935 lines
42 KiB
PHP
Executable File
935 lines
42 KiB
PHP
Executable File
<style type="text/css">
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.required:after {
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content:"*";
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color:red;
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}
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</style>
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<!--sidebar end-->
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<!--main content start-->
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<div class="content-body">
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<div class="row">
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<div class="col-12">
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<div class="card">
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<section id="main-content">
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<section class="wrapper site-min-height">
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<!-- page start-->
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<section class="row col-md-12">
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<!-- <header class="panel-heading">
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<?php
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if (!empty($nurse->id))
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echo lang('Edit Patient');
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else
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echo lang('Add referal Patient');
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?>
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</header> -->
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<div class="card-header">
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<h3 class="font-weight-bold"> <?php
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if (!empty($nurse->id))
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echo lang('Edit Patient');
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else
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echo lang('Add referal Patient');
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?></h3>
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</div>
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<!-- <div class="panel-body col-md-7">
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<div class="adv-table editable-table ">
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<div class="clearfix">
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<div class="col-lg-12">
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<section class="panel">
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<div class="panel-body">
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<div class="col-lg-12">
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</div>
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<input type="hidden" name="id" value='<?php
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if (!empty($nurse->id)) {
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echo $nurse->id;
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}
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?>'>
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<button type="submit" name="submit" class="btn btn-info"><?php echo lang('submit'); ?></button>
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</form>
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</div>
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</section>
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</div>
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</div>
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</div>
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</div> -->
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<?php
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$tab1 = '';
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$tab2 = '';
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$tab3 = '';
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$tabPane1 = '';
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$tabPane2 = '';
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$tabPane3 = '';
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if(!isset($_GET['pid'])){
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$tab1 = 'active';
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$tab2 = 'disabled';
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$tab3 = 'disabled';
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$tabPane1 = 'active in show';
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$tabPane2 = '';
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$tabPane3 = '';
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}
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if(isset($_GET['pid'])){
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$tab1 = 'disabled';
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$tab2 = 'active';
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$tab3 = 'disabled';
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$tabPane1 = '';
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$tabPane2 = 'active in show';
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$tabPane3 = '';
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}
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if(isset($_GET['phase2'])){
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$tab1 = 'disabled';
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$tab2 = 'disabled';
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$tab3 = 'active';
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$tabPane1 = '';
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$tabPane2 = '';
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$tabPane3 = 'active in show';
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}
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// if(isset($_GET['phase3'])){
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// $tab1 = 'disabled';
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// $tab2 = 'disabled';
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// $tab3 = 'disabled';
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// $tab4 = 'active';
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// $tabPane1 = '';
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// $tabPane2 = '';
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// $tabPane3 = '';
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// $tabPane4 = 'active in';
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// }
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?>
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<div class="panel-body col-md-12">
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<div class="col-lg-3"></div>
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<div class="col-lg-6">
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<?php echo validation_errors(); ?>
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<?php echo $this->session->flashdata('feedback'); ?>
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</div>
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<div class="col-lg-3"></div>
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<div class="col-md-12">
