function showCustomerForm($data, $action, $badFields)
{
formHeader($action, "<h1>Customer Info Form</h1>", "customerForm", "void");
customerFields($data, $badFields);
tableRow(array(tableData(""), tableData(""), tableData(""), tableData(""), tableData(""), tableData(submit("Enter/Edit Customer!"), "right")));
echo getWordpressHiddenFormField();
formFooter("customerForm");
}
function showPackageForm($data, $action, $badFields)
{
formHeader($action, "Package Form", "packageForm", "void");
packageFields($data, $badFields);
tableRow(array(tableData(""), tableData(""), tableData(""), tableData(""), tableData(""), tableData(submit("Submit!"))));
echo getWordpressHiddenFormField();
formFooter("packageForm");
}
function showOrderEntryForm($data, $badFields = array())
{
formHeader("", "", "orderEntry", "void");
customerFields($data, $badFields);
orderFields($data, $badFields);
if (inWordPress()) {
echo getWordpressHiddenFormField();
}
tableRow(array(tableData(""), tableData(""), tableData(""), tableData(""), tableData(""), tableData(submit("Enter Order!"), "right")));
formFooter("orderEntryForm");
}
function showShippingForm($data, $action, $badFields = array())
{
prepDatePicker();
formHeader($action, "<h1>Shipping Info Form</h1>", "shippingForm", "void");
shippingFields($data, $badFields);
tableRow(array(tableData(""), tableData(""), tableData(""), tableData(""), tableData(""), tableData(submit("Enter Shipping Details!"), "right")));
if (inWordPress()) {
echo getWordpressHiddenFormField();
}
formFooter("shippingForm");
}
<!-- Form generated from formsWiz -->
<?php
$fake_register_globals = false;
$sanitize_all_escapes = true;
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
formHeader("Form: dictation");
$returnurl = 'encounter_top.php';
?>
<html><head>
<?php
html_header_show();
?>
<link rel="stylesheet" href="<?php
echo $css_header;
?>
" type="text/css">
</head>
<body class="body_top">
<form method=post action="<?php
echo $rootdir;
?>
/forms/dictation/save.php?mode=new" name="my_form">
<span class="title"><?php
echo xlt('Speech Dictation');
?>
</span><br><br>
<span class=text><?php
echo xlt('Dictation: ');
?>
</span><br><textarea cols=80 rows=24 wrap=virtual name="dictation" ></textarea><br>
<?php
/*
* Sports Physical Form created by Jason Morrill: January 2009
*/
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
/** CHANGE THIS - name of the database table associated with this form **/
$table_name = "form_example";
/** CHANGE THIS name to the name of your form **/
$form_name = "My Example Form";
/** CHANGE THIS to match the folder you created for this form **/
$form_folder = "example";
formHeader("Form: " . $form_name);
$returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
/* load the saved record */
$record = formFetch($table_name, $_GET["id"]);
/* remove the time-of-day from the date fields */
if ($record['form_date'] != "") {
$dateparts = split(" ", $record['form_date']);
$record['form_date'] = $dateparts[0];
}
if ($record['dob'] != "") {
$dateparts = split(" ", $record['dob']);
$record['dob'] = $dateparts[0];
}
if ($record['sig_date'] != "") {
$dateparts = split(" ", $record['sig_date']);
$record['sig_date'] = $dateparts[0];
}
?>
<?php
$fake_register_globals = false;
$sanitize_all_escapes = true;
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
formHeader("Form: note");
$returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
$provider_results = sqlQuery("select fname, lname from users where username=?", array($_SESSION["authUser"]));
/* name of this form */
$form_name = "note";
// get the record from the database
if ($_GET['id'] != "") {
$obj = formFetch("form_" . $form_name, $_GET["id"]);
}
/* remove the time-of-day from the date fields */
if ($obj['date_of_signature'] != "") {
$dateparts = split(" ", $obj['date_of_signature']);
$obj['date_of_signature'] = $dateparts[0];
}
?>
<html><head>
<?php
html_header_show();
?>
