<?php
session_start();
include("dbConfig.php");
if(isset($_SESSION['username']) && isset($_SESSION['name']))
{
    $username=$_SESSION['username'];
    $name=$_SESSION['name'];
}

?>
<!DOCTYPE html>
<html>
<head>
  <title>
    
  </title>
  <meta charset="UTF-8">
  <link href="assets/img/favicon.png" rel="icon">
  <link href="assets/img/apple-touch-icon.png" rel="apple-touch-icon">
  <script src='https://maxcdn.bootstrapcdn.com/bootstrap/4.3.1/js/bootstrap.min.js'></script>
<script src='https://cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js'></script>
<link href='https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.0.3/css/font-awesome.css'>
<link href='https://maxcdn.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css'>
  <!-- Google Fonts -->
  <link href="https://fonts.googleapis.com/css?family=Open+Sans:300,300i,400,400i,700,700i|Raleway:300,400,500,700,800|Montserrat:300,400,700" rel="stylesheet">
<link href='https://maxcdn.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css'>
<link href='https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.0.3/css/font-awesome.css'>

  <!-- Vendor CSS Files -->
  <link href="assets/vendor/bootstrap/css/bootstrap.min.css" rel="stylesheet">
  <link href="assets/vendor/ionicons/css/ionicons.min.css" rel="stylesheet">
  <link href="assets/vendor/animate.css/animate.min.css" rel="stylesheet">
  <link href="assets/vendor/font-awesome/css/font-awesome.min.css" rel="stylesheet">
  <link href="assets/vendor/venobox/venobox.css" rel="stylesheet">
  <link href="assets/vendor/owl.carousel/assets/owl.carousel.min.css" rel="stylesheet">
  <link href="assets/vendor/boxicons/css/boxicons.min.css" rel="stylesheet">
  <script src="https://code.jquery.com/jquery.min.js"></script>
  <script src="jquery.dependent.fields.js"></script>
  

  <!-- Template Main CSS File -->
  <link href="assets/css/style.css" rel="stylesheet">
  <script src="https://code.jquery.com/jquery.min.js"></script>
<script src="jquery.dependent.fields.js"></script>
<link rel="stylesheet" href="js/select2.min.css" />
<style type="text/css">
.nav-menu a {
    padding: 3px 3px;
}

  .hide {
  display: none;
}
h4{
  padding-top: 5px;
  padding-bottom: 0px;
  color:#1abfbf;
  font-weight: bold;
}
hr{
  background-color:#1abfbf;
}
span{
  color:red;
}
.footer {
   position: fixed;
   left: 0;
   bottom: 0;
   width: 100%;
   background-color: #efe8e8;
   color: black;
   text-align: center;
   padding:4px;
   font-size:12px;
}.footer a{
  font-weight: bold;
  color:#0c0c67;
}
</style>

</head>
<body>
  <div style="text-align: center">
     <img src="assets/img/logo.png" width="100px" height="100px">
  </div>

    <header id="header">     

    <div class="container">
    <nav id="nav-menu-container">
        <ul class="nav-menu">
      <li class="menu-active">
        <a class="nav-link" style="padding:2;font-size:14px" href="index.php">Home</a>
      </li>
            <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">IPD Patients</a>
        <ul>
              <li><a href="AddPatient.php">IPD Patient Registration</a></li>
              <li><a href="AddAdvance.php">IPD add Advance</a></li>
              <li><a href="UpdateWard.php">Update Ward</a></li>
              <li><a href="IPDPatients.php">View IPD Patients</a></li>
              
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">OPD Patients</a>
        <ul>
            <li><a href="OPDRegistration.php">OPD Patient Registration</a></li>
            <li><a href="OPDPatientsList.php">View OPD Patients Lists</a></li>
            <li><a href="OPDPatients.php">View OPD Patients Bills</a></li>
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">Staff</a>
        <ul>
              <li><a href="AddStaff.php">Add Staff</a></li>
              <li><a href="StaffList.php">Staff List</a></li>
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">Billing</a>
        <ul>
              <li><a href="billingId.php">Generate Consolidate Bill</a></li>
              <li><a href="InvestigationId.php">Generate Investigation Bill</a></li>
              <li><a href="FinaleBillId.php">Generate Discharge Bill</a></li>
              <li><a href="SearchBill.php">Search Bill</a></li>
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">Particular</a>
        <ul>
              <li><a href="AddParticulars.php">Add Particulars</a></li>
              <li><a href="ViewParticulars.php">View Particulars</a></li>
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#">Report</a>
        <ul>
               <li><a href="UploadReport.php">Upload Patient Report</a></li>
              <li><a href="DailyTrans.php">Transactions</a></li>
              <li><a href="userTrans.php">User Transactions</a></li>
              <li><a href="ViewReport.php">View Patient Reports</a></li>
              
