
<?php } ?>
<?php if($re['usertype']=='OT'){
?>
<form method="post" enctype="multipart/form-data">
<h3><i class="fa fa-angle-right"></i> Basic Profile </h3>
<div class="row">
<div class="col-sm-12"> <div id="frmCheckUsername"></div></div>
<div class='col-sm-6'> <label for="item"> Name <span>*</span></label>
<input class="input100" type="text" name="Name" placeholder="Enter your Name" value="<?php echo $RowRMO['Name']; ?>" readonly />
<input type="hidden" name="otid" value="<?php echo $RowRMO['otid']; ?>" />
</div>
<div class='col-sm-6'><label for="item"> Email id<span>*</span></label>
<input class="input100" type="email" name="userid" value="<?php echo $RowRMO['user_id']; ?>" readonly />
</div>
<div class='col-sm-6'><label for="item"> Mobile Number<span>*</span></label>
<input type="text" name="numbers" id="numbers" value="<?php echo $RowRMO['numbers']; ?>" readonly /></div>
<div class='col-sm-6'><label for="item"> Fathers Name<span>*</span></label>
<input type="text" name="OTFathersName" id="FathersName" required placeholder="Father's Name" value="<?php echo $RowRMO['FathersName']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Gender<span>*</span></label>
<div class="checkbox"><input onclick="ValidateNo();" type="radio" name="OTGender" value="Male" required <?php echo ($RowRMO['Gender']=='Male')?'checked':'' ?>>
<span>Male </span></div><div class="checkbox">
<input type="radio" onclick="ValidateNo();" name="OTGender" value="Female" <?php echo ($RowRMO['Gender']=='Female')?'checked':'' ?>>
<span>Female </span></div><div class="checkbox"><input type="radio" onclick="ValidateNo();" name="OTGender" value="Other" <?php echo ($RowRMO['Gender']=='Other')?'checked':'' ?>>
<span>Other </span></div>
</div>
<div class='col-sm-6'><label for="item"> DOB<span>*</span></label>
<input type="date" name="OTDOB" id="DOB" placeholder="DOB" required value="<?php echo $RowRMO['DOB']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Blood Group<span>*</span></label>
<select name="OTBloodGroup" class="form-control" >
<option value="">Blood Group</option>
<option value='A+' <?php echo ($RowRMO['BloodGroup']=='A+')?'selected':'' ?>>A+</option>
<option value='A-' <?php echo ($RowRMO['BloodGroup']=='A-')?'selected':'' ?>>A-</option>
<option value='B+' <?php echo ($RowRMO['BloodGroup']=='B+')?'selected':'' ?>>B+</option>
<option value='B-' <?php echo ($RowRMO['BloodGroup']=='B-')?'selected':'' ?>>B-</option>
<option value='O+' <?php echo ($RowRMO['BloodGroup']=='O+')?'selected':'' ?>>O+</option>
<option value='O-' <?php echo ($RowRMO['BloodGroup']=='O-')?'selected':'' ?>>O-</option>
<option value='AB+' <?php echo ($RowRMO['BloodGroup']=='AB+')?'selected':'' ?>>AB+</option>
<option value='AB-' <?php echo ($RowRMO['BloodGroup']=='AB-')?'selected':'' ?>>AB-</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Nationality<span>*</span></label>
<select name="OTNationality" class="form-control">
<option value="0">Nationality</option>
<option value="Indian" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Indian')?'selected':'' ?>>Indian</option>
<option value="Nepali" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Nepali')?'selected':'' ?>>Nepali</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Marital Status<span>*</span></label>
<select name="OTMaritalStatus" class="form-control">
<option value="" disabled selected>Marital status </option>
<option value="Single" label="Single" <?php echo ($RowRMO['MaritalStatus']=='Single')?'selected':'' ?>>Single</option>
<option value="Married" label="Married" <?php echo ($RowRMO['MaritalStatus']=='Married')?'selected':'' ?>>Married</option>
<option value="Widowed" <?php echo ($RowRMO['MaritalStatus']=='Widowed')?'selected':'' ?>>Widowed</option>
<option value="divorced" label="divorced" <?php echo ($RowRMO['MaritalStatus']=='divorced')?'selected':'' ?>>Divorced</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Religion<span>*</span></label>
<select name="OTReligion" class="form-control" >
