551 lines
38 KiB
PHP
551 lines
38 KiB
PHP
<!DOCTYPE html>
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<html lang="en">
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<head>
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@include('layouts.shared/title-meta', ['title' => 'Register & Signup'])
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@include('layouts.shared/head-css', ['mode' => $mode ?? '', 'demo' => $demo ?? ''])
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<link href="{{ asset('assets/libs/flatpickr/flatpickr.min.css') }}" rel="stylesheet" type="text/css" />
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</head>
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<body class="loading authentication-bg authentication-bg-pattern" style="background-color: rgb(65, 154, 154);">
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<div class="account-pages mt-2 mb-5">
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<div class="container">
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<div class="row justify-content-center">
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<div class="col-md-8">
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<div class="card bg-pattern border">
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<div class="card-body p-4">
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<div class="text-center w-75 m-auto">
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<img src="{{ asset('/images/crest-logo.jpeg') }}" class="img-fluid"
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style="max-height: 100px;">
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<h4>Register for POC Spirometry</h4>
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</div>
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@if (session('error'))
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<div class="alert alert-danger">{{ session('error') }}</div>
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@endif
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@if (session('success'))
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<div class=" alert alert-success">{{ session('success') }}
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</div>
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@endif
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@if (sizeof($errors) > 0)
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<ul>
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@foreach ($errors->all() as $error)
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<li class="text-danger">{{ $error }}</li>
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@endforeach
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</ul>
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@endif
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<form method="POST" action="{{ route('submitpocuser') }}" class="mt-2">
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@csrf
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{{-- <input type="hidden" name="user_id" value="{{$user->id}}">
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<input type="hidden" name="position" value="{{$user->hierarchy_info->code}}"> --}}
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<hr>
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<div class="row mb-3">
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<label for="name_of_doctor" class="col-4 col-xl-3 col-form-label"> <span
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class="text-danger">*</span> Name of Doctor
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</label>
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<div class="col-8 col-xl-9">
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<input type="text" class="form-control" id="name_of_doctor"
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name="name_of_doctor"
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value="{{ isset($userdata->name_of_doctor) ? $userdata->name_of_doctor : '' }}"
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required>
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</div>
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</div>
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<div class="row mb-3">
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<label for="mobile_number" class="col-4 col-xl-3 col-form-label"><span
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class="text-danger">*</span> Mobile Number </label>
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<div class="col-8 col-xl-9">
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<input type="number" class="form-control" id="mobile_number"
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name="mobile_number"
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value="{{ isset($userdata->mobile_number) ? $userdata->mobile_number : '' }}"
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required>
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</div>
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</div>
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<div class="row mb-3">
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<label for="password" class="col-4 col-xl-3 col-form-label"><span
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class="text-danger">*</span> Password</label>
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<div class="col-8 col-xl-9">
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<input type="password" class="form-control" id="password" name="password"
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value="{{ isset($userdata->password) ? $userdata->password : '' }}"
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required>
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</div>
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</div>
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@include('partials.register-location-fields', [
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'showRequiredAsterisk' => true,
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'cityField' => 'city_town',
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'cityLabel' => 'City / Town',
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'persistCountryState' => false,
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])
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<div class="row mb-3">
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<label for="qualification" class="col-4 col-xl-3 col-form-label"><span
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class="text-danger">*</span> Qualification </label>
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<div class="col-8 col-xl-9">
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<select name="qualification" id="qualification" class="form-control" required>
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<option value="">-- Select --</option>
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<option value="MD"
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{{ isset($userdata->qualification) ? ($userdata->qualification == 'MD' ? 'selected' : '') : '' }}>
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MD</option>
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<option value="DNB"
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{{ isset($userdata->qualification) ? ($userdata->qualification == 'DNB' ? 'selected' : '') : '' }}>
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DNB</option>
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<option value="Diploma"
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{{ isset($userdata->qualification) ? ($userdata->qualification == 'Diploma' ? 'selected' : '') : '' }}>
