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| Şuanki Dosya : /home/wwwdreamtechnolo/public_html/kitchenfoodrecipes.com/disha/disha-foundation-old/a.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: 30px;
background-color: white;
width: 900px;
border: 3px solid black ;
padding: 50px;
margin-left: 0px;
text-align: justify;
}
.container{
border-radius: 0px;
background-color: white;
width: 750px;
border: 2px solid black ;
padding: 30px;
margin: 20px;
line-height: 20px;
}
.container
hr {
border: none;
border-top: 1px dotted black;
color: #fff;
background-color: #fff;
height: 1px;
width: 50%;
}
.container_2{
display:flex;
}
.container_3{
display:flex;
}
input {
border: none;
border-bottom: 1px solid #000;
}
input:focus {
border-bottom: 1px solid #000;
}
table, td{
border: 1px solid black;
border-collapse: collapse;
}
h4{
font-weight: normal;
margin: 10px;
}
</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 href="https://fonts.googleapis.com/css2?family=Tiro+Devanagari+Marathi:ital@0;1&display=swap" rel="stylesheet">
<title>Home</title>
<link rel="stylesheet" href="D:\style.css">
</head>
<body>
<div style="width:1050px; margin:auto; padding: 15px;">
<div style="text-align: center;">
<div style="float:right; font-size:14px; position: relative; width: 250px; text-align: center;">
रजि. नं. महा / ५९३/२०२० ता. २२/१२/२०२० <br /> नोंदणी क्र. एफ. ३०८३४ (सोलापूर)
</div>
<center>
<div style="position: relative; width: 500px;">
<h1 style="margin: 0px; margin-top: 20px; font-weight: 1000;">दिशा फाऊंडेशन</h1>
<h4 style="margin: 0px;"><b>व्यसनमुक्ती व पुनर्वसन केंद्र</b></h4>
</div>
</center>
--------------------------------------------------------------------------------------------------------------<br />
दारु व आम्लीय पदार्थ * शारीरीक व मानसिक उत्कृष्ठ अध्यात्मिक मार्गदर्शन<br />
--------------------------------------------------------------------------------------------------------------<br />
<div style="font-weight:bold; line-height: 25px;">
सोलापूर - पुणे हायवे रोड, मु. पो. केगांव, ता. उ. सोलापूर <br />
<span style="font-size:18px;">मो. 8999973160, 9359781303, 92847974037 * सेंटर -7620848123</span>
</div>
<!-- <hr style="border: none; height: 2px; background-color: black;margin-top: 0px"> -->
</div>
<hr>
<?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[55];
?>
<!-- <hr style="border: none; height: 2px; background-color: black;margin-top: 0px"> -->
<center>
<h2 style="text-align:center;">प्रतिज्ञापत्र</h2>
<div class="main_container">
<p> मी<input type="text" readonly value="<?php echo $pratidnya_name;; ?>" class="bottom-textbox" style="margin-left:10px; width:700px;"> असे लिहून देतो / देते की,</p>
<p> माझे पेशंट श्री.<input readonly type="text" value="<?php echo $name_patient ?>" class="bottom-textbox" style="margin-left:20px; width:770px;"></p>
<p> पत्ता<input type="text" readonly value="<?php echo $pratidnya_address ?>" class="bottom-textbox" style="margin-left:20px; width:650px;"> यांनी उपचाराचे कालावधीत </p>
<p style="line-height: 30px;">
काहीही उपद्रव केल्यास अथवा आत्महत्या करण्याचा प्रयत्न केल्यास त्याच्या कृतीची संपूर्ण जबाबदारी माझेवर राहील. तसेच प्रकृती बिघाडामुळे त्यास रुग्णालयात भरती
(अॅडमिट) करावे लागल्यास अथवा त्यापुर्वीच त्यांचा आकस्मित मृत्यु झाल्यास त्याची पुर्ण जबाबदारी माझेवर राहील व त्यासाठी येणाऱ्या खर्चाची जबाबदारी माझेवर राहील व
मी संस्थेस कोणत्याही प्रकारे जबाबदार धरणार नाही. त्याचप्रमाणे संस्थेने नमुद केलेल्या फी चे व इतर खर्चाचे पैसे वेळेत न भरल्यास, कायदेशीर कारवाईस पात्र ठरेन व सदर कारवाई मला मान्य आहे.
