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create_report.php
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<?php require_once("includes/session.php"); ?>
<?php require_once("includes/db_connection.php"); ?>
<?php require_once("includes/functions.php"); ?>
<?php require_once("includes/validation_functions.php"); ?>
<?php ?>
<?php
$report_set = find_all_report();
$patient_set = find_all_patients();
$report_no = find_patient_reg();
?>
<?php
if (isset($_POST['submit'])) {
// Process the form
// validations
$required_fields = array("report_date","reported_by","reg_no","statement");
validate_presences($required_fields);
if (empty($errors)) {
// Perform Update
$report_date = mysql_prep($_POST["report_date"]);
$reported_by = mysql_prep($_POST["reported_by"]);
$reg_no = mysql_prep($_POST["reg_no"]);
$statement = mysql_prep($_POST["statement"]);
$query = "INSERT INTO report (report_date,reported_by,reg_no,statement)".
"VALUES ('$report_date','$reported_by','$reg_no','$statement')";
$result = mysqli_query($connection, $query);
if(isset($connection)){
mysqli_close($connection);
}
}
} else {
// This is probably a GET request
} // end: if (isset($_POST['submit']))
?>
<!DOCTYPE>
<html>
<head><title>Patient</title>
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.6/css/bootstrap.min.css" >
<link rel="stylesheet" href="_/css/bootstrap.css" type="text/css" />
<link rel="stylesheet" href="_/css/free.css" type="text/css" />
<link href='https://fonts.googleapis.com/css?family=Bree+Serif|Merriweather:400,300,300italic,700,700italic,400italic' rel='stylesheet' type='text/css'>
<link rel="stylesheet" href="/css/font-awesome.min.css">
</head>
<body>
<header>
<nav class="navbar navbar-default navbar-fixed-top" role="navigation">
<div class="container">
<div class="navbar-header">
<a class="navbar-brand" href="#featured"><h1 style="color:#337ab7">Clinic <span class="subhead">Matters</span></h1></a>
</div><!-- navbar-header -->
<div class="collapse navbar-collapse" id="collapse">
<ul class="nav navbar-nav navbar-right">
<li class="active"><a href="logout.php">Logout</a></li>
</ul>
</div><!-- collapse navbar-collapse -->
</div><!-- container -->
</nav>
</header>
<div class="container" style="padding-top: 10px;">
<h1 class="page-header">Create Report</h1>
<div class="row">
<!-- left column -->
<div class="col-md-4 col-sm-6 col-xs-12">
<!-- <div class="text-center">
<img src="http://lorempixel.com/200/200/people/9/" class="avatar img-circle img-thumbnail" alt="avatar">
<h6>Upload a different photo...</h6>
<input type="file" class="text-center center-block well well-sm">
</div> -->
</div>
<!-- edit form column -->
<?php echo message(); ?>
<?php echo form_errors($errors); ?>
<form action="report.php" method="post" id="registrationForm">
<fieldset class="form-group">
<label for="exampleInputEmail1">File</label>
<small class="text-muted">A REPORT.</small>
</fieldset>
<fieldset class="form-group">
<div class="col-xs-6">
<label for="patient"><h4>Patient</h4></label>
<select class="form-control" name="pat_report" id="" >
<?php while( $patient = mysqli_fetch_assoc($patient_set)){
$pat = $patient['patient_firstname'] ;
$patt = $patient['patient_lastname'] ;
echo "<option>$pat $patt</option>";
?>
<?php } ?>
</select>
</div>
</fieldset>
<fieldset class="form-group">
<div class="col-xs-6">
<label for="first_name"><h4>Report Date</h4></label>
<input class="form-control" name="report_date" id="report_date" placeholder="" type=date>
</div>
</fieldset>
<fieldset disabled>
<div class="form-group col-xs-6">
<label for="disabledTextInput">Reported By</label>
<input type="text" id="disabledTextInput" class="form-control" placeholder="">
</div>
</fieldset>
<fieldset class="form-group">
<div class="col-xs-6">
<label for="reg_no"><h4>Registration Number</h4></label>
<select class="form-control" name="reg_no" id="reg_no" >
<?php while( $rep = mysqli_fetch_assoc($report_no)){
$report = $rep['reg_no'] ;
echo "<option>$report</option>";
?>
<?php } ?>
</select>
</div>
</fieldset>
<fieldset class="form-group">
<div class="col-xs-6">
<label for="username"><h4>Statement</h4></label>
<textarea class="form-control" name="statement" id="statement" placeholder="" title="" type="text" rows="15"></textarea>
</div>
</fieldset>
<fieldset class="form-group">
<div class="col-xs-12">
<br>
<button type="submit" name="submit" class="btn btn-primary">Create Report</button><br><br>
</div>
</fieldset>
</form>
</div>
</div>
</body>
</html>