<?php

include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
foreach ($_POST as $k => $var) {
    $_POST[$k] = add_escape_custom($var);
    echo "{$var}\n";
}
if ($encounter == "") {
    $encounter = date("Ymd");
}
if ($_GET["mode"] == "new") {
    $newid = formSubmit("form_individual_treatment_plan", $_POST, $_GET["id"], $userauthorized);
    addForm($encounter, "Individual Treatment Plan", $newid, "individual_treatment_plan", $pid, $userauthorized);
} elseif ($_GET["mode"] == "update") {
    sqlInsert("update form_individual_treatment_plan set pid = {$_SESSION["pid"]},groupname='" . $_SESSION["authProvider"] . "',user='" . $_SESSION["authUser"] . "',authorized={$userauthorized},activity=1, date = NOW(), \ndate_of_referal ='" . $_POST["date_of_referal"] . "',\ndcn ='" . $_POST["dcn"] . "',\nicd9 ='" . $_POST["icd9"] . "',\nprognosis ='" . $_POST["prognosis"] . "',\ndiagnosis_description ='" . $_POST["diagnosis_description"] . "',\npresenting_problem ='" . $_POST["presenting_problem"] . "',\nfrequency ='" . $_POST["frequency"] . "',\nduration ='" . $_POST["duration"] . "',\nscope ='" . $_POST["scope"] . "',\nshort_term_goals_1 ='" . $_POST["short_term_goals_1"] . "',\ntime_frame_1 ='" . $_POST["time_frame_1"] . "',\nshort_term_goals_2 ='" . $_POST["short_term_goals_2"] . "',\ntime_frame_2 ='" . $_POST["time_frame_2"] . "',\nshort_term_goals_3 ='" . $_POST["short_term_goals_3"] . "',\ntime_frame_3 ='" . $_POST["time_frame_3"] . "',\nlong_term_goals ='" . $_POST["long_term_goals"] . "',\ndischarge_criteria ='" . $_POST["discharge_criteria"] . "',\nindividual_family_therapy ='" . $_POST["individual_family_therapy"] . "',\nsubstance_abuse ='" . $_POST["substance_abuse"] . "',\ngroup_therapy ='" . $_POST["group_therapy"] . "',\nparenting ='" . $_POST["parenting"] . "',\naction_steps_by_supports ='" . $_POST["action_steps_by_supports"] . "',\nother_supports_name_1 ='" . $_POST["other_supports_name_1"] . "',\nother_supports_name_2 ='" . $_POST["other_supports_name_2"] . "',\nother_supports_contact_1 ='" . $_POST["other_supports_contact_1"] . "',\nother_supports_contact_2 ='" . $_POST["other_supports_contact_2"] . "',\nmedications_1 ='" . $_POST["medications_1"] . "',\nmedications_2 ='" . $_POST["medications_2"] . "',\nreferrals_1 ='" . $_POST["referrals_1"] . "',\nreferrals_2 ='" . $_POST["referrals_2"] . "' where id={$id}");
}
$_SESSION["encounter"] = $encounter;
formHeader("Redirecting....");
formJump();
formFooter();

    $data[$fld] = '';
}
foreach ($_POST as $k => $var) {
    $_POST[$k] = mysql_escape_string($var);
    if ($k != 'pname' && $k != 'pbdate' && $k != 'md_pid') {
        $data[$k] = $_POST[$k];
        if ($data[$k] == "YYYY-MM-DD") {
            $data[$k] = '';
        }
    }
    //echo "$var\n";
}
if ($_GET["mode"] == "new") {
    if ($encounter == "") {
        $encounter = date("Ymd");
    }
    $newid = formSubmit("form_medical_decision", $data, $_GET["id"], $userauthorized);
    addForm($encounter, "Medical decision", $newid, "medical_decision", $pid, $userauthorized);
    $_SESSION["encounter"] = $encounter;
} elseif ($_GET["mode"] == "update") {
    $q1 = '';
    foreach ($data as $key => $val) {
        $q1 .= "{$key}='{$val}', ";
    }
    sqlInsert("update form_medical_decision set pid = {$_SESSION["pid"]},groupname='" . $_SESSION["authProvider"] . "',user='" . $_SESSION["authUser"] . "',authorized={$userauthorized},activity=1, {$q1}  date = NOW() where id={$id}");
}
sqlInsert("update patient_data set DOB='" . $_POST['pbdate'] . "' where  id={$pid}");
//$_SESSION["pid"] = $pid;
formHeader("Redirecting....");
formJump();
formFooter();

