<?php
include("common/connection.php");
login_check();

$Lead_Req_Id=$_REQUEST['Lid'];
$user_type_sql="select User_Type from user_master where User_Name='".$_SESSION['user']."'";
$user_type_query=mysqli_query($con,$user_type_sql);
$user_type=mysqli_fetch_array($user_type_query);
?>

<!doctype html>
<html class="no-js" lang="en">

<head>
    <meta charset="utf-8">
    <meta http-equiv="x-ua-compatible" content="ie=edge">
    <title>Patient Assessment | Buurtzorg</title>
    <?php include("headerlink.php"); ?> 
    <link rel="stylesheet" href="css/pa.css">
    
     
    
    
    
    
    
    
    
    
    
     <link rel="stylesheet" href="css/form/all-type-forms.css">
    <!-- x-editor CSS
		============================================ -->
    <link rel="stylesheet" href="css/editor/select2.css">
    <link rel="stylesheet" href="css/editor/datetimepicker.css">
    <link rel="stylesheet" href="css/editor/bootstrap-editable.css">
    <link rel="stylesheet" href="css/editor/x-editor-style.css">

    
    <script>
	function unlock_form() {
	 
	$('#edit_c_form  input'). prop("disabled", false);
	//$('#not_editable  input'). prop("disabled", true);
	$('#edit_c_form  textarea'). prop("disabled", false);
	$('#edit_c_form  select'). prop("disabled", false);
	$('#update_btn').show();
	$('#edit_btn_1').hide();
	
 
	}
	</script>
    
    <script>
	function personaliz_label(per) {
	 
	
	 $('#ps').text(per);
	
	}
	
 
	</script> 
    <?php
	 $lead_basic_sql="select * from lead_master where Lead_ID='".$Lead_Req_Id."'";
	 $lead_basic_query=mysqli_query($con,$lead_basic_sql);
	 $lead_details=mysqli_fetch_array($lead_basic_query);
	?>   
    
    <script type="text/javascript">
	function ShowPersonalize()
	{
	   if(document.getElementById("personalize").checked==true)
	   {
	   
	      $('#personalize_div').show();
	   }
	   else
	   {
	      $('#personalize_div').hide();
	   }
	
	}
	</script> 
    
<script>
function isNumberKey(evt)
{
    var charCode = (evt.which) ? evt.which : event.keyCode;
    if (charCode != 46 && charCode > 31 && (charCode < 48 || charCode > 57))
    {
        return false;
    }
    else
    {
        return true;
    }
}

</script>    
</head>

<body>
    <!--[if lt IE 8]>
		<p class="browserupgrade">You are using an <strong>outdated</strong> browser. Please <a href="http://browsehappy.com/">upgrade your browser</a> to improve your experience.</p>
	<![endif]-->
    <!-- Start Left menu area -->
    
    
             
										<style>
                                        input { border:0 !important; border-bottom:1px solid #ccc !important; padding-left:0 !important; padding-top:0px !important;  padding-bottom:3px !important;  height:auto !important; } label { font-weight:normal !important; font-size:12px !important;} textarea {border:0 !important; border-bottom:1px solid #ccc !important; padding-left:0 !important; padding-top:3px !important;  padding-bottom:3px !important; text-transform:uppercase } 
                                        select { border:0 !important; border-bottom:1px solid #ccc !important; padding-left:0 !important; padding-top:0px !important;  padding-bottom:3px !important;  height:auto !important; } .panel-body {padding:0 !important; padding-top:10px !important;  } option, select {font-size:12px !important;  }
                                        </style>
    <?php include("left-menu.php"); ?>
    
    
    
    <!-- End Left menu area -->
    <!-- Start Welcome area -->
    <div class="all-content-wrapper">
        
        
       <?php include("header-menu.php"); ?> 
        
       
                                        	
        <!-- Static Table Start -->
        <div class="static-table-area">
        
       
        
        
        
            <div class="container-fluid">
                <div class="row">
                
                
                    
                    <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12" >
                         
                         
                         <div class="row" style="margin:0"> 
                         
                        <?php include 'progress.php' ?> 
                          
                          </div>
                         
                          
                         
                         
                         <div class="panel-group" id="accordion">
     
    <?php
if($_REQUEST['Personal_History'])
		  {
		
		   $UpdatePatientMaster="update patient_master set Birth_Problem='".$_REQUEST['Birth_Problem']."', Highest_Education='".$_REQUEST['Highest_Education']."',Marital_Status='".$_REQUEST['Marital_Status']."',Current_Or_Past_Occupation='".$_REQUEST['Current_Or_Past_Occupation']."',Currently_Working='".$_REQUEST['Currently_Working']."',Disability='".$_REQUEST['Disability']."' where Lead_ID='".$_REQUEST['Lid']."'";
			 mysqli_query($con,$UpdatePatientMaster);
          
	?>
    <script>window.location.href="patient_assessment_5.php?Lid=<?php echo $_REQUEST['Lid']; ?>"</script>
    <?php	   
		  }
		    $FetchPatientMaster=FetchData($con,'patient_master','Lead_ID',$_REQUEST['Lid']);
 ?>   
    
    <div class="panel panel-default" >
      <div class="panel-heading" >
        <h4 class="panel-title">
          <a>Personal History</a>
        </h4>
      </div>
      <div id="collapse2" class="panel-collapse collapse in">
        <div class="panel-body">
        <form method="post" id="form_s_2">
                                           