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<!-- <ul class="nav nav-tabs" id="myTab" role="tablist">
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<li class="nav-item <?php echo $tab1; ?>">
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<a class="nav-link " id="home-tab" data-toggle="tab" href="#home" role="tab" aria-controls="home" aria-selected="true">General Information</a>
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</li>
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<li class="nav-item <?php echo $tab2; ?>">
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<a class="nav-link" id="profile-tab" data-toggle="tab" href="#designate" role="tab" aria-controls="profile" aria-selected="false">Designate</a>
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</li>
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<li class="nav-item <?php echo $tab3; ?>">
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<a class="nav-link" id="contact-tab" data-toggle="tab" href="#service_need" role="tab" aria-controls="contact" aria-selected="false">Service & Referral</a>
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</li>
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</ul> -->
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<div class="wizard wizard-circle">
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<div class="steps">
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<ul class="nav nav-tabs" id="myTab" role="tablist" style="border: none;">
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<li class="nav-item first current <?php echo $tab1; ?>">
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<a class="nav-link " id="home-tab" data-toggle="tab" href="#home" role="tab" aria-selected="true" style="padding-top: 52px !important; border: none; cursor: pointer;"><span class="step">1</span>General Information</a>
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</li>
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<li class="nav-item first current <?php echo $tab2; ?>" >
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<a class="nav-link" id="profile-tab" data-toggle="tab" href="#designate" role="tab" aria-selected="false" style="padding-top: 52px !important; border: none; cursor: pointer;"><span class="step">2</span>Designate</a>
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</li>
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<li class="nav-item first current <?php echo $tab3; ?>">
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<a class="nav-link" id="contact-tab" data-toggle="tab" href="#service_need" role="tab" aria-selected="false" style="padding-top: 52px !important; border: none; cursor: pointer;"><span class="step">3</span>Service & Referral</a>
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</li>
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</ul>
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</div>
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</div>
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<!-- basic_info tab -->
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<div class="tab-content" id="myTabContent">
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<div class="tab-pane fade <?php echo $tabPane1; ?>" id="home" role="tabpanel" aria-labelledby="home-tab">
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<form role="form" action="patient/addReferralGenInfo?type=<?=$type?>" method="post" enctype="multipart/form-data" name="newGenInfo" onsubmit="return validateForm1()">
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<div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1" class="required"><?php echo lang('First name'); ?></label>
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<input type="text" class="form-control" name="fname" value=''>
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1" class="required"><?php echo lang('Last name'); ?></label>
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<input type="text" class="form-control" name="lname" value='' placeholder="">
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</div>
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</div>
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</div>
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<div class="form-group">
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<label for="exampleInputEmail1" class="required"><?php echo lang('email'); ?></label>
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<input type="email" class="form-control" name="email" id="exampleInputEmail1" value='' placeholder="">
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</div>
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<div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1" class="required"><?php echo lang('Gender'); ?></label>
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<select class="form-control" id="inputGroupSelect01" name="gender">
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<option value="" selected>Choose...</option>
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<option value="Male">Male</option>
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<option value="Female">Female</option>
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<option value="Others">Others</option>
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</select>
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1" class="required"><?php echo lang('Language Preferances'); ?></label>
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<select class="form-control" id="inputGroupSelect01" name="pnalguage">
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<option value="" selected>Choose...</option>
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<option value="1">English</option>
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<option value="2">Hindi</option>
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</select>
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="row">
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<div class="col-lg-4">
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<label for="exampleInputEmail1"><?php echo lang('Date of Birth'); ?></label>
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<input type="date" class="form-control" name="dob" value='' id='ptdob' placeholder="">
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</div>
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<!-- <div class="col-lg-4">
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<label for="exampleInputEmail1"><?php echo lang('Soc Sec #'); ?></label>
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<input type="text" class="form-control" name="socsec" value='' placeholder="">
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</div> -->
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<!-- <div class="col-lg-4">
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<label for="exampleInputEmail1"><?php echo lang('Merital Status'); ?></label>
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<select class="form-control" name="merital_stat" id="inputGroupSelect01" name="pnalguage">
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<option selected>Choose...</option>
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<option value="Married">Married</option>
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<option value="Unmarried">Unmarried</option>
