<?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outdated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 } 
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    <?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['Emergency_Contact'])
 {
         $delEc="delete from patient_emergency_contact where Lead_ID='".$_REQUEST['Lid']."'";
		  mysqli_query($con,$delEc);
 
	 for ($i = 1; $i <= 3; $i++)
	 {
		$Em_Contact_Name=$_REQUEST['Contact_Name'.$i];
		$Em_Relationship=$_REQUEST['Relationship'.$i];
		$Em_Mobile_No=$_REQUEST['Mobile_No'.$i];
		
		
		
		if($Em_Contact_Name!='' && $Em_Mobile_No!='')
		{
			$Sql_Add_Contact="insert into patient_emergency_contact(Lead_ID,Contact_Name,Mobile_No,Relationship)values('".$_REQUEST['Lid']."','".$Em_Contact_Name."','".$Em_Mobile_No."','".$Em_Relationship."')";
			$Qry_Add_Contact=mysqli_query($con,$Sql_Add_Contact);
		}
	}
	?>
     <script>window.location.href="patient_assessment_3.php?Lid=<?php echo $_REQUEST['Lid']; ?>"</script>
    <?php
}


            $Sql_Emergency_Contact_Master="select * from patient_emergency_contact where Lead_ID='".$_REQUEST['Lid']."' order by SLN";
			$Qry_Emergency_Contact_Master=mysqli_query($con,$Sql_Emergency_Contact_Master);									
			$Num_Contact=mysqli_num_rows($Qry_Emergency_Contact_Master);
				if($Num_Contact>0)
				{
				$x=1;
					while($Fetch_Emergency_Contact_Master=mysqli_fetch_array($Qry_Emergency_Contact_Master))
					{
			
					$EContact_Name[$x] =$Fetch_Emergency_Contact_Master['Contact_Name'];
					$ERelationship[$x] =$Fetch_Emergency_Contact_Master['Relationship'];
					$EMobile_No[$x] =   $Fetch_Emergency_Contact_Master['Mobile_No'];
				
					
			
					$x=$x+1;
					}
				}
 ?> 
    
    <div class="panel panel-default">
      <div class="panel-heading"  >
        <h4 class="panel-title" >
          <a>In Case of Emergency</a>
        </h4>
      </div>
      <div id="collapse3" class="panel-collapse collapse in">
        <div class="panel-body">
        <form method="post" id="form_s_3">
           
        <?php       
         for ($z = 1; $z <= 3; $z++)
	     {
           ?>    
               
           <div class="row" style="margin:0">     
             <div class="col-sm-12 col-xs-12" style="font-weight:bold; border-bottom:1px solid #ccc; padding-bottom:8px; margin-bottom:6px; border-top:1px solid #ccc; padding-top:8px; background-color: #FFFFFF" >
           Emergency Contact <?php echo $z; ?>
           </div>
           <div class="col-sm-4 col-xs-12" >
               <div class="form-group">
                    <label>Contact Name</label>
                    <input name="Contact_Name<?php echo $z; ?>" id="Contact_Name<?php echo $z; ?>" value="<?php echo $EContact_Name[$z]; ?>" type="text" class="form-control"> 
                </div>
               </div>
                
           <div class="col-sm-4  col-xs-6" >
               <div class="form-group">
                    <label>Relationship</label>
                    <input name="Relationship<?php echo $z; ?>" id="Relationship<?php echo $z; ?>" value="<?php echo $ERelationship[$z]; ?>" type="text" class="form-control" >
                </div>
               </div>
               
           <div class="col-sm-4  col-xs-6" >
               <div class="form-group">
                    <label>Mobile No</label>
                    <input name="Mobile_No<?php echo $z; ?>" id="Mobile_No<?php echo $z; ?>" value="<?php echo $EMobile_No[$z]; ?>"  type="text" class="form-control"  >
                </div>
               </div>
               
               
            </div>   
               
         <?php
		 }
		 ?>      
               
     <div class="row" style="margin:0">
          <div class="col-sm-6 col-xs-6">
       <div class="form-group"> 
             <a href="patient_assessment_1.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 col-xs-6">
                                           <div class="form-group"> 
                                                 <input type="submit" class="btn  btn-primary " name="Emergency_Contact" value="Save and Next" style="margin-top:10px; float:right; padding-left:10px !important; margin-bottom:12px !important; padding:5px 8px !important"  >
                                             </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>
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    </div>

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