<link rel="stylesheet" href="<?php
echo $css_header;
?>
" type="text/css">
<!-- supporting javascript code -->
<?php
////////////////////////////////////////////////////////////////////
// Form: PSYCHIATRISCH ONDERZOEK
// Package: Research psihiatric - Dutch specific form
// Created by: Larry Lart
// Version: 1.0 - 29-03-2008
////////////////////////////////////////////////////////////////////
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/patient.inc";
formHeader("Form: psychiatrisch_onderzoek");
$returnurl = 'encounter_top.php';
$result = getPatientData($pid, "fname,lname,pid,pubpid,phone_home,pharmacy_id,DOB,DATE_FORMAT(DOB,'%Y%m%d') as DOB_YMD");
$provider_results = sqlQuery("select * from users where username='******'");
////////////////////////////////////////////////////////////////////
// Function: getPatientDateOfLastEncounter
function getPatientDateOfLastEncounter($nPid)
{
// get date of last encounter F103 or F153
$strEventDate = sqlQuery("SELECT MAX(pc_eventDate) AS max \n FROM openemr_postcalendar_events \n WHERE pc_pid = {$nPid} \n AND pc_apptstatus = '@' \n AND ( pc_catid = 17 OR pc_catid = 25 OR pc_catid = 13 OR pc_catid = 26 ) \n AND pc_eventDate >= '2007-01-01'");
// now check if there was a previous encounter
if ($strEventDate['max'] != "") {
return $strEventDate['max'];
} else {
return "00-00-0000";
}
}
$m_strEventDate = getPatientDateOfLastEncounter($result['pid']);
// get last saved id for intakeverslag
$vectIntakeverslagQuery = sqlQuery("SELECT id FROM form_intakeverslag \n WHERE pid = " . $_SESSION["pid"] . " AND groupname='" . $_SESSION["authProvider"] . "' AND user='******' AND\n authorized={$userauthorized} AND activity=1\n AND autosave_flag=0 \n ORDER by id DESC limit 1");
<?php
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
# $patient = formNanak("patient_data", $_GET["id"]);
//#Use the formnanak function from api.inc to get values for manjit
formHeader("Form: chiro_history");
$returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
?>
<html><head>
<link rel=stylesheet href="<?php
echo $css_header;
?>
" type="text/css">
</head>
<body <?php
echo $top_bg_line;
?>
topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
<style type="text/css">@import url(../../../library/dynarch_calendar.css);</style>
<script type="text/javascript" src="../../../library/dialog.js"></script>
<script type="text/javascript" src="../../../library/textformat.js"></script>
<script type="text/javascript" src="../../../library/dynarch_calendar.js"></script>
<script type="text/javascript" src="../../../library/dynarch_calendar_en.js"></script>
<script type="text/javascript" src="../../../library/dynarch_calendar_setup.js"></script>
<script language='JavaScript'> var mypcc = '1'; </script>
<a href='<?php
echo $GLOBALS['webroot'];
?>
/interface/patient_file/encounter/<?php
<?php
# file habits/save.php
# saves what cames from habits/new.php
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
formHeader('Habits form submitted');
$_POST["smoke_quit"] = dateToDB($_POST["smoke_quit"]);
$id = formSubmit('form_habits', $_POST);
//this function adds the form to a table wich creates a registry
//don't forget to add it in your save.php file.
// then it may be retrievable by the report menu
if ($encounter == "") {
$encounter = date("Ymd");
}
//$newid=mysql_insert_id($GLOBALS['dbh']); // last id
if ($GLOBALS['lastidado'] > 0) {
$newid = $GLOBALS['lastidado'];
} else {
$newid = mysql_insert_id($GLOBALS['dbh']);
}
// last id
addForm($encounter, "Habits", $newid, "habits", $pid, $userauthorized);
formJump("./print.php?id={$id}");
formFooter();
<!-- view.php -->
<?php
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
formHeader("Form: Chiro_personal_injury_form");
$returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
$obj = formFetch("form_Chiro_personal_injury_form", $_GET["id"]);
//#Use the formFetch function from api.inc to get values for existing form.
