function form_other_info()
{
if (func_num_args() > 0) {
$arg_list = func_get_args();
$menu_id = $arg_list[0];
$post_vars = $arg_list[1];
$get_vars = $arg_list[2];
$validuser = $arg_list[3];
$isadmin = $arg_list[4];
}
print "<table width='300'>";
print "<form action = '" . $_SERVER["SELF"] . "?page=" . $get_vars["page"] . "&menu_id=" . $get_vars["menu_id"] . "&consult_id=" . $get_vars["consult_id"] . "&ptmenu=DETAILS&module=philhealth&philhealth=INFO' name='form_other_info' method='post'>";
print "<tr valign='top'><td>";
print "<b>PATIENT OTHER INFORMATION</b><br/><br/>";
// does member have philhealth id?
$patient_id = healthcenter::get_patient_id($get_vars["consult_id"]);
$patient_name = patient::get_name($patient_id);
$philhealth_id = philhealth::get_philhealth_id($patient_id);
if (!$philhealth_id) {
// try to see if any family member has a philhealth id
$family_id = family::get_family_id($patient_id);
$philhealth_info = philhealth::whois_philhealth_member($family_id);
$patient_name = $philhealth_info["patient_lastname"] . ", " . $philhealth_info["patient_firstname"];
$philhealth_id = $philhealth_info["philhealth_id"];
$patient_id = healthcenter::get_patient_id($get_vars["consult_id"]);
}
if ($philhealth_id && $patient_name) {
print "BENEFICIARY: <b>{$patient_name}</b><br/>";
print "PHILHEALTH ID: <b>{$philhealth_id}</b><br/><br/>";
print "<input type='hidden' name='philhealth_id' value='{$philhealth_id}'/>";
} else {
print "<font color='red'>No PHILHEALTH membership found.</font><br/>";
}
$sql = "SELECT religion_id, status_id, educ_id, occup_id FROM m_patient_philhealth_info WHERE patient_id = '{$patient_id}'";
if ($result = mysql_query($sql)) {
if (mysql_num_rows($result)) {
list($religion, $status, $educ, $occup) = mysql_fetch_array($result);
$button = "<input type='submit' value = 'Update Data' class='textbox' name='submitinfo' style='border: 1px solid #000000'><br> ";
} else {
$button = "<input type='submit' value = 'Save Data' class='textbox' name='submitinfo' style='border: 1px solid #000000'><br> ";
}
}
print "</td></tr>";
print "<tr valign='top'><td>";
print "<span class='boxtitle'>Religion:</span><br> ";
//print philhealth::checkbox_philhealth_services();
print philhealth::dropdown_religion($religion);
print "<br/><br/></td></tr>";
print "<tr valign='top'><td>";
print "<span class='boxtitle'>Civil Status:</span><br> ";
print philhealth::dropdown_status($status);
print "<br/><br/></td></tr>";
print "<tr valign='top'><td>";
print "<span class='boxtitle'>Highest Completed Educational Attainment:</span><br> ";
print philhealth::dropdown_education($educ);
print "<br/><br/></td></tr>";
print "<tr valign='top'><td>";
print "<span class='boxtitle'>Occupation:</span><br> ";
print philhealth::dropdown_occupation($occup);
print "<br/><br/></td></tr>";
print "<tr><td>";
//if ($_SESSION["priv_add"]) {
//print "<input type='submit' value = 'Save Data' class='textbox' name='submitinfo' style='border: 1px solid #000000'><br> ";
//}
print $button;
print "</td></tr>";
print "</form>";
print "</table><br>";
}
