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add-reports.php
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<?php
session_start();
?>
<!doctype html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Patients login</title>
<link href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css" rel="stylesheet">
<script src="https://kit.fontawesome.com/78e6212ab3.js" crossorigin="anonymous"></script>
<!-- favicon ko link -->
<link rel="shortcut icon" href="./images/logooo.png" type="image/x-icon">
<style>
input {
border: 2px solid green;
}
.border-success {
--bs-border-opacity: 1;
border-color: rgba(var(--bs-success-rgb), var(--bs-border-opacity)) !important;
}
</style>
</head>
<body>
<header class="p-3 mb-3 border-bottom bg-success">
<div class="container">
<div class="d-flex flex-wrap align-items-center justify-content-center justify-content-lg-start">
<a href="/" class="d-flex align-items-center mb-2 mb-lg-0 text-dark text-decoration-none">
<a class="navbar-brand fw-bold fs-3" href="#">We<i class="fa-solid fa-circle-nodes"></i>Care</a>
</a>
<ul class="nav col-12 col-lg-auto me-lg-auto mb-2 justify-content-center mb-md-0">
<li><a href="#" class="nav-link px-2 link-light fs-5 ">Add-Reports</a></li>
<li><a href="./doctor-report.php" class="nav-link px-2 link-dark fs-5">Medi-Reports</a></li>
<!-- <li><a href="/Medicine.html" class="nav-link px-2 link-light fs-5">Medi-Cine</a></li> -->
<!-- <li><a href="./symptoms.html" class="nav-link px-2 link-light fs-5">Symptoms</a></li> -->
<li><a href="#" class="nav-link px-2 link-dark fs-5">FAQs</a></li>
</ul>
<div class="dropdown text-end">
<a href="#" class="d-block link-dark text-decoration-none dropdown-toggle" id="dropdownUser1"
data-bs-toggle="dropdown" aria-expanded="false">
<img src="./images/yubi (1).jpeg" alt="mdo" width="32" height="32" class="rounded-circle">
</a>
<ul class="dropdown-menu text-small" aria-labelledby="dropdownUser1">
<li><a class="dropdown-item" href="#">New project...</a></li>
<li><a class="dropdown-item" href="#">Settings</a></li>
<li><a class="dropdown-item" href="#">Profile</a></li>
<li>
<hr class="dropdown-divider">
</li>
<li><a class="dropdown-item" href="./php/logout.php">Sign out</a></li>
</ul>
</div>
</div>
</div>
</header>
<!-- nav header part end here -->
<!-- <datalist id="datalistOptions">
<option value="Prof. Dr. Suman Sharma ">
<option value="Dr. Binay Rijal महिला तथा यौन रोग विशेषज्ञ">
<option value="Dr. Yubraj Adhikari प्रसुति वार्ड">
<option value="Dr. Aanjana Bhattrai आकस्मिक वार्ड">
<option value="Dr. Shreejana Sitaula GYNAECOLOGY">
<option value="Dr.Pooja Paudyal GYNAECOLOGY">
<option value="Dr. Nepal Nepali VASCULAR SURGERY">
<option value="Dr. Sujeet Poudyal
Department of UROLOGY">
<option value="Dr. Ghanshyam Kharel
Department of Neurology">
<option value="Dr. Krishna Bhattarai
Department of Anaesthesiology">
<option value="Dr. Bishika Pun
Department of Radiology">
</datalist> -->
<!-- <form action=""></form> -->
<form action="./php/add_reports.php" method="post" enctype="multipart/form-data">
<div class="container mt-3">
<label for="exampleDataList" class="form-label">Patients's Username(बिरामीको प्रयोगकर्ता नाम)</label>
<input class="form-control border border-2 border-success" list="datalistOptions" id="exampleDataList"
name="pusername" placeholder="Type Username to search...">
<div class="form-group mt-3 ">
<label for="exampleFormControlInput1">Patients's Email address(बिरामीको इमेल ठेगाना)</label>
<input type="email" class="form-control border border-2 border-success" name="pemail"
id="exampleFormControlInput1" placeholder="[email protected]">
</div>
<div class="form-group mt-3">
<label for="exampleFormControlSelect1">Witness(साक्षी) if Any </label>
<select class="form-control border border-2 border-success" id="exampleFormControlSelect1" name="witness">
<option value="No-one">No-one</option>
<option value="Father">Father</option>
<option value="Mother">Mother</option>
<option value="Sister">Sister</option>
<option value="Brother">Brother</option>
<option value="Friends">Friends</option>
<option value="Staff">Staff</option>
<option value="someone">Other</option>
</select>
</div>
<div class="form-group mt-3">
<label for="exampleFormControlTextarea1">Symptoms Of The Disease(रोग को लक्षण)</label>