<?php

//------------Forms generated from formsWiz
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
foreach ($_POST as $k => $var) {
    $_POST[$k] = mysql_escape_string($var);
    echo "{$var}\n";
}
if ($encounter == "") {
    $encounter = date("Ymd");
}
if ($_GET["mode"] == "new") {
    $newid = formSubmit("form_dictation", $_POST, $_GET["id"], $userauthorized);
    addForm($encounter, "Speech Dictation", $newid, "dictation", $pid, $userauthorized);
} elseif ($_GET["mode"] == "update") {
    sqlInsert("update form_dictation set pid = {$_SESSION["pid"]},groupname='" . $_SESSION["authProvider"] . "',user='" . $_SESSION["authUser"] . "',authorized={$userauthorized},activity=1, date = NOW(), dictation='" . $_POST["dictation"] . "', additional_notes='" . $_POST["additional_notes"] . "' where id={$id}");
}
$_SESSION["encounter"] = $encounter;
formHeader("Redirecting....");
formJump();
formFooter();

            sqlQuery($query, array('1', $_REQUEST['LOCKEDBY'], $form_id));
            //go on to save what we want...
        }
    } elseif (!$lock['LOCKED']) {
        // it is not locked yet
        $_REQUEST['LOCKED'] = '1';
        $query = "update " . $table_name . " set LOCKED=?,LOCKEDBY=? where id=?";
        sqlQuery($query, array('1', $_REQUEST['LOCKEDBY'], $form_id));
        //go on to save what we want...
    }
    if (!$_REQUEST['LOCKEDBY']) {
        $_REQUEST['LOCKEDBY'] = rand();
    }
}
if ($_REQUEST["mode"] == "new") {
    $newid = formSubmit($table_name, $_POST, $id, $userauthorized);
    addForm($encounter, $form_name, $newid, $form_folder, $pid, $userauthorized);
} elseif ($_REQUEST["mode"] == "update") {
    // The user has write privileges to work with...
    if ($_REQUEST['action'] == "store_PDF") {
        /*
         * We want to store/overwrite the current PDF version of this encounter's f
         * Currently this is only called 'beforeunload', ie. when you finish the form
         * In this current paradigm, anytime the form is opened, then closed, the PDF
         * is overwritten.  With esign implemented, the PDF should be locked.  I suppose
         * with esign the form can't even be opened so the only way to get to the PDF
         * is through the Documents->Encounters links.
         */
        $query = "select id from categories where name = 'Encounters'";
        $result = sqlStatement($query);
        $ID = sqlFetchArray($result);

