ikan Uploader :
Directory : /var/www/html/shardahospital_old.org/cowin/application/views/
Upload File : |
| Current File : /var/www/html/shardahospital_old.org/cowin/application/views/booking-confirmation.php |
<div class="container">
<div class="row">
<div class="col col-lg-12">
<div class="login-header">
</div>
</div>
</div>
</div>
<div class="container">
<div class="row">
<div class=" col-lg-3"></div>
<div class="col-lg-6">
<form action="<?=base_url('booking/validatebooking')?>" method="POST" enctype="multipart/form-data">
<div class="login-rectangle">
<?php
$urlArray = explode('/',$_SERVER['HTTP_REFERER']);
if(in_array('order',$urlArray)) { $url = base_url('order/details/'.base64_encode($userData['id'])); } else { $url = base_url('dashboard'); }?>
<a href="<?=$url?>" class="backtodash"><i class="fa fa-arrow-left" aria-hidden="true"></i> Back </a>
<div class="login-logo">
<img src="<?=base_url('assests/imgs')?>/logo_new.png">
</div>
<?php if($_GET['msg']) { ?>
<span style="color:red;">This User ID is already registered.</span>
<?php } ?>
<?php if($msg) { ?>
<span style="color:red;"><?=$msg?></span>
<?php } ?>
<?php if (validation_errors()) { ?>
<div class="alert alert-danger"><?= validation_errors() ?></div>
<?php } ?>
<?php if ($this->session->flashdata('error')) { ?>
<p style="color:red; font-size:18px;"><?php echo $this->session->flashdata('error'); ?></p>
<?php } ?>
<div class="user-detail">
<h4>Confirm Your Details</h4>
<ul>
<li><strong>Name</strong> <?=$userData['full_name']?></li>
<?php if($userData['email_id']) { ?>
<li><strong>Email</strong> <?=$userData['email_id']?></li>
<?php } ?>
<?php if($userData['contact_number']) { ?>
<li><strong>Phone</strong> <?=$userData['contact_number']?></li>
<?php } ?>
<?php if($userData['dob']) { ?>
<li><strong>Date Of Birth</strong> XX-XX-<?=date('Y',strtotime($userData['dob']))?></li>
<?php } ?>
<li><strong>ID Proof</strong> <?=$userData['aadhar_number']?> (<?=$userData['id_proof']?>)</li>
<li><strong>Age/Gender</strong> <?=$userData['age']?> Years/<?=$userData['gender']?></li>
</ul>
</div>
<div class="radio-btn">
<span>Select Does Type ?</span>
<label><input type="radio" name="does_type" id="doestype1" onclick="return validatedoestype('1')" value="1" checked>1st Does </label>
<label><input type="radio" name="does_type" id="doestype2" onclick="return validatedoestype('2')" value="2">2nd Does </label>
</div>
<!-- if does type==2 1 Dose Date and Vaccine Name like Covishield, Covaxin,etc. Also the attachment for 1st Dose Certificate-->
<div class="user-detail" id=>
<span>Select Your Vaccine </span>
<select name="test_name" id="test_name" required>
<option value="">Select Vaccine .... </option>
<?php foreach($testArray as $row) { ?>
<option value="<?=$row['id']?>" <?php if($bookingData['test_id']==$row['id']) { echo 'selected'; } ?>><?php echo $row['title'].' - <strong>Rs. '.$row['price'].'</strong>'; ?></option>
<?php } ?>
</select>
</div>
<div id="2nd_dose_column" style="display:none;">
<div class="user-detail">
<span>Select 1st Does Date</span>
<input type="date" name="does_date" autocomplete=OFF value="<?php if($bookingData['does_date']>0) { echo date('Y-m-d', $bookingData['does_date']); } ?>" class="form-control" id="does_date" value="YYYY/MM/DD" />
</div>
<div class="radio-btn">
<span>Upload 1st Dose Certificate</span>
<input type="file" name="photo_proof" id="photo_proof" placeholder="Upload 1st dose certificate">
<small>(Only jpg, jpeg, png and pdf allowed)</small>
</div>
</div>
<div class="user-detail">
<span>Current Address</span>
<textarea name="address" autocomplete=OFF class="form-control" id="address" required ><?php echo trim($bookingData['address']);?> </textarea>
</div>
<div class="user-detail">
<span>Pincode</span>
<input type="pincode" name="pincode" autocomplete=OFF value="<?php echo $bookingData['pincode']; ?>" class="form-control" maxlength=6 onkeyup="this.value=this.value.replace(/[^\d]/,'')" id="pincode" required />
</div>
<?php $companyArray = getCompanyDetails($userData['company_name']);
if(empty($companyArray )) {
?>
<div class="user-detail">
<span>Select Date </span>
<input type="date" name="slot_date" autocomplete=OFF value="<?php if($bookingData['slot_date']>0) { echo date('Y-m-d', $bookingData['slot_date']); } ?>" class="form-control" id="slot_date" value="YYYY/MM/DD" />
</div>
<div class="user-detail">
<span>Select Slot </span>
<select name="test_slot" id="test_slot" required>
<option value="">Select Slot .... </option>
<?php foreach($slotArray as $row) { ?>
<option value="<?=$row['id']?>" <?php if($bookingData['slot_id']==$row['id']) { echo 'selected'; } ?>><?php echo $row['title']; ?></option>
<?php } ?>
</select>
</div>
<?php } else { ?>
<div class="user-detail">
<span>Select Date </span>
<p><?=$companyArray->slot_new_date?></p>
<input type="hidden" name="slot_date" autocomplete=OFF value="<?php echo $companyArray->slot_new_date ?>" />
</div>
<div class="user-detail">
<span>Select Slot </span>
<p><?=$companyArray->slot_new_time?></p>
<input type="hidden" name="test_slot" autocomplete=OFF value="4" />
</div>
<?php } ?>
<input type="hidden" name="uid" id="uid" value="<?=$userData['id']?>" />
<input type="hidden" name="bid" id="bid" value="<?=$bookingData['id']?>" />
<div class="user-detail" style="padding:0 20px;">
<button type="submit">Proceed</button>
</div><br /><br />
<div class="login-pin"></div>
</div>
</form>
</div>
<div class="col col-lg-3"></div>
</div>
</div>
<script>
$(function() {
$('#test_name').change(function(){
var test_id = $(this).val();
$.ajax({
url:'<?= base_url('booking/getpricedetails') ?>',
method: 'post',
data: {test_id: test_id},
dataType: 'json',
success: function(response){
// Add options
$('#selected_test').html('');
$('#selected_test').html(response);
return false;
}
});
});
});
function validatedoestype(dType='')
{
if(dType=='2') {
$('#2nd_dose_column').show();
// $("#doestype2").prop("checked", true)
} else {
$('#2nd_dose_column').hide();
// $("#doestype1").prop("checked", true)
}
return true;
}
</script>
Kontol Shell Bypass