734 lines
44 KiB
PHP
Executable File
734 lines
44 KiB
PHP
Executable File
<!-- backend -->
|
||
<?php
|
||
$checklist_array1=[
|
||
"mem_ar_review"=>"Person-Centered Service Plan was reviewed with Member and or Authorized Representative (AR):",
|
||
"mem_imp_pcsp_review"=>"Member/AR verbalized understanding of importance of PCSP Review:",
|
||
"mem_agrmt_pcsp_review"=>"Member and or AR in agreement with current PCSP: (If no, include details in Notes)",
|
||
"mem_agrmt_intervention"=>"Member and or AR in agreement that the intervention(s) support the goal(s): (If no, include details in Notes)",
|
||
"mem_idf_barriers"=>"Member and or AR identified barriers to the achievement of goals: (If yes, include details in Notes)",
|
||
"mem_recv_all_authz_services"=>"Member/AR confirm receiving all Authorized Services: (If no, include details in Notes)",
|
||
"mem_req_modf_pcsp"=>"Member requested modification to the current PCSP: (If yes, include details in Notes)",
|
||
"mem_req_add_serv"=>"Member /AR placed additional service request (s): (If yes, include details in Notes) ",
|
||
"mem_stsf_archcare_services"=>"Member is satisfied with ArchCare Services: (If no, include details in Notes)",
|
||
"mem_home_culture"=>"Members home is safe, and living conditions are adequate, for the provision of services: (If no, include details in Notes)",
|
||
"mem_home_atmp"=>"Members home environment is clean, clutter free, with a clear pathway: (If no, include details in Notes)",
|
||
"mem_home_co_detector"=>"Smoke detector and Carbon Monoxide detector present in members home: (If no, include details in Notes)",
|
||
"mem_additional_issues"=>" Member identified additional issues/concerns that require care coordination: (If yes, include details in Notes)",
|
||
"mem_emerg_visit_last_ninety"=>" Member had an emergency room visit in the last 90 days: (If yes, include detail in Notes).",
|
||
"mem_injury_last_ninety"=>"Member experienced a fall with injury in the last 90 days: (If yes, include detail in Notes).",
|
||
"mem_recent_unctl_pain"=>"Member expressed experiencing uncontrolled pain at present time: (If yes, include detail such as location, pain level etc in Notes)",
|
||
"mem_is_distressed"=>"Member expressed feeling lonely or distressed:",
|
||
"mem_influ_vac_last_yr"=>"Member received an influenza vaccination in the last year: (If yes, include approx month, date in Note)",
|
||
"mem_covid_vac_last_yr"=>"Member received the COVID-19 vaccine in last year (or as required): (If yes, include approx month, date, the name of vaccine in Note)",
|
||
"mem_is_educated"=>"Member confirmed being educated on Advance Directives, (i.e. Health Care Proxy/DNR/MOLST) by Care Manager/staff from ArchCare Community Life: (If yes, include detail in Notes)",
|
||
"mem_ppv_vac_last_yr"=>"Member age 65 or older, received a pneumococcal vaccination in the last five years or after age 65: (If yes, include approx month, date in Note)",
|
||
"mem_dntl_exm_last_yr"=>"Members received a dental exam in the last year: (If yes, include approx month, date in Note)."