</p>
<div class="container">
<p>संस्थेने नमुद केलेली फी व खर्च (खालीलप्रमाणे)</p>
<p>प्रत्येक महिन्याची फी <input readonly type="text" value="रु. <?php echo $name_family_member; ?>" class="bottom-textbox" style="margin-left:150px; width:400px;"> </p>
<p>+ पेशंटच्या चेकअपचा खर्च रु. <input readonly type="text" value="रु. <?php echo $pratidnya_name; ?>" class="bottom-textbox" style="margin-left:92px; width:400px;"> </p>
<p>+ औषधांचा व इतर होणारा खर्च <span style="margin-left: 85px;"> रु. (जो काही होईल तो) </span> </p>
</div>
<h4> पेशंटचा आधार क्र. : <?php echo $aadhar_no ?></h4>
<!-- <table>
<tbody>
<tr>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
<td width="40" height="40"></td>
</tr>
</tbody>
</table> -->
<br>
<div class="container_2">
<h4> नातेवाईकाचे नाव :<input readonly type="text" value="<?php echo $pratidnya_name ?>" class="bottom-textbox" style="margin-left:20px; width:500px;"></h4>
<h4> सही :</h4>
</div>
<div class="container_3">
<h4> पेशंटची नाते :<input readonly type="text" value="<?php echo $relation ?>" class="bottom-textbox" style="margin-left:20px; width:540px;"></h4>
<h4> दिनांक : <?php echo date("d/m/y") ?></h4>
</div>
<h4>मो. नंबर : <input readonly type="text" value="<?php echo $mobile_family ?>" class="bottom-textbox" style="margin-left:20px; width:570px;"></h4>
</div>
<?php
}
}
?>
</body>
</html>
<br>
<br>
<br>
<br>
<br>
<br>
<br>
<br>
<br>
<br>
<br>
<br><br>
<br>
<br>
<br>
<br>
<br><br>
<br>
<br>
<br>
<br>
<br>
<style>
input {
border: none;
font-weight:600;
font-size:15px;
border-bottom: 1px solid #000;
/* font-size: 18px; */
}
input:focus {
border-bottom: 1px solid #000;
}
ol li{
font-size: 20px;
line-height: 30px;
text-align: justify;
}
</style>
<?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];
?>
<div style="width:1050px; margin:auto; padding: 15px;">
<div style="text-align: center;">
<div style="float:right; font-size:14px; position: relative; width: 250px; text-align: center;">
रजि. नं. महा / ५९३/२०२० ता. २२/१२/२०२० <br /> नोंदणी क्र. एफ. ३०८३४ (सोलापूर)
</div>
<center>
<div style="position: relative; width: 500px;">
<h1 style="margin: 0px; margin-top: 20px; font-weight: 1000;">दिशा फाऊंडेशन</h1>
<h4 style="margin: 0px;">व्यसनमुक्ती व पुनर्वसन केंद्र</h4>
</div>
</center>
--------------------------------------------------------------------------------------------------------------<br />
दारु व आम्लीय पदार्थ * शारीरीक व मानसिक उत्कृष्ठ अध्यात्मिक मार्गदर्शन <br />
--------------------------------------------------------------------------------------------------------------<br />
<div style="font-weight:bold; line-height: 25px;">
सोलापूर- पुणे हायवे रोड, मु. पो. केगांव, ता. उ. सोलापूर <br />
<span style="font-size:18px;">8999973160, 9359781303, 92847974037 * सेंटर - 7620848123</span>
</div>
</div>
<hr style="border: none; height: 2px; background-color: black;margin-top: 0px">
<div class="form" >
<b><h1 style="text-align:center;" >Undertaking From</h1></b>
</div>
<div style=" font-size: 20px; line-height:30px">
I <input type="text" value="<?php echo $name_family_member; ?>" class="bottom-textbox" style=" width:300px;"> Aged <input type="text" value="<?php echo $age; ?>" class="bottom-textbox" style=" width:50px;">
presently residing at <input type="text" value="<?php echo $address; ?>" class="bottom-textbox" style=" width:380px;"> And Patient Name <input type="text" value="<?php echo $name_patient ?>" class="bottom-textbox" style=" width:400px;">
both do here by solemnly declare and state as under
</div >
<div style="margin-right: 20px">
<ol>
<li>I have voluntarly and my own accord admitting myself to the de-addition facility run by.</li>
<li>
We declare and confirm that we have taken upon ourselves the entire responsibility, liability risk and
Consequences as may arise during or after the said de addication /rehabilitation center and the trustees/
members, as also the doctors, employees staff, servants representatives liable and or responsible in any
manner whalsever.
