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" = "$2" ] && printf checked}
  19
  20 cat <<END_HTML
  21 <form class="prescription" action="?action=update_prescription" method="POST">
  22 <input type="hidden" name="prescription" value="${mpx[prescription]}">
  23
  24 <table class="type"><tbody>
  25   <tr>
  26     <th>$(l10n doctor)</th>
  27     <th>$(l10n dentist)</th>
  28     <th>$(l10n noprescription)</th>
  29     <th>$(l10n altpractition)</th>
  30   </tr>
  31   <tr>
  32     <td class="selfpaid doctor">
  33       <input type=radio name=presctype id=doctor_selfpaid value=doctor_selfpaid>
  34       <label for=doctor_selfpaid>$(l10n selfpaid)</label>
  35     </td>
  36     <td class="selfpaid dentist">
  37       <input type=radio name=presctype id=dentist_selfpaid value=dentist_selfpaid>
  38       <label for=dentist_selfpaid>$(l10n selfpaid)</label>
  39     </td>
  40     <td class="selfpaid noprescription">
  41       <input type=radio name=presctype id=noprescription_selfpaid value=noprescription_selfpaid>
  42       <label for=noprescription_selfpaid>$(l10n selfpaid)</label>
  43     </td>
  44     <td class="selfpaid altpractition">
  45       <input type=radio name=presctype id=altpractition_selfpaid value=altpractition_selfpaid>
  46       <label for=altpractition_selfpaid>$(l10n selfpaid)</label>
  47     </td>
  48   </tr>
  49   <tr>
  50     <td class="private doctor">
  51       <input type=radio name=presctype id=doctor_private value=doctor_private>
  52       <label for=doctor_private>$(l10n private)</label>
  53     </td>
  54     <td class="private dentist">
  55       <input type=radio name=presctype id=dentist_private value=dentist_private>
  56       <label for=dentist_private>$(l10n private)</label>
  57     </td>
  58     <td class="private noprescription">
  59     </td>
  60     <td class="private altpractition">
  61       <input type=radio name=presctype id=altpractition_private value=altpractition_private>
  62       <label for=altpractition_private>$(l10n private)</label>
  63     </td>
  64   </tr>
  65   <tr>
  66     <td class="compulsory doctor">
  67       <input type=radio name=presctype id=doctor_compulsory value=doctor_compulsory>
  68       <label for=doctor_compulsory>$(l10n compulsory)</label>
  69     </td>
  70     <td class="compulsory dentist">
  71       <input type=radio name=presctype id=dentist_compulsory value=dentist_compulsory>
  72       <label for=dentist_compulsory>$(l10n compulsory)</label>
  73     </td>
  74     <td class="compulsory noprescription">
  75     </td>
  76     <td class="compulsory altpractition">
  77     </td>
  78   </tr>
  79 </tbody></table>
  80
  81 <fieldset class="baseinfo">
  82 <label for="insurance">$(l10n insurance)</label>
  83 <input id="insurance" name="insurance" value="${mpx[insurance]}" placeholder="$(l10n insurance)">
  84 <br>
  85 <label for="name">$(l10n name)</label>
  86 <label for="bday">$(l10n bday)</label>
  87 <br>
  88 <textarea id="name" name="name" placeholder="$(l10n name)">${mpx[name]}</textarea>
  89 <input id="bday" name="bday" value="${mpx[bday]}" placeholder="$(l10n bday)">
  90
  91 <br>
  92 <label for="date">$(l10n date)</label>
  93 <input id="date" name="date" value="${mpx[date]}" placeholder="$(l10n date)">
  94 </fieldset>
  95
  96 <fieldset class="misc">
  97 <h1 id="${mpx[prescription]}">$(l10n therapy_prescription)</h1>
  98
  99 <label for="addcontrib">$(l10n addcontrib)</label>
 100 <input id="addcontrib" name="addcontrib" value="${mpx[addcontrib]}" placeholder="$(l10n addcontrib)">
 101 <label for="contribconfirm">$(l10n contribconfirm)</label>
 102 <input id="contribconfirm" name="contribconfirm" value="${mpx[contribconfirm]}" placeholder="$(l10n contribconfirm)">