|
||
];
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||
$signature_array1=[
|
||
'signature_member'=>"Signature of Member:",
|
||
'signature_auth_representative'=>"Signature of Authorized Representative:",
|
||
'signature_visiting_rn_sw'=>"Signature of Visiting RN/SW:"
|
||
];
|
||
$checklist_array2=$signature_array2=[];
|
||
foreach($checklist_array1 as $key => $val){
|
||
$checklist_array2[]=[
|
||
'name'=>$key,
|
||
'description'=>$val
|
||
];
|
||
}
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||
foreach($signature_array1 as $key => $val){
|
||
$signature_array2[]=[
|
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'name'=>$key,
|
||
'description'=>$val
|
||
];
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}
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?>
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<!-- backend -->
|
||
|
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<!-- styling -->
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<style type="text/css">
|
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/*media queries*/
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:root{
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--grid-width: 70%;
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--page-pad:25px 20px 25px 20px;
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--width-changer:70%;
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/* --sig-canvas-width:300px;
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--sig-canvas-height:200px; */
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}
|
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@media screen and (max-width: 320px){
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||
:root{
|
||
--grid-width: 100%;
|
||
--page-pad:15px 10px 15px 10px;
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||
--width-changer:100%;
|
||
--sig-canvas-width:90%;
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||
--sig-canvas-height:200px;
|
||
}
|
||
}
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||
@media screen and (min-width: 321px) and (max-width: 480px){
|
||
:root{
|
||
--grid-width: 100%;
|
||
--page-pad:15px 10px 15px 10px;
|
||
--width-changer:100%;
|
||
--sig-canvas-width:90%;
|
||
--sig-canvas-height:200px;
|
||
}
|
||
}
|
||
@media screen and (min-width: 481px) and (max-width: 768px){
|
||
:root{
|
||
--grid-width: 100%;
|
||
--page-pad:15px 10px 15px 10px;
|
||
/* --sig-canvas-width:300px;
|
||
--sig-canvas-height:200px; */
|
||
}
|
||
}
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||
@media screen and (min-width: 769px) and (max-width: 1024px){
|
||
:root{
|
||
--grid-width: 100%;
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||
--page-pad:25px 20px 25px 20px;
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||
/* --sig-canvas-width:350px;
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||
--sig-canvas-height:220px; */
|
||
}
|
||
}
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@media screen and (min-width: 1025px) and (max-width: 1200px){
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||
:root{
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||
--grid-width: 70%;
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||
--page-pad:25px 20px 25px 20px;
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||
/* --sig-canvas-width:350px;
|
||
--sig-canvas-height:220px; */
|
||
}
|
||
}
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||
@media screen and (min-width: 1201px){
|
||
:root{
|
||
--grid-width: 70%;
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||
--page-pad:30px 25px 30px 25px;
|
||
/* --sig-canvas-width:350px;
|
||
--sig-canvas-height:220px; */
|
||
}
|
||
}
|
||
/*media queries*/
|
||
|
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/*footer*/
|
||
.footer_sec{background: #19b5fe;}
|
||
.foot_content{width: 100%;}
|
||
.footer_sec .foot_content p{font: 400 16px/24px 'Poppins', sans-serif;color: #fff;margin-top: 18px;}
|
||
.footer.footer_sec .copyright{background: #004d71;padding: 20px 0;}
|
||
.footer.footer_sec .copyright p{color: #fff;margin: 0;font-family: 'Poppins', sans-serif;}
|
||
