heightsidebar end-->
<!--main content start-->
<style type="text/css">
.required:after {
  content:"*";
  color:red;
}
</style>

<div class="content-body">
    <div class="row">
        <div class="col-12">
            <div class="card">
                <!--sidebar end-->
                <!--main content start-->
                <section id="main-content">
                    <section class="wrapper site-min-height">
                        <!-- page start-->
                        <section class="row col-md-10">
                            <div class="card-header">
                                <h3 class="font-weight-bold"> <?php
                                if (!empty($nurse->id))
                                echo lang('Edit Patient');
                                else
                                echo lang('Edit Patient');
                                ?></h3>
                            </div>
                            <!--   <div class="panel-body col-md-7">
                                <div class="adv-table editable-table ">
                                    <div class="clearfix">
                                        <div class="col-lg-12">
                                            <section class="panel">
                                                <div class="panel-body">
                                                    <div class="col-lg-12">
                                                        
                                                    </div>
                                                    
                                                    
                                                    <input type="hidden" name="id" value='<?php
                                                    if (!empty($nurse->id)) {
                                                    echo $nurse->id;
                                                    }
                                                    ?>'>
                                                    <button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
                                                </form>
                                            </div>
                                        </section>
                                    </div>
                                </div>
                            </div>
                        </div> -->
                        
                        <div class="panel-body col-md-12">
                            <div class="col-lg-3"></div>
                            <div class="col-lg-6">
                                <?php echo validation_errors(); ?>
                                <?php echo $this->session->flashdata('feedback'); ?>
                            </div>
                            <div class="col-lg-3"></div>
                            <div class="col-md-12">
                                <div class="wizard wizard-circle">
                                    <div class="steps">
                                        <ul class="nav nav-tabs" id="myTab" role="tablist" style="border: none;">
                                            <li class="nav-item first current">
                                                <a class="nav-link " id="home-tab" data-toggle="tab" href="#home" role="tab" aria-selected="true" style="padding-top: 52px !important; border: none; cursor: pointer;"><span class="step">1</span>General Information</a>
                                            </li>
                                            <li class="nav-item first current" >
                                                <a class="nav-link" id="profile-tab" data-toggle="tab" href="#designate" role="tab" aria-selected="false" style="padding-top: 52px !important; border: none; cursor: pointer;"><span class="step">2</span>Designate</a>
                                            </li>
                                            <li class="nav-item first current">
                                                <a class="nav-link" id="contact-tab" data-toggle="tab" href="#service_need" role="tab" aria-selected="false" style="padding-top: 52px !important; border: none; cursor: pointer;"><span class="step">3</span>Service Needed</a>
                                            </li>
                                            
                                        </ul>
                                    </div>
                                </div>
                                
                                
                                <!-- basic_info tab -->
                                <div class="tab-content" id="myTabContent">
                                    <div class="tab-pane fade active in show" name="newGenInfo" id="home" role="tabpanel" aria-labelledby="home-tab">
                                        
                                        <form role="form" action="patient/EditNewPatientChanges?pid=<?=$_GET['pid']?>" method="post" enctype="multipart/form-data">
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-md-6">
                                                      <div class="form-group">
                                                        <label for="firstName3">
                                                         <?php echo lang('Reffered Information'); ?>
                                                          <span class="danger">*</span>
                                                        </label>
                                                        <select class="form-control required" id="ref_info" name="pt_refrance_type">
                                                            <option value="New Patient">New Patient</option>
                                                            <option value="Reffered by Patient">Reffered by Patient</option>
                                                            <option value="Reffered by Vendor">Reffered by Vendor</option>
                                                        </select>
                                                      </div>
                                                    </div>

                                                    <div class="col-md-6" id="ref_by_ptn" style="display: none;">
                                                      <div class="form-group">
                                                        <label for="lastName3">
                                                         <?php echo lang('Patient Id'); ?>
                                                          <span class="danger">*</span>
                                                        </label>
                                                        <input type="text" class="form-control required" id="ref_pt_id" name="pt_refrance_value" value="<?php echo $pdata->reference_id; ?>">
                                                      </div>
                                                    </div>

                                                    <div class="col-md-6" id="ref_by_vendor" style="display: none;">
                                                      <div class="form-group">
                                                        <label for="lastName3">
                                                         <?php echo lang('Vendor'); ?>
                                                          <span class="danger">*</span>
                                                        </label>
                                                        <select class="form-control required" id="ref_vnd_id" name="vend_refrance_value">
                                                            <option value="" selected>Choose...</option>    
                                                            <?php foreach ($vendorList as $value) { ?>
                                                            <option <?php echo ($pdata->reference_id == $value->id)?'selected':'' ; ?> value="<?php echo $value->id; ?>"><?php echo $value->vedor_name; ?></option>
                                                            <?php } ?>
                                                        </select>
                                                      </div>
                                                    </div>
                                                    <script type="text/javascript">
                                                      $(function(){

                                                        $("#ref_info").change(function(){
                                                          var selVal = $(this).val();
                                                          if(selVal == 'Reffered by Patient')
                                                          {
                                                            $("#ref_by_ptn").show();
                                                            $("#ref_by_vendor").hide();

                                                          }
                                                          else if(selVal == 'Reffered by Vendor'){
                                                            $("#ref_by_ptn").hide();
                                                            $("#ref_by_vendor").show();
                                                          }
                                                          else{
                                                            $("#ref_by_ptn").hide();
                                                            $("#ref_by_vendor").hide();
                                                          }

