mirror of
https://gitlab.com/signalytic/client-external/streamline/streamline-emr.git
synced 2026-09-11 18:51:31 +00:00
219 lines
12 KiB
PHP
Executable File
219 lines
12 KiB
PHP
Executable File
@extends('layouts.main')
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@push('styles')
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<link href="{{ asset('elite/bower_components/bootstrap-datepicker/bootstrap-datepicker.min.css') }}" rel="stylesheet" type="text/css" />
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<link href="{{ asset('elite/bower_components/select2/select2.min.css') }}" rel="stylesheet" />
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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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<h4 class="page-title">{{ __('hospital_information.hospital_information') }}</h4>
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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') }}">{{ __('hospital_information.dashboard') }}</a></li>
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<li><a href="/hospital_information/edit">{{ __('hospital_information.hospital_information') }}</a></li>
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<li class="active">{{ __('hospital_information.edit') }}</li>
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</ol>
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</div>
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</div>
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<div class="row">
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<div class="col-sm-12">
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<!--Flash messages at the top -->
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@include('flash::message')
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<div class="white-box">
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@if (session()->has('streamline_setup'))
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<h3><font color="blue">Stre@mline {{ __('hospital_information.setup') }} ({{ __('hospital_information.step') }} 1 {{ __('hospital_information.of') }} 10)</font></h3>
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@endif
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{{ Form::open(['route' => 'hospital_information.store', 'data-toggle' => 'validator', 'files' => true]) }}
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<div class="row">
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<div class="col-md-6">
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<div class="form-group">
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{{ Form::label('name', __('hospital_information.hospital_name')) }}
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{{ Form::text('name', '', ['class' => 'form-control compulsory', 'required', 'data-error'=>'']) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('level', __('hospital_information.level')) }}
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{{ Form::text('level', '', ['class' => 'form-control compulsory', 'required']) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('code', __('hospital_information.code')) }}
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{{ Form::text('code', '', ['class' => 'form-control']) }}
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</div>
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<div class="form-group">
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{{ Form::label('parish', __('hospital_information.parish')) }}
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{{ Form::select('parish', $parishes, '', ['class' => 'form-control parish']) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('sub_county', __('hospital_information.sub_county')) }}
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{{ Form::select('sub_county', $subcounties, '', ['class' => 'form-control sub_county']) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('sub_district', __('hospital_information.health_sub_district')) }}
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{{ Form::text('sub_district', '', ['class' => 'form-control sub_district']) }}
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</div>
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<div class="form-group">
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{{ Form::label('address', __('hospital_information.address')) }}
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{{ Form::text('address', '', ['class' => 'form-control compulsory', 'required']) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('website', __('hospital_information.website')) }}
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{{ Form::text('website', '', ['class' => 'form-control']) }}
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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{{ Form::label('phone_number', __('hospital_information.phone_number')) }}
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{{ Form::text('phone_number', '', ['class' => 'form-control compulsory', 'required']) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('email', __('hospital_information.email')) }}
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{{ Form::email('email', '', ['class' => 'form-control compulsory', 'required']) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('financial_year_start_date', 'Start of Financial Year') }}
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{{-- {{ Form::date('financial_year_start_date', '', ['class' => 'form-control', 'required']) }} --}}
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<select id="month" name="financial_year_start_date" class = "form-control compulsory">
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<option value="">-- Select --</option>
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<option value="01">January</option>
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<option value="02">February</option>
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<option value="03">March</option>
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<option value="04">April</option>
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<option value="05">May</option>
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<option value="06">June</option>
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<option value="07">July</option>
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<option value="08">August</option>
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<option value="09">September</option>
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<option value="10">October</option>
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<option value="11">November</option>
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<option value="12">December</option>
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</select>
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('back_date', 'Back Dating Cutoff Days') }}
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{{ Form::number('back_date', '', ['class' => 'form-control compulsory', 'required','min' => 1]) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('district', __('hospital_information.district')) }}
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{{ Form::select('district', $districts, '', ['class' => 'form-control compulsory district']) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('country', __('hospital_information.country')) }}
