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127 lines
5.0 KiB
127 lines
5.0 KiB
2 years ago
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<?php
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/**
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* For various specialty forms to call from dialog using the
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* Ajax, iFrame, Alert, Confirm or HTML modes. Just follow
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* the example patient previous names history form pattern shown below.
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*
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* @package OpenEMR
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* @link https://www.open-emr.org
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* @author Jerry Padgett <sjpadgett@gmail.com>
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* @copyright Copyright (c) 2021 Jerry Padgett <sjpadgett@gmail.com>
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* @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
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*/
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require_once(__DIR__ . "/../interface/globals.php");
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use OpenEMR\Common\Csrf\CsrfUtils;
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use OpenEMR\Core\Header;
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if (!CsrfUtils::verifyCsrfToken($_GET["csrf_token_form"])) {
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CsrfUtils::csrfNotVerified();
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}
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$form = trim($_GET['form_handler']);
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echo "<script>var form=" . js_escape($form) . "</script>";
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?>
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<!DOCTYPE html>
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<html>
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<head>
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<title><?php echo xlt("Specialty Form"); ?></title>
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<meta name="viewport" content="width=device-width, initial-scale=1.0">
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<?php Header::setupHeader(['opener', 'datetime-picker']); ?>
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<script>
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$(function () {
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$("#names_form").submit(function(event) {
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event.preventDefault();
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const url = top.webroot_url + '/library/ajax/specialty_form_ajax.php';
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return fetch(
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url,
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{
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method: 'POST',
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body: new FormData(this)
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}
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).then(data => data.json())
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.then(data => {
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let ele = opener.document.getElementById('form_name_history');
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if (data !== false) {
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let newOption = new Option(data.name, data.id, true, true);
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ele.append(newOption);
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} else {
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let message = xl("Previous name history already exist. Try again or Cancel.");
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dialog.alert(message);
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}
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}).then(() => {
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dlgclose();
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});
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});
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$("#form_cancel").click(function(){
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dlgclose();
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});
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$('.datepicker').datetimepicker({
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<?php $datetimepicker_timepicker = false; ?>
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<?php $datetimepicker_showseconds = false; ?>
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<?php $datetimepicker_formatInput = true; ?>
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<?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
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});
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});
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</script>
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</head>
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<body>
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<?php if ($form === 'name_history') { ?>
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<div class="container-fluid">
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<form class="form" id="names_form">
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<input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>" />
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<input type="hidden" name="pid" value="<?php echo attr($pid); ?>" />
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<input type="hidden" name="task_name_history" value="save" />
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<div class="col">
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<p class="small text-center"><?php echo xlt("Patient previous names history. Ensure to add the date the name was last used if known."); ?></p>
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<div class="col">
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<div class="form-group">
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<input type="text" name="previous_name_prefix" id="previous_name_prefix" class="form-control" />
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<label class="form-label" for="previous_name_prefix"><?php echo xlt("Title"); ?></label>
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</div>
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</div>
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<div class="col">
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<div class="form-group">
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<input type="text" name="previous_name_first" id="previous_name_first" class="form-control" />
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<label class="form-label" for="previous_name_first"><?php echo xlt("First name"); ?></label>
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</div>
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</div>
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<div class="col">
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<div class="form-group">
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<input type="text" name="previous_name_middle" id="previous_name_middle" class="form-control" />
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<label class="form-label" for="previous_name_middle"><?php echo xlt("Middle name"); ?></label>
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</div>
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</div>
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<div class="col">
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<div class="form-group">
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<input type="text" name="previous_name_last" id="previous_name_last" class="form-control" />
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<label class="form-label" for="previous_name_last"><?php echo xlt("Last name"); ?></label>
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</div>
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</div>
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<div class="col">
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<div class="form-group">
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<input type="text" name="previous_name_suffix" id="previous_name_suffix" class="form-control" />
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<label class="form-label" for="previous_name_suffix"><?php echo xlt("Suffix"); ?></label>
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</div>
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</div>
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<div class="col">
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<div class="form-group">
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<input type="text" name="previous_name_enddate" id="previous_name_enddate" class="form-control datepicker" />
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<label class="form-label" for="previous_name_enddate"><?php echo xlt("End Date"); ?></label>
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</div>
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</div>
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</div>
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<div class="col-12 text-center">
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<div class="form-group">
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<button type='submit' class='btn btn-primary' name='form_save' id='form_save' value="save"><?php echo xlt('Save'); ?></button>
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<button type='button' class='btn btn-secondary' name='form_cancel' id='form_cancel'><?php echo xlt('Cancel'); ?></button>
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</div>
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</div>
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</form>
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</div>
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<?php } ?>
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</body>
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</html>
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