ikan Uploader :
Directory : /var/www/html/shardahospital.org/incident/application/views/
Upload File : |
| Current File : /var/www/html/shardahospital.org/incident/application/views/compliant.php |
<div class="container-wrapper login-home">
<div class="wrapper-left">
<img src="<?=base_url('assets/imgs/worldishere11.png'); ?>" width="465" height="498">
</div>
<div class="wrapper-right">
<div class="login-form-wrapper">
<div class="login-form-outer">
<ul class="nav nav-tabs" id="myTab" role="tablist">
<li class="nav-item form-tab active">
<a class="nav-link nav-active active" id="profile-tab" data-toggle="tab" href="#profile" role="tab" aria-controls="profile" aria-selected="true">Login </a>
</li>
</ul>
</div>
<div class="tab-content form-content" id="myTabContent">
<div class="tab-pane show active in" id="profile" role="tabpanel" aria-labelledby="profile-tab">
<form method="POST" action="<?=base_url('home')?>" enctype="multipart/form-data">
<div class="form-inner">
<p>Enter your details below</p>
<?php
if ($_GET['error_msg']) {
?>
<hr>
<div class="alert alert-info">Invalid System Id/ Date Of Birth</div>
<hr>
<?php } ?>
<div class="form-input">
<label>System ID</label>
<input type="text" name="system_id" id="system_id" autocomplete="off" required>
</div>
<div class="form-input">
<label>Date Of Birth</label>
<input type="text" id="date_of_birth" name="date_of_birth" autocomplete="off" required>
<script type="text/javascript">
$(function () {
$('#date_of_birth').datetimepicker({
format: 'DD-MM-YYYY',
maxDate: new Date,
defaultDate: '<?=$_POST['date_of_birth'] ?>'
});
});
</script>
</div>
<div class="text-center">
<input type="submit" class="button-primary" name="login" id="login" value="Get Details" />
<div id="loading" style="margin: 0px; padding: 0px; position: fixed; right: 0px; top: 0px; width: 100%; height: 100%; z-index: 30001; opacity: 0.8;">
<p style="position: absolute; color: White; top: 30%; left: 10%;"><img width="100" src="<?=base_url('assets/imgs/loading.gif')?>">
</p>
</div>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
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