340 lines
19 KiB
PHP
340 lines
19 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' => "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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<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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<input type="hidden" name="speciality_endocrinologist" id="field-speciality_endocrinologist" value="0">
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<input type="hidden" name="speciality_cardiologist" id="field-speciality_cardiologist" value="0">
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<input type="hidden" name="speciality_diabetologists" id="field-speciality_diabetologists" value="0">
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<input type="hidden" name="speciality_consulting_physician" id="field-speciality_consulting_physician" value="0">
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<input type="hidden" name="speciality_pulmonologist" id="field-speciality_pulmonologist" value="0">
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<input type="hidden" name="speciality_nephrologist" id="field-speciality_nephrologist" value="0">
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<input type="hidden" name="speciality_gynaecologist" id="field-speciality_gynaecologist" value="0">
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<input type="hidden" name="speciality_gastroenterologist" id="field-speciality_gastroenterologist" value="0">
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<input type="hidden" name="speciality_others" id="field-speciality_others" value="0">
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<input type="hidden" name="strength_2_5_mg" id="field-strength_2_5_mg" value="0">
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<input type="hidden" name="strength_5_mg" id="field-strength_5_mg" value="0">
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<input type="hidden" name="strength_7_5_mg" id="field-strength_7_5_mg" value="0">
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<input type="hidden" name="strength_10_mg" id="field-strength_10_mg" value="0">
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<input type="hidden" name="strength_12_5_mg" id="field-strength_12_5_mg" value="0">
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<input type="hidden" name="strength_15_mg" id="field-strength_15_mg" value="0">
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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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@case('email')
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@case('tel')
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@case('date')
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<input type="{{$question->type}}" id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" {{$question->required == 'yes'?'required':'' }} value="{{isset($question->value)?$question->value:''}}">
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@break
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@case('number')
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<input type="{{$question->type}}" min="0" max="9999999999" step="1" id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" {{$question->required == 'yes'?'required':'' }} value="{{isset($question->value)?$question->value:0}}">
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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 }}" {{ $question->required == 'yes' ? 'required' : '' }}>
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<option value=""> -- Select -- </option>
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@if($question->code == 'contact_id')
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@foreach ($question->options as $option)
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<option value="{{ $option->value }}"
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{{ isset($question->value) && $question->value == $option->value ? 'selected' : '' }}
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{{--
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We check if 'contact' exists and isn't null.
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If it's missing, we output an empty string to prevent the 500 error.
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--}}
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msl_code="{{ isset($option->contact->msl_code) ? $option->contact->msl_code : '' }}"
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speciality="{{ isset($option->contact->speciality) ? $option->contact->speciality : '' }}"
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>
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{{ $option->display }}
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</option>
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@endforeach
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<option value="Others">Others</option>
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@else
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@foreach ($question->options as $option)
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<option value="{{ $option->value }}"
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{{ isset($question->value) && $question->value == $option->value ? 'selected' : '' }}
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{{--
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We check if 'contact' exists and isn't null.
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If it's missing, we output an empty string to prevent the 500 error.
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--}}
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msl_code="{{ isset($option->contact->msl_code) ? $option->contact->msl_code : '' }}"
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speciality="{{ isset($option->contact->speciality) ? $option->contact->speciality : '' }}"
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>
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{{ $option->display }}
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</option>
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@endforeach
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@endif
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</select>
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@break
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@case('checkbox')
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@foreach($question->options as $option)
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<div class="form-check mb-2 form-check-primary">
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<input class="form-check-input" type="checkbox" id="field-{{$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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<input type="file" id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" value="" accept="image/jpg, image/jpeg, image/png" {{$question->required == 'yes'?'required':'' }}>
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@break
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@case('multitextbox')
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<div class="row">
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@foreach($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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</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').change(function(){
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let hierarchy = $('option:selected', this).attr('hierarchy');
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$('#field-hierarchy_id').val(hierarchy)
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event.preventDefault();
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$("#pageloader").fadeIn();
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$.ajax({
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type: "GET",
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url: '/form/getdoctorlist?partition={{$form->partition}}&hierarchy='+hierarchy,
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processData: false,
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contentType: false,
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success: function( data ) {
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$("#pageloader").fadeOut();
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$('#field-contact_id').html('')
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$('#field-contact_id').append($("<option></option>").attr("value",'').text('-- Select --'));
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for (let itm of data) {
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$('#field-contact_id').append($("<option></option>").attr("value",itm.value).text(itm.display).attr("msl_code", itm.contact.msl_code).attr("speciality",itm.contact.speciality));
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}
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$('#field-contact_id').change(function() {
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$('#field-msl_code').val($('option:selected', this).attr('msl_code'))
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})
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$('#field-contact_id').change(function() {
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$('#field-speciality').val($('option:selected', this).attr('speciality'))
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})
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$('#field-contact_id').append('<option value="others">Others</option>');
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},
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});
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console.log(hierarchy)
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})
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$('#field-contact_id').on('change',function(){
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$('#field-msl_code').val($("option:selected").attr('msl_code'));
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})
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$('#field-msl_code,#field-speciality').attr('readonly',true);
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$('#field-other_doctor_name,#field-other_speciality,#field-other_msl_code').prop({"required":false});
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$('#field-other_doctor_name,#field-other_speciality,#field-other_msl_code').parent().hide();
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$('#field-contact_id').on('change',function(){
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let dropDown=$('#field-contact_id').val();
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if(dropDown==='Others'){
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$('#field-other_doctor_name,#field-other_speciality,#field-other_msl_code').parent().show();
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$('#field-other_doctor_name,#field-other_speciality,#field-other_msl_code').prop({"required":true});
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$('#field-speciality,#field-msl_code').parent().hide();
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$('#field-speciality,#field-msl_code').prop({"required":false});
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}
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else{
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$('#field-other_doctor_name,#field-other_speciality,#field-other_msl_code').parent().hide();
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$('#field-other_doctor_name,#field-other_speciality,#field-other_msl_code').prop({"required":false});
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$('#field-speciality,#field-msl_code').parent().show();
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$('#field-speciality,#field-msl_code').prop({"required":true});
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}
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})
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//$('#field-contact_id').append('<option value="others">Others</option>');
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$('#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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$('#report-form').trigger("reset");
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} else {
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Swal.fire({
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icon: 'error',
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title: 'Data not submitted',
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text: 'Something went wrong, please try again after some time!'
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})
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}
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},
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});
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});
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$('#field-speciality').on('change', function () {
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let selected = $(this).val().trim();
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$('input[id^="field-speciality_"]').val(0);
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if (selected !== '') {
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let key = selected.toLowerCase().replace(/ /g, '_');
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$('#field-speciality_' + key).val(1);
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}
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});
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$('#field-no_of_rx_generated').attr({min:"1"});
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});
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</script>
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<script>
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$(document).ready(function () {
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$('#field-no_of_rx_generated, #field-strength').on('keyup change', function () {
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// get RX count (default 0)
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let rxCount = parseInt($('#field-no_of_rx_generated').val()) || 0;
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// reset all strength hidden fields
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$('[id^="field-strength_"]').val(0);
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// get selected strength
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let strength = $('#field-strength').val();
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if (!strength) return;
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// convert "2.5 mg" → "2_5_mg"
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let formattedStrength = strength
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.replace('.', '_')
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.replace(' ', '_')
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.toLowerCase();
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// update matching hidden field
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$('#field-strength_' + formattedStrength).val(rxCount);
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});
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});
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</script>
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</body>
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</html> |