* but WITHOUT ANY WARRANTY; without even the implied warranty of
* MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
* GNU General Public License for more details.
* You should have received a copy of the GNU General Public License
* along with this program. If not, see <http://opensource.org/licenses/gpl-license.php>;.
*
* @package OpenEMR
* @author  Roberto Vasquez <[email protected]>
* @link    http://www.open-emr.org 
*/
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
foreach ($_POST as $k => $var) {
    $_POST[$k] = mysql_escape_string($var);
    echo attr($var);
    echo "\n";
}
if ($encounter == "") {
    $encounter = date("Ymd");
}
if ($_GET["mode"] == "new") {
    $newid = formSubmit("form_reviewofs", $_POST, $_GET["id"], $userauthorized);
    addForm($encounter, "Review of Systems Checks", $newid, "reviewofs", $pid, $userauthorized);
} elseif ($_GET["mode"] == "update") {
    sqlInsert("update form_reviewofs set pid = {$_SESSION["pid"]},groupname='" . $_SESSION["authProvider"] . "',user='" . $_SESSION["authUser"] . "',authorized={$userauthorized},activity=1, date = NOW(), fever='" . $_POST["fever"] . "', chills='" . $_POST["chills"] . "', night_sweats='" . $_POST["night_sweats"] . "', weight_loss='" . $_POST["weight_loss"] . "', poor_appetite='" . $_POST["poor_appetite"] . "', insomnia='" . $_POST["insomnia"] . "', fatigued='" . $_POST["fatigued"] . "', depressed='" . $_POST["depressed"] . "', hyperactive='" . $_POST["hyperactive"] . "', exposure_to_foreign_countries='" . $_POST["exposure_to_foreign_countries"] . "', cataracts='" . $_POST["cataracts"] . "', cataract_surgery='" . $_POST["cataract_surgery"] . "', glaucoma='" . $_POST["glaucoma"] . "', double_vision='" . $_POST["double_vision"] . "', blurred_vision='" . $_POST["blurred_vision"] . "', poor_hearing='" . $_POST["poor_hearing"] . "', headaches='" . $_POST["headaches"] . "', ringing_in_ears='" . $_POST["ringing_in_ears"] . "', bloody_nose='" . $_POST["bloody_nose"] . "', sinusitis='" . $_POST["sinusitis"] . "', sinus_surgery='" . $_POST["sinus_surgery"] . "', dry_mouth='" . $_POST["dry_mouth"] . "', strep_throat='" . $_POST["strep_throat"] . "', tonsillectomy='" . $_POST["tonsillectomy"] . "', swollen_lymph_nodes='" . $_POST["swollen_lymph_nodes"] . "', throat_cancer='" . $_POST["throat_cancer"] . "', throat_cancer_surgery='" . $_POST["throat_cancer_surgery"] . "', heart_attack='" . $_POST["heart_attack"] . "', irregular_heart_beat='" . $_POST["irregular_heart_beat"] . "', chest_pains='" . $_POST["chest_pains"] . "', shortness_of_breath='" . $_POST["shortness_of_breath"] . "', high_blood_pressure='" . $_POST["high_blood_pressure"] . "', heart_failure='" . $_POST["heart_failure"] . "', poor_circulation='" . $_POST["poor_circulation"] . "', vascular_surgery='" . $_POST["vascular_surgery"] . "', cardiac_catheterization='" . $_POST["cardiac_catheterization"] . "', coronary_artery_bypass='" . $_POST["coronary_artery_bypass"] . "', heart_transplant='" . $_POST["heart_transplant"] . "', stress_test='" . $_POST["stress_test"] . "', emphysema='" . $_POST["emphysema"] . "', chronic_bronchitis='" . $_POST["chronic_bronchitis"] . "', interstitial_lung_disease='" . $_POST["interstitial_lung_disease"] . "', shortness_of_breath_2='" . $_POST["shortness_of_breath_2"] . "', lung_cancer='" . $_POST["lung_cancer"] . "', lung_cancer_surgery='" . $_POST["lung_cancer_surgery"] . "', pheumothorax='" . $_POST["pheumothorax"] . "', stomach_pains='" . $_POST["stomach_pains"] . "', peptic_ulcer_disease='" . $_POST["peptic_ulcer_disease"] . "', gastritis='" . $_POST["gastritis"] . "', endoscopy='" . $_POST["endoscopy"] . "', polyps='" . $_POST["polyps"] . "', colonoscopy='" . $_POST["colonoscopy"] . "', colon_cancer='" . $_POST["colon_cancer"] . "', colon_cancer_surgery='" . $_POST["colon_cancer_surgery"] . "', ulcerative_colitis='" . $_POST["ulcerative_colitis"] . "', crohns_disease='" . $_POST["crohns_disease"] . "', appendectomy='" . $_POST["appendectomy"] . "', divirticulitis='" . $_POST["divirticulitis"] . "', divirticulitis_surgery='" . $_POST["divirticulitis_surgery"] . "', gall_stones='" . $_POST["gall_stones"] . "', cholecystectomy='" . $_POST["cholecystectomy"] . "', hepatitis='" . $_POST["hepatitis"] . "', cirrhosis_of_the_liver='" . $_POST["cirrhosis_of_the_liver"] . "', splenectomy='" . $_POST["splenectomy"] . "', kidney_failure='" . $_POST["kidney_failure"] . "', kidney_stones='" . $_POST["kidney_stones"] . "', kidney_cancer='" . $_POST["kidney_cancer"] . "', kidney_infections='" . $_POST["kidney_infections"] . "', bladder_infections='" . $_POST["bladder_infections"] . "', bladder_cancer='" . $_POST["bladder_cancer"] . "', prostate_problems='" . $_POST["prostate_problems"] . "', prostate_cancer='" . $_POST["prostate_cancer"] . "', kidney_transplant='" . $_POST["kidney_transplant"] . "', sexually_transmitted_disease='" . $_POST["sexually_transmitted_disease"] . "', burning_with_urination='" . $_POST["burning_with_urination"] . "', discharge_from_urethra='" . $_POST["discharge_from_urethra"] . "', rashes='" . $_POST["rashes"] . "', infections='" . $_POST["infections"] . "', ulcerations='" . $_POST["ulcerations"] . "', pemphigus='" . $_POST["pemphigus"] . "', herpes='" . $_POST["herpes"] . "', osetoarthritis='" . $_POST["osetoarthritis"] . "', rheumotoid_arthritis='" . $_POST["rheumotoid_arthritis"] . "', lupus='" . $_POST["lupus"] . "', ankylosing_sondlilitis='" . $_POST["ankylosing_sondlilitis"] . "', swollen_joints='" . $_POST["swollen_joints"] . "', stiff_joints='" . $_POST["stiff_joints"] . "', broken_bones='" . $_POST["broken_bones"] . "', neck_problems='" . $_POST["neck_problems"] . "', back_problems='" . $_POST["back_problems"] . "', back_surgery='" . $_POST["back_surgery"] . "', scoliosis='" . $_POST["scoliosis"] . "', herniated_disc='" . $_POST["herniated_disc"] . "', shoulder_problems='" . $_POST["shoulder_problems"] . "', elbow_problems='" . $_POST["elbow_problems"] . "', wrist_problems='" . $_POST["wrist_problems"] . "', hand_problems='" . $_POST["hand_problems"] . "', hip_problems='" . $_POST["hip_problems"] . "', knee_problems='" . $_POST["knee_problems"] . "', ankle_problems='" . $_POST["ankle_problems"] . "', foot_problems='" . $_POST["foot_problems"] . "', insulin_dependent_diabetes='" . $_POST["insulin_dependent_diabetes"] . "', noninsulin_dependent_diabetes='" . $_POST["noninsulin_dependent_diabetes"] . "', hypothyroidism='" . $_POST["hypothyroidism"] . "', hyperthyroidism='" . $_POST["hyperthyroidism"] . "', cushing_syndrom='" . $_POST["cushing_syndrom"] . "', addison_syndrom='" . $_POST["addison_syndrom"] . "', additional_notes='" . $_POST["additional_notes"] . "' where id={$id}");
}
$_SESSION["encounter"] = $encounter;
formHeader("Redirecting....");
formJump();
formFooter();