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{{ Form::text('country', '', ['class' => 'form-control compulsory', 'required']) }}
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<div class="help-block with-errors"></div>
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</div>
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{{--<div class="form-group">
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{{ Form::label('app_name', 'App name') }}
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{{ Form::text('app_name', '', ['class' => 'form-control compulsory', 'required']) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('app_version', 'App version') }}
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{{ Form::number('app_version', '', ['class' => 'form-control compulsory', 'required', 'step' => 0.1]) }}
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<div class="help-block with-errors"></div>
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</div>--}}
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<div class="form-group">
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{{ Form::label('patient_number_abbr', __('hospital_information.patient_number_abbr')) }}
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{{ Form::text('patient_number_abbr', '', ['class' => 'form-control compulsory', 'required', 'max'=>'3']) }}
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<div class="help-block with-errors"></div>
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</div>
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@php
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use Carbon\Carbon;
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$currentYear = Carbon::now()->year;
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$current_year_last_two_digits = substr($currentYear,-2);
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@endphp
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<div class="form-group">
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<label for=""> {{ __('hospital_information.patient_number_year_prefix') }}</label>
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( ABC - {{$current_year_last_two_digits }} - 001 )
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<a href="javascript::void(0)" data-toggle="tooltip" rel="tooltip" data-placement="top" title="Enabling this feature will add the last two digits of the year to the Patient number abbreviation" data-original-title=""> <i class="fa fa-info-circle"></i></a>
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<br>
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<div class="card card-outline-secondary text-dark">
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<div class="card-block">
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<input checked="checked" name="patient_number_year_prefix" id="year_prefix_disabled" type="radio" value="0">
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<label for="year_prefix_disabled"> {{ __('hospital_information.disabled') }}</label>
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<br>
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<input name="patient_number_year_prefix" type="radio" id="year_prefix_enabled" value="1">
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<label for="year_prefix_enabled"> {{ __('hospital_information.enabled') }} </label>
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</div>
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</div><br>
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</div>
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<div class="form-group">
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{{ Form::label('logo', __('hospital_information.system_logo')) }}
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{{ Form::file('logo', null) }}
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{{ Form::text('current_logo', '', ['class' => 'form-control', 'hidden']) }}
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</div>
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<div class="form-group">
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{{ Form::label('stamp', __('hospital_information.stamp')) }}
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{{ Form::file('stamp', null) }}
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{{ Form::text('current_stamp', '', ['class' => 'form-control', 'hidden']) }}
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</div>
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<div class="form-group">
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{{ Form::label('lab_stamp', __('hospital_information.lab_stamp')) }}
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{{ Form::file('lab_stamp', null) }}
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{{ Form::text('current_lab_stamp', '', ['class' => 'form-control', 'hidden']) }}
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</div>
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</div>
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</div>
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{{ Form::button(__('hospital_information.next'),['type'=>'submit','class'=>'btn btn-success btn-lg waves-effect waves-light m-r-10']) }}
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{{--{{ Form::button('Skip',['type'=>'reset','class'=>'btn btn-default btn-lg waves-effect waves-light']) }}--}}
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{{ Form::close() }}
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</div>
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</div>
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</div>
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@endsection
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@push('scripts')
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<script src="{{ asset('elite/js/validator.js') }}"></script>
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<script src="{{ asset('elite/bower_components/select2/select2.min.js') }}"></script>
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<script type="text/javascript">
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$(document).ready(function(){
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$('.parish,.sub_county,.district').select2({
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placeholder: "-- select --"
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});
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$('.select2-selection.select2-selection--single').css('height','calc(3.85rem)');
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$('.select2-selection.select2-selection--single').css('padding-top','5px');
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//$('.select2-selection.select2-selection--single').css('border-left', '3px solid #F08080');/*add compulsory class*/
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$('.select2-selection.select2-selection--single.sec_d').css('border-left', '3px solid #aaa');
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$('.select2-selection__arrow').css('top','3px');
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})
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</script>
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@endpush
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