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Directory : /var/www/html/shardahospital.org/pdms/application/views/admin/feedbackcollection/
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| Current File : /var/www/html/shardahospital.org/pdms/application/views/admin/feedbackcollection/addrecord.php |
<div id="content-wrapper">
<div class="container-fluid">
<!-- Breadcrumbs-->
<ol class="breadcrumb">
<li class="breadcrumb-item">
<a href="<?php echo site_url('admin/Dashboard'); ?>"><i class="fas fa-fw fa-tachometer-alt"></i> Dashboard</a>
</li>
<li class="breadcrumb-item">
<a href="<?php echo site_url('admin/feedbackcollection'); ?>"> Manage Feedback</a>
</li>
<li class="breadcrumb-item active">Add Feedback</li>
</ol>
<!-- Page Content -->
<div class="card mb-3 fomr-news">
<div class="card-header card-header-new"> <h3>Add Feedback</h3></div>
</div>
<!---- Success Message ---->
<div class="card-body form-body">
<!---- Success Message ---->
<?php if ($this->session->flashdata('success')) { ?>
<p style="color:green; font-size:18px;"><?php echo $this->session->flashdata('success'); ?></p>
</div>
<?php } ?>
<!---- Error Message ---->
<?php if ($this->session->flashdata('error')) { ?>
<p style="color:red; font-size:18px;"><?php echo $this->session->flashdata('error');?></p>
<?php } ?>
<?php echo form_open('admin/feedbackcollection/addrecords');?>
<input type="hidden" name="id" name="id" value="<?=$sd['id']?>" />
<div class="form-group">
<div class="form-row">
<div class="col-md-6">
<label>Feedback Source <span style="color:#FF0000;">*</span></label>
<div class="form-label-group">
<select class="form-control" name="feedback_source" required>
<option value=""> Select Source</option>
<?php foreach($feedsourceArray as $row) { ?>
<option value="<?=$row['id']?>" <?php if($row['id']==$sd['feedback_source']) { echo 'selected'; }?>><?=$row['title']?></option>
<?php } ?>
</select>
<?php echo form_error('feedback_source',"<div style='color:red'>","</div>");?>
</div>
</div>
</div>
</div>
<div class="form-group">
<div class="form-row">
<div class="col-md-6">
<label>Feedback Type <span style="color:#FF0000;">*</span></label>
<div class="form-label-group">
<select class="form-control" name="feedback_type" id="feedback_type" required>
<option value=""> Select Type</option>
<option value="Appreciation" <?php if('Appreciation'==$sd['feedback_type']) { echo 'selected'; }?>>Appreciation</option>
<option value="Suggestion" <?php if('Suggestion'==$sd['feedback_type']) { echo 'selected'; }?>>Suggestion/Patient Voice</option>
<option value="Complaint" <?php if('Complaint'==$sd['feedback_type']) { echo 'selected'; }?>>Complaint</option>
</select>
<?php echo form_error('feedback_type',"<div style='color:red'>","</div>");?>
</div>
</div>
</div>
</div>
<div class="form-group">
<div class="form-row">
<div class="col-md-6">
<label>Remarks <span style="color:#FF0000;">*</span></label>
<div class="form-label-group">
<textarea name="remarks" id="remarks" class="form-control"><?php echo $sd['remarks']; ?></textarea>
<?php echo form_error('remarks',"<div style='color:red'>","</div>");?>
</div>
</div>
</div>
</div>
<div class="form-group">
<div class="form-row">
<div class="col-md-5">
<label>Department <span style="color:#FF0000;">*</span></label>
<div class="form-label-group">
<div class="form-row">
<select class="form-control" name="department_id" required>
<option value="">Select Department</option>
<?php foreach($departmentArray as $row) { ?>
<option value="<?=$row['id']?>" <?php if($sd['department_id']==$row['id']) { echo 'selected'; }?>><?=$row['department_name']?></option>
<?php } ?>
</select>
<?php echo form_error('department_id',"<div style='color:red'>","</div>");?>
</div>
</div>
</div>
<div class="col-md-2"> </div>
</div>
</div>
<div class="form-group alert alert-info">
<div class="form-row">
<div class="col-md-3">
<div class="form-incident">
<label>UHID </label>
<input type="text" class="form-control" name="UHID" id="UHID" value="<?php echo $sd['UHID']; ?>">
<?php echo form_error('UHID',"<div style='color:red'>","</div>");?>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Full Name </label>
<input type="text" class="form-control" name="full_name" id="full_name" value="<?php echo $sd['full_name']; ?>">
<?php echo form_error('full_name',"<div style='color:red'>","</div>");?>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Mobile </label>
<input type="text" class="form-control" name="contact_number" id="contact_number" value="<?php echo $sd['contact_number']; ?>">
<?php echo form_error('contact_number',"<div style='color:red'>","</div>");?>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Email Id </label>
<input type="text" class="form-control" name="email_id" id="email_id" value="<?php echo $sd['email_id']; ?>">
<?php echo form_error('full_name',"<div style='color:red'>","</div>");?>
</div>
</div>
</div>
</div>
<div class="form-group incident_div">
<div class="form-row">
<div class="col-md-5">
<label>Incident occurred with <span style="color:#FF0000;">*</span></label>
<div class="form-label-group">
<div class="form-row">
<select name="incident_occurred" class="form-control" id="incident_occurred" required>
<option value="">Select</option>
<option value="In-Patient" <?php if($sd['incident_occurred']=='In-Patient') { echo "selected"; }?>>In-Patient</option>
