mirror of
https://gitlab.com/signalytic/client-external/streamline/streamline-emr.git
synced 2026-09-11 18:51:31 +00:00
alec.turner
4a89356390
An updated set of source files and initialization was provided by streamline to address issues observed during initial testing. These files have been updated in order to generate a new set of app images.
60 lines
3.5 KiB
PHP
Executable File
60 lines
3.5 KiB
PHP
Executable File
<div class="modal fade" id="diagnosisModal" tabindex="-1" role="dialog">
|
|
<div class="modal-dialog modal-lg" role="document">
|
|
<div class="modal-content">
|
|
<div class="modal-header">
|
|
<button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button>
|
|
<h4 class="modal-title" id="exampleModalLabel1">{{ __('consultations.add_new_diagnosis') }}</h4>
|
|
</div>
|
|
<div class="modal-body">
|
|
<div class="row">
|
|
<div class="col-sm-6">
|
|
<div class="form-group">
|
|
{{ Form::label('diagnosis_name', __('diagnoses.diagnosis_name')) }}
|
|
{{ Form::text('diagnosis_name', '', ['class' => 'form-control compulsory', 'id'=>'diagnosis_name']) }}
|
|
<div class="help-block with-errors"></div>
|
|
</div>
|
|
|
|
<div class="form-group">
|
|
{{ Form::label('icd10_code', __('diagnoses.icd_10_code')) }}
|
|
{{ Form::text('icd10_code', '', ['class' => 'form-control','id'=>'icd10_code']) }}
|
|
</div>
|
|
|
|
<div class="form-group">
|
|
{{ Form::label('hmis_no_outpatient', __('diagnoses.hmis_out_patient_number')) }}
|
|
{{ Form::text('hmis_no_outpatient', '', ['class'=>'form-control','id'=>'hmis_no_outpatient']) }}
|
|
</div>
|
|
|
|
<div class="form-group">
|
|
{{ Form::label('hmis_no_inpatient', __('diagnoses.hmis_inpatient_category')) }}
|
|
{{ Form::text('hmis_no_inpatient', '', ['class'=>'form-control','id'=>'hmis_no_inpatient']) }}
|
|
</div>
|
|
|
|
<div class="form-group">
|
|
{{ Form::label('hmis_category', __('diagnoses.hmis_category')) }}
|
|
{{ Form::select('hmis_category', $hmis_categories, '', ['class' => 'form-control','id'=>'hmis_category']) }}
|
|
</div>
|
|
</div>
|
|
|
|
<div class="col-sm-6">
|
|
<div class="form-group">
|
|
{{ Form::label('diagnosis_prompts', __('diagnoses.diagnosis_prompt')) }}
|
|
{{ Form::textArea('diagnosis_prompts', '', ['class'=>'form-control','id'=>'diagnosis_prompts', 'rows' => 5]) }}
|
|
</div>
|
|
|
|
<div class="form-group">
|
|
{{ Form::label('', __('diagnoses.chronic_status'), ["class"=>'col-md-12']) }}
|
|
{{ __('diagnoses.yes') }} {{ Form::radio('chronic_status', 1, false, ['class' => 'check', 'id' => 'chronic_yes']) }}
|
|
{{ __('diagnoses.no') }} {{ Form::radio('chronic_status', 0, false, ['class' => 'check', 'id' => 'chronic_no']) }}
|
|
<div class="help-block with-errors"></div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
<div class="modal-footer">
|
|
<button type="button" class="btn btn-default" data-dismiss="modal">{{ __('consultations.cancel') }}</button>
|
|
<a class="btn btn-success" onclick="submitDiagnosis()">{{ __('consultations.add_diagnosis') }}</a>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div> |