function form_disease()
{
//
// form for registering patients in notifiable registry
//
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 = $arg_list[4];
//print_r($arg_list);
if ($get_vars["pid"]) {
$sql = "select philhealth_id, expiry_date from m_patient_philhealth " . "where philhealth_id = '" . $get_vars["pid"] . "'";
if ($result = mysql_query($sql)) {
if (mysql_num_rows($result)) {
$card = mysql_fetch_array($result);
}
}
}
}
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=notifiable¬ifiable=DISEASE' name='form_disease' method='post'>";
print "<tr valign='top'><td>";
$patient_id = healthcenter::get_patient_id($get_vars["consult_id"]);
print "<b>" . FTITLE_NOTIFIABLE_REGISTRATION . "</b><br/><br/>";
print "</td></tr>";
print "<tr valign='top'><td>";
print "<span class='boxtitle'>" . LBL_ONSET_DATE . "</span><br> ";
print "<input type='text' size='15' maxlength='10' class='textbox' name='onset_date' value='" . $post_vars["onset_date"] . "' style='border: 1px solid #000000'> ";
print "<a href=\"javascript:show_calendar4('document.form_disease.onset_date', document.form_disease.onset_date.value);\"><img src='../images/cal.gif' width='16' height='16' border='0' alt='Click Here to Pick up the date'></a><br>";
print "<small>Click on the calendar icon to select date. Otherwise use MM/DD/YYYY format.</small><br>";
print "<br/></td></tr>";
print "<tr valign='top'><td>";
print "<span class='boxtitle'>" . INSTR_NOTIFIABLE_DISEASE_SELECTION . "</span><br/>";
print notifiable::checkbox_notifiable_diseases($menu_id, $post_vars, $get_vars);
print "</td></tr>";
print "<tr><td><br/>";
if ($_SESSION["priv_add"]) {
print "<input type='hidden' name='patient_id' value='{$patient_id}' />";
print "<input type='submit' value = 'Save Disease Info' class='textbox' name='submitdisease' style='border: 1px solid #000000'> ";
}
print "</td></tr>";
print "</form>";
print "</table><br>";
}
