mirror of
https://gitlab.com/signalytic/client-external/streamline/streamline-emr.git
synced 2026-09-13 19:51:30 +00:00
updated streamline-setup v2
This commit is contained in:
Executable
+273
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@extends('layouts.main')
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@push('styles')
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<style>
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body{
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font-size: small;
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line-height: none;
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}
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</style>
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@endpush
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@section('content')
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<div class="row bg-title">
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<div class="col-lg-3 col-md-4 col-sm-4 col-xs-12">
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<h5 class="page-title">{{ __('reports.charge_book') }}</h5>
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</div>
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<div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
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<ol class="breadcrumb">
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<li><a href="{{ route('home') }}">{{ __('reports.dashboard') }}</a></li>
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<li><a href="{{ url('list_memorised_reports') }}">{{ __('reports.memorised_streamline_reports') }}</a></li>
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<li class="active">{{ __('reports.charge_book') }}</li>
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</ol>
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</div>
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</div>
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@php
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$count = 1;
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$item_count = 0;
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$items_max = 20;
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$number_of_sections = ceil(count($drugs) / $items_max);
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$number_of_table_row = ceil($number_of_sections / 3);
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@endphp
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<div class="white-box">
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<?php
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$drugChunk = round(count($drugs) / 2);
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$drug_items = array_chunk($drugs, $drugChunk, true);
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$procedureChunk = round(count($procedures) / 2);
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$procedure_items = array_chunk($procedures, $procedureChunk, true);
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$sundryChunk = round(count($sundries) / 2);
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$sundry_items = array_chunk($sundries, $sundryChunk, true);
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$investigationChunk = (count($investigations) / 2);
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$investigation_items = array_chunk($investigations, $investigationChunk, true);
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$serviceChunk = round(count($services) / 2);
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$service_items = array_chunk($services, $serviceChunk, true);
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$bedsChunk = round(count($bed_categories) / 2);
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$bed_category_items = array_chunk($bed_categories, $bedsChunk, true);
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?>
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<a class="btn btn-inverse float-right" target="_blank" href="<?php echo route('reports.charge-book.print'); ?>">{{ __('reports.print_pdf') }}</a>
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<h4 class="heading">{{ __('reports.bed_categories') }}</h4>
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<hr>
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<div class="row">
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@foreach($bed_category_items as $items)
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<div class="col-md-6">
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<table class="table color-bordered-table success-bordered-table">
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<thead>
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<tr>
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<th>#</th>
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<th>{{ __('bed_categories.bed_category_name') }}</th>
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<th>{{ __('bed_categories.type_of_pricing') }}</th>
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<th>{{ __('bed_categories.per_night') }}</th>
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<th>{{ __('bed_categories.first_night') }}</th>
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<th>{{ __('bed_categories.range_of_nights') }}</th>
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<th>{{ __('bed_categories.cost_for_range') }}</th>
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<th>{{ __('bed_categories.cost_there_after') }}</th>
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</tr>
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</thead>
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<tbody>
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@php $counter = 1; @endphp
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@foreach($items as $bed_category)
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<tr>
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<td>{{ $counter }}</td>
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<td>{{ $bed_category->name }}</td>
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<td>{{ $bed_category->cost_type == 1 ? 'Static Cost' : 'Structured cost' }}</td>
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<td>{{ !is_null($bed_category->cost_per_night) ? ugandan_shillings($bed_category->cost_per_night) : 'N/A' }}</td>
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<td>{{ !is_null($bed_category->cost_first_night) ? ugandan_shillings($bed_category->cost_first_night) : 'N/A' }}</td>
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<td>
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@if(!is_null($bed_category->to_night))
