git.plutz.net Git - confetti/blob - templates/edit_prescription.sh

   1 # Copyright 2016 Paul Hänsch
   2 #
   3 # This file is part of Confetti.
   4 #
   5 # Confetti is free software: you can redistribute it and/or modify
   6 # it under the terms of the GNU Affero General Public License as published by
   7 # the Free Software Foundation, either version 3 of the License, or
   8 # (at your option) any later version.
   9 #
  10 # Confetti is distributed in the hope that it will be useful,
  11 # but WITHOUT ANY WARRANTY; without even the implied warranty of
  12 # MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  13 # GNU Affero General Public License for more details.
  14 #
  15 # You should have received a copy of the GNU Affero General Public License
  16 # along with Confetti.  If not, see <http://www.gnu.org/licenses/>.
  17
  18 check(){ [ "$1" = "$2" ] && printf checked}
  19 [ -z $mpx[presctype] ] && mpx[presctype]=doctor_compulsory
  20
  21 cat <<END_HTML
  22 <form class="prescription" action="?action=update_prescription" method="POST">
  23 <input type="hidden" name="prescription" value="${mpx[prescription]}">
  24
  25 <label class=presctype>$(l10n doctor):</label>
  26 <input type=radio name=presctype id=doctor_selfpaid value=doctor_selfpaid $(check "$mpx[presctype]" doctor_selfpaid)>
  27 <label for=doctor_selfpaid>$(l10n selfpaid)</label>
  28 <input type=radio name=presctype id=doctor_private value=doctor_private $(check "$mpx[presctype]" doctor_private)>
  29 <label for=doctor_private>$(l10n private)</label>
  30 <input type=radio name=presctype id=doctor_compulsory value=doctor_compulsory $(check "$mpx[presctype]" doctor_compulsory)>
  31 <label for=doctor_compulsory>$(l10n compulsory)</label>
  32 <br>
  33
  34 <label class=presctype>$(l10n dentist):</label>
  35 <input type=radio name=presctype id=dentist_selfpaid value=dentist_selfpaid $(check "$mpx[presctype]" dentist_selfpaid)>
  36 <label for=dentist_selfpaid>$(l10n selfpaid)</label>
  37 <input type=radio name=presctype id=dentist_private value=dentist_private $(check "$mpx[presctype]" dentist_private)>
  38 <label for=dentist_private>$(l10n private)</label>
  39 <input type=radio name=presctype id=dentist_compulsory value=dentist_compulsory $(check "$mpx[presctype]" dentist_compulsory)>
  40 <label for=dentist_compulsory>$(l10n compulsory)</label>
  41 <br>
  42
  43 <label class=presctype>$(l10n noprescription):</label>
  44 <input type=radio name=presctype id=noprescription_selfpaid value=noprescription_selfpaid $(check "$mpx[presctype]" noprescription_selfpaid)>
  45 <label for=noprescription_selfpaid>$(l10n selfpaid)</label>
  46 <br>
  47
  48 <label class=presctype>$(l10n altpractition):</label>
  49 <input type=radio name=presctype id=altpractition_selfpaid value=altpractition_selfpaid $(check "$mpx[presctype]" altpractition_selfpaid)>
  50 <label for=altpractition_selfpaid>$(l10n selfpaid)</label>
  51 <input type=radio name=presctype id=altpractition_private value=altpractition_private $(check "$mpx[presctype]" altpractition_private)>
  52 <label for=altpractition_private>$(l10n private)</label>
  53 <br>
  54
  55 <fieldset class="baseinfo">
  56 <label for="insurance">$(l10n insurance)</label>
  57 <input id="insurance" name="insurance" value="${mpx[insurance]}" placeholder="$(l10n insurance)">
  58 <br>
  59 <label for="name">$(l10n name)</label>
  60 <label for="bday">$(l10n bday)</label>
  61 <br>
  62 <textarea id="name" name="name" placeholder="$(l10n name)">${mpx[name]}</textarea>
  63 <input id="bday" name="bday" value="${mpx[bday]}" placeholder="$(l10n bday)">
  64
  65 <br>
  66 <label for="date">$(l10n date)</label>
  67 <input id="date" name="date" value="${mpx[date]}" placeholder="$(l10n date)">
  68 </fieldset>
  69
  70 <fieldset class="misc">
  71 <h1 id="${mpx[prescription]}">$(l10n therapy_prescription)</h1>
  72
  73 <label for="addcontrib">$(l10n addcontrib)</label>
  74 <input id="addcontrib" name="addcontrib" value="${mpx[addcontrib]}" placeholder="$(l10n addcontrib)">