include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
// escape the strings
foreach ($_POST as $k => $var) {
    $_POST[$k] = add_escape_custom($var);
    // echo "$var\n";
}
/////////////////
// here we check to se if there was an autosave version prior to the real save
$vectAutosave = sqlQuery("SELECT id, autosave_flag, autosave_datetime FROM form_psychiatrisch_onderzoek\n                            WHERE pid = " . $_SESSION["pid"] . " AND groupname='" . $_SESSION["authProvider"] . "' AND user='" . $_SESSION["authUser"] . "' AND\n                            authorized={$userauthorized} AND activity=1\n                            AND autosave_flag=1 \n                            ORDER by id DESC limit 1");
// if yes then update this else insert
if ($vectAutosave['autosave_flag'] == 1 || $_POST["mode"] == "update") {
    if ($_POST["mode"] == "update") {
        $newid = $_POST["id"];
    } else {
        $newid = $vectAutosave['id'];
    }
    $strSql = "UPDATE form_psychiatrisch_onderzoek\n                SET pid = " . $_SESSION["pid"] . ", groupname='" . $_SESSION["authProvider"] . "', user='" . $_SESSION["authUser"] . "', \n                authorized={$userauthorized}, activity=1, date = NOW(), \n                datum_onderzoek='" . $_POST["datum_onderzoek"] . "',\n                reden_van_aanmelding='" . $_POST["reden_van_aanmelding"] . "', \n                conclusie_van_intake='" . $_POST["conclusie_van_intake"] . "',\n                medicatie='" . $_POST["medicatie"] . "',\n                anamnese='" . $_POST["anamnese"] . "',\n                psychiatrisch_onderzoek='" . $_POST["psychiatrisch_onderzoek"] . "',\n                beschrijvende_conclusie='" . $_POST["beschrijvende_conclusie"] . "',\n                behandelvoorstel='" . $_POST["behandelvoorstel"] . "',\n                autosave_flag=1, \n                autosave_datetime=NOW() \n                  WHERE id = " . $newid . ";";
    sqlQuery($strSql);
    //echo "DEBUG :: id=$newid, sql=$strSql<br>";
} else {
    $newid = formSubmit("form_psychiatrisch_onderzoek", $_POST, $_GET["id"], $userauthorized);
    addForm($encounter, "Psychiatric Examination", $newid, "psychiatrisch_onderzoek", $pid, $userauthorized);
    //echo "Debug :: insert<br>";
}
//get timestamp
$result = sqlQuery("SELECT autosave_datetime FROM form_psychiatrisch_onderzoek\n                            WHERE pid = " . $_SESSION["pid"] . " AND groupname='" . $_SESSION["authProvider"] . "' AND user='" . $_SESSION["authUser"] . "' AND\n                            authorized={$userauthorized} AND activity=1 AND id={$newid}\n                            AND autosave_flag=1 \n                            ORDER by id DESC limit 1");
//$timestamp = mysql_result($result, 0);
//output timestamp
echo xl('Last Saved') . ': ' . $result['autosave_datetime'];