function chkdata_Txt(&$obj, $var)
{
return htmlentities($obj["{$var}"]);
}
function chkdata_Date(&$obj, $var)
{
return htmlentities($obj["{$var}"]);
}
function chkdata_CB(&$obj, $nam, $var)
{
if (preg_match("/{$var}/", $obj[$nam])) {
return "checked";
} else {
return "";
}
}
function chkdata_Radio(&$obj, $nam, $var)
{
if (strpos($obj[$nam], $var) !== false) {
return "checked";
}
}
function chkdata_PopOrScroll(&$obj, $nam, $var)
//
// Author: Jacob T Paul <*****@*****.**>
// Vinish K <*****@*****.**>
//
// +------------------------------------------------------------------------------+
//SANITIZE ALL ESCAPES
$sanitize_all_escapes = true;
//STOP FAKE REGISTER GLOBALS
$fake_register_globals = false;
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
require_once "{$srcdir}/patient.inc";
require_once "{$srcdir}/options.inc.php";
require_once $GLOBALS['srcdir'] . '/csv_like_join.php';
require_once $GLOBALS['fileroot'] . '/custom/code_types.inc.php';
formHeader("Form:Care Plan Form");
$returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
$formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
if ($formid) {
$sql = "SELECT * FROM `form_care_plan` WHERE id=? AND pid = ? AND encounter = ?";
$res = sqlStatement($sql, array($formid, $_SESSION["pid"], $_SESSION["encounter"]));
for ($iter = 0; $row = sqlFetchArray($res); $iter++) {
$all[$iter] = $row;
}
$check_res = $all;
}
$check_res = $formid ? $check_res : array();
?>
<html>
<head>
<?php
<?php
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
formHeader("Form: Chirpractic_physical_therapy_form");
?>
<html><head>
<link rel=stylesheet href="<?php
echo $css_header;
?>
" type="text/css">
</head>
<body <?php
echo $top_bg_line;
?>
topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
<form method=post action="<?php
echo $rootdir;
?>
/forms/Chirpractic_physical_therapy_form/save.php?mode=new" name="my_form" onSubmit="return top.restoreSession()">
<h1> Chiropractic physical therapy form</h1>
<hr>
<input type="submit" name="submit form" value="submit form" /> <a href='<?php
echo $GLOBALS['webroot'];
?>
/interface/patient_file/encounter/<?php
echo $returnurl;
?>
' onclick='top.restoreSession()'> <?php
xl("[do not save]", 'e');
?>
<?php
include_once "../../globals.php";
include_once "../../../library/api.inc";
formHeader("Lab Results");
?>
<link rel=stylesheet href="<?php
echo $css_header;
?>
" type="text/css">
<html>
<head>
<?php
html_header_show();
?>
<title>New Patient Encounter</title>
</head>
<body <?php
echo $top_bg_line;
?>
topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
<br><br>
<?php
<?php
# print the habits form.
include "../../../library/api.inc";
formHeader("Habits form");
// this part is the copy of what we have inside the function on the report.php file
include_once 'form_report.php';
?>
<hr>
<a href="<?php
echo $GLOBALS['form_exit_url'];
?>
" onclick="top.restoreSession()">Done</a>
<?php
formFooter();
<!-- Form generated from formsWiz -->
<?php
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
formHeader("Form: contacts");
?>
<html><head>
<?php
html_header_show();
?>
<link rel=stylesheet href="<?php
echo $css_header;
?>
" type="text/css">
</head>
<body <?php
echo $top_bg_line;
?>
topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
<form method=post action="<?php
echo $rootdir;
?>
/forms/contacts/save.php?mode=new" name="my_form">
<span class="title">Contacts</span><br><br>
<table>
<tr>
<td valign=top>
<table>
<tr><td><span class=text>OD Base Curve: </span></td><td><input size=4 type=entry name="od_base_curve" value="" ></td></tr>
<tr><td><span class=text>OD Sphere: </span></td><td><input size=4 type=entry name="od_sphere" value="" ></td></tr>
<tr><td><span class=text>OD Cylinder: </span></td><td><input size=4 type=entry name="od_cylinder" value="" ></td></tr>
* along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
*
* @package OpenEMR
* @author Naina Mohamed <*****@*****.**>
* @link http://www.open-emr.org
*/
//SANITIZE ALL ESCAPES
$sanitize_all_escapes = true;
//STOP FAKE REGISTER GLOBALS
$fake_register_globals = false;
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
require_once "{$srcdir}/patient.inc";
require_once "{$srcdir}/options.inc.php";
