CrestRoad/laravel/resources/views/pocspirometry/register.blade.php

551 lines
38 KiB
PHP

<!DOCTYPE html>
<html lang="en">
<head>
@include('layouts.shared/title-meta', ['title' => 'Register & Signup'])
@include('layouts.shared/head-css', ['mode' => $mode ?? '', 'demo' => $demo ?? ''])
<link href="{{ asset('assets/libs/flatpickr/flatpickr.min.css') }}" rel="stylesheet" type="text/css" />
</head>
<body class="loading authentication-bg authentication-bg-pattern" style="background-color: rgb(65, 154, 154);">
<div class="account-pages mt-2 mb-5">
<div class="container">
<div class="row justify-content-center">
<div class="col-md-8">
<div class="card bg-pattern border">
<div class="card-body p-4">
<div class="text-center w-75 m-auto">
<img src="{{ asset('/images/crest-logo.jpeg') }}" class="img-fluid"
style="max-height: 100px;">
<h4>Register for POC Spirometry</h4>
</div>
@if (session('error'))
<div class="alert alert-danger">{{ session('error') }}</div>
@endif
@if (session('success'))
<div class=" alert alert-success">{{ session('success') }}
</div>
@endif
@if (sizeof($errors) > 0)
<ul>
@foreach ($errors->all() as $error)
<li class="text-danger">{{ $error }}</li>
@endforeach
</ul>
@endif
<form method="POST" action="{{ route('submitpocuser') }}" class="mt-2">
@csrf
{{-- <input type="hidden" name="user_id" value="{{$user->id}}">
<input type="hidden" name="position" value="{{$user->hierarchy_info->code}}"> --}}
<hr>
<div class="row mb-3">
<label for="name_of_doctor" class="col-4 col-xl-3 col-form-label"> <span
class="text-danger">*</span> Name of Doctor
</label>
<div class="col-8 col-xl-9">
<input type="text" class="form-control" id="name_of_doctor"
name="name_of_doctor"
value="{{ isset($userdata->name_of_doctor) ? $userdata->name_of_doctor : '' }}"
required>
</div>
</div>
<div class="row mb-3">
<label for="mobile_number" class="col-4 col-xl-3 col-form-label"><span
class="text-danger">*</span> Mobile Number </label>
<div class="col-8 col-xl-9">
<input type="number" class="form-control" id="mobile_number"
name="mobile_number"
value="{{ isset($userdata->mobile_number) ? $userdata->mobile_number : '' }}"
required>
</div>
</div>
<div class="row mb-3">
<label for="password" class="col-4 col-xl-3 col-form-label"><span
class="text-danger">*</span> Password</label>
<div class="col-8 col-xl-9">
<input type="password" class="form-control" id="password" name="password"
value="{{ isset($userdata->password) ? $userdata->password : '' }}"
required>
</div>
</div>
@include('partials.register-location-fields', [
'showRequiredAsterisk' => true,
'cityField' => 'city_town',
'cityLabel' => 'City / Town',
'persistCountryState' => false,
])
<div class="row mb-3">
<label for="qualification" class="col-4 col-xl-3 col-form-label"><span
class="text-danger">*</span> Qualification </label>
<div class="col-8 col-xl-9">
<select name="qualification" id="qualification" class="form-control" required>
<option value="">-- Select --</option>
<option value="MD"
{{ isset($userdata->qualification) ? ($userdata->qualification == 'MD' ? 'selected' : '') : '' }}>
MD</option>
<option value="DNB"
{{ isset($userdata->qualification) ? ($userdata->qualification == 'DNB' ? 'selected' : '') : '' }}>
DNB</option>
<option value="Diploma"
{{ isset($userdata->qualification) ? ($userdata->qualification == 'Diploma' ? 'selected' : '') : '' }}>
Diploma</option>
</select>
</div>
</div>
<div class="row mb-3">
<label for="specialization" class="col-4 col-xl-3 col-form-label"><span
class="text-danger">*</span> Specialization</label>
<div class="col-8 col-xl-9">
<select name="specialization" id="specialization" class="form-control" required>
@if(isset($userdata->specialization))
<option value="{{$userdata->specialization}}">{{$userdata->specialization}}</option>
@else
<option value="">-- Select --</option>
@endif
</select>
</div>
</div>
<hr>
<div class="row mb-3">
<div class="col-6">
<span class="text-danger">*</span>
