</td>
</tr>
<tr<?php
if (!$GLOBALS['athletic_team']) {
echo " style='display:none;'";
}
?>
id='row_medical_type'>
<td valign='top' nowrap><b><?php
xl('Medical Type', 'e');
?>
:</b></td>
<td>
<?php
echo generate_select_list('form_medical_type', 'medical_type', $irow['injury_type'], '');
?>
</td>
</tr>
<!-- End For Athletic Teams -->
<tr>
<td valign='top' nowrap><b><?php
xl('Begin Date', 'e');
?>
:</b></td>
<td>
<input type='text' size='10' name='form_begin' id='form_begin'
value='<?php
?>
</tr>
<tr<?php
if (!$GLOBALS['gbl_visit_referral_source']) {
echo " style='visibility:hidden;'";
}
?>
>
<td class='bold' nowrap><?php
echo xlt('Referral Source');
?>
:</td>
<td class='text'>
<?php
echo generate_select_list('form_referral_source', 'refsource', $viewmode ? $result['referral_source'] : '', '');
?>
</td>
</tr>
<tr>
<td class='bold' nowrap><?php
echo xlt('Date of Service:');
?>
</td>
<td class='text' nowrap>
<input type='text' size='10' name='form_date' id='form_date' <?php
echo $disabled;
?>
value='<?php
echo $viewmode ? substr($result['date'], 0, 10) : date('Y-m-d');
<td class="text"><?php
xl('Default Warehouse', 'e');
?>
: </td>
<td class='text'>
<?php
echo generate_select_list('default_warehouse', 'warehouse', '', '');
?>
</td>
<td class="text"><?php
xl('Invoice Refno Pool', 'e');
?>
: </td>
<td class='text'>
<?php
echo generate_select_list('irnpool', 'irnpool', '', xl('Invoice reference number pool, if used'));
?>
</td>
</tr>
<?php
}
?>
<?php
// List the access control groups if phpgacl installed
if (isset($phpgacl_location) && acl_check('admin', 'acl')) {
?>
<tr>
<td class='text'><?php
xl('Access Control', 'e');
?>
?>
'>
<!-- no restoreSession() on submit because session data are not relevant -->
<center>
<table border='0' width='100%'>
<tr>
<td width='1%' nowrap><b><?php
echo xlt('Procedure Type');
?>
:</b></td>
<td>
<?php
echo generate_select_list('form_procedure_type', 'proc_type', $row['procedure_type'], xl('The type of this entity'), ' ', '', 'proc_type_changed()');
?>
</td>
</tr>
<tr>
<td nowrap><b><?php
echo xlt('Name');
?>
:</b></td>
<td>
<input type='text' size='40' name='form_name' maxlength='63'
value='<?php
echo htmlspecialchars($row['name'], ENT_QUOTES);
?>
'
</tr>
<tr>
<td class='label'><?php
echo htmlspecialchars(xl('Race'), ENT_NOQUOTES);
?>
:</td>
<td><?php
echo generate_select_list('race', 'race', $sql_race, 'Select Race', 'Unassigned', '', '');
?>
</td>
<td class='label'><?php
echo htmlspecialchars(xl('Ethnicity'), ENT_NOQUOTES);
?>
:</td>
<td><?php
echo generate_select_list('ethnicity', 'ethnicity', $sql_ethnicity, 'Select Ethnicity', 'Unassigned', '', '');
?>
</td>
</tr>
<tr>
<td class='label' width='100'><?php
echo htmlspecialchars(xl('Lab Result'), ENT_NOQUOTES);
?>
:</td>
<td width='100'><input type='text' name='form_lab_results' size='13' maxlength='250' value='<?php
echo htmlspecialchars($form_lab_results, ENT_QUOTES);
?>
' title='<?php
echo htmlspecialchars(xl('Result, use % as a wildcard'), ENT_QUOTES);
?>
function generate_form_field($frow, $currvalue)
{
global $rootdir, $date_init;
$currescaped = htmlspecialchars($currvalue, ENT_QUOTES);
$data_type = $frow['data_type'];
$field_id = $frow['field_id'];
$list_id = $frow['list_id'];
// escaped variables to use in html
$field_id_esc = htmlspecialchars($field_id, ENT_QUOTES);
$list_id_esc = htmlspecialchars($list_id, ENT_QUOTES);
// Added 5-09 by BM - Translate description if applicable
$description = htmlspecialchars(xl_layout_label($frow['description']), ENT_QUOTES);
// added 5-2009 by BM to allow modification of the 'empty' text title field.
// Can pass $frow['empty_title'] with this variable, otherwise
// will default to 'Unassigned'.
// modified 6-2009 by BM to allow complete skipping of the 'empty' text title
// if make $frow['empty_title'] equal to 'SKIP'
$showEmpty = true;
if (isset($frow['empty_title'])) {
if ($frow['empty_title'] == "SKIP") {
//do not display an 'empty' choice
$showEmpty = false;
$empty_title = "Unassigned";
} else {
$empty_title = $frow['empty_title'];
}
} else {
$empty_title = "Unassigned";
}
// generic single-selection list
if ($data_type == 1) {
echo generate_select_list("form_{$field_id}", $list_id, $currvalue, $description, $showEmpty ? $empty_title : '');
} else {
if ($data_type == 2) {
$fldlength = htmlspecialchars($frow['fld_length'], ENT_QUOTES);
$maxlength = htmlspecialchars($frow['max_length'], ENT_QUOTES);
echo "<input type='text'" . " name='form_{$field_id_esc}'" . " id='form_{$field_id_esc}'" . " size='{$fldlength}'" . " maxlength='{$maxlength}'" . " title='{$description}'" . " value='{$currescaped}'";
if (strpos($frow['edit_options'], 'C') !== FALSE) {
echo " onchange='capitalizeMe(this)'";
}
$tmp = htmlspecialchars($GLOBALS['gbl_mask_patient_id'], ENT_QUOTES);
if ($field_id == 'pubpid' && strlen($tmp) > 0) {
echo " onkeyup='maskkeyup(this,\"{$tmp}\")'";
echo " onblur='maskblur(this,\"{$tmp}\")'";
}
echo " />";
} else {
if ($data_type == 3) {
$textCols = htmlspecialchars($frow['fld_length'], ENT_QUOTES);
$textRows = htmlspecialchars($frow['max_length'], ENT_QUOTES);
echo "<textarea" . " name='form_{$field_id_esc}'" . " id='form_{$field_id_esc}'" . " title='{$description}'" . " cols='{$textCols}'" . " rows='{$textRows}'>" . $currescaped . "</textarea>";
} else {
if ($data_type == 4) {
echo "<input type='text' size='10' name='form_{$field_id_esc}' id='form_{$field_id_esc}'" . " value='{$currescaped}'" . " title='{$description}'" . " onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />" . "<img src='{$rootdir}/pic/show_calendar.gif' align='absbottom' width='24' height='22'" . " id='img_{$field_id_esc}' border='0' alt='[?]' style='cursor:pointer'" . " title='" . htmlspecialchars(xl('Click here to choose a date'), ENT_QUOTES) . "' />";
$date_init .= " Calendar.setup({inputField:'form_{$field_id}', ifFormat:'%Y-%m-%d', button:'img_{$field_id}'});\n";
} else {
if ($data_type == 10) {
$ures = sqlStatement("SELECT id, fname, lname, specialty FROM users " . "WHERE active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " . "AND authorized = 1 " . "ORDER BY lname, fname");
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'>";
echo "<option value=''>" . htmlspecialchars(xl('Unassigned'), ENT_NOQUOTES) . "</option>";
while ($urow = sqlFetchArray($ures)) {
$uname = htmlspecialchars($urow['fname'] . ' ' . $urow['lname'], ENT_NOQUOTES);
$optionId = htmlspecialchars($urow['id'], ENT_QUOTES);
echo "<option value='{$optionId}'";
if ($urow['id'] == $currvalue) {
echo " selected";
}
echo ">{$uname}</option>";
}
echo "</select>";
} else {
if ($data_type == 11) {
$ures = sqlStatement("SELECT id, fname, lname, specialty FROM users " . "WHERE active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " . "AND ( authorized = 1 OR ( username = '' AND npi != '' ) ) " . "ORDER BY lname, fname");
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'>";
echo "<option value=''>" . htmlspecialchars(xl('Unassigned'), ENT_NOQUOTES) . "</option>";
while ($urow = sqlFetchArray($ures)) {
$uname = htmlspecialchars($urow['fname'] . ' ' . $urow['lname'], ENT_NOQUOTES);
$optionId = htmlspecialchars($urow['id'], ENT_QUOTES);
echo "<option value='{$optionId}'";
if ($urow['id'] == $currvalue) {
echo " selected";
}
echo ">{$uname}</option>";
}
echo "</select>";
} else {
if ($data_type == 12) {
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'>";
echo "<option value='0'></option>";
$pres = get_pharmacies();
while ($prow = sqlFetchArray($pres)) {
$key = $prow['id'];
$optionValue = htmlspecialchars($key, ENT_QUOTES);
$optionLabel = htmlspecialchars($prow['name'] . ' ' . $prow['area_code'] . '-' . $prow['prefix'] . '-' . $prow['number'] . ' / ' . $prow['line1'] . ' / ' . $prow['city'], ENT_NOQUOTES);
echo "<option value='{$optionValue}'";
if ($currvalue == $key) {
echo " selected";
}
echo ">{$optionLabel}</option>";
}
echo "</select>";
} else {
if ($data_type == 13) {
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'>";
echo "<option value=''> </option>";
$squads = acl_get_squads();
if ($squads) {
foreach ($squads as $key => $value) {
$optionValue = htmlspecialchars($key, ENT_QUOTES);
$optionLabel = htmlspecialchars($value[3], ENT_NOQUOTES);
echo "<option value='{$optionValue}'";
if ($currvalue == $key) {
echo " selected";
}
echo ">{$optionLabel}</option>\n";
}
}
echo "</select>";
} else {
if ($data_type == 14) {
if (strpos($frow['edit_options'], 'O') !== FALSE) {
$tmp = "abook_type LIKE 'ord\\_%'";
} else {
if (strpos($frow['edit_options'], 'V') !== FALSE) {
$tmp = "abook_type LIKE 'vendor%'";
} else {
$tmp = "( username = '' OR authorized = 1 )";
}
}
$ures = sqlStatement("SELECT id, fname, lname, organization, username FROM users " . "WHERE active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " . "AND {$tmp} " . "ORDER BY organization, lname, fname");
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'>";
echo "<option value=''>" . htmlspecialchars(xl('Unassigned'), ENT_NOQUOTES) . "</option>";
while ($urow = sqlFetchArray($ures)) {
$uname = $urow['organization'];
if (empty($uname) || substr($uname, 0, 1) == '(') {
$uname = $urow['lname'];
if ($urow['fname']) {
$uname .= ", " . $urow['fname'];
}
}
$optionValue = htmlspecialchars($urow['id'], ENT_QUOTES);
$optionLabel = htmlspecialchars($uname, ENT_NOQUOTES);
echo "<option value='{$optionValue}'";
$title = $urow['username'] ? xl('Local') : xl('External');
$optionTitle = htmlspecialchars($title, ENT_QUOTES);
echo " title='{$optionTitle}'";
if ($urow['id'] == $currvalue) {
echo " selected";
}
echo ">{$optionLabel}</option>";
}
echo "</select>";
} else {
if ($data_type == 15) {
$fldlength = htmlspecialchars($frow['fld_length'], ENT_QUOTES);
$maxlength = htmlspecialchars($frow['max_length'], ENT_QUOTES);
echo "<input type='text'" . " name='form_{$field_id_esc}'" . " id='form_related_code'" . " size='{$fldlength}'" . " maxlength='{$maxlength}'" . " title='{$description}'" . " value='{$currescaped}'" . " onclick='sel_related(this)' readonly" . " />";
} else {
if ($data_type == 21) {
// In this special case, fld_length is the number of columns generated.
$cols = max(1, $frow['fld_length']);
$avalue = explode('|', $currvalue);
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
echo "<table cellpadding='0' cellspacing='0' width='100%'>";
$tdpct = (int) (100 / $cols);
for ($count = 0; $lrow = sqlFetchArray($lres); ++$count) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars($option_id, ENT_QUOTES);
// if ($count) echo "<br />";
if ($count % $cols == 0) {
if ($count) {
echo "</tr>";
}
echo "<tr>";
}
echo "<td width='{$tdpct}%'>";
echo "<input type='checkbox' name='form_{$field_id_esc}[{$option_id_esc}]' id='form_{$field_id_esc}[{$option_id_esc}]' value='1'";
if (in_array($option_id, $avalue)) {
echo " checked";
}
// Added 5-09 by BM - Translate label if applicable
echo ">" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES);
echo "</td>";
}
if ($count) {
echo "</tr>";
if ($count > $cols) {
// Add some space after multiple rows of checkboxes.
$cols = htmlspecialchars($cols, ENT_QUOTES);
echo "<tr><td colspan='{$cols}' style='height:0.7em'></td></tr>";
}
}
echo "</table>";
} else {
if ($data_type == 22) {
$tmp = explode('|', $currvalue);
$avalue = array();
foreach ($tmp as $value) {
if (preg_match('/^([^:]+):(.*)$/', $value, $matches)) {
$avalue[$matches[1]] = $matches[2];
}
}
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
echo "<table cellpadding='0' cellspacing='0'>";
while ($lrow = sqlFetchArray($lres)) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars($option_id, ENT_QUOTES);
$maxlength = empty($frow['max_length']) ? 255 : $frow['max_length'];
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
// Added 5-09 by BM - Translate label if applicable
echo "<tr><td>" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES) . " </td>";
$fldlength = htmlspecialchars($fldlength, ENT_QUOTES);
$maxlength = htmlspecialchars($maxlength, ENT_QUOTES);
$optionValue = htmlspecialchars($avalue[$option_id], ENT_QUOTES);
echo "<td><input type='text'" . " name='form_{$field_id_esc}[{$option_id_esc}]'" . " id='form_{$field_id_esc}[{$option_id_esc}]'" . " size='{$fldlength}'" . " maxlength='{$maxlength}'" . " value='{$optionValue}'";
echo " /></td></tr>";
}
echo "</table>";
} else {
if ($data_type == 23) {
$tmp = explode('|', $currvalue);
$avalue = array();
foreach ($tmp as $value) {
if (preg_match('/^([^:]+):(.*)$/', $value, $matches)) {
$avalue[$matches[1]] = $matches[2];
}
}
$maxlength = empty($frow['max_length']) ? 255 : $frow['max_length'];
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
echo "<table cellpadding='0' cellspacing='0'>";
echo "<tr><td> </td><td class='bold'>" . htmlspecialchars(xl('N/A'), ENT_NOQUOTES) . " </td><td class='bold'>" . htmlspecialchars(xl('Nor'), ENT_NOQUOTES) . " </td>" . "<td class='bold'>" . htmlspecialchars(xl('Abn'), ENT_NOQUOTES) . " </td><td class='bold'>" . htmlspecialchars(xl('Date/Notes'), ENT_NOQUOTES) . "</td></tr>";
while ($lrow = sqlFetchArray($lres)) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars($option_id, ENT_QUOTES);
$restype = substr($avalue[$option_id], 0, 1);
$resnote = substr($avalue[$option_id], 2);
// Added 5-09 by BM - Translate label if applicable
echo "<tr><td>" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES) . " </td>";
for ($i = 0; $i < 3; ++$i) {
$inputValue = htmlspecialchars($i, ENT_QUOTES);
echo "<td><input type='radio'" . " name='radio_{$field_id_esc}[{$option_id_esc}]'" . " id='radio_{$field_id_esc}[{$option_id_esc}]'" . " value='{$inputValue}'";
if ($restype === "{$i}") {
echo " checked";
}
echo " /></td>";
}
$fldlength = htmlspecialchars($fldlength, ENT_QUOTES);
$maxlength = htmlspecialchars($maxlength, ENT_QUOTES);
$resnote = htmlspecialchars($resnote, ENT_QUOTES);
echo "<td><input type='text'" . " name='form_{$field_id_esc}[{$option_id_esc}]'" . " id='form_{$field_id_esc}[{$option_id_esc}]'" . " size='{$fldlength}'" . " maxlength='{$maxlength}'" . " value='{$resnote}' /></td>";
echo "</tr>";
}
echo "</table>";
} else {
if ($data_type == 24) {
$query = "SELECT title, comments FROM lists WHERE " . "pid = ? AND type = 'allergy' AND enddate IS NULL " . "ORDER BY begdate";
// echo "<!-- $query -->\n"; // debugging
$lres = sqlStatement($query, array($GLOBALS['pid']));
$count = 0;
while ($lrow = sqlFetchArray($lres)) {
if ($count++) {
echo "<br />";
}
echo htmlspecialchars($lrow['title'], ENT_NOQUOTES);
if ($lrow['comments']) {
echo ' (' . htmlspecialchars($lrow['comments'], ENT_NOQUOTES) . ')';
}
}
} else {
if ($data_type == 25) {
$tmp = explode('|', $currvalue);
$avalue = array();
foreach ($tmp as $value) {
if (preg_match('/^([^:]+):(.*)$/', $value, $matches)) {
$avalue[$matches[1]] = $matches[2];
}
}
$maxlength = empty($frow['max_length']) ? 255 : $frow['max_length'];
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
echo "<table cellpadding='0' cellspacing='0'>";
while ($lrow = sqlFetchArray($lres)) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars($option_id, ENT_QUOTES);
$restype = substr($avalue[$option_id], 0, 1);
$resnote = substr($avalue[$option_id], 2);
// Added 5-09 by BM - Translate label if applicable
echo "<tr><td>" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES) . " </td>";
$option_id = htmlspecialchars($option_id, ENT_QUOTES);
echo "<td><input type='checkbox' name='check_{$field_id_esc}[{$option_id_esc}]' id='check_{$field_id_esc}[{$option_id_esc}]' value='1'";
if ($restype) {
echo " checked";
}
echo " /> </td>";
$fldlength = htmlspecialchars($fldlength, ENT_QUOTES);
$maxlength = htmlspecialchars($maxlength, ENT_QUOTES);
$resnote = htmlspecialchars($resnote, ENT_QUOTES);
echo "<td><input type='text'" . " name='form_{$field_id_esc}[{$option_id_esc}]'" . " id='form_{$field_id_esc}[{$option_id_esc}]'" . " size='{$fldlength}'" . " maxlength='{$maxlength}'" . " value='{$resnote}' /></td>";
echo "</tr>";
}
echo "</table>";
} else {
if ($data_type == 26) {
echo "<select class='addtolistclass_{$list_id_esc}' name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'>";
if ($showEmpty) {
echo "<option value=''>" . htmlspecialchars(xl($empty_title), ENT_QUOTES) . "</option>";
}
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
$got_selected = FALSE;
while ($lrow = sqlFetchArray($lres)) {
$optionValue = htmlspecialchars($lrow['option_id'], ENT_QUOTES);
echo "<option value='{$optionValue}'";
if (strlen($currvalue) == 0 && $lrow['is_default'] || strlen($currvalue) > 0 && $lrow['option_id'] == $currvalue) {
echo " selected";
$got_selected = TRUE;
}
// Added 5-09 by BM - Translate label if applicable
echo ">" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES) . "</option>\n";
}
if (!$got_selected && strlen($currvalue) > 0) {
echo "<option value='{$currescaped}' selected>* {$currescaped} *</option>";
echo "</select>";
$fontTitle = htmlspecialchars(xl('Please choose a valid selection from the list.'), ENT_NOQUOTES);
$fontText = htmlspecialchars(xl('Fix this'), ENT_NOQUOTES);
echo " <font color='red' title='{$fontTitle}'>{$fontText}!</font>";
} else {
echo "</select>";
}
// show the add button if user has access to correct list
$inputValue = htmlspecialchars(xl('Add'), ENT_QUOTES);
$outputAddButton = "<input type='button' id='addtolistid_" . $list_id_esc . "' fieldid='form_" . $field_id_esc . "' class='addtolist' value='{$inputValue}'>";
if (aco_exist('lists', $list_id)) {
// a specific aco exist for this list, so ensure access
if (acl_check('lists', $list_id)) {
echo $outputAddButton;
}
} else {
// no specific aco exist for this list, so check for access to 'default' list
if (acl_check('lists', 'default')) {
echo $outputAddButton;
}
}
} else {
if ($data_type == 27) {
// In this special case, fld_length is the number of columns generated.