 103 <input type="checkbox" id="contribreceipt" name="contribreceipt" value="true" ${mpx[contribreceipt]:+checked}>
 104 <label for="contribreceipt">$(l10n contribreceipt)</label>
 105 </fieldset>
 106
 107 <input type="checkbox" id="prescreviewed" name="prescreviewed" value="true" ${mpx[prescreviewed]:+checked}>
 108 <label for="prescreviewed">$(l10n prescreviewed)</label>
 109
 110 <fieldset class="catalogue">
 111 <h2>$(l10n prescription_by_catalogue)</h2>
 112 <input type="radio" id="prescfirst" name="prescno" value="first" $(check "$mpx[prescno]" first)>
 113 <label for="prescfirst">$(l10n prescfirst)</label>
 114 <br>
 115 <input type="radio" id="prescfollow1" name="prescno" value="follow1" $(check "$mpx[prescno]" follow1)>
 116 <label for="prescfollow1">$(l10n prescfollow1)</label>
 117 <br>
 118 <input type="radio" id="prescfollow2" name="prescno" value="follow2" $(check "$mpx[prescno]" follow2)>
 119 <label for="prescfollow2">$(l10n prescfollow2)</label>
 120 <br>
 121 <input type="radio" id="prescother" name="prescno" value="other" $(check "$mpx[prescno]" other)>
 122 <label for="prescother">$(l10n prescother)</label>
 123 <br>
 124 <input type="radio" id="presccontinual" name="prescno" value="continual" $(check "$mpx[prescno]" continual)>
 125 <label for="presccontinual">$(l10n presccontinual)</label>
 126
 127 <br>
 128 <input type="checkbox" id="grouptherapy" name="grouptherapy" value="true" ${mpx[grouptherapy]:+checked}>
 129 <label for="grouptherapy">$(l10n grouptherapy)</label>
 130 <br>
 131 <input type="checkbox" id="housecall" name="housecall" value="true" ${mpx[housecall]:+checked}>
 132 <label for="housecall">$(l10n housecall)</label>
 133 <br>
 134 <input type="checkbox" id="report" name="report" value="true" ${mpx[report]:+checked}>
 135 <label for="report">$(l10n report)</label>
 136 </fieldset>
 137
 138 <fieldset class="description">
 139 <label for="quantity">$(l10n quantity)</label>
 140 <label for="remidy">$(l10n remidy)</label>
 141 <label for="quantity_weekly">$(l10n quantity_weekly)</label>
 142 <input id="quantity" name="quantity" value="${mpx[quantity]}" placeholder="$(l10n quantity)">
 143 <textarea id="remidy" name="remidy" placeholder="$(l10n remidy)">${mpx[remidy]}</textarea>
 144 <input id="quantity_weekly" name="quantity_weekly" value="${mpx[quantity_weekly]}" placeholder="$(l10n quantity_weekly)">
 145
 146 <label for="quantity1">$(l10n quantity)</label>
 147 <label for="remidy1">$(l10n remidy)</label>
 148 <label for="quantity_weekly1">$(l10n quantity_weekly)</label>
 149 <input id="quantity1" name="quantity1" value="${mpx[quantity1]}" placeholder="$(l10n quantity)">
 150 <textarea id="remidy1" name="remidy1" placeholder="$(l10n remidy)">${mpx[remidy1]}</textarea>
 151 <input id="quantity_weekly1" name="quantity_weekly1" value="${mpx[quantity_weekly1]}" placeholder="$(l10n quantity_weekly)">
 152
 153 <br>
 154 <p class="indicator_codes">
 155 <label for="indicator">$(l10n indicator)</label>
 156 <input id="indicator" name="indicator" value="${mpx[indicator]}" placeholder="$(l10n indicator)">
 157 <br>
 158 <label for="icd10">$(l10n icd10)</label>
 159 <input id="icd10" name="icd10" value="${mpx[icd10]}" placeholder="$(l10n icd10)">
 160 </p>
 161 <br>
 162 <p class="indicator_reading">
 163 <label for="indicator_reading">$(l10n indicator_reading)</label>
 164 <textarea id="indicator_reading" name="indicator_reading" placeholder="$(l10n indicator_reading)">${mpx[indicator_reading]}</textarea>
 165 </p>
 166 </fieldset>
 167
 168 <fieldset class="controls">
 169 <button type="submit" name="action" value="save">$(l10n save)</button>
 170 <button type="submit" name="action" value="cancel">$(l10n cancel)</button>
 171 <button type="submit" name="action" value="delete">$(l10n delete)</button>
 172 </fieldset>
 173
 174 </form>
 175 END_HTML