| Şuanki Dizin: /home/wwwdreamtechnolo/public_html/kitchenfoodrecipes.com/disha/disha-foundation/ |
| Şuanki Dosya : /home/wwwdreamtechnolo/public_html/kitchenfoodrecipes.com/disha/disha-foundation/discharge_form.php |
<?php
require_once("lib/function.php");
$db = new login_function();
if(isset($_GET['update_id'])) {
$up_id = $_GET['update_id'];
$_SESSION['current_update_id'] = $up_id;
} elseif(isset($_SESSION['current_update_id'])) {
$up_id = $_SESSION['current_update_id'];
}
?>
<!DOCTYPE html>
<html lang="en">
<head>
<style>
.main_container
{
border-radius: 0px;
background-color: white;
width: 900px;
border: 3px solid black ;
padding: 50px;
}
.main_container1
{
width: 300px;
height: 40px;
margin-top: -45px;
border-radius: 0px;
background-color: white;
border: 2px solid black ;
margin-left: 300px;
}
input
{
font-weight: 600;
font-size: 18px;
border: none;
border-bottom: 1px solid #000;
background-color:rgba(255,255,255,0.1);
}
input:focus {
border-bottom: 1px solid #000;
}
table{
width: 100%;
}
table, th, td {
border: 1px solid black;
border-collapse: collapse;
padding: 5px;
}
@media print {
.backimg {
background-image: url('logo/logoo-back.png');
background-size: 100% 150%;
background-repeat: no-repeat;
-webkit-print-color-adjust: exact;
print-color-adjust: exact;
}
}
</style>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<link rel="preconnect" href="https://fonts.googleapis.com">
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
<link rel="stylesheet" href="D:\style.css">
<link rel="preconnect" href="https://fonts.googleapis.com">
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
<link href="https://fonts.googleapis.com/css2?family=Yatra+One&display=swap" rel="stylesheet">
<link href="https://fonts.googleapis.com/css2?family=Tiro+Devanagari+Marathi:ital@0;1&display=swap" rel="stylesheet">
<link rel="preconnect" href="https://fonts.googleapis.com">
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
<link href="https://fonts.googleapis.com/css2?family=Yatra+One&display=swap" rel="stylesheet">
<title>Home</title>
<link rel="stylesheet" href="D:\style.css">
</head>
<div style="width:1000px; margin:auto; padding: 15px; ">
<div style="text-align: center;">
<div style="float:right; font-size:14px; position: relative; width: 250px; text-align: center; margin-top: 30px; ">
रजि. नं. महा / ५९३/२०२० ता.२२/१२/२०२० <br /> नोंदणी क्र. एफ. ३०८३४ (सोलापूर)
</div>
<center>
<div style="position: relative; width: 500px;">
<div class="" style="position: relative; right:80%; top:50px; ">
<img src="logo\disha.jpg" alt="" height="180px" width="170px" style="border-radius: 150px;" >
</div>
<h1 style="margin: 0px; margin-top: -170px; font-weight: 1100;font-family: Yatra One, system-ui; font-size: 60px;">दिशा फाऊंडेशन</h1>
<h2 style="margin: 0px;"><b>व्यसनमुक्ती व पुनर्वसन केंद्र</b></h2>
</div>
</center>
--------------------------------------------------------------------------------------------------------------<br />
<div style="font-size: 18px; font-weight: 600;"> दारु व आम्लीय पदार्थ * शारीरीक व मानसिक उत्कृष्ठ अध्यात्मिक मार्गदर्शन<br /></div>
--------------------------------------------------------------------------------------------------------------<br />
<div style="font-weight:bold; line-height: 26px;">
