frm_09.php
127 lines
| 3.9 KiB
| text/x-php
|
XmlPhpLexer
|
r0 | <script> | |
$(function() { | |||
$( "#date_exam" ).datepicker({ | |||
showWeek: true, | |||
dateFormat: 'dd/M/yy', | |||
firstDay: 1 | |||
}); | |||
$( "#date_exam_toxicology" ).datepicker({ | |||
showWeek: true, | |||
dateFormat: 'dd/M/yy', | |||
firstDay: 1 | |||
}); | |||
}); | |||
</script> | |||
<?php if("flag_edit"){ ?> | |||
<form name="frm_09" method="post" action="index.php"> | |||
<?php } ?> | |||
<div class="header_frm_page"> | |||
<label class="title1">Screening Urinalysis and Toxicology</label> | |||
<label class="title2">(Within 21 Days prior to Dose 1)</label> | |||
<label class="title3">(use if labs need to be transcribed)</label> | |||
</div> | |||
<table id="" class="" style="" > | |||
<tbody> | |||
<tr> | |||
<td>Date</td> | |||
<td style="text-align:right;"><input type="text" id="date_exam" name="datos[date_exam]" value="" /></td> | |||
</tr> | |||
</tbody> | |||
</table> | |||
<?php | |||
$cont = 1; | |||
//var_dump($data_fields); die(); | |||
foreach($data_fields as $data_field){ | |||
if($cont == 1){ | |||
?> | |||
<table id="" class="tbl_general" style=""> | |||
<thead> | |||
<tr> | |||
<th style="text-align:center;">Test</th> | |||
<th style="text-align:center;">Result<br>(include units)</th> | |||
<th style="text-align:center;">Flag<br>(H/L/Abn)</th> | |||
<th style="text-align:center;">Clinically<br> Significant?<br/>(Y/N)</th> | |||
<th style="text-align:center;">Repeated<br/>(Y/N)</th> | |||
<th style="text-align:center;">If no, comment</th> | |||
</tr> | |||
</thead> | |||
<tbody> | |||
<?php | |||
}else{ | |||
?> | |||
<hr> | |||
<span style="padding-top: 20px; margin-top: 10px"> | |||
<label>Date of Toxicology:</label><input type="text" id="date_exam_toxicology" name="datos[date_exam_toxicology]" value="" /> | |||
</span> | |||
<table width="100%" id="" class="tbl_general" style="padding-top: 10px;"> | |||
<thead> | |||
<tr> | |||
<th style="text-align:center;">Test</th> | |||
<th style="text-align:center;">Positive</th> | |||
<th style="text-align:center;">Negative</th> | |||
</tr> | |||
</thead> | |||
<tbody> | |||
<?php | |||
} | |||
foreach ($data_field as $value_data){ | |||
if($cont == 1){ | |||
?> | |||
<tr> | |||
<td style="text-align:left;"><?php echo $value_data['name_field'] ?></td> | |||
<td style="text-align:center;"><input type="text" id="sg_result" name="datos[result_<?php echo $cont; ?>]" value="" /></td> | |||
<td style="text-align:center;"> | |||
<select name="datos[flag_<?php echo $cont; ?>]" class="form_select"> | |||
<option value="H">H</option> | |||
<option value="L">L</option> | |||
<option value="Abn">Abn</option> | |||
</select> | |||
</td> | |||
<td style="text-align:center;"> | |||
<select name="datos[cs_<?php echo $cont; ?>]" class="form_select"> | |||
<option value="1">Yes</option> | |||
<option value="2">No</option> | |||
</select> | |||
</td> | |||
<td style="text-align:center;"> | |||
<select name="datos[repeat_<?php echo $cont; ?>]" class="form_select"> | |||
<option value="Y">Yes</option> | |||
<option value="N">No</option> | |||
</select> | |||
</td> | |||
<td style="text-align:center;"> | |||
<textarea name="datos[comment_<?php echo $cont; ?>]" id="sg_comment" style="width:210px; height:35px;"></textarea> | |||
</td> | |||
</tr> | |||
<?php | |||
}else{ | |||
?> | |||
<tr> | |||
<td><?php echo $value_data['name_field']; ?></td> | |||
<td style="text-align:center;"><input type="radio" name="datos[urine_toxico_screen]" value="1" /></td> | |||
<td style="text-align:center;"><input type="radio" name="datos[urine_toxico_screen]" value="2" /></td> | |||
</tr> | |||
<?php | |||
} | |||
} | |||
?> | |||
</tbody> | |||
</table> | |||
<?php | |||
$cont++; | |||
} | |||
?> | |||
<?php if($flag_edit){ ?> | |||
<div class="tool_buttons"> | |||
<input type="submit" value="save" id="btn_save" name="btn_save" /> | |||
</div> | |||
<input type="hidden" name="option" value="com_data" /> | |||
<input type="hidden" name="controller" value="urinalysis" /> | |||
<input type="hidden" name="action" value="save" /> | |||
<input type="hidden" name="name_form" value="frm_09" /> | |||
<input type="hidden" name="num_form" value="9" /> | |||
<input type="hidden" name="datos[idtest]" value="<?php echo $idtest; ?>" /> | |||
<input type="hidden" name="title_form" value="9" /> | |||
</form> | |||
<?php } ?> |