3318 lines
190 KiB
PHP
Executable File
3318 lines
190 KiB
PHP
Executable File
<style type="text/css">
|
||
div.patient-view-card-container{margin-top:5px;}
|
||
.patient-view-card-icons{font-size:40px;}
|
||
.patient-view-card{transition: 0.4s;padding: 10px 0;border:1px solid rgba(0,0,0,0.1);}
|
||
.patient-view-card:hover{box-shadow:5px 10px 10px rgba(0, 0, 0, 0.1);transition:0.4s;}
|
||
.fa-pencil{cursor:pointer;color:#fff;}
|
||
</style>
|
||
<style type="text/css">
|
||
span.highlight-container{width: 100px;}
|
||
i.highlight{position: relative;animation-name: example;animation-duration: 2.5s;animation-iteration-count: 3;}
|
||
@keyframes example {
|
||
0% {left:0px;}
|
||
100% {left:90px;}
|
||
}
|
||
@media(max-width: 500px){
|
||
span.highlight-container{display: none;}
|
||
}
|
||
</style>
|
||
|
||
<?php $userType = $userType[0];
|
||
// var_dump($userType->group_id);die;
|
||
// echo $phyExamForm;
|
||
// var_dump($HOME_CARE_REGISTRY_RELEASE_FORM);
|
||
?>
|
||
|
||
|
||
|
||
|
||
<?php
|
||
// echo 'CG-SKILL:'.$q_e_type->qualification_type.'<br>';
|
||
// echo 'EMP-TYPE:'.$q_e_type->employee_type.'<br>';
|
||
|
||
/*
|
||
| _________________________________________________________________________________
|
||
| ______________________________________________________
|
||
| type's ===================================
|
||
| RN/LPN(4/5) CONTRATOR : will have 6 tabs ------ type A (6 tabs)
|
||
| HHA/PCA(6/7) CONTRACTOR : will have 6 tabs ---- type B (6 tabs)
|
||
| RN/LPN(4/5) IN-HOUSE : will have 4 tabs ------- type C (4 tabs)
|
||
| HHA/PCA(6/7) IN-HOUSE : will have 7 tabs ------ type D (7 tabs)
|
||
| ______________________________________________________
|
||
|
|
||
| ________________________________________________
|
||
| pdf's =======================================
|
||
| APPLICATION OF EMPLOYMENT ---------- A/B/C/D
|
||
| Contractor Agreement --------------- A/B
|
||
| Background Check Form -------------- A/B/C/D
|
||
| i-9 Form --------------------------- A/B/C/D
|
||
| W-9 Form --------------------------- A/B
|
||
| Direct Deposit --------------------- A/B/C/D
|
||
| DOH CHRC 102 Form ------------------ D
|
||
| DOH CHRC 103 Form ------------------ D
|
||
| Home Care Registry Release Form ---- D
|
||
|---------------------------------------------------------------
|
||
|---------------------------------------------------------------
|
||
|
|
||
| RN Skills Check List --------------- A/C
|
||
| HHA Skills Check List -------------- B/D
|
||
|_________________________________________________
|
||
|
|
||
|_________________________________________________________________________________
|
||
|
|
||
*/
|
||
#Caregiver type
|
||
//A
|
||
if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5") && $q_e_type->employee_type == "contrator"){$cg_type="A";}
|
||
//B
|
||
if(($q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "contrator"){$cg_type="B";}
|
||
//C
|
||
if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5") && $q_e_type->employee_type == "inhouse"){$cg_type="C";}
|
||
//D
|
||
if(($q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "inhouse"){$cg_type="D";}
|
||
#Caregiver type
|
||
|
||
// //A,B type
|
||
// if(in_array("ApplicationEmployment",$signature_type) &&
|
||
// in_array("ContractorAgreement",$signature_type) &&
|
||
// in_array("BackgroundCheck",$signature_type) &&
|
||
// in_array("iNineForm",$signature_type) &&
|
||
// in_array("wNineForm",$signature_type) &&
|
||
// in_array("DirectDiposit",$signature_type)){$ab_type="true";}else{$ab_type="false";}
|
||
// //C type
|
||
// if(in_array("ApplicationEmployment",$signature_type) &&
|
||
// in_array("BackgroundCheck",$signature_type) &&
|
||
// in_array("iNineForm",$signature_type) &&
|
||
// in_array("DirectDiposit",$signature_type)){$c_type="true";}else{$c_type="false";}
|
||
// //D type
|
||
// if(in_array("ApplicationEmployment",$signature_type) &&
|
||
// in_array("BackgroundCheck",$signature_type) &&
|
||
// in_array("iNineForm",$signature_type) &&
|
||
// in_array("DirectDiposit",$signature_type) &&
|
||
// in_array("Doh102",$signature_type) &&
|
||
// in_array("Doh103",$signature_type) &&
|
||
// in_array("RegistryRelease",$signature_type)){$d_type="true";}else{$d_type="false";}
|
||
|
||
// if(in_array("ApplicationEmployment",$signature_type) &&
|
||
// in_array("BackgroundCheck",$signature_type)){$ab_type="true";}else{$ab_type="false";}
|
||
|
||
// if($cg_type=="A"){if($ab_type=="true"){$sigTabStatus=1;}else{$sigTabStatus=0;}}
|
||
// if($cg_type=="B"){if($ab_type=="true"){$sigTabStatus=1;}else{$sigTabStatus=0;}}
|
||
// if($cg_type=="C"){if($c_type=="true"){$sigTabStatus=1;}else{$sigTabStatus=0;}}
|
||
// if($cg_type=="D"){if($d_type=="true"){$sigTabStatus=1;}else{$sigTabStatus=0;}}
|
||
|
||
|
||
$type=$this->Caregiver_model->typeOfCaregiver($q_e_type->qualification_type,$q_e_type->employee_type);
|
||
$disclosures=$this->Caregiver_model->getDisclosureByType($type);
|
||
// pre($disclosures);die;
|
||
|
||
if($userType->group_id == "6"){
|
||
|
||
?>
|
||
<!-- tabs section -->
|
||
<ul class="nav nav-tabs nav-linetriangle no-hover-bg disclosure-pdf-tabs" id="myTab" role="tablist" style="border: none; margin-bottom: 20px;">
|
||
<?php
|
||
$active='active';
|
||
$ab_type=false;
|
||
// pre($disclosures);
|
||
foreach ($disclosures as $disclosure) {
|
||
if($disclosure['short_code']=='ApplicationEmployment'){$disclosure['id']='app-emp-tab'; }
|
||
if($disclosure['short_code']=='BackgroundCheck'){$disclosure['id']='bak-check-tab'; }
|
||
if($disclosure['short_code']=='Doh102'){$disclosure['id']='doh-102-tab'; }
|
||
if($disclosure['short_code']=='Doh103'){$disclosure['id']='doh-103-tab'; }
|
||
if($disclosure['short_code']=='RegistryRelease'){$disclosure['id']='reg-rel-tab'; }
|
||
if(!in_array($disclosure['short_code'],$signature_type))
|
||
{$ab_type=$c_type=$d_type=false; $sigTabStatus=0;}else{$ab_type=$c_type=$d_type=true;$sigTabStatus=1;}
|
||
?>
|
||
<li class="nav-item discloser_tab <?=$active?>" >
|
||
<a class="nav-link doc_tab_top <?=$active?>" id="<?=$disclosure['id']?>" data-toggle="tab" href="#<?=$disclosure['id']?>-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?=$disclosure['name']?>
|
||
</a>
|
||
</li>
|
||
<?php
|
||
$active='';
|
||
}
|
||
?>
|
||
<li class="nav-item discloser_tab" >
|
||
<a class="nav-link doc_tab_top" id="final-submt" data-toggle="tab" href="#final-submt-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
Final Submit
|
||
</a>
|
||
</li>
|
||
<?php /*
|
||
//AB
|
||
if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5" || $q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "contrator" ){
|
||
?>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top active" id="app-emp-tab" data-toggle="tab" href="#app-emp-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
1
|
||
</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="con-agree-tab" data-toggle="tab" href="#con-agree-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
2
|
||
</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="bak-check-tab" data-toggle="tab" href="#bak-check-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
3
|
||
</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="i-nine-tab" data-toggle="tab" href="#i-nine-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
4
|
||
</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="w-nine-tab" data-toggle="tab" href="#w-nine-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
5
|
||
</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="dir-depo-tab" data-toggle="tab" href="#dir-depo-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
6
|
||
</a>
|
||
</li>
|
||
<?php
|
||
}
|
||
|
||
//CD
|
||
if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5" || $q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "inhouse"){
|
||
?>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top active" id="app-emp-tab" data-toggle="tab" href="#app-emp-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
1
|
||
</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="bak-check-tab" data-toggle="tab" href="#bak-check-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
2
|
||
</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="i-nine-tab" data-toggle="tab" href="#i-nine-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
3
|
||
</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="dir-depo-tab" data-toggle="tab" href="#dir-depo-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
4
|
||
</a>
|
||
</li>
|
||
<?php
|
||
}
|
||
|
||
//D
|
||
if(($q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "inhouse"){
|
||
?>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="doh-102-tab" data-toggle="tab" href="#doh-102-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
5
|
||
</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="doh-103-tab" data-toggle="tab" href="#doh-103-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
6
|
||
</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="reg-rel-tab" data-toggle="tab" href="#reg-rel-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;">
|
||
<?php //if($progress->form2 < 5){ ?> <?php //} ?>
|
||
7
|
||
</a>
|
||
</li>
|
||
<?php
|
||
}
|
||
*/
|
||
?>
|
||
</ul>
|
||
<!-- Ending of tabs section -->
|
||
|
||
<!-- Disclosure tabs content section -->
|
||
<div class="tab-content disclosure-pdf-container" id="myTabContent">
|
||
<input type="hidden" id="cg_id" value="<?php echo $nurse->caregiver_table_id;?>">
|
||
<input type="hidden" id="cgType" value="<?php echo $caregiver_type;?>">
|
||
|
||
<div class="tab-pane disc_tab fade active in show" id="app-emp-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('app_emp_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation disclosure-signature-signform">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="ApplicationEmployment">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<!-- for refrashing the pdf page -->
|
||
<input type="hidden" id="tab_specific_id" value="app-emp-tab">
|
||
<!-- for refrashing the pdf page -->
|
||
|
||
<!-- Application Employeement pdf -->
|
||
<div class="row pdf-form-container-app-emp-tab">
|
||
<?php $url=$user_folder."/"."APPLICATION_EMPLOYMENT_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf"; ?>
|
||
<div class="col-lg-12 form-group pdf-form-app-emp-tab">
|
||
<embed
|
||
src="<?php echo base_url()?><?php echo $url;?>#toolbar=0&scrollbar=0&navpanes=0&view=FitH"
|
||
type="application/pdf"
|
||
frameBorder="0"
|
||
scrolling="auto"
|
||
height="600px"
|
||
width="100%"
|
||
></embed>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<input type="hidden" name="signature" id="signature_final_field_app_emp_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_app_emp_tab" value="">
|
||
</div>
|
||
</div>
|
||
<!-- End of Application Employeement pdf -->
|
||
|
||
<hr class="mt-3">
|
||
<?php
|
||
if(!in_array("ApplicationEmployment",$signature_type))
|
||
{
|
||
?>
|
||
<div id="date_signature_container_app_emp_tab">
|
||
<div class="row mt-3">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('app_emp_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas class="form-control" id="signature_canvas_app_emp_tab" width="400" height="200" ></canvas>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_app_emp_tab" id="signature_field_date_app_emp_tab" value="<?php echo date('m-d-Y'); ?> <?php echo date('H:i:s'); ?>" required readonly>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<!-- <div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="app_emp_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_app_emp_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" id="signature_field_date_write_app_emp_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i:s'); ?>" disabled="">
|
||
</div>
|
||
</div> -->
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" class="btn btn-info next_app_emp_tab" onclick="return signatureVal('app_emp_tab')"><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_app_emp_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<div class="container-next" id="container_next_app_emp_tab">
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_app_emp_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<div class="tab-pane disc_tab fade" id="con-agree-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('con_agree_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation disclosure-signature-signform">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="ContractorAgreement">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<!-- for refrashing the pdf page -->
|
||
<input type="hidden" id="tab_specific_id" value="con-agree-tab">
|
||
<!-- for refrashing the pdf page -->
|
||
|
||
<!-- calling the modal for inserting extra outer info -->
|
||
<?php
|
||
if(!in_array("ContractorAgreement",$signature_type)){
|
||
?>
|
||
<div class="row mb-2 extra-info-pdf-con-agree-tab">
|
||
<div class="col-lg-12 form-group">
|
||
<span class="float-right mx-2">
|
||
<button class="btn btn-info" type="button" id="card_1_edit" aria-hidden="true" data-toggle="modal" data-target="#infoModal" data-whatever="@mdo">
|
||
<i class="fa fa-pencil" ></i>
|
||
<?php echo lang('Click Here To Fill More Info'); ?>
|
||
</button>
|
||
</span>
|
||
<span class="float-right highlight-container">
|
||
<i class="fa fa-2x fa-hand-o-right text-info highlight"></i>
|
||
</span>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<!-- calling the modal for inserting extra outer info -->
|
||
|
||
<!-- Contractor Agreement pdf -->
|
||
<div class="row pdf-form-container-con-agree-tab">
|
||
<?php $url=$user_folder."/"."CONTRACTOR_AGREEMENT_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf"; ?>
|
||
<div class="col-lg-12 form-group pdf-form-con-agree-tab">
|
||
<?php
|
||
// if(!in_array("ContractorAgreement",$signature_type)){
|
||
// $url=$endAppPath."contractor_agreement.pdf";
|
||
// }else{
|
||
// $url=$user_folder."/"."CONTRACTOR_AGREEMENT_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf";
|
||
// }
|
||
?>
|
||
<embed
|
||
src="<?php echo base_url()?><?php echo $url;?>#toolbar=0&scrollbar=0&navpanes=0&view=FitH"
|
||
type="application/pdf"
|
||
frameBorder="0"
|
||
scrolling="auto"
|
||
height="600px"
|
||
width="100%"
|
||
></embed>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<input type="hidden" name="signature" id="signature_final_field_con_agree_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_con_agree_tab" value="">
|
||
</div>
|
||
</div>
|
||
<!-- End of Contractor Agreement pdf -->
|
||
|
||
<hr class="mt-3">
|
||
<?php
|
||
if(!in_array("ContractorAgreement",$signature_type))
|
||
{
|
||
?>
|
||
<div id="date_signature_container_con_agree_tab">
|
||
<div class="row mt-3">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('con_agree_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas class="form-control" id="signature_canvas_con_agree_tab" width="400" height="200" ></canvas>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_con_agree_tab" id="signature_field_date_con_agree_tab" value="<?php echo date('m-d-Y'); ?> <?php echo date('H:i:s'); ?>" required readonly>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<!-- <div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="con_agree_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_con_agree_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" id="signature_field_date_write_con_agree_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i:s'); ?>" disabled="">
|
||
</div>
|
||
</div> -->
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" class="btn btn-info next_con_agree_tab" onclick="return signatureVal('con_agree_tab')"><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_con_agree_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<div class="container-next" id="container_next_con_agree_tab">
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_con_agree_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<div class="tab-pane disc_tab fade" id="bak-check-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('bak_check_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation disclosure-signature-signform">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="BackgroundCheck">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<!-- for refrashing the pdf page -->
|
||
<input type="hidden" id="tab_specific_id" value="bak-check-tab">
|
||
<!-- for refrashing the pdf page -->
|
||
|
||
|
||
<!-- calling the modal for inserting extra outer info -->
|
||
<?php
|
||
if(!in_array("BackgroundCheck",$signature_type)){
|
||
?>
|
||
<div class="row mb-2 extra-info-pdf-bak-check-tab">
|
||
<div class="col-lg-12 form-group">
|
||
<span class="float-right mx-2">
|
||
<button class="btn btn-info" type="button" id="card_2_edit" aria-hidden="true" data-toggle="modal" data-target="#infoModal" data-whatever="@mdo">
|
||
<i class="fa fa-pencil" ></i>
|
||
<?php echo lang('Click Here To Fill More Info'); ?>
