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| Current File : /var/www/html/shardahospital.org/incident/application/views/lodge_complaint.php |
<div class="wrapper d-flex align-items-stretch">
<?php include('_parts/sidebar.php') ?>
<div id="content">
<?php include('_parts/user_internal_header.php') ?>
<div class="main-body">
<div class="headings">
<h4><i class="fa fa-comments" aria-hidden="true"></i> Lodge Incident</h4>
</div>
<?php if($_GET['msg']=='success')
{?>
<p class="alert alert-success"> Your complain has been successfully filled and your Incident No. is <?php echo base64_decode($_GET['cnumber']); ?>. <a href="<?=base_url('grievancehistory')?>">Click here</a> to view Incident history. </p>
<?php }
if(is_array($error_msg) && !empty($error_msg)){ ?>
<div class="alert alert-danger"> <?=$error_msg['error'] ?></div>
<?php } ?>
<?php echo validation_errors(); ?>
<form class="form-horizontal style-form" method="post" name="complaint" enctype="multipart/form-data">
<div class="white-box">
<div class="row form1">
<div class="col-md-12">
<div class="form-incident">
<label>Description of event /Incident <span style="color:#FF0000;">*</span></label>
<textarea name="complaindetails" id="complaindetails" required><?php echo $_POST['complaindetails'];?></textarea>
<script>
// Replace the <textarea id="question_title"> with a CKEditor 4
// instance, using default configuration.
CKEDITOR.replace( 'complaindetails' );
</script>
<div id="infoMessage"><?php echo form_error('complaindetails'); ?></div>
</div>
</div>
<div class="col-md-4">
<div class="form-incident">
<label>Incident occurred with <span style="color:#FF0000;">*</span></label>
<select name="incident_occurred" id="incident_occurred" required>
<option value="">Select</option>
<option value="In-Patient" <?php if($_POST['incident_occurred']=='In-Patient') { echo "selected"; }?>>In-Patient</option>
<option value="Out-Patient" <?php if($_POST['incident_occurred']=='Out-Patient') { echo "selected"; }?>>Out-Patient </option>
<option value="Attendant/visitor" <?php if($_POST['incident_occurred']=='Attendant/visitor') { echo "selected"; }?>>Attendant/ visitor </option>
<option value="Staff" <?php if($_POST['incident_occurred']=='Staff') { echo "selected"; }?>>Staff </option>
<option value="Hospital Facility" <?php if($_POST['incident_occurred']=='Hospital Facility') { echo "selected"; }?>>Hospital Facility</option>
</select>
<div id="infoMessage"><?php echo form_error('incident_occurred'); ?></div>
</div>
</div>
</div>
</div>
<div class="white-box">
<div class="row form1">
<div class="col-md-12">
<div class="form-incident">
<label>Details of where incident occurred (identification of person affected by incident)<span style="color:#FF0000;">*</span> </label>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Name <span style="color:#FF0000;" id="affected_person_name_span">*</span></label>
<input type="text" name="affected_person_name" id="affected_person_name" value="<?php echo $_POST['affected_person_name'];?>" required />
<div id="infoMessage"><?php echo form_error('affected_person_name'); ?></div>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Age <span style="color:#FF0000;" id="affected_person_age_span">*</span></label>
<select name="affected_person_age" id="affected_person_age" required>
<option value="">Select</option>
<?php for($i=1;$i<=120; $i++){?>
<option value="<?=$i?>" <?php if($_POST['affected_person_age']==$i) { echo "selected"; }?>><?=$i?> Years</option>
<?php } ?>
</select>
<div id="infoMessage"><?php echo form_error('affected_person_age'); ?></div>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Gender <span style="color:#FF0000;" id="affected_person_sex_span">*</span></label>
<select name="affected_person_sex" id="affected_person_sex" required>
<option value="">Select</option>
<option value="Male" <?php if($_POST['affected_person_sex']=='Male') { echo "selected"; }?>>Male</option>
<option value="Female" <?php if($_POST['affected_person_sex']=='Female') { echo "selected"; }?>>Female</option>
<option value="Other" <?php if($_POST['affected_person_sex']=='Other') { echo "selected"; }?>>Other</option>
</select>
<div id="infoMessage"><?php echo form_error('affected_person_sex'); ?></div>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>IP. NO. <span style="color:#FF0000;display:none;" id="affected_person_ipno_span">*</span></label>
<input type="text" name="affected_person_ipno" id="affected_person_ipno" value="<?php echo $_POST['affected_person_ipno'];?>" />
<div id="infoMessage"><?php echo form_error('affected_person_ipno'); ?></div>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Location <span style="color:#FF0000;">*</span></label>
<input type="text" name="affected_person_location" id="affected_person_location" value="<?php echo $_POST['affected_person_location'];?>" required />
<div id="infoMessage"><?php echo form_error('affected_person_location'); ?></div>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label> Unit/Dept/Head: <span style="color:#FF0000;">*</span></label>
<input type="text" name="affected_person_udhead" id="affected_person_udhead" value="<?php echo $_POST['affected_person_udhead'];?>" required />
<div id="infoMessage"><?php echo form_error('affected_person_udhead'); ?></div>
</div>
</div>
<div class="col-md-6">
<div class="form-incident">
<label>Date and time of incident occurrence: <span style="color:#FF0000;">*</span></label>
<input type="datetime-local" name="affected_person_date" id="affected_person_date" value="<?php echo $_POST['affected_person_date'];?>" required />
<div id="infoMessage"><?php echo form_error('affected_person_date'); ?></div>
