Team3 Form changes- TOBA TITANS Reporting
Specific Folder FTP Upload / ftp-deploy (push) Successful in 33s
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Specific Folder FTP Upload / ftp-deploy (push) Successful in 33s
Details
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<!DOCTYPE html>
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<html lang="en">
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<head>
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@include('layouts.shared/title-meta', ['title' => "Form"])
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@include('layouts.shared/head-css', ["mode" => $mode ?? '', "demo" => $demo ?? ''])
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<link href="{{asset('assets/libs/sweetalert2/sweetalert2.min.css')}}" rel="stylesheet" type="text/css" />
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</head>
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<div id="pageloader">
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<img src="http://cdnjs.cloudflare.com/ajax/libs/semantic-ui/0.16.1/images/loader-large.gif" alt="processing..." />
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</div>
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<body class="loading">
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<div class="account-pages">
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<div class="container">
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<div class="row justify-content-center">
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<div class="col-md-8 col-lg-6 col-xl-5 p-0">
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<div class="card bg-pattern">
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<div class="card-body p-3 row">
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@if(Session::has('error'))<div class="alert alert-danger">{{Session::get('error')}}</div>
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<br>@endif
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@if(session('success'))<div class=" alert alert-success">{{ session('success') }}
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</div>
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<br>@endif
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<div class="col-8">
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<h4 class="page-title">{{$form->title}}</h4>
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</div>
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@if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )
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<div class="col-4">
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@if($form->link_type == 'form')
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<a href="/form/history" class="float-end pt-1">View History</a>
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@else
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<a href="{{url()->previous()}}" class="float-end pt-1">Back</a>
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@endif
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</div>
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@endif
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@if(isset($form->user_info))
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<div class="col-12">
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<h6>Submitted By: {{$form->user_info->name}}</h6>
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</div>
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@endif
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<form method="POST" action="/form/submit" id="report-form" enctype="multipart/form-data">
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<input type="hidden" name="form_id" value="{{$form_id}}">
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@csrf
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@if($id)
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<input type="hidden" name="id" value="{{$id}}">
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@endif
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@if(isset($form->manager_can_submit) && $form->manager_can_submit == true)
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<div class="col-md-12 mb-2">
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<label for="field-user_id" class="form-label"> Select User / Territory <span class="text-danger">*</span> </label>
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<select class="form-control" id="field-user_id" name="user_id" required>
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<option value=""> -- Select -- </option>
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@foreach($form->users as $option)
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<option value="{{$option->value}}" hierarchy="{{$option->hierarchy_id}}" {{isset($question->value) && $question->value == $option->value ? 'selected':''}}>{{$option->display}}</option>
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@endforeach
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</select>
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<input type="hidden" id="field-hierarchy_id" name="hierarchy_id" value="">
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</div>
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@endif
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@foreach($questions as $question)
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<div class="col-md-12 mb-2">
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<label for="field-{{$question->code}}" class="form-label">{{$question->question}} {!!$question->required == 'yes' ? '<span class="text-danger">*</span>':''!!} </label>
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@switch($question->type)
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@case('hidden')
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<input type="{{$question->type}}" id="field-{{$question->code}}" name="{{$question->code}}" value="{{isset($question->value)?$question->value:''}}">
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@break
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@case('text')
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<input
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type="text"
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id="field-{{$question->code}}"
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name="{{$question->code}}"
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class="form-control"
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{{$question->required == 'yes' ? 'required' : ''}}
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value="{{isset($question->value) ? $question->value : ''}}"
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@if($form_id == '1793766025-480d8dde-07b3-497d-b55c-4f34a08ad5d1')
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@if(in_array($question->code, ['msl_code', 'pcode', 'speciality']))
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readonly
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@endif
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@if(in_array($question->question, ['Hospital/Clinic Name', 'City', 'Current NEB 1 Brand Prescribers']))
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oninput="this.value = this.value.replace(/[^a-zA-Z .'-]/g, '')"
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@endif
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@endif
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>
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@break
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@case('email')
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<input type="email"
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id="field-{{$question->code}}"
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name="{{$question->code}}"
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class="form-control"
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{{$question->required == 'yes' ? 'required' : ''}}
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value="{{isset($question->value) ? $question->value : ''}}">
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@break
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@case('tel')
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<input type="tel"
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id="field-{{$question->code}}"
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name="{{$question->code}}"
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class="form-control"
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{{$question->required == 'yes' ? 'required' : ''}}
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value="{{isset($question->value) ? $question->value : ''}}">
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@break
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@case('date')
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<input type="date"
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id="field-{{$question->code}}"
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name="{{$question->code}}"
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class="form-control"
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{{$question->required == 'yes' ? 'required' : ''}}
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value="{{isset($question->value) ? $question->value : ''}}"
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@if($form_id == '1793766025-480d8dde-07b3-497d-b55c-4f34a08ad5d1' && $question->code == 'record_date')
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min="2026-11-01"
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max="{{date('Y-m-d')}}"
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@endif>
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@break
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@case('number')
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<input
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type="text"
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inputmode="numeric"
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pattern="[0-9]*"
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min="0"
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id="field-{{$question->code}}"
