X-Git-Url: https://git.plutz.net/?p=confetti;a=blobdiff_plain;f=templates%2Fedit_prescription.sh;h=b9162582b9d2bfafae735d058999c9522c925361;hp=cfd2b5be8dcfd141cb263d659e5b62ddb87c8dbb;hb=2d79e3831a65f8b3a54aa2514ef1e65c4b073cf2;hpb=afdc06688cc51a168011da48adbafcba238d3ae1

diff --git a/templates/edit_prescription.sh b/templates/edit_prescription.sh
index cfd2b5b..b916258 100755
--- a/templates/edit_prescription.sh
+++ b/templates/edit_prescription.sh
@@ -21,27 +21,36 @@ cat <<END_HTML
 <form class="prescription" action="?action=update_prescription" method="POST">
 <input type="hidden" name="prescription" value="${mpx[prescription]}">
 
-<h1>$(l10n therapy_prescription)</h1>
-
+<fieldset class="baseinfo">
 <label for="insurance">$(l10n insurance)</label>
 <input id="insurance" name="insurance" value="${mpx[insurance]}" placeholder="$(l10n insurance)">
 <br>
 <label for="name">$(l10n name)</label>
-<textarea id="name" name="name" placeholder="$(l10n name)">${mpx[name]}</textarea>
-<br>
 <label for="bday">$(l10n bday)</label>
+<br>
+<textarea id="name" name="name" placeholder="$(l10n name)">${mpx[name]}</textarea>
 <input id="bday" name="bday" value="${mpx[bday]}" placeholder="$(l10n bday)">
 
 <br>
 <label for="date">$(l10n date)</label>
 <input id="date" name="date" value="${mpx[date]}" placeholder="$(l10n date)">
+</fieldset>
+
+<fieldset class="misc">
+<h1>$(l10n therapy_prescription)</h1>
 
-<br>
 <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)>
 <label for="prescfirst">$(l10n prescfirst)</label>
@@ -67,25 +76,21 @@ cat <<END_HTML
 <br>
 <input type="checkbox" id="report" name="report" value="true" ${mpx[report]:+checked}>
 <label for="report">$(l10n report)</label>
+</fieldset>
 
-<br>
-<label for="remidy">$(l10n remidy)</label>
-<textarea id="remidy" name="remidy" placeholder="$(l10n remidy)">${mpx[remidy]}</textarea>
-<br>
+<fieldset class="description">
 <label for="quantity">$(l10n quantity)</label>
-<input id="quantity" name="quantity" value="${mpx[quantity]}" placeholder="$(l10n quantity)">
-<br>
+<label for="remidy">$(l10n remidy)</label>
 <label for="quantity_weekly">$(l10n quantity_weekly)</label>
+<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)">
 
-<br>
-<label for="remidy1">$(l10n remidy)</label>
-<textarea id="remidy1" name="remidy1" placeholder="$(l10n remidy)">${mpx[remidy1]}</textarea>
-<br>
 <label for="quantity1">$(l10n quantity)</label>
-<input id="quantity1" name="quantity1" value="${mpx[quantity1]}" placeholder="$(l10n quantity)">
-<br>
+<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)">
 
 <br>
@@ -94,15 +99,13 @@ cat <<END_HTML
 <br>
 <label for="icd10">$(l10n icd10)</label>
 <input id="icd10" name="icd10" value="${mpx[icd10]}" placeholder="$(l10n icd10)">
+</fieldset>
 
-<br>
-<input type="checkbox" id="prescreviewed" name="prescreviewed" value="true" ${mpx[prescreviewed]:+checked}>
-<label for="prescreviewed">$(l10n prescreviewed)</label>
-
-<br>
+<fieldset class="controls">
 <button type="submit" name="action" value="save">$(l10n save)</button>
 <button type="submit" name="action" value="cancel">$(l10n cancel)</button>
 <button type="submit" name="action" value="delete">$(l10n delete)</button>
+</fieldset>
 
 </form>
 END_HTML