<option value="" disabled selected>Religion </option>
<option value="Hindu" label="Hindu" <?php echo ($RowRMO['Religion']=='Hindu')?'selected':'' ?>>Hindu</option>
<option value="Muslim" label="Muslim" <?php echo ($RowRMO['Religion']=='Muslim')?'selected':'' ?>>Muslim</option>
<option value="Christian" label="Cistian" <?php echo ($RowRMO['Religion']=='Christian')?'selected':'' ?>>Christian</option>
<option value="Sikh" label="Sikh" <?php echo ($RowRMO['Religion']=='Sikh')?'selected':'' ?>>Sikh</option>
<option value="Parsi" label="Parsi" <?php echo ($RowRMO['Religion']=='Parsi')?'selected':'' ?>>Parsi</option>
<option value="Jain" label="Jain" <?php echo ($RowRMO['Religion']=='Jain')?'selected':'' ?>>Jain</option>
<option value="Buddhist" label="Buddhist" <?php echo ($RowRMO['Religion']=='Buddhist')?'selected':'' ?>>Buddhist</option>
<option value="Jewish" label="Jewish" <?php echo ($RowRMO['Religion']=='Jewish')?'selected':'' ?>>Jewish</option>
<option value="No Religion" label="No Religion" <?php echo ($RowRMO['Religion']=='No Religion')?'selected':'' ?>>No Religion</option>
<option value="Spiritual - not religious" label="Spiritual" <?php echo ($RowRMO['Religion']=='Spiritual - not religious')?'selected':'' ?>>Spiritual</option>
<option value="Other" label="Other" <?php echo ($RowRMO['Religion']=='Other')?'selected':'' ?>>Other</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Aadhaar Number<span>*</span></label>
<input type="text" name="OTAadhaarNumber" id="AadhaarNumber" placeholder="Aadhaar Number" required value="<?php echo $RowRMO['AadhaarNumber']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Country<span>*</span></label>
<select class="form-control" name="OTCountry" id="country" required>
<option value="" disabled selected>Country</option>
<?php
include("dbconnection.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>
</div>
<div class='col-sm-6'><label for="item"> State<span>*</span></label>
<select class="form-control" name="OTState" id="state" required>
<option value="">Select country first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Distict<span>*</span></label>
<select class="form-control" name="OTDistict" id="city" required>
<option value="">Select state first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> PinCode<span>*</span></label>
<input type="text" name="OTPinCode" id="PinCode" required placeholder="PinCode" value="<?php echo $RowRMO['PinCode']; ?>"></div>
<div class='col-sm-6'><label for="item"> Address<span>*</span></label>
<input type="text" name="OTAddress" id="Address" required placeholder="Address" value="<?php echo $RowRMO['Address']; ?>"></div>
<div class='col-sm-6'><label>Select Image File:</label>
<input name="Upload_OT[]" type="file" multiple></div>
</div>
<input type="submit" id="clicknow" value="Submit" name="AddOT">
</form>
<?php } ?>
<?php if($re['usertype']=='Lab'){
?>
<form method="post" enctype="multipart/form-data">
<h3><i class="fa fa-angle-right"></i> Basic Profile </h3>
<div class="row">
<div class="col-sm-12"> <div id="frmCheckUsername"></div></div>
<div class='col-sm-6'> <label for="item"> Name <span>*</span></label>
<input class="input100" type="text" name="Name" placeholder="Enter your Name" value="<?php echo $RowRMO['Name']; ?>" readonly />
<input type="hidden" name="labid" value="<?php echo $RowRMO['labid']; ?>" />
</div>
<div class='col-sm-6'><label for="item"> Email id<span>*</span></label>
<input class="input100" type="email" name="userid" value="<?php echo $RowRMO['user_id']; ?>" readonly />
</div>
<div class='col-sm-6'><label for="item"> Mobile Number<span>*</span></label>
<input type="text" name="numbers" id="numbers" value="<?php echo $RowRMO['numbers']; ?>" readonly /></div>
<div class='col-sm-6'><label for="item"> Fathers Name<span>*</span></label>
<input type="text" name="LabFathersName" id="FathersName" required placeholder="Father's Name" value="<?php echo $RowRMO['FathersName']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Gender<span>*</span></label>