|
||
</button>
|
||
</span>
|
||
<span class="float-right highlight-container">
|
||
<i class="fa fa-2x fa-hand-o-right text-info highlight"></i>
|
||
</span>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<!-- calling the modal for inserting extra outer info -->
|
||
|
||
|
||
<!-- Background Check Form pdf -->
|
||
<div class="row pdf-form-container-bak-check-tab">
|
||
<?php $url=$user_folder."/"."BACKGROUND_CHECK_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf"; ?>
|
||
<div class="col-lg-12 form-group pdf-form-bak-check-tab">
|
||
<?php
|
||
// if(!in_array("BackgroundCheck",$signature_type)){
|
||
// $url=$endAppPath."background_check.pdf";
|
||
// }else{
|
||
// $url=$user_folder."/"."BACKGROUND_CHECK_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf";
|
||
// }
|
||
?>
|
||
<embed
|
||
src="<?php echo base_url()?><?php echo $url;?>#toolbar=0&scrollbar=0&navpanes=0&view=FitH"
|
||
type="application/pdf"
|
||
frameBorder="0"
|
||
scrolling="auto"
|
||
height="600px"
|
||
width="100%"
|
||
></embed>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<input type="hidden" name="signature" id="signature_final_field_bak_check_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_bak_check_tab" value="">
|
||
</div>
|
||
</div>
|
||
<!-- End of Background Check Form pdf -->
|
||
|
||
<hr class="mt-3">
|
||
<?php
|
||
if(!in_array("BackgroundCheck",$signature_type))
|
||
{
|
||
?>
|
||
<div id="date_signature_container_bak_check_tab">
|
||
<div class="row mt-3">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('bak_check_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas class="form-control" id="signature_canvas_bak_check_tab" width="400" height="200" ></canvas>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_bak_check_tab" id="signature_field_date_bak_check_tab" value="<?php echo date('m-d-Y'); ?> <?php echo date('H:i:s'); ?>" required readonly>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<!-- <div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="bak_check_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_bak_check_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" id="signature_field_date_write_bak_check_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i:s'); ?>" disabled="">
|
||
</div>
|
||
</div> -->
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" class="btn btn-info next_bak_check_tab" onclick="return signatureVal('bak_check_tab')"><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_bak_check_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<div class="container-next" id="container_next_bak_check_tab">
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_bak_check_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<div class="tab-pane disc_tab fade" id="i-nine-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('i_nine_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation disclosure-signature-signform">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="iNineForm">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<!-- for refrashing the pdf page -->
|
||
<input type="hidden" id="tab_specific_id" value="i-nine-tab">
|
||
<!-- for refrashing the pdf page -->
|
||
|
||
<!-- calling the modal for inserting extra outer info -->
|
||
<?php
|
||
if(!in_array("iNineForm",$signature_type)){
|
||
?>
|
||
<div class="row mb-2 extra-info-pdf-i-nine-tab">
|
||
<div class="col-lg-12 form-group">
|
||
<span class="float-right mx-2">
|
||
<button class="btn btn-info" type="button" id="card_3_edit" aria-hidden="true" data-toggle="modal" data-target="#infoModal" data-whatever="@mdo">
|
||
<i class="fa fa-pencil" ></i>
|
||
<?php echo lang('Click Here To Fill More Info'); ?>
|
||
</button>
|
||
</span>
|
||
<span class="float-right highlight-container">
|
||
<i class="fa fa-2x fa-hand-o-right text-info highlight"></i>
|
||
</span>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<!-- calling the modal for inserting extra outer info -->
|
||
|
||
<!-- i-9 Form pdf -->
|
||
<div class="row pdf-form-container-i-nine-tab">
|
||
<?php $url=$user_folder."/"."I_NINE_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf"; ?>
|
||
<div class="col-lg-12 form-group pdf-form-i-nine-tab">
|
||
<?php
|
||
// if(!in_array("iNineForm",$signature_type)){
|
||
// $url=$endAppPath."i_nine.pdf";
|
||
// }else{
|
||
// $url=$user_folder."/"."I_NINE_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf";
|
||
// }
|
||
?>
|
||
<embed
|
||
src="<?php echo base_url()?><?php echo $url;?>#toolbar=0&scrollbar=0&navpanes=0&view=FitH"
|
||
type="application/pdf"
|
||
frameBorder="0"
|
||
scrolling="auto"
|
||
height="600px"
|
||
width="100%"
|
||
></embed>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<input type="hidden" name="signature" id="signature_final_field_i_nine_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_i_nine_tab" value="">
|
||
</div>
|
||
</div>
|
||
<!-- End of i-9 Form pdf -->
|
||
|
||
<hr class="mt-3">
|
||
<?php
|
||
if(!in_array("iNineForm",$signature_type))
|
||
{
|
||
?>
|
||
<div id="date_signature_container_i_nine_tab">
|
||
<div class="row mt-3">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('i_nine_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas class="form-control" id="signature_canvas_i_nine_tab" width="400" height="200" ></canvas>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_i_nine_tab" id="signature_field_date_i_nine_tab" value="<?php echo date('m-d-Y'); ?> <?php echo date('H:i:s'); ?>" required readonly>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<!-- <div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="i_nine_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_i_nine_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" id="signature_field_date_write_i_nine_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i:s'); ?>" disabled="">
|
||
</div>
|
||
</div> -->
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" class="btn btn-info next_i_nine_tab" onclick="return signatureVal('i_nine_tab')"><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_i_nine_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<div class="container-next" id="container_next_i_nine_tab">
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_i_nine_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<div class="tab-pane disc_tab fade" id="w-nine-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('w_nine_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation disclosure-signature-signform">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="wNineForm">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<!-- for refrashing the pdf page -->
|
||
<input type="hidden" id="tab_specific_id" value="w-nine-tab">
|
||
<!-- for refrashing the pdf page -->
|
||
|
||
|
||
<!-- calling the modal for inserting extra outer info -->
|
||
<?php
|
||
if(!in_array("wNineForm",$signature_type)){
|
||
?>
|
||
<!-- <div class="row mb-2">
|
||
<div class="col-lg-12 form-group">
|
||
<span class="float-right mx-2">
|
||
<i class="fa fa-pencil" id="card_4_edit" aria-hidden="true" data-toggle="modal" data-target="#infoModal" data-whatever="@mdo"></i>
|
||
</span>
|
||
</div>
|
||
</div> -->
|
||
<div class="row mb-2 extra-info-pdf-w-nine-tab">
|
||
<div class="col-lg-12 form-group">
|
||
<span class="float-right mx-2">
|
||
<button class="btn btn-info" type="button" id="card_4_edit" aria-hidden="true" data-toggle="modal" data-target="#infoModal" data-whatever="@mdo">
|
||
<i class="fa fa-pencil" ></i>
|
||
<?php echo lang('Click Here To Fill More Info'); ?>
|
||
</button>
|
||
</span>
|
||
<span class="float-right highlight-container">
|
||
<i class="fa fa-2x fa-hand-o-right text-info highlight"></i>
|
||
</span>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<!-- calling the modal for inserting extra outer info -->
|
||
|
||
|
||
<!-- w-9 Form pdf -->
|
||
<div class="row pdf-form-container-w-nine-tab">
|
||
<?php $url=$user_folder."/"."W_NINE_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf"; ?>
|
||
<div class="col-lg-12 form-group pdf-form-w-nine-tab">
|
||
<?php
|
||
// if(!in_array("wNineForm",$signature_type)){
|
||
// $url=$endAppPath."w_nine.pdf";
|
||
// }else{
|
||
// $url=$user_folder."/"."W_NINE_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf";
|
||
// }
|
||
?>
|
||
<embed
|
||
src="<?php echo base_url()?><?php echo $url;?>#toolbar=0&scrollbar=0&navpanes=0&view=FitH"
|
||
type="application/pdf"
|
||
frameBorder="0"
|
||
scrolling="auto"
|
||
height="600px"
|
||
width="100%"
|
||
></embed>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<input type="hidden" name="signature" id="signature_final_field_w_nine_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_w_nine_tab" value="">
|
||
</div>
|
||
</div>
|
||
<!-- End of w-9 Form pdf -->
|
||
|
||
<hr class="mt-3">
|
||
<?php
|
||
if(!in_array("wNineForm",$signature_type))
|
||
{
|
||
?>
|
||
<div id="date_signature_container_w_nine_tab">
|
||
<div class="row mt-3">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('w_nine_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas class="form-control" id="signature_canvas_w_nine_tab" width="400" height="200" ></canvas>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_w_nine_tab" id="signature_field_date_w_nine_tab" value="<?php echo date('m-d-Y'); ?> <?php echo date('H:i:s'); ?>" required readonly>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<!-- <div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="w_nine_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_w_nine_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" id="signature_field_date_write_w_nine_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i:s'); ?>" disabled="">
|
||
</div>
|
||
</div> -->
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" class="btn btn-info next_w_nine_tab" onclick="return signatureVal('w_nine_tab')"><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_w_nine_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<div class="container-next" id="container_next_w_nine_tab">
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_w_nine_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<div class="tab-pane disc_tab fade" id="final-submt-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/send_approval" method="post" enctype="multipart/form-data" class="needs-validation" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="form_tab_status" value="12">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->caregiver_table_id)) echo $nurse->caregiver_table_id; ?>">
|
||
<input type="hidden" name="form_status" value="12">
|
||
<input type="hidden" name="ion_id" value="<?php echo $nurse->ion_user_id; ?>">
|
||
|
||
<div class="row">
|
||
<div class="form-group col-md-8" style="padding: 20px;">
|
||
<?php
|
||
// if($sigTabStatus==1){
|
||
?>
|
||
<div class="finalSubif" id="finalSubif" style="display: none">
|
||
<input class="" type="checkbox" name="agree" id="agree" value="1">
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label>
|
||
<?php
|
||
// }else{
|
||
?>
|
||
</div>
|
||
<div class="finalSubelse" id="finalSubelse" style="display: none">
|
||
<span class="required-field text-info">
|
||
<?php echo lang("Please Sign to the all Signature Panels before Print or Submit for Approval");?>
|
||
</span>
|
||
</div>
|
||
<?php
|
||
// }
|
||
?>
|
||
<!-- <input class="" type="checkbox" name="agree" id="agree" value="1">
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label> -->
|
||
</div>
|
||
<div class="form-group col-md-4" style="padding: 20px;">
|
||
<?php
|
||
//AB
|
||
// if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5" || $q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "contrator" ){
|
||
if($ab_type==true){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right">
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}if($ab_type==false){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right" disabled>
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
// }
|
||
//C
|
||
/*
|
||
if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5") && $q_e_type->employee_type == "inhouse"){
|
||
if($c_type=="true"){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right">
|
||
<?php echo lang('Submit For Approvalls');?>
|
||
</button>
|
||
<?php
|
||
}if($c_type=="false"){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right" disabled>
|
||
<?php echo lang('Submit For Approvall');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
} */
|
||
?>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
|
||
<!-- 16-11-2021 -->
|
||
<div class="tab-pane disc_tab fade" id="dir-depo-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
|
||
<!-- calling the modal for inserting extra outer info -->
|
||
<?php
|
||
if(!in_array("DirectDiposit",$signature_type)){
|
||
?>
|
||
<div class="row mb-2 extra-info-pdf-dir-depo-tab">
|
||
<div class="col-lg-12 form-group">
|
||
<span class="float-right mx-2">
|
||
<button class="btn btn-info" type="button" id="card_5_edit" aria-hidden="true" data-toggle="modal" data-target="#infoModal" data-whatever="@mdo">
|
||
<i class="fa fa-pencil" ></i>
|
||
<?php echo lang('Click Here To Fill More Info'); ?>
|
||
</button>
|
||
</span>
|
||
<span class="float-right highlight-container">
|
||
<i class="fa fa-2x fa-hand-o-right text-info highlight"></i>
|
||
</span>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<!-- calling the modal for inserting extra outer info -->
|
||
|
||
|
||
<!-- Direct Deposit pdf -->
|
||
<div class="row pdf-form-container-dir-depo-tab">
|
||
<?php $url=$user_folder."/"."DIRECT_DEPOSIT_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf"; ?>
|
||
<div class="col-lg-12 form-group pdf-form-dir-depo-tab">
|
||
<?php
|
||
// if(!in_array("DirectDiposit",$signature_type)){
|
||
// $url=$endAppPath."direct_deposit.pdf";
|
||
// }else{
|
||
// $url=$user_folder."/"."DIRECT_DEPOSIT_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf";
|
||
// }
|
||
?>
|
||
<embed
|
||
src="<?php echo base_url()?><?php echo $url;?>#toolbar=0&scrollbar=0&navpanes=0&view=FitH"
|
||
type="application/pdf"
|
||
frameBorder="0"
|
||
scrolling="auto"
|
||
height="600px"
|
||
width="100%"
|
||
></embed>
|
||
</div>
|
||
</div>
|
||
<!-- End of Direct Deposit pdf -->
|
||
|
||
<hr class="mt-3">
|
||
<?php
|
||
if(!in_array("DirectDiposit",$signature_type)){
|
||
?>
|
||
<div id="date_signature_container_dir_depo_tab">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('dir_depo_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation disclosure-signature-signform">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="DirectDiposit">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<!-- for refrashing the pdf page -->
|
||
<input type="hidden" id="tab_specific_id" value="dir-depo-tab">
|
||
<!-- for refrashing the pdf page -->
|
||
|
||
<input type="hidden" name="signature" id="signature_final_field_dir_depo_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_dir_depo_tab" value="">
|
||
|
||
<div class="row mt-3">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('dir_depo_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas class="form-control" id="signature_canvas_dir_depo_tab" width="400" height="200" ></canvas>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_dir_depo_tab" id="signature_field_date_dir_depo_tab" value="<?php echo date('m-d-Y'); ?> <?php echo date('H:i:s'); ?>" required readonly>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<!-- <div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="dir_depo_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_dir_depo_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" id="signature_field_date_write_dir_depo_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i:s'); ?>" disabled="">
|
||
</div>
|
||
</div> -->
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" class="btn btn-info next_dir_depo_tab" onclick="return signatureVal('dir_depo_tab')"><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
if($cg_type!="D"){
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-6" style="padding: 20px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/final_pdf" method="post" enctype="multipart/form-data" class="needs-validation">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash();?>" />
|
||
<input type="hidden" name="documentType" value="DirectDiposit">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<input type="hidden" name="cg_type" value="<?php echo $cg_type;?>" readonly>
|
||
|
||
<?php
|
||
//AB
|
||
// if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5" || $q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "contrator" ){
|
||
if($ab_type==true){
|
||
?>
|
||
<button type="submit" name="submit" id="next_" class="btn btn-info" formtarget="_blank">
|
||
<?php echo lang('Print Form');?>
|
||
</button>
|
||
<?php
|
||
}if($ab_type==false){
|
||
?>
|
||