          <div class="col-sm-12 col-xs-12" >
           <div class="form-group">
                <label>Problems with your birth ?</label>
                <textarea name="Birth_Problem" id="Birth_Problem" type="text" class="form-control"  
                 data-rule-required="true" data-msg-required="Please enter patient id" style="height:50px"><?php echo $FetchPatientMaster['Birth_Problem']; ?></textarea>
            </div>
           </div>
           
           
           
           
           <div class="col-sm-4 col-xs-6" >
           <div class="form-group">
                <label>Highest education</label>
                <select name="Highest_Education" class="form-control" id="Highest_Education"  data-rule-required="true" data-msg-required="Please select highest education">
                      <option value="">-- Select --</option>
                      <option value="High School" <?php if($FetchPatientMaster['Highest_Education']=="High School"){echo "selected";}?>>High School</option>
                      <option value="Some College" <?php if($FetchPatientMaster['Highest_Education']=="Some College"){echo "selected";}?>>Some College</option>
                      <option value="College graduate" <?php if($FetchPatientMaster['Highest_Education']=="College graduate"){echo "selected";}?>>College graduate</option>
                      <option value="Advanced degree" <?php if($FetchPatientMaster['Highest_Education']=="Advanced degree"){echo "selected";}?>>Advanced degree</option>
                 </select>
            </div>
           </div>
           
           
           
           <div class="col-sm-4 col-xs-6" >
           <div class="form-group">
                <label>Marital status</label>
                <select name="Marital_Status" class="form-control" id="Marital_Status"  data-rule-required="true" data-msg-required="Please select marital status">
                      <option value="">-- Select --</option>
                      <option value="Never married" <?php if($FetchPatientMaster['Marital_Status']=="Never married"){echo "selected";}?>>Never married</option>
                      <option value="Married" <?php if($FetchPatientMaster['Marital_Status']=="Married"){echo "selected";}?>>Married</option>
                      <option value="Divorced" <?php if($FetchPatientMaster['Marital_Status']=="Divorced"){echo "selected";}?>>Divorced</option>
                      <option value="Widowed" <?php if($FetchPatientMaster['Marital_Status']=="Divorced"){echo "selected";}?>>Widowed</option>
                 </select>
            </div>
           </div>

           
           
           <div class="col-sm-4 col-xs-12" >
           <div class="form-group">
                <label>Past occupation</label>
                <input name="Current_Or_Past_Occupation" id="Current_Or_Past_Occupation" type="text"  class="form-control"  
                 data-rule-required="true" data-msg-required="Please enter past occupation" value="<?php echo $FetchPatientMaster['Current_Or_Past_Occupation']; ?>">
            </div>
           </div>
           
           
        
           
          <div class="col-sm-2 col-xs-6">
           <div class="form-group">
           <div>
                <label style="text-transform:uppercase">Currently working</label></div>
                
               <label class="radio-inline">
                  <input name="Currently_Working" value="Yes" type="radio" <?php if($FetchPatientMaster['Currently_Working']=="Yes"){echo "checked";}?>>Yes
                </label>
                <label class="radio-inline">
                  <input name="Currently_Working" value="No" type="radio" <?php if($FetchPatientMaster['Currently_Working']=="No"){echo "checked";}?>>No
                </label> 
            </div>
           </div>
           
           
           <div class="col-sm-2 col-xs-6">
           <div class="form-group">
           <div>
                <label style="text-transform:uppercase">Receive disability</label></div>
                
               <label class="radio-inline">
                  <input name="Disability" value="Yes" type="radio" <?php if($FetchPatientMaster['Disability']=="Yes"){echo "checked";}?>>Yes
                </label>
                <label class="radio-inline">
                  <input name="Disability" value="No" type="radio" <?php if($FetchPatientMaster['Disability']=="No"){echo "checked";}?>>No
                </label> 
            </div>
           </div>  
    
           
           
       
  
	<div class="col-sm-12" style="padding:0">
      <div class="col-sm-6">
       <div class="form-group"> 
             <a href="patient_assessment_3.php?Lid=<?php echo $_REQUEST['Lid']; ?>"><input type="button" class="btn  btn-primary" name="Patient_Info" value="Previous" style="margin-top:10px; float:left; padding-left:10px !important;  padding:5px 8px !important; margin-bottom:10px;"  ></a>
         </div>                                                       
      </div> 
      
      <div class="col-sm-6">
       <div class="form-group"> 
             <input type="submit" class="btn  btn-primary" name="Personal_History" value="Save and Next" style="margin-top:10px; float:right; padding-left:10px !important;  padding:5px 8px !important; margin-bottom:10px;"  >
         </div>                                                       
      </div>
      </div>
                  
     </form>
        </div>
      </div>
    </div>
 
 
 
  </div> 
                         
                    </div> 
                    
                    
                 
                 
                              
                                      
                        </div>
                    </div>
                </div>
                
                
            </div>
        </div>
        <!-- Static Table End -->
        <div class="footer-copyright-area">
            <div class="container-fluid">
                <div class="row">
                    <div class="col-lg-12">
                        <div class="footer-copy-right">
                            <p>Copyright © 2019. All rights reserved. </p>
                           
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>

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      <script>
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				 var Reffered_opt = $("#Reffered_Buurtzorg_From").val();
				 
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				 $("#Doctor_div").show(400);
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					if(Reffered_opt!="Doctor") {
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