.footer.footer_sec .copyright p a{color: #fff;}
|
||
/*footer*/
|
||
|
||
/*~~~~~~~*/
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body, html{
|
||
background-color: rgba(0,0,0,0.03);
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||
}
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||
label{
|
||
color: #2b335e;
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||
font-family: "Open Sans", -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, "Helvetica Neue", Arial, sans-serif;
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||
}
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||
.required:after {
|
||
content: "*";
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||
color: red;
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}
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.width-changer{
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||
width:var(--width-changer);
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}
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||
.top-wecuro-logo{
|
||
width:170px;
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||
}
|
||
.individual-form-page-wrapper{
|
||
display: flex;
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flex-flow: wrap;
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||
width:var(--grid-width);
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||
}
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||
.individual-form-page-wrapper .individual-form-page{
|
||
background:#fff;
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box-shadow: -2px 2px 2px rgb(0 0 0 / 12%), 2px -2px 2px rgb(0 0 0 / 12%);;
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transition: 0.5s;
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min-height: 300px;
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width:100%;
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padding: var(--page-pad);
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||
}
|
||
.ftf-home-visit-logo{
|
||
width:230px;
|
||
align-self: center;
|
||
}
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||
.border-bottom{
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border-bottom: 1px solid rgba(0,0,0,0.4);
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}
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.gfhgftgv{
|
||
margin-bottom: 7px;
|
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}
|
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.gfhgftgv input.form-control[type="text"]{
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border:none;
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border-bottom: 1px solid rgba(0,0,0,0.2);
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}
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.gfhgftgv input.form-control[type="text"]::placeholder{
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||
font-size: 14px;
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}
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[data-signature-closure] [data-signature="digital"]{
|
||
display: none;
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||
}
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||
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canvas.signature-canvas{
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||
width:var(--sig-canvas-width);
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||
height:var(--sig-canvas-height);
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||
}
|
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.erase-signature{
|
||
cursor: pointer;
|
||
height: fit-content;
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||
}
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||
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[data-signature="upload"] input.upload-signature{
|
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max-width: 230px;
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}
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textarea[name="notes"]{
|
||
min-height: 100px !important;
|
||
}
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/*~~~~~~~*/
|
||