        }
        $field_names[$key] = $pos . $neg;
    } else {
        $field_names[$key] = $_POST[$key];
    }
    if ($field_names[$key] != '') {
        //          $field_names[$key] .= '.';
        $field_names[$key] = preg_replace('/\\s*,\\s*([^,]+)\\./', ' and $1.', $field_names[$key]);
        // replace last comma with 'and' and ending period
    }
}
//end special processing
foreach ($field_names as $k => $var) {
    #if (strtolower($k) == strtolower($var)) {unset($field_names[$k]);}
    $field_names[$k] = formDataCore($var);
    echo "{$var}\n";
}
if ($encounter == "") {
    $encounter = date("Ymd");
}
if ($_GET["mode"] == "new") {
    reset($field_names);
    $newid = formSubmit("form_Initial_New_Patient_Physical_Exam", $field_names, $_GET["id"], $userauthorized);
    addForm($encounter, "Initial New Patient Physical Exam", $newid, "Initial_New_Patient_Physical_Exam", $pid, $userauthorized);
} elseif ($_GET["mode"] == "update") {
    sqlInsert("update form_Initial_New_Patient_Physical_Exam set pid = {$_SESSION["pid"]},groupname='" . $_SESSION["authProvider"] . "',user='" . $_SESSION["authUser"] . "',authorized={$userauthorized},activity=1, date = NOW(), sweeter='" . $field_names["sweeter"] . "',bloater='" . $field_names["bloater"] . "',grazer='" . $field_names["grazer"] . "',general='" . $field_names["general"] . "',head='" . $field_names["head"] . "',eyes='" . $field_names["eyes"] . "',ears='" . $field_names["ears"] . "',nose='" . $field_names["nose"] . "',throat='" . $field_names["throat"] . "',oral_cavity='" . $field_names["oral_cavity"] . "',dentition='" . $field_names["dentition"] . "',neck='" . $field_names["neck"] . "',heart='" . $field_names["heart"] . "',lung='" . $field_names["lung"] . "',chest='" . $field_names["chest"] . "',breast='" . $field_names["breast"] . "',male='" . $field_names["male"] . "',female='" . $field_names["female"] . "',note='" . $field_names["note"] . "',abdomen='" . $field_names["abdomen"] . "',scar='" . $field_names["scar"] . "',umbilius='" . $field_names["umbilius"] . "',groins='" . $field_names["groins"] . "',extremities='" . $field_names["extremities"] . "',peripheral_pulses='" . $field_names["peripheral_pulses"] . "',right_peripheral_pulses='" . $field_names["right_peripheral_pulses"] . "',left_peripheral_pulses='" . $field_names["left_peripheral_pulses"] . "',neurological='" . $field_names["neurological"] . "',right_neurological='" . $field_names["right_neurological"] . "',left_neurological='" . $field_names["left_neurological"] . "',rectum='" . $field_names["rectum"] . "',pelvic='" . $field_names["pelvic"] . "',assessment='" . $field_names["assessment"] . "',note2='" . $field_names["note2"] . "',recommendations='" . $field_names["recommendations"] . "',note3='" . $field_names["note3"] . "' where id={$id}");
}
$_SESSION["encounter"] = $encounter;
formHeader("Redirecting....");
formJump();
formFooter();

                ), ''
);
print formHint('Note: leave empty to generate a random password automatically');
print formFieldsetClose();
// -------------------------------------------------------------------------------
print formFieldsetOpen('', array(
  'id' => '-x-field-do_not_email_password'
));

print formCheckbox('do_not_email_password', '1', false);
print formLabel(__('Do not email the password'));
print formHint('Note: by default the password will be emailed, but you can prevent this by unchecking this option');
print formFieldsetClose();
// -------------------------------------------------------------------------------
print formFieldsetOpen('', array(
  'id' => '-x-field-is_enabled'
));

print formCheckbox('is_enabled', '1', true);
print formLabel(__('Activate this user?'));
print formFieldsetClose();
// -------------------------------------------------------------------------------
// Print submit
print formSubmit(array(
                   'class' => '-b-button',
                   'name'  => 'submit',
                   'value' => __('Create user')
                 ));
// Close form
print formClose();
?>