<label class="form-check-label" for="type_of_practice">Type of Practice</label>
</div>
<div class="col-6">
@if (isset($userdata->type_of_practice))
@php
$practiceTypes = explode(',', $userdata->type_of_practice);
@endphp
@else
@php
$practiceTypes = [];
@endphp
@endif
<div class="form-check">
<input type="checkbox" class="form-check-input" id="private_clinic"
name="type_of_practice[]" value="Private Clinic"
{{ in_array('Private Clinic', $practiceTypes) ? 'checked' : '' }}>
<label class="form-check-label" for="private_clinic">Private
Clinic</label>
</div>
<div class="form-check">
<input type="checkbox" class="form-check-input" id="private_hospital"
name="type_of_practice[]" value="Private Hospital"
{{ in_array('Private Hospital', $practiceTypes) ? 'checked' : '' }}>
<label class="form-check-label" for="private_hospital">Private
Hospital</label>
</div>
<div class="form-check">
<input type="checkbox" class="form-check-input" id="goverment_set_up"
value="Goverment set up" name="type_of_practice[]"
{{ in_array('Goverment set up', $practiceTypes) ? 'checked' : '' }}>
<label class="form-check-label" for="goverment_set_up">Goverment set
up</label>
</div>
</div>
</div>
<div class="row mb-3">
<div class="col-6">
<label class="form-check-label" for="years_of_practice"><span
class="text-danger">*</span>Years of Practice</label>
</div>
<div class="col-6">
<div class="form-check">
<input type="radio" class="form-check-input" value="<5"
id="years_of_practice" name="years_of_practice"
{{ isset($userdata->years_of_practice) ? ($userdata->years_of_practice == '<5' ? 'checked' : '') : '' }}>
<label class="form-check-label"
for="less_than_five">{{ '<5' }}</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" value="5-10"
id="years_of_practice" name="years_of_practice"
{{ isset($userdata->years_of_practice) ? ($userdata->years_of_practice == '5-10' ? 'checked' : '') : '' }}>
<label class="form-check-label" for="5-10">5-10</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" value="10-20"
id="years_of_practice" name="years_of_practice"
{{ isset($userdata->years_of_practice) ? ($userdata->years_of_practice == '10-20' ? 'checked' : '') : '' }}>
<label class="form-check-label" for="10-20">10-20</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" value=">20"
id="years_of_practice" name="years_of_practice"
{{ isset($userdata->years_of_practice) ? ($userdata->years_of_practice == '>20' ? 'checked' : '') : '' }}>
<label class="form-check-label"
for=">20">{{ '>20' }}</label>
</div>
</div>
</div>
<div class="row mb-3">
<div class="col-6">
<label class="form-check-label" for="no_of_patients_seen_in_opd">
<span class="text-danger">*</span>
On an
average, in a day, how many patients do you see in your OPD?</label>
</div>
<div class="col-6">
<div class="form-check">
<input type="radio" class="form-check-input" value="<15"
id="no_of_patients_seen_in_opd" name="no_of_patients_seen_in_opd"
{{ isset($userdata->no_of_patients_seen_in_opd) ? ($userdata->no_of_patients_seen_in_opd == '<15' ? 'checked' : '') : '' }}>
<label class="form-check-label"
for="greater_than_fifteen">{{ '<15' }}</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" value="15-30"
id="no_of_patients_seen_in_opd" name="no_of_patients_seen_in_opd"
{{ isset($userdata->no_of_patients_seen_in_opd) ? ($userdata->no_of_patients_seen_in_opd == '15-30' ? 'checked' : '') : '' }}>
<label class="form-check-label" for="15-30">15-30</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" value="30-50"
id="no_of_patients_seen_in_opd" name="no_of_patients_seen_in_opd"
{{ isset($userdata->no_of_patients_seen_in_opd) ? ($userdata->no_of_patients_seen_in_opd == '30-50' ? 'checked' : '') : '' }}>
<label class="form-check-label" for="30-50">30-50</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" value=">50"
id="no_of_patients_seen_in_opd" name="no_of_patients_seen_in_opd"
{{ isset($userdata->no_of_patients_seen_in_opd) ? ($userdata->no_of_patients_seen_in_opd == '30-50' ? 'checked' : '') : '' }}>