<div class="checkbox"><input onclick="ValidateNo();" type="radio" name="LabGender" value="Male" required <?php echo ($RowRMO['Gender']=='Male')?'checked':'' ?>>
<span>Male </span></div><div class="checkbox">
<input type="radio" onclick="ValidateNo();" name="LabGender" value="Female" <?php echo ($RowRMO['Gender']=='Female')?'checked':'' ?>>
<span>Female </span></div><div class="checkbox"><input type="radio" onclick="ValidateNo();" name="LabGender" value="Other" <?php echo ($RowRMO['Gender']=='Other')?'checked':'' ?>>
<span>Other </span></div>
</div>
<div class='col-sm-6'><label for="item"> DOB<span>*</span></label>
<input type="date" name="LabDOB" id="DOB" placeholder="DOB" required value="<?php echo $RowRMO['DOB']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Blood Group<span>*</span></label>
<select name="LabBloodGroup" class="form-control" >
<option value="">Blood Group</option>
<option value='A+' <?php echo ($RowRMO['BloodGroup']=='A+')?'selected':'' ?>>A+</option>
<option value='A-' <?php echo ($RowRMO['BloodGroup']=='A-')?'selected':'' ?>>A-</option>
<option value='B+' <?php echo ($RowRMO['BloodGroup']=='B+')?'selected':'' ?>>B+</option>
<option value='B-' <?php echo ($RowRMO['BloodGroup']=='B-')?'selected':'' ?>>B-</option>
<option value='O+' <?php echo ($RowRMO['BloodGroup']=='O+')?'selected':'' ?>>O+</option>
<option value='O-' <?php echo ($RowRMO['BloodGroup']=='O-')?'selected':'' ?>>O-</option>
<option value='AB+' <?php echo ($RowRMO['BloodGroup']=='AB+')?'selected':'' ?>>AB+</option>
<option value='AB-' <?php echo ($RowRMO['BloodGroup']=='AB-')?'selected':'' ?>>AB-</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Nationality<span>*</span></label>
<select name="LabNationality" class="form-control">
<option value="0">Nationality</option>
<option value="Indian" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Indian')?'selected':'' ?>>Indian</option>
<option value="Nepali" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Nepali')?'selected':'' ?>>Nepali</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Marital Status<span>*</span></label>
<select name="LabMaritalStatus" class="form-control">
<option value="" disabled selected>Marital status </option>
<option value="Single" label="Single" <?php echo ($RowRMO['MaritalStatus']=='Single')?'selected':'' ?>>Single</option>
<option value="Married" label="Married" <?php echo ($RowRMO['MaritalStatus']=='Married')?'selected':'' ?>>Married</option>
<option value="Widowed" <?php echo ($RowRMO['MaritalStatus']=='Widowed')?'selected':'' ?>>Widowed</option>
<option value="divorced" label="divorced" <?php echo ($RowRMO['MaritalStatus']=='divorced')?'selected':'' ?>>Divorced</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Religion<span>*</span></label>
<select name="LabReligion" class="form-control" >
<option value="" disabled selected>Religion </option>
<option value="Hindu" label="Hindu" <?php echo ($RowRMO['Religion']=='Hindu')?'selected':'' ?>>Hindu</option>
<option value="Muslim" label="Muslim" <?php echo ($RowRMO['Religion']=='Muslim')?'selected':'' ?>>Muslim</option>
<option value="Christian" label="Cistian" <?php echo ($RowRMO['Religion']=='Christian')?'selected':'' ?>>Christian</option>
<option value="Sikh" label="Sikh" <?php echo ($RowRMO['Religion']=='Sikh')?'selected':'' ?>>Sikh</option>
<option value="Parsi" label="Parsi" <?php echo ($RowRMO['Religion']=='Parsi')?'selected':'' ?>>Parsi</option>
<option value="Jain" label="Jain" <?php echo ($RowRMO['Religion']=='Jain')?'selected':'' ?>>Jain</option>
<option value="Buddhist" label="Buddhist" <?php echo ($RowRMO['Religion']=='Buddhist')?'selected':'' ?>>Buddhist</option>
<option value="Jewish" label="Jewish" <?php echo ($RowRMO['Religion']=='Jewish')?'selected':'' ?>>Jewish</option>
<option value="No Religion" label="No Religion" <?php echo ($RowRMO['Religion']=='No Religion')?'selected':'' ?>>No Religion</option>