</li>
<li>I/we are aware that the period of 31 days of treatment is not liable to be increased or decreased under any
circumstances.</li>
<li>We would be paying the admission fees in advance and we aware that the some is not refundable any
circumnstances.
</li>
<li>We will meet the patient only on meeting day.</li>
<li>We will give full co-operation to the institution during the treatment period and follow their instructions.</li>
<li>The admission and the discharge rights are reserved with management and we will not interfere in them.</li>
<li>The promise to attend/visit the institution during patient admission/ discharge, all the parents meetings
instructed by the concerned councilor.
</li>
<li> I/we shall revel information about the disease history /medical history of the patient and any major
illness before or at the time of admission.
</li>
<li>In the event of the patient suffering form any contagious disease, or any other medical emergency the
institution hold full right to conduct required tests, transfer him to any other hospital. give him any
immediate treatment including surgery and if felt necessary, by the institution send the patient back home.
The institution is also permitted to test the patient for HIV. The institution and its office bearers shall not
be responsible for the ensuring risk and consequences. We undertake to be totly responsible for the same
and liable to pay any extra charges after the treatment including hospitalization and
medico surgical procedures.
</li>
<li>In the given circumstances if the institution feels that the presence of the patient in the institution is
undesirable
</li>
<li>I/we shall reveal whole information about the criminal background /record / cases pending & disposed
off introspect of the patient at the time of admission.
</li>
<li> In the eventuality of uncertain death during the 3 1 days treatment period in the institution, I/We hereby
grant our consent to the institution to take the dead body of patient for the post mortem.
</li>
<li>The institution has full authority to take an appropriate action in the case of my /our use/ exchange /
custody of to tabacco based products or any intoxication substances considered as harmful / detrimental
as per the rules of the institution.
</li>
<li> We will maintain regular follow up after the patinets discharge, as per the instruction from the counselor</li>
<li>We assure you the the person signing the admission form while admitting the patient will be present at
the time of the discharge of the patient without fail.
</li>
<li>All the above points are explained to me Marathi / Hindi.</li>
</ol>
</div>
<div class="text_1" style="display:flex; gap:600px;">
<div class="first_line">
<h4> Signature of the Patient </h4>
</div><div><h4>
<input type="date" id="date_taken" onchange="setTodayDate()"><br>
<label for="relative_signature">Signature of the Relative</label><br>
</h4>
</div>
<script>
document.addEventListener("DOMContentLoaded", function() {
var today = new Date();
var dd = String(today.getDate()).padStart(2, '0');
var mm = String(today.getMonth() + 1).padStart(2, '0'); // January is 0!
var yyyy = today.getFullYear();
today = yyyy + '-' + mm + '-' + dd;
document.getElementById("date_taken").value = today;
});
</script>
</div>
</div>
<?php
}
} else {
// Display a message if no data is found
?>
<?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
65.254.81.4