सोलापूर - पुणे हायवे रोड, मु. पो. केगांव, ता. उ. सोलापूर <br />
<span style="font-size:18px;">मो. 8999973160, 9359781303, 9284797403 * सेंटर - 7620848123</span>
</div>
</div>
<?php
$report_details = $db->get_all_admission_report_for_print($up_id);
if(!empty($report_details))
{
foreach($report_details as $record)
{
$id = $record[0];
$date_of_admission = $record[1];
$center = $record[2];
$name_patient = $record[3];
$gender = $record[4];
$address = $record[5];
$is_rural = $record[6];
$city = $record[7];
$state = $record[8];
$pin = $record[9];
$phone = $record[10];
$mobile = $record[11];
$email = $record[12];
$date_of_birth = $record[13];
$age = $record[14];
$religion = $record[15];
$education_qualification = $record[16];
$occupation = $record[17];
$income_per_month = $record[18];
$family = $record[19];
$marital_status = $record[20];
$living_arrangements = $record[21];
$name_family_member = $record[22];
$address_family_mem = $record[23];
$phone_family = $record[24];
$mobile_family = $record[25];
$email_family = $record[26];
$referred_by = $record[27];
$reason_of_addiction = $record[28];
$type_addiction = $record[29];
$jaundice = $record[30];
$malena = $record[31];
$hemelemesis = $record[32];
$convulsion = $record[33];
$ascitis = $record[34];
$chronic_pedal_oedems = $record[35];
$psychiatric_problem = $record[36];
$heart_attack = $record[37];
$shock = $record[38];
$tia = $record[39];
$kochs = $record[40];
$ht = $record[41];
$dm = $record[42];
$aadhar_no = $record[43];
$pratidnya_name = $record[44];
$pratidnya_address = $record[45];
$pratidnya_mobile = $record[46];
$pratidnya_age = $record[47];
$date = $record[48];
$time = $record[49];
$status = $record[50];
$totalamount = $record[51];
$doctor_name = $record[52];
$discharge_date = $record[53];
$samupdaykl_name = $record[54];
$relation = $record[57];
$pratidnya_p_name = $record[58];
$last_two_digits = date("y", strtotime($date_of_admission));
$formatted_aadhar_no = preg_replace('/(\d{4})(?=\d)/', '$1 ', $aadhar_no);
?>
<b>
<div class="main_container">
<div class="main_container1">
<center>
<h4 style="margin-top: 10px;">डिस्चार्ज फॉर्म / DISCHARGE FORM</h4>
</center>
</div> <div class="backimg" style="background-image: url('logo/logoo-back - Copy.png');background-repeat: no-repeat; background-size: 100% 100%;">
<div style="">पेशंटचे नांव :<input type="text" class="bottom-textbox" value="<?php echo $pratidnya_p_name ?>" style="margin-left:20px; width:640px;">केंद्र :
केगांव, सोलापूर.
<br><br> आधार नंबर:<input type="text" class="bottom-textbox" value="<?php echo $formatted_aadhar_no; ?>" style="margin-left:20px; width:350px;"> रजिस्ट्रेशन नंबर :<input type="text" class="bottom-textbox" value="DFC/<?php echo $last_two_digits; ?>/<?php echo $id; ?>" style="margin-left:20px; width:300px;">
<br><br> ॲडमिशन तारीख:<input type="text" value="<?php echo $date_of_admission = date("d-m-Y",strtotime($date_of_admission)); ?>" class="bottom-textbox" style="margin-left:20px; width:310px;">डिस्चार्ज तारीख:<input type="text" value="<?php if ($discharge_date == '') {
echo ' ';
} else {
echo $discharge_date = date("d-m-Y",strtotime($discharge_date));
}?>" class="bottom-textbox" style="margin-left:20px; width:300px;"><br><br>
