1407 lines
79 KiB
PHP
Executable File
1407 lines
79 KiB
PHP
Executable File
heightsidebar end-->
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<!--main content start-->
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<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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<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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<!--sidebar end-->
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<!--main content start-->
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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-10">
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<div class="card-header">
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<h3 class="font-weight-bold"> <?php
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if (!empty($nurse->id))
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echo lang('Edit Patient');
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else
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echo lang('Edit Patient');
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?></h3>
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</div>
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<!-- <div class="panel-body col-md-7">
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<div class="adv-table editable-table ">
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<div class="clearfix">
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<div class="col-lg-12">
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<section class="panel">
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<div class="panel-body">
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<div class="col-lg-12">
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</div>
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<input type="hidden" name="id" value='<?php
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if (!empty($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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<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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<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">
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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" >
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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">
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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 Needed</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 active in show" name="newGenInfo" id="home" role="tabpanel" aria-labelledby="home-tab">
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<form role="form" action="patient/EditNewPatientChanges?pid=<?=$_GET['pid']?>" method="post" 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-md-6">
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<div class="form-group">
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<label for="firstName3">
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<?php echo lang('Reffered Information'); ?>
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<span class="danger">*</span>
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</label>
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<select class="form-control required" id="ref_info" name="pt_refrance_type">
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<option value="New Patient">New Patient</option>
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<option value="Reffered by Patient">Reffered by Patient</option>
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<option value="Reffered by Vendor">Reffered by Vendor</option>
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</select>
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</div>
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</div>
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<div class="col-md-6" id="ref_by_ptn" style="display: none;">
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<div class="form-group">
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<label for="lastName3">
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<?php echo lang('Patient Id'); ?>
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<span class="danger">*</span>
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</label>
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<input type="text" class="form-control required" id="ref_pt_id" name="pt_refrance_value" value="<?php echo $pdata->reference_id; ?>">
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</div>
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</div>
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<div class="col-md-6" id="ref_by_vendor" style="display: none;">
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<div class="form-group">
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<label for="lastName3">
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<?php echo lang('Vendor'); ?>
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<span class="danger">*</span>
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</label>
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<select class="form-control required" id="ref_vnd_id" name="vend_refrance_value">
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<option value="" selected>Choose...</option>
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<?php foreach ($vendorList as $value) { ?>
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<option <?php echo ($pdata->reference_id == $value->id)?'selected':'' ; ?> value="<?php echo $value->id; ?>"><?php echo $value->vedor_name; ?></option>