    if ($field_names[$key] != '') {
        //          $field_names[$key] .= '.';
        $field_names[$key] = preg_replace('/\\s*,\\s*([^,]+)\\./', ' and $1.', $field_names[$key]);
        // replace last comma with 'and' and ending period
    }
}
//end special processing
if (get_magic_quotes_gpc()) {
    foreach ($field_names as $k => $var) {
        $field_names[$k] = stripslashes($var);
    }
}
foreach ($field_names as $k => $var) {
    #if (strtolower($k) == strtolower($var)) {unset($field_names[$k]);}
    $field_names[$k] = mysql_real_escape_string($var);
    echo "{$var}\n";
}
if ($encounter == "") {
    $encounter = date("Ymd");
}
if ($_GET["mode"] == "new") {
    reset($field_names);
    $newid = formSubmit("form_Chiro_personal_injury_form", $field_names, $_GET["id"], $userauthorized);
    addForm($encounter, "Chiro_personal_injury_form", $newid, "Chiro_personal_injury_form", $pid, $userauthorized);
} elseif ($_GET["mode"] == "update") {
    sqlInsert("update form_Chiro_personal_injury_form set pid = {$_SESSION["pid"]},groupname='" . $_SESSION["authProvider"] . "',user='" . $_SESSION["authUser"] . "',authorized={$userauthorized},activity=1, date = NOW(), _patient_name='" . $field_names["_patient_name"] . "',_middle_name='" . $field_names["_middle_name"] . "',_last_name='" . $field_names["_last_name"] . "',_address_direction='" . $field_names["_address_direction"] . "',_city='" . $field_names["_city"] . "',_state='" . $field_names["_state"] . "',_zip='" . $field_names["_zip"] . "',_phone_number_home='" . $field_names["_phone_number_home"] . "',_phone_number_work='" . $field_names["_phone_number_work"] . "',_sex='" . $field_names["_sex"] . "',_date_of_birth='" . $field_names["_date_of_birth"] . "',_social_security='" . $field_names["_social_security"] . "',_nature_of_accident='" . $field_names["_nature_of_accident"] . "',_other='" . $field_names["_other"] . "',_date_of_accident='" . $field_names["_date_of_accident"] . "',_insurance_name='" . $field_names["_insurance_name"] . "',_phone_no='" . $field_names["_phone_no"] . "',_address_of_insurance_company='" . $field_names["_address_of_insurance_company"] . "',_claim_number='" . $field_names["_claim_number"] . "',_policy_number='" . $field_names["_policy_number"] . "',_attorney_name='" . $field_names["_attorney_name"] . "',_attorney_phone_number='" . $field_names["_attorney_phone_number"] . "',_attorney_address='" . $field_names["_attorney_address"] . "',_health_insurance='" . $field_names["_health_insurance"] . "',_health_insurance_phone_number='" . $field_names["_health_insurance_phone_number"] . "',_address_of_health_insurance='" . $field_names["_address_of_health_insurance"] . "',_subscriber_id_number='" . $field_names["_subscriber_id_number"] . "',_group_number='" . $field_names["_group_number"] . "' where id={$id}");
}
$_SESSION["encounter"] = $encounter;
formHeader("Redirecting....");
formJump();
formFooter();

<?php

//------------Forms generated from formsWiz
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
foreach ($_POST as $k => $var) {
    $_POST[$k] = mysql_escape_string($var);
    echo "{$var}\n";
}
if ($encounter == "") {
    $encounter = date("Ymd");
}
if ($_GET["mode"] == "new") {
    $newid = formSubmit("form_hearingtest", $_POST, $_GET["id"], $userauthorized);
    addForm($encounter, "Hearing Test", $newid, "hearingtest", $pid, $userauthorized);
} elseif ($_GET["mode"] == "update") {
    sqlInsert("update form_hearingtest set pid = {$_SESSION["pid"]},groupname='" . $_SESSION["authProvider"] . "',user='" . $_SESSION["authUser"] . "',authorized={$userauthorized},activity=1, date = NOW(), right_ear_250='" . $_POST["right_ear_250"] . "', right_ear_500='" . $_POST["right_ear_500"] . "', right_ear_1000='" . $_POST["right_ear_1000"] . "', right_ear_2000='" . $_POST["right_ear_2000"] . "', right_ear_3000='" . $_POST["right_ear_3000"] . "', right_ear_4000='" . $_POST["right_ear_4000"] . "', right_ear_5000='" . $_POST["right_ear_5000"] . "', right_ear_6000='" . $_POST["right_ear_6000"] . "', left_ear_250='" . $_POST["left_ear_250"] . "', left_ear_500='" . $_POST["left_ear_500"] . "', left_ear_1000='" . $_POST["left_ear_1000"] . "', left_ear_2000='" . $_POST["left_ear_2000"] . "', left_ear_3000='" . $_POST["left_ear_3000"] . "', left_ear_4000='" . $_POST["left_ear_4000"] . "', left_ear_5000='" . $_POST["left_ear_5000"] . "', left_ear_6000='" . $_POST["left_ear_6000"] . "', with_hearing_aid='" . $_POST["with_hearing_aid"] . "', additional_notes='" . $_POST["additional_notes"] . "' where id={$id}");
}
$_SESSION["encounter"] = $encounter;
formHeader("Redirecting....");
formJump();
formFooter();

    public function actionEdit()
    {
        global $urlRequestRoot, $moduleFolder, $cmsFolder, $templateFolder, $sourceFolder, $STARTSCRIPTS;
        require_once $sourceFolder . "/" . $moduleFolder . "/publication/edit.php";
        $scriptFolder = "{$urlRequestRoot}/{$cmsFolder}/{$moduleFolder}/publication";
        $js = "<script src='{$scriptFolder}/edit.js'></script>";
        /* Check for get requests */
        if (isset($_GET['add'])) {
            add_new($this->moduleComponentId);
        }
        if (isset($_GET['del'])) {
            p_delete($this->moduleComponentId, $_GET['del']);
        }
        if (isset($_GET['subaction'])) {
            $pb_array = array();
            for ($i = 0; $i <= $_POST['num'] - 1; $i++) {
                $pb_array[$i] = $_POST['p' . $i];
            }
            formSubmit($this->moduleComponentId, $pb_array);
        }
        $view = '';
        $view1 = <<<FORM_AND_TABLE
<form id='p_form' method='POST' enctype='multipart/form-data' action='./+edit&subaction=SUBMIT'> 
   <table id="publications">
    \t<thead style="font-weight:bold;">
        \t<td >
                sl no.
        \t</td>
        \t<td >
                Publication
        \t</td>
        \t<td >
                Saved Time
        \t</td>
    \t\t<td >
      \t\t\tCreated Time
    \t\t</td>    \t
  \t\t</thead>