$cols = max(1, $frow['fld_length']);
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
echo "<table cellpadding='0' cellspacing='0' width='100%'>";
$tdpct = (int) (100 / $cols);
$got_selected = FALSE;
for ($count = 0; $lrow = sqlFetchArray($lres); ++$count) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars($option_id, ENT_QUOTES);
if ($count % $cols == 0) {
if ($count) {
echo "</tr>";
}
echo "<tr>";
}
echo "<td width='{$tdpct}%'>";
echo "<input type='radio' name='form_{$field_id_esc}' id='form_{$field_id_esc}[{$option_id_esc}]' value='{$option_id_esc}'";
if (strlen($currvalue) == 0 && $lrow['is_default'] || strlen($currvalue) > 0 && $option_id == $currvalue) {
echo " checked";
$got_selected = TRUE;
}
echo ">" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES);
echo "</td>";
}
if ($count) {
echo "</tr>";
if ($count > $cols) {
// Add some space after multiple rows of radio buttons.
$cols = htmlspecialchars($cols, ENT_QUOTES);
echo "<tr><td colspan='{$cols}' style='height:0.7em'></td></tr>";
}
}
echo "</table>";
if (!$got_selected && strlen($currvalue) > 0) {
$fontTitle = htmlspecialchars(xl('Please choose a valid selection.'), ENT_QUOTES);
$fontText = htmlspecialchars(xl('Fix this'), ENT_NOQUOTES);
echo "{$currescaped} <font color='red' title='{$fontTitle}'>{$fontText}!</font>";
}
} else {
if ($data_type == 28) {
$tmp = explode('|', $currvalue);
switch (count($tmp)) {
case "3":
$resnote = $tmp[0];
$restype = $tmp[1];
$resdate = $tmp[2];
break;
case "2":
$resnote = $tmp[0];
$restype = $tmp[1];
$resdate = "";
break;
case "1":
$resnote = $tmp[0];
$resdate = $restype = "";
break;
default:
$restype = $resdate = $resnote = "";
break;
}
$maxlength = empty($frow['max_length']) ? 255 : $frow['max_length'];
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
$fldlength = htmlspecialchars($fldlength, ENT_QUOTES);
$maxlength = htmlspecialchars($maxlength, ENT_QUOTES);
$resnote = htmlspecialchars($resnote, ENT_QUOTES);
$resdate = htmlspecialchars($resdate, ENT_QUOTES);
echo "<table cellpadding='0' cellspacing='0'>";
echo "<tr>";
// input text
echo "<td><input type='text'" . " name='form_{$field_id_esc}'" . " id='form_{$field_id_esc}'" . " size='{$fldlength}'" . " maxlength='{$maxlength}'" . " value='{$resnote}' /> </td>";
echo "<td class='bold'> " . htmlspecialchars(xl('Status'), ENT_NOQUOTES) . ": </td>";
// current
echo "<td><input type='radio'" . " name='radio_{$field_id_esc}'" . " id='radio_{$field_id_esc}[current]'" . " value='current" . $field_id_esc . "'";
if ($restype == "current" . $field_id) {
echo " checked";
}
echo "/>" . htmlspecialchars(xl('Current'), ENT_NOQUOTES) . " </td>";
// quit
echo "<td><input type='radio'" . " name='radio_{$field_id_esc}'" . " id='radio_{$field_id_esc}[quit]'" . " value='quit" . $field_id_esc . "'";
if ($restype == "quit" . $field_id) {
echo " checked";
}
echo "/>" . htmlspecialchars(xl('Quit'), ENT_NOQUOTES) . " </td>";
// quit date
echo "<td><input type='text' size='6' name='date_{$field_id_esc}' id='date_{$field_id_esc}'" . " value='{$resdate}'" . " title='{$description}'" . " onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' />" . "<img src='{$rootdir}/pic/show_calendar.gif' align='absbottom' width='24' height='22'" . " id='img_{$field_id_esc}' border='0' alt='[?]' style='cursor:pointer'" . " title='" . htmlspecialchars(xl('Click here to choose a date'), ENT_QUOTES) . "' /> </td>";
$date_init .= " Calendar.setup({inputField:'date_{$field_id}', ifFormat:'%Y-%m-%d', button:'img_{$field_id}'});\n";
// never
echo "<td><input type='radio'" . " name='radio_{$field_id_esc}'" . " id='radio_{$field_id_esc}[never]'" . " value='never" . $field_id_esc . "'";
if ($restype == "never" . $field_id) {
echo " checked";
}
echo " />" . htmlspecialchars(xl('Never'), ENT_NOQUOTES) . " </td>";
// Not Applicable
echo "<td><input type='radio'" . " name='radio_{$field_id}'" . " id='radio_{$field_id}[not_applicable]'" . " value='not_applicable" . $field_id . "'";
if ($restype == "not_applicable" . $field_id) {
echo " checked";
}
echo " />" . htmlspecialchars(xl('N/A'), ENT_QUOTES) . " </td>";
echo "</tr>";
echo "</table>";
} else {
if ($data_type == 31) {
echo nl2br($frow['description']);
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
echo " <option value='" . attr($date1) . "'>" . xlt('This visit begins new contraceptive use') . "</option>\n";
echo " <option value='" . attr($date0) . "'>" . xlt('Contraceptive services previously started') . "</option>\n";
echo " <option value=''>" . xlt('None of the above') . "</option>\n";
echo " </select>\n";
echo " \n";
}
}
}
// If there is a choice of warehouses, allow override of user default.
if ($prod_lino > 0) {
// if any products are in this form
$trow = sqlQuery("SELECT count(*) AS count FROM list_options WHERE list_id = 'warehouse'");
if ($trow['count'] > 1) {
$trow = sqlQuery("SELECT default_warehouse FROM users WHERE username = ?", array($_SESSION['authUser']));
echo " <span class='billcell'><b>" . xlt('Warehouse') . ":</b></span>\n";
echo generate_select_list('default_warehouse', 'warehouse', $trow['default_warehouse'], '');
echo " \n";
}
}
// Allow the patient price level to be fixed here.
$plres = sqlStatement("SELECT option_id, title FROM list_options " . "WHERE list_id = 'pricelevel' ORDER BY seq");
if (true) {
$trow = sqlQuery("SELECT pricelevel FROM patient_data WHERE " . "pid = ? LIMIT 1", array($pid));
$pricelevel = $trow['pricelevel'];
echo " <span class='billcell'><b>" . xlt('Price Level') . ":</b></span>\n";
echo " <select name='pricelevel'";
if ($isBilled) {
echo " disabled";
}
echo ">\n";
while ($plrow = sqlFetchArray($plres)) {
echo $screen == 'new_payment' ? htmlspecialchars('0.00') : htmlspecialchars($PayTotal);
?>
" style="text-align:right" class="class1 text " /></td>
<td align="left" ></td>
<td align="left" ></td>
<td align="left" class="text"><?php
echo htmlspecialchars(xl('Paying Entity'), ENT_QUOTES) . ':';
?>
</td>
<td align="left"><?php
if ($PaymentType == '' && $screen == 'edit_payment') {
$blankValue = ' ';
} else {
$blankValue = '';
}
echo generate_select_list("type_name", "payment_type", "{$PaymentType}", "Paying Entity", "{$blankValue}", "class1 text", 'PayingEntityAction()');
?>
</td>
<td align="left" ></td>
<td align="left" ></td>
<td align="left" class="text"><?php
echo htmlspecialchars(xl('Payment Category'), ENT_QUOTES) . ':';
?>
</td>
<td align="left"><?php
if ($AdjustmentCode == '' && $screen == 'edit_payment') {
$blankValue = ' ';
} else {
$blankValue = '';
}
echo generate_list_payment_category("adjustment_code", "payment_adjustment_code", "{$AdjustmentCode}", "Payment Category", "{$blankValue}", "class1 text", 'FilterSelection(this)', "{$PaymentType}", "{$screen}");
echo attr($age_from);
?>
" size='3' maxlength='3' /> <?php
echo xlt('To{{range}}');
?>
<input name='age_to' class="numeric_only" type='text' id="age_to" value="<?php
echo attr($age_to);
?>
" size='3' maxlength='3' /></td>
<td class='label'><?php
echo xlt('Gender');
?>
:</td>
<td colspan="2"><?php
echo generate_select_list('gender', 'sex', $sql_gender, 'Select Gender', 'Unassigned', '', '');
?>
</td>
</tr>
</table>
</div></td>
<td height="100%" valign='middle' width="175"><table style='border-left:1px solid; width:100%; height:100%'>
<tr>
<td width="130px"><div style='margin-left:15px'> <a href='#' class='css_button' onclick='submitForm();'> <span>
<?php
echo xlt('Submit');
?>
</span> </a>
</div>
/**
* Function to display the fields for a currently worn glasses/spectacle Rx.