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<?php } ?>
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</select>
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</div>
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</div>
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<script type="text/javascript">
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$(function(){
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$("#ref_info").change(function(){
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var selVal = $(this).val();
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if(selVal == 'Reffered by Patient')
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{
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$("#ref_by_ptn").show();
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$("#ref_by_vendor").hide();
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}
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else if(selVal == 'Reffered by Vendor'){
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$("#ref_by_ptn").hide();
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$("#ref_by_vendor").show();
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}
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else{
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$("#ref_by_ptn").hide();
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$("#ref_by_vendor").hide();
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}
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})
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var refInfo = "<?php echo $pdata->reference_information; ?>";
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// $("#id_100 select").val("val2");
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$('#ref_info').val(refInfo).trigger('change');
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});
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</script>
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</div>
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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'); ?><span class="danger">*</span></label>
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<input type="text" class="form-control" name="fname"
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value="<?php echo $pdata->first_name; ?>">
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<!-- value='<?php
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if (!empty($setval)) {
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echo set_value('name');
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}
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if (!empty($nurse->name)) {
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echo $nurse->name;
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}
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?>'> -->
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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'); ?><span class="danger">*</span></label>
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<input type="text" class="form-control" name="lname"
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value=<?php echo $pdata->last_name; ?>>
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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"><?php echo lang('email'); ?><span class="danger">*</span></label>
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<input type="text" class="form-control" name="email" id="exampleInputEmail1" value=<?php echo $pdata->patient_email; ?> placeholder="">
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</div>
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<div class="form-group">
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<div class="row">
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Gender'); ?><span class="danger">*</span></label>
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<select class="form-control" name="gender" id="inputGroupSelect01" name="pnalguage">
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<option selected>Choose...</option>
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<option <?php echo ($pdata->gender == 'Male')?'selected':'' ; ?> value="Male">Male</option>
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<option <?php echo ($pdata->gender == 'Female')?'selected':'' ; ?> value="Female">Female</option>
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<option <?php echo ($pdata->gender == 'Others')?'selected':'' ; ?> 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"><?php echo lang('Primary language'); ?><span class="danger">*</span></label>
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<select class="form-control" id="inputGroupSelect01" name="pnalguage">
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<option selected>Choose...</option>
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<option <?php echo ($pdata->primary_language == 'English')?'selected':'' ; ?> value="English">English</option>
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<option <?php echo ($pdata->primary_language == 'Hindi')?'selected':'' ; ?> value="Hindi">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'); ?><span class="danger">*</span></label>
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<input type="date" class="form-control" name="dob" value=<?php echo $pdata->dob; ?>>
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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 #'); ?><span class="danger">*</span></label>
