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  1. <html>
  2.  
  3.  
  4. <head>
  5. <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
  6. <title>HealthCare</title>
  7. <link rel="stylesheet" type="text/css" href="view.css" media="all">
  8. <script type="text/javascript" src="view.js"></script>
  9.  
  10. </head>
  11. <?php
  12.  
  13. $con = mysql_connect("localhost","root","");
  14. if (!$con)
  15. {
  16. die('Could not connect: ' . mysql_error());
  17. }
  18.  
  19. mysql_select_db("hc", $con);
  20.  
  21. echo "pagina2";
  22. echo $_GET["index"];
  23. $id=$_GET["index"];
  24. $result = mysql_query("SELECT * FROM hc where id=$id");
  25.  
  26.  
  27. $tutun_das='unchecked';
  28. $tutun_nus='unchecked';
  29. if($_GET['Tutun']) {$sel_radio_tutun = $_GET['Tutun'];
  30. if ($sel_radio_tutun == 'Da') {$tutun_das='checked';$tutun_nus='unchecked';}
  31. if ($sel_radio_tutun == 'Nu') {$tutun_nus='checked';$tutun_das='unchecked';}
  32. }
  33.  
  34. while($row = mysql_fetch_array($result))
  35. {
  36. ?>
  37.  
  38. <body id="main_body" >
  39.  
  40. <img id="top" src="top.png" alt="">
  41. <div id="form_container">
  42.  
  43. <h1><a>HealthCare</a></h1>
  44. <form id="form_44073" class="appnitro" method="post" action="pag5.php">
  45. <div class="form_description">
  46. <h2>HealthCare</h2>
  47. <p>Health Care Reports and Forms</p>
  48. </div>
  49. <ul >
  50.  
  51. <li id="li_1" >
  52. <label class="description" for="element_1">Nume </label>
  53. <div>
  54. <input id="element_1" name="Nume" class="element text medium" type="text" maxlength="255" text="<?php echo $row['Nume'];?>"/>
  55. </div>
  56. </li> <li id="li_2" >
  57. <label class="description" for="element_2">Prenume </label>
  58. <div>
  59. <input id="element_2" name="Prenume" class="element text medium" type="text" maxlength="255" text="<?php echo $row['Prenume'];?>"/>
  60. </div>
  61. </li> <li id="li_3" >
  62. <label class="description" for="element_3">Varsta </label>
  63. <div>
  64. <input id="element_3" name="Varsta" class="element text small" type="text" maxlength="255" value="<?php echo $row['Varsta'];?>"/>
  65. </div>
  66. </li> <li id="li_4" >
  67. <label class="description" for="element_4">CNP </label>
  68. <div>
  69. <input id="element_4" name="CNP" class="element text medium" type="text" maxlength="255" value="<?php echo $row['CNP'];?>"/>
  70. </div>
  71. </li> <li id="li_5" >
  72. <label class="description" for="element_5">Domiciliu </label>
  73. <div>
  74. <input id="element_5" name="Domiciliu" class="element text medium" type="text" maxlength="255" value="<?php echo $row['Domiciliu'];?>"/>
  75. </div>
  76. </li> <li id="li_6" >
  77. <label class="description" for="element_6">Ocupatie </label>
  78. <div>
  79. <input id="element_6" name="Ocupatie" class="element text medium" type="text" maxlength="255" value="<?php echo $row['Ocupatie'];?>"/>
  80. </div>
  81. </li> <li id="li_7" >
  82. <label class="description" for="element_7">PM </label>
  83. <div>
  84. <input id="element_7" name="PM" class="element text medium" type="text" maxlength="255" value="<?php echo $row['PM'];?>"/>
  85. </div>
  86. </li> <li id="li_8" >
  87. <label class="description" for="element_8">CM </label>
  88. <div>
  89. <input id="element_8" name="CM" class="element text medium" type="text" maxlength="255" value="<?php echo $row['CM'];?>"/>
  90. </div>
  91. </li> <li id="li_21" >
  92. <label class="description" for="element_21">Detalii CM </label>
  93. <div>
  94. <input id="element_21" name="Det_CM" class="element text medium" type="text" maxlength="255" value="<?php echo $row['Det_CM'];?>"/>
  95. </div>
  96. </li> <li id="li_9" >
  97. <label class="description" for="element_9">DVS </label>
  98. <div>
  99. <input id="element_9" name="DVS" class="element text medium" type="text" maxlength="255" value="<?php echo $row['DVS'];?>"/>
  100. </div>
  101. </li> <li id="li_10" >
  102. <label class="description" for="element_10">NPS </label>
  103. <div>
  104. <input id="element_10" name="NPS" class="element text medium" type="text" maxlength="255" value="<?php echo $row['NPS'];?>"/>
  105. </div>
  106. </li> <li id="li_11" >
  107. <label class="description" for="element_11">N </label>
  108. <div>
  109. <input id="element_11" name="N" class="element text medium" type="text" maxlength="255" value="<?php echo $row['N'];?>"/>
  110. </div>
  111. </li> <li id="li_12" >
  112. <label class="description" for="element_12">AB </label>
  113. <div>
  114. <input id="element_12" name="AB" class="element text medium" type="text" maxlength="255" value="<?php echo $row['AB'];?>"/>
  115. </div>
  116. </li> <li id="li_22" >
  117. <label class="description" for="element_22">Metoda de contraceptie </label>
  118. <span>
  119. <input id="element_22_1" name="Met_Contr1" class="element checkbox" type="checkbox" value="1" />
  120. <label class="choice" for="element_22_1">contraceptii oracle</label>
  121. <input id="element_22_2" name="Met_Contr2" class="element checkbox" type="checkbox" value="1" />
  122. <label class="choice" for="element_22_2">prezervativ</label>
  123. <input id="element_22_3" name="Met_Contr3" class="element checkbox" type="checkbox" value="1" />
  124. <label class="choice" for="element_22_3">sterilet</label>
  125.  
