frm_01.php
131 lines
| 4.6 KiB
| text/x-php
|
XmlPhpLexer
|
r0 | <?php | |
switch($method){ | |||
case "add": | |||
$flag_edit = TRUE; | |||
break; | |||
case "view": | |||
$flag_edit = FALSE; | |||
break; | |||
} | |||
?> | |||
<script> | |||
$(function() { | |||
//alert('hola'); | |||
$( "#sd" ).datepicker({ | |||
showWeek: true, | |||
dateFormat: 'dd/M/yy', | |||
firstDay: 1 | |||
}); | |||
$( "#dics" ).datepicker({ | |||
showWeek: true, | |||
dateFormat: 'dd/M/yy', | |||
firstDay: 1 | |||
}); | |||
$( "#db" ).datepicker({ | |||
changeMonth: true, | |||
changeYear: true, | |||
showWeek: true, | |||
dateFormat: 'dd/M/yy', | |||
firstDay: 1 | |||
}); | |||
}); | |||
</script> | |||
<form name="frm_demographics" method="post" action="index.php"> | |||
<div style="width:650px; margin:0 auto;"> | |||
<h1>Demographics</h1> | |||
<table id="" class="" style="" > | |||
<thead><tr><td colspan="2"></td></tr></thead> | |||
<tbody> | |||
<tr> | |||
<td>Subject Number:</td> | |||
<td><?php echo $data_result['code']; ?><input type="hidden" name="datos[txt_code]" value="<?php echo $data_result['idsubject']; ?>" /></td> | |||
</tr> | |||
<tr> | |||
<td>Screening Date</td> | |||
<td><?php if($flag_edit){ ?> | |||
<input type="text" id="sd" name="datos[sd]" value="" /> | |||
<?php }else{ echo $data_crf['screening_date']; } ?> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td>Date Informed Consent Signed</td> | |||
<td><?php if($flag_edit){ ?> | |||
<input type="text" id="dics" name="datos[dics]" value="" /> | |||
<?php }else{ echo $data_crf['date_consent']; } ?> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td>Date of Birth</td> | |||
<td><?php if($flag_edit){ ?> | |||
<input type="text" id="db" name="datos[db]" value="" /> | |||
<?php }else{ echo $data_result['date_birth']; } ?> | |||
</td> | |||
</tr> | |||
<tr> | |||
<td>Gender</td> | |||
<td><?php if($flag_edit){ ?> | |||
<label>Male</label><input type="radio" id="gender_male" name="datos[gender]" value="1"> | |||
<label>Female</label><input type="radio" id="gender_female" name="datos[gender]" value="2"> | |||
<?php }else{ echo $gender; } ?> | |||
</td> | |||
</tr> | |||
<tr> | |||
<?php if($flag_edit){ ?> | |||
<td style="vertical-align:top;"> | |||
<fieldset><legend>Race</legend> | |||
<input type="radio" id="race_ai_an" name="datos[race]" value="1"><label>American Indian OR Alaska Native</label><br /> | |||
<input type="radio" id="race_asian" name="datos[race]" value="2"><label>Asian</label><br /> | |||
<input type="radio" id="race_b_aa" name="datos[race]" value="3"><label>Black OR African American</label><br /> | |||
<input type="radio" id="race_nh_pi" name="datos[race]" value="4"><label>Native Hawaiian or Other Pacific Islander</label><br /> | |||
<input type="radio" id="race_w" name="datos[race]" value="5"><label>White</label><br /> | |||
<input type="radio" id="race_uk" name="datos[race]" value="6"><label>Unknown</label> | |||
</fieldset> | |||
</td> | |||
<?php }else{ ?> | |||
<td>Race</td> | |||
<td><?php echo $race; ?></td> | |||
<?php } ?> | |||
</tr> | |||
<tr> | |||
<?php if($flag_edit){ ?> | |||
<td style="vertical-align:top;"> | |||
<fieldset><legend>Ethnicity</legend> | |||
<input type="radio" id="ethnycity_hl" name="datos[ethnicity]" value="1"><label>Hispanic or Latin</label><br /> | |||
<input type="radio" id="ethnycity_nhl" name="datos[ethnicity]" value="2"><label>Not Hispanic or Latin</label><br /> | |||
<input type="radio" id="ethnycity_uk" name="datos[ethnicity]" value="3"><label>Unknown</label> | |||
</fieldset> | |||
</td> | |||
<?php }else{ ?> | |||
<td>Ethnicity:</td> | |||
<td><?php echo $ethnicity; ?></td> | |||
<?php } ?> | |||
</tr> | |||
<tr> | |||
<td>Subject Initials:</td> | |||
<td><?php if($flag_edit){ ?> | |||
<input type="text" name="datos[initials]" value="" /> | |||
<?php }else{ echo $data_result['initials']; } ?> | |||
</td> | |||
</tr> | |||
</tbody> | |||
</table> | |||
</div> | |||
<?php if($flag_edit){ ?> | |||
<div class="tool_buttons"> | |||
<input type="submit" value="save" id="btn_save" name="btn_save"> | |||
<input type="reset" value="clear" id="btn_clear" name="btn_clear"> | |||
</div> | |||
<?php }else{ ?> | |||
<div class="tool_links_navigator" style="padding-top: 10px"> | |||
<a href="index.php?option=com_data&controller=Data&action=add&name_form=frm_02">Next Form</a> | |||
</div> | |||
<?php } ?> | |||
<input type="hidden" name="option" value="com_data" /> | |||
<input type="hidden" name="controller" value="Data" /> | |||
<input type="hidden" name="action" value="save" /> | |||
<input type="hidden" name="name_form" value="frm_01" /> | |||
<input type="hidden" name="num_form" value="1" /> | |||
<input type="hidden" name="title_form" value="1" /> | |||
</form> |