##// END OF EJS Templates
verificado errores en controlador
verificado errores en controlador

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frm_32 (copia).php
116 lines | 6.5 KiB | text/x-php | XmlPhpLexer
<script>
$(function(){
$( ".txt_date" ).datepicker({
showWeek: true,
dateFormat: 'dd/M/yy',
firstDay: 1
});
$('.schedule_time').timepicker({
timeOnlyTitle: 'Choose Time',
timeText:'Time',
hourText:'Hour',
minuteText:'Minute',
secondText:'Second',
currentText:'Now',
closeText:'Done'
});
});
</script>
<div class="header_frm_page">
<span>
<label class="title4">28 Days Cycle #</label><input type="text" name="txt_cycle" style="width: 15px" />
<label class="title4">, Day</label><input type="text" name="txt_styDay" style="width: 15px" />
</span>
<label class="title2">Vital Signs and AE Query</label>
</div>
<br/>
<table border="0" class="tbl_general">
<thead>
<tr>
<th style="width:80px">Study<br/>Day</th>
<th style="width:120px">Date<br/><small>DD/MM/YYYY</small></th>
<th style="width:100px">Interval<br/>Hr pre<br/>or pro dose</th>
<th>Initial Reading and<br/>Repeat Readings<br/>(check box if needed)</th>
<th style="width:80px">Time<br/>Hr:Min</th>
<th style="width:120px">Blood<br/>Pressure<br/>nmHg</th>
<th style="width:100px">Pulse<br/>Rate<br/>bpm</th>
<th style="width:100px">Respirations<br/>rpm</th>
<th style="width:100px;">Temperature<br/>&deg;C</th>
<th style="width:100px;">AE?<br/>(Y/N)</th>
</tr>
</thead>
<tbody>
<tr>
<td><input type="text" name="txt_stdDay" style="width:20px"/></td>
<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
<td><input type="text" name="txt_interval" value="" style="width:60px" /></td>
<td>Initial</td>
<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
<td><input type="text" name="txt_blood" style="width:60px" /></td>
<td><input type="text" name="txt_pulse" style="width:60px" /></td>
<td><input type="text" name="txt_respirations" style="width:60px" /></td>
<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
</tr>
<tr>
<td><input type="text" name="txt_date1" style="width:20px" /></td>
<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
<td><input type="text" name="txt_dateRep" value="" style="width:60px" /></td>
<td>1st repeat</td>
<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
<td><input type="text" name="txt_blood" style="width:60px" /></td>
<td><input type="text" name="txt_pulse" style="width:60px" /></td>
<td><input type="text" name="txt_respirations" style="width:60px" /></td>
<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
</tr>
<tr>
<td><input type="text" name="txt_date1" style="width:20px" /></td>
<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
<td><input type="text" name="txt_dateRep" value="" style="width:60px" /></td>
<td>2nd repeat</td>
<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
<td><input type="text" name="txt_blood" style="width:60px" /></td>
<td><input type="text" name="txt_pulse" style="width:60px" /></td>
<td><input type="text" name="txt_respirations" style="width:60px" /></td>
<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
</tr>
<tr>
<td><input type="text" name="txt_date1" style="width:20px" /></td>
<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
<td></td>
<td>Initial</td>
<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
<td><input type="text" name="txt_blood" style="width:60px" /></td>
<td><input type="text" name="txt_pulse" style="width:60px" /></td>
<td><input type="text" name="txt_respirations" style="width:60px" /></td>
<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
</tr>
<tr>
<td><input type="text" name="txt_date1" style="width:20px" /></td>
<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
<td><input type="text" name="txt_dateRep" value="" style="width:60px" /></td>
<td>1st repeat</td>
<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
<td><input type="text" name="txt_blood" style="width:60px" /></td>
<td><input type="text" name="txt_pulse" style="width:60px" /></td>
<td><input type="text" name="txt_respirations" style="width:60px" /></td>
<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
</tr>
<tr>
<td><input type="text" name="txt_date1" style="width:20px" /></td>
<td><input type="text" name="txt_date1" style="width:60px" class="txt_date" /></td>
<td><input type="text" name="txt_dateRep" value="" style="width:60px" /></td>
<td>2nd repeat</td>
<td><input type="text" name="txt_time" style="width:40px" class="schedule_time" /></td>
<td><input type="text" name="txt_blood" style="width:60px" /></td>
<td><input type="text" name="txt_pulse" style="width:60px" /></td>
<td><input type="text" name="txt_respirations" style="width:60px" /></td>
<td><input type="text" name="txt_dateRep" style="width:60px" /></td>
<td><select name="ae" class="form_select" style="width: 50px"><option>Yes</option><option>No</option></select></td>
</tr>
</tbody>
</table>
<a href="#">Add</a>