FORM_AND_TABLE;
        //Get the publications from database
        $counter = 0;
        $query = "SELECT * FROM publication_details where module_component_id =" . $this->moduleComponentId . ";";
        $details = mysql_query($query) or die("error .." . mysql_error());
        $rows = mysql_num_rows($details) - 1;
        $view2 = '';
        while ($arr_details = mysql_fetch_array($details)) {
            $counter1 = $counter + 1;
            $view2 .= <<<ROWS
\t\t\t\t  <tr>
         \t\t\t<td > {$counter1} </td>
         \t\t\t<td ><textarea name='p{$counter}' id='p{$counter}'>{$arr_details['publication']}</textarea></td>
          \t\t\t<td >{$arr_details['saved_time']}</td>
         \t\t\t<td >{$arr_details['created_time']}</td>
         \t\t\t<td>
    \t\t\t\t\t<button> 
    \t\t\t\t\t\t<a href='./+edit&del={$counter}'>DELETE
    \t\t\t\t\t\t</a>
    \t\t\t\t\t</button>
    \t\t\t\t</td>    
ROWS;
            //Check for first row
            if ($counter != $rows) {
                $view2 .= <<<FIRST_ROW
\t\t\t\t\t<td ><button type="button" onclick="reorder({$counter},1);"><span style='font-weight:bolder;font-size:25px;'>&#x2193;</span></button></td>
FIRST_ROW;
            }
            //Check for last row
            if ($counter != 0) {
                $view2 .= <<<LAST_ROW
\t\t\t\t<td ><button type="button" onclick="reorder({$counter},-1);"><span style='font-weight:bolder;font-size:25px;'>&#x2191;</span></button></td>
LAST_ROW;
            }
            $view2 .= "</tr>";
            $counter++;
        }
        $view3 = <<<END_TABLE
   </table>
   <button><a href="./+edit&add=new">ADD NEW PUBLICATION</a></button>
   <input type='hidden' name='num' value='{$counter}'>
   <button type="submit" name="btn_submit">SUBMIT</button> 
 </form>  
END_TABLE;
        $view4 = <<<js
\t\t\t\t{$js}
js;
        $view .= $view1 . $view2 . $view3 . $view4;
        return $view;
    }

$data['pl_reactions'] = $_POST['pl_reactions'];
$data['pl_medications'] = $_POST['pl_medications'];
$si = 1;
while ($si < 26) {
    if ($_POST["pl_ed_{$si}"] != '') {
        $data["pl_problem_{$si}"] = $_POST["pl_ed_{$si}"] . '|~' . $_POST["pl_problem_{$si}"] . '|~' . $_POST["pl_onset_{$si}"] . '|~' . $_POST["pl_rd_{$si}"];
    } else {
        $data["pl_problem_{$si}"] = '';
    }
    $si++;
}
//if ($pid == "") { $pid = $_SESSION["pid"]; }
if ($_GET["mode"] == "new") {
    if ($encounter == "") {
        $encounter = date("Ymd");
    }
    $newid = formSubmit("form_plist", $data, $_GET["id"], $userauthorized);
    addForm($encounter, "Problem list", $newid, "plist", $pid, $userauthorized);
    $_SESSION["encounter"] = $encounter;
} elseif ($_GET["mode"] == "update") {
    $q1 = '';
    foreach ($data as $key => $val) {
        $q1 .= "{$key}='{$val}', ";
    }
    sqlInsert("update form_plist set pid = {$_SESSION["pid"]},groupname='" . $_SESSION["authProvider"] . "',user='" . $_SESSION["authUser"] . "',authorized={$userauthorized},activity=1, {$q1}  date = NOW() where id={$id}");
}
sqlInsert("update patient_data set DOB='" . $_POST['pbdate'] . "' where  id={$pid}");
//$_SESSION["pid"] = $pid;
formHeader("Redirecting....");
formJump();
formFooter();

