<td><select name="suspectedTreatmentFailureLastVLDateDay" id="suspectedTreatmentFailureLastVLDateDay" class="search"> <? if($suspectedTreatmentFailureLastVLDate) { echo "<option value=\"".getFormattedDateDay($suspectedTreatmentFailureLastVLDate)."\" selected=\"selected\">".getFormattedDateDay($suspectedTreatmentFailureLastVLDate)."</option>"; } else { echo "<option value=\"\" selected=\"selected\">Select Date</option>"; } for($j=1;$j<=31;$j++) { echo "<option value=\"".($j<10?"0$j":$j)."\">$j</option>"; } ?> </select></td> <td style="padding:0px 0px 0px 5px"><select name="suspectedTreatmentFailureLastVLDateMonth" id="suspectedTreatmentFailureLastVLDateMonth" class="search"> <? if($suspectedTreatmentFailureLastVLDate) { echo "<option value=\"".getFormattedDateMonth($suspectedTreatmentFailureLastVLDate)."\" selected=\"selected\">".getFormattedDateMonthname($suspectedTreatmentFailureLastVLDate)."</option>"; } else { echo "<option value=\"\" selected=\"selected\">Select Month</option>"; } ?> <option value="01">Jan</option> <option value="02">Feb</option> <option value="03">Mar</option> <option value="04">Apr</option> <option value="05">May</option> <option value="06">Jun</option> <option value="07">Jul</option> <option value="08">Aug</option> <option value="09">Sept</option> <option value="10">Oct</option> <option value="11">Nov</option>
<? if($assayDate) { echo "<option value=\"".getFormattedDateDay($assayDate)."\" selected=\"selected\">".getFormattedDateDay($assayDate)."</option>"; } else { echo "<option value=\"\" selected=\"selected\">Select Day</option>"; } for($j=1;$j<=31;$j++) { echo "<option value=\"".($j<10?"0$j":$j)."\">$j</option>"; } ?> </select></td> <td style="padding:0px 0px 0px 5px"> <select name="assayDateMonth" id="assayDateMonth" class="search"> <? if($assayDate) { echo "<option value=\"".getFormattedDateMonth($assayDate)."\" selected=\"selected\">".getFormattedDateMonthname($assayDate)."</option>"; } else { echo "<option value=\"\" selected=\"selected\">Select Month</option>"; } ?> <option value="01">Jan</option> <option value="02">Feb</option> <option value="03">Mar</option> <option value="04">Apr</option> <option value="05">May</option> <option value="06">Jun</option> <option value="07">Jul</option> <option value="08">Aug</option> <option value="09">Sept</option> <option value="10">Oct</option> <option value="11">Nov</option>
</tr> <tr> <td style="padding:10px 0px 0px 0px">To:</td> </tr> <tr> <td><table width="10%" border="0" cellspacing="0" cellpadding="0" class="vl"> <tr> <td><select name="toDay" id="toDay" class="search"> <? for($j=1;$j<=31;$j++) { echo "<option value=\"".($j<10?"0$j":$j)."\" ".($j==getFormattedDateDay(getDualInfoWithAlias("last_day(now())","lastmonth"))?"selected=\"selected\"":"").">$j</option>"; } ?> </select></td> <td style="padding:0px 0px 0px 5px"><select name="toMonth" id="toMonth" class="search"> <? echo "<option value=\"".getFormattedDateMonth(getDualInfoWithAlias("last_day(now())","lastmonth"))."\" selected=\"selected\">".getFormattedDateMonthname(getDualInfoWithAlias("last_day(now())","lastmonth"))."</option>"; ?> <option value="01">January</option> <option value="02">February</option> <option value="03">March</option> <option value="04">April</option> <option value="05">May</option> <option value="06">June</option> <option value="07">July</option> <option value="08">August</option> <option value="09">September</option> <option value="10">October</option> <option value="11">November</option> <option value="12">December</option> </select></td> <td style="padding:0px 0px 0px 5px"><select name="toYear" id="toYear" class="search"> <?
