<?php // php code to search data in mysql database and set it in input text if(isset($_POST['search'])) { // id to search $ic = $_POST['icnum']; // connect to mysql $connect = mysqli_connect("localhost", "root", "","himsdb"); // mysql search query $query = "SELECT patient_data.*, admit.* FROM patient_data INNER JOIN admit ON patient_data.ic_num = admit.ic_num WHERE patient_data.ic_num = '$ic' AND admit.ic_num = '$ic'"; $result = mysqli_query($connect, $query); // if id exist // show data in inputs if(mysqli_num_rows($result) > 0) { while ($row = mysqli_fetch_array($result)) { $serial_num = $row['serial_num']; $ic_num = $row['ic_num']; $name = $row['name']; $age = $row['age']; $address = $row['address']; $gender = $row['gender']; $race = $row['race']; $nationality = $row['nationality']; $birthdate = $row['birthdate']; $telephone = $row['telephone']; $religion = $row['religion']; $marrital = $row['marrital']; $w_name = $row['w_name']; $relation = $row['relation']; $w_telephone = $row['w_telephone']; $w_address = $row['w_address']; $status = $row['status']; $r_source = $row['r_source']; $ad_date = $row['ad_date']; $ad_date = date("Y-m-d\TH:i:s", strtotime($row['ad_date'])); $discp = $row['discp']; $wad = $row['wad']; $c_code = $row['c_code']; $legal = $row['legal']; } } // if the id not exist // show a message and clear inputs else { echo '<script type="text/javascript">'; echo 'alert("Pesakit belum daftar, Sila daftar di halaman berikut");'; echo 'window.location.href = "index.php?v=REG";'; echo '</script>'; } mysqli_free_result($result); mysqli_close($connect); } // in the first time inputs are empty else{ $serial_num =""; $ic_num =""; $name =""; $age =""; $address =""; $gender =""; $race =""; $nationality =""; $birthdate =""; $telephone =""; $religion =""; $marrital =""; $w_name =""; $relation =""; $w_telephone =""; $w_address =""; $r_source =""; $ad_date =""; $discp =""; $wad =""; $c_code =""; $legal =""; } ?> <!doctype html> <html lang="en"> <head> <link rel="icon" href="../dist/img/hims.png"> <!-- Required meta tags --> <meta charset="utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no"> <link rel="stylesheet" href="../assets/vendor/bootstrap/css/bootstrap.min.css"> <link href="../assets/vendor/fonts/circular-std/style.css" rel="stylesheet"> <link rel="stylesheet" href="../assets/libs/css/style.css"> <link rel="stylesheet" href="../assets/vendor/fonts/fontawesome/css/fontawesome-all.css"> <style> .form-group label{ color: #3d405c!important; } </style> <title>HIMS</title> <script type="text/javascript"> // Using jQuery. $(function() { $('ic').each(function() { $(this).find('input').keypress(function(e) { // Enter pressed? if(e.which == 10 || e.which == 13) { this.form.submit(); } }); $(this).find('input[type=submit]').hide(); }); }); </script> </head> <body> <!-- ============================================================== --> <!-- main wrapper --> <!-- ============================================================== --> <div class="dashboard-main-wrapper"> <!-- ============================================================== --> <!-- navbar --> <!-- ============================================================== --> <?php include $_SERVER['DOCUMENT_ROOT'].'/hims/include/nav.php'; ?> <!-- ============================================================== --> <!-- end navbar --> <!-- ============================================================== --> <!-- ============================================================== --> <!-- left sidebar --> <!-- ============================================================== --> <?php include $_SERVER['DOCUMENT_ROOT'].'/hims/include/sidebar.php'; ?> <!-- ============================================================== --> <!-- end left sidebar --> <!-- ============================================================== --> <!-- ============================================================== --> <!-- wrapper --> <!-- ============================================================== --> <div class="dashboard-wrapper"> <div class="container-fluid dashboard-content"> <!-- ============================================================== --> <!-- pageheader --> <!