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Diploma</option>
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</select>
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</div>
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</div>
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<div class="row mb-3">
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<label for="specialization" class="col-4 col-xl-3 col-form-label"><span
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class="text-danger">*</span> Specialization</label>
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<div class="col-8 col-xl-9">
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<select name="specialization" id="specialization" class="form-control" required>
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@if(isset($userdata->specialization))
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<option value="{{$userdata->specialization}}">{{$userdata->specialization}}</option>
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@else
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<option value="">-- Select --</option>
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@endif
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</select>
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</div>
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</div>
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<hr>
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<div class="row mb-3">
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<div class="col-6">
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<span class="text-danger">*</span>
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<label class="form-check-label" for="type_of_practice">Type of Practice</label>
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</div>
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<div class="col-6">
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@if (isset($userdata->type_of_practice))
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@php
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$practiceTypes = explode(',', $userdata->type_of_practice);
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@endphp
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@else
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@php
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$practiceTypes = [];
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@endphp
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@endif
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<div class="form-check">
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<input type="checkbox" class="form-check-input" id="private_clinic"
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name="type_of_practice[]" value="Private Clinic"
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{{ in_array('Private Clinic', $practiceTypes) ? 'checked' : '' }}>
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<label class="form-check-label" for="private_clinic">Private
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Clinic</label>
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</div>
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<div class="form-check">
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<input type="checkbox" class="form-check-input" id="private_hospital"
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name="type_of_practice[]" value="Private Hospital"
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{{ in_array('Private Hospital', $practiceTypes) ? 'checked' : '' }}>
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<label class="form-check-label" for="private_hospital">Private
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Hospital</label>
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</div>
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<div class="form-check">
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<input type="checkbox" class="form-check-input" id="goverment_set_up"
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value="Goverment set up" name="type_of_practice[]"
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{{ in_array('Goverment set up', $practiceTypes) ? 'checked' : '' }}>
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<label class="form-check-label" for="goverment_set_up">Goverment set
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up</label>
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</div>
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</div>
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</div>
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<div class="row mb-3">
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<div class="col-6">
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<label class="form-check-label" for="years_of_practice"><span
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class="text-danger">*</span>Years of Practice</label>
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</div>
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<div class="col-6">
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<div class="form-check">
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<input type="radio" class="form-check-input" value="<5"
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id="years_of_practice" name="years_of_practice"
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{{ isset($userdata->years_of_practice) ? ($userdata->years_of_practice == '<5' ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for="less_than_five">{{ '<5' }}</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" value="5-10"
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id="years_of_practice" name="years_of_practice"
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{{ isset($userdata->years_of_practice) ? ($userdata->years_of_practice == '5-10' ? 'checked' : '') : '' }}>
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<label class="form-check-label" for="5-10">5-10</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" value="10-20"
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id="years_of_practice" name="years_of_practice"
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{{ isset($userdata->years_of_practice) ? ($userdata->years_of_practice == '10-20' ? 'checked' : '') : '' }}>
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<label class="form-check-label" for="10-20">10-20</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" value=">20"
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id="years_of_practice" name="years_of_practice"
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{{ isset($userdata->years_of_practice) ? ($userdata->years_of_practice == '>20' ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for=">20">{{ '>20' }}</label>
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</div>
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</div>
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</div>
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<div class="row mb-3">
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<div class="col-6">
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<label class="form-check-label" for="no_of_patients_seen_in_opd">
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<span class="text-danger">*</span>
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On an
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average, in a day, how many patients do you see in your OPD?</label>
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</div>
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<div class="col-6">