        </ul>
      </li>
      <li class="menu-has-children">
        <a class="nav-link" style="padding:2;font-size:14px" href="#" style="font-size:15px"><? echo $name?></a>
        <ul>
               <li><a href="logout.php">Logout</a></li>
              <li><a href="ResetPassword.php">Reset Password</a></li>              
        </ul>
      </li>
        </ul>
      </nav><!-- #nav-menu-container -->
    </div>
  </header><!-- End Header -->      
  <section>
  <div class="row">
<div class="col-md-2"></div> 
<div class="col-md-8">
  <div class="shadow p-3 mb-5 bg-light rounded">
<form action="store.php" method="POST">
 
    

  <h2 style="text-align: center;font-weight: bold;color:#fff;background-color: #279480;padding:10px;">OPD Patient Registration</h2>

    <div class="row">
        <div class="form-group col">
    <label for="title">Title<span>*</span></label>
    <select class="form-control" name="title" id="title" required>
        <option value="" disabled selected>Select Title</option>
        <option value="Mr">Mr</option>
        <option value="Mrs">Mrs</option>   <option value="Miss">Miss</option>
        <option value="Master">Master</option>
        <option value="Baby">Baby</option>
    </select>
</div>

    <div class="form-group col">
      <label for="Pname">Patient Name<span>*</span></label>
      <input  class="form-control" type="text" name="opdname" id="opdname" required>
    </div>
    <div class="form-group col">
      <label for="fhname">Father/Husband Name</label>
      <input  class="form-control" type="text" name="fhname" id="fhname" >
    </div>
    <div class="form-group col">
      <label for="contact1">Contact No.<span>*</span></label>
      <input  class="form-control" type="text" name="contact1" id="contact1" required>
    </div>    

  </div>
    <div class="row">
  
    <div class="form-group col">
      <label for="email">Email Id</label>
      <input  class="form-control" type="email" name="email" id="email">
    </div>
       <div class="form-group col">
      <label for="age">Age<span>*</span></label>
      <input  class="form-control" type="text" name="age" id="age" required>
    </div>
    <div class="form-group col">
      <label for="Gender">Gender<span>*</span></label>
      <select class="form-control" name="Gender" id="Gender" required>
        <option value="">Choose Option</option>
        <option value="Male">Male</option>
        <option value="Female">Female</option>
      </select>
    </div>

  </div>

    <div class="row">    
      <div class="form-group col">
      <label for="Address">Address<span></span></label>
      <textarea class="form-control" name="Address" id="Address" rows="6" ></textarea>
        
    </div>
     <div class="form-group col">
      <label for="City">City<span></span></label>
      <input  class="form-control" type="text" name="City" id="City" >
                <label for="State">State<span>*</span></label>
                <input class="form-control" type="text" name="State" id="State" value="Karnataka" required>
                <label for="Country">Country<span>*</span></label>
                <input class="form-control" type="text" name="Country" id="Country" value="India" required>
    </div>
  </div>

  <div class="row">    
    <div class="form-group col">
      <label for="Consultant">Consultant<span>*</span></label>
      <!--<input  class="form-control" type="text" name="Consultant" id="Consultant" required>-->
    <select class="form-control" name="Consultant" id="Consultant" required>
    <option value="">Select</option>
    <?php 
      
        $docList = mysqli_query($conn, "SELECT doc_id, doc_name, doc_specialization, created_at, created_by FROM docotorslist"); 

        while($data = mysqli_fetch_array($docList)){
    ?>
        <!-- Display doc_name as option text and doc_id as value -->
        <option value="<?php echo $data['doc_name']; ?>"> 
            <?php echo $data['doc_name']; ?> (<?php echo $data['doc_specialization']; ?>)
        </option>
    <?php 
        }
    ?>
</select>

  </div>
<div class="form-group col">
    <div class="form-group col">
    <label for="AdmitDate">Date<span>*</span></label>
      <input class="form-control" type="date" name="admitDate" id="admitDate" value="<?php echo date('Y-m-d'); ?>" required>
  </div>
</div>

  </div>

  

</div>
<div style="text-align: center">
  <button type="submit" class="btn btn-primary">Save</button>
<a href="invoice.php"><button type="button" class="btn btn-danger" style="padding:7px 50px;">Cancel</button></a>
</div>
</form>
</div>
</div> 
<div class="col-md-2"></div>    
  </div>
  <section>
  <div class="footer">
        &copy; Copyright 2024 All Rights Reserved <strong>Vidyaranya Hospital PVt LTD.</strong>. | Designed by <a href="http://www.vatsinsoft.in/">Vatsin Soft</a>
      </div>


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  $(document).ready( function() {
        $("#Consultant").select2( {
        	placeholder: "Select",
        	allowClear: true
    	
    	} );
    	
        
    });
  </script>
</body>
</html>