<button type="submit" name="submit" id="next_" class="btn btn-info" formtarget="_blank" disabled>
|
||
<?php echo lang('Print Form');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
// }
|
||
//C
|
||
/*if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5") && $q_e_type->employee_type == "inhouse"){
|
||
if($c_type=="true"){
|
||
?>
|
||
<button type="submit" name="submit" id="next_" class="btn btn-info" formtarget="_blank">
|
||
<?php echo lang('Print Form');?>
|
||
</button>
|
||
<?php
|
||
}if($c_type=="false"){
|
||
?>
|
||
<button type="submit" name="submit" id="next_" class="btn btn-info" formtarget="_blank" disabled>
|
||
<?php echo lang('Print Form');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
} */
|
||
?>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/send_approval" method="post" enctype="multipart/form-data" class="needs-validation" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="form_tab_status" value="12">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->caregiver_table_id)) echo $nurse->caregiver_table_id; ?>">
|
||
<input type="hidden" name="form_status" value="12">
|
||
<input type="hidden" name="ion_id" value="<?php echo $nurse->ion_user_id; ?>">
|
||
|
||
<div class="row">
|
||
<div class="form-group col-md-8" style="padding: 20px;">
|
||
<?php
|
||
if($sigTabStatus==1){
|
||
?>
|
||
<input class="" type="checkbox" name="agree" id="agree" value="1">
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<span class="required-field text-info">
|
||
<?php echo lang("Please Sign to the all Signature Panels before Print or Submit for Approval");?>
|
||
</span>
|
||
<?php
|
||
}
|
||
?>
|
||
<!-- <input class="" type="checkbox" name="agree" id="agree" value="1">
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label> -->
|
||
</div>
|
||
<div class="form-group col-md-4" style="padding: 20px;">
|
||
<?php
|
||
//AB
|
||
// if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5" || $q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "contrator" ){
|
||
if($ab_type==true){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right">
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}if($ab_type==false){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right" disabled>
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
// }
|
||
//C
|
||
/*if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5") && $q_e_type->employee_type == "inhouse"){
|
||
if($c_type=="true"){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right">
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}if($c_type=="false"){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right" disabled>
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
} */
|
||
?>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_dir_depo_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
}
|
||
?>
|
||
<div class="container-next" id="container_next_dir_depo_tab">
|
||
<?php
|
||
if($cg_type!="D"){
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-6" style="padding: 20px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/final_pdf" method="post" enctype="multipart/form-data" class="needs-validation">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash();?>" />
|
||
<input type="hidden" name="documentType" value="DirectDiposit">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<input type="hidden" name="cg_type" value="<?php echo $cg_type;?>" readonly>
|
||
|
||
<?php
|
||
//AB
|
||
if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5" || $q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "contrator" ){
|
||
?>
|
||
<button type="submit" name="submit" id="next_" class="btn btn-info" formtarget="_blank" disabled>
|
||
<?php echo lang('Print Form');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
//C
|
||
if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5") && $q_e_type->employee_type == "inhouse"){
|
||
?>
|
||
<button type="submit" name="submit" id="next_" class="btn btn-info" formtarget="_blank" disabled>
|
||
<?php echo lang('Print Form');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
?>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/send_approval" method="post" enctype="multipart/form-data" class="needs-validation" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="form_tab_status" value="12">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->caregiver_table_id)) echo $nurse->caregiver_table_id; ?>">
|
||
<input type="hidden" name="form_status" value="12">
|
||
|
||
<div class="row">
|
||
<div class="form-group col-md-8" style="padding: 20px;">
|
||
<?php
|
||
if($sigTabStatus==1){
|
||
?>
|
||
<input class="" type="checkbox" name="agree" id="agree" value="1">
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<span class="required-field text-info">
|
||
<?php echo lang("Please Sign to the all Signature Panels before Print or Submit for Approval");?>
|
||
</span>
|
||
<br>
|
||
<span class="text-info">
|
||
<?php echo lang("Or Reload the page");?>
|
||
</span>
|
||
<?php
|
||
}
|
||
?>
|
||
<!-- <input class="" type="checkbox" name="agree" id="agree" value="1">
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label> -->
|
||
</div>
|
||
<div class="form-group col-md-4" style="padding: 20px;">
|
||
<?php
|
||
//AB
|
||
if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5" || $q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "contrator" ){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right">
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
//C
|
||
if(($q_e_type->qualification_type == "4" || $q_e_type->qualification_type == "5") && $q_e_type->employee_type == "inhouse"){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right">
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
?>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_dir_depo_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
</div>
|
||
</div>
|
||
<!-- 16-11-2021 -->
|
||
|
||
<div class="tab-pane disc_tab fade" id="doh-102-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('doh_102_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation disclosure-signature-signform">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="Doh102">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<!-- for refrashing the pdf page -->
|
||
<input type="hidden" id="tab_specific_id" value="doh-102-tab">
|
||
<!-- for refrashing the pdf page -->
|
||
|
||
<!-- DOH 102 Form pdf -->
|
||
<div class="row pdf-form-container-doh-102-tab">
|
||
<?php $url=$user_folder."/"."DOH_CHRC102_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf"; ?>
|
||
<div class="col-lg-12 form-group pdf-form-doh-102-tab">
|
||
<embed
|
||
src="<?php echo base_url()?><?php echo $url;?>#toolbar=0&scrollbar=0&navpanes=0&view=FitH"
|
||
type="application/pdf"
|
||
frameBorder="0"
|
||
scrolling="auto"
|
||
height="600px"
|
||
width="100%"
|
||
></embed>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<input type="hidden" name="signature" id="signature_final_field_doh_102_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_doh_102_tab" value="">
|
||
</div>
|
||
</div>
|
||
<!-- End of DOH 102 Form pdf -->
|
||
|
||
<hr class="mt-3">
|
||
<?php
|
||
if(!in_array("Doh102",$signature_type))
|
||
{
|
||
?>
|
||
<div id="date_signature_container_doh_102_tab">
|
||
<div class="row mt-3">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('doh_102_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas class="form-control" id="signature_canvas_doh_102_tab" width="400" height="200" ></canvas>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_doh_102_tab" id="signature_field_date_doh_102_tab" value="<?php echo date('m-d-Y'); ?> <?php echo date('H:i:s'); ?>" required readonly>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<!-- <div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="doh_102_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_doh_102_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" id="signature_field_date_write_doh_102_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i:s'); ?>" disabled="">
|
||
</div>
|
||
</div> -->
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" class="btn btn-info next_doh_102_tab" onclick="return signatureVal('doh_102_tab')"><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_doh_102_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<div class="container-next" id="container_next_doh_102_tab">
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_doh_102_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<div class="tab-pane disc_tab fade" id="doh-103-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('doh_103_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation disclosure-signature-signform">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="Doh103">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<!-- for refrashing the pdf page -->
|
||
<input type="hidden" id="tab_specific_id" value="doh-103-tab">
|
||
<!-- for refrashing the pdf page -->
|
||
|
||
<!-- DOH 103 Form pdf -->
|
||
<div class="row pdf-form-container-doh-103-tab">
|
||
<?php $url=$user_folder."/"."DOH_CHRC103_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf"; ?>
|
||
<div class="col-lg-12 form-group pdf-form-doh-103-tab">
|
||
<embed
|
||
src="<?php echo base_url()?><?php echo $url;?>#toolbar=0&scrollbar=0&navpanes=0&view=FitH"
|
||
type="application/pdf"
|
||
frameBorder="0"
|
||
scrolling="auto"
|
||
height="600px"
|
||
width="100%"
|
||
></embed>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<input type="hidden" name="signature" id="signature_final_field_doh_103_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_doh_103_tab" value="">
|
||
</div>
|
||
</div>
|
||
<!-- End of DOH 103 Form pdf -->
|
||
|
||
<hr class="mt-3">
|
||
<?php
|
||
if(!in_array("Doh103",$signature_type))
|
||
{
|
||
?>
|
||
<div id="date_signature_container_doh_103_tab">
|
||
<div class="row mt-3">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('doh_103_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas class="form-control" id="signature_canvas_doh_103_tab" width="400" height="200" ></canvas>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_doh_103_tab" id="signature_field_date_doh_103_tab" value="<?php echo date('m-d-Y'); ?> <?php echo date('H:i:s'); ?>" required readonly>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<!-- <div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="doh_103_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_doh_103_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" id="signature_field_date_write_doh_103_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i:s'); ?>" disabled="">
|
||
</div>
|
||
</div> -->
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" class="btn btn-info next_doh_103_tab" onclick="return signatureVal('doh_103_tab')"><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_doh_103_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<div class="container-next" id="container_next_doh_103_tab">
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="button" class="btn btn-info next_doh_103_tab"><?php echo lang('Next'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<!-- 16-11-2021 -->
|
||
<div class="tab-pane disc_tab fade" id="reg-rel-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<!-- Registry Release pdf -->
|
||
<div class="row pdf-form-container-reg-rel-tab">
|
||
<?php $url=$user_folder."/"."REGISTRY_RELEASE_".str_pad($ion_id, 6,"0",STR_PAD_LEFT).".pdf"; ?>
|
||
<div class="col-lg-12 form-group pdf-form-reg-rel-tab">
|
||
<embed
|
||
src="<?php echo base_url()?><?php echo $url;?>#toolbar=0&scrollbar=0&navpanes=0&view=FitH"
|
||
type="application/pdf"
|
||
frameBorder="0"
|
||
scrolling="auto"
|
||
height="600px"
|
||
width="100%"
|
||
></embed>
|
||
</div>
|
||
</div>
|
||
<!-- End of Registry Release pdf -->
|
||
|
||
<hr class="mt-3">
|
||
<?php
|
||
if(!in_array("RegistryRelease",$signature_type)){
|
||
?>
|
||
<div id="date_signature_container_reg_rel_tab">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('reg_rel_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation disclosure-signature-signform">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="RegistryRelease">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<!-- for refrashing the pdf page -->
|
||
<input type="hidden" id="tab_specific_id" value="reg-rel-tab">
|
||
<!-- for refrashing the pdf page -->
|
||
|
||
<input type="hidden" name="signature" id="signature_final_field_reg_rel_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_reg_rel_tab" value="">
|
||
|
||
<div class="row mt-3">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('reg_rel_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas class="form-control" id="signature_canvas_reg_rel_tab" width="400" height="200" ></canvas>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_reg_rel_tab" id="signature_field_date_reg_rel_tab" value="<?php echo date('m-d-Y'); ?> <?php echo date('H:i:s'); ?>" required readonly>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<!-- <div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="reg_rel_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_reg_rel_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" id="signature_field_date_write_reg_rel_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i:s'); ?>" disabled="">
|
||
</div>
|
||
</div> -->
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" id="next_reg_rel_tab" class="btn btn-info" onclick="return signatureVal('reg_rel_tab')"><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<div class="row">
|
||
<div class="form-group col-md-6" style="padding: 20px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/final_pdf" method="post" enctype="multipart/form-data" class="needs-validation">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash();?>" />
|
||
<input type="hidden" name="documentType" value="RegistryRelease">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<input type="hidden" name="cg_type" value="<?php echo $cg_type;?>" readonly>
|
||
|
||
<?php
|
||
//D
|
||
// if(($q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "inhouse"){
|
||
if($d_type==true){
|
||
?>
|
||
<button type="submit" name="submit" id="next_" class="btn btn-info" formtarget="_blank">
|
||
<?php echo lang('Print Form');?>
|
||
</button>
|
||
<?php
|
||
}if($d_type==false){
|
||
?>
|
||
<button type="submit" name="submit" id="next_" class="btn btn-info" formtarget="_blank" disabled>
|
||
<?php echo lang('Print Form');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
// }
|
||
?>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/send_approval" method="post" enctype="multipart/form-data" class="needs-validation" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="form_tab_status" value="12">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->caregiver_table_id)) echo $nurse->caregiver_table_id; ?>">
|
||
<input type="hidden" name="form_status" value="12">
|
||
<input type="hidden" name="ion_id" value="<?php echo $nurse->ion_user_id; ?>">
|
||
|
||
<div class="row">
|
||
<div class="form-group col-md-6" style="padding: 20px;">
|
||
<?php
|
||
if($sigTabStatus==1){
|
||
?>
|
||
<input class="" type="checkbox" name="agree" id="agree" value="1">
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<span class="required-field text-info">
|
||
<?php echo lang("Please Sign to the all Signature Panels before Print or Submit for Approval");?>
|
||
</span>
|
||
<?php
|
||
}
|
||
?>
|
||
<!-- <input class="" type="checkbox" name="agree" id="agree" value="1">
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label> -->
|
||
</div>
|
||
<div class="form-group col-md-6" style="padding: 20px;">
|
||
<?php
|
||
//D
|
||
// if(($q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "inhouse"){
|
||
if($d_type==true){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right">
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}if($d_type==false){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right" disabled>
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
// }
|
||
?>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
<div class="container-next" id="container_next_reg_rel_tab">
|
||
<div class="row">
|
||
<div class="form-group col-md-6" style="padding: 20px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/final_pdf" method="post" enctype="multipart/form-data" class="needs-validation">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash();?>" />
|
||
<input type="hidden" name="documentType" value="RegistryRelease">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
|
||
<input type="hidden" name="cg_type" value="<?php echo $cg_type;?>" readonly>
|
||
|
||
<?php
|
||
//D
|
||
if(($q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "inhouse"){
|
||
?>
|
||
<button type="submit" name="submit" id="next_" class="btn btn-info" formtarget="_blank" disabled>
|
||
<?php echo lang('Print Form');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