* @param $W - the Rx number, in order of documentation
*/
function generate_specRx($W)
{
global $pid, $form_id, $encounter, $display_W_width;
$query = "select * from form_eye_mag_wearing where PID=? and FORM_ID=? and ENCOUNTER=? and RX_NUMBER =?";
$wear = sqlQuery($query, array($pid, $form_id, $encounter, $W));
if ($wear) {
$RX_VALUE = '1';
@extract($wear);
} else {
$RX_VALUE = '';
$display_W = 'nodisplay';
}
ob_start();
?>
<input type="hidden" id="W_<?php
echo attr($W);
?>
" name="W_<?php
echo attr($W);
?>
" value="<?php
echo attr($RX_VALUE);
?>
">
<div id="LayerVision_W_<?php
echo attr($W);
?>
" name="currentRX" class="refraction current_W borderShadow <?php
echo attr($display_W);
?>
<?php
echo $display_W_width;
?>
">
<i class="closeButton fa fa-close" id="Close_W_<?php
echo attr($W);
?>
" name="Close_W_<?php
echo attr($W);
?>
"
title="<?php
echo xla('Close this panel and delete this Rx');
?>
"></i>
<i class="closeButton2 fa fa-arrows-h " id="W_width_display_<?php
echo attr($W);
?>
" name="W_width_display"
title="<?php
echo xla("Rx Details");
?>
" ></i>
<i onclick="top.restoreSession(); doscript('W','<?php
echo attr($pid);
?>
','<?php
echo attr($encounter);
?>
','<?php
echo attr($W);
?>
'); return false;"
title="<?php
echo xla("Dispense Rx");
?>
" class="closeButton3 fa fa-print"></i>
<i onclick="top.restoreSession(); dispensed('<?php
echo attr($pid);
?>
');return false;"
title="<?php
echo xla("List of previously dispensed Spectacle and Contact Lens Rxs");
?>
" class="closeButton4 fa fa-list-ul"></i>
<table id="wearing_<?php
echo attr($W);
?>
" >
<tr>
<th colspan="7"><?php
echo xlt('Current Glasses');
?>
: #<?php
echo attr($W);
?>
</th>
</tr>
<tr>
<td></td>
<td><i class="fa fa-gamepad" name="reverseme" title="<?php
echo xla('Convert between plus and minus cylinder');
?>
"aria-hidden="true" id="revW<?php
echo attr($W);
?>
" ></i></td>
<td><?php
echo xlt('Sph{{Sphere}}');
?>
</td>
<td><?php
echo xlt('Cyl{{Cylinder}}');
?>
</td>
<td><?php
echo xlt('Axis{{Axis of a glasses prescription}}');
?>
</td>
<td><?php
echo xlt('Acuity');
?>
</td>
<td name="W_wide"></td>
<td name="W_wide" title="<?php
echo xla('Horizontal Prism Power');
?>
"><?php
echo xlt('HP{{abbreviation for Horizontal Prism Power}}');
?>
</td>
<td name="W_wide" title="<?php
echo xla('Horizontal Prism Base');
?>
"><?php
echo xlt('HB{{abbreviation for Horizontal Prism Base}}');
?>
</td>
<td name="W_wide" title="<?php
echo xla('Vertical Prism Power');
?>
"><?php
echo xlt('VP{{abbreviation for Vertical Prism Power}}');
?>
</td>
<td name="W_wide" title="<?php
echo xla('Vertical Prism Base');
?>
"><?php
echo xlt('VB{{abbreviation for Vertical Prism Base}}');
?>
</td>
<td name="W_wide" title="<?php
echo xla('Slab Off');
?>
"><?php
echo xlt('Slab Off');
?>
</td>
<td name="W_wide" title="<?php
echo xla('Vertex Distance');
?>
"><?php
echo xlt('VD{{abbreviation for Vertex Distance}}');
?>
</td>
<td name="W_wide" title="<?php
echo xla('Monocular Pupillary Diameter - Distance');
?>
"><?php
echo xlt('MPD-D{{abbreviation for Monocular Pupillary Diameter - Distance}}');
?>
</td>
<td name="W_wide" title="<?php
echo xla('Monocular Pupillary Diameter - Near');
?>
"><?php
echo xlt('MPD-N{{abbreviation for Monocular Pupillary Diameter - Near}}');
?>
</td>
<td rowspan="6" class="right">
<?php
echo xlt('Rx Type{{Type of glasses prescription}}');
?>
</span><br />
<label for="Single_<?php
echo attr($W);
?>
" class="input-helper input-helper--checkbox"><?php
echo xlt('Single');
?>
</label>
<input type="radio" value="0" id="Single_<?php
echo attr($W);
?>
" name="RX_TYPE_<?php
echo attr($W);
?>
" <?php
if ($RX_TYPE == '0') {
echo 'checked="checked"';
}
?>
/></span><br /><br />
<label for="Bifocal_<?php
echo attr($W);
?>
" class="input-helper input-helper--checkbox"><?php
echo xlt('Bifocal');
?>
</label>
<input type="radio" value="1" id="Bifocal_<?php
echo attr($W);
?>
" name="RX_TYPE_<?php
echo attr($W);
?>
" <?php
if ($RX_TYPE == '1') {
echo 'checked="checked"';
}
?>
/></span><br /><br />
<label for="Trifocal_<?php
echo attr($W);
?>
" class="input-helper input-helper--checkbox"><?php
echo xlt('Trifocal');
?>
</label>
<input type="radio" value="2" id="Trifocal_<?php
echo attr($W);
?>
" name="RX_TYPE_<?php
echo attr($W);
?>
" <?php
if ($RX_TYPE == '2') {
echo 'checked="checked"';
}
?>
/></span><br /><br />
<label for="Progressive_<?php
echo attr($W);
?>
" class="input-helper input-helper--checkbox"><?php
echo xlt('Prog.{{Progressive lenses}}');
?>
</label>
<input type="radio" value="3" id="Progressive_<?php
echo attr($W);
?>
" name="RX_TYPE_<?php
echo attr($W);
?>
" <?php
if ($RX_TYPE == '3') {
echo 'checked="checked"';
}
?>
/></span><br />
</td>
</tr>
<tr>
<td rowspan="2"><?php
echo xlt('Dist{{distance}}');
?>
</td>
<td><b><?php
echo xlt('OD{{right eye}}');
?>
:</b></td>
<td><?php
echo ${"ODSPH_{$W}"};
?>
<input type="text" class="sphere" id="ODSPH_<?php
echo attr($W);
?>
" name="ODSPH_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODSPH);
?>
" tabindex="<?php
echo attr($W);
?>
0100"></td>
<td><input type="text" class="cylinder" id="ODCYL_<?php
echo attr($W);
?>
" name="ODCYL_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODCYL);
?>
" tabindex="<?php
echo attr($W);
?>
0101"></td>
<td><input type="text" class="axis" id="ODAXIS_<?php
echo attr($W);
?>
" name="ODAXIS_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODAXIS);
?>
" tabindex="<?php
echo attr($W);
?>
0102"></td>
<td><input type="text" class="acuity" id="ODVA_<?php
echo attr($W);
?>
" name="ODVA_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODVA);
?>
" tabindex="<?php
echo attr($W);
?>
0108"></td>
<td name="W_wide"></td>
<td name="W_wide"><input type="text" class="prism" id="ODHPD_<?php
echo attr($W);
?>
" name="ODHPD_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODHPD);
?>
" tabindex="<?php
echo attr($W);
?>
0112"></td>
<td name="W_wide"><input type="text" class="prism" id="ODHBASE_<?php
echo attr($W);
?>
" name="ODHBASE_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODHBASE);
?>
" tabindex="<?php
echo attr($W);
?>
0114"></td>
<td name="W_wide"><input type="text" class="prism" id="ODVPD_<?php
echo attr($W);
?>
" name="ODVPD_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODVPD);
?>
" tabindex="<?php
echo attr($W);
?>
0116"></td>
<td name="W_wide"><input type="text" class="prism" id="ODVBASE_<?php
echo attr($W);
?>
" name="ODVBASE_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODVBASE);
?>
" tabindex="<?php
echo attr($W);
?>
0118"></td>
<td name="W_wide"><input type="text" class="prism" id="ODSLABOFF_<?php
echo attr($W);
?>
" name="ODSLABOFF_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODSLABOFF);
?>
" tabindex="<?php
echo attr($W);
?>
0120"></td>
<td name="W_wide"><input type="text" class="prism" id="ODVERTEXDIST_<?php
echo attr($W);
?>
" name="ODVERTEXDIST_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODVERTEXDIST);
?>
" tabindex="<?php
echo attr($W);
?>
0122"></td>
<td name="W_wide"><input type="text" class="prism" id="ODMPDD_<?php
echo attr($W);
?>
" name="ODMPDD_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODMPDD);
?>
" tabindex="<?php
echo attr($W);
?>
0124"></td>
<td name="W_wide"><input type="text" class="prism" id="ODMPDN_<?php
echo attr($W);
?>
" name="ODMPDN_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODMPDN);
?>
" tabindex="<?php
echo attr($W);
?>
0126"></td>
</tr>
<tr>
<td><b><?php
echo xlt('OS{{left eye}}');
?>
:</b></td>
<td><input type="text" class="sphere" id="OSSPH_<?php
echo attr($W);
?>
" name="OSSPH_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSSPH);
?>
" tabindex="<?php
echo attr($W);
?>
0103"></td>
<td><input type="text" class="cylinder" id="OSCYL_<?php
echo attr($W);
?>
" name="OSCYL_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSCYL);
?>
" tabindex="<?php
echo attr($W);
?>
0104"></td>
<td><input type="text" class="axis" id="OSAXIS_<?php
echo attr($W);
?>
" name="OSAXIS_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSAXIS);
?>
" tabindex="<?php
echo attr($W);
?>
0105"></td>
<td><input type="text" class="acuity" id="OSVA_<?php
echo attr($W);
?>
" name="OSVA_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSVA);
?>
" tabindex="<?php
echo attr($W);
?>
0109"></td>
<td name="W_wide"></td>
<td name="W_wide"><input type="text" class="prism" id="OSHPD_<?php
echo attr($W);
?>
" name="OSHPD_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSHPD);
?>
" tabindex="<?php
echo attr($W);
?>
0113"></td>
<td name="W_wide"><input type="text" class="prism" id="OSHBASE_<?php
echo attr($W);
?>
" name="OSHBASE_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSHBASE);
?>
" tabindex="<?php
echo attr($W);
?>
0115"></td>
<td name="W_wide"><input type="text" class="prism" id="OSVPD_<?php
echo attr($W);
?>
" name="OSVPD_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSVPD);
?>
" tabindex="<?php
echo attr($W);
?>
0117"></td>
<td name="W_wide"><input type="text" class="prism" id="OSVBASE_<?php
echo attr($W);
?>
" name="OSVBASE_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSVBASE);
?>
" tabindex="<?php
echo attr($W);
?>
0119"></td>
<td name="W_wide"><input type="text" class="prism" id="OSSLABOFF_<?php
echo attr($W);
?>
" name="OSSLABOFF_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSSLABOFF);
?>
" tabindex="<?php
echo attr($W);
?>
0121"></td>
<td name="W_wide"><input type="text" class="prism" id="OSVERTEXDIST_<?php
echo attr($W);
?>
" name="OSVERTEXDIST_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSVERTEXDIST);
?>
" tabindex="<?php
echo attr($W);
?>
0123"></td>
<td name="W_wide"><input type="text" class="prism" id="OSMPDD_<?php
echo attr($W);
?>
" name="OSMPDD_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSMPDD);
?>
" tabindex="<?php
echo attr($W);
?>
0125"></td>
<td name="W_wide"><input type="text" class="prism" id="OSMPDN_<?php
echo attr($W);
?>
" name="OSMPDN_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSMPDN);
?>
" tabindex="<?php
echo attr($W);
?>
0127"></td>
</tr>
<tr class="WNEAR">
<td rowspan=2><?php
echo xlt('Mid{{middle Rx strength}}');
?>
/<br /><?php
echo xlt('Near');
?>
</td>
<td><b><?php
echo xlt('OD{{right eye}}');
?>
:</b></td>
<?php
echo '<input type="hidden" name="RXStart_' . $W . ' id="RXStart_' . $W . '" value="' . attr($RX_TYPE) . '">';
?>
<td class="WMid"><input type="text" class="presbyopia" id="ODMIDADD_<?php
echo attr($W);
?>
" name="ODMIDADD_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODMIDADD);
?>
"></td>
<td class="WAdd2"><input type="text" class="presbyopia" id="ODADD_<?php
echo attr($W);
?>
" name="ODADD_<?php
echo attr($W);
?>
" value="<?php
echo attr($ODADD);
?>
" tabindex="<?php
echo attr($W);
?>
0106"></td>
<td></td>
<td><input class="jaeger" type="text" id="NEARODVA_<?php
echo attr($W);
?>
" name="NEARODVA_<?php
echo attr($W);
?>
" value="<?php
echo attr($NEARODVA);
?>
" tabindex="<?php
echo attr($W);
?>
0110"></td>
<td name="W_wide"></td>
<td name="W_wide" title="<?php
echo xla('Binocular Pupillary Diameter - Distance');
?>
"><?php
echo xlt('PD-D{{abbreviation for Binocular Pupillary Diameter - Distance}}');
?>
</td>
<td name="W_wide" title="<?php
echo xla('Binocular Pupillary Diameter - Near');
?>
"><?php
echo xlt('PD-N{{abbreviation for Binocular Pupillary Diameter - Near}}');
?>
</td>
<td name="W_wide" title="<?php
echo xla('Lens Material');
?>
" colspan="2">
<a href="<?php
echo $GLOBALS['webroot'];
?>
/interface/super/edit_list.php?list_id=Eye_Lens_Material" target="RTop"
title="<?php
echo xla('Click here to edit list of available Lens Materials');
?>
"
name="Lens_mat"><span class="underline"><?php
echo xlt('Lens Material');
?>
</span> <i class="fa fa-pencil fa-fw"></i> </a>
</td>
<td name="W_wide2" colspan="4" rowspan="4">
<a href="<?php
echo $GLOBALS['webroot'];
?>
/interface/super/edit_list.php?list_id=Eye_Lens_Treatments" target="RTop"
title="<?php
echo xla('Click here to edit list of available Lens Treatment Options');
?>
"
name="Lens_txs"><span class="underline"><?php
echo xlt('Lens Treatments');
?>
</span> <i class="fa fa-pencil fa-fw"></i> </a>
<br />
<?php
echo generate_lens_treatments($W, $LENS_TREATMENTS);
?>
</td>
</tr>
<tr class="WNEAR">
<td><b><?php
echo xlt('OS{{left eye}}');
?>
:</b></td>
<td class="WMid"><input type="text" class="presbyopia" id="OSMIDADD_<?php
echo attr($W);
?>
" name="OSMIDADD_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSMIDADD);
?>
"></td>
<td class="WAdd2"><input type="text" class="presbyopia" id="OSADD_<?php
echo attr($W);
?>
" name="OSADD_<?php
echo attr($W);
?>
" value="<?php
echo attr($OSADD);
?>
" tabindex="<?php
echo attr($W);
?>
0107"></td>
<td></td>
<td><input class="jaeger" type="text" id="NEAROSVA_<?php
echo attr($W);
?>
" name="NEAROSVA_<?php
echo attr($W);
?>
" value="<?php
echo attr($NEAROSVA);
?>
" tabindex="<?php
echo attr($W);
?>
0111"></td>
<td name="W_wide"></td>
<td name="W_wide"><input type="text" class="prism" id="BPDD_<?php
echo attr($W);
?>
" name="BPDD_<?php
echo attr($W);
?>
" value="<?php
echo attr($BPDD);
?>
" tabindex="<?php
echo attr($W);
?>
0128"></td>
<td name="W_wide"><input type="text" class="prism" id="BPDN_<?php
echo attr($W);
?>
" name="BPDN_<?php
echo attr($W);
?>
" value="<?php
echo attr($BPDN);
?>
" tabindex="<?php
echo attr($W);
?>
0129"></td>
<td name="W_wide" title="<?php
echo xla('Lens Material Options');
?>
" colspan="2">
<?php
echo generate_select_list("LENS_MATERIAL_" . $W, "Eye_Lens_Material", "{$LENS_MATERIAL}", '', ' ', '', 'restoreSession;submit_form();', '', array('style' => 'width:120px', 'tabindex' => $W . '0130'));
?>
</td>
</tr>
<tr>
<td colspan="2"><b><?php
echo xlt('Comments');
?>
:</b>
</td>
<td colspan="4" class="up"></td>
</tr>
<tr>
<td colspan="6">
<textarea id="COMMENTS_<?php
echo attr($W);
?>
" name="COMMENTS_W" tabindex="<?php
echo attr($W);
?>
0110"><?php
echo text($COMMENTS);
?>
</textarea>
</td>
<td colspan="2">
</td>
</tr>
</table>
</div>
<?php
$output = ob_get_contents();
ob_end_clean();
return $output;
}
<?php
echo xlt('Specialty');
?>
:
<input type='text' name='form_specialty' size='10' value='<?php
echo attr($_POST['form_specialty']);
?>
'
class='inputtext' title='<?php
echo xla("Any part of the desired specialty");
?>
' />
<?php
echo xlt('Type') . ": ";
// Generates a select list named form_abook_type:
echo generate_select_list("form_abook_type", "abook_type", $_REQUEST['form_abook_type'], '', 'All');
?>
<input type='checkbox' name='form_external' value='1'<?php
if ($form_external) {
echo ' checked';
}
?>
title='<?php
echo xla("Omit internal users?");
?>
' />
<?php
echo xlt('External Only');
?>
<input type='submit' title='<?php
<td name="W_wide"></td>
<td name="W_wide"><input type="text" class="prism" id="BPDD_1" name="BPDD_1" value="<?php
echo attr($BPDD_1);
?>
" tabindex="138"></td>
<td name="W_wide"><input type="text" class="prism" id="BPDN_1" name="BPDN_1" value="<?php
echo attr($BPDN_1);
?>
" tabindex="140"></td>
<td name="W_wide" title="<?php
echo xla('Lens Material Options');
?>
" colspan="2" tabindex="142">
<?php
echo generate_select_list("LENS_MATERIAL_1", "Eye_Lens_Material", "{$LENS_MATERIAL_1}", '', '--Lens Material--', '', 'restoreSession;submit_form();', '', array('style' => 'width:120px'));
?>
</td>
</tr>
<tr>
<td colspan="2"><b><?php
echo xlt('Comments');
?>
:</b>
</td>
<td colspan="4" class="up"></td>
</tr>
<tr>
<td colspan="6">
<textarea id="COMMENTS_1" name="COMMENTS_W" tabindex="111"><?php
echo text($COMMENTS_1);
echo text($amendment_desc);
} else {
echo "";
}
?>
</textarea></td>
</tr>
<tr>
<td><span class=text ><?php
echo xlt('Request Status');
?>
</span></td>
<td>
<?php
echo generate_select_list("form_amendment_status", "amendment_status", $amendment_status, 'Amendment Status', ' ', '', '', '', $customAttributes);
?>
</td>
</tr>
<tr>
<td><span class=text ><?php
echo xlt('Comments');
?>
</span></td>
<td><textarea <?php
echo $onlyRead ? "readonly" : "";
?>
id="note" name="note" rows="4" cols="30"><?php
if ($amendment_id) {
echo "";
echo htmlspecialchars(xl('Cancel'), ENT_NOQUOTES);
?>
</span>
</a>
</td>
</tr>
</table>
<table class="text">
<tr><td>
<?php
echo htmlspecialchars(xl('Transaction Type'), ENT_NOQUOTES);
?>
: </td><td>
<?php
echo generate_select_list('title', 'transactions', $form_id, '', '', '', 'titleChanged()');
?>
</td></tr>
</table>
<div id='referdiv'>
<?php
if ($GLOBALS['enable_amc_prompting'] && 'LBTref' == $form_id) {
?>
<div style='float:right;margin-right:25px;border-style:solid;border-width:1px;'>
<div style='float:left;margin:5px 5px 5px 5px;'>
<?php
// Display the send records checkbox (AMC prompting)
$itemAMC = amcCollect("send_sum_amc", $pid, 'transactions', $transid);
?>
?>
)" type="text" style="width:60px;text-align:right; font-size:12px" /></td>
<td align="left" class="<?php
echo $StringClass;
?>
" ><input name="HiddenReasonCode<?php
echo $CountIndex;
?>
" id="HiddenReasonCode<?php
echo $CountIndex;
?>
" value="<?php
echo htmlspecialchars($ReasonCodeDB);
?>
" type="hidden"/><?php
echo generate_select_list("ReasonCode{$CountIndex}", "msp_remit_codes", "{$ReasonCodeDB}", "MSP Code");
?>
</td>
<td align="center" class="<?php
echo $StringClass;
?>
" ><input type="checkbox" id="FollowUp<?php
echo $CountIndex;
?>
" name="FollowUp<?php
echo $CountIndex;
?>
" value="y" onClick="ActionFollowUp(<?php
echo $CountIndex;
?>
)" <?php
?>
</td>
</tr>
<?php
if ($_GET['prov'] != true) {
?>
<tr>
<td nowrap>
<b><?php
echo xlt('Room Number');
?>
:</b>
</td>
<td colspan='4' nowrap>
<?php
echo generate_select_list('form_room', 'patient_flow_board_rooms', $pcroom, xl('Room Number'));
?>
</td>
</tr>
<?php
}
?>
<tr>
<td nowrap>
<b><?php
echo xlt('Comments');
?>
:</b>
</td>
<td colspan='4' nowrap>
<input type='text' size='40' name='form_comments' style='width:100%' value='<?php
public static function batch_despatch($var, $func, $data_credentials)
{
global $pid;
if (UserService::valid($data_credentials)) {
require_once "../../library/invoice_summary.inc.php";
require_once "../../library/options.inc.php";
require_once "../../library/acl.inc";
require_once "../../library/patient.inc";
if ($func == 'ar_responsible_party') {
$patient_id = $pid;
$encounter_id = $var['encounter'];
$x['ar_responsible_party'] = ar_responsible_party($patient_id, $encounter_id);
return UserService::function_return_to_xml($x);
} elseif ($func == 'getInsuranceData') {
$type = $var['type'];
$given = $var['given'];
$x = getInsuranceData($pid, $type, $given);
return UserService::function_return_to_xml($x);
} elseif ($func == 'generate_select_list') {
$tag_name = $var['tag_name'];
$list_id = $var['list_id'];
$currvalue = $var['currvalue'];
$title = $var['title'];
$empty_name = $var['empty_name'];
$class = $var['class'];
$onchange = $var['onchange'];
$x['generate_select_list'] = generate_select_list($tag_name, $list_id, $currvalue, $title, $empty_name, $class, $onchange);
return UserService::function_return_to_xml($x);
} elseif ($func == 'xl_layout_label') {
$constant = $var['constant'];
$x['xl_layout_label'] = xl_layout_label($constant);
return UserService::function_return_to_xml($x);
} elseif ($func == 'generate_form_field') {
$frow = $var['frow'];
$currvalue = $var['currvalue'];
ob_start();
generate_form_field($frow, $currvalue);
$x['generate_form_field'] = ob_get_contents();
ob_end_clean();
return UserService::function_return_to_xml($x);
} elseif ($func == 'getInsuranceProviders') {
$i = $var['i'];
$provider = $var['provider'];
$insurancei = getInsuranceProviders();
$x = $insurancei;
return $x;
} elseif ($func == 'get_layout_form_value') {
$frow = $var['frow'];
$_POST = $var['post_array'];
$x['get_layout_form_value'] = get_layout_form_value($frow);
return UserService::function_return_to_xml($x);
} elseif ($func == 'updatePatientData') {
$patient_data = $var['patient_data'];
$create = $var['create'];
updatePatientData($pid, $patient_data, $create);
$x['ok'] = 'ok';
return UserService::function_return_to_xml($x);
} elseif ($func == 'updateEmployerData') {
$employer_data = $var['employer_data'];
$create = $var['create'];
updateEmployerData($pid, $employer_data, $create);
$x['ok'] = 'ok';
return UserService::function_return_to_xml($x);
} elseif ($func == 'newHistoryData') {
newHistoryData($pid);
$x['ok'] = 'ok';
return UserService::function_return_to_xml($x);
} elseif ($func == 'newInsuranceData') {
$_POST = $var[0];
foreach ($var as $key => $value) {
if ($key >= 3) {
$var[$key] = formData($value);
}
if ($key >= 1) {
$parameters[$key] = $var[$key];
}
}
$parameters[12] = fixDate($parameters[12]);
$parameters[27] = fixDate($parameters[27]);
call_user_func_array('newInsuranceData', $parameters);
$x['ok'] = 'ok';
return UserService::function_return_to_xml($x);
} elseif ($func == 'generate_layout_validation') {
$form_id = $var['form_id'];
ob_start();
generate_layout_validation($form_id);
$x = ob_get_clean();
return $x;
}
} else {
throw new SoapFault("Server", "credentials failed");
}
}
function generate_form_field($frow, $currvalue) {
global $rootdir, $date_init, $ISSUE_TYPES, $code_types,$condition_str;
$currescaped = htmlspecialchars($currvalue, ENT_QUOTES);
$data_type = $frow['data_type'];
$field_id = $frow['field_id'];
$list_id = $frow['list_id'];
$backup_list = $frow['list_backup_id'];
$condition_str = get_conditions_str($condition_str,$frow);
// escaped variables to use in html
$field_id_esc= htmlspecialchars( $field_id, ENT_QUOTES);
$list_id_esc = htmlspecialchars( $list_id, ENT_QUOTES);
// Added 5-09 by BM - Translate description if applicable
$description = (isset($frow['description']) ? htmlspecialchars(xl_layout_label($frow['description']), ENT_QUOTES) : '');
// Support edit option T which assigns the (possibly very long) description as
// the default value.