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<div class="form-check">
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<input type="radio" class="form-check-input" value="<15"
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id="no_of_patients_seen_in_opd" name="no_of_patients_seen_in_opd"
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{{ isset($userdata->no_of_patients_seen_in_opd) ? ($userdata->no_of_patients_seen_in_opd == '<15' ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for="greater_than_fifteen">{{ '<15' }}</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" value="15-30"
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id="no_of_patients_seen_in_opd" name="no_of_patients_seen_in_opd"
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{{ isset($userdata->no_of_patients_seen_in_opd) ? ($userdata->no_of_patients_seen_in_opd == '15-30' ? 'checked' : '') : '' }}>
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<label class="form-check-label" for="15-30">15-30</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" value="30-50"
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id="no_of_patients_seen_in_opd" name="no_of_patients_seen_in_opd"
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{{ isset($userdata->no_of_patients_seen_in_opd) ? ($userdata->no_of_patients_seen_in_opd == '30-50' ? 'checked' : '') : '' }}>
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<label class="form-check-label" for="30-50">30-50</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" value=">50"
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id="no_of_patients_seen_in_opd" name="no_of_patients_seen_in_opd"
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{{ isset($userdata->no_of_patients_seen_in_opd) ? ($userdata->no_of_patients_seen_in_opd == '30-50' ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for=">50">{{ '>50' }}</label>
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</div>
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</div>
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</div>
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<div class="row mb-3">
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<div class="col-6">
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<label class="form-check-label" for="respiratory_symptoms_percentage">
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<span class="text-danger">*</span>
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On an average, in a day, approximately
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what percentage of patients that come to you, come for respiratory
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symptoms?</label>
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</div>
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<div class="col-6">
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<div class="form-check">
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<input type="radio" class="form-check-input" value="<30"
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id="respiratory_symptoms_percentage"
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name="respiratory_symptoms_percentage"
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{{ isset($userdata->respiratory_symptoms_percentage) ? ($userdata->respiratory_symptoms_percentage == '<30' ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for="<30">{{ '<30' }}</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" value="30-50"
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id="respiratory_symptoms_percentage"
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name="respiratory_symptoms_percentage"
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{{ isset($userdata->respiratory_symptoms_percentage) ? ($userdata->respiratory_symptoms_percentage == '30-50' ? 'checked' : '') : '' }}>
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<label class="form-check-label" for="30-50">30-50</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" value="50-80"
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id="respiratory_symptoms_percentage"
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name="respiratory_symptoms_percentage"
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{{ isset($userdata->respiratory_symptoms_percentage) ? ($userdata->respiratory_symptoms_percentage == '50-80' ? 'checked' : '') : '' }}>
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<label class="form-check-label" for="50-80">50-80</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" value="80-100"
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id="respiratory_symptoms_percentage"
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name="respiratory_symptoms_percentage"
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{{ isset($userdata->respiratory_symptoms_percentage) ? ($userdata->respiratory_symptoms_percentage == '80-100' ? 'checked' : '') : '' }}>
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<label class="form-check-label" for="80-100">80-100</label>
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</div>
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</div>
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</div>
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<div class="row mb-3">
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<div class="col-md-6 col-sm-4">
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<label class="form-check-label" for="diagnosis_basis"><span
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class="text-danger">*</span> On what basis do you diagnose the cases as
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Asthma or COPD?</label>
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</div>
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<div class="col-md-6 col-sm-8">
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<div class="form-check">
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<input type="radio" class="form-check-input" id="diagnosis_basis"
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name="diagnosis_basis" value="Clinical History"
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{{ isset($userdata->diagnosis_basis) ? ($userdata->diagnosis_basis == 'Clinical History' ? 'checked' : '') : '' }}>
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<label class="form-check-label" for="clinical_history">Clinical
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History</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" id="diagnosis_basis"
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name="diagnosis_basis" value="Clinical History and Examination"
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{{ isset($userdata->diagnosis_basis) ? ($userdata->diagnosis_basis == 'Clinical History and Examination' ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for="clinical_history_examination">Clinical History +
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Examination</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" id="diagnosis_basis"
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name="diagnosis_basis"
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value="Clinical History and Examination and Chest X-Ray">
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<label class="form-check-label"
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for="clinical_history_examination_chest_xray">Clinical History +
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Examination
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+ Chest X-Ray</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" id="diagnosis_basis"
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name="diagnosis_basis"
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value="Clinical History and Examination and Peak Flow Meter"