?>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
<div class="row">
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/send_approval" method="post" enctype="multipart/form-data" class="needs-validation" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="form_tab_status" value="12">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->caregiver_table_id)) echo $nurse->caregiver_table_id; ?>">
|
||
<input type="hidden" name="form_status" value="12">
|
||
<input type="hidden" name="ion_id" value="<?php echo $nurse->ion_user_id; ?>">
|
||
|
||
<div class="row">
|
||
<div class="form-group col-md-6" style="padding: 20px;">
|
||
<?php
|
||
if($sigTabStatus==1){
|
||
?>
|
||
<input class="" type="checkbox" name="agree" id="agree" value="1">
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label>
|
||
<?php
|
||
}else{
|
||
?>
|
||
<span class="required-field text-info">
|
||
<?php echo lang("Please Sign to the all Signature Panels before Print or Submit for Approval");?>
|
||
</span>
|
||
<br>
|
||
<span class="text-info">
|
||
<?php echo lang("Or Reload the page");?>
|
||
</span>
|
||
<?php
|
||
}
|
||
?>
|
||
<!-- <input class="" type="checkbox" name="agree" id="agree" value="1">
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label> -->
|
||
</div>
|
||
<div class="form-group col-md-6" style="padding: 20px;">
|
||
<?php
|
||
//D
|
||
if(($q_e_type->qualification_type == "6" || $q_e_type->qualification_type == "7") && $q_e_type->employee_type == "inhouse"){
|
||
?>
|
||
<button type="submit" name="submit" id="agreeSubmit" class="btn btn-success float-right">
|
||
<?php echo lang('Submit For Approval');?>
|
||
</button>
|
||
<?php
|
||
}
|
||
?>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
<!-- 16-11-2021 -->
|
||
</div>
|
||
|
||
<div class="tab-content loading-content">
|
||
<div class="w-100 ms-auto pt-4 pb-4">
|
||
<div class="center pb-1">
|
||
<img src="https://raw.githubusercontent.com/Codelessly/FlutterLoadingGIFs/master/packages/cupertino_activity_indicator_large.gif">
|
||
</div>
|
||
<h5 class="text-center timeCount-disclosure"></h5>
|
||
<h4 class="text-center text-info">Don't Reload the Page</h4>
|
||
<p class="text-center p-0 m-0 timeCount-disclosure-next">Please Wait We Are Creating Files...</p>
|
||
<h6 class="text-center">
|
||
<small>MAKE SURE YOU HAVE A STRONG INTERNATE CONNECTION!!</small>
|
||
</h6>
|
||
</div>
|
||
</div>
|
||
<!-- Ending of Disclosure Tabs Content Section -->
|
||
|
||
|
||
|
||
|
||
<!-- Modal box for filling information in pdf -->
|
||
|
||
<div class="modal fade" id="infoModal" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true">
|
||
<div class="modal-dialog modal-lg" role="document">
|
||
<div class="modal-content">
|
||
<div class="modal-header">
|
||
<h5 class="modal-title" id="exampleModalLabel"><?php echo lang("Fill Information");?></h5>
|
||
<div class="bg-lg m-auto">
|
||
<button type="button" class="close" data-dismiss="modal">×</button>
|
||
</div>
|
||
</div>
|
||
<div class="modal-body px-3">
|
||
<div id="card_1">
|
||
<form role="form" action="<?php echo base_url()?>CaregiversDashboard/ExtraPdfInfo" method="post" enctype="multipart/form-data" name="newGenInfo" class="disclosure-signature-extra-info-form">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="caregiverId" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<input type="hidden" name="documentType" value="ContractorAgreement">
|
||
<input type="hidden" class="get-class" value="con-agree-tab">
|
||
|
||
<?php if($extraPdfInfo['ContractorAgreement']){$con_agree=json_decode($extraPdfInfo['ContractorAgreement']);}?>
|
||
<div class="form-group">
|
||
<label for="jhgjkkjh" class="col-form-label"><?php echo lang("Do you agree with the terms of this agreement?");?></label> 
|
||
<div class="form-check form-check-inline">
|
||
<label class="form-check-label" for="agreement_checkbox_yes">Yes </label>
|
||
<input class="form-check-input" type="radio" name="checkbox_agree" id="agreement_checkbox_yes" value="yes"
|
||
<?php if($con_agree->checkbox_agree){if($con_agree->checkbox_agree=="yes"){echo "checked";}}?>>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<label class="form-check-label" for="agreement_checkbox_no">No </label>
|
||
<input class="form-check-input" type="radio" name="checkbox_agree" id="agreement_checkbox_no" value="no"
|
||
<?php if($con_agree->checkbox_agree){if($con_agree->checkbox_agree=="no"){echo "checked";}}?>>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="title" class="col-form-label"><?php echo lang("Title");?></label>
|
||
<input type="text" class="form-control" id="title" name="title" value="<?php if($con_agree->title){echo $con_agree->title;}?>">
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="federal_id" class="col-form-label"><?php echo lang("Federal ID Number");?></label>
|
||
<input type="text" class="form-control" id="federal_id" name="federal_id" value="<?php if($con_agree->federal_id){echo $con_agree->federal_id;}?>">
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group mt-2 center-y">
|
||
<button type="submit" class="btn btn-primary" id="submitBtn" class="btn btn-info">
|
||
<?php echo lang('Update'); ?>
|
||
</button>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
<div id="card_2">
|
||
<form role="form" action="<?php echo base_url()?>CaregiversDashboard/ExtraPdfInfo" method="post" enctype="multipart/form-data" name="newGenInfo" class="disclosure-signature-extra-info-form">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="caregiverId" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<input type="hidden" name="documentType" value="BackgroundCheck">
|
||
<input type="hidden" class="get-class" value="bak-check-tab">
|
||
|
||
<?php $bak_check=json_decode($extraPdfInfo['BackgroundCheck']);?>
|
||
<div class="form-group">
|
||
<div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<label for="auth_check_other_name" class="col-form-label"><?php echo lang("Maiden/Other Names");?></label>
|
||
<input type="text" class="form-control" id="auth_check_other_name" name="auth_check_other_name"
|
||
value="<?php if($bak_check->auth_check_other_name){echo $bak_check->auth_check_other_name;}?>">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label for="auth_check_years_used" class="col-form-label"><?php echo lang("Years Used");?></label>
|
||
<input type="number" class="form-control" id="auth_check_years_used" name="auth_check_years_used"
|
||
value="<?php if($bak_check->auth_check_years_used){echo $bak_check->auth_check_years_used;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="background_check_report" class="col-form-label">
|
||
<span style="font-weight: bold;"><?php echo lang("If you live or work for the Company in California, Minnesota or Oklahoma:");?></span>
|
||
<span><?php echo lang("Check this box if you would like a free copy of your background check report:");?></span>
|
||
</label>
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="checkbox" id="background_check_report" name="background_check_report" value="yes"
|
||
<?php if($bak_check->background_check_report){if($bak_check->background_check_report=="yes"){echo "checked";}}?>>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<label for="driver_license" class="col-form-label"><?php echo lang("Driver’s License Number");?></label>
|
||
<input type="text" class="form-control" id="driver_license" name="driver_license"
|
||
value="<?php if($bak_check->driver_license){echo $bak_check->driver_license;}?>">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label for="state_issuing_license" class="col-form-label"><?php echo lang("State Issuing License");?></label>
|
||
<input type="text" class="form-control" id="state_issuing_license" name="state_issuing_license"
|
||
value="<?php if($bak_check->state_issuing_license){echo $bak_check->state_issuing_license;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="other_details" class="col-form-label">
|
||
<span style="font-weight:bold;"><?php echo lang("Enter Any Other Names Used (including maiden names):");?></span>
|
||
</label>
|
||
<div class="row">
|
||
<div class="col-lg-4 form-group">
|
||
<label for="other_first_name1" class="col-form-label"><?php echo lang("First Name");?></label>
|
||
<input type="text" class="form-control" id="other_first_name1" name="other_first_name1"
|
||
value="<?php if($bak_check->other_first_name1){echo $bak_check->other_first_name1;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="other_middle_name1" class="col-form-label"><?php echo lang("Middle Name");?></label>
|
||
<input type="text" class="form-control" id="other_middle_name1" name="other_middle_name1"
|
||
value="<?php if($bak_check->other_middle_name1){echo $bak_check->other_middle_name1;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="other_last_name1" class="col-form-label"><?php echo lang("Last Name");?></label>
|
||
<input type="text" class="form-control" id="other_last_name1" name="other_last_name1"
|
||
value="<?php if($bak_check->other_last_name1){echo $bak_check->other_last_name1;}?>">
|
||
</div>
|
||
</div>
|
||
<div class="row">
|
||
<div class="col-lg-4 form-group">
|
||
<label for="other_first_name2" class="col-form-label"><?php echo lang("First Name");?></label>
|
||
<input type="text" class="form-control" id="other_first_name2" name="other_first_name2"
|
||
value="<?php if($bak_check->other_first_name2){echo $bak_check->other_first_name2;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="other_middle_name2" class="col-form-label"><?php echo lang("Middle Name");?></label>
|
||
<input type="text" class="form-control" id="other_middle_name2" name="other_middle_name2"
|
||
value="<?php if($bak_check->other_middle_name2){echo $bak_check->other_middle_name2;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="other_last_name2" class="col-form-label"><?php echo lang("Last Name");?></label>
|
||
<input type="text" class="form-control" id="other_last_name2" name="other_last_name2"
|
||
value="<?php if($bak_check->other_last_name2){echo $bak_check->other_last_name2;}?>">
|
||
</div>
|
||
</div>
|
||
<div class="row">
|
||
<div class="col-lg-4 form-group">
|
||
<label for="other_first_name3" class="col-form-label"><?php echo lang("First Name");?></label>
|
||
<input type="text" class="form-control" id="other_first_name3" name="other_first_name3"
|
||
value="<?php if($bak_check->other_first_name3){echo $bak_check->other_first_name3;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="other_middle_name3" class="col-form-label"><?php echo lang("Middle Name");?></label>
|
||
<input type="text" class="form-control" id="other_middle_name3" name="other_middle_name3"
|
||
value="<?php if($bak_check->other_middle_name3){echo $bak_check->other_middle_name3;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="other_last_name3" class="col-form-label"><?php echo lang("Last Name");?></label>
|
||
<input type="text" class="form-control" id="other_last_name3" name="other_last_name3"
|
||
value="<?php if($bak_check->other_last_name3){echo $bak_check->other_last_name3;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="other_address_details" class="col-form-label">
|
||
<span style="font-weight:bold;"><?php echo lang("Addresses Within The Past Seven Years (use a separate sheet as needed):");?></span>
|
||
</label>
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<label for="prior_street_address1" class="col-form-label"><?php echo lang("Prior Street Address");?></label>
|
||
<input type="text" class="form-control" id="prior_street_address1" name="prior_street_address1"
|
||
value="<?php if($bak_check->prior_street_address1){echo $bak_check->prior_street_address1;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="from_date1" class="col-form-label"><?php echo lang("From");?></label>
|
||
<input type="date" class="form-control not_future" id="from_date1" name="from_date1" data-error="Please enter a valid date" value="<?php if($bak_check->from_date1){echo $bak_check->from_date1;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="to_date1" class="col-form-label"><?php echo lang("To");?></label>
|
||
<input type="date" class="form-control not_future" id="to_date1" name="to_date1" data-error="Please enter a valid date"
|
||
value="<?php if($bak_check->to_date1){echo $bak_check->to_date1;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="city_state_zip2" class="col-form-label"><?php echo lang("City/State/ZIP");?></label>
|
||
<input type="text" class="form-control" id="city_state_zip2" name="city_state_zip2"
|
||
value="<?php if($bak_check->city_state_zip2){echo $bak_check->city_state_zip2;}?>">
|
||
</div>
|
||
</div>
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<label for="prior_street_address2" class="col-form-label"><?php echo lang("Prior Street Address");?></label>
|
||
<input type="text" class="form-control" id="prior_street_address2" name="prior_street_address2"
|
||
value="<?php if($bak_check->prior_street_address2){echo $bak_check->prior_street_address2;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="from_date2" class="col-form-label"><?php echo lang("From");?></label>
|
||
<input type="date" class="form-control not_future" id="from_date2" name="from_date2" data-error="Please enter a valid date"
|
||
value="<?php if($bak_check->from_date2){echo $bak_check->from_date2;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="to_date2" class="col-form-label"><?php echo lang("To");?></label>
|
||
<input type="date" class="form-control not_future" id="to_date2" name="to_date2"
|
||
value="<?php if($bak_check->to_date2){echo $bak_check->to_date2;}?>">
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<label for="city_state_zip3" class="col-form-label"><?php echo lang("City/State/ZIP");?></label>
|
||
<input type="text" class="form-control" id="city_state_zip3" name="city_state_zip3"
|
||
value="<?php if($bak_check->city_state_zip3){echo $bak_check->city_state_zip3;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group mt-2 center-y">
|
||
<button type="submit" class="btn btn-primary" id="submitBtn" class="btn btn-info">
|
||
<?php echo lang('Update'); ?>
|
||
</button>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
<div id="card_3">
|
||
<form role="form" action="<?php echo base_url()?>CaregiversDashboard/ExtraPdfInfo" method="post" enctype="multipart/form-data" name="newGenInfo" class="disclosure-signature-extra-info-form">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="caregiverId" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<input type="hidden" name="documentType" value="iNineForm">
|
||
<input type="hidden" class="get-class" value="i-nine-tab">
|
||
|
||
<?php $i_nine=json_decode($extraPdfInfo['iNineForm']);?>
|
||
<div class="form-group">
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<label for="other_last_name" class="col-form-label"><?php echo lang("Other Last Names Used (if any)");?></label>
|
||
<input type="text" class="form-control" id="other_last_name" name="other_last_name"
|
||
value="<?php if($i_nine->other_last_name){echo $i_nine->other_last_name;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="other_details" class="col-form-label">
|
||
<span style="font-weight:bold;">
|
||
<?php echo lang("I attest, under penalty of perjury, that I am (check one of the following boxes)");?>
|
||
</span>
|
||
</label>
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="country_citizen" id="country_citizen_citizen" value="citizen"
|
||
<?php if($i_nine->country_citizen){if($i_nine->country_citizen=="citizen"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="country_citizen_citizen"> 1. A citizen of the United States</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="country_citizen" id="country_citizen_non_citizen" value="non_citizen"
|
||
<?php if($i_nine->country_citizen){if($i_nine->country_citizen=="non_citizen"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="country_citizen_non_citizen"> 2. A noncitizen national of the United States (See instructions)</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="country_citizen" id="country_citizen_lawful_citizen" value="lawful_citizen" <?php if($i_nine->country_citizen){if($i_nine->country_citizen=="lawful_citizen"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="country_citizen_lawful_citizen"> 3. A lawful permanent resident</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label class="uscis_no" for="country_citizen_lawful_citizen">(Alien Registration Number/USCIS Number):</label>
|
||
<input type="text" class="form-control" id="uscis_no" name="uscis_no"
|
||
value="<?php if($i_nine->uscis_no){echo $i_nine->uscis_no;}?>">
|
||
</div>
|
||
|
||
<div class="col-lg-6 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="country_citizen" id="country_citizen_alien_authorized" value="alien_authorized" <?php if($i_nine->country_citizen){if($i_nine->country_citizen=="alien_authorized"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="country_citizen_alien_authorized"> 4. An alien authorized to work</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label class="uscis_no" for="alien_authorized_expire_date">until (expiration date, if applicable):</label>