                                                        })

                                                        var refInfo = "<?php echo $pdata->reference_information; ?>";
                                                        // $("#id_100 select").val("val2");
                                                        $('#ref_info').val(refInfo).trigger('change');


                                                      });


                                                      
                                                    </script>


                                                  </div>

                                                <div class="row">
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('First name'); ?><span class="danger">*</span></label>
                                                        <input type="text" class="form-control" name="fname"
                                                        value="<?php echo $pdata->first_name; ?>">
                                                        <!-- value='<?php
                                                        if (!empty($setval)) {
                                                        echo set_value('name');
                                                        }
                                                        if (!empty($nurse->name)) {
                                                        echo $nurse->name;
                                                        }
                                                        ?>'> -->
                                                    </div>
                                                    
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Last name'); ?><span class="danger">*</span></label>
                                                        <input type="text" class="form-control" name="lname"
                                                        value=<?php echo $pdata->last_name; ?>>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="form-group">
                                                <label for="exampleInputEmail1"><?php echo lang('email'); ?><span class="danger">*</span></label>
                                                <input type="text" class="form-control" name="email" id="exampleInputEmail1" value=<?php echo $pdata->patient_email; ?> placeholder="">
                                            </div>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Gender'); ?><span class="danger">*</span></label>
                                                        
                                                        <select class="form-control" name="gender" id="inputGroupSelect01" name="pnalguage">
                                                            <option selected>Choose...</option>
                                                            <option <?php echo ($pdata->gender == 'Male')?'selected':'' ; ?> value="Male">Male</option>
                                                            <option <?php echo ($pdata->gender == 'Female')?'selected':'' ; ?> value="Female">Female</option>
                                                            <option <?php echo ($pdata->gender == 'Others')?'selected':'' ; ?> value="Others">Others</option>
                                                        </select>
                                                    </div>
                                                    
                                                    
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Primary language'); ?><span class="danger">*</span></label>
                                                        <select class="form-control" id="inputGroupSelect01" name="pnalguage">
                                                            <option selected>Choose...</option>
                                                            <option  <?php echo ($pdata->primary_language == 'English')?'selected':'' ; ?> value="English">English</option>
                                                            <option  <?php echo ($pdata->primary_language == 'Hindi')?'selected':'' ; ?> value="Hindi">Hindi</option>
                                                        </select>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-4">
                                                        <label for="exampleInputEmail1"><?php echo lang('Date of Birth'); ?><span class="danger">*</span></label>
                                                        <input type="date" class="form-control" name="dob" value=<?php echo $pdata->dob; ?>>
                                                    </div>
                                                    <div class="col-lg-4">
                                                        <label for="exampleInputEmail1"><?php echo lang('Soc Sec #'); ?><span class="danger">*</span></label>
                                                        <input type="text" class="form-control" name="socsec" value=<?php echo $pdata->soc_sec_no; ?>>
                                                    </div>
                                                    <div class="col-lg-4">
                                                        <label for="exampleInputEmail1"><?php echo lang('Merital Status'); ?></label>
                                                        <select class="form-control" name="merital_stat" id="inputGroupSelect01" name="pnalguage">
                                                            <option selected>Choose...</option>
                                                            <option <?php echo ($pdata->marital_stat == 'Married')?'selected':'' ; ?> value="Married">Married</option>
                                                            <option <?php echo ($pdata->marital_stat == 'Unmarried')?'selected':'' ; ?> value="Unmarried">Unmarried</option>
                                                        </select>
                                                    </div>
                                                </div>
                                            </div>
                                            <?php 
                                                $HtFI = explode(',', $pdata->height);
                                                $Htf = $HtFI[0];
                                                $Hti = $HtFI[1];
                                            ?>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-4">
                                                        <label for="exampleInputEmail1"><?php echo lang('Height'); ?></label>
                                                        <select class="form-control" name="height" data-error="Please enter a valid height.">
                                                            <option value="" selected disabled>Select</option>
                                                            <?php for($i=1;$i<10;$i++){ ?>
                                                                <option  value="<?php echo $i; ?>" <?php if($Htf==$i) echo 'selected'; ?>><?php echo $i; ?></option>
                                                            <?php } ?>    
                                                        </select>
                                                    </div>

                                                    <div class="col-md-4">
                                                      <div class="form-group">
                                                        <label for="firstName3">
                                                         <?php echo lang('Inch'); ?>
                                                        </label>
                                                        <select class="form-control" name="heightInch" required data-error="Please enter a valid height.">
                                                                        <option value="" selected disabled>Select</option>
                                                                        <?php for($i=0;$i<12;$i++){ ?>
                                                                            <option value="<?php echo $i; ?>" <?php if($Hti==$i) echo 'selected'; ?>><?php echo $i; ?></option>
                                                                        <?php } ?>    
                                                        </select>
                                                      </div>
                                                    </div>
                                                    