if (strpos($frow['edit_options'], 'T') !== FALSE) {
if (strlen($currescaped) == 0) $currescaped = $description;
// Description used in this way is not suitable as a title.
$description = '';
}
// added 5-2009 by BM to allow modification of the 'empty' text title field.
// Can pass $frow['empty_title'] with this variable, otherwise
// will default to 'Unassigned'.
// modified 6-2009 by BM to allow complete skipping of the 'empty' text title
// if make $frow['empty_title'] equal to 'SKIP'
$showEmpty = true;
if (isset($frow['empty_title'])) {
if ($frow['empty_title'] == "SKIP") {
//do not display an 'empty' choice
$showEmpty = false;
$empty_title = "Unassigned";
}
else {
$empty_title = $frow['empty_title'];
}
}
else {
$empty_title = "Unassigned";
}
$disabled = strpos($frow['edit_options'], '0') === FALSE ? '' : 'disabled';
$lbfchange = (strpos($frow['form_id'], 'LBF') === 0 || strpos($frow['form_id'], 'LBT') === 0) ?
"checkSkipConditions();" : "";
$lbfonchange = $lbfchange ? "onchange='$lbfchange'" : "";
// generic single-selection list or Race and Ethnicity.
// These data types support backup lists.
if ($data_type == 1 || $data_type == 33) {
echo generate_select_list("form_$field_id", $list_id, $currvalue,
$description, ($showEmpty ? $empty_title : ''), '', $lbfchange, '',
($disabled ? array('disabled' => 'disabled') : null), false, $backup_list);
}
// simple text field
else if ($data_type == 2) {
$fldlength = htmlspecialchars( $frow['fld_length'], ENT_QUOTES);
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) $string_maxlength = "maxlength='".attr($maxlength)."'";
echo "<input type='text'" .
" name='form_$field_id_esc'" .
" id='form_$field_id_esc'" .
" size='$fldlength'" .
" $string_maxlength" .
" title='$description'" .
" value='$currescaped'";
$tmp = $lbfchange;
if (strpos($frow['edit_options'], 'C') !== FALSE)
$tmp .= "capitalizeMe(this);";
else if (strpos($frow['edit_options'], 'U') !== FALSE)
$tmp .= "this.value = this.value.toUpperCase();";
if ($tmp) echo " onchange='$tmp'";
$tmp = htmlspecialchars( $GLOBALS['gbl_mask_patient_id'], ENT_QUOTES);
if ($field_id == 'pubpid' && strlen($tmp) > 0) {
echo " onkeyup='maskkeyup(this,\"$tmp\")'";
echo " onblur='maskblur(this,\"$tmp\")'";
}
if (strpos($frow['edit_options'], '1') !== FALSE && strlen($currescaped) > 0) {
echo " readonly";
}
if ($disabled) echo ' disabled';
echo " />";
}
// long or multi-line text field
else if ($data_type == 3) {
$textCols = htmlspecialchars( $frow['fld_length'], ENT_QUOTES);
$textRows = htmlspecialchars( $frow['fld_rows'], ENT_QUOTES);
echo "<textarea" .
" name='form_$field_id_esc'" .
" id='form_$field_id_esc'" .
" title='$description'" .
" cols='$textCols'" .
" rows='$textRows' $lbfonchange $disabled" .
">" . $currescaped . "</textarea>";
}
// date
else if ($data_type == 4) {
$age_asof_date = ''; // optionalAge() sets this
$age_format = strpos($frow['edit_options'], 'A') === FALSE ? 3 : 0;
$agestr = optionalAge($frow, $currvalue, $age_asof_date);
if ($agestr) {
echo "<table cellpadding='0' cellspacing='0'><tr><td class='text'>";
}
echo "<input type='text' size='10' name='form_$field_id_esc' id='form_$field_id_esc'" .
" value='" . substr($currescaped, 0, 10) . "'";
if (!$agestr) echo " title='$description'";
echo " $lbfonchange onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' $disabled />";
if (!$disabled) {
echo "<img src='$rootdir/pic/show_calendar.gif' align='absbottom' width='24' height='22'" .
" id='img_$field_id_esc' border='0' alt='[?]' style='cursor:pointer'" .
" title='" . htmlspecialchars( xl('Click here to choose a date'), ENT_QUOTES) . "' />";
$date_init .= " Calendar.setup({" .
"inputField:'form_$field_id', " .
"ifFormat:'%Y-%m-%d', ";
if ($agestr) {
$date_init .= "onUpdate: function() {" .
"if (typeof(updateAgeString) == 'function') updateAgeString('$field_id','$age_asof_date', $age_format);" .
"}, ";
}
$date_init .= "button:'img_$field_id'})\n";
}
// Optional display of age or gestational age.
if ($agestr) {
echo "</td></tr><tr><td id='span_$field_id' class='text'>" . text($agestr) . "</td></tr></table>";
}
}
// provider list, local providers only
else if ($data_type == 10) {
$ures = sqlStatement("SELECT id, fname, lname, specialty FROM users " .
"WHERE active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " .
"AND authorized = 1 " .
"ORDER BY lname, fname");
echo "<select name='form_$field_id_esc' id='form_$field_id_esc' title='$description' $lbfonchange $disabled>";
echo "<option value=''>" . xlt($empty_title) . "</option>";
$got_selected = false;
while ($urow = sqlFetchArray($ures)) {
$uname = text($urow['fname'] . ' ' . $urow['lname']);
$optionId = attr($urow['id']);
echo "<option value='$optionId'";
if ($urow['id'] == $currvalue) {
echo " selected";
$got_selected = true;
}
echo ">$uname</option>";
}
if (!$got_selected && $currvalue) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
}
else {
echo "</select>";
}
}
// provider list, including address book entries with an NPI number
else if ($data_type == 11) {
$ures = sqlStatement("SELECT id, fname, lname, specialty FROM users " .
"WHERE active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " .
"AND ( authorized = 1 OR ( username = '' AND npi != '' ) ) " .
"ORDER BY lname, fname");
echo "<select name='form_$field_id_esc' id='form_$field_id_esc' title='$description'";
echo " $lbfonchange $disabled>";
echo "<option value=''>" . xlt('Unassigned') . "</option>";
$got_selected = false;
while ($urow = sqlFetchArray($ures)) {
$uname = text($urow['fname'] . ' ' . $urow['lname']);
$optionId = attr($urow['id']);
echo "<option value='$optionId'";
if ($urow['id'] == $currvalue) {
echo " selected";
$got_selected = true;
}
echo ">$uname</option>";
}
if (!$got_selected && $currvalue) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
}
else {
echo "</select>";
}
}
// pharmacy list
else if ($data_type == 12) {
echo "<select name='form_$field_id_esc' id='form_$field_id_esc' title='$description'";
echo " $lbfonchange $disabled>";
echo "<option value='0'></option>";
$pres = get_pharmacies();
$got_selected = false;
while ($prow = sqlFetchArray($pres)) {
$key = $prow['id'];
$optionValue = htmlspecialchars( $key, ENT_QUOTES);
$optionLabel = htmlspecialchars( $prow['name'] . ' ' . $prow['area_code'] . '-' .
$prow['prefix'] . '-' . $prow['number'] . ' / ' .
$prow['line1'] . ' / ' . $prow['city'], ENT_NOQUOTES);
echo "<option value='$optionValue'";
if ($currvalue == $key) {
echo " selected";
$got_selected = true;
}
echo ">$optionLabel</option>";
}
if (!$got_selected && $currvalue) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
}
else {
echo "</select>";
}
}
// squads
else if ($data_type == 13) {
echo "<select name='form_$field_id_esc' id='form_$field_id_esc' title='$description'";
echo " $lbfonchange $disabled>";
echo "<option value=''> </option>";
$squads = acl_get_squads();
if ($squads) {
foreach ($squads as $key => $value) {
$optionValue = htmlspecialchars( $key, ENT_QUOTES);
$optionLabel = htmlspecialchars( $value[3], ENT_NOQUOTES);
echo "<option value='$optionValue'";
if ($currvalue == $key) echo " selected";
echo ">$optionLabel</option>\n";
}
}
echo "</select>";
}
// Address book, preferring organization name if it exists and is not in
// parentheses, and excluding local users who are not providers.
// Supports "referred to" practitioners and facilities.
// Alternatively the letter L in edit_options means that abook_type
// must be "ord_lab", indicating types used with the procedure
// lab ordering system.
// Alternatively the letter O in edit_options means that abook_type
// must begin with "ord_", indicating types used with the procedure
// ordering system.
// Alternatively the letter V in edit_options means that abook_type
// must be "vendor", indicating the Vendor type.
// Alternatively the letter R in edit_options means that abook_type
// must be "dist", indicating the Distributor type.
else if ($data_type == 14) {
if (strpos($frow['edit_options'], 'L') !== FALSE)
$tmp = "abook_type = 'ord_lab'";
else if (strpos($frow['edit_options'], 'O') !== FALSE)
$tmp = "abook_type LIKE 'ord\\_%'";
else if (strpos($frow['edit_options'], 'V') !== FALSE)
$tmp = "abook_type LIKE 'vendor%'";
else if (strpos($frow['edit_options'], 'R') !== FALSE)
$tmp = "abook_type LIKE 'dist'";
else
$tmp = "( username = '' OR authorized = 1 )";
$ures = sqlStatement("SELECT id, fname, lname, organization, username FROM users " .
"WHERE active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " .
"AND $tmp " .
"ORDER BY organization, lname, fname");
echo "<select name='form_$field_id_esc' id='form_$field_id_esc' title='$description'";
echo " $lbfonchange $disabled>";
echo "<option value=''>" . htmlspecialchars( xl('Unassigned'), ENT_NOQUOTES) . "</option>";
while ($urow = sqlFetchArray($ures)) {
$uname = $urow['organization'];
if (empty($uname) || substr($uname, 0, 1) == '(') {
$uname = $urow['lname'];
if ($urow['fname']) $uname .= ", " . $urow['fname'];
}
$optionValue = htmlspecialchars( $urow['id'], ENT_QUOTES);
$optionLabel = htmlspecialchars( $uname, ENT_NOQUOTES);
echo "<option value='$optionValue'";
$title = $urow['username'] ? xl('Local') : xl('External');
$optionTitle = htmlspecialchars( $title, ENT_QUOTES);
echo " title='$optionTitle'";
if ($urow['id'] == $currvalue) echo " selected";
echo ">$optionLabel</option>";
}
echo "</select>";
}
// A billing code. If description matches an existing code type then that type is used.
else if ($data_type == 15) {
$fldlength = htmlspecialchars( $frow['fld_length'], ENT_QUOTES);
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) $string_maxlength = "maxlength='".attr($maxlength)."'";
//
if (strpos($frow['edit_options'], '2') !== FALSE && substr($frow['form_id'], 0, 3) == 'LBF') {
// Option "2" generates a hidden input for the codes, and a matching visible field
// displaying their descriptions. First step is computing the description string.
$currdescstring = '';
if (!empty($currvalue)) {
$relcodes = explode(';', $currvalue);
foreach ($relcodes as $codestring) {
if ($codestring === '') continue;
$code_text = lookup_code_descriptions($codestring);
if ($currdescstring !== '') $currdescstring .= '; ';
if (!empty($code_text)) {
$currdescstring .= $code_text;
}
else {
$currdescstring .= $codestring;
}
}
}
$currdescstring = attr($currdescstring);
//
echo "<input type='text'" .
" name='form_$field_id_esc'" .
" id='form_related_code'" .
" size='$fldlength'" .
" value='$currescaped'" .
" style='display:none'" .
" $lbfonchange readonly $disabled />";
// Extra readonly input field for optional display of code description(s).
echo "<input type='text'" .
" name='form_$field_id_esc" . "__desc'" .
" size='$fldlength'" .
" title='$description'" .
" value='$currdescstring'";
if (!$disabled) {
echo " onclick='sel_related(this,\"$codetype\")'";
}
echo " readonly $disabled />";
}
else {
echo "<input type='text'" .
" name='form_$field_id_esc'" .
" id='form_related_code'" .
" size='$fldlength'" .
" $string_maxlength" .
" title='$description'" .