<textarea class="form-control border border-2 border-success" id="exampleFormControlTextarea1" rows="5"
name="symptoms"></textarea>
</div>
<div class="form-group mt-3">
<label for="exampleFormControlTextarea1">Description Of The Disease(रोग को विवरण)</label>
<textarea class="form-control border border-2 border-success" id="exampleFormControlTextarea1" rows="7"
name="disease"></textarea>
</div>
<div class="form-group mt-3">
<label for="exampleFormControlTextarea1">Description Of Medicines(औषधिको विवरण)</label>
<textarea class="form-control border border-2 border-success" id="exampleFormControlTextarea1" rows="5"
name="medicine"></textarea>
</div>
<div class="form-group mt-3">
<label for="exampleFormControlTextarea1">Necessary Medical Reports(आवश्यक मेडिकल रिपोर्टहरू)</label>
<textarea class="form-control border border-2 border-success" id="exampleFormControlTextarea1" rows="5"
name="reports"></textarea>
</div>
<div class="form-group mt-3">
<label for="exampleFormControlTextarea1">Instruction Regarding Diet(आहार सम्बन्धि निर्देशन)</label>
<textarea class="form-control border border-2 border-success" id="exampleFormControlTextarea1" rows="5"
name="diet"></textarea>
</div>
<div class="form-group mt-3">
<label for="exampleFormControlInput1">Next Visit Date(अर्को भ्रमण मिति)</label>
<input type="datetime-local" class="form-control border border-2 border-success" id="exampleFormControlInput1"
placeholder="dd/mm/yyyy" name="visit_date">
</div>
<div class="form-group mt-3">
<label for="exampleFormControlInput1">Doctor's Name(डाक्टरको नाम)</label>
<input type="text" class="form-control border border-2 border-success"
id="exampleFormControlInput1" readonly value=<?php echo $_SESSION['doctor']; ?> name="doctor_name">
</div>
<!-- Report photo -->
<div class="form-group mt-3">
<label for="exampleFormControlFile1">Input the File Photo (Everything_All_About_Disease)</label>
<input type="file" class="form-control-file border border-2 border-success" id="exampleFormControlFile1"
name="photo">
</div>
<!-- report photo End here -->
<div class="d-grid gap-2 mt-3">
<button class="btn btn-success" type="submit" name="submit" value="submit">Update Details</button>
</div>
</div>
</form>
<!-- footer start form here -->
<div class="container-fluid">
<footer class="row row-cols-1 row-cols-sm-2 row-cols-md-5 px-5 py-5 my-5 border-top bg-secondary">
<div class="col mb-3">
<a href="/" class="d-flex align-items-center mb-3 link-dark text-decoration-none">
<svg class="bi me-2" width="40" height="32">
<use xlink:href="#bootstrap"></use>
</svg>
</a>
<p class="text-muted">WeCare 2022 © All Rights Reserved</p>
</div>
<div class="col mb-3">
</div>
<div class="col mb-3">
<h5>Pages</h5>
<ul class="nav flex-column ">
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning">Home</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-light">Features</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning">Pricing</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning">FAQs</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning">About</a></li>
</ul>
</div>
<div class="col mb-3">
<h5>Contacts</h5>
<ul class="nav flex-column">
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning">Home</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning">Features</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning">Pricing</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning">FAQs</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning">About</a></li>
</ul>
</div>
<div class="col mb-3">
<h5>Social Links</h5>
<ul class="nav flex-column">
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning"><i
class="fa-brands fa-facebook"></i>Facebook</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning"><i
class="fa-brands fa-telegram"></i>Telegram</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning"><i
class="fa-brands fa-twitter"></i>Twitter</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning"><i
class="fa-brands fa-instagram"></i>Instagram</a></li>
<li class="nav-item mb-2"><a href="#" class="nav-link p-0 text-muted link-warning"><i
class="fa-brands fa-youtube"></i>Youtube</a></li>
</ul>
</div>
</footer>
</div>
<script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.bundle.min.js"></script>
</body>
</html>