<option value="Spiritual - not religious" label="Spiritual" <?php echo ($RowRMO['Religion']=='Spiritual - not religious')?'selected':'' ?>>Spiritual</option>
<option value="Other" label="Other" <?php echo ($RowRMO['Religion']=='Other')?'selected':'' ?>>Other</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Aadhaar Number<span>*</span></label>
<input type="text" name="LabAadhaarNumber" id="AadhaarNumber" placeholder="Aadhaar Number" required value="<?php echo $RowRMO['AadhaarNumber']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Country<span>*</span></label>
<select class="form-control" name="LabCountry" id="country" required>
<option value="" disabled selected>Country</option>
<?php
include("dbconnection.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>
</div>
<div class='col-sm-6'><label for="item"> State<span>*</span></label>
<select class="form-control" name="LabState" id="state" required>
<option value="">Select country first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Distict<span>*</span></label>
<select class="form-control" name="LabDistict" id="city" required>
<option value="">Select state first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> PinCode<span>*</span></label>
<input type="text" name="LabPinCode" id="PinCode" required placeholder="PinCode" value="<?php echo $RowRMO['PinCode']; ?>"></div>
<div class='col-sm-6'><label for="item"> Address<span>*</span></label>
<input type="text" name="LabAddress" id="Address" required placeholder="Address" value="<?php echo $RowRMO['Address']; ?>"></div>
<div class='col-sm-6'><label>Select Image File:</label>
<input name="Upload_Lab[]" type="file" multiple></div>
</div>
<input type="submit" id="clicknow" value="Submit" name="AddLab">
</form>
<?php } ?>
<?php if($re['usertype']=='Diagnostic'){
?>
<form method="post" enctype="multipart/form-data">
<h3><i class="fa fa-angle-right"></i> Basic Profile </h3>
<div class="row">
<div class="col-sm-12"> <div id="frmCheckUsername"></div></div>
<div class='col-sm-6'> <label for="item"> Name <span>*</span></label>
<input class="input100" type="text" name="Name" placeholder="Enter your Name" value="<?php echo $RowRMO['Name']; ?>" readonly />
<input type="hidden" name="dignoid" value="<?php echo $RowRMO['dignoid']; ?>" />
</div>
<div class='col-sm-6'><label for="item"> Email id<span>*</span></label>
<input class="input100" type="email" name="userid" value="<?php echo $RowRMO['user_id']; ?>" readonly />
</div>
<div class='col-sm-6'><label for="item"> Mobile Number<span>*</span></label>
<input type="text" name="numbers" id="numbers" value="<?php echo $RowRMO['numbers']; ?>" readonly /></div>
<div class='col-sm-6'><label for="item"> Fathers Name<span>*</span></label>
<input type="text" name="DiagnosticFathersName" id="FathersName" required placeholder="Father's Name" value="<?php echo $RowRMO['FathersName']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Gender<span>*</span></label>
<div class="checkbox"><input onclick="ValidateNo();" type="radio" name="DiagnosticGender" value="Male" required <?php echo ($RowRMO['Gender']=='Male')?'checked':'' ?>>
<span>Male </span></div><div class="checkbox">
<input type="radio" onclick="ValidateNo();" name="DiagnosticGender" value="Female" <?php echo ($RowRMO['Gender']=='Female')?'checked':'' ?>>
<span>Female </span></div><div class="checkbox"><input type="radio" onclick="ValidateNo();" name="DiagnosticGender" value="Other" <?php echo ($RowRMO['Gender']=='Other')?'checked':'' ?>>
<span>Other </span></div>
</div>
<div class='col-sm-6'><label for="item"> DOB<span>*</span></label>
<input type="date" name="DiagnosticDOB" id="DOB" placeholder="DOB" required value="<?php echo $RowRMO['DOB']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Blood Group<span>*</span></label>
<select name="DiagnosticBloodGroup" class="form-control" >
<option value="">Blood Group</option>
<option value='A+' <?php echo ($RowRMO['BloodGroup']=='A+')?'selected':'' ?>>A+</option>