// Created by:	Larry Lart
// Version:	1.0 - 30-03-2008
////////////////////////////////////////////////////////////////////
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
foreach ($_POST as $k => $var) {
    $_POST[$k] = mysql_real_escape_string($var);
    // echo "$var\n";
}
if ($encounter == "") {
    $encounter = date("Ymd");
}
if ($_GET["mode"] == "new") {
    if ($_GET["id"] != '') {
        $_GET["id"] = '0';
        $newid = formSubmit("form_brief_aan_verwijzer", $_POST, $_GET["id"], $userauthorized);
        // add shoul be here or downoutside if block ?
        addForm($encounter, "Psychiatric Brief Letter", $newid, "brief_aan_verwijzer", $pid, $userauthorized);
    } else {
        $_POST['autosave_flag'] = 0;
        $newid = formUpdate("form_brief_aan_verwijzer", $_POST, $_GET["saveid"], $userauthorized);
    }
} elseif ($_GET["mode"] == "update") {
    $strSql = "UPDATE form_brief_aan_verwijzer\n                SET pid = " . $_SESSION["pid"] . ", groupname='" . $_SESSION["authProvider"] . "', user='" . $_SESSION["authUser"] . "', \n                authorized={$userauthorized}, activity=1, date = NOW(), \n                introductie='" . $_POST["introductie"] . "',\n                reden_van_aanmelding='" . $_POST["reden_van_aanmelding"] . "', \n                anamnese='" . $_POST["anamnese"] . "',\n                psychiatrisch_onderzoek='" . $_POST["psychiatrisch_onderzoek"] . "',\n                beschrijvend_conclusie='" . $_POST["beschrijvend_conclusie"] . "',\n                advies_beleid='" . $_POST["advies_beleid"] . "',\n                autosave_flag=0, \n                autosave_datetime=NOW() \n                  WHERE id = " . $_GET['id'] . ";";
    sqlQuery($strSql);
}
$_SESSION["encounter"] = $encounter;
formHeader("Redirecting....");
formJump();
formFooter();

$ftitle = 'Patient intake history';
$old = sqlStatement("select form_id, formdir from forms where (form_name='{$ftitle}') and (pid={$pid}) order by date desc limit 1");
if ($old) {
    $dt = sqlFetchArray($old);
    $fid = $dt['form_id'];
    if ($fid && $fid != 0 && $fid != '') {
        $fdir = $dt['formdir'];
        unset($dt);
        $dt = formFetch($frmn, $fid);
        $linked = $dt['linked_ros_id'];
        $oldros = sqlStatement("select * from form_patient_intake_history_ros where id={$linked}");
        $dtros = sqlFetchArray($oldros);
        //$dtros = formFetch("form_patient_intake_history_ros", $linked);
        $newid = formSubmit("form_patient_intake_history_ros", array_slice($dtros, 7), $id, $userauthorized);
        $dt['linked_ros_id'] = $newid;
        $newid = formSubmit("form_patient_intake_history", array_slice($dt, 7), $id, $userauthorized);
        addForm($encounter, "Patient intake history", $newid, "patient_intake_history", $pid, $userauthorized);
        $id = $newid;
        formJump("{$rootdir}/patient_file/encounter/view_form.php?formname={$fdir}&id={$newid}");
        exit;
    }
}
?>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
"http://www.w3.org/TR/html4/loose.dtd">

<html>
<head>
<?php 
html_header_show();
?>

     This program is distributed in the hope that it will be useful,
     but WITHOUT ANY WARRANTY; without even the implied warranty of
     MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
     GNU General Public License for more details.

    You should have received a copy of the GNU General Public License
    along with this program; if not, write to the Free Software
    Foundation, Inc., 59 Temple Place - Suite 330, Boston, MA  02111-1307, USA. -->

<?php 
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
/* 
 * name of the database table associated with this form
 */
$table_name = "form_note";
if ($encounter == "") {
    $encounter = date("Ymd");
}
if ($_GET["mode"] == "new") {
    $newid = formSubmit($table_name, $_POST, $_GET["id"], $userauthorized);
    addForm($encounter, "Work/School Note", $newid, "note", $pid, $userauthorized);
} elseif ($_GET["mode"] == "update") {
    $success = formUpdate($table_name, $_POST, $_GET["id"], $userauthorized);
}
$_SESSION["encounter"] = $encounter;
formHeader("Redirecting....");
formJump();
formFooter();

<?php

//------------Form created by Nikolai Vitsyn by 2004/01/23
include_once "../../globals.php";
include_once "{$srcdir}/api.inc";
include_once "{$srcdir}/forms.inc";
foreach ($_POST as $k => $var) {
    $_POST[$k] = mysql_escape_string($var);
    echo "{$var}\n";
}
if ($encounter == "") {
    $encounter = date("Ymd");
}
if ($_GET["mode"] == "new") {
    $newid = formSubmit("form_bronchitis", $_POST, $_GET["id"], $userauthorized);
    addForm($encounter, "Bronchitis Form", $newid, "bronchitis", $pid, $userauthorized);
}