<table width="100%" border="0" class="vl"> <tr> <td width="20%">Date Dispatched <font class="vl_red">*</font></td> <td width="80%"> <table width="10%" border="0" cellspacing="0" cellpadding="0" class="vl"> <tr> <td><select name="dispatchedDateDay" id="dispatchedDateDay" class="search"> <? echo "<option value=\"".getFormattedDateDay($oldDispatchedDate?$oldDispatchedDate:$datetime)."\" selected=\"selected\">".getFormattedDateDay($oldDispatchedDate?$oldDispatchedDate:$datetime)."</option>"; for($j=1;$j<=31;$j++) { echo "<option value=\"".($j<10?"0$j":$j)."\">$j</option>"; } ?> </select></td> <td style="padding:0px 0px 0px 5px"><select name="dispatchedDateMonth" id="dispatchedDateMonth" class="search"> <? echo "<option value=\"".getFormattedDateMonth($oldDispatchedDate?$oldDispatchedDate:$datetime)."\" selected=\"selected\">".getFormattedDateMonthname($oldDispatchedDate?$oldDispatchedDate:$datetime)."</option>"; ?> <option value="01">Jan</option> <option value="02">Feb</option> <option value="03">Mar</option> <option value="04">Apr</option> <option value="05">May</option> <option value="06">Jun</option> <option value="07">Jul</option> <option value="08">Aug</option> <option value="09">Sept</option> <option value="10">Oct</option> <option value="11">Nov</option> <option value="12">Dec</option> </select></td> <td style="padding:0px 0px 0px 5px"><select name="dispatchedDateYear" id="dispatchedDateYear" class="search"> <?
</tr> <tr> <td>Date Received <font class="vl_red">*</font></td> <td> <table width="10%" border="0" cellspacing="0" cellpadding="0" class="vl"> <tr> <td><select name="receivedDateDay" id="receivedDateDay" class="search"> <? echo "<option value=\"".getFormattedDateDay($created)."\" selected=\"selected\">".getFormattedDateDay($created)."</option>"; for($j=1;$j<=31;$j++) { echo "<option value=\"".($j<10?"0$j":$j)."\">$j</option>"; } ?> </select></td> <td style="padding:0px 0px 0px 5px"><select name="receivedDateMonth" id="receivedDateMonth" class="search"> <? echo "<option value=\"".getFormattedDateMonth($created)."\" selected=\"selected\">".getFormattedDateMonthname($created)."</option>"; ?> <option value="01">Jan</option> <option value="02">Feb</option> <option value="03">Mar</option> <option value="04">Apr</option> <option value="05">May</option> <option value="06">Jun</option> <option value="07">Jul</option> <option value="08">Aug</option> <option value="09">Sept</option> <option value="10">Oct</option> <option value="11">Nov</option> <option value="12">Dec</option> </select></td> <td style="padding:0px 0px 0px 5px"><select name="receivedDateYear" id="receivedDateYear" class="search"> <?
echo "<option value=\"".getFormattedDateDay($dateOfBirth)."\" selected=\"selected\">".getFormattedDateDay($dateOfBirth)."</option>"; } else { echo "<option value=\"\" selected=\"selected\">Select Date</option>"; } for($j=1;$j<=31;$j++) { echo "<option value=\"".($j<10?"0$j":$j)."\">$j</option>"; } ?> </select></td> <td style="padding:0px 0px 0px 5px"><select name="dateOfBirthMonth" id="dateOfBirthMonth" class="search" <?php echo $noDateOfBirthSupplied ? "disabled=\"disabled\"" : ""; ?> > <? if($dateOfBirth) { echo "<option value=\"".getFormattedDateMonth($dateOfBirth)."\" selected=\"selected\">".getFormattedDateMonthname($dateOfBirth)."</option>"; } else { echo "<option value=\"\" selected=\"selected\">Select Month</option>"; } ?> <option value="01">Jan</option> <option value="02">Feb</option> <option value="03">Mar</option> <option value="04">Apr</option> <option value="05">May</option> <option value="06">Jun</option> <option value="07">Jul</option> <option value="08">Aug</option> <option value="09">Sept</option> <option value="10">Oct</option> <option value="11">Nov</option>