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addpatient.html
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addpatient.html
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<!DOCTYPE html>
<style>
body {font-family: Arial, Helvetica, sans-serif; }
* {box-sizing: border-box}
/* Full-width input fields */
input,textarea, select {
width: 100%;
padding: 15px;
margin: 5px 0 22px 0;
display: inline-block;
border: none;
background: #f6f6f6;
}
input, textarea{
background-color: #ddd;
outline: none;
}
hr {
border: 1px solid #f1f1f1;
margin-bottom: 25px;
}
/* Set a style for all buttons */
button {
background-color: #4CAF50;
color: white;
padding: 14px 20px;
margin: 8px 0;
border: none;
cursor: pointer;
width: 100%;
opacity: 0.9;
}
button:hover {
opacity:1;
}
/* Extra styles for the cancel button */
.cancelbtn {
padding: 14px 20px;
background-color: #f44336;
}
/* Float cancel and signup buttons and add an equal width */
.cancelbtn, .signupbtn {
float: left;
width: 50%;
}
/* Add padding to container elements */
.container {
padding: 16px;
}
/* Clear floats */
.clearfix::after {
content: "";
clear: both;
display: table;
}
/* Change styles for cancel button and signup button on extra small screens */
@media screen and (max-width: 300px) {
.cancelbtn, .signupbtn {
width: 100%;
}
}
</style>
<body>
<form action="addpatient.php" method= "POST" style="border:1px solid #ccc">
<div class="container">
<h1>Add patient details</h1>
<hr>
<label for="name"><b>Patient Name</b></label>
<input type="text" placeholder="Enter patient's name" name="name" required><br>
<br>
<br>
<label for="email"><b>Patient's age</b></label>
<input type="number" placeholder="Enter Patient's age" name="age" required>
<br>
<br>
<label><b>Current state of patient</b></label><br>
<SELECT id="s1" name="selection" required>
<Option value="stage1">Stage 1</option>
<Option value="stage2">Stage 2</option>
<Option value="stage3">Stage 3</option>
<Option value="critical">Critical</option>
<Option value="dead">Critical</option>
<Option value="free">Critical</option>
</SELECT><br>
<br>
<label for="name"><b>Method of transmission</b></label><br>
<textarea name="meth_infc" placeholder = "Method of transmissi" rows="5" cols="30"> </textarea><br>
<br>
<br>
<label for="name"><b>Patient's previous medical history</b></label><br>
<textarea name="predisease" placeholder = "Previous history"rows="5" cols="30"> </textarea> <br>
<br>
<br>
<label for="name"><b>Treatment used</b></label><br>
<textarea name="meth_trtmnt" placeholder = "Treatment method used"rows="5" cols="30"> </textarea> <br>
<br>
<br>
<label for="name"><b>Admission Date </b></label><br>
<input type="date" placeholder="Admission date" name="admdate" required><br>
<label for="name"><b>Discharge date</b></label><br>
<input type="date" placeholder="Discharge date" name="disdate" default= "N/A"><br>
<div class="clearfix">
<button type="reset" class="cancelbtn">Reset</button>
<button type="submit" class="signupbtn" name = "submit">Add </button>
<button name="back" onclick="Back()" value = "Back">Back</button>
<script type="text/javascript">
function Back() {window.location.assign('options.html')}</script>
</div>
</div>
</form>
</body>
</html>