<option value='A-' <?php echo ($RowRMO['BloodGroup']=='A-')?'selected':'' ?>>A-</option>
<option value='B+' <?php echo ($RowRMO['BloodGroup']=='B+')?'selected':'' ?>>B+</option>
<option value='B-' <?php echo ($RowRMO['BloodGroup']=='B-')?'selected':'' ?>>B-</option>
<option value='O+' <?php echo ($RowRMO['BloodGroup']=='O+')?'selected':'' ?>>O+</option>
<option value='O-' <?php echo ($RowRMO['BloodGroup']=='O-')?'selected':'' ?>>O-</option>
<option value='AB+' <?php echo ($RowRMO['BloodGroup']=='AB+')?'selected':'' ?>>AB+</option>
<option value='AB-' <?php echo ($RowRMO['BloodGroup']=='AB-')?'selected':'' ?>>AB-</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Nationality<span>*</span></label>
<select name="DiagnosticNationality" class="form-control">
<option value="0">Nationality</option>
<option value="Indian" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Indian')?'selected':'' ?>>Indian</option>
<option value="Nepali" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Nepali')?'selected':'' ?>>Nepali</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Marital Status<span>*</span></label>
<select name="DiagnosticMaritalStatus" class="form-control">
<option value="" disabled selected>Marital status </option>
<option value="Single" label="Single" <?php echo ($RowRMO['MaritalStatus']=='Single')?'selected':'' ?>>Single</option>
<option value="Married" label="Married" <?php echo ($RowRMO['MaritalStatus']=='Married')?'selected':'' ?>>Married</option>
<option value="Widowed" <?php echo ($RowRMO['MaritalStatus']=='Widowed')?'selected':'' ?>>Widowed</option>
<option value="divorced" label="divorced" <?php echo ($RowRMO['MaritalStatus']=='divorced')?'selected':'' ?>>Divorced</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Religion<span>*</span></label>
<select name="DiagnosticReligion" class="form-control" >
<option value="" disabled selected>Religion </option>
<option value="Hindu" label="Hindu" <?php echo ($RowRMO['Religion']=='Hindu')?'selected':'' ?>>Hindu</option>
<option value="Muslim" label="Muslim" <?php echo ($RowRMO['Religion']=='Muslim')?'selected':'' ?>>Muslim</option>
<option value="Christian" label="Cistian" <?php echo ($RowRMO['Religion']=='Christian')?'selected':'' ?>>Christian</option>
<option value="Sikh" label="Sikh" <?php echo ($RowRMO['Religion']=='Sikh')?'selected':'' ?>>Sikh</option>
<option value="Parsi" label="Parsi" <?php echo ($RowRMO['Religion']=='Parsi')?'selected':'' ?>>Parsi</option>
<option value="Jain" label="Jain" <?php echo ($RowRMO['Religion']=='Jain')?'selected':'' ?>>Jain</option>
<option value="Buddhist" label="Buddhist" <?php echo ($RowRMO['Religion']=='Buddhist')?'selected':'' ?>>Buddhist</option>
<option value="Jewish" label="Jewish" <?php echo ($RowRMO['Religion']=='Jewish')?'selected':'' ?>>Jewish</option>
<option value="No Religion" label="No Religion" <?php echo ($RowRMO['Religion']=='No Religion')?'selected':'' ?>>No Religion</option>
<option value="Spiritual - not religious" label="Spiritual" <?php echo ($RowRMO['Religion']=='Spiritual - not religious')?'selected':'' ?>>Spiritual</option>
<option value="Other" label="Other" <?php echo ($RowRMO['Religion']=='Other')?'selected':'' ?>>Other</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Aadhaar Number<span>*</span></label>
<input type="text" name="DiagnosticAadhaarNumber" id="AadhaarNumber" placeholder="Aadhaar Number" required value="<?php echo $RowRMO['AadhaarNumber']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Country<span>*</span></label>
<select class="form-control" name="DiagnosticCountry" id="country" required>
<option value="" disabled selected>Country</option>
<?php
include("dbconnection.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>
</div>
<div class='col-sm-6'><label for="item"> State<span>*</span></label>
<select class="form-control" name="DiagnosticState" id="state" required>
<option value="">Select country first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Distict<span>*</span></label>