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<input type="text" class="form-control" name="socsec" value=<?php echo $pdata->soc_sec_no; ?>>
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</div>
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<div class="col-lg-4">
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<label for="exampleInputEmail1"><?php echo lang('Merital Status'); ?></label>
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<select class="form-control" name="merital_stat" id="inputGroupSelect01" name="pnalguage">
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<option selected>Choose...</option>
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<option <?php echo ($pdata->marital_stat == 'Married')?'selected':'' ; ?> value="Married">Married</option>
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<option <?php echo ($pdata->marital_stat == 'Unmarried')?'selected':'' ; ?> value="Unmarried">Unmarried</option>
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</select>
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</div>
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</div>
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</div>
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<?php
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$HtFI = explode(',', $pdata->height);
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$Htf = $HtFI[0];
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$Hti = $HtFI[1];
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?>
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<div class="form-group">
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<div class="row">
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<div class="col-lg-4">
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<label for="exampleInputEmail1"><?php echo lang('Height'); ?></label>
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<select class="form-control" name="height" data-error="Please enter a valid height.">
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<option value="" selected disabled>Select</option>
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<?php for($i=1;$i<10;$i++){ ?>
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<option value="<?php echo $i; ?>" <?php if($Htf==$i) echo 'selected'; ?>><?php echo $i; ?></option>
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<?php } ?>
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</select>
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</div>
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<div class="col-md-4">
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<div class="form-group">
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<label for="firstName3">
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<?php echo lang('Inch'); ?>
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</label>
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<select class="form-control" name="heightInch" required data-error="Please enter a valid height.">
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<option value="" selected disabled>Select</option>
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<?php for($i=0;$i<12;$i++){ ?>
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<option value="<?php echo $i; ?>" <?php if($Hti==$i) echo 'selected'; ?>><?php echo $i; ?></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 class="col-lg-4">
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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=<?php echo $pdata->weight; ?>>
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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('Telephone'); ?></label>
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<input type="text" class="form-control" name="telephone" value='<?php echo $pdata->telephone; ?>'>
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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'); ?><span class="danger">*</span></label>
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<input type="text" class="form-control" name="cellphone"
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value="<?php echo $pdata->cellphone; ?>" >
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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="otr_number" value="<?php echo $pdata->other_no; ?>" >
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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'); ?><span class="danger">*</span></label>
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<textarea class="form-control" name="address" id="exampleInputEmail1"> <?php echo $pdata->address; ?></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" >
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<?php echo $pdata->alt_billing_address; ?> </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" >
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<?php echo $pdata->direction; ?>
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</textarea>
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</div>
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</div>
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</div>
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<div class="col-md-12 form-group" >
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<button type="submit" name="submit" value="gen_info" class="btn btn-info"><?php echo lang('submit'); ?></button>
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</div>
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</form>
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</div>
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<!-- designate tab -->