                                                    
                                                    <div class="col-lg-4">
                                                        <label for="exampleInputEmail1"><?php echo lang('Weight'); ?></label>
                                                        <input type="text" class="form-control" name="weight" id="exampleInputEmail1" value=<?php echo $pdata->weight; ?>>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-4">
                                                        <label for="exampleInputEmail1"><?php echo lang('Telephone'); ?></label>
                                                        <input type="text" class="form-control" name="telephone" value='<?php echo $pdata->telephone; ?>'>
                                                    </div>
                                                    <div class="col-lg-4">
                                                        <label for="exampleInputEmail1"><?php echo lang('Cell phone'); ?><span class="danger">*</span></label>
                                                        <input type="text" class="form-control" name="cellphone"
                                                        value="<?php echo $pdata->cellphone; ?>" >
                                                    </div>
                                                    <div class="col-lg-4">
                                                        <label for="exampleInputEmail1"><?php echo lang('Other number'); ?></label>
                                                        <input type="text" class="form-control" name="otr_number" value="<?php echo $pdata->other_no; ?>" >
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Address'); ?><span class="danger">*</span></label>
                                                        <textarea class="form-control" name="address" id="exampleInputEmail1"> <?php echo $pdata->address; ?></textarea>
                                                    </div>
                                                    
                                                    
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Alternating Billing Address'); ?></label>
                                                        <textarea class="form-control" name="alt_address" id="exampleInputEmail1" >
                                                        <?php echo $pdata->alt_billing_address; ?> </textarea>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-12">
                                                        <label for="exampleInputEmail1"><?php echo lang('Direction'); ?></label>
                                                        <textarea class="form-control" name="direction" id="exampleInputEmail1" >
                                                        <?php echo $pdata->direction; ?>
                                                        </textarea>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="col-md-12 form-group" >
                                                <button type="submit" name="submit" value="gen_info" class="btn btn-info"><?php echo lang('submit'); ?></button>
                                            </div>
                                            
                                        </form>
                                    </div>
                                    <!-- designate tab -->
                                    <div class="tab-pane fade" id="designate" role="tabpanel" aria-labelledby="profile-tab">
                                        <form role="form" action="patient/EditNewPatientChanges?pid=<?=$_GET['pid']?>" method="post" enctype="multipart/form-data">
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-12">
                                                        <label for="exampleInputEmail1"><?php echo lang('Level of care needed'); ?></label>
                                                        <select class="form-control" name="level_care" id="inputGroupSelect01">
                                                            <option >Choose...</option>
                                                            <option <?php echo ($pdata->level_of_care == '1')?'selected':'' ; ?> value="1">1</option>
                                                            <option <?php echo ($pdata->level_of_care == '2')?'selected':'' ; ?> value="2">2</option>
                                                            <option <?php echo ($pdata->level_of_care == '3')?'selected':'' ; ?> value="3">3</option>
                                                            <option <?php echo ($pdata->level_of_care == '4')?'selected':'' ; ?> value="4">4</option>
                                                            <option <?php echo ($pdata->level_of_care == '5')?'selected':'' ; ?> value="5">5</option>
                                                        </select>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Designate First name'); ?></label>
                                                        <input type="text" class="form-control" name="dg_fname" value='<?php echo $pdata->designate_first_name; ?>'>
                                                    </div>
                                                    
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Designate Last name'); ?></label>
                                                        <input type="text" class="form-control" name="dg_lname" value='<?php echo $pdata->designate_last_name; ?>' placeholder="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Designate Telephone'); ?></label>
                                                        <input type="text" class="form-control" name="dg_telephone" value='<?php echo $pdata->designate_telephone; ?>'>
                                                    </div>
                                                    
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Designate Cell'); ?></label>
                                                        <input type="text" class="form-control" name="dg_cell" value='<?php echo $pdata->designate_cell; ?>' placeholder="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('EVV Verification'); ?></label>
                                                        <input type="text" class="form-control" name="evv_verification" value='<?php echo $pdata->evv_verification; ?>'>
                                                    </div>
                                                    
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Coardinator'); ?></label>
                                                        <input type="text" class="form-control" name="coardinator" value='<?php echo $pdata->coordinator; ?>' placeholder="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Intake Nurse'); ?></label>
                                                        <input type="text" class="form-control" name="intake_nurse" value='<?php echo $pdata->intake_nurse; ?>'>
                                                    </div>
                                                    
                                                    <div class="col-lg-6">
                                                        <label for="exampleInputEmail1"><?php echo lang('Primary Nurse'); ?></label>
                                                        <input type="text" class="form-control" name="primary_nurse" value='<?php echo $pdata->primary_nurse; ?>' placeholder="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="form-group">
                                                <div class="row">
                                                    <div class="col-lg-12">
                                                        <label for="exampleInputEmail1"><?php echo lang('Referral Source'); ?></label>
                                                        <select class="form-control" name="referal_source" id="inputGroupSelect01">
                                                            <option selected>Choose...</option>
                                                            <?php
                                                            foreach ($preferal as $value)
                                                            {
                                                            ?>
                                                            <option <?php echo ($pdata->referral_source == $value->id)?'selected':'' ; ?> value="<?php echo $value->id; ?>"><?php echo $value->name; ?></option>
                                                            <?php } ?>
                                                            <!-- <option selected>Choose...</option> -->
                                                            <!-- <option value="1">English</option> -->
                                                            <!-- <option value="2">Hindi</option> -->
                                                        </select>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="col-md-12 form-group" >
                                                <button type="submit" name="submit" name="designate" value="designate" class="btn btn-info"><?php echo lang('submit'); ?></button>
                                            </div>
                                        </form>
                                    </div>

                                    <div class="tab-pane fade" id="service_need" role="tabpanel" aria-labelledby="contact-tab">
                                        <form role="form" action="patient/EditNewPatientChanges?pid=<?php echo $_GET['pid']; ?>" method="post" enctype="multipart/form-data">
                                            
