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upload.html
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upload.html
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<!doctype html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Upload Data | Healthcare Record</title>
<link rel="icon" type="image/x-icon" href="/images/icon.png">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.6.3/jquery.min.js"></script>
<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0-alpha3/dist/css/bootstrap.min.css" rel="stylesheet"
integrity="sha384-KK94CHFLLe+nY2dmCWGMq91rCGa5gtU4mk92HdvYe+M/SXH301p5ILy+dN9+nJOZ" crossorigin="anonymous">
<link href="/css/style.css" rel="stylesheet">
</head>
<body class="content">
<!-- navbar start here -->
<nav class="navbar navbar-expand-lg ">
<div class="container-fluid">
<a class="navbar-brand" href="/homepage">
<div class="d-flex align-items-center">
<img src="/images/icon.png" alt="Logo" width="35" height="35" class="d-inline-block align-text-top">
<h3 class="ms-2 mb-0"><b style="font-family:'Franklin Gothic Medium', 'Arial Narrow', Arial, sans-serif">
HEALTHCARE RECORD</b></h3>
</div>
</a>
<button class="navbar-toggler" type="button" data-bs-toggle="collapse" data-bs-target="#navbarNav"
aria-controls="navbarNav" aria-expanded="false" aria-label="Toggle navigation">
<span class="navbar-toggler-icon"></span>
</button>
<div class="collapse navbar-collapse justify-content-end" id="navbarNav">
<ul class="navbar-nav ">
<li class="nav-item">
<a class="nav-link active" aria-current="page" href="/homepage">Home</a>
</li>
<li class="nav-item">
<a class="nav-link active link" data-bs-toggle="modal" data-bs-target=".aboutusModal">About us</a>
</li>
<li class="nav-item">
<div class="dropdown">
<a class="btn dropdown-toggle" href="#" role="button" data-bs-toggle="dropdown"
aria-expanded="false">Contact
</a>
<ul class="dropdown-menu">
<li>
<a class="dropdown-item"
href="https://mail.google.com/mail/?view=cm&fs=1&to=healthcare.record.management@gmail.com">Mail</a>
</li>
</ul>
<li class="nav-item">
<a data-bs-toggle="modal" data-bs-target=".myModal" class="user link">
<img src="/images/profile.png" class="profile-img" width="45" height="45">
<span class="profile-text">Profile</span>
</a>
</li>
</div>
</div>
</nav>
<!-- navbar end here -->
<!-- login modal starts here -->
<div class="modal fade myModal" >
<div class="modal-dialog">
<div class="modal-content">
<div class="modal-header center">
<h1 class="modal-title fs-5 " style="color: green;"><b>Logged-In</b></h1>
</div>
<div class="modal-body">
<div class="center showUser" >
<h5><b>User :</b> jamesbond@gmail.com</h5>
</div>
<br>
<div class="center">
<button class="btn btn-danger logout" >Logout</button>
</div>
</div>
</div>
</div>
</div>
<!-- login Modal ends here -->
<!-- About us Modal start here -->
<div class="modal fade aboutusModal" >
<div class="modal-dialog">
<div class="modal-content ">
<div class="modal-header center" >
<h1 class="modal-title fs-5 " ><b style="color: blue;">About us:</b></h1>
</div>
<div class="modal-body center mb-4">
Welcome to <b>Healthcare Record</b>, a dedicated team
of professionals committed to <b>revolutionizing</b>
the way patient data is <b>stored</b>, <b>managed</b>, and <b>accessed</b>.
Our mission is to provide a <b>secure</b>, and
<b>privacy-focused</b> platform for <b>hospitals</b> to securely store
and <b>analyze</b> patient data while prioritizing patient <b>confidentiality</b>.
<br>
Join us on this journey as we redefine the way patient data is stored,
managed, and accessed. Experience the power of secure
and <b>distributed patient data storage</b> with <b>Healthcare Record</b>.
