</td>
</tr>
<tr>
<td class="addHeader"><label>Last Name:</label></td>
<td class="addField">
<div class="patient-field">
<input type="text" name="lastname" id="lastname" class="ptField" title="Input Patient's Last Name" maxlength="50" required="required"/>
</div>
</td>
<td class="addHeader"><label>Membership:</label></td>
<td class="addField">
<div class="patient-field">
<select name="membership" id="membership" class="ptField">
<option value="">Select</option>
<?php
$membershiptype = getAllPriceList();
foreach ($membershiptype as $m) {
echo '<option value=' . $m["membership"] . '>' . $m["membership"] . '</option>';
}
?>
</select>
</div>
</td>
</tr>
<tr>
<td class="addHeader"><label>Sex:</label></td>
<td class="addField">
<div class="patient-field">
<select name="sex" id="sex" class="ptField">
<option value="">Select</option>
<option value="Female">Female</option>
<div id="accountHolder">
<span class="pageTitle">System Settings</span>
<?php
$pricelist = getAllPriceList();
?>
<br/>
<span class="pageTitle" style="padding-left: 100px;">PhilHealth Price List</span>
<div id="phil-health-pricing-list">
<div class="phil-row">
<div class="phil-cell-header" style="border-top:1px solid #ccc;">Type</div>
<?php
foreach ($pricelist as $pr) {
?>
<div class="phil-cell-header" style="border-left: none;border-top:1px solid #ccc;"><?php
echo $pr["membership"];
?>
<span style="float: right;"><a onClick='window.open( "editphilhealthpricing.php?phid=<?php
echo $pr['phid'];
?>
&membershiptype=<?php
echo $pr['membership'];
?>
", "myWindow",
"status = 1, height = 700, width = 700, resizable = 1" )'>[Edit]</a></span></div>
<?php
}
?>
</div>
<div class="phil-row">
<div class="phil-cell-header">D/M</div>
<?php