ठरवलेल्या उपचार कालावधीपूर्वी / प्रमाणे आम्ही श्री. <input type="text" class="bottom-textbox" value="<?php echo $pratidnya_p_name; ?>" style="margin-left:20px; width:500px;" > यांना <br><br> <span style="line-height: 40px">आज दिनांक :
<input type="text" class="bottom-textbox" value="<?php if ($discharge_date == '') {
echo ' ';
} else {
echo $discharge_date = date("d-m-Y",strtotime($discharge_date));
} ?>" style="margin-left:20px; width:320px;">आमच्या जबाबदारीवर घेऊन जात आहोत. आमची कोणतीही वस्तू व सामान <span style="font-weight: 600; font-size: 20px;">दिशा फाऊंडेशन</span> मध्ये राहिलेलं नाही.</span>
<br>
<br>
<div class="" style="display:flex ;line-height: 20px;gap:300px;border-bottom: 1px solid black;">
<h4 style="margin-left: 200px;">पेशंटची सही</h4> <h4>नातेवाईकांची सही</h4>
</div>
<span style="line-height: 30px; margin-left:150px">मी <input type="text" value="<?php echo $samupdaykl_name; ?>" class="bottom-textbox" style="margin-left:20px; width:500px;"> (समुपदेशक) यांना डिस्चार्ज देण्यास माझी संमती आहे
आणि प्रमाणित करतो की, मी त्यांचे डिस्चार्जच्या वेळी वर्कबुक तपासले आहे आणि अल्कोहोलिक / नार्कोटिकच्या मिंटीग व
पत्याबाबत सविस्तर माहिती दिली आहे. </span><br><br>
<div class="" style="display:flex ;gap:100px;border-bottom: 1px solid black;"> <h4 style="margin-left: 200px;">पेशंटची सही</h4> <h4>समुपदेशकांची सही</h4> <h4>फोन नंबर : <input style="width:150px" value="+91 92847 97403"> </i</h4>
</div> <span style="line-height: 50px;"> मी, डॉ <input type="text" value="<?php echo $doctor_name; ?>" class="bottom-textbox" style="margin-left:20px; width:300px;">प्रमाणित करतो की श्री.<input type="text" value="<?php echo $pratidnya_p_name ?>" class="bottom-textbox" style="margin-left:20px; width:340px;">
यांना डिस्चार्ज देण्यास माझी संमती आहे व डिस्चार्ज नंतर घेण्याची औषधे मी त्यांना सुचवले आहे.</span><br> <br> <br>
<div class="" style="position: absolute; margin-left:750px"><b>डॉक्टरांची सही</b></div>
<br><br>
<hr>
<div class="" style="position: absolute;left:45%;"> <b>अकाऊंट विभाग करीता </b></div>
<br>
<table style="border: none!important;">
<tr >
<td style="border: none!important;">
<table>
<thead class="thead-default thead-lg">
<tr>
<style>
th{
text-align: left;
}
.inputtbl{
width:100%;
border-bottom:none;
}
</style>
</tr>
<tr>
<th width="100">Balance Fees:</th>
<td width="100"><input style="text-decoration:none" class="inputtbl"></input></td>
</tr>
<tr>
<th>Medicine & Medical Examination Amount :</th>
<td><input class="inputtbl"></input></td>
</tr>
<tr>
<th>Toiletries:</th>
<td><input class="inputtbl"></input></td>
</tr>
<tr>
<th>Other Facility Fees:</th>
<td><input class="inputtbl"></input></td>
</tr>
<tr>
<th>Total Amount:</th>
<td > <input class="inputtbl"></input></td>
</tr>
</thead>
</table>
<br>
श्री. <input type="text" class="bottom-textbox" value="<?php echo $pratidnya_p_name; ?>" style=" width:450px;">त्यानी उर्वरित रक्कम रु. <input type="text" class="bottom-textbox" style=" width:150px;">
दिलेली आहे.
<br>
<br>
<br>
हिशेबनीसाची सही व नाव :
<br>
<br></b>
<div class="" style="display:flex ;gap:450px;">
<h4> डिस्चार्ज देण्यास माझी संमती आहे / नाही </h4><h4> डायरेक्टर / सेंटर मॅनेजर</h4>
</div>
<?php
}
}
?>
Linux 65-254-81-4.cprapid.com 5.14.0-284.11.1.el9_2.x86_64 #1 SMP PREEMPT_DYNAMIC Tue May 9 05:49:00 EDT 2023 x86_64
Apache
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