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Directory : /var/www/html/shardahospital.org/application/views/admin/
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| Current File : /var/www/html/shardahospital.org/application/views/admin/old_AddPatientStory.php |
<?php
include("includes/header.php");
include("includes/sidebar.php");
?>
<!-- Page Content -->
<div class="right_col" role="main">
<div class="">
<!-- Page Title Bar -->
<div class="page-title">
<div class="title_left">
<h3>Patient Stories</h3>
</div>
<div class="title_right">
<div class="col-md-5 col-sm-5 col-xs-12 form-group pull-right top_search">
<div class="input-group">
<input type="text" class="form-control" placeholder="Search for...">
<span class="input-group-btn">
<button class="btn btn-default" type="button">Go!</button>
</span>
</div>
</div>
</div>
</div>
<!-- End of Page Title Bar -->
<div class="clearfix"></div>
<!-- Content Section -->
<div class="row">
<div class="col-md-12 col-sm-12 col-xs-12">
<div class="x_panel">
<!-- Panel Title -->
<div class="x_title">
<h2>Add New Patient Story</h2>
<ul class="nav navbar-right panel_toolbox">
<li><a class="collapse-link"><i class="fa fa-chevron-up"></i></a>
</li>
</ul>
<div class="clearfix"></div>
</div>
<!-- End of Panel Title -->
<!-- Panel Content -->
<div class="x_content">
<div class="left-margin">
<?php if(isset($data_string)){ echo $data_string;} ?>
<?php echo validation_errors(); ?>
<?php echo form_open_multipart('admin/PatientStory/add_patient_story', 'class="form-vertical form-label-left" id="addPatientStory"'); ?>
<div class="clearfix"></div>
<!-- Hidden Field for Doctor ID if updating Doctor -->
<?php if(isset($PatientStoryID)){?>
<input type="hidden" name="PatientStoryID" value="<?php echo $PatientStoryID;?>">
<?php }?>
<!-- Patient Story Title Required -->
<div class="form-group col-md-8">
<label>Title<span class="required">*</span></label>
<input type="text" class="form-control" name="PatientStoryTitle" id="title" required="required" placeholder="Enter Title for Patient Story" value="<?php if(isset($PatientStoryTitle)){echo $PatientStoryTitle;} ?>">
</div>
<!-- Slug Required -->
<div class="form-group col-md-8">
<label>Slug<span class="required">*</span></label>
<input type="text" class="form-control" name="PatientStoryPageURL" id="link" required="required" placeholder="Enter Slug" value="<?php if(isset($PatientStoryPageURL)){echo $PatientStoryPageURL;} ?>">
</div>
<!-- Departments Grouped into COE and Speciality using Select2 Plugin-->
<div class="form-group col-md-8">
<label>Department<span class="required">*</span></label>
<select name="PatientStoryDepartment" class="form-control select2-single" require="required">
<option value=""></option>
<?php if($departments){
foreach($departments as $department){
$selected='';
if(isset($PatientStoryDepartment)&&($department['DepartmentID']==$PatientStoryDepartment)){
$selected="selected";
}
echo '<option value="'.$department['DepartmentID'].'" '.$selected.'>'.$department['DepartmentName'].'</option>';
}
} ?>
</select>
<!-- Add this script in footer to use Select2 plugin
<script type="text/javascript">
$(document).ready(function() {
$('.select2-single').select2();
});
</script> -->
</div>
<!-- Patient Nationality Required -->
<div class="form-group col-md-8">
<label>Patient Nationality<span class="required">*</span></label>
<select class="form-control select2-single" name="PatientStoryNationality">
<option value="">Select Nationality</option>
<?php if($nationalities){
foreach($nationalities as $nationality){
$selected='';
if(isset($PatientStoryNationality)&&($PatientStoryNationality==$nationality['NationalityName'])){
$selected="selected";
}
echo '<option value="'.$nationality['NationalityName'].'" '.$selected.'>'.$nationality['NationalityName'].'</option>';
}
} ?>
</select>
</div>
<!-- Condition Required - display if Indian selected -->
<div class="form-group col-md-8">
<label>Condition<span class="required">*</span></label>
<select class="form-control select2-single" name="PatientStoryCondition">
<option value="">Select Condition</option>
<?php if($conditions){
foreach($conditions as $condition){
$selected='';
if(isset($PatientStoryCondition)&&($PatientStoryCondition==$condtion['HealthConditionID'])){
$selected="selected";
}
echo '<option value="'.$condition['HealthConditionID'].'" '.$selected.'>'.$state['HealthConditionID'].'</option>';
}
} ?>
</select>
</div>
<!-- Story -->
<div class="form-group col-md-12">
<label>Story</label>
<textarea class="form-control" placeholder="" name="PatientStoryContent" id="PatientStoryContent" rows="10"><?php echo (isset($PatientStoryContent))?$PatientStoryContent:''?></textarea>
</div>
<script>
// Replace the <textarea id="editor1"> with a CKEditor
// instance, using default configuration.