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<div class="tab-pane fade" id="designate" role="tabpanel" aria-labelledby="profile-tab">
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<form role="form" action="patient/EditNewPatientChanges?pid=<?=$_GET['pid']?>" method="post" 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"><?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 >Choose...</option>
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<option <?php echo ($pdata->level_of_care == '1')?'selected':'' ; ?> value="1">1</option>
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<option <?php echo ($pdata->level_of_care == '2')?'selected':'' ; ?> value="2">2</option>
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<option <?php echo ($pdata->level_of_care == '3')?'selected':'' ; ?> value="3">3</option>
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<option <?php echo ($pdata->level_of_care == '4')?'selected':'' ; ?> value="4">4</option>
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<option <?php echo ($pdata->level_of_care == '5')?'selected':'' ; ?> value="5">5</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"><?php echo lang('Designate First name'); ?></label>
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<input type="text" class="form-control" name="dg_fname" value='<?php echo $pdata->designate_first_name; ?>'>
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Designate Last name'); ?></label>
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<input type="text" class="form-control" name="dg_lname" value='<?php echo $pdata->designate_last_name; ?>' 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('Designate Telephone'); ?></label>
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<input type="text" class="form-control" name="dg_telephone" value='<?php echo $pdata->designate_telephone; ?>'>
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</div>
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<div class="col-lg-6">
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<label for="exampleInputEmail1"><?php echo lang('Designate Cell'); ?></label>
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<input type="text" class="form-control" name="dg_cell" value='<?php echo $pdata->designate_cell; ?>' 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('EVV Verification'); ?></label>
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<input type="text" class="form-control" name="evv_verification" value='<?php echo $pdata->evv_verification; ?>'>
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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='<?php echo $pdata->coordinator; ?>' 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='<?php echo $pdata->intake_nurse; ?>'>
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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='<?php echo $pdata->primary_nurse; ?>' placeholder="">
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</div>
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</div>
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</div>
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<div class="form-group">
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<div class="row">
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<div class="col-lg-12">
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<label for="exampleInputEmail1"><?php echo lang('Referral Source'); ?></label>
|
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<select class="form-control" name="referal_source" id="inputGroupSelect01">
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<option selected>Choose...</option>
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<?php
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foreach ($preferal as $value)
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{
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?>
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<option <?php echo ($pdata->referral_source == $value->id)?'selected':'' ; ?> value="<?php echo $value->id; ?>"><?php echo $value->name; ?></option>
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<?php } ?>
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<!-- <option 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="col-md-12 form-group" >
|
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<button type="submit" name="submit" name="designate" value="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" id="service_need" role="tabpanel" aria-labelledby="contact-tab">
|
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<form role="form" action="patient/EditNewPatientChanges?pid=<?php echo $_GET['pid']; ?>" method="post" enctype="multipart/form-data">
|
|
|
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<div class="row">
|
|
<div class="col-md-12">
|
|
<div class="form-group">
|
|
<label for="firstName3">
|
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<?php echo lang('Level of Service needed'); ?>
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</label>
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<select class="form-control" name="level_service" id="level_service">
|
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<option value="" selected>Choose...</option>
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<?php foreach ($lvlService as $value) { ?>
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<option <?php echo ($pdata->level_service == $value->id)?'selected':'' ; ?> value="<?php echo $value->id; ?>" attr_name="<?php echo $value->name; ?>"><?php echo $value->name; ?></option>
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<?php } ?>
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</select>