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2 - {{ $bed_category->to_night }}
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@else
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N/A
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@endif
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</td>
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<td>{{ !is_null($bed_category->cost_range) ? ugandan_shillings($bed_category->cost_range) : 'N/A'}}</td>
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<td>{{ !is_null($bed_category->cost_after) ? ugandan_shillings($bed_category->cost_after) : 'N/A' }}</td>
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</tr>
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@php $counter++; @endphp
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@endforeach
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</tbody>
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</table>
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</div>
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@endforeach
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</div>
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<h4 class="heading">{{ __('reports.drugs') }}</h4>
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<hr>
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<div class="row">
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<?php $index = 1; ?>
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@foreach($drug_items as $items)
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<div class = "col-md-6">
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<table class = "table table-sm color-table success-table">
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<thead>
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<tr>
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<th width='2%'>#</th>
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<th>{{ __('reports.name') }}</th>
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<th>{{ __('reports.non_insured') }}</th>
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<th>{{ __('reports.insured') }}</th>
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</tr>
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</thead>
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<tbody>
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@foreach($items as $item)
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<tr>
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<td><?php echo $index; ?></td>
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@if($item->insurance_coverage == 0)
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<td style = "color: orange;">{{ trim($item->name) }}</td>
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@else
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<td style = "color: green;">{{ trim($item->name) }}</td>
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@endif
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<td>{{ commas($item->non_insured_price) }}</td>
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<td>{{ commas($item->insured_price) }}</td>
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</tr>
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<?php $index++; ?>
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@endforeach
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</tbody>
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</table>
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</div>
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@endforeach
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</div>
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<h4 class="heading">{{ __('reports.sundries') }}</h4>
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<hr>
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<div class = "row">
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<?php $index = 1; ?>
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@foreach($sundry_items as $items)
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<div class = "col-md-6">
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<table class = "table table-sm color-table success-table">
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<thead>
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<tr>
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<th>#</th>
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<th>{{ __('reports.name') }}</th>
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<th>{{ __('reports.non_insured') }}</th>
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<th>{{ __('reports.insured') }}</th>
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</tr>
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</thead>
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<tbody>
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@foreach($items as $item)
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<tr>
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<td>{{ $index }}</td>
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<td>{{ $item->name }}</td>
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<td>{{ commas($item->non_insured_price) }}</td>
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<td>{{ commas($item->insured_price) }}</td>
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</tr>
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<?php $index++ ?>
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@endforeach
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</tbody>
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</table>
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</div>
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@endforeach
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</div>
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<h4 class="heading">{{ __('reports.procedures') }}</h4>
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<hr>
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<div class = "row">
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<?php $index = 1; ?>
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@foreach($procedure_items as $items)
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<div class = "col-md-6">
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<table class = "table table-sm color-table success-table">
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<thead>
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<tr>
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<th>#</th>
