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92 lines
4.5 KiB
92 lines
4.5 KiB
<?php |
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/** |
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* contacts view.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 andres_paglayan <andres_paglayan> |
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* @author sunsetsystems <sunsetsystems> |
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* @author cornfeed <jdough823@gmail.com> |
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* @author fndtn357 <fndtn357@gmail.com> |
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* @author Brady Miller <brady.g.miller@gmail.com> |
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* @author Daniel Ehrlich <daniel.ehrlich1@gmail.com> |
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* @copyright Copyright (c) 2005 andres_paglayan <andres_paglayan> |
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* @copyright Copyright (c) 2007 sunsetsystems <sunsetsystems> |
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* @copyright Copyright (c) 2011 cornfeed <jdough823@gmail.com> |
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* @copyright Copyright (c) 2012 fndtn357 <fndtn357@gmail.com> |
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* @copyright Copyright (c) 2018 Brady Miller <brady.g.miller@gmail.com> |
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* @copyright Copyright (c) 2018 Daniel Ehrlich <daniel.ehrlich1@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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?> |
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<!-- Forms generated from formsWiz --> |
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<?php |
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require_once("../../globals.php"); |
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use OpenEMR\Common\Csrf\CsrfUtils; |
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use OpenEMR\Core\Header; |
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?> |
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<html><head> |
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<?php Header::setupHeader(); ?> |
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</head> |
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<body <?php echo $top_bg_line;?> topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0> |
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<?php |
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require_once("$srcdir/api.inc"); |
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$obj = formFetch("form_contacts", $_GET["id"]); |
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?> |
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<form method=post action="<?php echo $rootdir?>/forms/contacts/save.php?mode=update&id=<?php echo attr_url($_GET["id"]); ?>" name="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">Contacts</span><br /><br /> |
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<table> |
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<tr> |
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<td valign=top> |
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<table> |
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<tr><td><span class=text>OD Base Curve: </span></td><td><input size=4 type="text" name="od_base_curve" value="<?php echo attr($obj["od_base_curve"]); ?>" ></td></tr> |
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<tr><td><span class=text>OD Sphere: </span></td><td><input size=4 type="text" name="od_sphere" value="<?php echo attr($obj["od_sphere"]); ?>" ></td></tr> |
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<tr><td><span class=text>OD Cylinder: </span></td><td><input size=4 type="text" name="od_cylinder" value="<?php echo attr($obj["od_cylinder"]); ?>" ></td></tr> |
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<tr><td><span class=text>OD Axis: </span></td><td><input size=4 type="text" name="od_axis" value="<?php echo attr($obj["od_axis"]); ?>" ></td></tr> |
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<tr><td><span class=text>OD Diameter: </span></td><td><input size=4 type="text" name="od_diameter" value="<?php echo attr($obj["od_diameter"]); ?>" ></td></tr> |
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</table> |
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</td> |
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<td valign=top> |
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<table> |
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<tr><td><span class=text>OS Base Curve: </span></td><td><input size=4 type="text" name="os_base_curve" value="<?php echo attr($obj["os_base_curve"]); ?>" ></td></tr> |
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<tr><td><span class=text>OS Sphere: </span></td><td><input size=4 type="text" name="os_sphere" value="<?php echo attr($obj["os_sphere"]); ?>" ></td></tr> |
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<tr><td><span class=text>OS Cylinder: </span></td><td><input size=4 type="text" name="os_cylinder" value="<?php echo attr($obj["os_cylinder"]); ?>" ></td></tr> |
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<tr><td><span class=text>OS Axis: </span></td><td><input size=4 type="text" name="os_axis" value="<?php echo attr($obj["os_axis"]); ?>" ></td></tr> |
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<tr><td><span class=text>OS Diameter: </span></td><td><input size=4 type="text" name="os_diameter" value="<?php echo attr($obj["os_diameter"]); ?>" ></td></tr> |
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</table> |
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</td> |
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</tr> |
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</table> |
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<table> |
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<tr> |
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<td><span class=text>Material: </span></td><td><input size=4 type="text" name="material" value="<?php echo attr($obj["material"]); ?>" ></td> |
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<td><span class=text>Color: </span></td><td><input size=4 type="text" name="color" value="<?php echo attr($obj["color"]); ?>" ></td> |
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<td><span class=text>Bifocal Type: </span></td><td><input size=4 type="text" name="bifocal_type" value="<?php echo attr($obj["bifocal_type"]); ?>" ></td> |
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<td><span class=text>Add: </span></td><td><input size=4 type="text" name="add_value" value="<?php echo attr($obj["add_value"]); ?>" ></td> |
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<td><span class=text>V/A Far: </span></td><td><input size=4 type="text" name="va_far" value="<?php echo attr($obj["va_far"]); ?>" ></td> |
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<td><span class=text>V/A Near: </span></td><td><input size=4 type="text" name="va_near" value="<?php echo attr($obj["va_near"]); ?>" ></td> |
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</tr> |
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</table> |
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<table> |
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<tr> |
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<td valign=top> |
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<span class=text>Additional Notes: </span><br /><textarea cols=40 rows=8 wrap=virtual name="additional_notes" ><?php echo text($obj["additional_notes"]);?></textarea><br /> |
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</td> |
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</tr> |
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</table> |
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<br /> |
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<a href="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save]</a> |
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<br /> |
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<a href="<?php echo $GLOBALS['form_exit_url']; ?>" class="link" onclick="top.restoreSession()">[Don't Save Changes]</a> |
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</form> |
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<?php |
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formFooter(); |
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?>
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