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</div>
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</div>
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</div>
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<div id="rnlnp" style="display: <?php echo($pdata->level_service== $rnId || $pdata->level_service== $lnpId)?'block' :'none' ; ?>">
|
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<div class="row">
|
|
<div class="col-md-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('New order'); ?></label>
|
|
<div class="form-check">
|
|
<input class="form-check-input" type="radio" name="new_order" id="radio" value="option1" checked>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check">
|
|
<input class="form-check-input" type="radio" name="new_order" id="radio" value="option2">
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<?php $dbData = explode(',', $pdata->service_activity);
|
|
// var_dump($dbData);
|
|
?>
|
|
<div class="col-md-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Service Activity needed'); ?></label>
|
|
<select class="form-control" name="service_activity[]" id="inputGroupSelect01" multiple>
|
|
<option value="">Choose...</option>
|
|
<?php
|
|
foreach ($serviceActivity as $value)
|
|
{
|
|
?>
|
|
<option <?php echo (in_array($value->id, $dbData))? 'selected' : '' ; ?> value="<?php echo $value->id; ?>"><?php echo $value->name; ?></option>
|
|
|
|
<?php } ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<?php $dbData = explode(',', $pdata->therapy_type); ?>
|
|
<div class="row">
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Therapy type'); ?></label>
|
|
<select class="form-control" name="therapy_type[]" id="inputGroupSelect01" multiple>
|
|
<option value="">Choose...</option>
|
|
<?php foreach ($therapyType as $value) { ?>
|
|
<option <?php echo (in_array($value->id, $dbData))? 'selected' : '' ; ?> value="<?php echo $value->id; ?>"><?php echo $value->name; ?></option>
|
|
<?php } ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
|
|
<?php $dbData = explode(',', $pdata->type_access);
|
|
// var_dump($dbData);
|
|
?>
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Type Of access'); ?></label>
|
|
<select class="form-control" name="type_access[]" id="inputGroupSelect01" multiple>
|
|
<option value="">Choose...</option>
|
|
<?php foreach ($accessType as $value) { ?>
|
|
<option <?php echo (in_array($value->id, $dbData))? 'selected' : '' ; ?> value="<?php echo $value->id; ?>"><?php echo $value->name; ?></option>
|
|
<?php } ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
|
|
|
|
<div class="row">
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Patient seen by MD'); ?></label>
|
|
<input type="date" value="$pdata->patient_seen_by_MD" class="form-control" name="patient_seen_by_MD" value=''>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Current Lab Work'); ?></label>
|
|
<div class="form-check">
|
|
<input class="form-check-input" type="radio" name="current_lab_work" id="radio" value="option1" checked>
|
|
<label class="form-check-label" for="YES">
|
|
YES
|
|
</label>
|
|
</div>
|
|
<div class="form-check">
|
|
<input class="form-check-input" type="radio" name="current_lab_work" id="radio" value="option2">
|
|
<label class="form-check-label" for="NO">
|
|
NO
|
|
</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
<div class="row">
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Lab Order'); ?></label>
|
|
<input type="text" class="form-control" name="lab_order" value="<?php echo $pdata->lab_order; ?>">
|
|
</div>
|
|
</div>
|
|
|
|
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Additional Lab Orders'); ?></label>
|
|
<input type="text" class="form-control" name="additional_lab_order" value="<?php echo $pdata->additional_lab_order; ?>" placeholder="">
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
|
|
<div class="row">
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Lab Frequency'); ?></label>
|
|
<select class="form-control" name="lab_frequency" id="inputGroupSelect01">
|
|
<option <?php echo ($pdata->lab_frequency == 'Weekly')?'selected':'' ; ?> value="Weekly">Weekly</option>
|
|
<option <?php echo ($pdata->lab_frequency == 'Every 2 weeks')?'selected':'' ; ?> value="Every 2 weeks">Every 2 weeks</option>
|
|
<option <?php echo ($pdata->lab_frequency == 'Every other week')?'selected':'' ; ?> value="Every other week">Every other week</option>
|
|
<option <?php echo ($pdata->lab_frequency == 'Every 6 months')?'selected':'' ; ?> value="Every 6 months">Every 6 months</option>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Other Lab Frequency'); ?></label>
|
|
<input type="text" class="form-control" name="other_lab_frequency" value="<?php echo $pdata->other_lab_frequency; ?>">
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
<div class="row">
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Tube'); ?></label>
|
|
<select class="form-control" name="tube_type" id="inputGroupSelect01">
|
|
<option value="" selected>Choose...</option>
|
|
<?php foreach ($tubes as $value) { ?>
|
|
<option value="<?php echo $value->name; ?>"><?php echo $value->name; ?></option>
|
|
<?php } ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Formula'); ?></label>
|
|
<input type="text" class="form-control" name="formula"
|
|
value="<?php echo set_value('fname'); ?>">
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
|
|
<div class="row">
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Schedule'); ?></label>
|
|
<input type="text" class="form-control" name="schedule" value="">
|
|
</div>
|
|
</div>
|
|
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Flush With'); ?></label>
|
|
<select class="form-control" name="flush_with" id="inputGroupSelect01">