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<th>{{ __('reports.name') }}</th>
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<th>{{ __('reports.non_insured') }}</th>
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<th>{{ __('reports.insured') }}</th>
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</tr>
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</thead>
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<tbody>
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@foreach($items as $item)
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<tr>
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<td>{{ $index }}</td>
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<td>{{ $item->name }}</td>
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<td>{{ commas($item->non_insured_price) }}</td>
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<td>{{ commas($item->insured_price) }}</td>
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</tr>
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<?php $index++ ?>
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@endforeach
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</tbody>
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</table>
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</div>
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@endforeach
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</div>
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<h4 class="heading">{{ __('reports.investigations') }}</h4>
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<hr>
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<div class = "row">
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<?php $index = 1; ?>
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@foreach($investigation_items as $items)
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<div class = "col-md-6">
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<table class = "table table-sm color-table success-table">
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<thead>
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<tr>
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<th>#</th>
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<th>{{ __('reports.name') }}</th>
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<th>{{ __('reports.insured') }}</th>
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<th>{{ __('reports.non_insured') }}</th>
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<th>{{ __('reports.insured') }}</th>
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</tr>
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</thead>
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<tbody>
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@foreach($items as $item)
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<tr>
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<td>{{ $index }}</td>
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<td>{{ $item->name }}</td>
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@if($item->insurance_coverage == 0)
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<td style = "color: red">{{ __('reports.no') }}</td>
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@else
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<td style = "color: green">{{ __('reports.yes') }}</td>
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@endif
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<td>{{ commas($item->non_insured_price) }}</td>
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<td>{{ commas($item->insured_price) }}</td>
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</tr>
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<?php $index++; ?>
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@endforeach
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</tbody>
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</table>
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</div>
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@endforeach
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</div>
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<h4 class="heading">{{ __('reports.services') }}</h4>
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<hr>
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<div class = "row">
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<?php $index = 1; ?>
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@foreach($service_items as $items)
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<div class = "col-md-6">
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<table class = "table table-sm color-table success-table">
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<thead>
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<tr>
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<th>#</th>
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<th>{{ __('reports.name') }}</th>
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<th>{{ __('reports.non_insured') }}</th>
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<th>{{ __('reports.insured') }}</th>
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</tr>
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</thead>
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<tbody>
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@foreach($items as $item)
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<tr>
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<td>{{ $index }}</td>
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@if($item->insurance_coverage == 0)
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<td style="color: orange;">{{ $item->name }}</td>
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@else
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<td style = "color: green">{{ $item->name }}</td>
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@endif
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<td>{{ commas($item->non_insured_price) }}</td>
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<td>{{ commas($item->insured_price) }}</td>
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</tr>
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<?php $index++; ?>
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@endforeach
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</tbody>
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</table>
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</div>
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@endforeach
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</div>
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</div>
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@endsection