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</select>
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</div> -->
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</div>
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</div>
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<!-- <div class="form-group">
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<div class="row">
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<div class="col-lg-3">
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<label for="exampleInputEmail1"><?php echo lang('Height: feet'); ?></label>
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<input type="text" class="form-control" name="height" id="exampleInputEmail1">
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</div>
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<div class="col-lg-3">
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<label for="exampleInputEmail1"><?php echo lang('Inch'); ?></label>
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<input type="text" class="form-control" name="heightInch" id="exampleInputEmail1">
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Weight'); ?></label>
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<input type="text" class="form-control" name="weight" id="exampleInputEmail1" value='' placeholder="">
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</div>
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</div>
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</div> -->
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<div class="form-group">
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<div class="row">
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<div class="col-lg-4">
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<label for="exampleInputEmail1" class="required"><?php echo lang('Telephone'); ?></label>
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<input type="text" class="form-control" onkeypress="return isNumberKey(event)" name="telephone" value='' placeholder="">
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</div>
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<!-- <div class="col-lg-4">
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<label for="exampleInputEmail1"><?php echo lang('Cell phone'); ?></label>
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<input type="text" class="form-control" name="cellphone" value='' placeholder="">
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</div>
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<div class="col-lg-4">
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<label for="exampleInputEmail1"><?php echo lang('Other number'); ?></label>
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<input type="text" class="form-control" name="merital_stat" value='' placeholder="">
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</div> -->
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</div>
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</div>
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<!-- <div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Address'); ?></label>
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<textarea class="form-control" name="address" id="exampleInputEmail1" value='' placeholder=""> </textarea>
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Alternating Billing Address'); ?></label>
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<textarea class="form-control" name="alt_address" id="exampleInputEmail1" value='' placeholder=""> </textarea>
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</div>
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</div>
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</div> -->
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<!-- <div class="form-group">
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<div class="row">
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<div class="col-lg-12">
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<label for="exampleInputEmail1"><?php echo lang('Direction'); ?></label>
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<textarea class="form-control" name="direction" id="exampleInputEmail1" value='' placeholder=""> </textarea>
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</div>
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</div>
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</div> -->
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<div class="col-md-12 form-group">
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<button type="submit" name="submit" value="gen_info" class="btn btn-info"><?php echo lang('submit'); ?></button>
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</div>
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</form>
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</div>
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<!-- designate tab -->
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<div class="tab-pane fade <?php echo $tabPane2; ?>" id="designate" role="tabpanel" aria-labelledby="profile-tab">
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<form role="form" action="patient/addReferralGenInfo?type=referral&pid=<?php echo $_GET['pid']; ?>" method="post" enctype="multipart/form-data" name="newDesgFrom" onsubmit="return validateForm2()">
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<!-- <hr class="my-4">
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<h4 class="display-4">Designate Information</h4>
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<hr class="my-4"> -->
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<div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('First name'); ?></label>
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<input type="text" class="form-control" name="dg_fname" value=''>
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Last name'); ?></label>
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<input type="text" class="form-control" name="dg_lname" value='' placeholder="">
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Telephone'); ?></label>
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<input type="text" onkeypress="return isNumberKey(event)" class="form-control" name="dg_telephone" value=''>
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Cell'); ?></label>
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<input type="text" onkeypress="return isNumberKey(event) "class="form-control" name="dg_cell" value='' placeholder="">
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Email'); ?></label>
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<input type="text" class="form-control" name="fname" value=''>
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</div>
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</div>
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</div>
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<!-- <div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('EVV Verification'); ?></label>
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<input type="text" class="form-control" name="evv_verification" value=''>
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Coardinator'); ?></label>
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<input type="text" class="form-control" name="coardinator" value='' placeholder="">
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</div>