<label class="form-check-label"
for=">50">{{ '>50' }}</label>
</div>
</div>
</div>
<div class="row mb-3">
<div class="col-6">
<label class="form-check-label" for="respiratory_symptoms_percentage">
<span class="text-danger">*</span>
On an average, in a day, approximately
what percentage of patients that come to you, come for respiratory
symptoms?</label>
</div>
<div class="col-6">
<div class="form-check">
<input type="radio" class="form-check-input" value="<30"
id="respiratory_symptoms_percentage"
name="respiratory_symptoms_percentage"
{{ isset($userdata->respiratory_symptoms_percentage) ? ($userdata->respiratory_symptoms_percentage == '<30' ? 'checked' : '') : '' }}>
<label class="form-check-label"
for="<30">{{ '<30' }}</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" value="30-50"
id="respiratory_symptoms_percentage"
name="respiratory_symptoms_percentage"
{{ isset($userdata->respiratory_symptoms_percentage) ? ($userdata->respiratory_symptoms_percentage == '30-50' ? 'checked' : '') : '' }}>
<label class="form-check-label" for="30-50">30-50</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" value="50-80"
id="respiratory_symptoms_percentage"
name="respiratory_symptoms_percentage"
{{ isset($userdata->respiratory_symptoms_percentage) ? ($userdata->respiratory_symptoms_percentage == '50-80' ? 'checked' : '') : '' }}>
<label class="form-check-label" for="50-80">50-80</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" value="80-100"
id="respiratory_symptoms_percentage"
name="respiratory_symptoms_percentage"
{{ isset($userdata->respiratory_symptoms_percentage) ? ($userdata->respiratory_symptoms_percentage == '80-100' ? 'checked' : '') : '' }}>
<label class="form-check-label" for="80-100">80-100</label>
</div>
</div>
</div>
<div class="row mb-3">
<div class="col-md-6 col-sm-4">
<label class="form-check-label" for="diagnosis_basis"><span
class="text-danger">*</span> On what basis do you diagnose the cases as
Asthma or COPD?</label>
</div>
<div class="col-md-6 col-sm-8">
<div class="form-check">
<input type="radio" class="form-check-input" id="diagnosis_basis"
name="diagnosis_basis" value="Clinical History"
{{ isset($userdata->diagnosis_basis) ? ($userdata->diagnosis_basis == 'Clinical History' ? 'checked' : '') : '' }}>
<label class="form-check-label" for="clinical_history">Clinical
History</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" id="diagnosis_basis"
name="diagnosis_basis" value="Clinical History and Examination"
{{ isset($userdata->diagnosis_basis) ? ($userdata->diagnosis_basis == 'Clinical History and Examination' ? 'checked' : '') : '' }}>
<label class="form-check-label"
for="clinical_history_examination">Clinical History +
Examination</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" id="diagnosis_basis"
name="diagnosis_basis"
value="Clinical History and Examination and Chest X-Ray">
<label class="form-check-label"
for="clinical_history_examination_chest_xray">Clinical History +
Examination
+ Chest X-Ray</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" id="diagnosis_basis"
name="diagnosis_basis"
value="Clinical History and Examination and Peak Flow Meter"
{{ isset($userdata->diagnosis_basis) ? ($userdata->diagnosis_basis == 'Clinical History and Examination and Peak Flow Meter' ? 'checked' : '') : '' }}>
<label class="form-check-label"
for="clinical_history_examination_peak_flow_meter">Clinical History +
Examination + Peak Flow Meter</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" id="diagnosis_basis"
name="diagnosis_basis"
value="Clinical History and Examination and Spirometry"
{{ isset($userdata->diagnosis_basis) ? ($userdata->diagnosis_basis == 'Clinical History and Examination and Spirometry' ? 'checked' : '') : '' }}>
<label class="form-check-label"
for="clinical_history_examination_spirometry">Clinical History +
Examination + Spirometry</label>
</div>