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name="{{$question->code}}"
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class="form-control"
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{{$question->required == 'yes' ? 'required' : ''}}
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value="{{isset($question->value) ? $question->value : ''}}"
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@if($form_id == '1793766025-480d8dde-07b3-497d-b55c-4f34a08ad5d1')
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oninput="this.value = this.value.replace(/[^0-9]/g, '')"
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@endif
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>
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@break
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@case('textarea')
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<textarea id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" {{$question->required == 'yes'?'required':'' }}>{{isset($question->value)?$question->value:''}}</textarea>
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@break
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@case('dropdown')
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<select class="form-control" id="field-{{$question->code}}" name="{{$question->code}}" {{$question->required == 'yes'?'required':'' }}>
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<option value=""> -- Select -- </option>
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@foreach($question->options as $option)
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<option value="{{$option->value}}" {{isset($question->value) && $question->value == $option->value ? 'selected':''}}>{{$option->display}}</option>
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@endforeach
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</select>
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@break
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@case('radio')
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@foreach($question->options as $option)
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<div class="form-check mb-2 form-check-success">
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<input class="form-check-input" type="radio" name="{{$question->code}}" id="field-{{$question->code}}_{{$option->value}}" value="{{$option->value}}">
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<label class="form-check-label" for="field-{{$question->code}}_{{$option->value}}">{{$option->display}}</label>
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</div>
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@endforeach
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@break
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@case('radiometrix')
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@php
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// Decode the first option's value to use as heading labels
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$headings =
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count($question->options) > 0
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? json_decode($question->options[0]->value)
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: [];
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@endphp
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{{-- Matrix Wrapper with Horizontal Scroll on Small Screens --}}
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<div class="table-responsive">
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<div class="d-table w-100">
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{{-- Table Headers --}}
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<div class="d-table-row font-weight-bold">
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<div class="d-table-cell p-2" style="width: 150px;"></div>
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{{-- Placeholder for row labels --}}
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@foreach ($headings as $head)
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<div class="d-table-cell text-center p-2">{{ $head }}
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</div>
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@endforeach
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</div>
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{{-- Table Rows --}}
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@foreach ($question->options as $option)
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@php $nn = json_decode($option->value); @endphp
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<div class="d-table-row align-middle">
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<div class="d-table-cell font-weight-bold p-2"
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style="width: 150px;">
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{{ $option->display }}
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</div>
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@foreach ($nn as $value)
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<div class="d-table-cell text-center p-2">
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<input type="radio"
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id="field-{{ $option->display }}-{{ $value }}"
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name="{{ $question->code }}[{{$option->display}}]" value="{{$value}}" class="form-check-input"
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{{ isset($question->display) && $option->display != $option->display ? 'checked' : '' }}>
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</div>
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@endforeach
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</div>
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@endforeach
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</div>
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</div>
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@break
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@case('checkbox')
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@foreach($question->options as $option)
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<div class="form-check mb-2 form-check-primary ms-2">
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<input class="form-check-input" type="checkbox" id="field-{{$question->code}}-{{$option->value}}" name="{{$question->code}}[]" value="{{$option->value}}" {{isset($question->value) && $question->value != '' && in_array($option->value, $question->value) ? 'checked':''}}>
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<label class="form-check-label" for="field-{{$question->code}}-{{$option->value}}">{{$option->display}}</label>
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</div>
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@endforeach
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@break
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@case('file')
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@if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )
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<input type="file" id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" value="" {{$question->required == 'yes'?'required':'' }}>
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@elseif(isset($question->value))
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<img src="{{$question->value}}" class="img-fluid">
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@endif
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@break
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@case('multitextbox')
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<div class="row">
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@foreach($question->options as $option)
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<div class="col-6">{{$option->display}}</div>
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<div class="col-6 mb-1">
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<input type="number" id="field-{{$option->value}}" name="{{$option->value}}" class="form-control" required value="{{isset($option->val)?$option->val:0}}">
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</div>
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@endforeach
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</div>
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@break
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@endswitch
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</div>
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@endforeach
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@if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )
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<div class="text-center d-grid mt-3">
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<button class="btn btn-primary" type="submit" id="submit-btn"> Submit </button>
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</div>
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@endif
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</form>
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</div> <!-- end card-body -->
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</div>
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<!-- end card -->
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<!-- end row -->
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</div> <!-- end col -->
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</div>
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<!-- end row -->
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</div>
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<!-- end container -->
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</div>
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<!-- end page -->
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<style type="text/css">
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#pageloader {
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background: rgba( 255, 255, 255, 0.8 );
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display: none;
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height: 100%;