                                            <div class="row">
                               <div class="col-md-12">
                              <div class="form-group">
                                <label for="firstName3">
                                <?php echo lang('Level of Service needed'); ?>
                                </label>
                                   <select class="form-control" name="level_service" id="level_service">
                                              <option value="" selected>Choose...</option>
                                              <?php foreach ($lvlService as $value) { ?>
                                              <option <?php echo ($pdata->level_service == $value->id)?'selected':'' ; ?> value="<?php echo $value->id; ?>" attr_name="<?php echo $value->name; ?>"><?php echo $value->name; ?></option>
                                              <?php } ?>
                                          </select>
                               </div>
                                   </div>
                              </div>
                              <div id="rnlnp" style="display: <?php echo($pdata->level_service== $rnId || $pdata->level_service== $lnpId)?'block' :'none' ; ?>">
                              <div class="row">
                                  <div class="col-md-6">
                                      <div class="form-group">
                                      <label for="exampleInputEmail1"><?php echo lang('New order'); ?></label>
                                          <div class="form-check">
                                              <input class="form-check-input" type="radio" name="new_order" id="radio" value="option1" checked>
                                              <label class="form-check-label" for="YES">
                                              YES
                                              </label>
                                          </div>
                                          <div class="form-check">
                                              <input class="form-check-input" type="radio" name="new_order" id="radio" value="option2">
                                              <label class="form-check-label" for="NO">
                                              NO
                                              </label>
                                          </div>
                                      </div>
                                  </div>
                                  <?php $dbData = explode(',', $pdata->service_activity); 
                                  // var_dump($dbData);
                                  ?>
                                  <div class="col-md-6">
                                      <div class="form-group">
                                      <label for="exampleInputEmail1"><?php echo lang('Service Activity needed'); ?></label>
                                          <select class="form-control" name="service_activity[]" id="inputGroupSelect01" multiple>
                                          <option value="">Choose...</option>
                                              <?php 
                                                  foreach ($serviceActivity as $value) 
                                                      { 
                                              ?>
                                              <option <?php echo (in_array($value->id, $dbData))? 'selected' : '' ; ?> value="<?php echo $value->id; ?>"><?php echo $value->name; ?></option>

                                              <?php } ?>
                                       </select>
                                  </div>
                              </div>
                              </div>
                              
                              <?php $dbData = explode(',', $pdata->therapy_type); ?>
                               <div class="row">
                                      <div class="col-lg-6"> 
                                       <div class="form-group"> 
                                          <label for="exampleInputEmail1"><?php echo lang('Therapy type'); ?></label>
                                          <select class="form-control" name="therapy_type[]" id="inputGroupSelect01" multiple>
                                              <option value="">Choose...</option>
                                              <?php foreach ($therapyType as $value) { ?>
                                              <option <?php echo (in_array($value->id, $dbData))? 'selected' : '' ; ?> value="<?php echo $value->id; ?>"><?php echo $value->name; ?></option>
                                              <?php } ?>
                                          </select>
                                      </div>
                                      </div>

                                      <?php $dbData = explode(',', $pdata->type_access); 
                                      // var_dump($dbData);
                                      ?>
                                      <div class="col-lg-6"> 
                                           <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Type Of access'); ?></label>
                                          <select class="form-control" name="type_access[]" id="inputGroupSelect01" multiple>
                                              <option value="">Choose...</option>
                                              <?php foreach ($accessType as $value) { ?>
                                              <option  <?php echo (in_array($value->id, $dbData))? 'selected' : '' ; ?> value="<?php echo $value->id; ?>"><?php echo $value->name; ?></option>
                                              <?php } ?>
                                          </select>
                                      </div>
                                  </div>
                                  </div>



                                   
                                  <div class="row">
                                      <div class="col-lg-6"> 
                                      <div class="form-group">   
                                          <label for="exampleInputEmail1"><?php echo lang('Patient seen by MD'); ?></label>
                                          <input type="date" value="$pdata->patient_seen_by_MD" class="form-control" name="patient_seen_by_MD" value=''>
                                      </div>
                                  </div>

              
                                      <div class="col-lg-6"> 
                                          <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Current Lab Work'); ?></label>
                                          <div class="form-check">
                                              <input class="form-check-input" type="radio" name="current_lab_work" id="radio" value="option1" checked>
                                              <label class="form-check-label" for="YES">
                                              YES
                                              </label>
                                          </div>
                                          <div class="form-check">
                                              <input class="form-check-input" type="radio" name="current_lab_work" id="radio" value="option2">
                                              <label class="form-check-label" for="NO">
                                              NO
                                              </label>
                                          </div>
                                      </div>
                                  </div>
                                  </div>


                                  <div class="row">
                                      <div class="col-lg-6">    
                                          <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Lab Order'); ?></label>
                                          <input type="text" class="form-control" name="lab_order" value="<?php echo $pdata->lab_order; ?>">
                                      </div>
                                      </div>

              
                                      <div class="col-lg-6"> 
                                          <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Additional Lab Orders'); ?></label>
                                          <input type="text" class="form-control" name="additional_lab_order" value="<?php echo $pdata->additional_lab_order; ?>" placeholder="">
                                      </div>
                                  </div>
                              </div>


