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ecg.php
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ecg.php
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<?php
include 'includes/header.php';
// show errors
ini_set('display_errors', 1);
ini_set('display_startup_errors', 1);
error_reporting(E_ALL);
?>
<!-- partial -->
<div class="main-panel">
<div class="content-wrapper">
<div class="page-header">
<h3 class="page-title">
<span class="page-title-icon bg-gradient-danger text-white me-2">
<i class="mdi mdi-home"></i>
</span>
Manage Patients
</h3>
<nav aria-label="breadcrumb">
<ul class="breadcrumb">
<li class="breadcrumb-item active" aria-current="page">
<span></span>Overview
<i class="mdi mdi-alert-circle-outline icon-sm text-primary align-middle"></i>
</li>
</ul>
</nav>
</div>
<!-- blood requests table -->
<div class="row">
<div class="col-md-6 grid-margin stretch-card">
<div class="card">
<div class="card-body">
<h4 class="card-title">Blood Investigations</h4>
<p class="card-description"> Enter Details
</p>
<h4 style="color:red"> <?php if(isset($insert_id)){
echo 'Patient Added Successfully with ID: '.$insert_id.'';
} ?></h4>
<form class="forms-sample" method="POST">
<input type="hidden" name="pid" value="<?php if($pid!=''){
echo $pid;
}else{
echo '0';
} ?>">
<div class="form-group">
<label for="exampleInputUsername1">Name</label>
<input type="text" class="form-control" id="exampleInputUsername1" placeholder="Name"
name="name">
</div>
<div class="form-group">
<label for="exampleInputUsername1">Age</label>
<input type="number" class="form-control" id="exampleInputUsername1" placeholder="Age"
name="age">
</div>
<div class="form-group">
<label for="exampleFormControlSelect3">Gender</label>
<select class="form-control form-control-sm" id="exampleFormControlSelect3"
name="gender">
<option value="1">Male</option>
<option value="2">Female</option>
</select>
</div>
<div class="form-group">
<label for="exampleInputUsername1">Mobile</label>
<input type="number" class="form-control" id="exampleInputUsername1" value="<?php if($mobile!=''){
echo $mobile;
} ?>" placeholder="Mobile" name="mobile">
</div>
<div class="form-group">
<label for="exampleInputEmail1">Email address</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Email"
name="email">
</div>
<div class="form-group">
<label for="exampleInputEmail1">Red address</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Email"
name="email">
</div>
<div class="form-group">
<label for="exampleFormControlSelect3">Blood Group</label>
<select class="form-control form-control-sm" id="exampleFormControlSelect3"
name="blood_group">
<option value="1">A+</option>
<option value="2">A-</option>
<option value="3">B+</option>
<option value="4">B-</option>
<option value="5">O+</option>
<option value="6">O-</option>
<option value="7">AB+</option>
<option value="8">AB-</option>
<option value="9">Other</option>
</select>
</div>
<button type="submit" class="btn btn-gradient-primary me-2">Submit</button>
<button class="btn btn-light">Cancel</button>
</form>
</div>
</div>
</div>
</div>
</div>
<!-- content-wrapper ends -->
<?php
include 'includes/footer.php';