|
||
<input type="date" class="form-control" id="alien_authorized_expire_date" name="alien_authorized_expire_date"
|
||
value="<?php if($i_nine->alien_authorized_expire_date){echo $i_nine->alien_authorized_expire_date;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="other_details" class="col-form-label">
|
||
<span style="font-weight:bold;">
|
||
<?php echo lang("Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:");?>
|
||
</span>
|
||
<span style="font-weight:bold;">
|
||
<?php echo lang("An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.");?>
|
||
</span>
|
||
</label>
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<label class="form-check-label" for="alien_uscis_no">1. Alien Registration Number/USCIS Number: </label>
|
||
<input class="form-check-input" type="text" name="alien_uscis_no" id="alien_uscis_no"
|
||
value="<?php if($i_nine->alien_uscis_no){echo $i_nine->alien_uscis_no;}?>">
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-12 form-group center">OR</div>
|
||
<div class="col-lg-12 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<label class="form-check-label" for="form_I_94_no">2. Form I-94 Admission Number: </label>
|
||
<input class="form-check-input" type="text" name="form_I_94_no" id="form_I_94_no"
|
||
value="<?php if($i_nine->form_I_94_no){echo $i_nine->form_I_94_no;}?>">
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-12 form-group center">OR</div>
|
||
<div class="col-lg-12 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<label class="form-check-label" for="foreign_passport_no">3. Foreign Passport Number: </label>
|
||
<input class="form-check-input" type="text" name="foreign_passport_no" id="foreign_passport_no"
|
||
value="<?php if($i_nine->foreign_passport_no){echo $i_nine->foreign_passport_no;}?>">
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<label class="form-check-label" for="county_issuance">Country of Issuance: </label>
|
||
<input class="form-check-input" type="text" name="county_issuance" id="county_issuance"
|
||
value="<?php if($i_nine->county_issuance){echo $i_nine->county_issuance;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="other_details" class="col-form-label">
|
||
<h4 style="font-weight:bold;">
|
||
<?php echo lang("Preparer and/or Translator Certification (check one):");?>
|
||
</h4>
|
||
</label>
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="translator_use" id="translator_use_no" value="no"
|
||
<?php if($i_nine->translator_use){if($i_nine->translator_use=="no"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="translator_use_no"> I did not use a preparer or translator</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="translator_use" id="translator_use_yes" value="yes"
|
||
<?php if($i_nine->translator_use){if($i_nine->translator_use=="yes"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="translator_use_yes">
|
||
A preparer(s) and/or translator(s) assisted the employee in completing Section 1
|
||
</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="form-group">
|
||
<label for="other_details" class="col-form-label">
|
||
<span style="font-weight:bold;">
|
||
<?php echo lang("I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.");?>
|
||
</span>
|
||
</label>
|
||
<div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<label class="uscis_no" for="translator_last_name">Last Name (Family Name)</label>
|
||
<input type="text" class="form-control" id="translator_last_name" name="translator_last_name"
|
||
value="<?php if($i_nine->translator_last_name){echo $i_nine->translator_last_name;}?>">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label class="uscis_no" for="translator_first_name">First Name (Given Name) </label>
|
||
<input type="text" class="form-control" id="translator_first_name" name="translator_first_name"
|
||
value="<?php if($i_nine->translator_first_name){echo $i_nine->translator_first_name;}?>">
|
||
</div>
|
||
|
||
<div class="col-lg-6 form-group">
|
||
<label class="uscis_no" for="translator_street">Address (Street Number and Name)</label>
|
||
<input type="text" class="form-control" id="translator_street" name="translator_street"
|
||
value="<?php if($i_nine->translator_street){echo $i_nine->translator_street;}?>">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label class="uscis_no" for="translator_city">City or Town</label>
|
||
<input type="text" class="form-control" id="translator_city" name="translator_city"
|
||
value="<?php if($i_nine->translator_city){echo $i_nine->translator_city;}?>">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label class="uscis_no" for="translator_state">State</label>
|
||
<input type="text" class="form-control" id="translator_state" name="translator_state"
|
||
value="<?php if($i_nine->translator_state){echo $i_nine->translator_state;}?>">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label class="uscis_no" for="translator_zip">ZIP Code</label>
|
||
<input type="text" class="form-control" id="translator_zip" name="translator_zip"
|
||
value="<?php if($i_nine->translator_zip){echo $i_nine->translator_zip;}?>">
|
||
</div>
|
||
|
||
<div class="col-lg-12 form-group">
|
||
<label class="uscis_no" for="review_immigration_status">Citizenship/Immigration Status</label>
|
||
<input type="text" class="form-control" id="review_immigration_status" name="review_immigration_status"
|
||
value="<?php if($i_nine->review_immigration_status){echo $i_nine->review_immigration_status;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group mt-2 center-y">
|
||
<button type="submit" class="btn btn-primary" id="submitBtn" class="btn btn-info">
|
||
<?php echo lang('Update'); ?>
|
||
</button>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
<div id="card_4">
|
||
<form role="form" action="<?php echo base_url()?>CaregiversDashboard/ExtraPdfInfo" method="post" enctype="multipart/form-data" name="newGenInfo" class="disclosure-signature-extra-info-form">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="caregiverId" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<input type="hidden" name="documentType" value="wNineForm">
|
||
<input type="hidden" class="get-class" value="w-nine-tab">
|
||
|
||
|
||
<?php $w_nine=json_decode($extraPdfInfo['wNineForm']);?>
|
||
<div class="form-group">
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<label for="business_name" class="col-form-label">
|
||
<?php echo lang("2. Business name/disregarded entity name, if different from above");?>
|
||
</label>
|
||
<input type="text" class="form-control" id="business_name" name="businessName"
|
||
value="<?php if($w_nine->businessName){echo $w_nine->businessName;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="other_details" class="col-form-label">
|
||
<span style="font-weight:bold;">
|
||
<?php echo lang("3. Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. ");?>
|
||
</span>
|
||
</label>
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="tax_classification" id="tax_classification_individual" value="individual" <?php if($w_nine->tax_classification){if($w_nine->tax_classification=="individual"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="tax_classification_individual"> Individual/sole proprietor or single-member LLC</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="tax_classification" id="tax_classification_c_corporation" value="c_corporation" <?php if($w_nine->tax_classification){if($w_nine->tax_classification=="c_corporation"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="tax_classification_c_corporation"> C Corporation</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="tax_classification" id="tax_classification_s_corporation" value="s_corporation" <?php if($w_nine->tax_classification){if($w_nine->tax_classification=="s_corporation"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="tax_classification_s_corporation"> S Corporation</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="tax_classification" id="tax_classification_partnership" value="partnership" <?php if($w_nine->tax_classification){if($w_nine->tax_classification=="partnership"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="tax_classification_partnership"> Partnership</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-4 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="tax_classification" id="tax_classification_estate" value="estate"
|
||
<?php if($w_nine->tax_classification){if($w_nine->tax_classification=="estate"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="tax_classification_estate"> Trust/estate</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-8 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="tax_classification" id="tax_classification_liability" value="liability"
|
||
<?php if($w_nine->tax_classification){if($w_nine->tax_classification=="liability"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="tax_classification_liability"> Limited liability company</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="tax_classification" id="tax_classification_other" value="other"
|
||
<?php if($w_nine->tax_classification){if($w_nine->tax_classification=="other"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="tax_classification_other"> Other (see instructions)</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="other_details" class="col-form-label">
|
||
<span style="font-weight:bold;">
|
||
<?php echo lang("4. Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):");?>
|
||
</span>
|
||
</label>
|
||
<div class="row">
|
||
<div class="col-lg-5 form-group">
|
||
<label for="exempt_payee_code" class="col-form-label"><?php echo lang("Exempt payee code (if any)");?></label>
|
||
<input type="text" class="form-control" id="exempt_payee_code" name="exempt_payee_code"
|
||
value="<?php if($w_nine->exempt_payee_code){echo $w_nine->exempt_payee_code;}?>">
|
||
</div>
|
||
<div class="col-lg-7 form-group">
|
||
<label for="exempt_reporting_code" class="col-form-label"><?php echo lang("Exemption from FATCA reporting code (if any)");?></label>
|
||
<input type="text" class="form-control" id="exempt_reporting_code" name="exempt_reporting_code"
|
||
value="<?php if($w_nine->exempt_reporting_code){echo $w_nine->exempt_reporting_code;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<label for="list_account_no" class="col-form-label"><?php echo lang("7. List account number(s) here (optional)");?></label>
|
||
<input type="text" class="form-control" id="list_account_no" name="list_account_no"
|
||
value="<?php if($w_nine->list_account_no){echo $w_nine->list_account_no;}?>">
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<label for="requester_optional_name_address" class="col-form-label"><?php echo lang("Requester’s name and address (optional)");?></label>
|
||
<input type="text" class="form-control" id="requester_optional_name_address" name="requester_optional_name_address"
|
||
value="<?php if($w_nine->requester_optional_name_address){echo $w_nine->requester_optional_name_address;}?>">
|
||
</div>
|
||
<div class="col-lg-12 form-group">
|
||
<label for="emp_id" class="col-form-label"><?php echo lang("Employer Identification number");?></label>
|
||
<input type="text" class="form-control" id="emp_id" name="emp_id"
|
||
value="<?php if($w_nine->emp_id){echo $w_nine->emp_id;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group mt-2 center-y">
|
||
<button type="submit" class="btn btn-primary" id="submitBtn" class="btn btn-info">
|
||
<?php echo lang('Update'); ?>
|
||
</button>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
<div id="card_5">
|
||
<form role="form" action="<?php echo base_url()?>CaregiversDashboard/ExtraPdfInfo" method="post" enctype="multipart/form-data" name="newGenInfo" class="disclosure-signature-extra-info-form">
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="caregiverId" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<input type="hidden" name="documentType" value="DirectDiposit">
|
||
<input type="hidden" class="get-class" value="dir-depo-tab">
|
||
|
||
<?php $dir_depo=json_decode($extraPdfInfo['DirectDiposit']);?>
|
||
<div class="form-group">
|
||
<label for="other_details" class="col-form-label">
|
||
<h4 style="font-weight:bold;">
|
||
<?php echo lang("Account #1");?>
|
||
</h4>
|
||
</label>
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<label for="jhgjkkjh" class="col-form-label"><?php echo lang("Account #1 Type (check one):");?></label> 
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="account1_type" id="account1_type_checking" value="checking"
|
||
<?php if($dir_depo->account1_type){if($dir_depo->account1_type=="checking"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="account1_type_checking"> Checking</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="account1_type" id="account1_type_saving" value="saving"
|
||
<?php if($dir_depo->account1_type){if($dir_depo->account1_type=="saving"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="account1_type_saving"> Savings</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label for="account1_employee_bank_name" class="col-form-label"><?php echo lang("Employee Bank Name");?></label>
|
||
<input type="text" class="form-control" id="account1_employee_bank_name" name="account1_employee_bank_name"
|
||
value="<?php if($dir_depo->account1_employee_bank_name){echo $dir_depo->account1_employee_bank_name;}?>">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label for="account1_bank_routing_account" class="col-form-label"><?php echo lang("Bank Routing# (ABA#) Account# ");?></label>
|
||
<input type="text" class="form-control" id="account1_bank_routing_account" name="account1_bank_routing_account"
|
||
value="<?php if($dir_depo->account1_bank_routing_account){echo $dir_depo->account1_bank_routing_account;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group">
|
||
<label for="other_details" class="col-form-label">
|
||
<h4 style="font-weight:bold;">
|
||
<?php echo lang("Account #2 (remainder to be deposited to this account)");?>
|
||
</h4>
|
||
</label>
|
||
<div class="row">
|
||
<div class="col-lg-12 form-group">
|
||
<label for="jhgjkkjh" class="col-form-label"><?php echo lang("Account #2 Type (check one):");?></label> 
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="account2_type" id="account2_type_checking" value="checking"
|
||
<?php if($dir_depo->account2_type){if($dir_depo->account2_type=="checking"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="account2_type_checking"> Checking</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="account2_type" id="account2_type_saving" value="saving"
|
||
<?php if($dir_depo->account2_type){if($dir_depo->account2_type=="saving"){echo "checked";}}?>>
|
||
<label class="form-check-label" for="account2_type_saving"> Savings</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label for="account2_employee_bank_name" class="col-form-label"><?php echo lang("Employee Bank Name");?></label>
|
||
<input type="text" class="form-control" id="account2_employee_bank_name" name="account2_employee_bank_name"
|
||
value="<?php if($dir_depo->account2_employee_bank_name){echo $dir_depo->account2_employee_bank_name;}?>">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label for="account2_bank_routing_account" class="col-form-label"><?php echo lang("Bank Routing# (ABA#) Account# ");?></label>
|
||
<input type="text" class="form-control" id="account2_bank_routing_account" name="account2_bank_routing_account"
|
||
value="<?php if($dir_depo->account2_bank_routing_account){echo $dir_depo->account2_bank_routing_account;}?>">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<hr/>
|
||
<div class="form-group mt-2 center-y">
|
||
<button type="submit" class="btn btn-primary" id="submitBtn" class="btn btn-info">
|
||
<?php echo lang('Update'); ?>
|
||
</button>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!-- Modal box for filling information in pdf -->
|
||
|
||
|
||
<!-- Scripts for Disclosure tabs content section -->
|
||
<script type="text/javascript">
|
||
$(document).ready(function(){
|
||
$(".container-next").hide();
|
||
});
|
||
</script>
|
||
<script type="text/javascript">
|
||
$(document).ready(function(){
|
||
$(".disclosure-signature-signform").submit(function(e) {
|
||
e.preventDefault(); // avoid to execute the actual submit of the form.
|
||
var form = $(this);
|
||
var url = form.attr('action');
|
||
|
||
// for refreshing the pdf files
|
||
var className=$(this).children("input#tab_specific_id").val();
|
||
var target=$(".pdf-form-container-"+className).children(".pdf-form-"+className);
|
||
var embed=target.children("embed");
|
||
var src=embed.attr("src");
|
||
// alert(src);
|
||
// for refreshing the pdf files
|
||
|
||
$.ajax({
|
||
type: "POST",
|
||
url: url,
|
||
data: form.serialize(), // serializes the form's elements.