" value='$currescaped'";
if (!$disabled) {
echo " onclick='sel_related(this,\"$codetype\")'";
}
echo " $lbfonchange readonly $disabled />";
}
}
// insurance company list
else if ($data_type == 16) {
echo "<select name='form_$field_id_esc' id='form_$field_id_esc' title='$description'>";
echo "<option value='0'></option>";
$insprovs = getInsuranceProviders();
$got_selected = false;
foreach ($insprovs as $key => $ipname) {
$optionValue = htmlspecialchars($key, ENT_QUOTES);
$optionLabel = htmlspecialchars($ipname, ENT_NOQUOTES);
echo "<option value='$optionValue'";
if ($currvalue == $key) {
echo " selected";
$got_selected = true;
}
echo ">$optionLabel</option>";
}
if (!$got_selected && $currvalue) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
}
else {
echo "</select>";
}
}
// issue types
else if ($data_type == 17) {
echo "<select name='form_$field_id_esc' id='form_$field_id_esc' title='$description'>";
echo "<option value='0'></option>";
$got_selected = false;
foreach ($ISSUE_TYPES as $key => $value) {
$optionValue = htmlspecialchars($key, ENT_QUOTES);
$optionLabel = htmlspecialchars($value[1], ENT_NOQUOTES);
echo "<option value='$optionValue'";
if ($currvalue == $key) {
echo " selected";
$got_selected = true;
}
echo ">$optionLabel</option>";
}
if (!$got_selected && strlen($currvalue) > 0) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
}
else {
echo "</select>";
}
}
// Visit categories.
else if ($data_type == 18) {
$cres = sqlStatement("SELECT pc_catid, pc_catname " .
"FROM openemr_postcalendar_categories ORDER BY pc_catname");
echo "<select name='form_$field_id_esc' id='form_$field_id_esc' title='$description'" .
" $lbfonchange $disabled>";
echo "<option value=''>" . xlt($empty_title) . "</option>";
$got_selected = false;
while ($crow = sqlFetchArray($cres)) {
$catid = $crow['pc_catid'];
if (($catid < 9 && $catid != 5) || $catid == 11) continue;
echo "<option value='" . attr($catid) . "'";
if ($catid == $currvalue) {
echo " selected";
$got_selected = true;
}
echo ">" . text(xl_appt_category($crow['pc_catname'])) . "</option>";
}
if (!$got_selected && $currvalue) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
}
else {
echo "</select>";
}
}
// a set of labeled checkboxes
else if ($data_type == 21) {
// In this special case, fld_length is the number of columns generated.
$cols = max(1, $frow['fld_length']);
$avalue = explode('|', $currvalue);
$lres = sqlStatement("SELECT * FROM list_options " .
"WHERE list_id = ? AND activity = 1 ORDER BY seq, title", array($list_id) );
echo "<table cellpadding='0' cellspacing='0' width='100%'>";
$tdpct = (int) (100 / $cols);
for ($count = 0; $lrow = sqlFetchArray($lres); ++$count) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars( $option_id, ENT_QUOTES);
// if ($count) echo "<br />";
if ($count % $cols == 0) {
if ($count) echo "</tr>";
echo "<tr>";
}
echo "<td width='$tdpct%'>";
echo "<input type='checkbox' name='form_{$field_id_esc}[$option_id_esc]'" .
"id='form_{$field_id_esc}[$option_id_esc]' value='1' $lbfonchange";
if (in_array($option_id, $avalue)) echo " checked";
// Added 5-09 by BM - Translate label if applicable
echo " $disabled />" . htmlspecialchars( xl_list_label($lrow['title']), ENT_NOQUOTES);
echo "</td>";
}
if ($count) {
echo "</tr>";
if ($count > $cols) {
// Add some space after multiple rows of checkboxes.
$cols = htmlspecialchars( $cols, ENT_QUOTES);
echo "<tr><td colspan='$cols' style='height:0.7em'></td></tr>";
}
}
echo "</table>";
}
// a set of labeled text input fields
else if ($data_type == 22) {
$tmp = explode('|', $currvalue);
$avalue = array();
foreach ($tmp as $value) {
if (preg_match('/^([^:]+):(.*)$/', $value, $matches)) {
$avalue[$matches[1]] = $matches[2];
}
}
$lres = sqlStatement("SELECT * FROM list_options " .
"WHERE list_id = ? AND activity = 1 ORDER BY seq, title", array($list_id) );
echo "<table cellpadding='0' cellspacing='0'>";
while ($lrow = sqlFetchArray($lres)) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars( $option_id, ENT_QUOTES);
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) $string_maxlength = "maxlength='".attr($maxlength)."'";
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
// Added 5-09 by BM - Translate label if applicable
echo "<tr><td>" . htmlspecialchars( xl_list_label($lrow['title']), ENT_NOQUOTES) . " </td>";
$fldlength = htmlspecialchars( $fldlength, ENT_QUOTES);
$optionValue = htmlspecialchars( $avalue[$option_id], ENT_QUOTES);
echo "<td><input type='text'" .
" name='form_{$field_id_esc}[$option_id_esc]'" .
" id='form_{$field_id_esc}[$option_id_esc]'" .
" size='$fldlength'" .
" $string_maxlength" .
" value='$optionValue'";
echo " $lbfonchange $disabled /></td></tr>";
}
echo "</table>";
}
// a set of exam results; 3 radio buttons and a text field:
else if ($data_type == 23) {
$tmp = explode('|', $currvalue);
$avalue = array();
foreach ($tmp as $value) {
if (preg_match('/^([^:]+):(.*)$/', $value, $matches)) {
$avalue[$matches[1]] = $matches[2];
}
}
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) $string_maxlength = "maxlength='".attr($maxlength)."'";
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
$lres = sqlStatement("SELECT * FROM list_options " .
"WHERE list_id = ? AND activity = 1 ORDER BY seq, title", array($list_id) );
echo "<table cellpadding='0' cellspacing='0'>";
echo "<tr><td> </td><td class='bold'>" .
htmlspecialchars( xl('N/A'), ENT_NOQUOTES) .
" </td><td class='bold'>" .
htmlspecialchars( xl('Nor'), ENT_NOQUOTES) . " </td>" .
"<td class='bold'>" .
htmlspecialchars( xl('Abn'), ENT_NOQUOTES) . " </td><td class='bold'>" .
htmlspecialchars( xl('Date/Notes'), ENT_NOQUOTES) . "</td></tr>";
while ($lrow = sqlFetchArray($lres)) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars( $option_id, ENT_QUOTES);
$restype = substr($avalue[$option_id], 0, 1);
$resnote = substr($avalue[$option_id], 2);
// Added 5-09 by BM - Translate label if applicable
echo "<tr><td>" . htmlspecialchars( xl_list_label($lrow['title']), ENT_NOQUOTES) . " </td>";
for ($i = 0; $i < 3; ++$i) {
$inputValue = htmlspecialchars( $i, ENT_QUOTES);
echo "<td><input type='radio'" .
" name='radio_{$field_id_esc}[$option_id_esc]'" .
" id='radio_{$field_id_esc}[$option_id_esc]'" .
" value='$inputValue' $lbfonchange";
if ($restype === "$i") echo " checked";
echo " $disabled /></td>";
}
$fldlength = htmlspecialchars( $fldlength, ENT_QUOTES);
$resnote = htmlspecialchars( $resnote, ENT_QUOTES);
echo "<td><input type='text'" .
" name='form_{$field_id_esc}[$option_id_esc]'" .
" id='form_{$field_id_esc}[$option_id_esc]'" .
" size='$fldlength'" .
" $string_maxlength" .
" value='$resnote' $disabled /></td>";
echo "</tr>";
}
echo "</table>";
}
// the list of active allergies for the current patient
// this is read-only!
else if ($data_type == 24) {
$query = "SELECT title, comments FROM lists WHERE " .
"pid = ? AND type = 'allergy' AND enddate IS NULL " .
"ORDER BY begdate";
// echo "<!-- $query -->\n"; // debugging
$lres = sqlStatement($query, array($GLOBALS['pid']));
$count = 0;
while ($lrow = sqlFetchArray($lres)) {
if ($count++) echo "<br />";
echo htmlspecialchars( $lrow['title'], ENT_NOQUOTES);
if ($lrow['comments']) echo ' (' . htmlspecialchars( $lrow['comments'], ENT_NOQUOTES) . ')';
}
}
// a set of labeled checkboxes, each with a text field:
else if ($data_type == 25) {
$tmp = explode('|', $currvalue);
$avalue = array();
foreach ($tmp as $value) {
if (preg_match('/^([^:]+):(.*)$/', $value, $matches)) {
$avalue[$matches[1]] = $matches[2];
}
}
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) $string_maxlength = "maxlength='".attr($maxlength)."'";
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
$lres = sqlStatement("SELECT * FROM list_options " .
"WHERE list_id = ? AND activity = 1 ORDER BY seq, title", array($list_id) );
echo "<table cellpadding='0' cellspacing='0'>";
while ($lrow = sqlFetchArray($lres)) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars( $option_id, ENT_QUOTES);
$restype = substr($avalue[$option_id], 0, 1);
$resnote = substr($avalue[$option_id], 2);
// Added 5-09 by BM - Translate label if applicable
echo "<tr><td>" . htmlspecialchars( xl_list_label($lrow['title']), ENT_NOQUOTES) . " </td>";
$option_id = htmlspecialchars( $option_id, ENT_QUOTES);
echo "<td><input type='checkbox' name='check_{$field_id_esc}[$option_id_esc]'" .
" id='check_{$field_id_esc}[$option_id_esc]' value='1' $lbfonchange";
if ($restype) echo " checked";
echo " $disabled /> </td>";
$fldlength = htmlspecialchars( $fldlength, ENT_QUOTES);
$resnote = htmlspecialchars( $resnote, ENT_QUOTES);
echo "<td><input type='text'" .
" name='form_{$field_id_esc}[$option_id_esc]'" .
" id='form_{$field_id_esc}[$option_id_esc]'" .
" size='$fldlength'" .
" $string_maxlength" .
" value='$resnote' $disabled /></td>";
echo "</tr>";
}
echo "</table>";
}
// single-selection list with ability to add to it
else if ($data_type == 26) {
echo generate_select_list("form_$field_id", $list_id, $currvalue,
$description, ($showEmpty ? $empty_title : ''), 'addtolistclass_'.$list_id, $lbfchange, '',
($disabled ? array('disabled' => 'disabled') : null), false, $backup_list);
// show the add button if user has access to correct list
$inputValue = htmlspecialchars( xl('Add'), ENT_QUOTES);
$outputAddButton = "<input type='button' id='addtolistid_" . $list_id_esc . "' fieldid='form_" .
$field_id_esc . "' class='addtolist' value='$inputValue' $disabled />";
if (aco_exist('lists', $list_id)) {
// a specific aco exist for this list, so ensure access
if (acl_check('lists', $list_id)) echo $outputAddButton;
}
else {
// no specific aco exist for this list, so check for access to 'default' list
if (acl_check('lists', 'default')) echo $outputAddButton;
}
}
// a set of labeled radio buttons
else if ($data_type == 27) {
// In this special case, fld_length is the number of columns generated.
$cols = max(1, $frow['fld_length']);
$lres = sqlStatement("SELECT * FROM list_options " .
"WHERE list_id = ? AND activity = 1 ORDER BY seq, title", array($list_id) );
echo "<table cellpadding='0' cellspacing='0' width='100%'>";
$tdpct = (int) (100 / $cols);
$got_selected = FALSE;
for ($count = 0; $lrow = sqlFetchArray($lres); ++$count) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars( $option_id, ENT_QUOTES);
if ($count % $cols == 0) {
if ($count) echo "</tr>";
echo "<tr>";
}
echo "<td width='$tdpct%'>";
echo "<input type='radio' name='form_{$field_id_esc}' id='form_{$field_id_esc}[$option_id_esc]'" .
" value='$option_id_esc' $lbfonchange";
if ((strlen($currvalue) == 0 && $lrow['is_default']) ||
(strlen($currvalue) > 0 && $option_id == $currvalue))
{
echo " checked";
$got_selected = TRUE;
}
echo " $disabled />" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES);
echo "</td>";
}
if ($count) {
echo "</tr>";
if ($count > $cols) {
// Add some space after multiple rows of radio buttons.
$cols = htmlspecialchars($cols, ENT_QUOTES);
echo "<tr><td colspan='$cols' style='height:0.7em'></td></tr>";
}
}
echo "</table>";
if (!$got_selected && strlen($currvalue) > 0) {
$fontTitle = htmlspecialchars( xl('Please choose a valid selection.'), ENT_QUOTES);
$fontText = htmlspecialchars( xl('Fix this'), ENT_NOQUOTES);
echo "$currescaped <font color='red' title='$fontTitle'>$fontText!</font>";
}
}
// special case for history of lifestyle status; 3 radio buttons and a date text field:
// VicarePlus :: A selection list box for smoking status:
else if ($data_type == 28 || $data_type == 32) {
$tmp = explode('|', $currvalue);
switch(count($tmp)) {
case "4": {
$resnote = $tmp[0];
$restype = $tmp[1];
$resdate = $tmp[2];
$reslist = $tmp[3];
} break;
case "3": {
$resnote = $tmp[0];
$restype = $tmp[1];
$resdate = $tmp[2];
} break;
case "2": {
$resnote = $tmp[0];
$restype = $tmp[1];
$resdate = "";
} break;
case "1": {
$resnote = $tmp[0];
$resdate = $restype = "";
} break;
default: {
$restype = $resdate = $resnote = "";
} break;
}
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) $string_maxlength = "maxlength='".attr($maxlength)."'";
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
$fldlength = htmlspecialchars( $fldlength, ENT_QUOTES);
$resnote = htmlspecialchars( $resnote, ENT_QUOTES);
$resdate = htmlspecialchars( $resdate, ENT_QUOTES);
echo "<table cellpadding='0' cellspacing='0'>";
echo "<tr>";
if ($data_type == 28)
{
// input text
echo "<td><input type='text'" .
" name='form_$field_id_esc'" .
" id='form_$field_id_esc'" .
" size='$fldlength'" .
" $string_maxlength" .
" value='$resnote' $disabled /> </td>";
echo "<td class='bold'> ".
" ".
htmlspecialchars( xl('Status'), ENT_NOQUOTES).": </td>";
}
else if($data_type == 32)
{
// input text
echo "<tr><td><input type='text'" .
" name='form_text_$field_id_esc'" .
" id='form_text_$field_id_esc'" .
" size='$fldlength'" .
" $string_maxlength" .
" value='$resnote' $disabled /> </td></tr>";
echo "<td>";
//Selection list for smoking status
$onchange = 'radioChange(this.options[this.selectedIndex].value)';//VicarePlus :: The javascript function for selection list.
echo generate_select_list("form_$field_id", $list_id, $reslist,
$description, ($showEmpty ? $empty_title : ''), '', $onchange, '',
($disabled ? array('disabled' => 'disabled') : null));
echo "</td>";
echo "<td class='bold'> " . xlt('Status') . ": </td>";
}
// current
echo "<td class='text' ><input type='radio'" .
" name='radio_{$field_id_esc}'" .
" id='radio_{$field_id_esc}[current]'" .
" value='current" . $field_id_esc . "' $lbfonchange";
if ($restype == "current" . $field_id) echo " checked";
if ($data_type == 32) echo " onClick='smoking_statusClicked(this)'";
echo " />" . xlt('Current') . " </td>";
// quit
echo "<td class='text'><input type='radio'" .
" name='radio_{$field_id_esc}'" .
" id='radio_{$field_id_esc}[quit]'" .
" value='quit".$field_id_esc."' $lbfonchange";
if ($restype == "quit" . $field_id) echo " checked";
if($data_type == 32) echo " onClick='smoking_statusClicked(this)'";
echo " $disabled />" . xlt('Quit') . " </td>";
// quit date
echo "<td class='text'><input type='text' size='6' name='date_$field_id_esc' id='date_$field_id_esc'" .
" value='$resdate'" .
" title='$description'" .
" onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' $disabled />";
if (!$disabled) {
echo "<img src='$rootdir/pic/show_calendar.gif' align='absbottom' width='24' height='22'" .
" id='img_$field_id_esc' border='0' alt='[?]' style='cursor:pointer'" .
" title='" . htmlspecialchars( xl('Click here to choose a date'), ENT_QUOTES) . "' />";
$date_init .= " Calendar.setup({inputField:'date_$field_id', ifFormat:'%Y-%m-%d', button:'img_$field_id'});\n";
}
echo " </td>";
// never
echo "<td class='text'><input type='radio'" .
" name='radio_{$field_id_esc}'" .
" id='radio_{$field_id_esc}[never]'" .
" value='never" . $field_id_esc . "' $lbfonchange";
if ($restype == "never" . $field_id) echo " checked";
if($data_type == 32) echo " onClick='smoking_statusClicked(this)'";
echo " />" . xlt('Never') . " </td>";
// Not Applicable
echo "<td class='text'><input type='radio'" .
" name='radio_{$field_id}'" .
" id='radio_{$field_id}[not_applicable]'" .
" value='not_applicable" . $field_id . "' $lbfonchange";
if ($restype == "not_applicable" . $field_id) echo " checked";
if($data_type == 32) echo " onClick='smoking_statusClicked(this)'";
echo " $disabled />" . xlt('N/A') . " </td>";
//
//Added on 5-jun-2k14 (regarding 'Smoking Status - display SNOMED code description')
echo "<td class='text' ><div id='smoke_code'></div></td>";
echo "</tr>";
echo "</table>";
}
// static text. read-only, of course.
else if ($data_type == 31) {
echo nl2br($frow['description']);
}
//$data_type == 33
// Race and Ethnicity. After added support for backup lists, this is now the same as datatype 1; so have migrated it there.