<option value="Out-Patient" <?php if($sd['incident_occurred']=='Out-Patient') { echo "selected"; }?>>Out-Patient </option>
<option value="Attendant/visitor" <?php if($sd['incident_occurred']=='Attendant/visitor') { echo "selected"; }?>>Attendant/ visitor </option>
<option value="Staff" <?php if($sd['incident_occurred']=='Staff') { echo "selected"; }?>>Staff </option>
<option value="Hospital Facility" <?php if($sd['incident_occurred']=='Hospital Facility') { echo "selected"; }?>>Hospital Facility</option>
</select>
<?php echo form_error('department_id',"<div style='color:red'>","</div>");?>
</div>
</div>
</div>
<div class="col-md-7"> </div>
</div>
</div>
<div class="form-group alert alert-success incident_div">
<div class="form-row">
<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" class="form-control" id="affected_person_name" value="<?php echo $_POST['affected_person_name'];?>" required />
<div id="infoMessage"><?php echo form_error('affected_person_name'); ?></div>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Age <span style="color:#FF0000;" id="affected_person_name_span">*</span></label>
<select name="affected_person_age" class="form-control" id="affected_person_age" required>
<option value="">Select</option>
<?php for($i=1;$i<=120; $i++){?>
<option value="<?=$i?>" <?php if($_POST['affected_person_age']==$i) { echo "selected"; }?>><?=$i?> Years</option>
<?php } ?>
</select>
<div id="infoMessage"><?php echo form_error('affected_person_age'); ?></div>
</div>
</div>
<div class="col-md-3">
<div class="form-incident">
<label>Gender <span style="color:#FF0000;" id="affected_person_name_span">*</span></label>
<select name="affected_person_sex" class="form-control" id="affected_person_sex" required>
<option value="">Select</option>
<option value="Male" <?php if($_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" class="form-control" 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" class="form-control" 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" class="form-control" 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-3">
<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" class="form-control" id="affected_person_date" value="<?php echo $_POST['affected_person_date'];?>" required />
<div id="infoMessage"><?php echo form_error('affected_person_date'); ?></div>
</div>
</div>
</div>
</div>
<div class="form-group incident_div">
<div class="form-row">
<div class="col-md-5">
<label>Employee Acknowledgement <span style="color:#FF0000;">*</span></label>
<div class="form-label-group">
<div class="form-row">
<select name="employee_acknowledgement" class="form-control" id="employee_acknowledgement" onchange="getOtherDetails();" required>
<option value="">Select</option>
<option value="self" <?php if($_POST['employee_acknowledgement']=='self') { echo "selected"; }?>>Self</option>
<option value="other" <?php if($_POST['employee_acknowledgement']=='other') { echo "selected"; }?>>Other</option>
</select>
<?php echo form_error('department_id',"<div style='color:red'>","</div>");?>
</div>
</div>
</div>
<div class="col-md-7"> </div>
</div>
</div>
<script>
function getOtherDetails(){
let acknowledgement = $("#employee_acknowledgement").val();
if(acknowledgement=='self'){
$(".acknowledgement_div").hide();
} else {
$(".acknowledgement_div").show();
}
}
</script>
<div class="form-group incident_div">
<div class="form-row form1 acknowledgement_div" <?php if($_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" class="form-control" 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" class="form-control" 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" class="form-control" 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" class="form-control" id="acknowledgement_employee_department" value="<?php echo $_POST['acknowledgement_employee_department'];?>" />
</div>
</div>
</div>
</div>
<div class="form-group form-btn">
<div class="form-row">
<div class="col-md-4">
<a href="<?=base_url('admin/feedbackcollection')?>" class="btn btn-block btn-cancel"> Cancel</a>
<?php echo form_submit(['name'=>'adduser','value'=>'Save Feedback','class'=>'btn btn-primary btn-block']); ?> </div>
<div class="col-md-5"> </div>
</div>
</div>
</form>
</div>
<!-- /.container-fluid -->
</div>
<!-- /.content-wrapper -->
<script src="https://code.jquery.com/jquery-3.7.1.min.js" integrity="sha256-/JqT3SQfawRcv/BIHPThkBvs0OEvtFFmqPF/lYI/Cxo=" crossorigin="anonymous"></script>
<script type="text/javascript">
// baseURL variable
var baseURL= "<?php echo base_url();?>";
$(document).ready(function(){
$('#feedback_type').change(function(){
var feedback_type = $(this).val();
if(feedback_type!='Complaint'){
document.getElementById("incident_occurred").required = false;
document.getElementById("incident_occurred").required = false;
document.getElementById("employee_acknowledgement").required = false;
document.getElementById("affected_person_name").required = false;
document.getElementById("affected_person_age").required = false;
document.getElementById("affected_person_udhead").required = false;
document.getElementById("affected_person_sex").required = false;
document.getElementById("affected_person_location").required = false;
document.getElementById("affected_person_date").required = false;
$(".incident_div").hide();
} else {
$(".incident_div").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;
}
});
});
</script>
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