|
||
beforeSend : function(){
|
||
$(".loading-content").show();
|
||
$(".disclosure-pdf-container,.disclosure-pdf-tabs").hide();
|
||
},
|
||
success: function(data)
|
||
{
|
||
if(data){
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'success',
|
||
title: 'Signature successfully saved.',
|
||
showConfirmButton: false,
|
||
timer: 2500
|
||
});
|
||
}
|
||
else{
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'error',
|
||
title: 'Some error occure please try again.',
|
||
showConfirmButton: false,
|
||
timer: 2500
|
||
});
|
||
}
|
||
$(".loading-content").hide();
|
||
$(".disclosure-pdf-container,.disclosure-pdf-tabs").show();
|
||
|
||
// for refreshing the pdf files
|
||
var emb='<embed src="'+src+'" height="600px" width="100%"></embed>';
|
||
target.html(emb);
|
||
// for refreshing the pdf files
|
||
|
||
//hide extra info edit modal calling button
|
||
$(".extra-info-pdf-"+className).hide();
|
||
//hide extra info edit modal calling button
|
||
|
||
}
|
||
});
|
||
});
|
||
});
|
||
</script>
|
||
<script>
|
||
function ajaxforFinalSubmit()
|
||
{
|
||
// alert('<?=base_url()?>CaregiversDashboard/getFinalSubmitStatus?qualification_type=<?php echo $q_e_type->qualification_type; ?>'+'&employee_type=<?php echo $q_e_type->employee_type; ?>'+'&caregiverId=<?php echo $nurse->id; ?>');
|
||
$.ajax({
|
||
url:'<?=base_url()?>CaregiversDashboard/getFinalSubmitStatus?qualification_type=<?php echo $q_e_type->qualification_type; ?>'+'&employee_type=<?php echo $q_e_type->employee_type; ?>'+'&caregiverId=<?php echo $nurse->id; ?>',
|
||
type :'GET',
|
||
dataType: "json",
|
||
beforeSend: function() {
|
||
$("#finalSubif").hide();
|
||
$("#finalSubelse").show();
|
||
},
|
||
success:function(data){
|
||
console.log(data);
|
||
if(data==1)
|
||
{
|
||
$("#finalSubif").show();
|
||
$("#finalSubelse").hide();
|
||
}
|
||
else
|
||
{
|
||
$("#finalSubif").hide();
|
||
$("#finalSubelse").show();
|
||
}
|
||
}
|
||
});
|
||
|
||
}
|
||
</script>
|
||
<script type="text/javascript">
|
||
$(document).ready(function(){
|
||
ajaxforFinalSubmit()
|
||
var type=$("#cgType").val();
|
||
// $(".next_app_emp_tab").click(function(){
|
||
// $(".disc_tab").removeClass('active in show');
|
||
// $(".doc_tab_top").removeClass('active');
|
||
// if(type=="A"){
|
||
// $("#con-agree-tab-dsc").addClass('active in show');
|
||
// $("#con-agree-tab").addClass('active');
|
||
// }if(type=="B"){
|
||
// $("#con-agree-tab-dsc").addClass('active in show');
|
||
// $("#con-agree-tab").addClass('active');
|
||
// }if(type=="C"){
|
||
// $("#bak-check-tab-dsc").addClass('active in show');
|
||
// $("#bak-check-tab").addClass('active');
|
||
// }if(type=="D"){
|
||
// $("#bak-check-tab-dsc").addClass('active in show');
|
||
// $("#bak-check-tab").addClass('active');
|
||
// }
|
||
// });
|
||
$(".next_app_emp_tab").click(function(){
|
||
var selector=$(".discloser_tab.active").next('li');
|
||
$(".discloser_tab").removeClass('active');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$(".disc_tab").removeClass('active in show');
|
||
selector.addClass('active');
|
||
var next_active_id='#'+selector.find('a').attr('id')+'-dsc';
|
||
$(next_active_id).addClass('active in show');
|
||
var next_active_tab='#'+selector.find('a').attr('id');
|
||
$(next_active_tab).addClass('active');
|
||
});
|
||
// $(".next_con_agree_tab").click(function(){
|
||
// $(".disc_tab").removeClass('active in show');
|
||
// $(".doc_tab_top").removeClass('active');
|
||
// if(type=="A"){
|
||
// $("#bak-check-tab-dsc").addClass('active in show');
|
||
// $("#bak-check-tab").addClass('active');
|
||
// }if(type=="B"){
|
||
// $("#bak-check-tab-dsc").addClass('active in show');
|
||
// $("#bak-check-tab").addClass('active');
|
||
// }
|
||
// });
|
||
$(".next_con_agree_tab").click(function(){
|
||
var selector=$(".discloser_tab.active").next('li');
|
||
$(".discloser_tab").removeClass('active');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$(".disc_tab").removeClass('active in show');
|
||
selector.addClass('active');
|
||
var next_active_id='#'+selector.find('a').attr('id')+'-dsc';
|
||
$(next_active_id).addClass('active in show');
|
||
var next_active_tab='#'+selector.find('a').attr('id');
|
||
$(next_active_tab).addClass('active');
|
||
});
|
||
// $(".next_bak_check_tab").click(function(){
|
||
// $(".disc_tab").removeClass('active in show');
|
||
// $(".doc_tab_top").removeClass('active');
|
||
// if(type=="A"){
|
||
// $("#i-nine-tab-dsc").addClass('active in show');
|
||
// $("#i-nine-tab").addClass('active');
|
||
// }if(type=="B"){
|
||
// $("#i-nine-tab-dsc").addClass('active in show');
|
||
// $("#i-nine-tab").addClass('active');
|
||
// }if(type=="C"){
|
||
// $("#i-nine-tab-dsc").addClass('active in show');
|
||
// $("#i-nine-tab").addClass('active');
|
||
// }if(type=="D"){
|
||
// $("#i-nine-tab-dsc").addClass('active in show');
|
||
// $("#i-nine-tab").addClass('active');
|
||
// }
|
||
// });
|
||
$(".next_bak_check_tab").click(function(){
|
||
var selector=$(".discloser_tab.active").next('li');
|
||
$(".discloser_tab").removeClass('active');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$(".disc_tab").removeClass('active in show');
|
||
selector.addClass('active');
|
||
var next_active_id='#'+selector.find('a').attr('id')+'-dsc';
|
||
$(next_active_id).addClass('active in show');
|
||
var next_active_tab='#'+selector.find('a').attr('id');
|
||
$(next_active_tab).addClass('active');
|
||
ajaxforFinalSubmit();
|
||
});
|
||
// $(".next_i_nine_tab").click(function(){
|
||
// $(".disc_tab").removeClass('active in show');
|
||
// $(".doc_tab_top").removeClass('active');
|
||
// if(type=="A"){
|
||
// $("#w-nine-tab-dsc").addClass('active in show');
|
||
// $("#w-nine-tab").addClass('active');
|
||
// }if(type=="B"){
|
||
// $("#w-nine-tab-dsc").addClass('active in show');
|
||
// $("#w-nine-tab").addClass('active');
|
||
// }if(type=="C"){
|
||
// $("#dir-depo-tab-dsc").addClass('active in show');
|
||
// $("#dir-depo-tab").addClass('active');
|
||
// }if(type=="D"){
|
||
// $("#dir-depo-tab-dsc").addClass('active in show');
|
||
// $("#dir-depo-tab").addClass('active');
|
||
// }
|
||
// });
|
||
$(".next_i_nine_tab").click(function(){
|
||
var selector=$(".discloser_tab.active").next('li');
|
||
$(".discloser_tab").removeClass('active');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$(".disc_tab").removeClass('active in show');
|
||
selector.addClass('active');
|
||
var next_active_id='#'+selector.find('a').attr('id')+'-dsc';
|
||
$(next_active_id).addClass('active in show');
|
||
var next_active_tab='#'+selector.find('a').attr('id');
|
||
$(next_active_tab).addClass('active');
|
||
});
|
||
// $(".next_w_nine_tab").click(function(){
|
||
// $(".disc_tab").removeClass('active in show');
|
||
// $(".doc_tab_top").removeClass('active');
|
||
// if(type=="A"){
|
||
// $("#dir-depo-tab-dsc").addClass('active in show');
|
||
// $("#dir-depo-tab").addClass('active');
|
||
// }if(type=="B"){
|
||
// $("#dir-depo-tab-dsc").addClass('active in show');
|
||
// $("#dir-depo-tab").addClass('active');
|
||
// }
|
||
// });
|
||
$(".next_w_nine_tab").click(function(){
|
||
var selector=$(".discloser_tab.active").next('li');
|
||
$(".discloser_tab").removeClass('active');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$(".disc_tab").removeClass('active in show');
|
||
selector.addClass('active');
|
||
var next_active_id='#'+selector.find('a').attr('id')+'-dsc';
|
||
$(next_active_id).addClass('active in show');
|
||
var next_active_tab='#'+selector.find('a').attr('id');
|
||
$(next_active_tab).addClass('active');
|
||
});
|
||
// $(".next_dir_depo_tab").click(function(){
|
||
// if(type=="D"){
|
||
// $(".disc_tab").removeClass('active in show');
|
||
// $(".doc_tab_top").removeClass('active');
|
||
|
||
// $("#doh-102-tab-dsc").addClass('active in show');
|
||
// $("#doh-102-tab").addClass('active');
|
||
// }
|
||
// });
|
||
$(".next_dir_depo_tab").click(function(){
|
||
var selector=$(".discloser_tab.active").next('li');
|
||
$(".discloser_tab").removeClass('active');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$(".disc_tab").removeClass('active in show');
|
||
selector.addClass('active');
|
||
var next_active_id='#'+selector.find('a').attr('id')+'-dsc';
|
||
$(next_active_id).addClass('active in show');
|
||
var next_active_tab='#'+selector.find('a').attr('id');
|
||
$(next_active_tab).addClass('active');
|
||
});
|
||
// $(".next_doh_102_tab").click(function(){
|
||
// $(".disc_tab").removeClass('active in show');
|
||
// $(".doc_tab_top").removeClass('active');
|
||
// if(type=="D"){
|
||
// $("#doh-103-tab-dsc").addClass('active in show');
|
||
// $("#doh-103-tab").addClass('active');
|
||
// }
|
||
// });
|
||
$(".next_doh_102_tab").click(function(){
|
||
var selector=$(".discloser_tab.active").next('li');
|
||
$(".discloser_tab").removeClass('active');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$(".disc_tab").removeClass('active in show');
|
||
selector.addClass('active');
|
||
var next_active_id='#'+selector.find('a').attr('id')+'-dsc';
|
||
$(next_active_id).addClass('active in show');
|
||
var next_active_tab='#'+selector.find('a').attr('id');
|
||
$(next_active_tab).addClass('active');
|
||
});
|
||
// $(".next_doh_103_tab").click(function(){
|
||
// $(".disc_tab").removeClass('active in show');
|
||
// $(".doc_tab_top").removeClass('active');
|
||
// if(type=="D"){
|
||
// $("#reg-rel-tab-dsc").addClass('active in show');
|
||
// $("#reg-rel-tab").addClass('active');
|
||
// }
|
||
// });
|
||
$(".next_doh_103_tab").click(function(){
|
||
var selector=$(".discloser_tab.active").next('li');
|
||
$(".discloser_tab").removeClass('active');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$(".disc_tab").removeClass('active in show');
|
||
selector.addClass('active');
|
||
var next_active_id='#'+selector.find('a').attr('id')+'-dsc';
|
||
$(next_active_id).addClass('active in show');
|
||
var next_active_tab='#'+selector.find('a').attr('id');
|
||
$(next_active_tab).addClass('active');
|
||
});
|
||
|
||
});
|
||
</script>
|
||
<script type="text/javascript">
|
||
$(document).ready(function(){
|
||
$(".loading-content").hide();
|
||
$("#disclouser_sign_ancore").click(function(){
|
||
var cg_id=$("#cg_id").val();
|
||
var tabStat=<?php echo $tabstatus['doc']?>;
|
||
if(tabStat==1 || tabStat==2){
|
||
hitDisclosureAjax(cg_id);
|
||
}
|
||
});
|
||
});
|
||
</script>
|
||
<script type="text/javascript">
|
||
function hitDisclosureAjax(cg_id){
|
||
$.ajax({
|
||
url:"<?php echo base_url()?>CaregiversDashboard/disclosureAjax",
|
||
type:"GET",
|
||
data:{cg_id:cg_id},
|
||
// dataType: "json",
|
||
beforeSend : function(){
|
||
$(".loading-content").show();
|
||
$(".disclosure-pdf-container,.disclosure-pdf-tabs").hide();
|
||
|
||
//loading timer
|
||
$(".timeCount-disclosure-next").html("Please Wait We Are Creating Files...");
|
||
$(".timeCount-disclosure").show();
|
||
var targetTime=23;
|
||
var i=0;
|
||
var x = setInterval(function(){
|
||
var distance = targetTime-i;
|
||
$(".timeCount-disclosure").html(distance+"s");
|
||
if(distance<=0){
|
||
clearInterval(x);
|
||
$(".timeCount-disclosure-next").html("Files Are Ready Almost....");
|
||
$(".timeCount-disclosure").hide();
|
||
}
|
||
i++;
|
||
}, 1000);
|
||
//loading timer
|
||
|
||
},
|
||
success:function(data){
|
||
$(".loading-content").hide();
|
||
$(".disclosure-pdf-container,.disclosure-pdf-tabs").show();
|
||
}
|
||
});
|
||
}
|
||
</script>
|
||
<!-- Ending of Scripts for Disclosure tabs content section -->
|
||
|
||
<!-- Scripts for fill information madal box cards -->
|
||
<script type="text/javascript">
|
||
$('#infoModal').on('show.bs.modal', function (event) {
|
||
var button = $(event.relatedTarget);
|
||
var recipient = button.data('whatever');
|
||
var modal = $(this);
|
||
modal.find('.modal-title').text('New message to ' + recipient);
|
||
modal.find('.modal-body input').val(recipient);
|
||
});
|
||
$(document).ready(function(){
|
||
$("#card_1_edit").click(function(){
|
||
$("#card_1").show();
|
||
$("#card_1").siblings().hide();
|
||
});
|
||
$("#card_2_edit").click(function(){
|
||
$("#card_2").show();
|
||
$("#card_2").siblings().hide();
|
||
});
|
||
$("#card_3_edit").click(function(){
|
||
$("#card_3").show();
|
||
$("#card_3").siblings().hide();
|
||
});
|
||
$("#card_4_edit").click(function(){
|
||
$("#card_4").show();
|
||
$("#card_4").siblings().hide();
|
||
});
|
||
$("#card_5_edit").click(function(){
|
||
$("#card_5").show();
|
||
$("#card_5").siblings().hide();
|
||
});
|
||
$("#card_6_edit").click(function(){
|
||
$("#card_6").show();
|
||
$("#card_6").siblings().hide();
|
||
});
|
||
});
|
||
</script>
|
||
<!-- Scripts for fill information madal box cards -->
|
||
|
||
<script type="text/javascript">
|
||
$(document).ready(function(){
|
||
$(".disclosure-signature-extra-info-form").submit(function(e) {
|
||
e.preventDefault(); // avoid to execute the actual submit of the form.