//$data_type == 33
else if($data_type == 34){
$arr = explode("|*|*|*|",$currvalue);
echo "<a href='../../../library/custom_template/custom_template.php?type=form_{$field_id}&contextName=".htmlspecialchars($list_id_esc,ENT_QUOTES)."' class='iframe_medium' style='text-decoration:none;color:black;'>";
echo "<div id='form_{$field_id}_div' class='text-area'>".htmlspecialchars($arr[0],ENT_QUOTES)."</div>";
echo "<div style='display:none'><textarea name='form_{$field_id}' id='form_{$field_id}' style='display:none' $lbfonchange $disabled>" . $currvalue . "</textarea></div>";
echo "</a>";
}
//facilities drop-down list
else if ($data_type == 35) {
if (empty($currvalue)){
$currvalue = 0;
}
dropdown_facility($selected = $currvalue, $name = "form_$field_id_esc",
$allow_unspecified = true, $allow_allfacilities = false, $disabled, $lbfchange);
}
//multiple select
// supports backup list
else if ($data_type == 36) {
echo generate_select_list("form_$field_id", $list_id, $currvalue,
$description, $showEmpty ? $empty_title : '', '', $onchange, '', null, true, $backup_list);
}
// Canvas and related elements for browser-side image drawing.
// Note you must invoke lbf_canvas_head() (below) to use this field type in a form.
else if ($data_type == 40) {
// Unlike other field types, width and height are in pixels.
$canWidth = intval($frow['fld_length']);
$canHeight = intval($frow['fld_rows']);
if (empty($currvalue)) {
if (preg_match('/\\bimage=([a-zA-Z0-9._-]*)/', $frow['description'], $matches)) {
// If defined this is the filename of the default starting image.
$currvalue = $GLOBALS['web_root'] . '/sites/' . $_SESSION['site_id'] . '/images/' . $matches[1];
}
}
echo "<div id='form_$field_id_esc'></div>";
// Hidden form field exists to send updated data to the server at submit time.
echo "<input type='hidden' name='form_$field_id_esc' value='' />";
// Hidden image exists to support initialization of the canvas.
echo "<img src='" . attr($currvalue) . "' id='form_{$field_id_esc}_img' style='display:none'>";
// $date_init is a misnomer but it's the place for browser-side setup logic.
$date_init .= " lbfCanvasSetup('form_$field_id_esc', $canWidth, $canHeight);\n";
}
}
}
echo "</td>\n";
echo " <td>";
echo "<input type='text' size='4' name='form_result_units[{$lino}]'" . " class='celltext' value='" . attr($result_units) . "' " . " title='" . xl('Units applicable to the result value') . "'" . " />";
echo "</td>\n";
echo " <td>";
echo "<input type='text' size='8' name='form_result_range[{$lino}]'" . " class='celltext' value='" . attr($result_range) . "' " . " title='" . xl('Reference range of results') . "'" . " />";
// Include a hidden form field containing all IDs for this line.
echo "<input type='hidden' name='form_line[{$lino}]' " . "value='{$order_id}:{$order_seq}:{$report_id}:{$result_id}' />";
echo "</td>\n";
echo " <td class='bold' style='cursor:pointer' " . "onclick='extShow({$lino}, this)' align='center' " . "title='" . xl('Click here to view/edit more details') . "'>";
echo " ? ";
echo "</td>\n";
echo " </tr>\n";
// Create a floating div for additional attributes of this result.
$extra_html .= "<div id='ext_{$lino}' " . "style='position:absolute;width:750px;border:1px solid black;" . "padding:2px;background-color:#cccccc;visibility:hidden;" . "z-index:1000;left:-1000px;top:0px;font-size:9pt;'>\n" . "<table width='100%'>\n" . "<tr><td class='bold' align='center' colspan='2' style='padding:4pt 0 4pt 0'>" . htmlspecialchars($result_text) . "</td></tr>\n" . "<tr><td class='bold' width='1%' nowrap>" . xlt('Status') . ": </td>" . "<td>" . generate_select_list("form_result_status[{$lino}]", 'proc_res_status', $result_status, xl('Result Status'), '') . "</td></tr>\n" . "<tr><td class='bold' nowrap>" . xlt('Facility') . ": </td>" . "<td><input type='text' size='15' name='form_facility[{$lino}]'" . " value='{$result_facility}' " . " title='" . xla('Supplier facility name') . "'" . " style='width:100%' /></td></tr>\n" . "<tr><td class='bold' nowrap>" . xlt('Comments') . ": </td>" . "<td><textarea rows='3' cols='15' name='form_comments[{$lino}]'" . " title='" . xla('Comments for this result or recommendation') . "'" . " style='width:100%' />" . htmlspecialchars($result_comments) . "</textarea></td></tr>\n" . "<tr><td class='bold' nowrap>" . xlt('Notes') . ": </td>" . "<td><textarea rows='4' cols='15' name='form_notes[{$lino}]'" . " title='" . xla('Additional notes for this result or recommendation') . "'" . " style='width:100%' />" . htmlspecialchars($result_notes) . "</textarea></td></tr>\n" . "</table>\n" . "<p><center><input type='button' value='" . xla('Close') . "' " . "onclick='extShow({$lino}, false)' /></center></p>\n" . "</div>";
$lastpoid = $order_id;
$lastpcid = $order_seq;
$lastprid = $report_id;
++$lino;
}
}
if (!empty($facilities)) {
// display facility information
$extra_html .= "<table>";
$extra_html .= "<tr><th>" . xl('Performing Laboratory Facility') . "</th></tr>";
foreach ($facilities as $facilityID) {
foreach (explode(":", $facilityID) as $lab_facility) {
$facility_array = getFacilityInfo($lab_facility);
if ($facility_array) {
$extra_html .= "<tr><td><hr></td></tr>" . "<tr><td>" . htmlspecialchars($facility_array['fname']) . " " . htmlspecialchars($facility_array['lname']) . ", " . htmlspecialchars($facility_array['title']) . "</td></tr>" . "<tr><td>" . htmlspecialchars($facility_array['organization']) . "</td></tr>" . "<tr><td>" . htmlspecialchars($facility_array['street']) . " " . htmlspecialchars($facility_array['city']) . " " . htmlspecialchars($facility_array['state']) . "</td></tr>" . "<tr><td>" . htmlspecialchars(formatPhone($facility_array['phone'])) . "</td></tr>";
<body class="body_top">
<center>
<form id="form_note" method="post" action="patient_tracker_status.php?tracker_id=<?php echo attr($tracker_id) ?>" enctype="multipart/form-data" >
<table>
<h2><?php echo xlt('Change Status for'). " " . text($row['fname']) . " " . text($row['lname']); ?></h2>
<span class=text><?php echo xlt('Status Type'); ?>: </span><br>
<?php
# Generate drop down list for status.
echo generate_select_list('statustype', 'apptstat',$trow['laststatus'], xl('Status Type'));
?>
<br><br>
<span class=text><?php echo xlt('Exam Room Number'); ?>: </span><br>
<?php
# Generate drop down list for room number.
echo generate_select_list('roomnum', 'patient_flow_board_rooms',$trow['lastroom'], xl('Exam Room Number'));
?>
<br><br>
<tr>
<td>
<a href='javascript:;' class='css_button_small' style='color:gray' onclick='document.getElementById("form_note").submit();'><span><?php echo xla('Save')?></span></a>
<a href='javascript:;' class='css_button_small' style='color:gray' onclick="window.close().submit();" ><span><?php echo xla('Cancel'); ?></span></a>
</td>
</tr>
</table>
</td>
</form>
</center>
</body>
</html>
echo htmlspecialchars(xl('Cancel'), ENT_NOQUOTES);
?>
</span>
</a>
</td>
</tr>
</table>
<table class="text">
<tr><td>
<?php
echo htmlspecialchars(xl('Transaction Type'), ENT_NOQUOTES);
?>
: </td><td>
<?php
echo generate_select_list('title', 'transactions', $_REQUEST['title'], '', '', '', 'titleChanged()');
?>
</td></tr>
</table>
<div id='referdiv'>
<div id="DEM">
<ul class="tabNav">
<?php
$fres = sqlStatement("SELECT * FROM layout_options " . "WHERE form_id = 'REF' AND uor > 0 " . "ORDER BY group_name, seq");
$last_group = '';
$cell_count = 0;
$item_count = 0;
$display_style = 'block';
while ($frow = sqlFetchArray($fres)) {
</td>
<td>
<textarea class='text' name="note" id="note" rows=5 cols=25><?php
echo htmlspecialchars($note, ENT_NOQUOTES);
?>
</textarea> </td>
</tr>
<tr>
<td align="right" class='text'>
<?php
echo htmlspecialchars(xl('Completion Status'), ENT_NOQUOTES);
?>
</td>
<td>
<?php
echo generate_select_list('immuniz_completion_status', 'Immunization_Completion_Status', $immuniz_completion_status, 'Select Completion Status', ' ');
?>
</td>
</tr>
<tr>
<td colspan="3" align="center">
<input type="button" name="save" id="save" value="<?php
echo htmlspecialchars(xl('Save Immunization'), ENT_QUOTES);
?>
">
<input type="button" name="print" id="print" value="<?php
echo htmlspecialchars(xl('Print Record') . xl('PDF', '', ' (', ')'), ENT_QUOTES);
?>
">
</td>
</tr>
<tr<?php
if ($GLOBALS['athletic_team'] || $GLOBALS['ippf_specific']) {
echo " style='display:none;'";
}
?>
>
<td valign='top' nowrap><b><?php
xl('Outcome', 'e');
?>
:</b></td>
<td>
<?php
echo generate_select_list('form_outcome', 'outcome', $irow['outcome'], '', '', '', 'outcomeClicked(this);');
?>
</td>
</tr>
<tr<?php
if ($GLOBALS['athletic_team'] || $GLOBALS['ippf_specific']) {
echo " style='display:none;'";
}
?>
>
<td valign='top' nowrap><b><?php
xl('Destination', 'e');
?>
:</b></td>
<td>
function generate_form_field($frow, $currvalue)
{
global $rootdir, $date_init, $ISSUE_TYPES, $code_types;
$currescaped = htmlspecialchars($currvalue, ENT_QUOTES);
$data_type = $frow['data_type'];
$field_id = $frow['field_id'];
$list_id = $frow['list_id'];
$backup_list = $frow['list_backup_id'];
// escaped variables to use in html
$field_id_esc = htmlspecialchars($field_id, ENT_QUOTES);
$list_id_esc = htmlspecialchars($list_id, ENT_QUOTES);
// Added 5-09 by BM - Translate description if applicable
$description = isset($frow['description']) ? htmlspecialchars(xl_layout_label($frow['description']), ENT_QUOTES) : '';
// Support edit option T which assigns the (possibly very long) description as
// the default value.
if (strpos($frow['edit_options'], 'T') !== FALSE) {
if (strlen($currescaped) == 0) {
$currescaped = $description;
}
// Description used in this way is not suitable as a title.
$description = '';
}
// added 5-2009 by BM to allow modification of the 'empty' text title field.
// Can pass $frow['empty_title'] with this variable, otherwise
// will default to 'Unassigned'.
// modified 6-2009 by BM to allow complete skipping of the 'empty' text title
// if make $frow['empty_title'] equal to 'SKIP'
$showEmpty = true;
if (isset($frow['empty_title'])) {
if ($frow['empty_title'] == "SKIP") {
//do not display an 'empty' choice
$showEmpty = false;
$empty_title = "Unassigned";
} else {
$empty_title = $frow['empty_title'];
}
} else {
$empty_title = "Unassigned";
}
$disabled = strpos($frow['edit_options'], '0') === FALSE ? '' : 'disabled';
$lbfchange = strpos($frow['form_id'], 'LBF') === 0 ? "checkSkipConditions();" : "";
$lbfonchange = $lbfchange ? "onchange='{$lbfchange}'" : "";
// generic single-selection list or Race and Ethnicity.
// These data types support backup lists.
if ($data_type == 1 || $data_type == 33) {
echo generate_select_list("form_{$field_id}", $list_id, $currvalue, $description, $showEmpty ? $empty_title : '', '', $lbfchange, '', $disabled ? array('disabled' => 'disabled') : null, false, $backup_list);
} else {
if ($data_type == 2) {
$fldlength = htmlspecialchars($frow['fld_length'], ENT_QUOTES);
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) {
$string_maxlength = "maxlength='" . attr($maxlength) . "'";
}
echo "<input type='text'" . " name='form_{$field_id_esc}'" . " id='form_{$field_id_esc}'" . " size='{$fldlength}'" . " {$string_maxlength}" . " title='{$description}'" . " value='{$currescaped}'";
$tmp = $lbfchange;
if (strpos($frow['edit_options'], 'C') !== FALSE) {
$tmp .= "capitalizeMe(this);";
} else {
if (strpos($frow['edit_options'], 'U') !== FALSE) {
$tmp .= "this.value = this.value.toUpperCase();";
}
}
if ($tmp) {
echo " onchange='{$tmp}'";
}
$tmp = htmlspecialchars($GLOBALS['gbl_mask_patient_id'], ENT_QUOTES);
if ($field_id == 'pubpid' && strlen($tmp) > 0) {
echo " onkeyup='maskkeyup(this,\"{$tmp}\")'";
echo " onblur='maskblur(this,\"{$tmp}\")'";
}
if (strpos($frow['edit_options'], '1') !== FALSE && strlen($currescaped) > 0) {
echo " readonly";
}
if ($disabled) {
echo ' disabled';
}
echo " />";
} else {
if ($data_type == 3) {
$textCols = htmlspecialchars($frow['fld_length'], ENT_QUOTES);
$textRows = htmlspecialchars($frow['fld_rows'], ENT_QUOTES);
echo "<textarea" . " name='form_{$field_id_esc}'" . " id='form_{$field_id_esc}'" . " title='{$description}'" . " cols='{$textCols}'" . " rows='{$textRows}' {$lbfonchange} {$disabled}" . ">" . $currescaped . "</textarea>";
} else {
if ($data_type == 4) {
$age_asof_date = '';
// optionalAge() sets this
$age_format = strpos($frow['edit_options'], 'A') === FALSE ? 3 : 0;
$agestr = optionalAge($frow, $currvalue, $age_asof_date);
if ($agestr) {
echo "<table cellpadding='0' cellspacing='0'><tr><td class='text'>";
}
echo "<input type='text' size='10' name='form_{$field_id_esc}' id='form_{$field_id_esc}'" . " value='" . substr($currescaped, 0, 10) . "'";
if (!$agestr) {
echo " title='{$description}'";
}
echo " {$lbfonchange} onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' {$disabled} />";
if (!$disabled) {
echo "<img src='{$rootdir}/pic/show_calendar.gif' align='absbottom' width='24' height='22'" . " id='img_{$field_id_esc}' border='0' alt='[?]' style='cursor:pointer'" . " title='" . htmlspecialchars(xl('Click here to choose a date'), ENT_QUOTES) . "' />";
$date_init .= " Calendar.setup({" . "inputField:'form_{$field_id}', " . "ifFormat:'%Y-%m-%d', ";
if ($agestr) {
$date_init .= "onUpdate: function() {" . "if (typeof(updateAgeString) == 'function') updateAgeString('{$field_id}','{$age_asof_date}', {$age_format});" . "}, ";
}
$date_init .= "button:'img_{$field_id}'})\n";
}
// Optional display of age or gestational age.