</style>
|
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<!-- styling -->
|
||
|
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<!-- content -->
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<div class="container w-100 p-0">
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<div class="row w-100 mx-auto px-0">
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||
<div class="col-md-12 mt-3">
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<a href="<?=base_url()?>">
|
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<img class="top-wecuro-logo" src="<?=base_url()?>common/frontend/assets/images/logo.png" alt="wecuro logo">
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</a>
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</div>
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<div class="col-md-12 p-0 cntr">
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||
<div class="individual-form-page-wrapper mt-3 mb-3">
|
||
<form role="form" class="form-chgaswexxd3ed4d w-100" id="ftf_home_visit_form" method="post" action="<?=base_url()?>home_visit/save_ftf_home_visit_form"
|
||
onsubmit="return validateForm('ftf_home_visit_form')" enctype="multipart/form-data">
|
||
<input type="hidden" name="<?=$this->security->get_csrf_token_name()?>" value="<?=$this->security->get_csrf_hash()?>">
|
||
<input type="submit" class="post-hgfrts45stue" hidden>
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||
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<?php for($i=0;$i<count($signature_array2);$i++){?>
|
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<input type="hidden" name="digital_<?=$signature_array2[$i]['name']?>" id="digital_<?=$signature_array2[$i]['name']?>" value="">
|
||
<input type="hidden" name="upload_<?=$signature_array2[$i]['name']?>" id="upload_<?=$signature_array2[$i]['name']?>" value="">
|
||
<?php } ?>
|
||
|
||
<div class="individual-form-page mt-3" title="Page 1">
|
||
<div class="row w-100 mx-auto px-4 py-3">
|
||
<div class="col-md-12 mt-2 text-center">
|
||
<div class="card mt-2 mb-2 br-none" style="box-shadow: none;border:none">
|
||
<img class="card-img-top ftf-home-visit-logo" src="<?php echo base_url(); ?>common/plan-review-assets/img/archcare.png" alt="logo">
|
||
<div class="card-body pt-0">
|
||
<p class="card-text fs-17p mb-0">
|
||
ArchCare Community Life
|
||
</p>
|
||
<p class="card-text fs-17p mb-0">
|
||
205 Lexington Ave, 8<sup>th</sup> Floor
|
||
</p>
|
||
<p class="card-text fs-17p mb-0">
|
||
New York, NY 10016
|
||
</p>
|
||
<p class="card-text fs-17p mb-0">
|
||
1‑855‑467 9351 (TTY: 711)
|
||
</p>
|
||
<p class="card-text fs-17p mb-0 fw-bold">
|
||
Fax # 646 219 7363
|
||
</p>
|
||
</div>
|
||
<div class="card-footer bg-white br-none">
|
||
<h5 class="text-capitalize text-decoration-underline fs-16p">
|
||
Face to Face Person-Centered Service Plan Review Checklist
|
||
</h5>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-md-12 mt-2 mb-4">
|
||
<div class="row gfhgftgv">
|
||
<div class="col-auto">
|
||
<label for="member_name" class="col-form-label fs-15p fw-bold required">Member Name: </label>
|
||
</div>
|
||
<div class="col-auto w-70pr">
|
||
<input type="text" class="form-control" id="member_name" name="member_name" aria-describedby="memberName" placeholder="Write member name ..." required>
|
||
</div>
|
||
</div>
|
||
<div class="row gfhgftgv">
|
||
<div class="col-auto">
|
||
<label for="member_medicaid" class="col-form-label fs-15p fw-bold required">Member Medicaid #: </label>
|
||
</div>
|
||
<div class="col-auto w-70pr">
|
||
<input type="text" class="form-control" id="member_medicaid" name="member_medicaid" aria-describedby="memberMedicaid" placeholder="Write member medicaid ..." required>
|
||
</div>
|
||
</div>
|
||
<div class="row gfhgftgv">
|
||
<div class="col-auto">
|
||
<label for="member_phone" class="col-form-label fs-15p fw-bold required">Member Phone #: </label>
|
||
</div>
|
||
<div class="col-auto w-70pr">
|
||
<input type="text" class="form-control" id="member_phone" name="member_phone" aria-describedby="memberPhone" placeholder="Write member phone ..." required>
|
||
</div>
|
||
</div>
|
||
<div class="row gfhgftgv">
