X-Git-Url: http://git.plutz.net/?a=blobdiff_plain;f=templates%2Fedit_prescription.sh;h=4701ebb813a51f42671ce3e21325ade4960c93b3;hb=015242823eb4a79cf615bef6951b0af6bd0a5b01;hp=85eeb20b3aa7051f2c9249a6ae30e2014ddeb1c5;hpb=547778804d2beb3394ae47218d7490e6095b778c;p=confetti

diff --git a/templates/edit_prescription.sh b/templates/edit_prescription.sh
index 85eeb20..4701ebb 100755
--- a/templates/edit_prescription.sh
+++ b/templates/edit_prescription.sh
@@ -21,6 +21,63 @@ cat <<END_HTML
 <form class="prescription" action="?action=update_prescription" method="POST">
 <input type="hidden" name="prescription" value="${mpx[prescription]}">
 
+<table class="type"><tbody>
+  <tr>
+    <th>$(l10n doctor)</th>
+    <th>$(l10n dentist)</th>
+    <th>$(l10n noprescription)</th>
+    <th>$(l10n altpractition)</th>
+  </tr>
+  <tr>
+    <td class="selfpaid doctor">
+      <input type=radio name=presctype id=doctor_selfpaid value=doctor_selfpaid>
+      <label for=doctor_selfpaid>$(l10n selfpaid)</label>
+    </td>
+    <td class="selfpaid dentist">
+      <input type=radio name=presctype id=dentist_selfpaid value=dentist_selfpaid>
+      <label for=dentist_selfpaid>$(l10n selfpaid)</label>
+    </td>
+    <td class="selfpaid noprescription">
+      <input type=radio name=presctype id=noprescription_selfpaid value=noprescription_selfpaid>
+      <label for=noprescription_selfpaid>$(l10n selfpaid)</label>
+    </td>
+    <td class="selfpaid altpractition">
+      <input type=radio name=presctype id=altpractition_selfpaid value=altpractition_selfpaid>
+      <label for=altpractition_selfpaid>$(l10n selfpaid)</label>
+    </td>
+  </tr>
+  <tr>
+    <td class="private doctor">
+      <input type=radio name=presctype id=doctor_private value=doctor_private>
+      <label for=doctor_private>$(l10n private)</label>
+    </td>
+    <td class="private dentist">
+      <input type=radio name=presctype id=dentist_private value=dentist_private>
+      <label for=dentist_private>$(l10n private)</label>
+    </td>
+    <td class="private noprescription">
+    </td>
+    <td class="private altpractition">
+      <input type=radio name=presctype id=altpractition_private value=altpractition_private>
+      <label for=altpractition_private>$(l10n private)</label>
+    </td>
+  </tr>
+  <tr>
+    <td class="compulsory doctor">
+      <input type=radio name=presctype id=doctor_compulsory value=doctor_compulsory>
+      <label for=doctor_compulsory>$(l10n compulsory)</label>
+    </td>
+    <td class="compulsory dentist">
+      <input type=radio name=presctype id=dentist_compulsory value=dentist_compulsory>
+      <label for=dentist_compulsory>$(l10n compulsory)</label>
+    </td>
+    <td class="compulsory noprescription">
+    </td>
+    <td class="compulsory altpractition">
+    </td>
+  </tr>
+</tbody></table>
+
 <fieldset class="baseinfo">
 <label for="insurance">$(l10n insurance)</label>
 <input id="insurance" name="insurance" value="${mpx[insurance]}" placeholder="$(l10n insurance)">
@@ -37,14 +94,19 @@ cat <<END_HTML
 </fieldset>
 
 <fieldset class="misc">
-<h1>$(l10n therapy_prescription)</h1>
+<h1 id="${mpx[prescription]}">$(l10n therapy_prescription)</h1>
 
 <label for="addcontrib">$(l10n addcontrib)</label>
 <input id="addcontrib" name="addcontrib" value="${mpx[addcontrib]}" placeholder="$(l10n addcontrib)">
-<input type="checkbox" id="contribconfirm" name="contribconfirm" value="true" ${mpx[contribconfirm]:+checked}>
 <label for="contribconfirm">$(l10n contribconfirm)</label>
+<input id="contribconfirm" name="contribconfirm" value="${mpx[contribconfirm]}" placeholder="$(l10n contribconfirm)">
+<input type="checkbox" id="contribreceipt" name="contribreceipt" value="true" ${mpx[contribreceipt]:+checked}>
+<label for="contribreceipt">$(l10n contribreceipt)</label>
 </fieldset>
 
+<input type="checkbox" id="prescreviewed" name="prescreviewed" value="true" ${mpx[prescreviewed]:+checked}>
+<label for="prescreviewed">$(l10n prescreviewed)</label>
+
 <fieldset class="catalogue">
 <h2>$(l10n prescription_by_catalogue)</h2>
 <input type="radio" id="prescfirst" name="prescno" value="first" $(check "$mpx[prescno]" first)>
@@ -56,11 +118,11 @@ cat <<END_HTML
 <input type="radio" id="prescfollow2" name="prescno" value="follow2" $(check "$mpx[prescno]" follow2)>
 <label for="prescfollow2">$(l10n prescfollow2)</label>
 <br>
-<input type="radio" id="presccontinual" name="prescno" value="continual" $(check "$mpx[prescno]" continual)>
-<label for="presccontinual">$(l10n presccontinual)</label>
-<br>
 <input type="radio" id="prescother" name="prescno" value="other" $(check "$mpx[prescno]" other)>
 <label for="prescother">$(l10n prescother)</label>
+<br>
+<input type="radio" id="presccontinual" name="prescno" value="continual" $(check "$mpx[prescno]" continual)>
+<label for="presccontinual">$(l10n presccontinual)</label>
 
 <br>
 <input type="checkbox" id="grouptherapy" name="grouptherapy" value="true" ${mpx[grouptherapy]:+checked}>
@@ -89,16 +151,20 @@ cat <<END_HTML
 <input id="quantity_weekly1" name="quantity_weekly1" value="${mpx[quantity_weekly1]}" placeholder="$(l10n quantity_weekly)">
 
 <br>
+<p class="indicator_codes">
 <label for="indicator">$(l10n indicator)</label>
 <input id="indicator" name="indicator" value="${mpx[indicator]}" placeholder="$(l10n indicator)">
 <br>
 <label for="icd10">$(l10n icd10)</label>
 <input id="icd10" name="icd10" value="${mpx[icd10]}" placeholder="$(l10n icd10)">
+</p>
+<br>
+<p class="indicator_reading">
+<label for="indicator_reading">$(l10n indicator_reading)</label>
+<textarea id="indicator_reading" name="indicator_reading" placeholder="$(l10n indicator_reading)">${mpx[indicator_reading]}</textarea>
+</p>
 </fieldset>
 
-<input type="checkbox" id="prescreviewed" name="prescreviewed" value="true" ${mpx[prescreviewed]:+checked}>
-<label for="prescreviewed">$(l10n prescreviewed)</label>
-
 <fieldset class="controls">
 <button type="submit" name="action" value="save">$(l10n save)</button>
 <button type="submit" name="action" value="cancel">$(l10n cancel)</button>