createTR($errorfax, 'fax', $LDFax, $fax, 2);
}
if (!$person_email_hide) {
createTR($erroremail, 'email', $LDEmail, $email, 2);
}
if (!$person_citizenship_hide) {
createTR($errorcitizen, 'citizenship', $LDCitizenship, $citizenship, 2);
}
if (!$person_sss_nr_hide) {
createTR($errorsss, 'sss_nr', $LDSSSNr, $sss_nr, 2);
}
if (!$person_nat_id_nr_hide) {
createTR($errornatid, 'nat_id_nr', $LDNatIdNr, $nat_id_nr, 2);
}
if (!$person_religion_hide) {
createTR($errorreligion, 'religion', $LDReligion, $religion, 2);
}
if (!$person_ethnic_orig_hide) {
/** Add by Jean-Philippe LIOT 13/05/2004 **/
?>
<tr>
<td><FONT SIZE=-1 FACE="Arial"><?php
if ($errortown) {
echo "<font color=red>";
}
echo $LDEthnicOrigin;
?>
:
</td>
<td><input name="ethnic_orig_txt" type="text" size="35" value="<?php
echo $ethnic_orig_txt;
<?php
if (!$GLOBAL_CONFIG['person_name_2_hide']) {
createTR($LDName2, $name_2);
}
if (!$GLOBAL_CONFIG['person_name_3_hide']) {
createTR($LDName3, $name_3);
}
if (!$GLOBAL_CONFIG['person_name_middle_hide']) {
createTR($LDNameMid, $name_middle);
}
if (!$GLOBAL_CONFIG['person_name_maiden_hide']) {
createTR($LDNameMaiden, $name_maiden);
}
if (!$GLOBAL_CONFIG['person_name_others_hide']) {
createTR($LDNameOthers, $name_others);
}
?>
<tr>
<td bgColor="#eeeeee"><FONT SIZE=-1 FACE="Arial"><?php
echo $LDBday;
?>
:
</td>
<td bgcolor="#ffffee" ><FONT SIZE=-1 FACE="Arial" color="#990000">
<b><?php
echo @formatDate2Local($date_birth, $date_format);
?>
</b>
</td>
</option>
<?php
# Generate discharge types
while ($dis_type = $discharge_types->FetchRow()) {
echo '<option value="' . $dis_type['nr'] . '">' . $dis_type['name'] . '</option>';
}
?>
</select>
</td>
</tr>
<?php
createTR('discharged_by', 'Discharged By', $discharged_by);
?>
<tr bgcolor="white">
<!--d.r. from merotech: Remove Bill Type from Archive form-->
<!--<td background="<?php
echo createBgSkin($root_path, 'tableHeaderbg3.gif');
?>
"> <?php
echo $LDBillType;
?>
:-->
</td>
<td colspan=2 bgcolor="#eeeeee">
<?php
createTR($errorcitizen, 'citizenship', $LDCitizenship, $citizenship, 2);
}
if (!$person_sss_nr_hide) {
createTR($errorsss, 'sss_nr', $LDSSSNr, $sss_nr, 2);
}
if (!$person_nat_id_nr_hide) {
createTR($errornatid, 'nat_id_nr', $LDNatIdNr, $nat_id_nr, 2);
}
if (!$person_religion_hide) {
createTR($errorreligion, 'religion', $LDReligion, $religion, 2);
}
if (!$person_ethnic_orig_hide) {
if (!$ethnic_orig) {
$ethnic_orig = '';
}
createTR($errorethnicorig, 'ethnic_orig', $LDEthnicOrigin, $ethnic_orig, 2);
}
?>
<tr>
<td bgColor="#eeeeee"><FONT SIZE=-1 FACE="Arial" ><FONT SIZE=2 FACE="Arial"><?php
echo $LDRegBy;
?>
</td>
<td colspan=2><FONT SIZE=-1 FACE="Arial"><nobr>
<input name="user_id" type="text" value=<?php
if ($user_id != '') {
echo '"' . $user_id . '"';
} else {
echo '"' . $_COOKIE[$local_user . $sid] . '"';
}
?>
$LD = $result['LD_var'];
if (isset(${$LD}) && !empty(${$LD})) {
echo ${$LD};
} else {
echo $result['name'];
}
echo ' ';
}
}
?>
</td>
</tr>
<?php
createTR('insurance_nr', $LDInsuranceNr, $insurance_nr);
createTR('insurance_firm_name', $LDInsuranceCo, $insurance_firm_name);
?>
<?php
//if (!$GLOBAL_CONFIG['patient_care_service_hide'] && $care_ok)
if (!$GLOBAL_CONFIG['patient_service_care_hide']) {
?>
<tr>
<td background="<?php
echo createBgSkin($root_path, 'tableHeaderbg3.gif');
?>
"><FONT SIZE=-1 FACE="Arial"><?php
echo $LDCareServiceClass;
?>
:
</td>
if (!isset($nat_id_nr)) {
$nat_id_nr = '';
}
createTR('nat_id_nr', $LDNatIdNr, $nat_id_nr, 2);
}
if (!$GLOBAL_CONFIG['person_religion_hide']) {
if (!isset($religion)) {
$religion = '';
}
createTR('religion', $LDReligion, $religion, 2);
}
if (!$GLOBAL_CONFIG['person_ethnic_orig_hide']) {
if (!isset($ethnic_orig)) {
$ethnic_orig = '';
}
createTR('ethnic_orig', $LDEthnicOrigin, $ethnic_orig, 2);
}
/*
if (!$GLOBAL_CONFIG['insurance_ID_hide'])
{
if(!isset($insurance_ID)) $insurance_ID='';
createTR('insurance_ID', $LDInsurance,$insurance_ID,2);
}
*/
?>
</table>
<p>
<input type=hidden name="sid" value=<?php
echo $sid;