</div>
</div>
</div>
</div>
<!-- About us Modal end here -->
<!-- card start here -->
<div class="card container card-container">
<div class="center my-4">
<h3><b>Fill the details below</b></h3>
</div>
<form class="row g-3 my-3">
<div class="col-md-5">
<label class="form-label"><b>Uploading date :</b></label>
<input type="date" class="form-control" id="_date" value="" required>
</div>
<div class="col-md-5">
<label class="form-label"><b>Email :</b></label>
<input type="email" class="form-control" id="_email" value="" required>
</div>
<div class="col-md-5">
<label class="form-label"><b>Name :</b></label>
<input type="text" class="form-control" id="_name" value="" required>
</div>
<div class="col-md-1">
<label class="form-label"><b>Age :</b></label>
<input type="number" class="form-control" id="_age" value="" required>
</div>
<div class="col-md-2">
<label class="form-label"><b>Gender :</b></label>
<select class='form-control cards' id="_gender" >
<option value='' required> ----select---- </option>
<option value='Male' required> Male </option>
<option value='Female' required> Female </option>
<option value='Other' required> Others </option>
</select>
</div>
<div class="col-md-2">
<label class="form-label"><b>Blood Group :</b></label>
<select class='form-control cards' id="_blood_group">
<option value='' required> ----select---- </option>
<option value='A+' required> A+ </option>
<option value='A-' required> A- </option>
<option value='B+' required> B+ </option>
<option value='B-' required> B- </option>
<option value='AB+' required> AB+ </option>
<option value='AB-' required> AB- </option>
<option value='O+' required> O+ </option>
<option value='O-' required> O- </option>
<option value='rh-null' required> rh-null </option>
<option value='other' required> Other </option>
</select>
</div>
<div class="col-md-5">
<label class="form-label"><b>Height (in cm) :</b></label>
<input type="number" step="0.1" class="form-control" id="_height" value="" required>
</div>
<div class="col-md-5">
<label class="form-label"><b>Weight (in kg) :</b></label>
<input type="number" step="0.1" class="form-control" id="_weight" value="" required>
</div>
<div class="col-md-3">
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="_smoke" >
<label class="form-check-label" for="smoke"><b>Smoking</b></label>
</div>
</div>
<div class="col-md-3">
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="_drink" >
<label class="form-check-label" for="drink"><b>Drinking</b></label>
</div>
</div>
<div class="col-md-3">
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="_tobacco">
<label class="form-check-label" for="tobacco"><b>Tobacco</b></label>
</div>
</div>
<div class="col-md-5">
<label class="form-label"><b>Disease 1 :</b></label>
<input type="text" class="form-control" id="_disease1" value="">
</div>
<div class="col-md-5">
<label class="form-label"><b>Disease 2 :</b></label>
<input type="text" class="form-control" id="_disease2" value="">
</div>
<div class="col-md-5">
<label class="form-label"><b>Disease 3 :</b></label>
<input type="text" class="form-control" id="_disease3" value="">
</div>
<div class="col-md-5">
<label class="form-label"><b>Disease 4 :</b></label>
<input type="text" class="form-control" id="_disease4" value="">
</div>
<div class="col-md-5">
<label class="form-label"><b>Disease 5 :</b></label>
<input type="text" class="form-control" id="_disease5" value="">
</div>
<div class="col-md-5">
<label class="form-label"><b>Disease 6 :</b></label>
<input type="text" class="form-control" id="_disease6" value="">
</div>
<div class="col-md-5">
<label class="form-label"><b>Covid Vaccination Status :</b></label>
<select class='form-control cards' id="_covid" >
<option value='' required> ----select---- </option>
<option value='First Dose' required> First Dose </option>
<option value='Second Dose' required> Second Dose </option>
<option value='Booster Dose' required> Booster Dose </option>
<option value='None' required> No Dosage </option>
</select>
</div>
<div class="col-md-5 description">
<label class="form-label my-2"><b>Any other problems or symptoms :</b></label>
<textarea class="form-control" id="_other" rows="4"></textarea>
</div>
<div class="center mb-3"><button id="submit" class="col-md-2 btn btn-primary" >Submit</button></div>
</form>
</div>
<!-- card end here -->
<!-- modal activate start -->
<button id="activateModal" disabled data-bs-toggle="modal" data-bs-target="#cnfModal">.</button>
<!-- modal activate end -->
<!-- Doc_ID modal start here -->
<div class="modal fade" id="cnfModal" >
<div class="modal-dialog">
<div class="modal-content ">
<div class="modal-header center" >
<h1 class="modal-title fs-5 " id="cnfHead">Message :</h1>
</div>
<div class="modal-body spinner">
<div class="mb-3 row center">
<h1><b id="cnf">Unknown Error !</b></h1>
</div>
<div class="mb-3 row alert">
<small>Keep this '<b>Doc_ID</b>' for further use.</small>
</div>
</div>
<div class="modal-footer">
<button type="button" class="btn btn-secondary" id="cancel" data-bs-dismiss="modal">Close</button>
</div>
</div>
</div>
</div>
<!-- Doc_ID modal end here -->
<!-- footer start here -->
<footer class="footer sticky-bottom" style="margin-top: 6%;">
<div class="container center">
<span class="text-muted ">copyright ©2023</span>
<span class="text-muted">Created and Designed by room no. 241, P. D. Tandon Hostel</span>
</div>
</footer>
<!-- footer end here -->
<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0-alpha3/dist/js/bootstrap.bundle.min.js"
integrity="sha384-ENjdO4Dr2bkBIFxQpeoTz1HIcje39Wm4jDKdf19U8gI4ddQ3GYNS7NTKfAdVQSZe"
crossorigin="anonymous"></script>
<script src="/js/main.js"></script>
</body>
</html>