  126. </span>
  127. </li> <li id="li_13" >
  128. <label class="description" for="element_13">Antecedente patologice personale </label>
  129. <div>
  130. <input id="element_13" name="Ant1" class="element text medium" type="text" maxlength="255" value="<?php echo $row['Ant1'];?>"/>
  131. </div>
  132. </li> <li id="li_14" >
  133. <label class="description" for="element_14">Antecedente heredo-colaterale </label>
  134. <div>
  135. <input id="element_14" name="Ant2" class="element text medium" type="text" maxlength="255" value="<?php echo $row['Ant2'];?>"/>
  136. </div>
  137. </li> <li id="li_23" >
  138. <label class="description" for="element_23">Tutun </label>
  139. <span>
  140. <input id="element_23_1" name="Tutun" class="element checkbox" type="checkbox" value="1" />
  141. <label class="choice" for="element_23_1" checked='<?php $tutun_das?>'>DA</label>
  142. <input id="element_23_2" name="Tutun" class="element checkbox" type="checkbox" value="1" />
  143. <label class="choice" for="element_23_2" checked='<?php $tutun_nus?>'>NU</label>
  144.  
  145. </span>
  146. </li> <li id="li_15" >
  147. <label class="description" for="element_15">Detalii tutun </label>
  148. <div>
  149. <input id="element_15" name="Det_tutun" class="element text medium" type="text" maxlength="255" value="<?php echo $row['Det_tutun'];?>"/>
  150. </div>
  151. </li> <li id="li_24" >
  152. <label class="description" for="element_24">Cafea </label>
  153. <span>
  154. <input id="element_24_1" name="Cafea" class="element checkbox" type="checkbox" value="1" />
  155. <label class="choice" for="element_24_1">DA</label>
  156. <input id="element_24_2" name="Cafea" class="element checkbox" type="checkbox" value="1" />
  157. <label class="choice" for="element_24_2">NU</label>
  158.  
  159. </span>
  160. </li> <li id="li_16" >
  161. <label class="description" for="element_16">Detalii cafea </label>
  162. <div>
  163. <input id="element_16" name="Det_Cafea" class="element text medium" type="text" maxlength="255" value="<?php echo $row['Det_Cafea'];?>"/>
  164. </div>
  165. </li> <li id="li_25" >
  166. <label class="description" for="element_25">Alcool </label>
  167. <span>
  168. <input id="element_25_1" name="Alcool" class="element checkbox" type="checkbox" value="1" />
  169. <label class="choice" for="element_25_1">DA</label>
  170. <input id="element_25_2" name="Alcool" class="element checkbox" type="checkbox" value="1" />
  171. <label class="choice" for="element_25_2">NU</label>
  172.  
  173. </span>
  174. </li> <li id="li_17" >
  175. <label class="description" for="element_17">Detalii alcool </label>
  176. <div>
  177. <input id="element_17" name="Det_Alcool" class="element text medium" type="text" maxlength="255" value="<?php echo $row['Det_Alcool'];?>"/>
  178. </div>
  179. </li> <li id="li_26" >
  180. <label class="description" for="element_26">Droguri </label>
  181. <span>
  182. <input id="element_26_1" name="Droguri" class="element checkbox" type="checkbox" value="1" />
  183. <label class="choice" for="element_26_1">DA</label>
  184. <input id="element_26_2" name="Droguri" class="element checkbox" type="checkbox" value="1" />
  185. <label class="choice" for="element_26_2">NU</label>
  186.  
  187. </span>
  188. </li> <li id="li_18" >
  189. <label class="description" for="element_18">Detalii droguri </label>
  190. <div>
  191. <input id="element_18" name="Det_Droguri" class="element text medium" type="text" maxlength="255" value="<?php echo $row['Det_Droguri'];?>"/>
  192. </div>
  193. </li> <li id="li_19" >
  194. <label class="description" for="element_19">Medicatie </label>
  195. <div>
  196. <textarea id="element_19" name="Medicatie" class="element textarea medium" value="<?php echo $row['Medicatie'];?>"><?php echo $row['Medicatie'];?></textarea>
  197. </div>
  198. </li> <li id="li_20" >
  199. <label class="description" for="element_20">Istoric </label>
  200. <div>
  201. <textarea id="element_20" name="Istoric" class="element textarea medium" value="<?php echo $row['Istoric'];?>"><?php echo $row['Istoric'];?></textarea>
  202. </div>
  203. </li>
  204.  
  205. <li class="buttons">
  206. <input type="hidden" name="id" value="<?php echo $row['ID'];?>" />
  207.  
  208. <input id="saveForm" class="button_text" type="submit" name="submit" value="SAVE" />
  209. </li>
  210. </ul>
  211. </form>
  212.  
  213.  
  214. <?php
  215. }
  216. ?>
  217.  
  218.  
  219. </body></html>
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