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position: fixed;
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width: 100%;
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z-index: 9999;
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}
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#pageloader img {
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left: 50%;
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margin-left: -32px;
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margin-top: -32px;
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position: absolute;
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top: 50%;
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}
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.form-label {
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font-weight:bold;
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font-size:16px;
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}
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</style>
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@include('layouts.shared/footer-script')
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<script src="{{asset('assets/libs/sweetalert2/sweetalert2.min.js')}}"></script>
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<script type="text/javascript">
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jQuery(document).ready(function($){
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$('#field-user_id').on('change', function () {
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let hierarchy = $(this).find('option:selected').attr('hierarchy');
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$('#field-hierarchy_id').val(hierarchy || '');
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if (!hierarchy) return;
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$('#pageloader').fadeIn();
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$.ajax({
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type: 'GET',
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url: '/form/getdoctorlist',
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data: {
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partition: @json($form->partition),
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hierarchy: hierarchy,
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@if($form_id == '1793766025-480d8dde-07b3-497d-b55c-4f34a08ad5d1')
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attribute: 'toba_titans_drs',
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attribute_value: 'Yes'
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@endif
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},
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success: function (data) {
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$('#pageloader').fadeOut();
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console.log('Doctor API response:', data);
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let doctorDropdown = $('#field-contact_id');
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doctorDropdown.empty();
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doctorDropdown.append('<option value=""> -- Select -- </option>');
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$.each(data, function (index, itm) {
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let contact = itm.contact || itm;
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let option = $('<option></option>')
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.val(itm.value)
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.text(itm.display)
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.attr('msl_code', contact.legacy_code || '')
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.attr('pcode', contact.msl_code || '')
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.attr('speciality', contact.speciality || '');
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console.log('Creating doctor option:', {
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name: itm.display,
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legacy_code: contact.legacy_code,
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msl_code: contact.msl_code,
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speciality: contact.speciality
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});
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doctorDropdown.append(option);
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});
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$('#field-msl_code, #field-pcode, #field-speciality').val('');
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// Trigger only AFTER options are populated
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$('#field-contact_id').trigger('change');
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},
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error: function (xhr) {
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$('#pageloader').fadeOut();
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console.error('Doctor list request failed:', xhr.responseText);
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}
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});
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});
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$('#report-form').on('submit', function(event){
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event.preventDefault();
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$("#pageloader").fadeIn();
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$.ajax({
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type: "POST",
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url: '/form/ajaxsubmit',
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data: new FormData($('#report-form')[0]),
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processData: false,
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contentType: false,
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success: function( data ) {
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$("#pageloader").fadeOut();
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if(data.status == 'success') {
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Swal.fire({
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title: 'Great!',
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text: 'Your data is successfully submitted!',
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icon: 'success'
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})
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$('#report-form').trigger("reset");
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} else {
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Swal.fire({
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icon: 'error',
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title: data.hasOwnProperty('message') ? 'You are not mapped to any position code' : 'Data not submitted',
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text: data.hasOwnProperty('message') ? 'for resolution please email Position code, L1 Manager and L2 Manager details to support1@stratawiz.com':'Something went wrong, please try again after some time!'
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})
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}
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},
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});
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});
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var today = new Date();
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var dd = String(today.getDate()).padStart(2, '0');
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var mm = String(today.getMonth() + 1).padStart(2, '0');
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var yyyy = today.getFullYear();
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today = yyyy + '-' + mm + '-' + dd;
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var plandateField = document.getElementById('field-record_date');
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if (plandateField && @json($form_id) === '1793766025-480d8dde-07b3-497d-b55c-4f34a08ad5d1') {
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plandateField.min = '2026-11-01';
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plandateField.max = today;
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}
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// Make fields readonly
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$('#field-msl_code, #field-pcode, #field-speciality')
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.prop('readonly', true);
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$(document).on('change', '#field-contact_id', function () {
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let selectedOption = $(this).find(':selected');
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let legacyCode = selectedOption.attr('msl_code') || '';
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let mslCode = selectedOption.attr('pcode') || '';
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let speciality = selectedOption.attr('speciality') || '';
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$('#field-msl_code').val(legacyCode);
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$('#field-pcode').val(mslCode);
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$('#field-speciality').val(speciality);
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console.log('Doctor selected:', selectedOption.text());
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console.log('Populated fields:', {
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legacyCode: legacyCode,
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mslCode: mslCode,
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speciality: speciality
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});
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});
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});
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</script>
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</body>
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</html>
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