-- ============================================================== --> <div class="row"> <div class="col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12"> <div class="page-header"> <h2 class="pageheader-title">Admission </h2> <div class="page-breadcrumb"> <nav aria-label="breadcrumb"> <ol class="breadcrumb"> <li class="breadcrumb-item"><a href="#" class="breadcrumb-link">Dashboard</a></li> <li class="breadcrumb-item active" aria-current="page">Admission</li> </ol> </nav> </div> </div> </div> </div> <!-- ============================================================== --> <!-- end pageheader --> <!-- ============================================================== --> <div class=""> <div class="container-fluid dashboard-content"> <div class="row"> <div class="col-xl-10"> <div class="row"> <!-- ============================================================== --> <!-- basic form --> <!-- ============================================================== --> <div class="col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12"> <?php include $_SERVER['DOCUMENT_ROOT'].'/hims/include/messages.php'; ?> <div class="card"> <h5 class="card-header">Patient Form</h5> <div class="card-body"> <form action="<?php echo WEB_ROOT; ?>views/?v=ADM" class="form-horizontal" method="post" id="validationform" data-parsley-validate="" novalidate="" class="needs-validation" novalidate> <div class="form-group row"> <label for="inputWebSite" class="col-3 col-lg-2 col-form-label text-left">IC Num</label> <div class="col-9 col-lg-10"> <input id="ic" type="" name="icnum" data-parsley-type="" placeholder="" class="form-control" value="<?php echo $ic_num;?>" required=""> <input type="submit" name="search" hidden> </div> </div> </form> <form role="form" action="<?php echo WEB_ROOT; ?>views/process.php?cmd=admission" id="validationform" data-parsley-validate="" novalidate="" method="post" class="needs-validation" novalidate> <input id="ic" type="text" name="icnum" data-parsley-type="" placeholder="" class="form-control" value="<?php echo $ic_num;?>" hidden> <input id="admitstat" type="text" name="status" required="" data-parsley-type="" placeholder="" class="form-control" value="ADMITTED" hidden> <div class="form-group row"> <label for="inputWebSite" class="col-3 col-lg-2 col-form-label text-left">Serial Number</label> <div class="col-9 col-lg-10"> <input id="ic" type="" name="serial_num" required="" data-parsley-type="" placeholder="" class="form-control" value="<?php echo $serial_num;?>"> </div> </div> <div class="form-group row"> <label for="inputWebSite" class="col-3 col-lg-2 col-form-label text-left">Name</label> <div class="col-9 col-lg-10"> <input name="name" id="inputWebSite" type="text" required="" data-parsley-type="" placeholder="" class="form-control" value="<?php echo $name;?>"> </div> </div> <div class="form-group row"> <label for="inputWebSite" class="col-3 col-lg-2 col-form-label text-left">Age</label> <div class="col-9 col-lg-10"> <input name="age" id="inputWebSite" type="text" required="" data-parsley-type="" placeholder="" class="form-control" value="<?php echo $age;?>"> </div> </div> <div class="form-group row"> <label for="exampleFormControlTextarea1" class="col-3 col-lg-2 col-form-label text-left">Address</label> <div class="col-9 col-lg-10"> <textarea name="address" class="form-control" id="exampleFormControlTextarea1" rows="3" required=""><?php echo $address; ?></textarea> </div> </div> <div class="form-group row"> <label for="input-select" class="col-3 col-lg-2 col-form-label text-left">Gender</label> <div class="col-9 col-lg-10"> <select class="form-control" name="gender" id="input-select" value="" required=""> <option value="<?php echo strtoupper($gender);?>"><?php echo strtoupper($gender);?></option> <option value="MALE">MALE</option> <option value="FEMALE">FEMALE</option> </select> </div> </div> <div class="form-group row"> <label for="input-select" class="col-3 col-lg-2 col-form-label text-left">Race</label> <div class="col-9 col-lg-10"> <select name="race" class="form-control" id="input-select" required=""> <option value="<?php echo $race;?>"><?php echo strtoupper($race);?></option> <option value="MELAYU">MELAYU</option> <option value="CINA">CINA</option> <option value="IBAN">IBAN</option> <option value="BIDAYUH">BIDAYUH</option> <option value="KADAZAN">KADAZAN</option> <option value="MILANAU">MILANAU</option> <option value="PRIBUMI">PRIBUMI</option> <option value="LAIN-LAIN">LAIN-LAIN</option> </select> </div> </div> <div class="form-group row"> <label for="input-select" class="col-3 col-lg-2 col-form-label text-left">Nationality</label> <div class="col-9 col-lg-10"> <select name="nationality" class="form-control" id="input-select" required=""> <option value="<?php echo $nationality;?