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Executable
+278
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<!DOCTYPE html>
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<html lang="{{ app()->getLocale() }}">
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<head>
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<meta charset="utf-8">
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<meta http-equiv="X-UA-Compatible" content="IE=edge">
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<meta name="viewport" content="width=device-width, initial-scale=1">
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<meta name="description" content="">
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<meta name="author" content="">
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<link rel="icon" type="image/png" sizes="16x16" href="{{ asset('uploads/streamline/color/streamline_icon-02.png') }}">
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<title>{{ config('app.name', 'HMIS Report 105 - Stre@mline') }}</title>
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<!-- Bootstrap Core CSS -->
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<link href="{{ asset('bootstrap/css/bootstrap.min.css') }}" rel="stylesheet">
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<style style="text-css">
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body{
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/*font-size: 1.2em;*/
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}
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thead {
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display: table-header-group;
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}
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tfoot {
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display: table-row-group;
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}
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tr {
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page-break-inside: avoid;
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}
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</style>
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</head>
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<?php
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$drugChunk = round(count($drugs) / 2);
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$drug_items = array_chunk($drugs, $drugChunk, true);
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$procedureChunk = round(count($procedures) / 2);
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$procedure_items = array_chunk($procedures, $procedureChunk, true);
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$sundryChunk = round(count($sundries) / 2);
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$sundry_items = array_chunk($sundries, $sundryChunk, true);
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$investigationChunk = (count($investigations) / 2);
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$investigation_items = array_chunk($investigations, $investigationChunk, true);
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$serviceChunk = round(count($services) / 2);
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$service_items = array_chunk($services, $serviceChunk, true);
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$bedsChunk = round(count($bed_categories) / 2);
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$bed_category_items = array_chunk($bed_categories, $bedsChunk, true);
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?>
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<body>
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<div class="container-fluid">
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@include('layouts.header_pdf_print')
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<h3 class="heading" style="text-align: center;">{{ __('reports.charge_book') }}</h3>
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<h4 class="heading">{{ __('reports.bed_categories') }}</h4>
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<div class="row">
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@foreach($bed_category_items as $items)
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<div class="col">
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<table class="table color-bordered-table success-bordered-table">
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<thead>
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<tr>
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<th>#</th>
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<th>{{ __('bed_categories.name') }}</th>
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<th>{{ __('bed_categories.type') }}</th>
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<th>{{ __('bed_categories.per_night') }}</th>
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<th>{{ __('bed_categories.first_night') }}</th>
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<th>{{ __('bed_categories.range_of_nights') }}</th>
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<th>{{ __('bed_categories.cost_for_range') }}</th>
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<th>{{ __('bed_categories.cost_there_after') }}</th>
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</tr>
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</thead>
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<tbody>
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@php $counter = 1; @endphp
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@foreach($items as $bed_category)
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<tr>
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<td>{{ $counter }}</td>
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<td>{{ $bed_category->name }}</td>
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<td>{{ $bed_category->cost_type == 1 ? 'Static Cost' : 'Structured cost' }}</td>
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<td>{{ !is_null($bed_category->cost_per_night) ? ugandan_shillings($bed_category->cost_per_night) : 'N/A' }}</td>
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<td>{{ !is_null($bed_category->cost_first_night) ? ugandan_shillings($bed_category->cost_first_night) : 'N/A' }}</td>
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<td>
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@if(!is_null($bed_category->to_night))
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2 - {{ $bed_category->to_night }}
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@else
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N/A