|
|
<option value="" selected>Choose...</option>
|
|
<?php for($i = 10; $i<=240; $i++) { ?>
|
|
<option <?php echo ($pdata->flush_with == $i." ML")?'selected':'' ; ?> value="<?=$i?>"><?php echo $i; ?> ML</option>
|
|
<?php } ?>
|
|
</select>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
|
|
<div class="row">
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Daily Intake Requirment'); ?></label>
|
|
<input type="text" class="form-control" name="daily_intake_requirment" value="">
|
|
</div>
|
|
</div>
|
|
|
|
<div class="col-lg-6">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Flush Frequency'); ?></label>
|
|
<div class="form-check form-check">
|
|
<input class="form-check-input" name="flush_frequency" type="radio" id="inlineCheckbox1" value="Before Feed">
|
|
<label class="form-check-label" for="inlineCheckbox1">Before Feed</label>
|
|
</div>
|
|
<div class="form-check form-check">
|
|
<input class="form-check-input" name="flush_frequency" type="radio" id="inlineCheckbox2" value="After Feed">
|
|
<label class="form-check-label" for="inlineCheckbox2">After Feed</label>
|
|
</div>
|
|
<div class="form-check form-check">
|
|
<input class="form-check-input" name="flush_frequency" type="radio" id="inlineCheckbox2" value="Before Medication">
|
|
<label class="form-check-label" for="inlineCheckbox2">Before Medication</label>
|
|
</div>
|
|
<div class="form-check form-check">
|
|
<input class="form-check-input" name="flush_frequency" type="radio" id="inlineCheckbox2" value="After Madication">
|
|
<label class="form-check-label" for="inlineCheckbox2">After Madication</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
|
|
<div class="row">
|
|
<div class="col-lg-4">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Fluide Restrictions'); ?></label>
|
|
<div class="form-check form-check-inline">
|
|
<input class="form-check-input" type="radio" name="fluid_restriction" id="fluid_restriction_yes" value="Yes">
|
|
<label class="form-check-label" for="fluid_restriction_yes">Yes</label>
|
|
</div>
|
|
<div class="form-check form-check-inline">
|
|
<input class="form-check-input" type="radio" name="fluid_restriction" id="fluid_restriction_no" value="No" checked>
|
|
<label class="form-check-label" for="fluid_restriction_no">No</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="col-lg-4">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Fluide Restriction Amount'); ?></label>
|
|
<input type="text" class="form-control" name="fluide_restric_amount"
|
|
value="<?php echo set_value('fname'); ?>">
|
|
</div>
|
|
</div>
|
|
|
|
<div class="col-lg-4">
|
|
<div class="form-group">
|
|
<label for="exampleInputEmail1"><?php echo lang('Fluide Restriction Frequency'); ?></label>
|
|
<div class="form-check form-check">
|
|
<input class="form-check-input" name="fluide_restric_frequency" type="radio" id="inlineCheckbox3" value="Per day">
|
|
<label class="form-check-label" for="inlineCheckbox2">Per day</label>
|
|
</div>
|
|
<div class="form-check form-check">
|
|
<input class="form-check-input" name="fluide_restric_frequency" type="radio" id="inlineCheckbox4" value="Per Hour">
|
|
<label class="form-check-label" for="inlineCheckbox2">Per Hour</label>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
|
|
<div class="col-md-12 form-group">
|
|
<button type="submit" name="submit" value="services" class="btn btn-info"><?php echo lang('submit'); ?></button>
|
|
</div>
|
|
</form>
|
|
</form>
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<!-- page end-->
|
|
</section>
|
|
</section>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
|
|
|
|
<script type="text/javascript">
|
|
|
|
function secDigActive(_this){
|
|
var val = $(_this).val();
|
|
if (val=='Secondary') {
|
|
$("#secondaryDiagonosis").show();
|
|
}
|
|
else{
|
|
$("#secondaryDiagonosis").hide();
|
|
}
|
|
}
|
|
|
|
|
|
$("#advanceDirectiveIfyes").change(function(){
|
|
var val = $(this).val();
|
|
if(val == 'file-upload'){
|
|
$("#advUploadFIle").show();
|
|
}
|
|
else{
|
|
$("#advUploadFIle").hide();
|
|
}
|
|
});
|
|
</script>
|
|
<!--
|
|
<?php if(isset($_GET['pid']) && !isset($_GET['phase2']) && !isset($_GET['phase3'])): ?>
|
|
<script type="text/javascript">
|
|
|
|
$(function(){
|
|
$('#myTab li:nth-child(2) a').tab('show');
|
|
})
|
|
|
|
</script>
|
|
<?php endif; ?>
|
|
|
|
<?php if( isset($_GET['pid']) && isset($_GET['phase2']) ): ?>
|
|
<script type="text/javascript">
|
|
$(function(){
|
|
$('#myTab li:nth-child(3) a').tab('show');
|
|
})
|
|
|
|
</script>
|
|
<?php endif; ?>
|
|
|
|
<?php if( isset($_GET['pid']) && isset($_GET['phase3']) && !isset($_GET['phase2'])): ?>
|
|
<script type="text/javascript">
|
|
$(function(){
|
|
$('#myTab li:nth-child(4) a').tab('show');
|
|
|
|
})
|
|
|
|
</script>
|
|
<?php endif; ?> -->
|
|
|
|
|
|
<script type="text/javascript"> /* future date dob not accept */
|
|
|
|
$(document).ready(function () {
|
|
// alert("dateSec");
|
|
var todaysDate = new Date(); // Gets today's date
|
|
|
|
// Max date attribute is in "YYYY-MM-DD". Need to format today's date accordingly
|
|
|
|
var year = todaysDate.getFullYear(); // YYYY
|
|
var month = ("0" + (todaysDate.getMonth() + 1)).slice(-2); // MM
|
|
var day = ("0" + todaysDate.getDate()).slice(-2); // DD
|
|
|
|
var maxDate = (year +"-"+ month +"-"+ day); // Results in "YYYY-MM-DD" for today's date
|
|
|
|
// Now to set the max date value for the calendar to be today's date
|
|
$('#ptdob').attr('max',maxDate);
|
|
|
|
});
|
|
|
|
</script>
|
|
|
|
|
|
|
|
<!-- general from validation -->
|
|
|
|
<script>
|
|
$( document ).ready(function() {
|
|
$('.nav-item').click(function(event){
|
|
if ($(this).hasClass('disabled')) {
|
|
return false;
|
|
}
|
|
});
|
|
});
|
|
</script>
|
|
|
|
<script type="text/javascript">