>"><?php echo strtoupper($nationality);?></option> <option value="KELANTAN">KELANTAN</option> <option value="KEDAH">KEDAH</option> <option value="KUALA LUMPUR">KUALA LUMPUR</option> <option value="TERENGGANU">TERENGGANU</option> <option value="MELAKA">MELAKA</option> <option value="NEGERI SEMBILAN">NEGERI SEMBILAN</option> <option value="PAHANG">PAHANG</option> <option value="PENANG">PENANG</option> <option value="PERAK">PERAK</option> <option value="PERLIS">PERLIS</option> <option value="SABAH">SABAH</option> <option value="SARAWAK">SARAWAK</option> <option value="SELANGOR">SELANGOR</option> <option value="JOHOR">JOHOR</option> </select> </div> </div> <div class="form-group row"> <label for="inputWebSite" class="col-3 col-lg-2 col-form-label text-left">Birthdate</label> <div class="col-9 col-lg-10"> <input name="birthdate" id="inputWebSite" type="date" required="" data-parsley-type="date" placeholder="Birthdate" class="form-control" format="dd/mm/yyyy" value="<?php echo $birthdate;?>"> </div> </div> <div class="form-group row"> <label for="inputWebSite" class="col-3 col-lg-2 col-form-label text-left">Telephone</label> <div class="col-9 col-lg-10"> <input name="telephone" id="inputWebSite" required="" data-parsley-type="number" placeholder="" class="form-control" value="<?php echo $telephone;?>"> </div> </div> <div class="form-group row"> <label for="input-select" class="col-3 col-lg-2 col-form-label text-left">Religion</label> <div class="col-9 col-lg-10"> <select name="religion" class="form-control" id="input-select" required=""> <option value="<?php echo $religion;?>"><?php echo strtoupper($religion);?></option> <option value="ISLAM">ISLAM</option> <option value="BUDDHA">BUDDHA</option> <option value="HINDU">HINDU</option> <option value="KRISTIAN">KRISTIAN</option> <option value="OTHERS">OTHERS</option> <option value="NIL">NIL</option> </select> </div> </div> <div class="form-group row"> <label for="input-select" class="col-3 col-lg-2 col-form-label text-left">Marrital</label> <div class="col-9 col-lg-10"> <select name="marrital" class="form-control" id="input-select" required=""> <option value="<?php echo $marrital;?>"><?php echo strtoupper($marrital);?></option> <option value="MARRIED">MARRIED</option> <option value="SINGLE">SINGLE</option> </select> </div> </div> <hr> <div class="form-group row"> <label for="input-select" class="col-3 col-lg-2 col-form-label text-left">REF Source</label> <div class="col-9 col-lg-10"> <select name="refsource" class="form-control" id="input-select" required=""> <option value="<?php echo $r_source;?>"><?php echo $r_source;?></option> <option value="JABATAN KECEMASAN">JABATAN KECEMASAN</option> <option value="KLINIK PAKAR P/L">KLINIK PAKAR P/L</option> <option value="LAIN-LAIN HOSPITAL">LAIN-LAIN HOSPITAL</option> <option value="PUSAT KESIHATAN">PUSAT KESIHATAN</option> <option value="DOKTOR SWASTA">DOKTOR SWASTA</option> <option value="LAIN-LAIN">LAIN-LAIN</option> <option value="BERSALIN">BERSALIN</option> <option value="KLINIK KEISHATAN BANDAR">KLINIK KEISHATAN BANDAR</option> <option value="PINDAH WAD">PINDAH WAD</option> <option value="DARI WAD BERSALIN">DARI WAD BERSALIN</option> </select> </div> </div> <div class="form-group row"> <label for="inputWebSite" class="col-3 col-lg-2 col-form-label text-left">Admit</label> <div class="col-9 col-lg-10"> <input name="admitdate" id="inputWebSite" type="datetime-local" required="" data-parsley-type="date" placeholder="Admit Date" class="form-control" value="<?php echo $ad_date;?>"> </div> </div> <div class="form-group row"> <label for="input-select" class="col-3 col-lg-2 col-form-label text-left">Discipline</label> <div class="col-9 col-lg-10"> <select name="discipline" class="form-control" id="input-select" required=""> <option value="<?php echo $discp;?>" ><?php echo $discp;?></option> <option value="PERUBATAN">PERUBATAN</option> <option value="PEMBEDAHAN">PEMBEDAHAN</option> <option value="OBSTETRIK">OBSTETRIK</option> <option value="PADIATRIK">PADIATRIK</option> <option value="GINEKOLOGI">GINEKOLOGI</option> <option value="OTOPIDIK">OTOPIDIK</option> <option value="TELINGA,HIDUNG,TEKAK">TELINGA,HIDUNG,TEKAK</option> <option value="OFTALMOLOGI">OFTALMOLOGI</option> <option value="DENTAL">DENTAL</option> <option value="TANPA KLASIFIKASI">TANPA KLASIFIKASI</option> <option value="SURGICAL PAEDTRIC">SURGICAL PAEDTRIC</option> <option value="PEADIATRIX NURSERY">PEADIATRIX NURSERY</option> </select> </div> </div> <div class="form-group row"> <label for="input-select" class="col-3 col-lg-2 col-form-label text-left">WAD</label> <div class="col-9 col-lg-10"> <select name="wad" class="form-control" id="input-select" required=""> <option value="<?php echo $wad;?