                             
                                  <div class="row">
                                      <div class="col-lg-6"> 
                                           <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Lab Frequency'); ?></label>
                                          <select class="form-control" name="lab_frequency" id="inputGroupSelect01">       
                                              <option <?php echo ($pdata->lab_frequency == 'Weekly')?'selected':'' ; ?> value="Weekly">Weekly</option>
                                              <option <?php echo ($pdata->lab_frequency == 'Every 2 weeks')?'selected':'' ; ?> value="Every 2 weeks">Every 2 weeks</option>
                                              <option <?php echo ($pdata->lab_frequency == 'Every other week')?'selected':'' ; ?> value="Every other week">Every other week</option>
                                              <option <?php echo ($pdata->lab_frequency == 'Every 6 months')?'selected':'' ; ?> value="Every 6 months">Every 6 months</option>
                                          </select>
                                      </div>
                                      </div>

                                      <div class="col-lg-6"> 
                                           <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Other Lab Frequency'); ?></label>
                                          <input type="text" class="form-control" name="other_lab_frequency" value="<?php echo $pdata->other_lab_frequency; ?>">
                                      </div>
                                  </div>
                                  </div>


                                  <div class="row">
                                      <div class="col-lg-6"> 
                                          <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Tube'); ?></label>
                                          <select class="form-control" name="tube_type" id="inputGroupSelect01">
                                          <option value="" selected>Choose...</option>
                                              <?php foreach ($tubes as $value) { ?>
                                                  <option value="<?php echo $value->name; ?>"><?php echo $value->name; ?></option>
                                              <?php } ?>
                                          </select>
                                      </div>
                                      </div>

                                      <div class="col-lg-6"> 
                                          <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Formula'); ?></label>
                                            <input type="text" class="form-control" name="formula" 
                                          value="<?php echo set_value('fname'); ?>">
                                      </div>
                                  </div>
                              </div>


                              
                                  <div class="row">
                                      <div class="col-lg-6">
                                       <div class="form-group"> 
                                          <label for="exampleInputEmail1"><?php echo lang('Schedule'); ?></label>
                                          <input type="text" class="form-control" name="schedule" value="">
                                      </div>
                                      </div>

                                      <div class="col-lg-6"> 
                                           <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Flush With'); ?></label>
                                              <select class="form-control" name="flush_with" id="inputGroupSelect01">
                                                  <option value="" selected>Choose...</option>
                                                  <?php for($i = 10; $i<=240; $i++) { ?>
                                                  <option <?php echo ($pdata->flush_with == $i." ML")?'selected':'' ; ?> value="<?=$i?>"><?php echo $i; ?> ML</option>
                                                  <?php } ?>
                                              </select>
                                      </div>
                                  </div>
                              </div>


                              
                                  <div class="row">
                                      <div class="col-lg-6"> 
                                          <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Daily Intake Requirment'); ?></label>
                                          <input type="text" class="form-control" name="daily_intake_requirment" value="">
                                      </div>
                                      </div>

                                      <div class="col-lg-6"> 
                                           <div class="form-group">
                                          <label for="exampleInputEmail1"><?php echo lang('Flush Frequency'); ?></label>
                                                  <div class="form-check form-check">
                                                    <input class="form-check-input" name="flush_frequency" type="radio" id="inlineCheckbox1" value="Before Feed">
                                                    <label class="form-check-label" for="inlineCheckbox1">Before Feed</label>
                                                  </div>
                                                  <div class="form-check form-check">
                                                    <input class="form-check-input" name="flush_frequency" type="radio" id="inlineCheckbox2" value="After Feed">
                                                    <label class="form-check-label" for="inlineCheckbox2">After Feed</label>
                                                  </div>
                                                  <div class="form-check form-check">
                                                    <input class="form-check-input" name="flush_frequency" type="radio" id="inlineCheckbox2" value="Before Medication">
                                                    <label class="form-check-label" for="inlineCheckbox2">Before Medication</label>
                                                  </div>
                                                  <div class="form-check form-check">
                                                    <input class="form-check-input" name="flush_frequency" type="radio" id="inlineCheckbox2" value="After Madication">
                                                    <label class="form-check-label" for="inlineCheckbox2">After Madication</label>
                                                  </div>
                                              </div>
                                      </div>
                                      </div>


                                     
                                          <div class="row">
                                              <div class="col-lg-4"> 
                                                   <div class="form-group">
                                              <label for="exampleInputEmail1"><?php echo lang('Fluide Restrictions'); ?></label>
                                                <div class="form-check form-check-inline">
                                                    <input class="form-check-input" type="radio" name="fluid_restriction" id="fluid_restriction_yes" value="Yes">
                                                    <label class="form-check-label" for="fluid_restriction_yes">Yes</label>
                                                </div>
                                                <div class="form-check form-check-inline">
                                                    <input class="form-check-input" type="radio" name="fluid_restriction" id="fluid_restriction_no" value="No" checked>
                                                    <label class="form-check-label" for="fluid_restriction_no">No</label>
                                                </div>
                                            </div>
                                              </div>

                                              <div class="col-lg-4"> 
                                                   <div class="form-group">
                                                  <label for="exampleInputEmail1"><?php echo lang('Fluide Restriction Amount'); ?></label>
                                                    <input type="text" class="form-control" name="fluide_restric_amount" 
                                                  value="<?php echo set_value('fname'); ?>"> 
                                                  </div>                       
                                              </div>

