122 lines
5.0 KiB
PHP
Executable File
122 lines
5.0 KiB
PHP
Executable File
<!-- backend -->
|
|
<?php
|
|
$form_name="CPRO CPA Patient Agreement Form";
|
|
$nav_tabs=[
|
|
'cpro_pagt_complaints'=>(object)[
|
|
'full_title'=>"Complaints",
|
|
'short_title'=>"Complaints"
|
|
],
|
|
'cpro_pagt_home_care_bill_of_rights_client_responsibilities'=>(object)[
|
|
'full_title'=>"Home Care Bill of Rights & Client Responsibilities",
|
|
'short_title'=>"HCBR & CR"
|
|
],
|
|
'cpro_pagt_services_consent'=>(object)[
|
|
'full_title'=>"Services Consent",
|
|
'short_title'=>"Services Consent"
|
|
],
|
|
'cpro_pagt_assignment_of_insurance_benefits'=>(object)[
|
|
'full_title'=>"Assignment of Insurance Benefits",
|
|
'short_title'=>"AOIB"
|
|
],
|
|
'cpro_pagt_notice_of_privacy_practices'=>(object)[
|
|
'full_title'=>"Notice of Privacy Practices",
|
|
'short_title'=>"NOPP"
|
|
]
|
|
];
|
|
?>
|
|
<!-- backend -->
|
|
|
|
<!-- styling -->
|
|
<style type="text/css">
|
|
|
|
</style>
|
|
<!-- styling -->
|
|
|
|
<!-- content -->
|
|
<div class="container-sm p-0">
|
|
<div class="row w-100 mx-auto">
|
|
<div class="col-md-12 mt-3">
|
|
<a href="<?=base_url()?>">
|
|
<img class="top-wecuro-logo" src="<?=base_url()?>common/frontend/assets/images/logo.png" alt="wecuro logo">
|
|
</a>
|
|
</div>
|
|
<div class="col-md-12 my-3 p-0 shadow-border-all">
|
|
<div class="card text-center">
|
|
<div class="card-header">
|
|
<h5 class="text-info text-break bg-light p-2 rounded-lg"><?=$form_name?></h5>
|
|
<ul class="nav nav-pills card-header-pills" id="cpro_patient_agreement_tab_list" role="tablist">
|
|
<?php
|
|
$ii=0;
|
|
foreach($nav_tabs as $key=>$value){
|
|
?>
|
|
<li class="nav-item text-truncate" role="presentation">
|
|
<a href="javascript:void(0)"
|
|
class="nav-link"
|
|
id="<?=$key?>_tab"
|
|
data-toggle="tab"
|
|
data-target="#<?=$key?>"
|
|
type="button"
|
|
role="tab"
|
|
aria-controls="<?=$key?>"
|
|
aria-selected="false"
|
|
>
|
|
<?=$value->short_title?>
|
|
</a>
|
|
</li>
|
|
<?php
|
|
$ii++;
|
|
}
|
|
?>
|
|
</ul>
|
|
</div>
|
|
<div class="card-body">
|
|
<div class="tab-content hgjffvdrt5sder" id="cpro_patient_agreement_tab_content">
|
|
<?php
|
|
$ii=0;
|
|
foreach($nav_tabs as $key=>$value){
|
|
?>
|
|
<div
|
|
class="tab-pane fade"
|
|
id="<?=$key?>"
|
|
role="tabpanel"
|
|
aria-labelledby="<?=$key?>_tab"
|
|
>
|
|
<h5 class="card-title text-secondary">
|
|
<u><?=$value->full_title?></u>
|
|
</h5>
|
|
|
|
<div class="row w-100 mx-auto">
|
|
<div class="col-md-12 hgjffvdrt5sder">
|
|
|
|
</div>
|
|
</div>
|
|
<small class="card-text d-block text-adjust-end text-break text-muted">
|
|
<!-- Form : <?=$value->short_title?>, <?=date('Y-m-d')?> -->
|
|
<?=$form_name?><br>@wecuro
|
|
</small>
|
|
</div>
|
|
<?php
|
|
$ii++;
|
|
}
|
|
?>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<!-- content -->
|
|
|
|
<!-- scripting -->
|
|
<script type="text/javascript">
|
|
$(document).ready(function(){
|
|
var trgt=$("#cpro_patient_agreement_tab_list");
|
|
activateNavTab(trgt);
|
|
callLeaveModal(true,{title:"<?=$form_name?>"});
|
|
});
|
|
$(document).on('click','#cpro_patient_agreement_tab_list a[data-target]',function(){
|
|
hashPushState($(this));
|
|
});
|
|
</script>
|
|
<!-- scripting -->
|