frm_04_1.php
106 lines
| 3.3 KiB
| text/x-php
|
XmlPhpLexer
|
r0 | |||
<script> | ||||
$(function(){ | ||||
$("#h_mh_yes").click(function(){ | ||||
$("#div_history").css("display","block"); | ||||
}); | ||||
$("#h_mh_no").click(function(){ | ||||
$("#div_history").css("display","none"); | ||||
}); | ||||
$(".txt_date").datepicker({ | ||||
showWeek: true, | ||||
dateFormat: 'dd/M/yy', | ||||
firstDay: 1 | ||||
}); | ||||
$("#rbnActive_yes").click(function(){ | ||||
$("#stop_date").css("display","none"); | ||||
}); | ||||
$("#rbnActive_no").click(function(){ | ||||
$("#stop_date").css("display","block"); | ||||
}); | ||||
}) | ||||
</script> | ||||
<div style="width:650px; margin:0 auto;"> | ||||
<h1>Screening Medical History</h1> | ||||
<form name="frm_screeningmedicalhistory" method="post" action="index.php"> | ||||
<table width="100%" id="" class="" style="" > | ||||
<tbody> | ||||
<tr> | ||||
<td><p>Does the subject have another clinically significant medical history?</p></td> | ||||
</tr> | ||||
<tr> | ||||
<td style="text-align:right;"> | ||||
<label>Yes (specific below)</label><input type="radio" <?php //echo $html_ok ?> id="h_mh_yes" name="datos[mh]" value="Y"> | ||||
<label>No</label><input type="radio" id="h_mh_no" name="datos[mh]" value="N" /> | ||||
</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<div> | ||||
<input type="submit" value="save" id="btn_save" name="btn_save"> | ||||
</div> | ||||
<div id="div_history" style="border:1px solid #f00; width: 100%; margin-top: 10px; <?php //echo $html_ocultar;?>"> | ||||
<table id="" class="" style="" width="100%" border="1"> | ||||
<thead> | ||||
<tr> | ||||
<td>Clinically significant Medical History</td> | ||||
</tr> | ||||
<tr> | ||||
<td> List Finding Below</td> | ||||
</tr> | ||||
</thead> | ||||
<tbody> | ||||
<tr> | ||||
<td> | ||||
<textarea id="finding" name="datos[finding]" style="width:450px; height:50px"></textarea> | ||||
</td> | ||||
</tr> | ||||
</tbody> | ||||
</table> | ||||
<div style="margin-top: 5px; margin-bottom: 20px"> | ||||
<div class="row_reg" style="float: left; width: 200px; border: 1px solid #1cc"> | ||||
<label style="display: block">Started date:</label> | ||||
<input type="text" class="txt_date" name="txt_date" value="" /> | ||||
</div> | ||||
<div class="row_reg" style="float: left; width: 200px; border: 1px solid #1cc"> | ||||
<label style="display: block">Active:</label> | ||||
<input type="radio" id="rbnActive_yes" name="optActive" value="1" />Yes | ||||
<input type="radio" id="rbnActive_no" name="optActive" value="0" />No | ||||
</div> | ||||
<div id="stop_date" style="float: left; width: 200px; border: 1px solid #1cc; display: none"> | ||||
<label style="display: block">If not active when it stop:</label> | ||||
<input type="text" class="txt_date" name="txt_date" value="" /> | ||||
</div> | ||||
<div style="clear: both; overflow: hidden"></div> | ||||
</div> | ||||
<table border="0" width="100%" > | ||||
<thead> | ||||
<tr> | ||||
<th colspan="4">List Finding Below</th> | ||||
</tr> | ||||
<tr> | ||||
<td> </td> | ||||
<td style="text-align:center;"> </td> | ||||
<td style="width:65px; text-align:center;">Active</td> | ||||
<td style="width:65px; text-align:center;">No Active</td> | ||||
</tr> | ||||
</thead> | ||||
<tbody> | ||||
<?php //echo $html_history; ?> | ||||
</tbody> | ||||
<tfoot> | ||||
<tr> | ||||
<td colspan="2"></td> | ||||
</tr> | ||||
</tfoot> | ||||
</table> | ||||
</div> | ||||
<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_04" /> | ||||
<input type="hidden" name="num_form" value="4" /> | ||||
<input type="hidden" name="title_form" value="4" /> | ||||
</form> | ||||
</div> | ||||