if ($agestr) {
echo "</td></tr><tr><td id='span_{$field_id}' class='text'>" . text($agestr) . "</td></tr></table>";
}
} else {
if ($data_type == 10) {
$ures = sqlStatement("SELECT id, fname, lname, specialty FROM users " . "WHERE active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " . "AND authorized = 1 " . "ORDER BY lname, fname");
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}' {$lbfonchange} {$disabled}>";
echo "<option value=''>" . xlt($empty_title) . "</option>";
$got_selected = false;
while ($urow = sqlFetchArray($ures)) {
$uname = text($urow['fname'] . ' ' . $urow['lname']);
$optionId = attr($urow['id']);
echo "<option value='{$optionId}'";
if ($urow['id'] == $currvalue) {
echo " selected";
$got_selected = true;
}
echo ">{$uname}</option>";
}
if (!$got_selected && $currvalue) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
} else {
echo "</select>";
}
} else {
if ($data_type == 11) {
$ures = sqlStatement("SELECT id, fname, lname, specialty FROM users " . "WHERE active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " . "AND ( authorized = 1 OR ( username = '' AND npi != '' ) ) " . "ORDER BY lname, fname");
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'";
echo " {$lbfonchange} {$disabled}>";
echo "<option value=''>" . xlt('Unassigned') . "</option>";
$got_selected = false;
while ($urow = sqlFetchArray($ures)) {
$uname = text($urow['fname'] . ' ' . $urow['lname']);
$optionId = attr($urow['id']);
echo "<option value='{$optionId}'";
if ($urow['id'] == $currvalue) {
echo " selected";
$got_selected = true;
}
echo ">{$uname}</option>";
}
if (!$got_selected && $currvalue) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
} else {
echo "</select>";
}
} else {
if ($data_type == 12) {
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'";
echo " {$lbfonchange} {$disabled}>";
echo "<option value='0'></option>";
$pres = get_pharmacies();
$got_selected = false;
while ($prow = sqlFetchArray($pres)) {
$key = $prow['id'];
$optionValue = htmlspecialchars($key, ENT_QUOTES);
$optionLabel = htmlspecialchars($prow['name'] . ' ' . $prow['area_code'] . '-' . $prow['prefix'] . '-' . $prow['number'] . ' / ' . $prow['line1'] . ' / ' . $prow['city'], ENT_NOQUOTES);
echo "<option value='{$optionValue}'";
if ($currvalue == $key) {
echo " selected";
$got_selected = true;
}
echo ">{$optionLabel}</option>";
}
if (!$got_selected && $currvalue) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
} else {
echo "</select>";
}
} else {
if ($data_type == 13) {
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'";
echo " {$lbfonchange} {$disabled}>";
echo "<option value=''> </option>";
$squads = acl_get_squads();
if ($squads) {
foreach ($squads as $key => $value) {
$optionValue = htmlspecialchars($key, ENT_QUOTES);
$optionLabel = htmlspecialchars($value[3], ENT_NOQUOTES);
echo "<option value='{$optionValue}'";
if ($currvalue == $key) {
echo " selected";
}
echo ">{$optionLabel}</option>\n";
}
}
echo "</select>";
} else {
if ($data_type == 14) {
if (strpos($frow['edit_options'], 'L') !== FALSE) {
$tmp = "abook_type = 'ord_lab'";
} else {
if (strpos($frow['edit_options'], 'O') !== FALSE) {
$tmp = "abook_type LIKE 'ord\\_%'";
} else {
if (strpos($frow['edit_options'], 'V') !== FALSE) {
$tmp = "abook_type LIKE 'vendor%'";
} else {
if (strpos($frow['edit_options'], 'R') !== FALSE) {
$tmp = "abook_type LIKE 'dist'";
} else {
$tmp = "( username = '' OR authorized = 1 )";
}
}
}
}
$ures = sqlStatement("SELECT id, fname, lname, organization, username FROM users " . "WHERE active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " . "AND {$tmp} " . "ORDER BY organization, lname, fname");
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'";
echo " {$lbfonchange} {$disabled}>";
echo "<option value=''>" . htmlspecialchars(xl('Unassigned'), ENT_NOQUOTES) . "</option>";
while ($urow = sqlFetchArray($ures)) {
$uname = $urow['organization'];
if (empty($uname) || substr($uname, 0, 1) == '(') {
$uname = $urow['lname'];
if ($urow['fname']) {
$uname .= ", " . $urow['fname'];
}
}
$optionValue = htmlspecialchars($urow['id'], ENT_QUOTES);
$optionLabel = htmlspecialchars($uname, ENT_NOQUOTES);
echo "<option value='{$optionValue}'";
$title = $urow['username'] ? xl('Local') : xl('External');
$optionTitle = htmlspecialchars($title, ENT_QUOTES);
echo " title='{$optionTitle}'";
if ($urow['id'] == $currvalue) {
echo " selected";
}
echo ">{$optionLabel}</option>";
}
echo "</select>";
} else {
if ($data_type == 15) {
$fldlength = htmlspecialchars($frow['fld_length'], ENT_QUOTES);
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) {
$string_maxlength = "maxlength='" . attr($maxlength) . "'";
}
//
if (strpos($frow['edit_options'], '2') !== FALSE && substr($frow['form_id'], 0, 3) == 'LBF') {
// Option "2" generates a hidden input for the codes, and a matching visible field
// displaying their descriptions. First step is computing the description string.
$currdescstring = '';
if (!empty($currvalue)) {
$relcodes = explode(';', $currvalue);
foreach ($relcodes as $codestring) {
if ($codestring === '') {
continue;
}
$code_text = lookup_code_descriptions($codestring);
if ($currdescstring !== '') {
$currdescstring .= '; ';
}
if (!empty($code_text)) {
$currdescstring .= $code_text;
} else {
$currdescstring .= $codestring;
}
}
}
$currdescstring = attr($currdescstring);
//
echo "<input type='text'" . " name='form_{$field_id_esc}'" . " id='form_related_code'" . " size='{$fldlength}'" . " value='{$currescaped}'" . " style='display:none'" . " {$lbfonchange} readonly {$disabled} />";
// Extra readonly input field for optional display of code description(s).
echo "<input type='text'" . " name='form_{$field_id_esc}" . "__desc'" . " size='{$fldlength}'" . " title='{$description}'" . " value='{$currdescstring}'";
if (!$disabled) {
echo " onclick='sel_related(this,\"{$codetype}\")'";
}
echo " readonly {$disabled} />";
} else {
echo "<input type='text'" . " name='form_{$field_id_esc}'" . " id='form_related_code'" . " size='{$fldlength}'" . " {$string_maxlength}" . " title='{$description}'" . " value='{$currescaped}'";
if (!$disabled) {
echo " onclick='sel_related(this,\"{$codetype}\")'";
}
echo " {$lbfonchange} readonly {$disabled} />";
}
} else {
if ($data_type == 16) {
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'>";
echo "<option value='0'></option>";
$insprovs = getInsuranceProviders();
$got_selected = false;
foreach ($insprovs as $key => $ipname) {
$optionValue = htmlspecialchars($key, ENT_QUOTES);
$optionLabel = htmlspecialchars($ipname, ENT_NOQUOTES);
echo "<option value='{$optionValue}'";
if ($currvalue == $key) {
echo " selected";
$got_selected = true;
}
echo ">{$optionLabel}</option>";
}
if (!$got_selected && $currvalue) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
} else {
echo "</select>";
}
} else {
if ($data_type == 17) {
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'>";
echo "<option value='0'></option>";
$got_selected = false;
foreach ($ISSUE_TYPES as $key => $value) {
$optionValue = htmlspecialchars($key, ENT_QUOTES);
$optionLabel = htmlspecialchars($value[1], ENT_NOQUOTES);
echo "<option value='{$optionValue}'";
if ($currvalue == $key) {
echo " selected";
$got_selected = true;
}
echo ">{$optionLabel}</option>";
}
if (!$got_selected && strlen($currvalue) > 0) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
} else {
echo "</select>";
}
} else {
if ($data_type == 18) {
$cres = sqlStatement("SELECT pc_catid, pc_catname " . "FROM openemr_postcalendar_categories ORDER BY pc_catname");
echo "<select name='form_{$field_id_esc}' id='form_{$field_id_esc}' title='{$description}'" . " {$lbfonchange} {$disabled}>";
echo "<option value=''>" . xlt($empty_title) . "</option>";
$got_selected = false;
while ($crow = sqlFetchArray($cres)) {
$catid = $crow['pc_catid'];
if ($catid < 9 && $catid != 5 || $catid == 11) {
continue;
}
echo "<option value='" . attr($catid) . "'";
if ($catid == $currvalue) {
echo " selected";
$got_selected = true;
}
echo ">" . text(xl_appt_category($crow['pc_catname'])) . "</option>";
}
if (!$got_selected && $currvalue) {
echo "<option value='" . attr($currvalue) . "' selected>* " . text($currvalue) . " *</option>";
echo "</select>";
echo " <font color='red' title='" . xla('Please choose a valid selection from the list.') . "'>" . xlt('Fix this') . "!</font>";
} else {
echo "</select>";
}
} else {
if ($data_type == 21) {
// In this special case, fld_length is the number of columns generated.
$cols = max(1, $frow['fld_length']);
$avalue = explode('|', $currvalue);
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
echo "<table cellpadding='0' cellspacing='0' width='100%'>";
$tdpct = (int) (100 / $cols);
for ($count = 0; $lrow = sqlFetchArray($lres); ++$count) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars($option_id, ENT_QUOTES);
// if ($count) echo "<br />";
if ($count % $cols == 0) {
if ($count) {
echo "</tr>";
}
echo "<tr>";
}
echo "<td width='{$tdpct}%'>";
echo "<input type='checkbox' name='form_{$field_id_esc}[{$option_id_esc}]'" . "id='form_{$field_id_esc}[{$option_id_esc}]' value='1' {$lbfonchange}";
if (in_array($option_id, $avalue)) {
echo " checked";
}
// Added 5-09 by BM - Translate label if applicable
echo " {$disabled} />" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES);
echo "</td>";
}
if ($count) {
echo "</tr>";
if ($count > $cols) {
// Add some space after multiple rows of checkboxes.
$cols = htmlspecialchars($cols, ENT_QUOTES);
echo "<tr><td colspan='{$cols}' style='height:0.7em'></td></tr>";
}
}
echo "</table>";
} else {
if ($data_type == 22) {
$tmp = explode('|', $currvalue);
$avalue = array();
foreach ($tmp as $value) {
if (preg_match('/^([^:]+):(.*)$/', $value, $matches)) {
$avalue[$matches[1]] = $matches[2];
}
}
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
echo "<table cellpadding='0' cellspacing='0'>";
while ($lrow = sqlFetchArray($lres)) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars($option_id, ENT_QUOTES);
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) {
$string_maxlength = "maxlength='" . attr($maxlength) . "'";
}
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
// Added 5-09 by BM - Translate label if applicable
echo "<tr><td>" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES) . " </td>";
$fldlength = htmlspecialchars($fldlength, ENT_QUOTES);
$optionValue = htmlspecialchars($avalue[$option_id], ENT_QUOTES);
echo "<td><input type='text'" . " name='form_{$field_id_esc}[{$option_id_esc}]'" . " id='form_{$field_id_esc}[{$option_id_esc}]'" . " size='{$fldlength}'" . " {$string_maxlength}" . " value='{$optionValue}'";
echo " {$lbfonchange} {$disabled} /></td></tr>";
}
echo "</table>";
} else {
if ($data_type == 23) {
$tmp = explode('|', $currvalue);
$avalue = array();
foreach ($tmp as $value) {
if (preg_match('/^([^:]+):(.*)$/', $value, $matches)) {
$avalue[$matches[1]] = $matches[2];
}
}
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) {
$string_maxlength = "maxlength='" . attr($maxlength) . "'";
}
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
echo "<table cellpadding='0' cellspacing='0'>";
echo "<tr><td> </td><td class='bold'>" . htmlspecialchars(xl('N/A'), ENT_NOQUOTES) . " </td><td class='bold'>" . htmlspecialchars(xl('Nor'), ENT_NOQUOTES) . " </td>" . "<td class='bold'>" . htmlspecialchars(xl('Abn'), ENT_NOQUOTES) . " </td><td class='bold'>" . htmlspecialchars(xl('Date/Notes'), ENT_NOQUOTES) . "</td></tr>";
while ($lrow = sqlFetchArray($lres)) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars($option_id, ENT_QUOTES);
$restype = substr($avalue[$option_id], 0, 1);
$resnote = substr($avalue[$option_id], 2);
// Added 5-09 by BM - Translate label if applicable
echo "<tr><td>" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES) . " </td>";
for ($i = 0; $i < 3; ++$i) {
$inputValue = htmlspecialchars($i, ENT_QUOTES);
echo "<td><input type='radio'" . " name='radio_{$field_id_esc}[{$option_id_esc}]'" . " id='radio_{$field_id_esc}[{$option_id_esc}]'" . " value='{$inputValue}' {$lbfonchange}";
if ($restype === "{$i}") {
echo " checked";
}
echo " {$disabled} /></td>";
}
$fldlength = htmlspecialchars($fldlength, ENT_QUOTES);
$resnote = htmlspecialchars($resnote, ENT_QUOTES);
echo "<td><input type='text'" . " name='form_{$field_id_esc}[{$option_id_esc}]'" . " id='form_{$field_id_esc}[{$option_id_esc}]'" . " size='{$fldlength}'" . " {$string_maxlength}" . " value='{$resnote}' {$disabled} /></td>";
echo "</tr>";
}
echo "</table>";
} else {
if ($data_type == 24) {
$query = "SELECT title, comments FROM lists WHERE " . "pid = ? AND type = 'allergy' AND enddate IS NULL " . "ORDER BY begdate";
// echo "<!-- $query -->\n"; // debugging
$lres = sqlStatement($query, array($GLOBALS['pid']));
$count = 0;
while ($lrow = sqlFetchArray($lres)) {
if ($count++) {
echo "<br />";
}
echo htmlspecialchars($lrow['title'], ENT_NOQUOTES);
if ($lrow['comments']) {
echo ' (' . htmlspecialchars($lrow['comments'], ENT_NOQUOTES) . ')';
}
}
} else {
if ($data_type == 25) {
$tmp = explode('|', $currvalue);
$avalue = array();
foreach ($tmp as $value) {
if (preg_match('/^([^:]+):(.*)$/', $value, $matches)) {
$avalue[$matches[1]] = $matches[2];
}
}
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) {
$string_maxlength = "maxlength='" . attr($maxlength) . "'";
}
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
echo "<table cellpadding='0' cellspacing='0'>";
while ($lrow = sqlFetchArray($lres)) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars($option_id, ENT_QUOTES);
$restype = substr($avalue[$option_id], 0, 1);
$resnote = substr($avalue[$option_id], 2);
// Added 5-09 by BM - Translate label if applicable
echo "<tr><td>" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES) . " </td>";
$option_id = htmlspecialchars($option_id, ENT_QUOTES);
echo "<td><input type='checkbox' name='check_{$field_id_esc}[{$option_id_esc}]'" . " id='check_{$field_id_esc}[{$option_id_esc}]' value='1' {$lbfonchange}";
if ($restype) {
echo " checked";
}
echo " {$disabled} /> </td>";
$fldlength = htmlspecialchars($fldlength, ENT_QUOTES);
$resnote = htmlspecialchars($resnote, ENT_QUOTES);
echo "<td><input type='text'" . " name='form_{$field_id_esc}[{$option_id_esc}]'" . " id='form_{$field_id_esc}[{$option_id_esc}]'" . " size='{$fldlength}'" . " {$string_maxlength}" . " value='{$resnote}' {$disabled} /></td>";
echo "</tr>";
}
echo "</table>";
} else {
if ($data_type == 26) {
echo generate_select_list("form_{$field_id}", $list_id, $currvalue, $description, $showEmpty ? $empty_title : '', 'addtolistclass_' . $list_id, $lbfchange, '', $disabled ? array('disabled' => 'disabled') : null, false, $backup_list);
// show the add button if user has access to correct list
$inputValue = htmlspecialchars(xl('Add'), ENT_QUOTES);
$outputAddButton = "<input type='button' id='addtolistid_" . $list_id_esc . "' fieldid='form_" . $field_id_esc . "' class='addtolist' value='{$inputValue}' {$disabled} />";
if (aco_exist('lists', $list_id)) {
// a specific aco exist for this list, so ensure access
if (acl_check('lists', $list_id)) {
echo $outputAddButton;
}
} else {
// no specific aco exist for this list, so check for access to 'default' list
if (acl_check('lists', 'default')) {
echo $outputAddButton;
}
}
} else {
if ($data_type == 27) {
// In this special case, fld_length is the number of columns generated.
$cols = max(1, $frow['fld_length']);
$lres = sqlStatement("SELECT * FROM list_options " . "WHERE list_id = ? ORDER BY seq, title", array($list_id));
echo "<table cellpadding='0' cellspacing='0' width='100%'>";
$tdpct = (int) (100 / $cols);
$got_selected = FALSE;
for ($count = 0; $lrow = sqlFetchArray($lres); ++$count) {
$option_id = $lrow['option_id'];
$option_id_esc = htmlspecialchars($option_id, ENT_QUOTES);
if ($count % $cols == 0) {
if ($count) {
echo "</tr>";
}
echo "<tr>";
}
echo "<td width='{$tdpct}%'>";
echo "<input type='radio' name='form_{$field_id_esc}' id='form_{$field_id_esc}[{$option_id_esc}]'" . " value='{$option_id_esc}' {$lbfonchange}";
if (strlen($currvalue) == 0 && $lrow['is_default'] || strlen($currvalue) > 0 && $option_id == $currvalue) {
echo " checked";
$got_selected = TRUE;
}
echo " {$disabled} />" . htmlspecialchars(xl_list_label($lrow['title']), ENT_NOQUOTES);
echo "</td>";
}
if ($count) {
echo "</tr>";
if ($count > $cols) {
// Add some space after multiple rows of radio buttons.