</div>
</div>
</div>
</div>
<div class="white-box">
<div class="row form1">
<div class="col-md-4">
<div class="form-incident">
<label>Employee Acknowledgement <span style="color:#FF0000;">*</span></label>
<select name="employee_acknowledgement" id="employee_acknowledgement" onchange="getOtherDetails();" required>
<option value="">Select</option>
<option value="self" <?php if($_POST['employee_acknowledgement']=='self') { echo "selected"; }?>>Self</option>
<option value="other" <?php if($_POST['employee_acknowledgement']=='other') { echo "selected"; }?>>Other</option>
</select>
<div id="infoMessage"><?php echo form_error('employee_acknowledgement'); ?></div>
</div>
</div>
</div>
<script>
function getOtherDetails(){
let acknowledgement = $("#employee_acknowledgement").val();
if(acknowledgement=='self'){
$(".acknowledgement_div").hide();
} else {
$(".acknowledgement_div").show();
}
}
</script>
<div class="row form1 acknowledgement_div" <?php if($_POST['employee_acknowledgement']!='other'){ ?> style="display:none;" <?php } ?>>
<div class="col-md-3">
<div class="form-incident">
<label>Employee Name </label>
<input type="text" name="acknowledgement_employee" id="acknowledgement_employee" value="<?php echo $_POST['acknowledgement_employee'];?>"/>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Employee/ID No </label>
<input type="text" name="acknowledgement_employee_id" id="acknowledgement_employee_id" value="<?php echo $_POST['acknowledgement_employee_id'];?>" />
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Designation </label>
<input type="text" name="acknowledgement_employee_designation" id="acknowledgement_employee_designation" value="<?php echo $_POST['acknowledgement_employee_designation'];?>" />
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Department </label>
<input type="text" name="acknowledgement_employee_department" id="acknowledgement_employee_department" value="<?php echo $_POST['acknowledgement_employee_department'];?>" />
</div>
</div>
</div>
<div class="row form1">
<div class="col-md-6">
<div class="form-incident">
<label>Attachment(In Any)</label>
<input type="file" name="complaint_doc" id="complaint_doc" />
<div id="complaint_doc"><?php echo form_error('complaint_doc'); ?></div>
</div>
</div>
</div>
<div class="row form1">
<div class="col-md-12">
<div class="form-incident">
<br />
<span id="error_msg"><?=$error_msg?></span>
<button type="submit" class="btn button5" name='submit' value='submit' />Submit</button>
</div>
</div>
</div>
</div>
</form>
</div>
</div>
<script src="<?=base_url('assets/js/popper.js'); ?>"></script>
<script src="<?=base_url('assets/js/main.js'); ?>"></script>
<script src="<?php echo base_url(); ?>assets/js/jquery-3.0.0.js"></script>
<script type="text/javascript">
// baseURL variable
var baseURL= "<?php echo base_url();?>";
$(document).ready(function(){
$('.button5').click(function(){
var school_id = $('#school_id').val();
var department_id = $('#department_id').val();
var grievance_type = $('#grievance_type').val();
var otp = $('#otp').val();
if(otp!='' && grievance_type!='' && department_id!='' && school_id!=''){
$('#loading').show();
}
});
$('#incident_occurred').change(function(){
var incident_occurred = $(this).val();
if(incident_occurred=='Hospital Facility'){
$("#affected_person_name_span").hide();
$("#affected_person_age_span").hide();
$("#affected_person_sex_span").hide();
$("#affected_person_ipno_span").hide();
document.getElementById("affected_person_name").required = false;
document.getElementById("affected_person_age").required = false;
document.getElementById("affected_person_sex").required = false;
} else if(incident_occurred=='In-Patient'){
$("#affected_person_name_span").show();
$("#affected_person_age_span").show();
$("#affected_person_sex_span").show();
$("#affected_person_ipno_span").show();
document.getElementById("affected_person_name").required = true;
document.getElementById("affected_person_age").required = true;
document.getElementById("affected_person_sex").required = true;
document.getElementById("affected_person_ipno").required = true;
} else {
$("#affected_person_name_span").show();
$("#affected_person_age_span").show();
$("#affected_person_sex_span").show();
$("#affected_person_ipno_span").hide();
document.getElementById("affected_person_name").required = true;
document.getElementById("affected_person_age").required = true;
document.getElementById("affected_person_sex").required = true;
document.getElementById("affected_person_ipno").required = false;
}
});
$('#send_user_otp').click(function(){
var school_id = $('#school_id').val();
var department_id = $('#department_id').val();
var grievance_type = $('#grievance_type').val();
var complaindetails = $('#complaindetails').val();
$('#error_msg').html('');
$('#loading').show();
if(school_id!='' && department_id!='' && grievance_type!='' && complaindetails!='')
{
$.ajax({
url:'<?= base_url('lodgegrievance/sendotp') ?>',
method: 'post',
data: {send_otp: 1},
dataType: 'json',
success: function(response){
// Add options
if(response=='1001'){
$('#error_msg').html('<p style="color:green">OTP Send Successfully to your registered mobile number and email id.</p>');
} else if(response=='1002'){
$('#error_msg').html('<p style="color:green">OTP send Successfully to your registered mobile number and email id.</p>');
} else {
$('#error_msg').html('<p style="color:red">Invalid request.</p>');
}
$('#loading').hide();
}
});
} else {
$('#error_msg').html('<p style="color:red">All above fields are required</p>');
$('#loading').hide();
}
});
});
</script>
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