|
||
<div class="col-auto">
|
||
<label for="appointment_date" class="col-form-label fs-15p fw-bold required">Date scheduled appointment or attempted contact : </label>
|
||
</div>
|
||
<div class="col-auto">
|
||
<input type="date" class="form-control" id="appointment_date" name="appointment_date" aria-describedby="appointmentDate" required>
|
||
</div>
|
||
</div>
|
||
<div class="row gfhgftgv">
|
||
<div class="col-auto">
|
||
<label for="visit_date" class="col-form-label fs-15p fw-bold required">Visit date : </label>
|
||
</div>
|
||
<div class="col-auto">
|
||
<input type="date" class="form-control" id="visit_date" name="visit_date" aria-describedby="visitDate" required>
|
||
</div>
|
||
</div>
|
||
<div class="row gfhgftgv">
|
||
<div class="col-auto">
|
||
<label for="visit_time" class="col-form-label fs-15p fw-bold required">Time of Visit : </label>
|
||
</div>
|
||
<div class="col-auto">
|
||
<input type="time" class="form-control" id="visit_time" name="visit_time" aria-describedby="visitTime" required>
|
||
</div>
|
||
</div>
|
||
<div class="row gfhgftgv">
|
||
<div class="col-auto">
|
||
<label for="languages" class="col-form-label fs-15p fw-bold required">Language : </label>
|
||
</div>
|
||
<div class="col-auto w-70pr">
|
||
<select class="form-control w-100 js-example-basic-multiple" id="languages" name="languages[]" multiple="multiple" aria-describedby="language" required>
|
||
<?php
|
||
foreach($language as $lang){
|
||
?>
|
||
<option value="<?=$lang->name?>">
|
||
<?=$lang->name?>
|
||
</option>
|
||
<?php
|
||
}
|
||
?>
|
||
</select>
|
||
</div>
|
||
</div>
|
||
<div class="row gfhgftgv">
|
||
<div class="col-auto">
|
||
<label for="review_witness" class="col-form-label fs-15p fw-bold required">
|
||
Person(s) chosen by member to be present during review: (Name and relationship) :
|
||
</label>
|
||
</div>
|
||
<div class="col-auto w-100">
|
||
<input type="text" class="form-control" id="review_witness" name="review_witness" aria-describedby="reviewWitness" required>
|
||
</div>
|
||
</div>
|
||
<div class="row gfhgftgv">
|
||
<div class="col-md-6">
|
||
<div class="row">
|
||
<div class="col-auto">
|
||
<label for="name_visiting_rn" class="col-form-label fs-15p fw-bold required rn_label">
|
||
Name of Visiting RN :
|
||
</label>
|
||
</div>
|
||
<div class="col-auto">
|
||
<input type="text" class="form-control" onkeyup="check_rn()" id="name_visiting_rn" name="name_visiting_rn" aria-describedby="nameVisitingRn" placeholder="Write ..." required>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-md-6">
|
||
<div class="row">
|
||
<div class="col-auto">
|
||
<label for="license_visiting_rn" class="col-form-label fs-15p fw-bold required rn_label">
|
||
RN License #:
|
||
</label>
|
||
</div>
|
||
<div class="col-auto">
|
||
<input type="text" class="form-control" onkeyup="check_rn()" id="license_visiting_rn" name="license_visiting_rn" aria-describedby="licenseVisitingRn" placeholder="Write ..." required>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="row gfhgftgv">
|
||
<div class="col-md-6">
|
||
<div class="row">
|
||
<div class="col-auto">
|
||
<label for="name_visiting_sw" class="col-form-label fs-15p fw-bold required sw_label">
|
||
Name of Visiting SW :
|
||
</label>
|
||
</div>
|
||
<div class="col-auto">
|
||
<input type="text" class="form-control" onkeyup="check_sw()" id="name_visiting_sw" name="name_visiting_sw" aria-describedby="nameVisitingSw" placeholder="Write ..." required>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-md-6">
|
||
<div class="row">
|
||
<div class="col-auto">
|
||
<label for="license_visiting_sw" class="col-form-label fs-15p fw-bold required sw_label">
|
||
SW License #:
|
||
</label>
|
||
</div>
|
||
<div class="col-auto">
|
||
<input type="text" class="form-control" onkeyup="check_sw()" id="license_visiting_sw" name="license_visiting_sw" aria-describedby="licenseVisitingSw" placeholder="Write ..." required>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="row gfhgftgv">
|
||
<div class="col-md-6">
|
||
<div class="row">
|
||
<div class="col-auto">
|
||
<label for="name_visiting_lchsa" class="col-form-label fs-15p fw-bold">
|
||
Name of Vendor :
|
||