|
|
function validateForm1(){
|
|
|
|
var x = document.forms["newGenInfo"]["fname"].value;
|
|
if (x == "") {
|
|
document.forms["newGenInfo"]["fname"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter first name',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newGenInfo"]["lname"].value;
|
|
if (x == "") {
|
|
document.forms["newGenInfo"]["lname"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter last name',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newGenInfo"]["email"].value;
|
|
if (x == "") {
|
|
document.forms["newGenInfo"]["email"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter email name',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newGenInfo"]["gender"].value;
|
|
if (x == "") {
|
|
document.forms["newGenInfo"]["gender"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select a gender',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newGenInfo"]["pnalguage"].value;
|
|
if (x == "") {
|
|
document.forms["newGenInfo"]["pnalguage"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select a language',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newGenInfo"]["dob"].value;
|
|
if (x == "") {
|
|
document.forms["newGenInfo"]["dob"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter you Date of Birth',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newGenInfo"]["socsec"].value;
|
|
if (x == "") {
|
|
document.forms["newGenInfo"]["socsec"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter SOC SEC#',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
// var x = document.forms["newGenInfo"]["weight"].value;
|
|
// if (x == "") {
|
|
// document.forms["newGenInfo"]["weight"].focus();
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter weight',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newGenInfo"]["height"].value;
|
|
// if (x == "") {
|
|
// document.forms["newGenInfo"]["height"].focus();
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter height',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
var x = document.forms["newGenInfo"]["cellphone"].value;
|
|
if (x == "") {
|
|
document.forms["newGenInfo"]["cellphone"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter cellphone number',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newGenInfo"]["address"].value;
|
|
if (x == "") {
|
|
document.forms["newGenInfo"]["address"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please enter address',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
// var x = document.forms["newGenInfo"]["alt_address"].value;
|
|
// if (x == "" || x == " ") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter alternate address',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newGenInfo"]["direction"].value;
|
|
// if (x == "" || x == " ") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter direction',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
}
|
|
|
|
function validateForm2(){
|
|
|
|
var x = document.forms["newDesgFrom"]["level_care"].value;
|
|
if (x == "") {
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select level of care',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
// var x = document.forms["newDesgFrom"]["dg_fname"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please select designate first name',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newDesgFrom"]["dg_lname"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please select designate first name',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
|
|
// var x = document.forms["newDesgFrom"]["dg_cell"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please select designate Cell phone number',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newDesgFrom"]["evv_verification"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please EVV verification',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newDesgFrom"]["coardinator"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter coardinator',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newDesgFrom"]["intake_nurse"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter intake nurse',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newDesgFrom"]["primary_nurse"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter primary nurse',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newDesgFrom"]["referal_source"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please enter referal source',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
}
|
|
|
|
function validateForm3(){
|
|
|
|
var x = document.forms["servicesForm"]["level_service"].value;
|
|
if (x == "") {
|
|
document.forms["servicesForm"]["level_service"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select level of service',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["servicesForm"]["new_order"].value;
|
|
if (x == "") {
|
|
document.forms["servicesForm"]["new_order"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select new order',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["servicesForm"]["service_activity"].value;
|
|
if (x == "") {
|
|
document.forms["servicesForm"]["service_activity"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select service activity',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
|
|
|
|
}
|
|
|
|
/*rn and lnp*/
|
|
|
|
$("#level_service").change(function(){
|
|
var valu = $("#level_service option:selected"). attr("attr_name")
|
|
// var valu = $(this).("option:selected").attr("attr_name");
|
|
// alert(valu);
|
|
// var valu = $(this).val();
|
|
if(valu != 'RN' && valu != 'LNP')
|
|
$("#rnlnp").hide();
|
|
else
|
|
$("#rnlnp").show();
|
|
|
|
});
|
|
|
|
/*rn and lnp*/
|
|
$('#insurance_type').change(function(){
|
|
|
|
var insType = $(this).val();
|
|