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</div>
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</div> -->
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<!-- <div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Intake Nurse'); ?></label>
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<input type="text" class="form-control" name="intake_nurse" value=''>
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Primary Nurse'); ?></label>
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<input type="text" class="form-control" name="primary_nurse" value='' placeholder="">
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</div>
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</div>
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</div> -->
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<div class="col-md-12 form-group">
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<button type="submit" name="submit" value="ref_designate" class="btn btn-info"><?php echo lang('submit'); ?></button>
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</div>
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</form>
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</div>
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<div class="tab-pane fade <?php echo $tabPane3; ?>" id="service_need" role="tabpanel" aria-labelledby="contact-tab">
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<form role="form" action="patient/addReferralGenInfo?type=type=referral&pid=<?php echo $_GET['pid']; ?>&phase2=complete" method="post" name="referalFrom" onsubmit="return validateForm3()" enctype="multipart/form-data">
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<div class="form-group">
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<div class="row">
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<div class="col-lg-12">
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<label for="exampleInputEmail1" class="required"><?php echo lang('Level of care needed'); ?></label>
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<select class="form-control" name="level_care" id="inputGroupSelect01">
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<option value="" selected>Choose...</option>
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<option value="1">1 high</option>
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<option value="2">2</option>
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<option value="3">3</option>
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<option value="4">4</option>
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<option value="5">5 low</option>
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</select>
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1" class="required"><?php echo lang('Referal source'); ?></label>
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<select class="form-control" name="referal_source" id="inputGroupSelect01">
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<option value="" selected>Choose...</option>
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<?php foreach ($preferal as $value) { ?>
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<option value="<?php echo $value->name; ?>"><?php echo $value->name; ?></option>
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<?php } ?>
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</select>
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1" class="required"><?php echo lang('Referal Recive Date'); ?></label>
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<input type="date" class="form-control" name="referal_recive_date" id="exampleInputEmail1" >
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Referal contact'); ?></label>
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<select class="form-control" name="referal_contact" id="inputGroupSelect01">
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<option value="" selected>Choose...</option>
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<option value="Name">Name</option>
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<option value="Address">Address</option>
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<option value="Email">Email</option>
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<option value="Fax">Fax</option>
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<option value="Phone">Phone</option>
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</select>
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Referal Type'); ?></label>
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<select class="form-control" name="referal_type" id="inputGroupSelect01">
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<option value="" selected>Choose...</option>
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<option value="New">New</option>
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<option value="Restart">Restart</option>
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</select>
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</div>
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<!-- <div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Referal Address'); ?></label>
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<input type="text" class="form-control" name="referal_address" id="exampleInputEmail1">
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</div> -->
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</div>
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</div>
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<!-- <div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Referal email'); ?></label>
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<input type="text" class="form-control" name="referal_email" id="exampleInputEmail1">
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Referal Phone'); ?></label>
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<input type="text" class="form-control" name="referal_phone" id="exampleInputEmail1">
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</div>
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</div>
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</div> -->
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<div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1" class="required"><?php echo lang('Level of Service needed'); ?></label>
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<select class="form-control" name="level_service" id="inputGroupSelect01">
|
|
<option value="" selected>Choose...</option>
|
|
<?php foreach ($lvlService as $value) { ?>
|
|
<option value="<?php echo $value->name; ?>"><?php echo $value->name; ?></option>
|
|
<?php } ?>
|
|
</select>
|
|
</div>
|
|
|
|
|
|
<div class="col-lg-6">
|
|
<label for="exampleInputEmail1"><?php echo lang('Service Activity Needed'); ?></label>
|
|
<select class="form-control" name="service_activity[]" id="inputGroupSelect01" multiple>
|
|
<option value="" selected>Choose...</option>
|
|
<?php foreach ($serviceActivity as $value) { ?>
|
|
<option value="<?php echo $value->name; ?>"><?php echo $value->name; ?></option>
|
|
<?php } ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
<div class="form-group">
|
|
<div class="row">
|
|
<div class="col-lg-6">
|
|
<label for="exampleInputEmail1"><?php echo lang('Therapy Type'); ?></label>
|
|
<select class="form-control" name="therapy_type[]" id="inputGroupSelect01" multiple>
|
|
<option value="" selected>Choose...</option>