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@endif
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</td>
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<td>{{ !is_null($bed_category->cost_range) ? ugandan_shillings($bed_category->cost_range) : 'N/A'}}</td>
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<td>{{ !is_null($bed_category->cost_after) ? ugandan_shillings($bed_category->cost_after) : 'N/A' }}</td>
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</tr>
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@php $counter++; @endphp
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@endforeach
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</tbody>
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</table>
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</div>
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@endforeach
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</div>
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<h4 class="heading mt-4">{{ __('reports.drugs') }}</h4>
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<!--<hr>-->
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<div class="row">
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<?php $index = 1; ?>
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@foreach($drug_items as $items)
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<div class = "col">
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<table class = "table table-sm color-table success-table">
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<thead class="thead-light">
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<tr>
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<th width='2%'>#</th>
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<th>{{ __('reports.name') }}</th>
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<th>{{ __('reports.non_insured') }}</th>
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<th>{{ __('reports.insured') }}</th>
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</tr>
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</thead>
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<tbody>
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@foreach($items as $item)
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<tr>
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<td><?php echo $index; ?></td>
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@if($item->insurance_coverage == 0)
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<td style = "color: orange;">{{ trim($item->name) }}</td>
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@else
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<td style = "color: green;">{{ trim($item->name) }}</td>
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@endif
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<td>{{ commas($item->non_insured_price) }}</td>
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<td>{{ commas($item->insured_price) }}</td>
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</tr>
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<?php $index++; ?>
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@endforeach
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</tbody>
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</table>
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</div>
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@endforeach
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</div>
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<h4 class="heading mt-5">{{ __('reports.sundries') }}</h4>
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<hr>
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<div class = "row">
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<?php $index = 1; ?>
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@foreach($sundry_items as $items)
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<div class = "col">
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<table class = "table table-sm color-table success-table">
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<thead class="thead-light">
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<tr>
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<th>#</th>
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<th>{{ __('reports.name') }}</th>
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<th>{{ __('reports.non_insured') }}</th>
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<th>{{ __('reports.insured') }}</th>
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</tr>
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</thead>
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<tbody>
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@foreach($items as $item)
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<tr>
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<td>{{ $index }}</td>
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<td>{{ $item->name }}</td>
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<td>{{ commas($item->non_insured_price) }}</td>
|
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<td>{{ commas($item->insured_price) }}</td>
|
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</tr>
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||||
<?php $index++ ?>
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@endforeach
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</tbody>
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</table>
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</div>
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@endforeach
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</div>
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||||
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<h4 class="heading mt-3">{{ __('reports.procedures') }}</h4>
|
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<hr>
|
||||
<div class = "row">
|
||||
<?php $index = 1; ?>
|
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@foreach($procedure_items as $items)
|
||||
<div class = "col">
|
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<table class = "table table-sm color-table success-table">
|
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<thead class="thead-light">
|
||||
<tr>
|
||||
<th>#</th>
|
||||
<th>{{ __('reports.name') }}</th>
|
||||
<th>{{ __('reports.non_insured') }}</th>
|
||||
<th>{{ __('reports.insured') }}</th>
|
||||
</tr>
|
||||
</thead>
|
||||
<tbody>
|
||||
@foreach($items as $item)
|
||||
<tr>
|
||||
<td>{{ $index }}</td>
|
||||
<td>{{ $item->name }}</td>
|
||||
<td>{{ commas($item->non_insured_price) }}</td>
|
||||