<select class="form-control" name="DiagnosticDistict" id="city" required>
<option value="">Select state first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> PinCode<span>*</span></label>
<input type="text" name="DiagnosticPinCode" id="PinCode" required placeholder="PinCode" value="<?php echo $RowRMO['PinCode']; ?>"></div>
<div class='col-sm-6'><label for="item"> Address<span>*</span></label>
<input type="text" name="DiagnosticAddress" id="Address" required placeholder="Address" value="<?php echo $RowRMO['Address']; ?>"></div>
<div class='col-sm-6'><label>Select Image File:</label>
<input name="Upload_Diagnostic[]" type="file" multiple></div>
</div>
<input type="submit" id="clicknow" value="Submit" name="AddDiagnostic">
</form>
<?php } ?>
<?php
if($re['usertype']=='Optometrist'){
?>
<form method="post" enctype="multipart/form-data">
<h3><i class="fa fa-angle-right"></i> Basic Profile </h3>
<div class="row">
<div class="col-sm-12"> <div id="frmCheckUsername"></div></div>
<div class='col-sm-6'> <label for="item"> Name <span>*</span></label>
<input class="input100" type="text" name="Name" placeholder="Enter your Name" value="<?php echo $RowRMO['uname']; ?>" readonly />
<input type="text" name="Optomatrixid" value="<?php echo $RowRMO['OptomatrixId']; ?>" />
</div>
<div class='col-sm-6'><label for="item"> Email id<span>*</span></label>
<input class="input100" type="email" name="userid" value="<?php echo $RowRMO['user_id']; ?>" readonly />
</div>
<div class='col-sm-6'><label for="item"> Mobile Number<span>*</span></label>
<input type="text" name="numbers" id="numbers" value="<?php echo $RowRMO['numbers']; ?>" readonly /></div>
<div class='col-sm-6'><label for="item"> Fathers Name<span>*</span></label>
<input type="text" name="OptomatrixFathersName" id="FathersName" required placeholder="Father's Name" value="<?php echo $RowRMO['FathersName']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Gender<span>*</span></label>
<div class="checkbox"><input onclick="ValidateNo();" type="radio" name="OptomatrixGender" value="Male" required <?php echo ($RowRMO['Gender']=='Male')?'checked':'' ?>>
<span>Male </span></div><div class="checkbox">
<input type="radio" onclick="ValidateNo();" name="OptomatrixGender" value="Female" <?php echo ($RowRMO['Gender']=='Female')?'checked':'' ?>>
<span>Female </span></div><div class="checkbox"><input type="radio" onclick="ValidateNo();" name="OptomatrixGender" value="Other" <?php echo ($RowRMO['Gender']=='Other')?'checked':'' ?>>
<span>Other </span></div>
</div>
<div class='col-sm-6'><label for="item"> DOB<span>*</span></label>
<input type="date" name="OptomatrixDOB" id="DOB" placeholder="DOB" required value="<?php echo $RowRMO['DOB']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Blood Group<span>*</span></label>
<select name="OptomatrixBloodGroup" class="form-control" >
<option value="">Blood Group</option>
<option value='A+' <?php echo ($RowRMO['BloodGroup']=='A+')?'selected':'' ?>>A+</option>
<option value='A-' <?php echo ($RowRMO['BloodGroup']=='A-')?'selected':'' ?>>A-</option>
<option value='B+' <?php echo ($RowRMO['BloodGroup']=='B+')?'selected':'' ?>>B+</option>
<option value='B-' <?php echo ($RowRMO['BloodGroup']=='B-')?'selected':'' ?>>B-</option>
<option value='O+' <?php echo ($RowRMO['BloodGroup']=='O+')?'selected':'' ?>>O+</option>
<option value='O-' <?php echo ($RowRMO['BloodGroup']=='O-')?'selected':'' ?>>O-</option>
<option value='AB+' <?php echo ($RowRMO['BloodGroup']=='AB+')?'selected':'' ?>>AB+</option>
<option value='AB-' <?php echo ($RowRMO['BloodGroup']=='AB-')?'selected':'' ?>>AB-</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Nationality<span>*</span></label>
<select name="OptomatrixNationality" class="form-control">
<option value="0">Nationality</option>
<option value="Indian" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Indian')?'selected':'' ?>>Indian</option>