                                              <div class="col-lg-4"> 
                                                   <div class="form-group">
                                                  <label for="exampleInputEmail1"><?php echo lang('Fluide Restriction Frequency'); ?></label>
                                                    <div class="form-check form-check">
                                                      <input class="form-check-input" name="fluide_restric_frequency" type="radio" id="inlineCheckbox3" value="Per day">
                                                      <label class="form-check-label" for="inlineCheckbox2">Per day</label>
                                                    </div>
                                                    <div class="form-check form-check">
                                                      <input class="form-check-input" name="fluide_restric_frequency" type="radio" id="inlineCheckbox4" value="Per Hour">
                                                      <label class="form-check-label" for="inlineCheckbox2">Per Hour</label>
                                                    </div>
                                              </div>
                                          </div>
                                       </div>

                              </div>        

                                <div class="col-md-12 form-group"> 
                                  <button type="submit" name="submit"  value="services" class="btn btn-info"><?php echo lang('submit'); ?></button>
                                </div>
                             </form>
                                                </form>
                                            </div>
                                    </div>
                                        
                                    </div>
                                </div>
                            </section>
                            <!-- page end-->
                        </section>
                    </section>
                </div>
            </div>
        </div>
    </div>


<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>

<script type="text/javascript">

function secDigActive(_this){
    var val = $(_this).val();
    if (val=='Secondary') {
        $("#secondaryDiagonosis").show();
    }
    else{
        $("#secondaryDiagonosis").hide();   
    }
}


$("#advanceDirectiveIfyes").change(function(){
    var val = $(this).val();
    if(val == 'file-upload'){
        $("#advUploadFIle").show();
    }
    else{
        $("#advUploadFIle").hide();
    }
});
</script>
<!-- 
<?php if(isset($_GET['pid']) && !isset($_GET['phase2']) && !isset($_GET['phase3'])): ?>
<script type="text/javascript">
    
    $(function(){
        $('#myTab li:nth-child(2) a').tab('show');
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</script>
<?php endif; ?>

<?php if( isset($_GET['pid']) && isset($_GET['phase2']) ): ?>
<script type="text/javascript">
    $(function(){
        $('#myTab li:nth-child(3) a').tab('show');
    })
    
</script>
<?php endif; ?>

<?php if( isset($_GET['pid']) && isset($_GET['phase3'])  && !isset($_GET['phase2'])): ?>
<script type="text/javascript">
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        $('#myTab li:nth-child(4) a').tab('show');
         
    })
    
</script>
<?php endif; ?> -->


<script type="text/javascript"> /* future date dob not accept */
   
      $(document).ready(function () {
        // alert("dateSec");
       var todaysDate = new Date(); // Gets today's date
        
        // Max date attribute is in "YYYY-MM-DD".  Need to format today's date accordingly
        
        var year = todaysDate.getFullYear();                        // YYYY
        var month = ("0" + (todaysDate.getMonth() + 1)).slice(-2);  // MM
        var day = ("0" + todaysDate.getDate()).slice(-2);           // DD

        var maxDate = (year +"-"+ month +"-"+ day); // Results in "YYYY-MM-DD" for today's date 
        
        // Now to set the max date value for the calendar to be today's date
        $('#ptdob').attr('max',maxDate);
      
      });
  
</script>



<!-- general from validation -->

<script>
    $( document ).ready(function() {
        $('.nav-item').click(function(event){
            if ($(this).hasClass('disabled')) {
                return false;
            }
        });
    });
</script>

<script type="text/javascript">
        function validateForm1(){

              var x = document.forms["newGenInfo"]["fname"].value;
              if (x == "") {
                document.forms["newGenInfo"]["fname"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please enter first name',
                          showConfirmButton: true,
                        });
                return false;
              }

              var x = document.forms["newGenInfo"]["lname"].value;
              if (x == "") {
                document.forms["newGenInfo"]["lname"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please enter last name',
                          showConfirmButton: true,
                        });
                return false;
              }

              var x = document.forms["newGenInfo"]["email"].value;
              if (x == "") {
                document.forms["newGenInfo"]["email"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please enter email name',
                          showConfirmButton: true,
                        });
                return false;
              }

              var x = document.forms["newGenInfo"]["gender"].value;
              if (x == "") {
                document.forms["newGenInfo"]["gender"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please select a gender',
                          showConfirmButton: true,
                        });
                return false;
              }

              var x = document.forms["newGenInfo"]["pnalguage"].value;
              if (x == "") {
              document.forms["newGenInfo"]["pnalguage"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please select a language',
                          showConfirmButton: true,
                        });
                return false;
              }

              var x = document.forms["newGenInfo"]["dob"].value;
              if (x == "") {
              document.forms["newGenInfo"]["dob"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please enter you Date of Birth',
                          showConfirmButton: true,
                        });
                return false;
              }

              var x = document.forms["newGenInfo"]["socsec"].value;
              if (x == "") {
              document.forms["newGenInfo"]["socsec"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please enter SOC SEC#',
                          showConfirmButton: true,
                        });
                return false;
              }

              // var x = document.forms["newGenInfo"]["weight"].value;
              // if (x == "") {
              //   document.forms["newGenInfo"]["weight"].focus();
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please enter weight',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }

              // var x = document.forms["newGenInfo"]["height"].value;
              // if (x == "") {
              //   document.forms["newGenInfo"]["height"].focus();
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please enter height',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }
              var x = document.forms["newGenInfo"]["cellphone"].value;
              if (x == "") {
                document.forms["newGenInfo"]["cellphone"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please enter cellphone number',
                          showConfirmButton: true,
                        });
                return false;
              }

              var x = document.forms["newGenInfo"]["address"].value;
              if (x == "") {
                document.forms["newGenInfo"]["address"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please enter address',
                          showConfirmButton: true,
                        });
                return false;
              }