require_once "{$srcdir}/htmlspecialchars.inc.php";
formHeader("Form:AfterCare Planning");
$returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
$formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
$obj = $formid ? formFetch("form_aftercare_plan", $formid) : array();
?>
<html>
<head>
<?php
html_header_show();
?>
<script type="text/javascript" src="../../../library/dialog.js"></script>
<!-- pop up calendar -->
<style type="text/css">@import url(<?php
echo $GLOBALS['webroot'];
?>
/library/dynarch_calendar.css);</style>
<?php
////////////////////////////////////////////////////////////////////
// Form: brief_aan_verwijzer
// Package: letter to verwijzer - Dutch specific form
// Created by: Larry Lart
// Version: 1.0 - 30-03-2008
////////////////////////////////////////////////////////////////////
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/patient.inc";
formHeader("Form: brief_aan_verwijzer");
$returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
$result = getPatientData($pid, "fname,lname,pid,pubpid,phone_home,sex,pharmacy_id,DOB,DATE_FORMAT(DOB,'%Y%m%d') as DOB_YMD");
$provider_results = sqlQuery("select * from users where username='******'");
////////////////////////////////////////////////////////////////////
// Function: getPatientDateOfLastEncounter
function getPatientDateOfLastEncounter($nPid)
{
// get date of last encounter no codes
$strEventDate = sqlQuery("SELECT MAX(pc_eventDate) AS max \n FROM openemr_postcalendar_events \n WHERE pc_pid = {$nPid} \n AND pc_apptstatus = '@' \n AND pc_eventDate >= '2007-01-01'");
// now check if there was a previous encounter
if ($strEventDate['max'] != "") {
return $strEventDate['max'];
} else {
return "00-00-0000";
}
}
$m_strEventDate = getPatientDateOfLastEncounter($result['pid']);
// get last saved id for intakeverslag
$vectIntakeverslagQuery = sqlQuery("SELECT id FROM form_intakeverslag \n WHERE pid = " . $_SESSION["pid"] . " AND groupname='" . $_SESSION["authProvider"] . "' AND user='******' AND\n authorized={$userauthorized} AND activity=1\n AND autosave_flag=0 \n ORDER by id DESC limit 1");
<!-- view.php -->
<?php
include_once "../../globals.php";
include_once "../../../library/api.inc";
formHeader("Form: CAMOS");
$returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
$textarea_rows = 20;
$textarea_cols = 40;
?>
<html><head>
<link rel=stylesheet href="<?php
echo $css_header;
?>
" type="text/css">
<script type="text/javascript">
function checkall(){
var f = document.my_form;
var x = f.elements.length;
var i;
for(i=0;i<x;i++) {
if (f.elements[i].type == 'checkbox') {
f.elements[i].checked = true;
}
}
}
function uncheckall(){
var f = document.my_form;
var x = f.elements.length;
var i;
for(i=0;i<x;i++) {
if (f.elements[i].type == 'checkbox') {
<?php
// file new.php for pediatric EMESIS evaluation
// presents a blank form for evaluating pediatric FEVER
// this file made by andres@paglayan.com on 2004-09-23
// input designed by Lowell Gordon, MD lgordon@whssf.org
// to max the billing complexity coding
include_once "../../globals.php";
include_once "../../../library/api.inc";
formHeader("Pediatric GI Evaluation");
?>
<html><head>
<?php
html_header_show();
?>
<link rel="stylesheet" href="<?php
echo $css_header;
?>
" type="text/css">
</head>
<body class="body_top">
<!--REM note that every input method has the same name as a valid column, this will make things easier in save.php -->
<?php
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
formHeader("Form: Forms_Cardiology");
?>
<html><head>
<link rel=stylesheet href="<?php
echo $css_header;
?>
" type="text/css">
</head>
<body <?php
echo $top_bg_line;
?>
topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
<form method=post action="<?php
echo $rootdir;
?>
/forms/Forms_Cardiology/save.php?mode=new" name="my_form" onSubmit="return top.restoreSession()">
<h1> Forms_Cardiology </h1>
<hr>
<input type="submit" name="submit form" value="submit form" />
<table width="100%" cellpadding="0" cellspacing="0">
<tr>
<td class='text' valign="top" style="border: 1px #000000 solid; height: 15px;">
<table width="100%" cellpadding="0" cellspacing="0">
<?php
//================================================
//Form Created by
//Z&H Healthcare Solutions, LLC.