<td>{{ commas($item->insured_price) }}</td>
|
||||
</tr>
|
||||
<?php $index++ ?>
|
||||
@endforeach
|
||||
</tbody>
|
||||
</table>
|
||||
</div>
|
||||
@endforeach
|
||||
</div>
|
||||
|
||||
<h4 class="heading mt-3">{{ __('reports.investigations') }}</h4>
|
||||
<hr>
|
||||
<div class = "row">
|
||||
<?php $index = 1; ?>
|
||||
@foreach($investigation_items as $items)
|
||||
<div class = "col">
|
||||
<table class = "table table-sm color-table success-table">
|
||||
<thead class="thead-light">
|
||||
<tr>
|
||||
<th>#</th>
|
||||
<th>{{ __('reports.name') }}</th>
|
||||
<th>{{ __('reports.insured') }}</th>
|
||||
<th>{{ __('reports.non_insured') }}</th>
|
||||
<th>{{ __('reports.insured') }}</th>
|
||||
</tr>
|
||||
</thead>
|
||||
<tbody>
|
||||
@foreach($items as $item)
|
||||
<tr>
|
||||
<td>{{ $index }}</td>
|
||||
<td>{{ $item->name }}</td>
|
||||
@if($item->insurance_coverage == 0)
|
||||
<td style = "color: red">{{ __('reports.no') }}</td>
|
||||
@else
|
||||
<td style = "color: green">{{ __('reports.yes') }}</td>
|
||||
@endif
|
||||
<td>{{ commas($item->non_insured_price) }}</td>
|
||||
<td>{{ commas($item->insured_price) }}</td>
|
||||
</tr>
|
||||
<?php $index++; ?>
|
||||
@endforeach
|
||||
</tbody>
|
||||
</table>
|
||||
</div>
|
||||
@endforeach
|
||||
</div>
|
||||
|
||||
<h4 class="heading mt-3">{{ __('reports.services') }}</h4>
|
||||
<hr>
|
||||
<div class = "row">
|
||||
<?php $index = 1; ?>
|
||||
@foreach($service_items as $items)
|
||||
<div class = "col">
|
||||
<table class = "table table-sm color-table success-table">
|
||||
<thead class="thead-light">
|
||||
<tr>
|
||||
<th>#</th>
|
||||
<th>{{ __('reports.name') }}</th>
|
||||
<th>{{ __('reports.non_insured') }}</th>
|
||||
<th>{{ __('reports.insured') }}</th>
|
||||
</tr>
|
||||
</thead>
|
||||
<tbody>
|
||||
@foreach($items as $item)
|
||||
<tr>
|
||||
<td>{{ $index }}</td>
|
||||
@if($item->insurance_coverage == 0)
|
||||
<td style="color: orange;">{{ $item->name }}</td>
|
||||
@else
|
||||
<td style = "color: green">{{ $item->name }}</td>
|
||||
@endif
|
||||
<td>{{ commas($item->non_insured_price) }}</td>
|
||||
<td>{{ commas($item->insured_price) }}</td>
|
||||
</tr>
|
||||
<?php $index++; ?>
|
||||
@endforeach
|
||||
</tbody>
|
||||
</table>
|
||||
</div>
|
||||
@endforeach
|
||||
</div>
|
||||
</div>
|
||||
|
||||
</body>
|
||||
</html>
|
||||
+199
@@ -0,0 +1,199 @@
|
||||
@extends('layouts.main')
|
||||
|
||||
@push('styles')
|
||||
<style type="text/css">
|
||||
/* code {
|
||||
text-decoration-line: underline;
|
||||
text-decoration-style: dotted;
|
||||
}*/
|
||||
</style>
|
||||
@endpush
|
||||
|
||||
@section('content')
|
||||
<div class="row bg-title">
|
||||
<div class="col-lg-3 col-md-4 col-sm-4 col-xs-12">
|
||||
<h4 class="page-title">Notification of Birth</h4>
|
||||
</div>
|
||||
<div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
|
||||
<ol class="breadcrumb">
|
||||
<li><a href="{{ route('home') }}">Dashboard</a></li>
|
||||
<li class="active">NIRA Birth Report</li>
|
||||
<li class=""><button id="printPurchaseOrderReceipt" class="btn btn-sm btn-inverse waves-effect waves-light"> <i class="fa fa-print m-r-5"></i> <span>PRINT</span></button></li>
|
||||
</ol>
|
||||
</div>
|
||||
</div>
|
||||
|
||||
<div class="white-box" id="printableContent">
|
||||
|
||||
<div class="row" id="divToPrint">
|
||||
<div class="col-md-12">
|
||||
@include('flash::message')
|
||||
FORM 3
|
||||
Regulation 8 (1)
|
||||
<table class="table-condensed table-borderless" width="100%">
|
||||
<thead >
|
||||
<tr>
|
||||
<th scope="col"> </th>
|
||||
<th scope="col" style="text-align: center;">
|
||||
<img src="{{ asset('uploads/images/nira/nira-logo.PNG') }}" class="center-block" style="height: 180px; width: 320px;"> <br />
|
||||
THE REGISTRATION OF PERSONS (BIRTHS AND DEATHS)<br />
|
||||
REGULATIONS, 2015
|
||||
</th>
|
||||
</tr>
|
||||
</thead>
|
||||
<tbody>
|
||||
<tr>
|
||||
<td colspan="2"><strong>NOTICE OF BIRTH OF A CHILD</strong></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>1</td>
|
||||
<td> Date of birth (dd/mm/yy): <code class="text-info" style='font-size: medium;'>{{ $babyOne['dob'] }}</code> Time of birth <code class="text-info" style='font-size: medium;'>{{ $babyOne['delivery_time'] }}</code></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>2</td>
|
||||
<td>Place of birth <code class="text-info" style='font-size: medium;'>{{ $babyOne['hospitalLocation'] }}</code> <br />Name of medical facility <code class="text-info" style='font-size: medium;'>{{ $babyOne['hospitalName'] }}</code> <br>No. of
|
||||
House and name of street .....................................................................................................................<br />
|
||||
City, Municipality, town or village <code class="text-info" style='font-size: medium;'>{{ $babyOne['hospitalLocation'] }}</code><br />
|
||||
District <code class="text-info" style='font-size: medium;'>{{ $babyOne['hospitalDistrict'] }}</code> </td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>3</td>
|
||||
<td>Name (if any) of child ..............................................................................................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>4</td>
|
||||
<td>Sex of child <code class="text-info" style='font-size: medium;'>{{ $babyOne['gender'] == 1 ? 'Male' : 'Female' }}</code></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>5</td>
|
||||
<td>Weight at birth <code class="text-info" style='font-size: medium;'>{{ $babyOne['weight'] }} Kg</code></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td> </td>
|
||||
<td><strong>FATHER</strong></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>6</td>
|
||||
<td> Surname......................................................................................................................................<br />
|
||||
Given Name........................................Other Names....................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>7</td>
|
||||
<td> Address (both physical and postal) .....................................................................................................<br />
|
||||
a) Village.............................................................................................................................<br />
|
||||
b) Parish...............................................................................................................................<br />
|
||||
c) Sub county ......................................................................................................................<br />
|
||||
d) County............................................................................................................................<br />
|
||||
