muzima-form/BarcodeCaptureTestForm.html at master · muzima/muzima-form · GitHub

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
<html>
   <head>
       <meta name="viewport" content="width=device-width, initial-scale=1">
       <link href="css/bootstrap.min.css" rel="stylesheet">
       <link href="css/muzima.css" rel="stylesheet">
       <link href="css/jquery.datetimepicker.css" rel="stylesheet">
       <link href="css/ui-darkness/jquery-ui-1.10.4.custom.min.css" rel="stylesheet">
       <script src="js/jquery.min.js"></script>
       <script src="js/jquery-ui-1.10.4.custom.min.js"></script>
       <script src="js/jquery.validate.min.js"></script>
       <script src="js/additional-methods.min.js"></script>
       <script src="js/jquery.datetimepicker.js"></script>
       <script src="js/muzima.js"></script>
       <title>Barcode Capture Test Form</title>
       <style>
       </style>
   </head>
   <body class="col-md-10 col-md-offset-1">
   <div id="pre_populate_data"></div>
   <form id="media_capture_form" name="media_capture_form">
	 <h2 class="text-center">Barcode Capture Test Form</h2>
	 <div class="form-group">
			 <input class="form-control" id="patient.uuid" name="patient.uuid" type="hidden" readonly="readonly">
	 </div>
   <div class="section">
		   <div class="form-group">
				<label for="obs.barcode">Barcode:</label>
				<input type="button" class='btn barcode_btn'>
				<input class="video_record_text form-control" id="obs.barcode" readonly="readonly"
					   name="obs.barcode" type="text" />
			</div>
   </div>
   <div class="section">
		   <div class="form-group">
		       <label for="encounter.location_id">Encounter Location:<span class="required">*</span></label>
		       <input class="form-control valid-location-only" id="encounter.location_id" type="text" placeholder="Start typing something..." required="required">
		       <input class="form-control" name="encounter.location_id" type="hidden">
		   </div>

		   <div class="form-group hidden">
		       <label for="encounter.location_id_select">Encounter Location <span class="required">*</span></label>
		       <select class="form-control" id="encounter.location_id_select" required="required">
		           <option>...</option>
		       </select>
		   </div>
		   <div class="form-group">
		       <label for="encounter.provider_id_select">Provider Name:</label>
		       <input class="form-control valid-provider-only" id="encounter.provider_id_select" type="text" placeholder="Start typing something...">
		       <input class="form-control" name="encounter.provider_id_select" type="hidden">
		   </div>
		   <div class="form-group hidden">
		       <select id="select_providers">
		       </select>
		   </div>
		   <div class="form-group show_provider_id_text">
		       <label for="encounter.provider_id">Provider's system-id:<span class="required">*</span></label>
		       <input class="form-control checkDigit" id="encounter.provider_id" name="encounter.provider_id"
		          type="text" required="required" disabled="disabled">
		   </div>
		   <div class="form-group">
		       <label for="encounter.encounter_datetime">Encounter Date <span class="required">*</span></label>
		       <input class="form-control nonFutureDate past-date datepicker" readonly="readonly" id="encounter.encounter_datetime"
		              name="encounter.encounter_datetime" type="text" required="required">
		   </div>
		   <div class="form-group">
		       <input class="form-control" id="encounter.form_uuid" name="encounter.form_uuid"
		              type="hidden" required="required">
		   </div>
		</div>
   </form>
   </body>
   <script type="text/javascript">
   $(document).ready(function () {
       document.setupAutoCompleteDataForProvider('encounter\\\\.provider_id_select');
       document.setupAutoCompleteData('encounter\\\\.location_id');
       document.setupValidationForProvider($('#encounter\\\\.provider_id_select').val(),$("#encounter\\\\.provider_id"));
       document.setupValidationForLocation($('#encounter\\\\.location_id').val(),$("encounter\\\\.location_id"));
   });
   </script>
</html>