ikan Uploader :
Directory : /var/www/html/shardadiagnostics.in/application/views/templates/redlabel/
Upload File : |
| Current File : /var/www/html/shardadiagnostics.in/application/views/templates/redlabel/upload_priscription.php |
<div class="container breadCrumbBox">
<div class="row">
<ul class="appointBreadcrumb col-md-12">
<li><a href="<?= base_url() ?>">Home</a></li>
<li><a href="javascript:void(0)">Upload Prescription</a></li>
</ul>
</div>
</div>
<div class="container feedbackBox">
<h1>Book Test from Prescription</h1>
<div class="udp-midsection">
<div class="top_navigation" id="top-nav">
<div class="row top_nav">
<div class="col-md-6 presLeft">
<h5>Step 1</h5>
<p>Upload prescription</p>
</div>
<div class="col-md-6 presRight">
<h5>Step 2</h5>
<p>Enter below information</p>
</div>
</div>
</div>
<!--main section -->
<div class="udp-mid-panel" id="uploadProcess">
<form method="post" action="" novalidate="" enctype="multipart/form-data">
<div class="col-md-6 left-panel">
<div class="upload-image">
<div class="row">
<div class="col-md-2" id="prescription_img">
<img src="assets/imgs/PresImg.png" class="presIcon">
</div>
<div class="col-md-10">
<h4>Click below to Upload a Prescription</h4>
<input type="file" name="file" id="file" onChange="return uploadPrescription();" multiple="" accept=".png, .jpg, .jpeg, .JPG, .JPEG, .PNG,.PDF,.pdf,.txt,.TXT,.docx,.DOCX" maxsize="2048" class="fileUpl">
<div id="img-req" class="help-block ng-hide">
<span>Please Choose Prescription</span>
</div>
<div id="myProfileImage" style="display:none;"></div>
<p>* File size should not exceed 2 MB.
<!--<br> * Maximum 3 prescription can be uploaded.--></p>
</div>
</div>
</div>
<!--<div class="upload-photos">
<h5>Attached Prescription</h5>
<ul>
<li class="defaultprescriptionimage" ng-if="files.length==0" id="prescription_img">
<img src="assets/imgs/image-report-default.png" width="101" height="103px">
</li>
</ul>
</div>-->
</div>
<div class="col-md-6 mt-30">
<div class="form_section">
<div class="form-group inputPresForm">
<input name="patient_name" id="patient_name" type="text" class="form-control" placeholder="Full Name of Patient*" value="<?php if(!empty($_SESSION['logged_user']['name'])) { echo $_SESSION['logged_user']['name']; } ?>" required="required">
<input name="pres_img" type="hidden" id="pres_img" value="">
</div>
<div class="form-group inputPresForm">
<input id="customerno" min="10" maxlength="10" name="customerno" onkeyup="if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,'')" oninput="editPhone()" type="text" class="form-control" placeholder="Mobile*" value="<?php if(!empty($_SESSION['logged_user']['phone'])) { echo $_SESSION['logged_user']['phone']; } ?>" required="required">
<span>Send OTP on this No.</span>
<div id="mob-req" class="help-block ng-hide">
<span>Mobile No. is required</span>
<span id="mob-invalid" class="ng-hide">
Enter valid Mobile
</span>
</div>
</div>
<div class="form-group ng-hide" id="showOTP">
<input name="Userotp" id="Userotp" type="text" placeholder="Enter OTP" maxlength="4" onkeyup="if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,'')" class="form-control" required="">
<div id="otp-req" class="help-block ng-hide">
<span> Enter OTP</span>
<span id="otp-invalid" class="ng-hide">Invalid OTP</span>
</div>
</div>
<button type="submit" class="btn btn-default upload-complete" name="submit" id="prescription">Submit</button>
<button type="submit" class="btn btn-default upload-complete ng-hide" name="prescription" id="prescription_submit">Submit</button>
<a href="javascript:void(0)" id="resendOTP" style="color: #00a0a8;font-size: 12px;float: right;padding: 16px 0;" class="ng-hide">Resend OTP</a>
<div ng-show="callbackopt_error" style="color:#f00;padding-top: 10px;" class="ng-hide">
<p ng-bind="callbackopt_message"></p>
</div>
<div ng-show="callbackopt_success" style="color:green;padding-top: 10px;" class="ng-hide">
<p ng-bind="callbackopt_success_message"></p>
</div>
</div>
</div>
</form>
</div>
<!--main section -->
<!--thankyou section -->
<div class="udp-mid-thanks ng-hide" id="uploadSuccess">
<img src="<?=base_url('assets/imgs/checkmark.gif'); ?>">
<h2>Thank You !!!</h2>
<p>Your prescription has been uploaded,
<br> Our health advisor will get back to you between 10:00 am to 7:00 pm. </p>
<p class="view_all"><a href="<?=base_url('/UploadPrescription'); ?>">Upload another prescription</a></p>
</div>
<!--thankyou section ends -->
</div>
</div>
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