<option value="Nepali" style="color:#004F00" <?php echo ($RowRMO['Nationality']=='Nepali')?'selected':'' ?>>Nepali</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Marital Status<span>*</span></label>
<select name="OptomatrixMaritalStatus" class="form-control">
<option value="" disabled selected>Marital status </option>
<option value="Single" label="Single" <?php echo ($RowRMO['MaritalStatus']=='Single')?'selected':'' ?>>Single</option>
<option value="Married" label="Married" <?php echo ($RowRMO['MaritalStatus']=='Married')?'selected':'' ?>>Married</option>
<option value="Widowed" <?php echo ($RowRMO['MaritalStatus']=='Widowed')?'selected':'' ?>>Widowed</option>
<option value="divorced" label="divorced" <?php echo ($RowRMO['MaritalStatus']=='divorced')?'selected':'' ?>>Divorced</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Religion<span>*</span></label>
<select name="OptomatrixReligion" class="form-control" >
<option value="" disabled selected>Religion </option>
<option value="Hindu" label="Hindu" <?php echo ($RowRMO['Religion']=='Hindu')?'selected':'' ?>>Hindu</option>
<option value="Muslim" label="Muslim" <?php echo ($RowRMO['Religion']=='Muslim')?'selected':'' ?>>Muslim</option>
<option value="Christian" label="Christian" <?php echo ($RowRMO['Religion']=='Christian')?'selected':'' ?>>Christian</option>
<option value="Sikh" label="Sikh" <?php echo ($RowRMO['Religion']=='Sikh')?'selected':'' ?>>Sikh</option>
<option value="Parsi" label="Parsi" <?php echo ($RowRMO['Religion']=='Parsi')?'selected':'' ?>>Parsi</option>
<option value="Jain" label="Jain" <?php echo ($RowRMO['Religion']=='Jain')?'selected':'' ?>>Jain</option>
<option value="Buddhist" label="Buddhist" <?php echo ($RowRMO['Religion']=='Buddhist')?'selected':'' ?>>Buddhist</option>
<option value="Jewish" label="Jewish" <?php echo ($RowRMO['Religion']=='Jewish')?'selected':'' ?>>Jewish</option>
<option value="No Religion" label="No Religion" <?php echo ($RowRMO['Religion']=='No Religion')?'selected':'' ?>>No Religion</option>
<option value="Spiritual - not religious" label="Spiritual" <?php echo ($RowRMO['Religion']=='Spiritual - not religious')?'selected':'' ?>>Spiritual</option>
<option value="Other" label="Other" <?php echo ($RowRMO['Religion']=='Other')?'selected':'' ?>>Other</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Aadhaar Number<span>*</span></label>
<input type="text" name="OptomatrixAadhaarNumber" id="AadhaarNumber" placeholder="Aadhaar Number" required value="<?php echo $RowRMO['AadhaarNumber']; ?>"/></div>
<div class='col-sm-6'><label for="item"> Country<span>*</span></label>
<select class="form-control" name="OptomatrixCountry" id="country" required>
<option value="" disabled selected>Country</option>
<?php
include("dbconnection.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>
</div>
<div class='col-sm-6'><label for="item"> State<span>*</span></label>
<select class="form-control" name="OptomatrixState" id="state" required>
<option value="">Select country first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> Distict<span>*</span></label>
<select class="form-control" name="OptomatrixDistict" id="city" required>
<option value="">Select state first</option>
</select>
</div>
<div class='col-sm-6'><label for="item"> PinCode<span>*</span></label>
<input type="text" name="OptomatrixPinCode" id="PinCode" required placeholder="PinCode" value="<?php echo $RowRMO['PinCode']; ?>"></div>
<div class='col-sm-6'><label for="item"> Address<span>*</span></label>
<input type="text" name="OptomatrixAddress" id="Address" required placeholder="Address" value="<?php echo $RowRMO['Address']; ?>"></div>
<div class='col-sm-6'><label>Select Image File:</label>
<input name="Upload_Optomatrix[]" type="file" multiple></div>
</div>
<input type="submit" id="clicknow" value="Submit" name="AddOptomatrix">
</form>
<?php } ?>
</div>
</body>
<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>');
}
});
});
$(document).ready(function () {
$('select').selectize({
sortField: 'text'
});
});
</script>
</html>
<?php //} ?>