//www.zhservices.com
//sam@zhholdings.com
//Initial New Patient Physical Exam
//================================================
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
formHeader("Form: Initial New Patient Physical Exam");
?>
<html><head>
<?php
html_header_show();
?>
<link rel="stylesheet" href="<?php
echo $css_header;
?>
" type="text/css">
</head>
<body class="body_top">
<form method=post action="<?php
echo $rootdir;
?>
/forms/Initial_New_Patient_Physical_Exam/save.php?mode=new" name="my_form" onSubmit="return top.restoreSession()">
<table width="100%" border="0" cellspacing="0" cellpadding="0" >
<tr>
<td align="center" colspan="5"><h3> <?php
xl("015 Initial New Patient Physical Exam - ", 'e');
<?php
$users = $db->users;
$user = $users->findOne(array("facebookid" => $_SESSION['user']));
if (isset($_POST['submit'])) {
$user['location'] = $_POST['location'];
$user['phone'] = $_POST['phone'];
$user['description'] = $_POST['description'];
$users->update(array("facebookid" => $_SESSION['user']), $user);
wallPost($_SESSION['user'], $_SESSION['user'], "editprofile", "?profile/edit");
}
$_POST = $user;
formHeader("Edit your profile");
formField("User", "user", "disabled", "", "Your user");
formField("Name", "first", "disabled", "", "Your name");
formField("E-mail", "email", "disabled", "", "Your email");
formField("Joined", "date", "disabled", "", "");
formField("Location", "location", "text", "", "Your location (country, city)");
formField("Phone", "phone", "text", "", "Your phone number");
formField("Short description", "description", "textarea");
formFooter("Save changes");
// openemr/interface/login/GnuGPL.html
// For more information write to the Free Software
// Foundation, Inc., 59 Temple Place - Suite 330, Boston, MA 02111-1307, USA.
//
// Author: Jacob Paul <*****@*****.**>
//
// +------------------------------------------------------------------------------+
//SANITIZE ALL ESCAPES
$sanitize_all_escapes = true;
//STOP FAKE REGISTER GLOBALS
$fake_register_globals = false;
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
require_once "{$srcdir}/patient.inc";
require_once "{$srcdir}/options.inc.php";
formHeader("Form:Clinical Instructions Form");
$returnurl = $GLOBALS['concurrent_layout'] ? 'encounter_top.php' : 'patient_encounter.php';
$formid = 0 + (isset($_GET['id']) ? $_GET['id'] : '');
$check_res = $formid ? formFetch("form_clinical_instructions", $formid) : array();
?>
<html>
<head>
<link rel="stylesheet" href="<?php
echo $css_header;
?>
" type="text/css">
</head>
<body class="body_top">
<p><span class="forms-title"><?php
echo xlt('Clinical Instructions Form');
?>
<!-- Form generated from formsWiz -->
<?php
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
formHeader("Form: reviewofs");
?>
<html><head>
<?php
html_header_show();
?>
<link rel="stylesheet" href="<?php
echo $css_header;
?>
" type="text/css">
</head>
<body class="body_top">
<form method=post action="<?php
echo $rootdir;
?>
/forms/reviewofs/save.php?mode=new" name="my_form">
<span class="title">Review of Systems Checks</span><br><br>
<table><tr><td valign=top>
<span class=bold>General</span><br>
<input type=checkbox name='fever' ><span class=text>Fever</span><br>
<input type=checkbox name='chills' ><span class=text>Chills</span><br>
<input type=checkbox name='night_sweats' ><span class=text>Night Sweats</span><br>
<input type=checkbox name='weight_loss' ><span class=text>Weight Loss</span><br>
<input type=checkbox name='poor_appetite' ><span class=text>Poor Appetite</span><br>
<input type=checkbox name='insomnia' ><span class=text>Insomnia</span><br>