CKEDITOR.replace( 'PatientStoryContent' );
</script>
<!-- Testimonial -->
<div class="form-group col-md-12">
<label>Testimonial</label>
<textarea class="form-control" placeholder="" name="PatientStoryTestimonial" id="PatientStoryTestimonial" rows="5"><?php echo (isset($PatientStoryTestimonial))?$PatientStoryTestimonial:''?></textarea>
</div>
<!-- Date -->
<div class="form-group col-md-8">
<label>Date</label>
<div class='input-group date col-md-3' id='myDatepicker2'>
<input type='text' class="form-control" name="date" value="<?php if(isset($PatientStoryDate)){echo $PatientStoryDate;} ?>"/>
<span class="input-group-addon">
<span class="glyphicon glyphicon-calendar"></span>
</span>
</div>
</div>
<!-- Thumbnail -->
<div class="form-group col-md-8">
<label>Upload Thumbnail</label>
<input name="thumbnail" type="file" id="thumbnail" />
<?php if((isset($PatientStoryThumbnail))&&($PatientStoryThumbnail)){ ?>
<img src="<?php echo base_url();?>uploads/patient_stories/<?php echo $PatientStoryThumbnail; ?>" style="height:60px;" />
<a href="<?php echo base_url();?>uploads/patient_stories/<?php echo $PatientStoryThumbnail; ?>"><?php echo $MedicalPackageBanner; ?></a>
<?php } ?>
</div>
<!-- Poster Image -->
<div class="form-group col-md-8">
<label>Upload Poster Image</label>
<input name="image" type="file" id="poster" />
<?php if((isset($PatientStoryBanner))&&($PatientStoryBanner)){ ?>
<img src="<?php echo base_url();?>uploads/patient_stories/<?php echo $PatientStoryBanner; ?>" style="height:60px;" />
<a href="<?php echo base_url();?>uploads/patient_stories/<?php echo $PatientStoryBanner; ?>"><?php echo $MedicalPackageBanner; ?></a>
<?php } ?>
</div>
<!-- Display Order -->
<div class="form-group col-md-8">
<label>Display Order </label>
<input type="text" class="" name="PatientStoryPriorityOrder" id="priority-order" size="3" value="<?php echo (isset($PatientStoryPriorityOrder))?$PatientStoryPriorityOrder:'0' ?>">
</div>
<!-- Display Status -->
<div class="form-group col-md-8">
<label>Display Status</label>
<?php if(!(isset($Status))){$Status="A";} ?>
<div class="radio">
<label>
<input type="radio" class="flat" name="Status" value="A" <?php if((isset($Status))&&($Status=="A")){echo 'checked';} ?>> Active
</label>
<label>
<input type="radio" class="flat" name="Status" value="I" <?php if((isset($Status))&&($Status=="I")){echo 'checked';} ?>> Inactive
</label>
</div>
</div>
<div class="clearfix"></div>
<!-- Buttons -->
<div class="form-group col-md-12">
<button type="submit" class="btn btn-success btn-md">Submit</button>
<button class="btn btn-primary btn-md" type="button">Cancel</button>
<button class="btn btn-primary btn-md" type="reset">Reset</button>
</div>
<?php echo form_close(); ?>
</div>
</div>
<!-- End of Panel Content -->
</div>
</div>
</div>
<!-- End of Content Section -->
</div>
</div>
<!-- End of Page Content -->
<?php
include("includes/footer.php");
?>
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