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121 lines
3.6 KiB
121 lines
3.6 KiB
2 years ago
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<?php
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/*
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* Work/School Note Form new.php
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*
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* @package OpenEMR
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* @link http://www.open-emr.org
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* @author Nikolai Vitsyn
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* @author Brady Miller <brady.g.miller@gmail.com>
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* @copyright Copyright (c) 2004-2005 Nikolai Vitsyn
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* @copyright Copyright (c) Open Source Medical Software
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* @copyright Copyright (c) 2019 Brady Miller <brady.g.miller@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__ . "/../../globals.php");
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require_once("$srcdir/api.inc");
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use OpenEMR\Common\Csrf\CsrfUtils;
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use OpenEMR\Core\Header;
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formHeader("Form: note");
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$returnurl = 'encounter_top.php';
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$provider_results = sqlQuery("select fname, lname from users where username=?", array($_SESSION["authUser"]));
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/* name of this form */
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$form_name = "note";
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?>
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<html><head>
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<?php Header::setupHeader('datetime-picker'); ?>
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<script>
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// required for textbox date verification
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var mypcc = <?php echo js_escape($GLOBALS['phone_country_code']); ?>;
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</script>
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</head>
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<body class="body_top">
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<?php echo text(date("F d, Y", time())); ?>
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<form method=post action="<?php echo $rootdir . "/forms/" . $form_name . "/save.php?mode=new";?>" name="my_form" id="my_form">
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<input type="hidden" name="csrf_token_form" value="<?php echo attr(CsrfUtils::collectCsrfToken()); ?>" />
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<span class="title"><?php echo xlt('Work/School Note'); ?></span><br /><br />
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<div style="margin: 10px;">
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<input type="button" class="save" value=" <?php echo xla('Save'); ?> ">
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<input type="button" class="dontsave" value="<?php echo xla('Don\'t Save'); ?>">
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</div>
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<select name="note_type">
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<option value="WORK NOTE"><?php echo xlt('WORK NOTE'); ?></option>
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<option value="SCHOOL NOTE"><?php echo xlt('SCHOOL NOTE'); ?></option>
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</select>
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<br />
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<b><?php echo xlt('MESSAGE:'); ?></b>
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<br />
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<textarea name="message" id="message" rows="7" cols="47"></textarea>
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<br />
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<?php
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// commented out below private field, because no field in database, and causes error.
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?>
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<!--
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<input type="checkbox" name="private" id="private"><label for="private">This note is private</label>
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<br />
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-->
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<br />
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<b><?php echo xlt('Signature:'); ?></b>
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<br />
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<table>
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<tr><td>
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<?php echo xlt('Doctor:'); ?>
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<input type="text" name="doctor" id="doctor" value="<?php echo attr($provider_results["fname"]) . ' ' . attr($provider_results["lname"]); ?>">
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</td>
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<td>
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<span class="text"><?php echo xlt('Date'); ?></span>
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<input type='text' size='10' class='datepicker' name='date_of_signature' id='date_of_signature'
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value='<?php echo attr(date('Y-m-d', time())); ?>'
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title='<?php echo xla('yyyy-mm-dd'); ?>' />
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</td>
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</tr>
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</table>
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<div style="margin: 10px;">
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<input type="button" class="save" value=" <?php echo xla('Save'); ?> ">
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<input type="button" class="dontsave" value="<?php echo xla('Don\'t Save'); ?>">
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</div>
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</form>
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</body>
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<script>
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// jQuery stuff to make the page a little easier to use
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$(function () {
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$(".save").click(function() { top.restoreSession(); $('#my_form').submit(); });
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$(".dontsave").click(function() { parent.closeTab(window.name, false); });
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//$("#printform").click(function() { PrintForm(); });
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$('.datepicker').datetimepicker({
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<?php $datetimepicker_timepicker = false; ?>
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<?php $datetimepicker_showseconds = false; ?>
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<?php $datetimepicker_formatInput = false; ?>
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<?php require($GLOBALS['srcdir'] . '/js/xl/jquery-datetimepicker-2-5-4.js.php'); ?>
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<?php // can add any additional javascript settings to datetimepicker here; need to prepend first setting with a comma ?>
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});
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});
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</script>
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</html>
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