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addpatient.php
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addpatient.php
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<?php
session_start();
if(isset($_SESSION['id'])){
if(!($_SESSION['privileges'] == 'sec' || $_SESSION['privileges'] == 'aux' || $_SESSION['privileges'] == 'den' || $_SESSION['privileges'] == 'man' || $_SESSION['privileges'] == 'web')){
header('Location:denied.php');
}
}
else{
header('Location:index.php');
}
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Dental: Agregar Paciente</title>
<link rel="shortcut icon" type="image/x-icon" href="images/favicon.ico" />
<?php include('includes/styles.php');?>
<?php include('includes/jquery.php');?>
<script type="text/javascript" src="js/addpatient.js"></script>
</head>
<body>
<div id="header">
<div class="center"><a href="menu.php"><img alt="logo" src="images/logo.png" /></a></div>
<ul class="innerlinks">
<li><a href="addpatient.php">Agregar Paciente</a></li>
<li><a href="loadpatient.php">Cargar Paciente</a></li>
<li><a href="patientslist.php">Lista de Pacientes</a></li>
</ul>
<div class="usersession">
<img alt="user" src="images/user.png" />
Registrado como <?php echo $_SESSION['firstname'] . ' ' . $_SESSION['firstlastname'] . ' ' . $_SESSION['secondlastname'];?> |
<a href="logout.php" class="session">Cerrar Sesión</a>
</div>
</div>
<div id="outer-wrapper">
<fieldset>
<legend>Agregar Paciente</legend>
<form action="#">
<p class="form">
<label for="documenttype">Tipo de Identificación</label>
<select id="documenttype" name="documenttype">
<option value="1">Cédula de Ciudadanía</option>
<option value="2">Tarjeta de Identidad</option>
<option value="3">Registro Civil</option>
<option value="4">Pasaporte</option>
<option value="5">Cédula de Extranjería</option>
</select>
</p>
<p class="form">
<label for="documentnumber">*No. Identificación</label>
<input id="documentnumber" name="documentnumber" type="text" style="width:10%;" />
</p>
<p class="form">
<label for="firstname">*Primer Nombre</label>
<input id="firstname" name="firstname" type="text" />
</p>
<p class="form">
<label for="middlename">Segundo Nombre</label>
<input id="middlename" name="middlename" type="text" />
</p>
<p class="form">
<label for="firstlastname">*Primer Apellido</label>
<input id="firstlastname" name="firstlastname" type="text" />
</p>
<p class="form">
<label for="secondlastname">*Segundo Apellido</label>
<input id="secondlastname" name="secondlastname" type="text" />
</p>
<p class="form">
<label for="sex">Sexo</label>
<select id="sex" name="sex">
<option value="1">Masculino</option>
<option value="2">Femenino</option>
</select>
</p>
<p class="form">
<label for="birthdate">*Fecha de Nacimiento</label>
<input id="birthdate" name="birthdate" type="text" style="width:10%;" />
<span style="font-style:italic;">mm/dd/aaaa</span>
</p>
<p class="form">
<label for="bloodtype">R.H.</label>
<select id="bloodtype" name="bloodtype">
<option value="1">O-</option>
<option value="2">O+</option>
<option value="3">A-</option>
<option value="4">A+</option>
<option value="5">B-</option>
<option value="6">B+</option>
<option value="7">AB-</option>
<option value="8">AB+</option>
</select>
</p>
<p class="form">
<label for="address">*Dirección</label>
<input id="address" name="address" type="text" />
</p>
<p class="form">
<label for="phonehome">*Teléfono fijo</label>
<input id="phonehome" name="phonehome" type="text" style="width:10%;" />
</p>
<p class="form">
<label for="phoneoffice">Teléfono oficina</label>
<input id="phoneoffice" name="phoneoffice" type="text" style="width:10%;" />
</p>
<p class="form">
<label for="cellnumber">Celular</label>
<input id="cellnumber" name="cellnumber" type="text" style="width:10%;" />
</p>
<p class="form">
<label for="email">Correo Electrónico</label>
<input id="email" name="email" type="text" />
</p>
<p class="form">
<label for="maritalstatus">Estado Civil</label>
<select id="maritalstatus" name="maritalstatus">
<option value="1">Soltero</option>
<option value="2">Casado</option>
<option value="3">Unión Libre</option>
<option value="4">Separado</option>
<option value="5">Divorciado</option>
<option value="6">Viudo</option>
</select>
</p>
<p class="form">
<label for="occupation">Ocupación</label>
<input id="occupation" name="occupation" type="text" />
</p>
<p class="form">
<label for="contact">Acudiente</label>
<input id="contact" name="contact" type="text" />
</p>
<p class="form">
<label for="contactnumber">Número Acudiente</label>
<input id="contactnumber" name="contactnumber" style="width:10%;" type="text" />
</p>
<p class="form center">
<img alt="loader" id="loader" src="images/loader.gif" style="display:none;" />
<input type="button" value="Ingresar Nuevo paciente" />
</p>
</form>
</fieldset>
<div id="message" style="display:none;"></div>
</div>
</body>
</html>