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{{ isset($userdata->diagnosis_basis) ? ($userdata->diagnosis_basis == 'Clinical History and Examination and Peak Flow Meter' ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for="clinical_history_examination_peak_flow_meter">Clinical History +
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Examination + Peak Flow Meter</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" id="diagnosis_basis"
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name="diagnosis_basis"
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value="Clinical History and Examination and Spirometry"
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{{ isset($userdata->diagnosis_basis) ? ($userdata->diagnosis_basis == 'Clinical History and Examination and Spirometry' ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for="clinical_history_examination_spirometry">Clinical History +
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Examination + Spirometry</label>
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</div>
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<div class="form-check">
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<input type="radio" class="form-check-input" id="diagnosis_basis"
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name="diagnosis_basis" name="Diagnosis written by a specialist"
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value="Diagnosis written by a specialist"
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{{ isset($userdata->diagnosis_basis) ? ($userdata->diagnosis_basis == 'Diagnosis written by a specialist' ? 'checked' : '') : '' }}>
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<label class="form-check-label" for="specialist_diagnosis">Diagnosis
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written by a specialist</label>
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</div>
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</div>
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</div>
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@if (isset($userdata->spirometry_done_from_where))
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@php
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$sdw = explode(',', $userdata->spirometry_done_from_where);
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@endphp
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@else
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@php
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$sdw = [];
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@endphp
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@endif
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<div class="row mb-3 spirometry_done_from_where">
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<div class="col-md-6 col-sm-4">
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<label class="form-check-label" for="spirometry_done_from_where"><span
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class="text-danger">*</span> Where do you get the Spirometry
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done?</label>
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</div>
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<div class="col-md-6 col-sm-8">
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<div class="form-check">
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<input type="checkbox" class="form-check-input" id="you_do_it_yourself"
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name="spirometry_done_from_where[]" value="You do it yourself"
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{{ count($sdw) > 0 ? (in_array('You do it yourself', $sdw) ? 'checked' : '') : '' }}>
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<label class="form-check-label" for="you_do_it_yourself">You do it
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yourself</label>
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</div>
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<div class="form-check">
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<input type="checkbox" class="form-check-input"
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id="take_help_professional_spirometry_technicians_clinic"
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name="spirometry_done_from_where[]"
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value="You take help from professional Spirometry Technicians in your clinic"
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{{ count($sdw) > 0 ? (in_array('You take help from professional Spirometry Technicians in your clinic', $sdw) ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for="take_help_professional_spirometry_technicians_clinic">You take
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help from professional Spirometry Technicians in your clinic</label>
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</div>
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<div class="form-check">
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<input type="checkbox" class="form-check-input"
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id="refer_patient_diagnostic_centre_spirometry"
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name="spirometry_done_from_where[]"
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value="You refer the patient to a diagnostic centre for Spirometry"
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{{ count($sdw) > 0 ? (in_array('You refer the patient to a diagnostic centre for Spirometry', $sdw) ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for="refer_patient_diagnostic_centre_spirometry">You refer the
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patient
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to a diagnostic centre for Spirometry</label>
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</div>
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<div class="form-check">
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<input type="checkbox" class="form-check-input"
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id="refer_patient_specialist_suspect_asthma_copd"
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name="spirometry_done_from_where[]"
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value="You refer the patient to a specialist if you suspect Asthma or COPD"
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{{ count($sdw) > 0 ? (in_array('You refer the patient to a specialist if you suspect Asthma or COPD', $sdw) ? 'checked' : '') : '' }}>
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<label class="form-check-label"
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for="refer_patient_specialist_suspect_asthma_copd">You refer the
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patient to a specialist if you suspect Asthma or COPD</label>
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</div>
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</div>
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</div>
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@if (isset($userdata->what_prevented_you_to_buy_spirometer))
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@php
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$wpy = explode(',', $userdata->what_prevented_you_to_buy_spirometer);
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@endphp
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@else
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@php
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$wpy = [];
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@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>
|