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