e) District............................................................................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>8</td>
|
||||
<td>Occupation..........................................................................................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>9</td>
|
||||
<td>Nationality...........................................................................................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>10</td>
|
||||
<td>National Identification Number/Alien Identification Number*<br />
|
||||
..../..../..../..../..../..../..../..../..../..../..../..../..../..../</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td> </td>
|
||||
<td><strong>MOTHER</strong></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>11</td>
|
||||
<td>Surname <code class="text-info" style='font-size: medium;'>{{ $mother['last_name'] }} </code><br />
|
||||
Given Name <code class="text-info" style='font-size: medium;'>{{ $mother['first_name'] }} </code> Other Names....................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>12</td>
|
||||
<td>Maiden name ....................................................................................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>13</td>
|
||||
<td>Address<br />
|
||||
(a) Village <code class="text-info" style='font-size: medium;'>{{ $mother['village'] }}</code><br />
|
||||
(b) Parish <code class="text-info" style='font-size: medium;'>{{ $mother['parish'] }}</code><br />
|
||||
(c) Sub county <code class="text-info" style='font-size: medium;'>{{ $mother['subcounty'] }}</code><br />
|
||||
(d) County <code class="text-info" style='font-size: medium;'>{{ $mother['county'] }}</code><br />
|
||||
(e) District <code class="text-info" style='font-size: medium;'>{{ $mother['district'] }}</code></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>14</td>
|
||||
<td>Occupation <code class="text-info" style='font-size: medium;'>{{ $mother['occupation'] }}</code></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>16</td>
|
||||
<td>Parity1 ................................................................................................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>17</td>
|
||||
<td>Nationality <code class="text-info" style='font-size: medium;'>Ugandan</code></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>18</td>
|
||||
<td>National Identification Number/Alien Identification Number*<br />
|
||||
@php
|
||||
if(empty($mother['NIN'])):
|
||||
echo '..../..../..../..../..../..../..../..../..../..../..../..../..../..../';
|
||||
else:
|
||||
echo '<code class="text-info" style="font-size: medium;">' . $mother['NIN'] .'</code>';
|
||||
endif
|
||||
@endphp
|
||||
</tr>
|
||||
<tr>
|
||||
<td>19</td>
|
||||
<td>Why was the birth not registered within the prescribed period? <strong>*</strong><br />
|
||||
..................................................................................................................................................................................<br />
|
||||
I, ......................................................................................(Name)............... ...................................................., by occupation<br />
|
||||
residing at ....................................... in the district of.......................... in Uganda, declare that the information above, given by me, is true and correct, that I know this of my own knowledge and that my means of knowing this is (briefly state your means of knowledge and the capacity in which you give this information)<br />
|
||||
.............................................................................................................................................................................................<br />
|
||||
.............................................................................................................................................................................................<br />
|
||||
Signed by ............................ at .......................on this day of .................., 20........<br />
|
||||
.........................................<br />
|
||||
Signature of Declarant<br />
|
||||
In the presence of ......................................................................................... (full name of witness)<br />
|
||||
Living at .................................................................................. (full address)<br />
|
||||
N.B.—<br />
|
||||
1.All names must be written clearly in block capital letters.<br />
|
||||
2. All alterations must be initialed.<br />
|
||||
3.State whether the child is 1st, 2nd or 3rd, etc.<br />
|
||||
* delete whichever is not applicable.</td>
|
||||
</tr>
|
||||
</tbody>
|
||||
</table>
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
@endsection
|
||||
|
||||
@push('scripts')
|
||||
<script type="text/javascript">
|
||||
function printElementContent(elem, title) {
|
||||
var mywindow = window.open('', 'PRINT', 'height=400,width=600');
|
||||
var css = '<link href="/elite/bootstrap/dist/css/bootstrap.min.css" rel="stylesheet">';
|
||||
|
||||
mywindow.document.write('<html><head><title></title>');
|
||||
mywindow.document.write('</head><body >');
|
||||
mywindow.document.write(css);
|
||||
mywindow.document.write('<center><h3>' + title + '</h3></center>');
|
||||
mywindow.document.write(document.getElementById(elem).innerHTML);
|
||||
mywindow.document.write('</body></html>');
|
||||
mywindow.document.close(); // necessary for IE >= 10
|
||||
//mywindow.focus(); // necessary for IE >= 10*/
|
||||
setTimeout(function () {
|
||||
mywindow.focus();
|
||||
mywindow.print();
|
||||
mywindow.remove();
|
||||
}, 500);
|
||||
return true;
|
||||
}
|
||||
|
||||
$("#printPurchaseOrderReceipt").click(function (e) {
|
||||
printElementContent('printableContent', '');
|
||||
});
|
||||
</script>
|
||||
@endpush
|
||||
+171
@@ -0,0 +1,171 @@
|
||||
@extends('layouts.main')
|
||||
|
||||
@push('styles')
|
||||
<style type="text/css">
|
||||
/* code {
|
||||
text-decoration-line: underline;
|
||||
text-decoration-style: dotted;
|
||||
}*/
|
||||
</style>
|
||||
@endpush
|
||||
|
||||
@section('content')
|
||||
<div class="row bg-title">
|
||||
<div class="col-lg-3 col-md-4 col-sm-4 col-xs-12">
|
||||
<h4 class="page-title">Notification of Death</h4>
|
||||
</div>
|
||||
<div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
|
||||
<ol class="breadcrumb">
|
||||
<li><a href="{{ route('home') }}">Dashboard</a></li>
|
||||
<li class="active">NIRA Death Report</li>
|
||||
<li class=""><button id="printPurchaseOrderReceipt" class="btn btn-sm btn-inverse waves-effect waves-light"> <i class="fa fa-print m-r-5"></i> <span>PRINT</span></button></li>
|
||||
</ol>
|
||||
</div>
