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