</label>
|
||
</div>
|
||
<div class="col-auto">
|
||
<input type="text" class="form-control" id="name_visiting_lchsa" name="name_visiting_lchsa" aria-describedby="nameVisitingLchsa" placeholder="Write ..." value="Caregiver Pro">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-md-6">
|
||
<div class="row">
|
||
<div class="col-auto">
|
||
<label for="phone_visiting_lchsa" class="col-form-label fs-15p fw-bold">
|
||
Phone # of Vendor :
|
||
</label>
|
||
</div>
|
||
<div class="col-auto">
|
||
<input type="text" class="form-control" id="phone_visiting_lchsa" name="phone_visiting_lchsa" aria-describedby="licenseVisitingLchsa" placeholder="Write ..." value="718-504-8054">
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-md-12">
|
||
<h5 class="text-capitalize text-decoration-underline fs-17p">Checklist:</h5>
|
||
<div class="row">
|
||
<?php
|
||
for($i=0;$i<4;$i++){
|
||
?>
|
||
<div class="col-md-12 mt-2">
|
||
<label class="d-block" for="<?=$checklist_array2[$i]['name']?>">
|
||
<?=$i+1?>. <?=$checklist_array2[$i]['description']?>
|
||
</label>
|
||
<div class="mx-3">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="<?=$checklist_array2[$i]['name']?>" id="<?=$checklist_array2[$i]['name']?>_yes" value="1" required>
|
||
<label class="form-check-label" for="<?=$checklist_array2[$i]['name']?>_yes">Yes</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="<?=$checklist_array2[$i]['name']?>" id="<?=$checklist_array2[$i]['name']?>_no" value="0">
|
||
<label class="form-check-label" for="<?=$checklist_array2[$i]['name']?>_no">No</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="individual-form-page mt-3" title="Page 2">
|
||
<div class="row w-100 mx-auto px-4 py-3">
|
||
<div class="col-md-12 mt-2 mb-4">
|
||
<div class="row">
|
||
<?php
|
||
for($i=4;$i<20;$i++){
|
||
?>
|
||
<div class="col-md-12 mt-3">
|
||
<label class="d-block" for="<?=$checklist_array2[$i]['name']?>">
|
||
<?=$i+1?>. <?=$checklist_array2[$i]['description']?>
|
||
</label>
|
||
<div class="mx-3">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="<?=$checklist_array2[$i]['name']?>" id="<?=$checklist_array2[$i]['name']?>_yes" value="1" required>
|
||
<label class="form-check-label" for="<?=$checklist_array2[$i]['name']?>_yes">Yes</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="<?=$checklist_array2[$i]['name']?>" id="<?=$checklist_array2[$i]['name']?>_no" value="0">
|
||
<label class="form-check-label" for="<?=$checklist_array2[$i]['name']?>_no">No</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="individual-form-page mt-3" title="Page 3">
|
||
<div class="row w-100 mx-auto px-4 py-3">
|
||
<div class="col-md-12 mt-2 mb-4">
|
||
<div class="row">
|
||
<?php
|
||
for($i=20;$i<count($checklist_array2);$i++){
|
||
?>
|
||
<div class="col-md-12 mt-3">
|
||
<label class="d-block" for="<?=$checklist_array2[$i]['name']?>">
|
||
<?=$i+1?>. <?=$checklist_array2[$i]['description']?>
|
||
</label>
|
||
<div class="mx-3">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="<?=$checklist_array2[$i]['name']?>" id="<?=$checklist_array2[$i]['name']?>_yes" value="1" required>
|
||
<label class="form-check-label" for="<?=$checklist_array2[$i]['name']?>_yes">Yes</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="<?=$checklist_array2[$i]['name']?>" id="<?=$checklist_array2[$i]['name']?>_no" value="0">
|
||
<label class="form-check-label" for="<?=$checklist_array2[$i]['name']?>_no">No</label>
|
||
</div>
|
||
<?php
|
||
if($checklist_array2[$i]['name']=='mem_ppv_vac_last_yr'){
|
||
?>
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="<?=$checklist_array2[$i]['name']?>" id="<?=$checklist_array2[$i]['name']?>_na" value="2">
|
||
<label class="form-check-label" for="<?=$checklist_array2[$i]['name']?>_na">N/A</label>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
</div>
|
||
</div>
|
||
<div class="col-md-12 mt-2 mb-4">
|
||
<div class="row gfhgftgv">
|
||
<div class="col-auto">
|
||
<label for="notes" class="col-form-label fs-15p fw-bold">Note : </label>
|
||
</div>
|
||
<div class="col-auto width-changer">
|
||
<div class="form-floating">
|
||
<textarea class="form-control" id="notes" name="notes" placeholder="Leave a comment here"></textarea>