|
||||
</div>
|
||||
|
||||
<div class="white-box" id="printableContent">
|
||||
|
||||
<div class="row" id="divToPrint">
|
||||
<div class="col-md-12">
|
||||
@include('flash::message')
|
||||
FORM 12
|
||||
Regulation 19(4),20(1)
|
||||
<table class="table-condensed table-borderless" width="100%">
|
||||
<thead >
|
||||
<tr>
|
||||
<th colspan="2" scope="col" style="text-align: center; font-weight: bold">
|
||||
<img src="{{ asset('uploads/images/nira/nira-logo.PNG') }}" class="center-block" style="height: 180px; width: 320px;"> <br />
|
||||
THE REGISTRATION OF PERSONS (BIRTHS AND<br />
|
||||
DEATHS) REGULATIONS, 2015
|
||||
</th>
|
||||
</tr>
|
||||
</thead>
|
||||
<tbody>
|
||||
<tr>
|
||||
<td colspan="2"><strong>NOTIFICATION OF DEATH</strong></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td width="4%">1</td>
|
||||
<td width="96%">Name of deceased<br />
|
||||
Surname ...................................................................................<br />
|
||||
GivenName …………………................OtherName(s) .................................... <br /></td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>2</td>
|
||||
<td>Date of birth (dd/mm/yy)............................ <br />
|
||||
Place of birth ….............................................................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>3</td>
|
||||
<td>Date of death (dd/mm/yy) ............................Time of death........................................... <br />
|
||||
Place of death …............................................................................................................ <br />
|
||||
Name of hospital ......................................................... </td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>4</td>
|
||||
<td>No. of house and name of street..................................... <br />
|
||||
City, Municipality, town or village District..................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>5</td>
|
||||
<td>Sex</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>6</td>
|
||||
<td>Age</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>7</td>
|
||||
<td>Occupatoion</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>8</td>
|
||||
<td>Residence <br />
|
||||
a. Village <br />
|
||||
b. Parish <br />
|
||||
c. Sub County<br />
|
||||
d. County <br />
|
||||
e. District </td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>9</td>
|
||||
<td> Nationality </td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>10</td>
|
||||
<td>National Identification Number or Alien Identification Number <br />
|
||||
…/…/…/…/…/…/…/…/…/…/…/…/…/…</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>11</td>
|
||||
<td>Cause of death ...........................................................................................................</td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>12</td>
|
||||
<td>If a dead body is found, also the name and address of the finder and narrate <br />
|
||||
shortly the circumstances .................................................................................................<br />
|
||||
............................................................................................................................. ....... <br />
|
||||
............................................................................................................................. ....... </td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>13</td>
|
||||
<td>If name unknown, give full description for purposes of identification........................ <br />
|
||||
......................................................................... .................................................... ........ <br />
|
||||
.......................................................................................................................... .. ......... </td>
|
||||
</tr>
|
||||
<tr>
|
||||
<td>14</td>
|
||||
<td><p>Why was the death not registered within the prescribed period?*............................. <br />
|
||||
............................................................................................................................. ........ <br />
|
||||
I, ......................................., by occupation a …….…………..,residing <br />
|
||||
<br />
|
||||
at ...........................................,in the district of …………………………….<br />
|
||||
<br />
|
||||
in Uganda, declare that the information above, given by me, is true and<br />
|
||||
correct, that I know this of my own knowledge and that my means of<br />
|
||||
knowing this is (briefly state the means of knowledge and the capacity in <br />
|
||||
which you give this information) ............................................................... <br />
|
||||
.................................................................................................................... <br />
|
||||
Signed by …………………………………………… Date(dd/mm/yy)………………………… <br />
|
||||
.......................................................................... <br />
|
||||
Signature of Notifier <br />
|
||||
In the presence of ................................................................................ (name of witness) Living <br />
|
||||
at............................................................................................... .............. (full address) <br />
|
||||
.......................................................................... <br />
|
||||
Signature of Witness </p>
|
||||
<p>*delete whichever is not applicable. </p></td>
|
||||
</tr>
|
||||
</tbody>
|
||||
</table>
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
@endsection
|
||||
|
||||
@push('scripts')
|
||||
<script type="text/javascript">
|
||||
function printElementContent(elem, title) {
|
||||
var mywindow = window.open('', 'PRINT', 'height=400,width=600');
|
||||
var css = '<link href="/elite/bootstrap/dist/css/bootstrap.min.css" rel="stylesheet">';
|
||||
|
||||
mywindow.document.write('<html><head><title></title>');
|
||||
mywindow.document.write('</head><body >');
|
||||
mywindow.document.write(css);
|
||||
mywindow.document.write('<center><h3>' + title + '</h3></center>');
|
||||
mywindow.document.write(document.getElementById(elem).innerHTML);
|
||||
mywindow.document.write('</body></html>');
|
||||
mywindow.document.close(); // necessary for IE >= 10
|
||||
//mywindow.focus(); // necessary for IE >= 10*/
|
||||
setTimeout(function () {
|
||||
mywindow.focus();
|
||||
mywindow.print();
|
||||
mywindow.remove();
|
||||
}, 500);
|
||||
return true;
|
||||
}
|
||||
|
||||
$("#printPurchaseOrderReceipt").click(function (e) {
|
||||
printElementContent('printableContent', '');
|
||||
});
|
||||
</script>
|
||||
@endpush
|
||||
Reference in New Issue
Block a user