|
||
var form = $(this);
|
||
var url = form.attr('action');
|
||
|
||
var className=$(this).children("input.get-class").val();
|
||
// alert(className);
|
||
|
||
$.ajax({
|
||
type: "POST",
|
||
url: url,
|
||
data: form.serialize(), // serializes the form's elements.
|
||
beforeSend : function(){
|
||
|
||
},
|
||
success: function(data)
|
||
{
|
||
if(data){
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'success',
|
||
title: 'New information added successfully',
|
||
showConfirmButton: false,
|
||
timer: 2500
|
||
});
|
||
}
|
||
else{
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'error',
|
||
title: 'Some error occure please try again.',
|
||
showConfirmButton: false,
|
||
timer: 2500
|
||
});
|
||
}
|
||
$("#infoModal").modal('hide');
|
||
// var className="w-nine-tab";
|
||
|
||
var src=$(".pdf-form-"+className).children("embed").attr("src");
|
||
var emb='<embed src="'+src+'" height="600px" width="100%"></embed>';
|
||
$(".pdf-form-"+className).html(emb);
|
||
}
|
||
});
|
||
});
|
||
});
|
||
</script>
|
||
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
var today = new Date();
|
||
var dd = today.getDate();
|
||
var mm = today.getMonth()+1; //January is 0!
|
||
var yyyy = today.getFullYear();
|
||
if(dd<10){
|
||
dd='0'+dd
|
||
}
|
||
if(mm<10){
|
||
mm='0'+mm
|
||
}
|
||
|
||
today = yyyy+'-'+mm+'-'+dd;
|
||
$(".not_future").attr("max", today);
|
||
})
|
||
</script>
|
||
|
||
<?php
|
||
}
|
||
?>
|
||
|
||
|
||
|
||
<!-- ============================================================================================= -->
|
||
|
||
|
||
<?php
|
||
if($userType->group_id == "6")
|
||
{
|
||
/*
|
||
?>
|
||
<ul class="nav nav-tabs nav-linetriangle no-hover-bg" id="myTab" role="tablist" style="border: none; margin-bottom: 20px;">
|
||
<li class="nav-item disclouser_tab">
|
||
<a class="nav-link doc_tab_top active" id="basic-tab" data-toggle="tab" href="#basic-tab-dsc" role="tab" aria-selected="true" style=" cursor: pointer;">1</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="exp-tab" data-toggle="tab" href="#exp-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;"> <?php //if($progress->form2 < 5){ ?> <?php //} ?>2</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="emp-tab" data-toggle="tab" href="#emp-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;"> <?php //if($progress->form2 < 5){ ?> <?php //} ?>3</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="phy-tab" data-toggle="tab" href="#phy-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;"> <?php //if($progress->form2 < 5){ ?> <?php //} ?>4</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="documents-tab" data-toggle="tab" href="#documents-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;"> <?php //if($progress->form2 < 5){ ?> <?php //} ?>5</a>
|
||
</li>
|
||
<li class="nav-item disclouser_tab" >
|
||
<a class="nav-link doc_tab_top" id="disclouser-tab" data-toggle="tab" href="#disclouser-tab-dsc" role="tab" aria-selected="false" style="cursor: pointer;"> <?php //if($progress->form2 < 5){ ?> <?php //} ?>6</a>
|
||
</li>
|
||
</ul>
|
||
|
||
<div class="tab-content" id="myTabContent">
|
||
<div class="tab-pane disc_tab fade active in show" id="basic-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('basic_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation signForm" >
|
||
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="BasicDoc">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<div class="row">
|
||
<div class="col-lg-12">
|
||
<!-- <iframe style="width: 100%;height:1000px; " src="<?php //echo base_url()."CaregiversDashboard/HOME_CARE_REGISTRY_RELEASE_FORM"; ?>" >"></iframe> -->
|
||
<?php echo $homecareRegitryRelease;?>
|
||
<!-- <iframe srcdoc="<p>Hello world!</p>" >"></iframe> -->
|
||
</div>
|
||
<input type="hidden" name="signature" id="signature_final_field_basic_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_basic_tab" value="">
|
||
<textarea name="rawForm" style="display: none"><?php echo $homecareRegitryRelease;?></textarea>
|
||
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('basic_tab')" class="badge badge-info">Erasess</span></label>
|
||
<canvas class="form-control" id="signature_canvas_basic_tab" width="400" height="200" ></canvas>
|
||
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_basic_tab" id="signature_field_date_basic_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" required>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="basic_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_basic_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" id="signature_field_date_write_basic_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" disabled="">
|
||
</div>
|
||
</div>
|
||
<div class="row" >
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" id="next_basic_tab" class="btn btn-info "><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<div class="tab-pane disc_tab fade" id="exp-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('emp_skill')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation signForm" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="EmpSkill">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<div class="row">
|
||
<div class="col-lg-12">
|
||
<?php echo $homecareHealthAid; ?>
|
||
</div>
|
||
<input type="hidden" name="signature" id="signature_final_field_emp_skill" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_emp_skill" value="">
|
||
<textarea name="rawForm" style="display: none"><?php echo $homecareHealthAid;?></textarea>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('emp_skill')" class="badge badge-info">Erase</span></label>
|
||
<canvas class="form-control" id="signature_canvas_emp_skill" width="400" height="200" ></canvas>
|
||
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_emp_skill" id="signature_field_date_emp_skill" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" required>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="emp_skill" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_emp_skill" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_write_emp_skill" id="signature_field_date_write_emp_skill" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" disabled="">
|
||
</div>
|
||
</div>
|
||
<div class="row" >
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" id="next_EmpSkill_tab" class="btn btn-info "><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<div class="tab-pane disc_tab fade" id="emp-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('emp_hist')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation signForm" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="EmpHist">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<div class="col-lg-12">
|
||
<?php echo $Professional_Profile; ?>
|
||
</div>
|
||
<textarea name="rawForm" style="display: none"><?php echo $Professional_Profile;?></textarea>
|
||
|
||
<div class="row">
|
||
<input type="hidden" name="signature" id="signature_final_field_emp_hist" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_emp_hist" value="">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('emp_hist')" class="badge badge-info">Erase</span></label>
|
||
<canvas class="form-control" id="signature_canvas_emp_hist" width="400" height="200" ></canvas>
|
||
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_emp_hist" id="signature_field_date_emp_hist" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" required>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="emp_hist" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_emp_hist" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_write_emp_hist" id="signature_field_date_write_emp_hist" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" disabled="">
|
||
</div>
|
||
</div>
|
||
<div class="row" >
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" id="next_EmpHist_tab" class="btn btn-info "><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<div class="tab-pane disc_tab fade" id="phy-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('phy_info')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation signForm" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="PhyInfo">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<div class="row">
|
||
<div class="col-lg-12">
|
||
<?php echo $annual_physical_exam_form; ?>
|
||
</div>
|
||
<input type="hidden" name="signature" id="signature_final_field_phy_info" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_phy_info" value="">
|
||
<textarea name="rawForm" style="display: none"><?php echo $annual_physical_exam_form;?></textarea>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('phy_info')" class="badge badge-info">Erase</span></label>
|
||
<canvas class="form-control" id="signature_canvas_phy_info" width="400" height="200" ></canvas>
|
||
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_phy_info" id="signature_field_date_phy_info" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" required>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="phy_info" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_phy_info" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_write_phy_info" id="signature_field_date_write_phy_info" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" disabled="">
|
||
</div>
|
||
</div>
|
||
<div class="row" >
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" id="next_PhyInfo_tab" class="btn btn-info "><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<div class="tab-pane disc_tab fade" id="documents-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('doc_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation signForm" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="documentType" value="DocTab">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<div class="row">
|
||
<div class="col-lg-12">
|
||
<?php echo $Employee_Health; ?>
|
||
</div>
|
||
<input type="hidden" name="signature" id="signature_final_field_doc_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_doc_tab" value="">
|
||
<textarea name="rawForm" style="display: none"><?php echo $Employee_Health;?></textarea>
|
||
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('doc_tab')" class="badge badge-info">Erase</span></label>
|
||
<canvas class="form-control" id="signature_canvas_doc_tab" width="400" height="200" ></canvas>
|
||
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_doc_tab" id="signature_field_date_doc_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" required>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="doc_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_doc_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_write_doc_tab" id="signature_field_date_write_doc_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" disabled="">
|
||
</div>
|
||
</div>
|
||
<div class="row" >
|
||
<div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" id="next_DocTab_tab" class="btn btn-info "><?php echo lang('Save'); ?></button>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$("#next_basic_tab").click(function(){
|
||
$(".disc_tab").removeClass('active in show');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$("#exp-tab-dsc").addClass('active in show');
|
||
$("#exp-tab").addClass('active');
|
||
})
|
||
|
||
$("#next_EmpSkill_tab").click(function(){
|
||
$(".disc_tab").removeClass('active in show');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$("#emp-tab-dsc").addClass('active in show');
|
||
$("#emp-tab").addClass('active');
|
||
})
|
||
|
||
$("#next_EmpHist_tab").click(function(){
|
||
$(".disc_tab").removeClass('active in show');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$("#phy-tab-dsc").addClass('active in show');
|
||
$("#phy-tab").addClass('active');
|
||
})
|
||
|
||
$("#next_PhyInfo_tab").click(function(){
|
||
$(".disc_tab").removeClass('active in show');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$("#documents-tab-dsc").addClass('active in show');
|
||
$("#documents-tab").addClass('active');
|
||
})
|
||
|
||
$("#next_DocTab_tab").click(function(){
|
||
$(".disc_tab").removeClass('active in show');
|
||
$(".doc_tab_top").removeClass('active');
|
||
$("#disclouser-tab-dsc").addClass('active in show');
|
||
$("#disclouser-tab").addClass('active');
|
||
})
|
||
})
|
||
</script>
|
||
|
||
<div class="tab-pane fade" id="disclouser-tab-dsc" role="tabpanel" aria-labelledby="" style="padding: 20px; border: 1px solid #ccc; margin-bottom: 15px; border-radius: 5px;">
|
||
|
||
<form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/send_for_approval" method="post" onsubmit="return validateFormSig('dclsr_tab')" enctype="multipart/form-data" class="needs-validation" >
|
||
<input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" />
|
||
<input type="hidden" name="form_tab_status" value="12">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->caregiver_table_id)) echo $nurse->caregiver_table_id; ?>">
|
||
<input type="hidden" name="form_status" value="12">
|
||
<div class="row">
|
||
<input type="hidden" name="ion_id" value="<?php echo $nurse->ion_user_id; ?>">
|
||
<?php if($nurse->qualification_type==4 || $nurse->qualification_type==5){ ?>
|
||
<div class="col-md-12">
|
||
<p>Dear <?=$nurse->fname?> <?=$nurse->mid_name?> <?=$nurse->lname?> </p>
|
||
<p>
|
||
We are an equal employment opportunity employer. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability or any other status that may be protected by Federal, State or local law. I understand that I am required by state law and will be under contractual obligation to provide WECURO, INC. withupdated (upon or before the date of expiration) documents for current and continued employment. In addition, I am required to fulfill WECURO INC.’s In-service Education Program(s) annually in a timely manner. Please complete the application in its entirety and be as accurate as possible prior to your first assignment.
|
||
</p>
|
||
<p><strong>Requirements For Employment includes the following:</strong></p>
|
||
<ul>
|
||
<li>Professional Profile</li>
|
||
<li>Record of Employment</li>
|
||
<li>Skills Checklist</li>
|
||
<li>NYS Nursing Registration Certificate (Every 3 years)</li>
|
||
<li>Malpractice Insurance Policy (Annual)</li>
|
||
<li>CPR Card (Every 2 years)</li>
|
||
<li>Annual Physical Health Assessment</li>
|
||
<ul>
|
||
<li>PPD/ Mantoux Skin Test for TB OR</li>
|
||
<li>Chest X-Ray for TB (if history of + PPD every 3 years)</li>
|
||
<li>Rubeola and Rubella Titre</li>
|
||
<li>Drug Screen (Annual)</li>
|
||
</ul>
|
||
<li>Medical History/Tuberculosis Questionnaire</li>
|
||
<li>Employee Hepatitis B Vaccine Waiver</li>
|
||
<li>Employee Resume &2 References</li>
|
||
<li>NPI Number</li>
|
||
<li>Social Security Card &Picture ID or Passport/Green Card/Work Permit</li>
|
||
<li>Authorization Release Form</li>
|
||
</ul>
|
||
</div>
|
||
<?php } ?>
|
||
<?php if($nurse->qualification_type==6 || $nurse->qualification_type==7){ ?>
|
||
<div class="col-md-12">
|
||
<p>Dear <?=$nurse->fname?> <?=$nurse->mid_name?> <?=$nurse->lname?> </p>
|
||
<p>
|
||
We are an equal employment opportunity employer. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability or any other status that may be protected by Federal, State or local law. I understand that I am required by state law and will be under contractual obligation to provide WECURO, INC. withupdated (upon or before the date of expiration) documents for current and continued employment. In addition, I am required to fulfill WECURO INC.’s In-service Education Program(s) annually in a timely manner. Please complete the application in its entirety and be as accurate as possible prior to your first assignment.