|
||
<label for="notes" class="fs-14p">Write down notes</label>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<div class="col-md-12 mt-2 mb-4">
|
||
<?php
|
||
for($i=0;$i<count($signature_array2);$i++){
|
||
?>
|
||
<div class="row gfhgftgv" data-signature-closure="<?=$signature_array2[$i]['name']?>">
|
||
<div class="col-auto">
|
||
<label class="col-form-label fs-15p fw-bold" for="<?=$signature_array2[$i]['name']?>">
|
||
<?=$signature_array2[$i]['description']?>
|
||
</label>
|
||
</div>
|
||
<div class="col-auto mt-2">
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="<?=$signature_array2[$i]['name']?>_type" id="<?=$signature_array2[$i]['name']?>_type_digital" value="digital" toggling-signature-type="">
|
||
<label class="form-check-label" for="<?=$signature_array2[$i]['name']?>_type_digital">Digital</label>
|
||
</div>
|
||
<div class="form-check form-check-inline">
|
||
<input class="form-check-input" type="radio" name="<?=$signature_array2[$i]['name']?>_type" id="<?=$signature_array2[$i]['name']?>_type_upload" value="upload" toggling-signature-type="" checked>
|
||
<label class="form-check-label" for="<?=$signature_array2[$i]['name']?>_type_upload">Upload</label>
|
||
</div>
|
||
</div>
|
||
<div class="col-auto width-changer mt-2" data-signature="digital" id="">
|
||
<div class="flex-start">
|
||
<canvas class="form-control me-1 signature-canvas" id="signature_canvas_<?=$signature_array2[$i]['name']?>" title="Draw your signaure here"></canvas>
|
||
<span class="badge bg-primary erase-signature" title="Erase signature" onclick="eraseCanvas('<?=$signature_array2[$i]['name']?>')">
|
||
<i class="fas fa-eraser"></i>
|
||
</span>
|
||
</div>
|
||
</div>
|
||
<div class="col-auto mt-2" data-signature="upload">
|
||
<input type="file" class="btn btn-sm btn-primary upload-signature" value="Upload File" accept="image/jpeg,image/jpg,image/png">
|
||
</div>
|
||
</div>
|
||
<?php
|
||
}
|
||
?>
|
||
</div>
|
||
<div class="col-md-12 mt-5">
|
||
<div class="flex-end">
|
||
<button type="button" class="btn btn-outline-secondary me-4" style="padding:7px 35px;">Cancel</button>
|
||
<button type="button" class="btn btn-success light post-hgfrts45sweq" style="padding:7px 35px;">Submit</button>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</form>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
</div>
|
||
<!-- content -->
|
||
|
||
<!-- scripting -->
|
||
<script src="https://cdnjs.cloudflare.com/ajax/libs/signature_pad/1.5.3/signature_pad.min.js"></script>
|
||
<!-- <script src="<?php echo base_url(); ?>common/signature/drawing-table-multi.js" type="text/javascript"></script> -->
|
||
<script type="text/javascript">
|
||
if(typeof swalAlert==="undefined"){
|
||
function swalAlert(icon,msg){
|
||
Swal.fire({
|
||
position: 'center',
|
||
icon: icon,
|
||
title: msg,
|
||
showConfirmButton: false,
|
||
timer: 1500
|
||
});
|
||
}
|
||
}
|
||
</script>
|
||
<script type="text/javascript">
|
||
$(document).ready(function(){
|
||
$('.js-example-basic-multiple').select2();
|
||
callLeaveModal(true);
|
||
});
|
||
$(document).on('click','[toggling-signature-type]',function(){
|
||
var val=$(this).val();
|
||
var trgt=$(this).closest("[data-signature-closure]");
|
||
var sig_name=trgt.attr('data-signature-closure');
|
||
if(val=='digital'){
|
||
resetFileInput(trgt);
|
||
$("#upload_"+sig_name+"").val('');
|
||
trgt.find("[data-signature='digital']").show('slow');
|
||
trgt.find("[data-signature='upload']").hide('slow');
|
||
|
||
var signaturePad = new SignaturePad(document.getElementById('signature_canvas_'+sig_name), {
|
||
backgroundColor: 'rgb(255, 255, 255)',
|
||
penColor: 'rgb(0, 0, 0)',
|
||
minWidth: 0.8,
|
||
maxWidth: 1
|
||
});
|
||
}
|
||
else if(val=='upload'){
|
||
eraseCanvas(sig_name);
|
||
$("#digital_"+sig_name+"").val('');
|
||
trgt.find("[data-signature='digital']").hide('slow');
|
||
trgt.find("[data-signature='upload']").show('slow');
|
||
}
|
||
});
|
||
$(document).on('change','[data-signature="upload"] input.upload-signature',function(){
|
||
var trgt=$(this).closest("[data-signature-closure]");
|
||
var sig_name=trgt.attr('data-signature-closure');
|
||
|
||
if(!this.files || !this.files[0]){