              // var x = document.forms["newGenInfo"]["alt_address"].value;
              // if (x == "" || x == " ") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please enter alternate address',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }
              
              // var x = document.forms["newGenInfo"]["direction"].value;
              // if (x == "" || x == " ") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please enter direction',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }
        }

        function validateForm2(){

              var x = document.forms["newDesgFrom"]["level_care"].value;
              if (x == "") {
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please select level of care',
                          showConfirmButton: true,
                        });
                return false;
              }

              // var x = document.forms["newDesgFrom"]["dg_fname"].value;
              // if (x == "") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please select designate first name',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }

              // var x = document.forms["newDesgFrom"]["dg_lname"].value;
              // if (x == "") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please select designate first name',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }


              // var x = document.forms["newDesgFrom"]["dg_cell"].value;
              // if (x == "") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please select designate Cell phone number',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }

              // var x = document.forms["newDesgFrom"]["evv_verification"].value;
              // if (x == "") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please EVV verification',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }

              // var x = document.forms["newDesgFrom"]["coardinator"].value;
              // if (x == "") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please enter coardinator',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }

              // var x = document.forms["newDesgFrom"]["intake_nurse"].value;
              // if (x == "") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please enter intake nurse',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }

              // var x = document.forms["newDesgFrom"]["primary_nurse"].value;
              // if (x == "") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please enter primary nurse',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }

              // var x = document.forms["newDesgFrom"]["referal_source"].value;
              // if (x == "") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please enter referal source',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }

}

        function validateForm3(){

              var x = document.forms["servicesForm"]["level_service"].value;
              if (x == "") {
                document.forms["servicesForm"]["level_service"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please select level of service',
                          showConfirmButton: true,
                        });
                return false;
              }

              var x = document.forms["servicesForm"]["new_order"].value;
              if (x == "") {
                document.forms["servicesForm"]["new_order"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please select new order',
                          showConfirmButton: true,
                        });
                return false;
              }

              var x = document.forms["servicesForm"]["service_activity"].value;
              if (x == "") {
                document.forms["servicesForm"]["service_activity"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please select service activity',
                          showConfirmButton: true,
                        });
                return false;
              }



        }

        /*rn and lnp*/

        $("#level_service").change(function(){
            var valu = $("#level_service option:selected"). attr("attr_name")
            // var valu = $(this).("option:selected").attr("attr_name");
            // alert(valu);
            // var valu = $(this).val();
            if(valu != 'RN' && valu != 'LNP')
                $("#rnlnp").hide();
            else
                $("#rnlnp").show();

        });

        /*rn and lnp*/
        $('#insurance_type').change(function(){

            var insType = $(this).val();
            if(insType == 'Madicaid')
              {
                    document.getElementById("medicaidInfoSection").style.display = "block";
                    document.getElementById("pvtInsInfoSection").style.display = "none";
              }
              if(insType == 'Private') 
              {
                    document.getElementById("medicaidInfoSection").style.display = "none";
                    document.getElementById("pvtInsInfoSection").style.display = "block";
              }
        })
              

        function validateForm4(){

              var insType = document.forms["newInsuranceFrom"]["insurance_type"].value;
              if (insType == "") {
                document.forms["newInsuranceFrom"]["insurance_type"].focus();
                Swal.fire({
                          position: 'center',
                          icon: 'error',
                          title: 'Please select Insurance Type',
                          showConfirmButton: true,
                        });
                return false;
              }

              // var x = document.forms["newInsuranceFrom"]["insurance_plan"].value;
              // if (x == "") {
              //   Swal.fire({
              //             position: 'center',
              //             icon: 'error',
              //             title: 'Please select Insurance Plan',
              //             showConfirmButton: true,
              //           });
              //   return false;
              // }

              /*private and medica*/
              if (insType == 'Madicaid') {

                    var x = document.forms["newInsuranceFrom"]["MedicaidId"].value;
                    if (x == "") 
                    {
                      document.forms["newInsuranceFrom"]["MedicaidId"].focus();
                        Swal.fire({
                                  position: 'center',
                                  icon: 'error',
                                  title: 'Please Enter Medicaid Id',
                                  showConfirmButton: true,
                                });
                        return false;
                    }

                    var x = document.forms["newInsuranceFrom"]["medicaidAdult"].value;
                    if (x == "") 
                    {
                      document.forms["newInsuranceFrom"]["medicaidAdult"].focus();
                        Swal.fire({
                                  position: 'center',
                                  icon: 'error',
                                  title: 'Please Enter Medicaid Adult',
                                  showConfirmButton: true,
                                });
                        return false;
                    }

                    var x = document.forms["newInsuranceFrom"]["MedicaidPediriatic"].value;
                    if (x == "") 
                    {
                      document.forms["newInsuranceFrom"]["MedicaidPediriatic"].focus();
                        Swal.fire({
                                  position: 'center',
                                  icon: 'error',
                                  title: 'Please Enter Medicaid Pediriatic',
                                  showConfirmButton: true,
                                });
                        return false;
                    }

                    var x = document.forms["newInsuranceFrom"]["primarySeconday"].value;
                    if (x == "") 
                    {
                      document.forms["newInsuranceFrom"]["primarySeconday"].focus();
                        Swal.fire({
                                  position: 'center',
                                  icon: 'error',
                                  title: 'Please Choose Primary Or secondary',
                                  showConfirmButton: true,
                                });
                        return false;
                    }  