  75 <label for="contribconfirm">$(l10n contribconfirm)</label>
  76 <input id="contribconfirm" name="contribconfirm" value="${mpx[contribconfirm]}" placeholder="$(l10n contribconfirm)">
  77 <input type="checkbox" id="contribreceipt" name="contribreceipt" value="true" ${mpx[contribreceipt]:+checked}>
  78 <label for="contribreceipt">$(l10n contribreceipt)</label>
  79 </fieldset>
  80
  81 <input type="checkbox" id="prescreviewed" name="prescreviewed" value="true" ${mpx[prescreviewed]:+checked}>
  82 <label for="prescreviewed">$(l10n prescreviewed)</label>
  83
  84 <fieldset class="catalogue">
  85 <h2>$(l10n prescription_by_catalogue)</h2>
  86 <input type="radio" id="prescfirst" name="prescno" value="first" $(check "$mpx[prescno]" first)>
  87 <label for="prescfirst">$(l10n prescfirst)</label>
  88 <br>
  89 <input type="radio" id="prescfollow1" name="prescno" value="follow1" $(check "$mpx[prescno]" follow1)>
  90 <label for="prescfollow1">$(l10n prescfollow1)</label>
  91 <br>
  92 <input type="radio" id="prescfollow2" name="prescno" value="follow2" $(check "$mpx[prescno]" follow2)>
  93 <label for="prescfollow2">$(l10n prescfollow2)</label>
  94 <br>
  95 <input type="radio" id="prescother" name="prescno" value="other" $(check "$mpx[prescno]" other)>
  96 <label for="prescother">$(l10n prescother)</label>
  97 <br>
  98 <input type="radio" id="presccontinual" name="prescno" value="continual" $(check "$mpx[prescno]" continual)>
  99 <label for="presccontinual">$(l10n presccontinual)</label>
 100
 101 <br>
 102 <input type="checkbox" id="grouptherapy" name="grouptherapy" value="true" ${mpx[grouptherapy]:+checked}>
 103 <label for="grouptherapy">$(l10n grouptherapy)</label>
 104 <br>
 105 <input type="checkbox" id="housecall" name="housecall" value="true" ${mpx[housecall]:+checked}>
 106 <label for="housecall">$(l10n housecall)</label>
 107 <br>
 108 <input type="checkbox" id="report" name="report" value="true" ${mpx[report]:+checked}>
 109 <label for="report">$(l10n report)</label>
 110 </fieldset>
 111
 112 <fieldset class="description">
 113 <label for="quantity">$(l10n quantity)</label>
 114 <label for="remidy">$(l10n remidy)</label>
 115 <label for="quantity_weekly">$(l10n quantity_weekly)</label>
 116 <input id="quantity" name="quantity" value="${mpx[quantity]}" placeholder="$(l10n quantity)">
 117 <textarea id="remidy" name="remidy" placeholder="$(l10n remidy)">${mpx[remidy]}</textarea>
 118 <input id="quantity_weekly" name="quantity_weekly" value="${mpx[quantity_weekly]}" placeholder="$(l10n quantity_weekly)">
 119
 120 <label for="quantity1">$(l10n quantity)</label>
 121 <label for="remidy1">$(l10n remidy)</label>
 122 <label for="quantity_weekly1">$(l10n quantity_weekly)</label>
 123 <input id="quantity1" name="quantity1" value="${mpx[quantity1]}" placeholder="$(l10n quantity)">
 124 <textarea id="remidy1" name="remidy1" placeholder="$(l10n remidy)">${mpx[remidy1]}</textarea>
 125 <input id="quantity_weekly1" name="quantity_weekly1" value="${mpx[quantity_weekly1]}" placeholder="$(l10n quantity_weekly)">
 126
 127 <br>
 128 <p class="indicator_codes">
 129 <label for="indicator">$(l10n indicator)</label>
 130 <input id="indicator" name="indicator" value="${mpx[indicator]}" placeholder="$(l10n indicator)">
 131 <br>
 132 <label for="icd10">$(l10n icd10)</label>
 133 <input id="icd10" name="icd10" value="${mpx[icd10]}" placeholder="$(l10n icd10)">
 134 </p>
 135 <br>
 136 <p class="indicator_reading">
 137 <label for="indicator_reading">$(l10n indicator_reading)</label>
 138 <textarea id="indicator_reading" name="indicator_reading" placeholder="$(l10n indicator_reading)">${mpx[indicator_reading]}</textarea>
 139 </p>
 140 </fieldset>
 141
 142 <fieldset class="controls">
 143 <button type="submit" name="action" value="save">$(l10n save)</button>
 144 <button type="submit" name="action" value="cancel">$(l10n cancel)</button>
 145 <button type="submit" name="action" value="delete">$(l10n delete)</button>
 146 </fieldset>
 147
 148 </form>
 149 END_HTML