<div class="form-check">
<input type="radio" class="form-check-input" id="diagnosis_basis"
name="diagnosis_basis" name="Diagnosis written by a specialist"
value="Diagnosis written by a specialist"
{{ isset($userdata->diagnosis_basis) ? ($userdata->diagnosis_basis == 'Diagnosis written by a specialist' ? 'checked' : '') : '' }}>
<label class="form-check-label" for="specialist_diagnosis">Diagnosis
written by a specialist</label>
</div>
</div>
</div>
@if (isset($userdata->spirometry_done_from_where))
@php
$sdw = explode(',', $userdata->spirometry_done_from_where);
@endphp
@else
@php
$sdw = [];
@endphp
@endif
<div class="row mb-3 spirometry_done_from_where">
<div class="col-md-6 col-sm-4">
<label class="form-check-label" for="spirometry_done_from_where"><span
class="text-danger">*</span> Where do you get the Spirometry
done?</label>
</div>
<div class="col-md-6 col-sm-8">
<div class="form-check">
<input type="checkbox" class="form-check-input" id="you_do_it_yourself"
name="spirometry_done_from_where[]" value="You do it yourself"
{{ count($sdw) > 0 ? (in_array('You do it yourself', $sdw) ? 'checked' : '') : '' }}>
<label class="form-check-label" for="you_do_it_yourself">You do it
yourself</label>
</div>
<div class="form-check">
<input type="checkbox" class="form-check-input"
id="take_help_professional_spirometry_technicians_clinic"
name="spirometry_done_from_where[]"
value="You take help from professional Spirometry Technicians in your clinic"
{{ count($sdw) > 0 ? (in_array('You take help from professional Spirometry Technicians in your clinic', $sdw) ? 'checked' : '') : '' }}>
<label class="form-check-label"
for="take_help_professional_spirometry_technicians_clinic">You take
help from professional Spirometry Technicians in your clinic</label>
</div>
<div class="form-check">
<input type="checkbox" class="form-check-input"
id="refer_patient_diagnostic_centre_spirometry"
name="spirometry_done_from_where[]"
value="You refer the patient to a diagnostic centre for Spirometry"
{{ count($sdw) > 0 ? (in_array('You refer the patient to a diagnostic centre for Spirometry', $sdw) ? 'checked' : '') : '' }}>
<label class="form-check-label"
for="refer_patient_diagnostic_centre_spirometry">You refer the
patient
to a diagnostic centre for Spirometry</label>
</div>
<div class="form-check">
<input type="checkbox" class="form-check-input"
id="refer_patient_specialist_suspect_asthma_copd"
name="spirometry_done_from_where[]"
value="You refer the patient to a specialist if you suspect Asthma or COPD"
{{ count($sdw) > 0 ? (in_array('You refer the patient to a specialist if you suspect Asthma or COPD', $sdw) ? 'checked' : '') : '' }}>
<label class="form-check-label"
for="refer_patient_specialist_suspect_asthma_copd">You refer the
patient to a specialist if you suspect Asthma or COPD</label>
</div>
</div>
</div>
@if (isset($userdata->what_prevented_you_to_buy_spirometer))
@php
$wpy = explode(',', $userdata->what_prevented_you_to_buy_spirometer);
@endphp
@else
@php
$wpy = [];
@endphp
@endif
<div class="row mb-3">
<div class="col-md-6 col-sm-4">
<label class="form-check-label"
for="what_prevented_you_to_buy_spirometer"><span
class="text-danger">*</span> What is it that prevented you from buying
a spirometer till now?</label>
</div>
<div class="col-md-6 col-sm-8">
<div class="form-check">
<input type="checkbox" class="form-check-input"
id="non_availability_good_quality_validated_point_care_spirometer"
name="what_prevented_you_to_buy_spirometer[]"
value="Non-availability of good quality validated point-of-care spirometer"
{{ in_array('Non-availability of good quality validated point-of-care spirometer', $wpy) ? 'checked' : '' }}>
<label class="form-check-label"
for="non_availability_good_quality_validated_point_care_spirometer">Non-availability
of good quality validated point-of-care spirometer</label>
</div>
<div class="form-check">
<input type="checkbox" class="form-check-input" id="high_cost_device"