|
|
<?php foreach ($therapyType as $value) { ?>
|
|
<option value="<?php echo $value->name; ?>"><?php echo $value->name; ?></option>
|
|
<?php } ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
<div class="form-group">
|
|
<div class="row">
|
|
<div class="col-lg-6">
|
|
<label for="exampleInputEmail1"><?php echo lang('Type of access'); ?></label>
|
|
<select class="form-control" name="type_access[]" id="inputGroupSelect01" multiple>
|
|
<option value="" selected>Choose...</option>
|
|
<?php foreach ($accessType as $value) { ?>
|
|
<option value="<?php echo $value->name; ?>"><?php echo $value->name; ?></option>
|
|
<?php } ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<div class="col-md-12 form-group">
|
|
<button type="submit" name="submit" value="services" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
|
</div>
|
|
</form>
|
|
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<!-- page end-->
|
|
</section>
|
|
</section>
|
|
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
|
|
<?php if(isset($_GET['pid']) && !isset($_GET['phase2'])): ?>
|
|
<script type="text/javascript">
|
|
$(function(){
|
|
$('#myTab li:nth-child(2) a').tab('show');
|
|
})
|
|
|
|
</script>
|
|
<?php endif; ?>
|
|
|
|
<?php if( isset($_GET['pid']) && isset($_GET['phase2']) ): ?>
|
|
<script type="text/javascript">
|
|
$(function(){
|
|
$('#myTab li:nth-child(3) a').tab('show');
|
|
})
|
|
|
|
</script>
|
|
<?php endif; ?>
|
|
|
|
<script type="text/javascript"> /* future date dob not accept */
|
|
|
|
$(document).ready(function () {
|
|
// alert("dateSec");
|
|
var todaysDate = new Date(); // Gets today's date
|
|
|
|
// Max date attribute is in "YYYY-MM-DD". Need to format today's date accordingly
|
|
|
|
var year = todaysDate.getFullYear(); // YYYY
|
|
var month = ("0" + (todaysDate.getMonth() + 1)).slice(-2); // MM
|
|
var day = ("0" + todaysDate.getDate()).slice(-2); // DD
|
|
|
|
var maxDate = (year +"-"+ month +"-"+ day); // Results in "YYYY-MM-DD" for today's date
|
|
|
|
// Now to set the max date value for the calendar to be today's date
|
|
$('#ptdob').attr('max',maxDate);
|
|
|
|
});
|
|
|
|
</script>
|
|
|
|
<script type="text/javascript">
|
|
|
|
|
|
function validateForm1(){
|
|
|
|
var x = document.forms["newGenInfo"]["fname"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter first name',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newGenInfo"]["lname"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter last name',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
// var x = document.forms["newGenInfo"]["email"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter email name',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
|
|
var x = document.forms["newGenInfo"]["gender"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select a gender',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newGenInfo"]["pnalguage"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select a language',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newGenInfo"]["telephone"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter Telephone',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
// var x = document.forms["newGenInfo"]["dob"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter you Date of Birth',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newGenInfo"]["socsec"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter SOC SEC#',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newGenInfo"]["weight"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter weight',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newGenInfo"]["height"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter height',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
// var x = document.forms["newGenInfo"]["cellphone"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter cellphone number',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newGenInfo"]["address"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter address',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newGenInfo"]["alt_address"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter alternate address',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newGenInfo"]["direction"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter direction',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
}
|
|
|
|
function validateForm2(){
|
|
|
|
var x = document.forms["newDesgFrom"]["level_care"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select level of care',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newDesgFrom"]["dg_fname"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select designate first name',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newDesgFrom"]["dg_lname"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select designate first name',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
|
|
var x = document.forms["newDesgFrom"]["dg_cell"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select designate Cell phone number',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newDesgFrom"]["evv_verification"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please EVV verification',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newDesgFrom"]["coardinator"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter coardinator',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newDesgFrom"]["intake_nurse"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter intake nurse',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newDesgFrom"]["primary_nurse"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter primary nurse',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
|
|
|
|
}
|
|
|
|
function validateForm3(){
|
|
|
|
var x = document.forms["referalFrom"]["referal_source"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter referal source',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["referalFrom"]["level_service"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select level of care',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
var x = document.forms["referalFrom"]["referal_name"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter referral name',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
var x = document.forms["referalFrom"]["referal_name"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter referral name',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
var x = document.forms["referalFrom"]["referal_address"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter referral address',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
var x = document.forms["referalFrom"]["referal_email"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter referral Email',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
var x = document.forms["referalFrom"]["referal_phone"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter referral phone',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
}
|
|
|
|
|
|
|
|
</script>
|
|
|
|
<script>
|
|
$( document ).ready(function() {
|
|
$('.nav-item').click(function(event){
|
|
if ($(this).hasClass('disabled')) {
|
|
return false;
|
|
}
|
|
});
|
|
});
|
|
</script>
|
|
<script type="text/javascript">
|
|
function isNumberKey(evt){
|
|
var charCode = (evt.which) ? evt.which : evt.keyCode
|
|
if (charCode > 31 && (charCode < 48 || charCode > 57))
|
|
return false;
|
|
return true;
|
|
}
|
|
|
|
</script>
|
|
|
|
<!--main content end-->
|
|
<!--footer start-->
|