$cols = htmlspecialchars($cols, ENT_QUOTES);
echo "<tr><td colspan='{$cols}' style='height:0.7em'></td></tr>";
}
}
echo "</table>";
if (!$got_selected && strlen($currvalue) > 0) {
$fontTitle = htmlspecialchars(xl('Please choose a valid selection.'), ENT_QUOTES);
$fontText = htmlspecialchars(xl('Fix this'), ENT_NOQUOTES);
echo "{$currescaped} <font color='red' title='{$fontTitle}'>{$fontText}!</font>";
}
} else {
if ($data_type == 28 || $data_type == 32) {
$tmp = explode('|', $currvalue);
switch (count($tmp)) {
case "4":
$resnote = $tmp[0];
$restype = $tmp[1];
$resdate = $tmp[2];
$reslist = $tmp[3];
break;
case "3":
$resnote = $tmp[0];
$restype = $tmp[1];
$resdate = $tmp[2];
break;
case "2":
$resnote = $tmp[0];
$restype = $tmp[1];
$resdate = "";
break;
case "1":
$resnote = $tmp[0];
$resdate = $restype = "";
break;
default:
$restype = $resdate = $resnote = "";
break;
}
$maxlength = $frow['max_length'];
$string_maxlength = "";
// if max_length is set to zero, then do not set a maxlength
if ($maxlength) {
$string_maxlength = "maxlength='" . attr($maxlength) . "'";
}
$fldlength = empty($frow['fld_length']) ? 20 : $frow['fld_length'];
$fldlength = htmlspecialchars($fldlength, ENT_QUOTES);
$resnote = htmlspecialchars($resnote, ENT_QUOTES);
$resdate = htmlspecialchars($resdate, ENT_QUOTES);
echo "<table cellpadding='0' cellspacing='0'>";
echo "<tr>";
if ($data_type == 28) {
// input text
echo "<td><input type='text'" . " name='form_{$field_id_esc}'" . " id='form_{$field_id_esc}'" . " size='{$fldlength}'" . " {$string_maxlength}" . " value='{$resnote}' {$disabled} /> </td>";
echo "<td class='bold'> " . " " . htmlspecialchars(xl('Status'), ENT_NOQUOTES) . ": </td>";
} else {
if ($data_type == 32) {
// input text
echo "<tr><td><input type='text'" . " name='form_text_{$field_id_esc}'" . " id='form_text_{$field_id_esc}'" . " size='{$fldlength}'" . " {$string_maxlength}" . " value='{$resnote}' {$disabled} /> </td></tr>";
echo "<td>";
//Selection list for smoking status
$onchange = 'radioChange(this.options[this.selectedIndex].value)';
//VicarePlus :: The javascript function for selection list.
echo generate_select_list("form_{$field_id}", $list_id, $reslist, $description, $showEmpty ? $empty_title : '', '', $onchange, '', $disabled ? array('disabled' => 'disabled') : null);
echo "</td>";
echo "<td class='bold'> " . xlt('Status') . ": </td>";
}
}
// current
echo "<td class='text' ><input type='radio'" . " name='radio_{$field_id_esc}'" . " id='radio_{$field_id_esc}[current]'" . " value='current" . $field_id_esc . "' {$lbfonchange}";
if ($restype == "current" . $field_id) {
echo " checked";
}
if ($data_type == 32) {
echo " onClick='smoking_statusClicked(this)'";
}
echo " />" . xlt('Current') . " </td>";
// quit
echo "<td class='text'><input type='radio'" . " name='radio_{$field_id_esc}'" . " id='radio_{$field_id_esc}[quit]'" . " value='quit" . $field_id_esc . "' {$lbfonchange}";
if ($restype == "quit" . $field_id) {
echo " checked";
}
if ($data_type == 32) {
echo " onClick='smoking_statusClicked(this)'";
}
echo " {$disabled} />" . xlt('Quit') . " </td>";
// quit date
echo "<td class='text'><input type='text' size='6' name='date_{$field_id_esc}' id='date_{$field_id_esc}'" . " value='{$resdate}'" . " title='{$description}'" . " onkeyup='datekeyup(this,mypcc)' onblur='dateblur(this,mypcc)' {$disabled} />";
if (!$disabled) {
echo "<img src='{$rootdir}/pic/show_calendar.gif' align='absbottom' width='24' height='22'" . " id='img_{$field_id_esc}' border='0' alt='[?]' style='cursor:pointer'" . " title='" . htmlspecialchars(xl('Click here to choose a date'), ENT_QUOTES) . "' />";
$date_init .= " Calendar.setup({inputField:'date_{$field_id}', ifFormat:'%Y-%m-%d', button:'img_{$field_id}'});\n";
}
echo " </td>";
// never
echo "<td class='text'><input type='radio'" . " name='radio_{$field_id_esc}'" . " id='radio_{$field_id_esc}[never]'" . " value='never" . $field_id_esc . "' {$lbfonchange}";
if ($restype == "never" . $field_id) {
echo " checked";
}
if ($data_type == 32) {
echo " onClick='smoking_statusClicked(this)'";
}
echo " />" . xlt('Never') . " </td>";
// Not Applicable
echo "<td class='text'><input type='radio'" . " name='radio_{$field_id}'" . " id='radio_{$field_id}[not_applicable]'" . " value='not_applicable" . $field_id . "' {$lbfonchange}";
if ($restype == "not_applicable" . $field_id) {
echo " checked";
}
if ($data_type == 32) {
echo " onClick='smoking_statusClicked(this)'";
}
echo " {$disabled} />" . xlt('N/A') . " </td>";
//
//Added on 5-jun-2k14 (regarding 'Smoking Status - display SNOMED code description')
echo "<td class='text' ><div id='smoke_code'></div></td>";
echo "</tr>";
echo "</table>";
} else {
if ($data_type == 31) {
echo nl2br($frow['description']);
} else {
if ($data_type == 34) {
$arr = explode("|*|*|*|", $currvalue);
echo "<a href='../../../library/custom_template/custom_template.php?type=form_{$field_id}&contextName=" . htmlspecialchars($list_id_esc, ENT_QUOTES) . "' class='iframe_medium' style='text-decoration:none;color:black;'>";
echo "<div id='form_{$field_id}_div' class='text-area'>" . htmlspecialchars($arr[0], ENT_QUOTES) . "</div>";
echo "<div style='display:none'><textarea name='form_{$field_id}' id='form_{$field_id}' style='display:none' {$lbfonchange} {$disabled}>" . $currvalue . "</textarea></div>";
echo "</a>";
} else {
if ($data_type == 35) {
if (empty($currvalue)) {
$currvalue = 0;
}
dropdown_facility($selected = $currvalue, $name = "form_{$field_id_esc}", $allow_unspecified = true, $allow_allfacilities = false, $disabled, $lbfchange);
} else {
if ($data_type == 36) {
echo generate_select_list("form_{$field_id}", $list_id, $currvalue, $description, $showEmpty ? $empty_title : '', '', $onchange, '', null, true, $backup_list);
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
}
<center>
<table border='0' width='100%'>
<?php
if (acl_check('admin', 'practice')) {
// allow choose type option if have admin access
?>
<tr>
<td width='1%' nowrap><b><?php
xl('Type', 'e');
?>
:</b></td>
<td>
<?php
echo generate_select_list('form_abook_type', 'abook_type', $row['abook_type'], '', 'Unassigned', '', 'typeSelect(this.value)');
?>
</td>
</tr>
<?php
}
// end of if has admin access
?>
<tr id="nameRow">
<td width='1%' nowrap><b><?php
xl('Name', 'e');
?>
:</b></td>
<td>
<?php
function timeunit_select($args)
{
require_once $GLOBALS["srcdir"] . "/options.inc.php";
return generate_select_list($args['name'], $args['context'], $args['value']->code, $args['name'], '', '', '', $args['id'], array("data-grp-tgt" => $args['target']));
}
<div id='ajax_div_insurance_error'> </div>
<div id="ajax_div_insurance" style="display:none;"></div>
</div>
</div> </td>
<td width="50" style="padding-left:5px;"><div name="div_insurance_or_patient" id="div_insurance_or_patient" class="text" style="border:1px solid black; padding-left:5px; width:50px; height:17px;"><?php
echo htmlspecialchars(formData('hidden_type_code'));
?>
</div><input type="hidden" name="description" id="description" /><input type="text" name="deposit_date" id="deposit_date" style="display:none"/></td>
</tr>
</table> </td>
<td align="left" class="text"><?php
echo htmlspecialchars(xl('Sort Result by'), ENT_QUOTES) . ':';
?>
</td>
<td align="left" class="text"><?php
echo generate_select_list("PaymentSortBy", "payment_sort_by", "{$PaymentSortBy}", "Sort Result by", " ", "class1 text");
?>
</td>
<td align="left" class="text"></td>
<td align="left" class="text"><table border="0" cellspacing="0" cellpadding="0">
<tr>
<td><a href="#" class="css_button" onClick="javascript:return SearchPayment();" ><span><?php
echo htmlspecialchars(xl('Search'), ENT_QUOTES);
?>
</span></a></td>
</tr>
</table></td>
<td align="left"></td>
</tr>
<tr height="5">
<td colspan="12" align="left" ></td>
?>
" type="hidden"/></td>
<td align="left" class="<?php
echo $StringClass;
?>
" ><input name="HiddenIns<?php
echo $CountIndex;
?>
" id="HiddenIns<?php
echo $CountIndex;
?>
" value="<?php
echo htmlspecialchars($Ins);
?>
" type="hidden"/><?php
echo generate_select_list("payment_ins{$CountIndex}", "payment_ins", "{$Ins}", "Insurance/Patient", '', '', 'ActionOnInsPat("' . $CountIndex . '")');
?>
</td>
<td class="<?php
echo $StringClass;
?>
" ><?php
echo htmlspecialchars($ServiceDate);
?>
</td>
<td align="right" class="<?php
echo $StringClass;
?>
" ><input name="HiddenEncounter<?php
echo $CountIndex;
?>
function writeOptionLine($option_id, $title, $seq, $default, $value, $mapping = '', $notes = '', $codes = '', $tog1 = '', $tog2 = '', $active = '', $subtype = '')
{
global $opt_line_no, $list_id;
++$opt_line_no;
$bgcolor = "#" . ($opt_line_no & 1 ? "ddddff" : "ffdddd");
$checked = $default ? " checked" : "";
$checked_tog1 = $tog1 ? " checked" : "";
$checked_tog2 = $tog2 ? " checked" : "";
$checked_active = $active ? " checked" : "";
echo " <tr bgcolor='{$bgcolor}'>\n";
echo " <td align='center' class='optcell'>";
echo "<input type='text' name='opt[{$opt_line_no}][id]' value='" . htmlspecialchars($option_id, ENT_QUOTES) . "' size='12' maxlength='63' class='optin' />";
echo "</td>\n";
echo " <td align='center' class='optcell'>";
echo "<input type='text' name='opt[{$opt_line_no}][title]' value='" . htmlspecialchars($title, ENT_QUOTES) . "' size='20' maxlength='63' class='optin' />";
echo "</td>\n";
// if not english and translating lists then show the translation
if ($GLOBALS['translate_lists'] && $_SESSION['language_choice'] > 1) {
echo " <td align='center' class='translation'>" . htmlspecialchars(xl($title), ENT_QUOTES) . "</td>\n";
}
echo " <td align='center' class='optcell'>";
echo "<input type='text' name='opt[{$opt_line_no}][seq]' value='" . htmlspecialchars($seq, ENT_QUOTES) . "' size='4' maxlength='10' class='optin' />";
echo "</td>\n";
echo " <td align='center' class='optcell'>";
echo "<input type='checkbox' name='opt[{$opt_line_no}][default]' value='1' " . "onclick='defClicked({$opt_line_no})' class='optin'{$checked} />";
echo "</td>\n";
echo " <td align='center' class='optcell'>";
echo "<input type='checkbox' name='opt[{$opt_line_no}][activity]' value='1' " . " class='optin'{$checked_active} />";
echo "</td>\n";
// Tax rates, contraceptive methods and LBF names have an additional attribute.
//
if ($list_id == 'taxrate' || $list_id == 'contrameth' || $list_id == 'lbfnames' || $list_id == 'transactions') {
echo " <td align='center' class='optcell'>";
echo "<input type='text' name='opt[{$opt_line_no}][value]' value='" . htmlspecialchars($value, ENT_QUOTES) . "' size='8' maxlength='15' class='optin' />";
echo "</td>\n";
} else {
if ($list_id == 'adjreason') {
echo " <td align='center' class='optcell'>";
echo "<select name='opt[{$opt_line_no}][value]' class='optin'>";
foreach (array(1 => xl('Charge adjustment'), 2 => xl('Coinsurance'), 3 => xl('Deductible'), 4 => xl('Other pt resp'), 5 => xl('Comment')) as $key => $desc) {
echo "<option value='{$key}'";
if ($key == $value) {
echo " selected";
}
echo ">" . htmlspecialchars($desc) . "</option>";
}
echo "</select>";
echo "</td>\n";
} else {
if ($list_id == 'abook_type') {
echo " <td align='center' class='optcell'>";
echo "<select name='opt[{$opt_line_no}][value]' class='optin'>";
foreach (array(1 => xl('Unassigned'), 2 => xl('Person'), 3 => xl('Company')) as $key => $desc) {
echo "<option value='{$key}'";
if ($key == $value) {
echo " selected";
}
echo ">" . htmlspecialchars($desc) . "</option>";
}
echo "</select>";
echo "</td>\n";
} else {
if ($list_id == 'immunizations') {
echo " <td align='center' class='optcell'>";
echo "<input type='text' size='10' name='opt[{$opt_line_no}][value]' " . "value='" . htmlspecialchars($value, ENT_QUOTES) . "' onclick='sel_cvxcode(this)' " . "title='" . htmlspecialchars(xl('Click to select or change CVX code'), ENT_QUOTES) . "'/>";
echo "</td>\n";
}
}
}
}
// IPPF includes the ability to map each list item to a "master" identifier.
// Sports teams use this for some extra info for fitness levels.
//
if ($GLOBALS['ippf_specific'] || $list_id == 'fitness') {
echo " <td align='center' class='optcell'>";
echo "<input type='text' name='opt[{$opt_line_no}][mapping]' value='" . htmlspecialchars($mapping, ENT_QUOTES) . "' size='12' maxlength='15' class='optin' />";
echo "</td>\n";
} else {
if ($list_id == 'apptstat') {
list($apptstat_color, $apptstat_timealert) = explode("|", $notes);
echo " <td align='center' class='optcell'>";
echo "<input type='text' class='color' name='opt[{$opt_line_no}][apptstat_color]' value='" . htmlspecialchars($apptstat_color, ENT_QUOTES) . "' size='6' maxlength='6' class='optin' />";
echo "</td>\n";
echo " <td align='center' class='optcell'>";
echo "<input type='text' name='opt[{$opt_line_no}][apptstat_timealert]' value='" . htmlspecialchars($apptstat_timealert, ENT_QUOTES) . "' size='2' maxlength='2' class='optin' />";
echo "</td>\n";
} else {
echo " <td align='center' class='optcell'>";
echo "<input type='text' name='opt[{$opt_line_no}][notes]' value='" . htmlspecialchars($notes, ENT_QUOTES) . "' size='25' maxlength='255' class='optin' />";
echo "</td>\n";
}
}
if ($list_id == 'apptstat') {
echo " <td align='center' class='optcell'>";
echo "<input type='checkbox' name='opt[{$opt_line_no}][toggle_setting_1]' value='1' " . "onclick='defClicked({$opt_line_no})' class='optin'{$checked_tog1} />";
echo "</td>\n";
echo " <td align='center' class='optcell'>";
echo "<input type='checkbox' name='opt[{$opt_line_no}][toggle_setting_2]' value='1' " . "onclick='defClicked({$opt_line_no})' class='optin'{$checked_tog2} />";
echo "</td>\n";
}
echo " <td align='center' class='optcell'>";
echo "<input type='text' name='opt[{$opt_line_no}][codes]' title='" . xla('Clinical Term Code(s)') . "' value='" . htmlspecialchars($codes, ENT_QUOTES) . "' onclick='select_clin_term_code(this)' size='25' maxlength='255' class='optin' />";
echo "</td>\n";
if (preg_match('/_issue_list$/', $list_id)) {
echo " <td align='center' class='optcell'>";
echo generate_select_list("opt[{$opt_line_no}][subtype]", 'issue_subtypes', $subtype, 'Subtype', ' ', 'optin');
echo "</td>\n";
}
echo " </tr>\n";
}
<td><br/><?php
echo $cat;
?>
</td>
</tr>
<tr>
<td>
select Building:
</td>
<td>
<?php
$q = "select buildingName from Building";
$x = "buildingName";
$query4 = "select Building.buildingName from Room,Building where roomId=" . $id . " and Room.buildingName=Building.buildId";
$result4 = execute($query4);
$b = "";
while ($roww4 = mysql_fetch_row($result4)) {
$b = $roww4[0];
}
$st = generate_select_list($q, $x, $b);
echo $st;
?>
</td>
</tr>
<tr><td>
</td><td>
<input type='submit' name='submit' id='submit' value='Edit Room'/><button type='reset' value='Reset'/>Reset</td></tr>
</table></form>
<?php
}
require_once "footer.php";
