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add_patient.php
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add_patient.php
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<?php
session_start();
?>
<!DOCTYPE html>
<html lang="en">
<head>
<!-- Required meta tags-->
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<title>Organ DOnation</title>
<!-- Icons font CSS-->
<link href="vendor/mdi-font/css/material-design-iconic-font.min.css" rel="stylesheet" media="all">
<link href="vendor/font-awesome-4.7/css/font-awesome.min.css" rel="stylesheet" media="all">
<!-- Font special for pages-->
<link href="https://fonts.googleapis.com/css?family=Poppins:100,100i,200,200i,300,300i,400,400i,500,500i,600,600i,700,700i,800,800i,900,900i" rel="stylesheet">
<!-- Vendor CSS-->
<link href="vendor/select/select2.min.css" rel="stylesheet" media="all">
<link href="vendor/datepicker/daterangepicker.css" rel="stylesheet" media="all">
<!-- Main CSS-->
<link href="css/main.css" rel="stylesheet" media="all">
</head>
<body>
<div class="page-wrapper bg-gra-02 p-t-130 p-b-100 font-poppins">
<div class="wrapper wrapper--w680">
<div class="card card-4">
<div class="card-body">
<h2 class="title">Add Patient</h2>
<form method="POST" action="insertpatient.php">
<div class="row row-space">
<div class="col-2">
<div class="input-group">
<label class="label">first name</label>
<input class="input--style-4" type="text" name="first_name">
</div>
</div>
<div class="col-2">
<div class="input-group">
<label class="label">last name</label>
<input class="input--style-4" type="text" name="last_name">
</div>
</div>
</div>
<div class="row row-space">
<div class="col-2">
<div class="input-group">
<label class="label">Age</label>
<div class="input-group-icon">
<input class="input--style-4 js-datepicker" type="number" name="age">
</div>
</div>
</div>
</div>
<div class="row row-space">
<div class="col-2">
<div class="input-group">
<label class="label">Medical History</label>
<input class="input--style-4" type="text" name="medical_history">
</div>
</div>
<div class="col-2">
<div class="input-group">
<label class="label">Doctor Id</label>
<input class="input--style-4" type="text" name="doctor">
</div>
</div>
</div>
<div class="row row-space">
<div class="col-2">
<div class="input-group">
<label class="label">Area</label>
<input class="input--style-4" type="text" name="area">
</div>
</div>
<div class="col-2">
<div class="input-group">
<label class="label">City</label>
<input class="input--style-4" type="text" name="city">
</div>
</div>
</div>
<div class="row row-space">
<div class="col-2">
<div class="input-group">
<label class="label">State</label>
<input class="input--style-4" type="text" name="state">
</div>
</div>
<div class="col-2">
<div class="input-group">
<label class="label">Postal Code</label>
<input class="input--style-4" type="text" name="postal">
</div>
</div>
</div>
<div class="row row-space">
<div class="col-2">
<div class="input-group">
<label class="label">Phone Number</label>
<input class="input--style-4" type="number" name="phone">
</div>
</div>
</div>
<div class="col-2">
<div class="input-group">
<label class="label">Blood_group</label>
<input class="input--style-4" type="text" name="Blood_group">
</div>
</div>
<div class="p-t-15">
<input type="submit" name="save" value="submit"/>
</div>
</form>
</div>
</div>
</div>
</div>
</body>
</html>
<!-- end document-->