>" ><?php echo $wad;?></option> <option value="W5A">WAD 5A</option> <option value="W5B">WAD 5B</option> <option value="W5C">WAD 5C</option> <option value="W5D">WAD 5D</option> <option value="W6A">WAD 6A</option> <option value="W6B">WAD 6B</option> <option value="W6C">WAD 6C</option> <option value="W6D">WAD 6D</option> </select> </div> </div> <div class="form-group row"> <label for="input-select" class="col-3 col-lg-2 col-form-label text-left">Charge Code</label> <div class="col-9 col-lg-10"> <select name="chargecode" class="form-control" id="input-select" required=""> <option value="<?php echo $c_code;?>" ><?php echo $c_code;?></option> <option value="AWM">ORANG AWAM</option> <option value="KER">K/T KERAJAAN</option> <option value="PES">PESARA</option> <option value="KNK">KANAK-KANAK BWH 1 THN</option> <option value="WA">WARGANEGARA ASING</option> <option value="PER">PER/MURID/KKM/BKMASY</option> <option value="SWA">SWASTA/KILANG</option> <option value="MAC">IBU MENGIRINGI ANAK</option> </select> </div> </div> <div class="form-group row"> <label for="input-select" class="col-3 col-lg-2 col-form-label text-left">Legal</label> <div class="col-9 col-lg-10"> <select name="legal" class="form-control" id="input-select" required=""> <option value="<?php echo $legal;?>" ><?php echo $legal;?></option> <option value="YES">YES</option> <option value="NO">NO</option> </select> </div> </div> <div class="row pt-2 pt-sm-5 mt-1"> <div class="col-sm-6 pb-2 pb-sm-4 pb-lg-0 pr-0"> </div> <div class="col-sm-6 pl-0"> <p class="text-right"> <button type="submit" class="btn btn-space btn-primary">Admit</button> </p> </div> </div> </form> </div> </div> </div> <!-- ============================================================== --> <!-- end basic form --> <!-- ============================================================== --> </div> </div> </div> </div> </div> </div> <!-- ============================================================== --> <!-- footer --> <!-- ============================================================== --> <div class="footer"> <div class="container-fluid"> <div class="row"> <div class="col-xl-6 col-lg-6 col-md-12 col-sm-12 col-12"> Copyright © 2018 Concept. All rights reserved. Dashboard by <a href="https://colorlib.com/wp/">Colorlib</a>. </div> <div class="col-xl-6 col-lg-6 col-md-12 col-sm-12 col-12"> <div class="text-md-right footer-links d-none d-sm-block"> <a href="javascript: void(0);">About</a> <a href="javascript: void(0);">Support</a> <a href="javascript: void(0);">Contact Us</a> </div> </div> </div> </div> </div> <!-- ============================================================== --> <!-- end footer --> <!-- ============================================================== --> </div> </div> <!-- ============================================================== --> <!-- end main wrapper --> <!-- ============================================================== --> <!-- Optional JavaScript --> <script src="../assets/vendor/jquery/jquery-3.3.1.min.js"></script> <script src="../assets/vendor/bootstrap/js/bootstrap.bundle.js"></script> <script src="../assets/vendor/slimscroll/jquery.slimscroll.js"></script> <script src="../assets/vendor/parsley/parsley.js"></script> <script src="../assets/libs/js/main-js.js"></script> <script> $('#form').parsley(); </script> <script> // Example starter JavaScript for disabling form submissions if there are invalid fields (function() { 'use strict'; window.addEventListener('load', function() { // Fetch all the forms we want to apply custom Bootstrap validation styles to var forms = document.getElementsByClassName('needs-validation'); // Loop over them and prevent submission var validation = Array.prototype.filter.call(forms, function(form) { form.addEventListener('submit', function(event) { if (form.checkValidity() === false) { event.preventDefault(); event.stopPropagation(); } form.classList.add('was-validated'); }, false); }); }, false); })(); </script> </body> </html>