|
||
</p>
|
||
<p><strong>Requirements For Employment includes the following:</strong></p>
|
||
<ul>
|
||
<li>Professional Profile</li>
|
||
<li>Record of Employment</li>
|
||
<li>Skills Checklist</li>
|
||
<li>Annual Physical Health Assessment</li>
|
||
<ul>
|
||
<li>PPD/ Mantoux Skin Test for TB OR</li>
|
||
<li>Chest X-Ray for TB (if history of + PPD every 3 years)</li>
|
||
<li>Rubeola and Rubella Titre</li>
|
||
<li>Drug Screen (Annual)</li>
|
||
</ul>
|
||
<li>Medical History/Tuberculosis Questionnaire</li>
|
||
<li>Employee Hepatitis B Vaccine Waiver</li>
|
||
<li>Employee Resume &2 References</li>
|
||
<li>Social Security Card &Picture ID or Passport/Green Card/Work Permit</li>
|
||
<li>Acknowledgement and Consent Fom1 for Fingerprinting and Disclosure of Criminal History Record</li>
|
||
<li>Request for Criminal History Record Check</li>
|
||
<li>Authorization Release Form</li>
|
||
<li>Home Care Registry Release Form</li>
|
||
</ul>
|
||
</div>
|
||
<?php } ?>
|
||
<div class="col-md-12">
|
||
<p class="text-justify">Please read each statement carefully before signing and submitting. </p>
|
||
<p class="text-justify"> I hereby certify that all the information provided by me in this application (or any other accompanying or required documents) is true and complete to the best of my knowledge. I understand that the falsification, misrepresentation, or omission of any facts may be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. </p>
|
||
<p class="text-justify"> I hereby consent and understand that I may be required to submit to a pre-employment medical examination, a pre-and/or post-employment drug screen and background check as a condition of employment if required. I understand that unsatisfactory results, refusal to cooperate with, or any attempt to affect the results of these pre/post-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed. I hereby authorize any and all former employers, references, schools, courts, and any others whether listed or not to provide relevant information that may be useful in making a hiring decision. I release all parties involved from any and all legal liability in providing such information. </p>
|
||
<p class="text-justify"> I understand that submission of an application does not guarantee employment. I further understand that this application, verbal statements, made by management or subsequent employment does not create an express or implied contract of employment, nor guarantee employment for any definite period of time. I further understand that should an offer of employment be extended that EMPLOYMENT IS AT WILL for no specified duration and may be terminated by either the company or myself at any time with our without cause or notice. I understand that no representative of company except the President has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President of the company. </p>
|
||
<p class="text-justify"> The statements made in this application are true to the best of my knowledge. I understand that any falsification will be the basis for disqualification of employment or termination of services. I authorize WECURO, INC. to verify the information I have provided and to contact past employers and references concerning my ability, character and employment record. I release all such persons from liability for furnishing said information. I authorize WECURO, INC, as my employer, to release any medical and background information, which may be relevant to my assignment to its client facilities. By submitting this application to WECURO, INC, I authorize release of this information to all other affiliates of the company and I acknowledge and agree that they may contact me using facsimile or any other means. Nothing contained in this employment application, or in the granting of an interview, is intended to create an employment contract between WECURO, INC and the applicant for either employment or for providing of any benefit. All offers of employment are made conditional upon the applicant’s proving employment eligibility and identity in accordance with the Immigration Reform and Control Act of 1986. </p>
|
||
<p class="text-justify"> I herby attest that I have the necessary experience to work with patients of the conditions I have selected and that I am willing to work with patients who have those types of conditions. </p>
|
||
</div>
|
||
|
||
</div>
|
||
<!-- </form> -->
|
||
<!-- <form role="form" action="<?php echo base_url(); ?>CaregiversDashboard/saveDocumentSignature" onsubmit="return validateFormSig('dclsr_tab')" id="caregiverBasicForm" method="post" enctype="multipart/form-data" class="needs-validation signForm" > -->
|
||
<!-- <input type="hidden" name="<?php echo $this->security->get_csrf_token_name(); ?>" value="<?php echo $this->security->get_csrf_hash(); ?>" /> -->
|
||
<input type="hidden" name="documentType" value="DisclosureTab">
|
||
<input type="hidden" name="id" id="caregiver_id" value="<?php if (!empty($nurse->id)) echo $nurse->id; ?>">
|
||
<div class="row">
|
||
<input type="hidden" name="signature" id="signature_final_field_dclsr_tab" value="">
|
||
<input type="hidden" name="date" id="signature_final_date_dclsr_tab" value="">
|
||
<div class="col-lg-6 form-group">
|
||
<label>Signature</label>
|
||
<label class="pull-right"><span style="cursor: pointer" onclick="clearCanvas('dclsr_tab')" class="badge badge-info">Erase</span></label>
|
||
<canvas class="form-control" id="signature_canvas_dclsr_tab" width="400" height="200" ></canvas>
|
||
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_dclsr_tab" id="signature_field_date_dclsr_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" required>
|
||
</div>
|
||
</div>
|
||
<hr>
|
||
<div class="row">
|
||
<div class="col-lg-6 form-group">
|
||
<input class="sigorwrite" type="checkbox" name="signature_type" id="dclsr_tab" value="write">
|
||
<label><b>Or Type Your Name</b></label>
|
||
<input type="text" class="form-control" id="signature_field_write_dclsr_tab" value="" disabled="">
|
||
</div>
|
||
<div class="col-lg-6 form-group">
|
||
<label>Date</label>
|
||
<?php $now_time=date('Y-m-d'); ?>
|
||
<input type="datetime" class="form-control" name="signature_field_date_write_dclsr_tab" id="signature_field_date_write_dclsr_tab" value="<?php echo date('Y-m-d'); ?> <?php echo date('H:i'); ?>" disabled="">
|
||
</div>
|
||
</div>
|
||
<div class="row" >
|
||
<!-- <div class="form-group col-md-12" style="padding: 20px;">
|
||
<button type="submit" name="submit" class="btn btn-info "><?php echo lang('Save'); ?></button>
|
||
</div> -->
|
||
<div class="form-check col-md-12">
|
||
<input class="" type="checkbox" name="agree" id="agree" value="1" >
|
||
<label class="" for="agree">I agree to the Terms and Conditions</label>
|
||
</div>
|
||
<div class="form-check col-md-12">
|
||
<button type="submit" id="agreeSubmit" class="btn btn-success btn_clr float-right">Submit For Approval</button>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
|
||
?>
|
||
<script src="https://code.jquery.com/jquery-3.4.1.min.js" integrity="sha384-vk5WoKIaW/vJyUAd9n/wmopsmNhiy+L2Z+SBxGYnUkunIxVxAv/UtMOhba/xskxh" crossorigin="anonymous"></script>
|
||
<script src="<?php echo base_url(); ?>common/signature/drawing-table-multi.js" type="text/javascript"></script>
|
||
<script type="text/javascript">
|
||
$(function(){
|
||
$(".sigorwrite").click(function(){
|
||
if($(this).is(":checked"))
|
||
{
|
||
var elid=$(this).attr('id');
|
||
$("#signature_field_write_"+elid).prop( "disabled", false );
|
||
$("#signature_field_date_write_"+elid).prop( "disabled", false );
|
||
$("#signature_field_date_"+elid).prop( "disabled", true );
|
||
clearCanvas(elid);
|
||
}
|
||
else
|
||
{
|
||
var elid=$(this).attr('id');
|
||
$("#signature_field_write_"+elid).prop( "disabled", true );
|
||
$("#signature_field_date_write_"+elid).prop( "disabled", true );
|
||
$("#signature_field_date_"+elid).prop( "disabled", false );
|
||
}
|
||
|
||
})
|
||
})
|
||
function clearCanvas(id)
|
||
{
|
||
var cnvid = "signature_canvas_"+id;
|
||
var c = document.getElementById(cnvid);
|
||
var ctx = c.getContext("2d");
|
||
ctx.fillStyle = "red";
|
||
ctx.clearRect(0, 0, 400, 200);
|
||
}
|
||
function validateFormSig(id)
|
||
{
|
||
if($("#"+id).is(":checked"))
|
||
{
|
||
var sig = $("#signature_field_write_"+id).val();
|
||
var dateSig = $("#signature_field_date_write_"+id).val();
|
||
$("#signature_final_field_"+id).val(sig);
|
||
$("#signature_final_date_"+id).val(dateSig);
|
||
}
|
||
else
|
||
{
|
||
var canvas1 = document.getElementById('signature_canvas_'+id);
|
||
if(canvas1){
|
||
var signature=canvas1.toDataURL("image/png");
|
||
$("#signature_final_field_"+id).val(signature);
|
||
var dateSig = $("#signature_field_date_"+id).val();
|
||
$("#signature_final_date_"+id).val(dateSig);
|
||
}
|
||
}
|
||
}
|
||
|
||
$(".signForm").submit(function(e) {
|
||
|
||
e.preventDefault(); // avoid to execute the actual submit of the form.
|
||
|
||
var form = $(this);
|
||
var url = form.attr('action');
|
||
|
||
$.ajax({
|
||
type: "POST",
|
||
url: url,
|
||
data: form.serialize(), // serializes the form's elements.
|
||
success: function(data)
|
||
{
|
||
if(data == '1' || data == 1)
|
||
{
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'success',
|
||
title: 'Signature successfully saved.',
|
||
showConfirmButton: false,
|
||
timer: 2500
|
||
});
|
||
}
|
||
else
|
||
{
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: 'error',
|
||
title: 'Some error occure please try again.',
|
||
showConfirmButton: false,
|
||
timer: 2500
|
||
});
|
||
}
|
||
}
|
||
});
|
||
});
|
||
</script>
|
||
<?php
|
||
*/
|
||
}
|
||
?>
|
||
|
||
<?php
|
||
if($userType->group_id == "1")
|
||
{
|
||
?>
|
||
<div class="row">
|
||
<input type="hidden" name="ion_id" value="<?php echo $nurse->ion_user_id; ?>">
|
||
<?php if($nurse->qualification_type==4 || $nurse->qualification_type==5){ ?>
|
||
<div class="col-md-12">
|
||
<p>Dear <?=$nurse->fname?> <?=$nurse->mid_name?> <?=$nurse->lname?> </p>
|
||
<p>
|
||
We are an equal employment opportunity employer. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability or any other status that may be protected by Federal, State or local law. I understand that I am required by state law and will be under contractual obligation to provide WECURO, INC. withupdated (upon or before the date of expiration) documents for current and continued employment. In addition, I am required to fulfill WECURO INC.’s In-service Education Program(s) annually in a timely manner. Please complete the application in its entirety and be as accurate as possible prior to your first assignment.
|
||
</p>
|
||
<p><strong>Requirements For Employment includes the following:</strong></p>
|
||
<ul>
|
||
<li>Professional Profile</li>
|
||
<li>Record of Employment</li>
|
||
<li>Skills Checklist</li>
|
||
<li>NYS Nursing Registration Certificate (Every 3 years)</li>
|
||
<li>Malpractice Insurance Policy (Annual)</li>
|
||
<li>CPR Card (Every 2 years)</li>
|
||
<li>Annual Physical Health Assessment</li>
|
||
<ul>
|
||
<li>PPD/ Mantoux Skin Test for TB OR</li>
|
||
<li>Chest X-Ray for TB (if history of + PPD every 3 years)</li>
|
||
<li>Rubeola and Rubella Titre</li>
|
||
<li>Drug Screen (Annual)</li>
|
||
</ul>
|
||
<li>Medical History/Tuberculosis Questionnaire</li>
|
||
<li>Employee Hepatitis B Vaccine Waiver</li>
|
||
<li>Employee Resume &2 References</li>
|
||
<li>NPI Number</li>
|
||
<li>Social Security Card &Picture ID or Passport/Green Card/Work Permit</li>
|
||
<li>Authorization Release Form</li>
|
||
</ul>
|
||
</div>
|
||
<?php } ?>
|
||
<?php if($nurse->qualification_type==6 || $nurse->qualification_type==7){ ?>
|
||
<div class="col-md-12">
|
||
<p>Dear <?=$nurse->fname?> <?=$nurse->mid_name?> <?=$nurse->lname?> </p>
|
||
<p>
|
||
We are an equal employment opportunity employer. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability or any other status that may be protected by Federal, State or local law. I understand that I am required by state law and will be under contractual obligation to provide WECURO, INC. withupdated (upon or before the date of expiration) documents for current and continued employment. In addition, I am required to fulfill WECURO INC.’s In-service Education Program(s) annually in a timely manner. Please complete the application in its entirety and be as accurate as possible prior to your first assignment.
|
||
</p>
|
||
<p><strong>Requirements For Employment includes the following:</strong></p>
|
||
<ul>
|
||
<li>Professional Profile</li>
|
||
<li>Record of Employment</li>
|
||
<li>Skills Checklist</li>
|
||
<li>Annual Physical Health Assessment</li>
|
||
<ul>
|
||
<li>PPD/ Mantoux Skin Test for TB OR</li>
|
||
<li>Chest X-Ray for TB (if history of + PPD every 3 years)</li>
|
||
<li>Rubeola and Rubella Titre</li>
|
||
<li>Drug Screen (Annual)</li>
|
||
</ul>
|
||
<li>Medical History/Tuberculosis Questionnaire</li>
|
||
<li>Employee Hepatitis B Vaccine Waiver</li>
|
||
<li>Employee Resume &2 References</li>
|
||
<li>Social Security Card &Picture ID or Passport/Green Card/Work Permit</li>
|
||
<li>Acknowledgement and Consent Fom1 for Fingerprinting and Disclosure of Criminal History Record</li>
|
||
<li>Request for Criminal History Record Check</li>
|
||
<li>Authorization Release Form</li>
|
||
<li>Home Care Registry Release Form</li>
|
||
</ul>
|
||
</div>
|
||
<?php } ?>
|
||
<div class="col-md-12">
|
||
<p class="text-justify">Please read each statement carefully before signing and submitting. </p>
|
||
<p class="text-justify"> I hereby certify that all the information provided by me in this application (or any other accompanying or required documents) is true and complete to the best of my knowledge. I understand that the falsification, misrepresentation, or omission of any facts may be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. </p>
|
||
<p class="text-justify"> I hereby consent and understand that I may be required to submit to a pre-employment medical examination, a pre-and/or post-employment drug screen and background check as a condition of employment if required. I understand that unsatisfactory results, refusal to cooperate with, or any attempt to affect the results of these pre/post-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed. I hereby authorize any and all former employers, references, schools, courts, and any others whether listed or not to provide relevant information that may be useful in making a hiring decision. I release all parties involved from any and all legal liability in providing such information. </p>
|
||
<p class="text-justify"> I understand that submission of an application does not guarantee employment. I further understand that this application, verbal statements, made by management or subsequent employment does not create an express or implied contract of employment, nor guarantee employment for any definite period of time. I further understand that should an offer of employment be extended that EMPLOYMENT IS AT WILL for no specified duration and may be terminated by either the company or myself at any time with our without cause or notice. I understand that no representative of company except the President has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President of the company. </p>
|
||
<p class="text-justify"> The statements made in this application are true to the best of my knowledge. I understand that any falsification will be the basis for disqualification of employment or termination of services. I authorize WECURO, INC. to verify the information I have provided and to contact past employers and references concerning my ability, character and employment record. I release all such persons from liability for furnishing said information. I authorize WECURO, INC, as my employer, to release any medical and background information, which may be relevant to my assignment to its client facilities. By submitting this application to WECURO, INC, I authorize release of this information to all other affiliates of the company and I acknowledge and agree that they may contact me using facsimile or any other means. Nothing contained in this employment application, or in the granting of an interview, is intended to create an employment contract between WECURO, INC and the applicant for either employment or for providing of any benefit. All offers of employment are made conditional upon the applicant’s proving employment eligibility and identity in accordance with the Immigration Reform and Control Act of 1986. </p>
|
||
<p class="text-justify"> I hereby attest that I have the necessary experience to work with patients of the conditions I have selected and that I am willing to work with patients who have those types of conditions. </p>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
|
||
|
||
|
||
|
||
|
||
|
||
|
||
|
||
|
||
|
||
|
||
|
||
|