<?php
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
formHeader("Form: individual_treatment_plan");
?>
<html><head>
<?php
html_header_show();
?>
<link rel=stylesheet href="<?php
echo $css_header;
?>
" type="text/css">
</head>
<body <?php
echo $top_bg_line;
?>
topmargin=0 rightmargin=0 leftmargin=2 bottommargin=0 marginwidth=2 marginheight=0>
<form method=post action="<?php
echo $rootdir;
?>
/forms/individual_treatment_plan/save.php?mode=new" name="my_form">
<br>
<span class="title"><center>Individual Treatment Plan</center></span><br><br>
<center><a href="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save]</a>
<img src="../../../images/space.gif" width="5" height="1">
<a href="<?php
echo $GLOBALS['form_exit_url'];
?>
" class="link_submit" onclick="top.restoreSession()">[Don't Save]</a></center>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
"http://www.w3.org/TR/html4/loose.dtd">
<?php
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
include_once "{$srcdir}/calendar.inc";
formHeader("Form: Routine screening record");
?>
<html>
<head>
<?php
html_header_show();
?>
<title>Form: Routine screening record</title>
<link rel="stylesheet" href="<?php
echo $css_header;
?>
" type="text/css">
<link rel="stylesheet" href="../../acog.css" type="text/css">
<script language="JavaScript" src="../../acog.js" type="text/JavaScript"></script>
<?php
include "../../../library/api.inc";
formHeader("View my form");
?>
<form method=post action=save.php name=new_encounter>
<input type=hidden name=id value='<?php
echo $_GET["id"];
?>
'>
<span class=title>New Patient Encounter Form</span>
<br>
<span class=text>Reason for Visit:</span><br>
<textarea name=reason cols=40 rows=6 wrap=virtual><?php
$result = formFetch('newer_patient', "7");
echo $result["reason"];
?>
</textarea>
<br>
<?php
echo "<input type='text' name='cats' value='{$result['cats']}'>";
?>
<br>
<a href="javascript:top.restoreSession();document.new_encounter.submit();" class="link_submit">[Save]</a>
<br>
</form>
<?php
<?php
//------------Forms generated from formsWiz
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
foreach ($_POST as $k => $var) {
$_POST[$k] = mysql_escape_string($var);
echo "{$var}\n";
}
if ($encounter == "") {
$encounter = date("Ymd");
}
if ($_GET["mode"] == "new") {
$newid = formSubmit("form_dictation", $_POST, $_GET["id"], $userauthorized);
addForm($encounter, "Speech Dictation", $newid, "dictation", $pid, $userauthorized);
} elseif ($_GET["mode"] == "update") {
sqlInsert("update form_dictation set pid = {$_SESSION["pid"]},groupname='" . $_SESSION["authProvider"] . "',user='******',authorized={$userauthorized},activity=1, date = NOW(), dictation='" . $_POST["dictation"] . "', additional_notes='" . $_POST["additional_notes"] . "' where id={$id}");
}
$_SESSION["encounter"] = $encounter;
formHeader("Redirecting....");
formJump();
formFooter();
<!-- Form created by Nikolai Vitsyn: 2004/01/23 -->
<!-- Update 2004/01/29 -->
<?php
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
formHeader("Form: bronchitis");
$returnurl = 'encounter_top.php';
?>
<html><head>
<?php
html_header_show();
?>
<SCRIPT LANGUAGE="JavaScript">
<!--
function onset_check (form) {
var d, s = "Today's date is: "; //Declare variables.
d = new Date(); //Create Date object.
s += (d.getMonth() + 1) + "-"; //Get month
s += d.getDate() + "-"; //Get day
s += d.getYear(); //Get year.
onset_str = form.bronchitis_date_of_illness.value;
if (onset_str == "") {
alert("No valid date into Onset of illness field!!! Enter date as YYYY-MM-DD");
alert(d);
return;
}
if (onset_str.length != 10) {