if(insType == 'Madicaid')
|
|
{
|
|
document.getElementById("medicaidInfoSection").style.display = "block";
|
|
document.getElementById("pvtInsInfoSection").style.display = "none";
|
|
}
|
|
if(insType == 'Private')
|
|
{
|
|
document.getElementById("medicaidInfoSection").style.display = "none";
|
|
document.getElementById("pvtInsInfoSection").style.display = "block";
|
|
}
|
|
})
|
|
|
|
|
|
function validateForm4(){
|
|
|
|
var insType = document.forms["newInsuranceFrom"]["insurance_type"].value;
|
|
if (insType == "") {
|
|
document.forms["newInsuranceFrom"]["insurance_type"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please select Insurance Type',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
// var x = document.forms["newInsuranceFrom"]["insurance_plan"].value;
|
|
// if (x == "") {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please select Insurance Plan',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
/*private and medica*/
|
|
if (insType == 'Madicaid') {
|
|
|
|
var x = document.forms["newInsuranceFrom"]["MedicaidId"].value;
|
|
if (x == "")
|
|
{
|
|
document.forms["newInsuranceFrom"]["MedicaidId"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter Medicaid Id',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newInsuranceFrom"]["medicaidAdult"].value;
|
|
if (x == "")
|
|
{
|
|
document.forms["newInsuranceFrom"]["medicaidAdult"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter Medicaid Adult',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newInsuranceFrom"]["MedicaidPediriatic"].value;
|
|
if (x == "")
|
|
{
|
|
document.forms["newInsuranceFrom"]["MedicaidPediriatic"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter Medicaid Pediriatic',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newInsuranceFrom"]["primarySeconday"].value;
|
|
if (x == "")
|
|
{
|
|
document.forms["newInsuranceFrom"]["primarySeconday"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Choose Primary Or secondary',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
|
|
}
|
|
if (insType == 'Private') {
|
|
|
|
var x = document.forms["newInsuranceFrom"]["privatePolicyNumber"].value;
|
|
if (x == "")
|
|
{
|
|
document.forms["newInsuranceFrom"]["privatePolicyNumber"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter Private Policy Number',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newInsuranceFrom"]["Private_claim_number"].value;
|
|
if (x == "")
|
|
{
|
|
document.forms["newInsuranceFrom"]["Private_claim_number"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter Private Claim No',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
}
|
|
|
|
|
|
// var x = document.forms["newInsuranceFrom"]["emgName"].value;
|
|
// if (x == "")
|
|
// {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please Enter Emergency Name',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
// var x = document.forms["newInsuranceFrom"]["emgRelationtoPt"].value;
|
|
// if (x == "")
|
|
// {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please Enter Relationship with Patient',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newInsuranceFrom"]["emgCellNumber"].value;
|
|
// if (x == "")
|
|
// {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please Enter Emergency cell No',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newInsuranceFrom"]["emgEmail"].value;
|
|
// if (x == "")
|
|
// {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please Enter Emergency Email',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
//
|
|
|
|
var x = document.forms["newInsuranceFrom"]["advanceDirective"].value;
|
|
if (x == "")
|
|
{
|
|
document.forms["newInsuranceFrom"]["advanceDirective"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter advance directive',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
// var x = document.forms["newInsuranceFrom"]["emgEvacZone"].value;
|
|
// if (x == "")
|
|
// {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please Enter Evacuation zone',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newInsuranceFrom"]["emgMobilityStat"].value;
|
|
// if (x == "")
|
|
// {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please Enter Mobility Status',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newInsuranceFrom"]["emgEvaclocation"].value;
|
|
// if (x == "")
|
|
// {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please Enter Evacuation location',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
// var x = document.forms["newInsuranceFrom"]["emgEleDEpendency"].value;
|
|
// if (x == "")
|
|
// {
|
|
// Swal.fire({
|
|
// position: 'center',
|
|
// icon: 'error',
|
|
// title: 'Please Enter Electrical Dependency',
|
|
// showConfirmButton: true,
|
|
// });
|
|
// return false;
|
|
// }
|
|
|
|
var x = document.forms["newInsuranceFrom"]["phymdName"].value;
|
|
if (x == "")
|
|
{
|
|
document.forms["newInsuranceFrom"]["advanceDirective"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter MD Name',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newInsuranceFrom"]["phymdTelephone"].value;
|
|
if (x == "")
|
|
{
|
|
document.forms["newInsuranceFrom"]["phymdTelephone"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Enter MD Telephone',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
var x = document.forms["newInsuranceFrom"]["diagICD"].value;
|
|
if (x == "")
|
|
{
|
|
document.forms["newInsuranceFrom"]["diagICD"].focus();
|
|
Swal.fire({
|
|
position: 'center',
|
|
icon: 'error',
|
|
title: 'Please Select an Icd',
|
|
showConfirmButton: true,
|
|
});
|
|
return false;
|
|
}
|
|
|
|
/*private and medica*/
|
|
}
|
|
</script>
|
|
|
|
<script>
|
|
/*tool tip section*/
|
|
$(document).ready(function(){
|
|
$('[data-toggle="tooltip"]').tooltip();
|
|
});
|
|
</script>
|