name="what_prevented_you_to_buy_spirometer[]"
value="High cost of the device"
{{ in_array('High cost of the device', $wpy) ? 'checked' : '' }}>
<label class="form-check-label" for="high_cost_device">High cost of the
device</label>
</div>
<div class="form-check">
<input type="checkbox" class="form-check-input"
id="fear_cross_transmission_infections_device"
name="what_prevented_you_to_buy_spirometer[]"
value="Fear of cross-transmission of infections through the device"
{{ in_array('Fear of cross-transmission of infections through the device', $wpy) ? 'checked' : '' }}>
<label class="form-check-label"
for="fear_cross_transmission_infections_device">Fear of
cross-transmission of infections through the device</label>
</div>
<div class="form-check">
<input type="checkbox" class="form-check-input"
id="lack_of_space_for_the_set_up"
name="what_prevented_you_to_buy_spirometer[]"
value="Lack of space for the set up"
{{ in_array('Lack of space for the set up', $wpy) ? 'checked' : '' }}>
<label class="form-check-label" for="lack_of_space_for_the_set_up">Lack of
space for the set up</label>
</div>
<div class="form-check">
<input type="checkbox" class="form-check-input"
id="lack_of_training_in_the_procedure"
name="what_prevented_you_to_buy_spirometer[]"
value="Lack of training in the procedure"
{{ in_array('Lack of training in the procedure', $wpy) ? 'checked' : '' }}>
<label class="form-check-label"
for="lack_of_training_in_the_procedure">Lack of training in the
procedure</label>
</div>
</div>
</div>
<div class="text-center d-grid">
<button class="btn btn-success" type="submit" style="max-width:30%"> Sign Up
</button>
</div>
</form>
</div> <!-- end card-body -->
</div>
<!-- end card -->
</div> <!-- end col -->
</div>
<!-- end row -->
</div>
<!-- end container -->
</div>
<!-- end page -->
@include('layouts.shared/footer-script')
@include('partials.register-location-scripts')
<script src="{{ asset('assets/libs/flatpickr/flatpickr.min.js') }}"></script>
<script type="text/javascript">
$('.datepicker').flatpickr();
//$('#wrapper-other-specialization').hide()
// $('#specialization').change(function() {
// if ($(this).val() == 'Other') {
// $('#wrapper-other-specialization').show()
// $('#other-specialization').prop('required', true);
// } else {
// $('#wrapper-other-specialization').hide()
// $('#other-specialization').removeAttr('required');
// }
// })
jQuery(document).ready(function($) {
$('#qualification').change(function() {
var selectedQualification = $('#qualification').val();
var specializationDropdown = $('#specialization');
if (selectedQualification == 'MD') {
specializationDropdown.empty();
specializationDropdown.append('<option value="">-- Select --</option>');
specializationDropdown.append('<option value="Chest"> Chest </option>');
specializationDropdown.append('<option value="Pediatrics"> Pediatrics </option>');
} else if (selectedQualification == 'DNB') {
specializationDropdown.empty();
specializationDropdown.append('<option value="">-- Select --</option>');
specializationDropdown.append(
'<option value="Internal Medicine"> Internal Medicine </option>');
specializationDropdown.append(
'<option value="Family Medicine"> Family Medicine </option>');
} else if (selectedQualification == 'Diploma') {
specializationDropdown.empty();
specializationDropdown.append('<option value="">-- Select --</option>');
specializationDropdown.append('<option value="Chest"> Chest </option>');
specializationDropdown.append('<option value="Pediatrics"> Pediatrics </option>');
} else {
specializationDropdown.empty();
specializationDropdown.append('<option value="">-- Select --</option>');
}
});
$('.spirometry_done_from_where').hide();
$('input[name="diagnosis_basis"]').change(function() {
if ($(this).val() === 'Clinical History and Examination and Spirometry') {
$('.spirometry_done_from_where').show();
} else {
$('.spirometry_done_from_where').hide();
}
});
});
</script>
</body>
</html>