# along with Confetti. If not, see <http://www.gnu.org/licenses/>.
check(){ [ "$1" = "$2" ] && printf checked}
+[ -z $mpx[presctype] ] && mpx[presctype]=doctor_compulsory
cat <<END_HTML
<form class="prescription" action="?action=update_prescription" method="POST">
<input type="hidden" name="prescription" value="${mpx[prescription]}">
+<label class=presctype>$(l10n doctor):</label>
+<input type=radio name=presctype id=doctor_selfpaid value=doctor_selfpaid $(check "$mpx[presctype]" doctor_selfpaid)>
+<label for=doctor_selfpaid>$(l10n selfpaid)</label>
+<input type=radio name=presctype id=doctor_private value=doctor_private $(check "$mpx[presctype]" doctor_private)>
+<label for=doctor_private>$(l10n private)</label>
+<input type=radio name=presctype id=doctor_compulsory value=doctor_compulsory $(check "$mpx[presctype]" doctor_compulsory)>
+<label for=doctor_compulsory>$(l10n compulsory)</label>
+<br>
+
+<label class=presctype>$(l10n dentist):</label>
+<input type=radio name=presctype id=dentist_selfpaid value=dentist_selfpaid $(check "$mpx[presctype]" dentist_selfpaid)>
+<label for=dentist_selfpaid>$(l10n selfpaid)</label>
+<input type=radio name=presctype id=dentist_private value=dentist_private $(check "$mpx[presctype]" dentist_private)>
+<label for=dentist_private>$(l10n private)</label>
+<input type=radio name=presctype id=dentist_compulsory value=dentist_compulsory $(check "$mpx[presctype]" dentist_compulsory)>
+<label for=dentist_compulsory>$(l10n compulsory)</label>
+<br>
+
+<label class=presctype>$(l10n noprescription):</label>
+<input type=radio name=presctype id=noprescription_selfpaid value=noprescription_selfpaid $(check "$mpx[presctype]" noprescription_selfpaid)>
+<label for=noprescription_selfpaid>$(l10n selfpaid)</label>
+<br>
+
+<label class=presctype>$(l10n altpractition):</label>
+<input type=radio name=presctype id=altpractition_selfpaid value=altpractition_selfpaid $(check "$mpx[presctype]" altpractition_selfpaid)>
+<label for=altpractition_selfpaid>$(l10n selfpaid)</label>
+<input type=radio name=presctype id=altpractition_private value=altpractition_private $(check "$mpx[presctype]" altpractition_private)>
+<label for=altpractition_private>$(l10n private)</label>
+<br>
+
<fieldset class="baseinfo">
<label for="insurance">$(l10n insurance)</label>
<input id="insurance" name="insurance" value="${mpx[insurance]}" placeholder="$(l10n insurance)">
</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)">
<label for="quantity">$(l10n quantity)</label>
<label for="remidy">$(l10n remidy)</label>
<label for="quantity_weekly">$(l10n quantity_weekly)</label>
+<p>
<input id="quantity" name="quantity" value="${mpx[quantity]}" placeholder="$(l10n quantity)">
<textarea id="remidy" name="remidy" placeholder="$(l10n remidy)">${mpx[remidy]}</textarea>
<input id="quantity_weekly" name="quantity_weekly" value="${mpx[quantity_weekly]}" placeholder="$(l10n quantity_weekly)">
+</p>
-<label for="quantity1">$(l10n quantity)</label>
-<label for="remidy1">$(l10n remidy)</label>
-<label for="quantity_weekly1">$(l10n quantity_weekly)</label>
-<input id="quantity1" name="quantity1" value="${mpx[quantity1]}" placeholder="$(l10n quantity)">
-<textarea id="remidy1" name="remidy1" placeholder="$(l10n remidy)">${mpx[remidy1]}</textarea>
-<input id="quantity_weekly1" name="quantity_weekly1" value="${mpx[quantity_weekly1]}" placeholder="$(l10n quantity_weekly)">
+$( for n in {0..10}; do
+ if [ "$n" -eq 0 -o -n "${mpx[quantity$n]}" -o -n "${mpx[remidy$n]}" -o -n "${mpx[quantity_weekly$n]}" ]; then
+ printf '<input class="trailbtn" type="checkbox" checked="checked" />'
+ else
+ printf '<input class="trailbtn" type="checkbox" />'
+ fi
+ printf '<p class="trailbox">
+ <input class="quantity" name="quantity" placeholder="%s" value="%s">
+ <textarea class="remidy" name="remidy" placeholder="%s">%s</textarea>
+ <input class="quantity_weekly" name="quantity_weekly" placeholder="%s" value="%s">
+ </p>
+ ' "$(l10n quantity)" "${mpx[quantity$n]}" \
+ "$(l10n remidy)" "${mpx[remidy$n]}" \
+ "$(l10n quantity_weekly)" "${mpx[quantity_weekly$n]}"
+done )
<br>
+<p class="indicator_codes">
<label for="indicator">$(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>
+<br>
+<p class="issuer">
+ <label>$(l10n issuer)</label>
+ <input type="radio" name="issuer_select" value="list" id="issuer_select_list" checked /><label for="issuer_select_list">$(l10n issuer_from_list)</label><!--
+ --><input type="radio" name="issuer_select" value="other" id="issuer_other"><label for="issuer_other">$(l10n issuer_other)</label>
+ <select class="item" name="issuer">
+ <option value="" disabled="disabled" $([ -z "${mpx[issuer]}" ] && printf 'selected' )>$(l10n issuer)...</option>
+ $(list_prescription_issuers |while read f; do
+ [ "$f" = "$mpx[issuer]" ] \
+ && printf '<option value="%s" selected>%s</option>' "$f" "$f" \
+ || printf '<option value="%s">%s</option>' "$f" "$f"
+ done)
+ </select>
+ <input type="text" name="issuer_other" value="" placeholder="$(l10n issuer)..." />
+</p>
</fieldset>
<fieldset class="controls">
projects / confetti / blobdiff