              }
              if (insType == 'Private') {

                var x = document.forms["newInsuranceFrom"]["privatePolicyNumber"].value;
                    if (x == "") 
                    {
                      document.forms["newInsuranceFrom"]["privatePolicyNumber"].focus();
                        Swal.fire({
                                  position: 'center',
                                  icon: 'error',
                                  title: 'Please Enter Private Policy Number',
                                  showConfirmButton: true,
                                });
                        return false;
                    }

                var x = document.forms["newInsuranceFrom"]["Private_claim_number"].value;
                    if (x == "") 
                    {
                      document.forms["newInsuranceFrom"]["Private_claim_number"].focus();
                        Swal.fire({
                                  position: 'center',
                                  icon: 'error',
                                  title: 'Please Enter Private Claim No',
                                  showConfirmButton: true,
                                });
                        return false;
                    }

              }


                // var x = document.forms["newInsuranceFrom"]["emgName"].value;
                //     if (x == "") 
                //     {
                //         Swal.fire({
                //                   position: 'center',
                //                   icon: 'error',
                //                   title: 'Please Enter Emergency Name',
                //                   showConfirmButton: true,
                //                 });
                //         return false;
                //     }
                // var x = document.forms["newInsuranceFrom"]["emgRelationtoPt"].value;
                //     if (x == "") 
                //     {
                //         Swal.fire({
                //                   position: 'center',
                //                   icon: 'error',
                //                   title: 'Please Enter Relationship with Patient',
                //                   showConfirmButton: true,
                //                 });
                //         return false;
                //     }

                // var x = document.forms["newInsuranceFrom"]["emgCellNumber"].value;
                //     if (x == "") 
                //     {
                //         Swal.fire({
                //                   position: 'center',
                //                   icon: 'error',
                //                   title: 'Please Enter Emergency cell No',
                //                   showConfirmButton: true,
                //                 });
                //         return false;
                //     }

                // var x = document.forms["newInsuranceFrom"]["emgEmail"].value;
                //     if (x == "") 
                //     {
                //         Swal.fire({
                //                   position: 'center',
                //                   icon: 'error',
                //                   title: 'Please Enter Emergency Email',
                //                   showConfirmButton: true,
                //                 });
                //         return false;
                //     }
                //     

                var x = document.forms["newInsuranceFrom"]["advanceDirective"].value;
                    if (x == "") 
                    {
                      document.forms["newInsuranceFrom"]["advanceDirective"].focus();
                        Swal.fire({
                                  position: 'center',
                                  icon: 'error',
                                  title: 'Please Enter advance directive',
                                  showConfirmButton: true,
                                });
                        return false;
                    }

                // var x = document.forms["newInsuranceFrom"]["emgEvacZone"].value;
                //     if (x == "") 
                //     {
                //         Swal.fire({
                //                   position: 'center',
                //                   icon: 'error',
                //                   title: 'Please Enter Evacuation zone',
                //                   showConfirmButton: true,
                //                 });
                //         return false;
                //     }

                // var x = document.forms["newInsuranceFrom"]["emgMobilityStat"].value;
                //     if (x == "") 
                //     {
                //         Swal.fire({
                //                   position: 'center',
                //                   icon: 'error',
                //                   title: 'Please Enter Mobility Status',
                //                   showConfirmButton: true,
                //                 });
                //         return false;
                //     }

                // var x = document.forms["newInsuranceFrom"]["emgEvaclocation"].value;
                //     if (x == "") 
                //     {
                //         Swal.fire({
                //                   position: 'center',
                //                   icon: 'error',
                //                   title: 'Please Enter Evacuation location',
                //                   showConfirmButton: true,
                //                 });
                //         return false;
                //     }

                // var x = document.forms["newInsuranceFrom"]["emgEleDEpendency"].value;
                //     if (x == "") 
                //     {
                //         Swal.fire({
                //                   position: 'center',
                //                   icon: 'error',
                //                   title: 'Please Enter Electrical Dependency',
                //                   showConfirmButton: true,
                //                 });
                //         return false;
                //     }

                var x = document.forms["newInsuranceFrom"]["phymdName"].value;
                    if (x == "") 
                    {
                      document.forms["newInsuranceFrom"]["advanceDirective"].focus();
                        Swal.fire({
                                  position: 'center',
                                  icon: 'error',
                                  title: 'Please Enter MD Name',
                                  showConfirmButton: true,
                                });
                        return false;
                    }

                var x = document.forms["newInsuranceFrom"]["phymdTelephone"].value;
                    if (x == "") 
                    {
                      document.forms["newInsuranceFrom"]["phymdTelephone"].focus();
                        Swal.fire({
                                  position: 'center',
                                  icon: 'error',
                                  title: 'Please Enter MD Telephone',
                                  showConfirmButton: true,
                                });
                        return false;
                    }

                var x = document.forms["newInsuranceFrom"]["diagICD"].value;
                    if (x == "") 
                    {
                      document.forms["newInsuranceFrom"]["diagICD"].focus();
                        Swal.fire({
                                  position: 'center',
                                  icon: 'error',
                                  title: 'Please Select an Icd',
                                  showConfirmButton: true,
                                });
                        return false;
                    }

              /*private and medica*/
        }
</script>

<script>
/*tool tip section*/
$(document).ready(function(){
  $('[data-toggle="tooltip"]').tooltip();
});
</script>