Location: PHPKode > projects > Clinical Handover Database > output/templates/Nursing_Handover_add.htm
<html>
<head><title>Nursing Handover</title>
<link REL="stylesheet" href="include/style.css" type="text/css">
{$includes}
</head>

<body bgcolor=white {$bodyonload}>
<form name="editform" encType="multipart/form-data" method="post" action="Nursing_Handover_add.php" {$onsubmit}>

{include_if_exists file="include/header.php"}

<h1>Nursing Handover, Add new record</h1>

{doevent name="AddOnLoad"}
{$message}


<div align=left><hr width=300 noshade size=1></div>

&nbsp;&nbsp;&nbsp;<a href="Nursing_Handover_list.php?a=return">Back to list</a><br><br>
<table cellpadding=2>


  <tr><td class=shade  width=150>Ward</td><td width=250>
    {build_edit_control field="Ward" mode="add" value=$value_Ward}
      &nbsp;<img src="images/icon_required.gif">
  </td></tr>
  <tr><td class=shade  width=150>Bed</td><td width=250>
    {build_edit_control field="Bed" mode="add" value=$value_Bed}
      &nbsp;<img src="images/icon_required.gif">
  </td></tr>
  <tr><td class=shade  width=150>Patient Name</td><td width=250>
    {build_edit_control field="Patient Name" mode="add" value=$value_Patient_Name}
      &nbsp;<img src="images/icon_required.gif">
  </td></tr>
  <tr><td class=shade  width=150>Date of Birth</td><td width=250>
    {build_edit_control field="Date of Birth" mode="add" value=$value_Date_of_Birth}
      &nbsp;<img src="images/icon_required.gif">
  </td></tr>
  <tr><td class=shade  width=150>Unit Number</td><td width=250>
    {build_edit_control field="Unit Number" mode="add" value=$value_Unit_Number}
      &nbsp;<img src="images/icon_required.gif">
  </td></tr>
  <tr><td class=shade  width=150>Sex</td><td width=250>
    {build_edit_control field="Sex" mode="add" value=$value_Sex}
      &nbsp;<img src="images/icon_required.gif">
  </td></tr>
  <tr><td class=shade  width=150>Consultant</td><td width=250>
    {build_edit_control field="Consultant" mode="add" value=$value_Consultant}
      &nbsp;<img src="images/icon_required.gif">
  </td></tr>
  <tr><td class=shade  width=150>Code</td><td width=250>
    {build_edit_control field="Code" mode="add" value=$value_Code}
    </td></tr>
  <tr><td class=shade  width=150>Diagnosis</td><td width=250>
    {build_edit_control field="Diagnosis" mode="add" value=$value_Diagnosis}
    </td></tr>
  <tr><td class=shade  width=150>Allergies</td><td width=250>
    {build_edit_control field="Allergies" mode="add" value=$value_Allergies}
    </td></tr>
  <tr><td class=shade  width=150>Nurses</td><td width=250>
    {build_edit_control field="Nurses" mode="add" value=$value_Nurses}
    </td></tr>
  <tr><td class=shade  width=150>Social Services</td><td width=250>
    {build_edit_control field="Social Services" mode="add" value=$value_Social_Services}
    </td></tr>
  <tr><td class=shade  width=150>Team</td><td width=250>
    {build_edit_control field="Team" mode="add" value=$value_Team}
    </td></tr>
  <tr><td class=shade  width=150>Notes</td><td width=250>
    {build_edit_control field="Notes" mode="add" value=$value_Notes}
    </td></tr>

 <tr height=50><td colspan=2 align=center>
 <input class=button type=submit value="Save" id=submit1 name=submit1>
 <input class=button type=reset value="Reset">
   <input type=hidden name="a" value="added">
 </td></tr>

</form>
 
   <!-- legend -->
   <tr height=50><td colspan=2 align=left>
   <hr width=300 noshade size=1>
   <br><img src="images/icon_required.gif"> - Required field
   </td></tr>

</table>

{include_if_exists file="include/footer.php"}

{$linkdata}
<script>SetToFirstControl();</script>
</body>
</html>

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