|
||
return;
|
||
}
|
||
|
||
var file_type=this.files[0].type;
|
||
if(["image/jpeg","image/jpg","image/png"].includes(file_type)){
|
||
const FR=new FileReader();
|
||
FR.addEventListener("load",function(evt){
|
||
var signature=evt.target.result;
|
||
$("#upload_"+sig_name+"").val(signature);
|
||
});
|
||
FR.readAsDataURL(this.files[0]);
|
||
}
|
||
else{
|
||
resetFileInput(trgt);
|
||
swalAlert("error","Only JPEG, JPG, PNG files are allowed! Please Try with another file.");
|
||
return false;
|
||
}
|
||
});
|
||
$(document).on('click','.post-hgfrts45sweq',function(){
|
||
$('.post-hgfrts45stue').trigger('click');
|
||
});
|
||
$(".form-chgaswexxd3ed4d").submit(function(e){
|
||
e.preventDefault();
|
||
var form=$(this);
|
||
form.serialize();
|
||
var actionUrl=form.attr('action');
|
||
$.ajax({
|
||
type: "POST",
|
||
url: actionUrl,
|
||
data: form.serialize(),
|
||
beforeSend: function(){
|
||
callLoader_hgy67vg(true);
|
||
},
|
||
success: function(data) {
|
||
var data=$.parseJSON(data);
|
||
callLoader_hgy67vg(false);
|
||
if(data.status==200){
|
||
createPdf(data.data.inserted_id);
|
||
}
|
||
},
|
||
error: function(){
|
||
callLoader_hgy67vg(false);
|
||
console.log('error in form submitting - form-chgaswexxd3ed4d');
|
||
},
|
||
complete: function(){
|
||
}
|
||
});
|
||
});
|
||
function eraseCanvas(of){
|
||
var cnvid="signature_canvas_"+of;
|
||
var ctx = new SignaturePad(document.getElementById('signature_canvas_'+of));
|
||
ctx.clear();
|
||
}
|
||
function validateForm(of){
|
||
var sig_array=['signature_member','signature_auth_representative','signature_visiting_rn_sw'];
|
||
for(var i=0;i<sig_array.length;i++){
|
||
var sig_name=sig_array[i];
|
||
var sig_type=$("[name='"+sig_name+"_type']:checked").val();
|
||
if(sig_type=='digital'){
|
||
var canvas=document.getElementById('signature_canvas_'+sig_name);
|
||
if(canvas){
|
||
// var signature = canvas.toDataURL();
|
||
var signature=canvas.toDataURL("image/png");
|
||
$("#digital_"+sig_name+"").val(signature);
|
||
}
|
||
}
|
||
else if(sig_type=='upload'){
|
||
//...
|
||
}
|
||
}
|
||
}
|
||
function createPdf(id){
|
||
var url="<?=base_url()?>home_visit/create_pdf_ftf_home_visit_form";
|
||
$.ajax({
|
||
type: "GET",
|
||
url: url,
|
||
data: {
|
||
id:id
|
||
},
|
||
beforeSend: function(){
|
||
callLoader_hgy67vg(true,'creating pdf...');
|
||
},
|
||
success: function(data) {
|
||
var data=$.parseJSON(data);
|
||
if(data.status==200){
|
||
swalAlert('success','Saved Successfully');
|
||
window.location.href="<?=base_url()?>"+data.data.pdf;
|
||
}
|
||
callLoader_hgy67vg(false,'');
|
||
},
|
||
error: function(){
|
||
callLoader_hgy67vg(false,'');
|
||
console.log('error in pdf creation - form-chgaswexxd3ed4d');
|
||
},
|
||
complete: function(){
|
||
}
|
||
});
|
||
}
|
||
function check_rn(){
|
||
var license_visiting_rn = $('#license_visiting_rn').val();
|
||
var name_visiting_rn = $('#name_visiting_rn').val();
|
||
if(license_visiting_rn != '' || name_visiting_rn != ''){
|
||
$("#name_visiting_sw").attr("required", false);
|
||
$("#license_visiting_sw").attr("required", false);
|
||
$('.sw_label').removeClass('required');
|
||
}
|
||
else{
|
||
$("#name_visiting_sw").attr("required", true);
|
||
$("#license_visiting_sw").attr("required", true);
|
||
$('.sw_label').addClass('required');
|
||
}
|
||
}
|
||
function check_sw(){
|
||
var name_visiting_sw = $('#name_visiting_sw').val();
|
||
var license_visiting_sw = $('#license_visiting_sw').val();
|
||
if(name_visiting_sw != '' || license_visiting_sw != ''){
|
||
$("#license_visiting_rn").attr("required", false);
|
||
$("#name_visiting_rn").attr("required", false);
|
||
$('.rn_label').removeClass('required');
|
||
}else{
|
||
$("#license_visiting_rn").attr("required", true);
|
||
$("#name_visiting_rn").attr("required", true);
|
||
$('.rn_label').addClass('required');
|
||
}
|
||
}
|
||
function resetFileInput(trgt){
|
||
trgt.find("[data-signature='upload']").empty();
|
||
trgt.find("[data-signature='upload']").html('<input type="file" class="btn btn-sm btn-primary upload-signature" value="Upload File" accept="image/jpeg,image/jpg,image/png">');
|
||
}
|
||
</script>
|
||
<!-- scripting -->
|