ikan Uploader :
Directory : /var/www/html/shardahospital.org/drbooking/application/views/
Upload File : |
| Current File : /var/www/html/shardahospital.org/drbooking/application/views/add_new_profile.php |
<?php $userData = $this->session->userdata('user_data'); ?>
<div class="doctor-detail">
<div class="container">
<div class="row">
<div class="col-md-8">
<?php if($this->session->flashdata('msg')){ ?>
<p class="alert alert-success"><?=$this->session->flashdata('msg')?></p>
<?php } ?>
<form method="post" name="feedbak" action="<?=base_url('user/addnewprofile')?>">
<div class="drb-leftbar">
<h1>Add New Dependant </h1>
<div class="feebbackform">
<div class="row">
<div class="col-md-12">
<div class="feedback-in">
<label><input type="radio" name="is_dependant" value="1" checked="">Self Profile</label>
<label><input type="radio" name="is_dependant" value="2">Dependant Profile</label>
</div>
</div>
<div class="col-md-3">
<div class="pdata-form">
<select name="title_id" id="title_id">
<option value="">Select Title</option>
<?php foreach($titleArray as $trow) { ?>
<option value="<?=$trow['id']?>"><?=$trow['name']?></option>
<?php }?>
</select>
</div>
</div>
<div class="col-md-9">
<div class="pdata-form">
<input type="text" name="full_name" id="full_name" maxlength="190" placeholder="Enter your Full Name">
</div>
</div>
<div class="col-md-4">
<div class="pdata-form">
<select name="gender" id="gender">
<option value="">Select Gender</option>
<?php foreach($titleArray as $trow) { ?>
<option value="<?=$trow['id']?>"><?=$trow['gender_name']?></option>
<?php }?>
</select>
</div>
</div>
<div class="col-md-4">
<div class="pdata-form">
<input type="date" id="dateofbirth" name="dateofbirth" placeholder="Date of Birth" autocomplete="off" required>
</div>
</div>
<div class="col-md-4">
<div class="pdata-form">
<input type="text" name="age" id="age" placeholder="Age">
</div>
</div>
<div class="col-md-6">
<div class="pdata-form">
<input type="email" name="email_id" id="email_id" placeholder="Email ID" >
</div>
</div>
<div class="col-md-6">
<div class="pdata-form">
<input type="text" name="mobile_no" id="mobile_no" placeholder="Contact No." required>
</div>
</div>
<div class="col-md-12">
<div class="pdata-form">
<input type="text" name="address" id="address" placeholder="Address1" required>
</div>
</div>
<div class="col-md-4">
<div class="pdata-form">
<select name="country_id" id="country_id" required>
<option value="">Select Country</option>
<option value="74">India</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="pdata-form">
<select name="state_id" id="state_id" required>
<option value="">Select State</option>
<?php foreach($stateArray as $trow) { ?>
<option value="<?=$trow['id']?>"><?=$trow['state_name']?></option>
<?php }?>
</select>
</div>
</div>
<div class="col-md-4">
<div class="pdata-form">
<select name="city_id" id="city_id" required>
<option value="">Select City</option>
<?php foreach($cityArray as $trow) { ?>
<option value="<?=$trow['id']?>"><?=$trow['city_name']?></option>
<?php }?>
</select>
</div>
</div>
</div>
<div class="radio-btn">
<span style="color:red;">*All Fileds are mandatory</span>
</div>
<div class="feedback-in">
<input type="submit" name="submit" id="submit" value="Submit" />
</div>
</div>
</div>
</form>
</div>
<div class="col-md-4">
<?php include('_parts/lhs_part.php')?>
</div>
</div>
</div>
</div>
</div>
<script>
$(document).ready(function() {
$('#country_id').change(function(){
var country_id = $('#country_id').val();
$.ajax({
url : $('body').attr('data-base-url') + 'bookappointment/get_statelist',
method: 'post',
data : {
country_id: country_id
}
}).done(function(response) {
$('#loading').hide();
$('#state_id').html('');
$('#state_id').append($('<option>').text(' -- Select State -- ').attr('value', ''));
$.each(response,function(i,value){
$('#state_id').append($('<option>').text(value).attr('value', i));
});
});
});
$('#state_id').change(function(){
var state_id = $('#state_id').val();
$.ajax({
url : $('body').attr('data-base-url') + 'bookappointment/get_citylist',
method: 'post',
data : {
state_id: state_id
}
}).done(function(response) {
$('#loading').hide();
$('#city_id').html('');
$('#city_id').append($('<option>').text(' -- Select City -- ').attr('value', ''));
$.each(response,function(i,value){
$('#city_id').append($('<option>').text(value).attr('value', i));
});
})
});
$("#dob").change(function(){
var today = new Date();
var birthDate = new Date($('#dob').val());
var age = today.getFullYear() - birthDate.getFullYear();
var m = today.getMonth() - birthDate.getMonth();
if (m < 0 || (m === 0 && today.getDate() < birthDate.getDate())) {
age--;
}
return $('#age').html(age+' years old');
});
$("#dateofbirth").change(function(){
var today = new Date();
var birthDate = new Date($('#dateofbirth').val());
var age = today.getFullYear() - birthDate.getFullYear();
var m = today.getMonth() - birthDate.getMonth();
if (m < 0 || (m === 0 && today.getDate() < birthDate.getDate())) {
age--;
}
if(age>0){
$('#age').val(age+' years');
} else {
$('#age').val(age+' year');
}
});
});
</script>
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