input { font-size: 16px;}
$TELNUM = $_POST[telnum];
$HOSPNUM = $_POST[hnum];
$ROOMNUM = $_POST[rnum];
$LASTNAME = $_POST[lname];
$FIRSTNAME = $_POST[fname];
$MIDNAME = $_POST[mname];
$ADDRESS = $_POST[address];
$NURSE = $_POST[nurse];
$ADATE = $_POST[adate];
$ADTIME = $_POST[adtym];
$CSTAT = $_POST[cs];
$AGE = $_POST[age];
$BDAY = $_POST[bday];
$SEX = $_POST[sex];
?>
ADMISSION INFORMATION SHEET | |||||||||||
Hospital # | : | "> if(empty($HOSPNUM)) print "* Hospital Number required! ?> | Room # | : | "> if(empty($ROOMNUM )) print "* Room Number required! ?> | Admission Date | : | "> if(empty($ADATE)) print "* Admission Date required! ?> | |||
Last Name | : | "> if(empty($LASTNAME)) print "* Last Name required! ?> | First Name | : | "> if(empty($FIRSTNAME)) print "* First Name required! ?> | Middle Name | : | "> if(empty($MIDNAME)) print "* Middle Name required! ?> | Admission Time | : | "> if(empty($ADTIME)) print "* Admission Time required! ?> |
Civil Status | : | "> if(empty($CSTAT)) print "* Civil Status required! ?> | Age | : | "> if(empty($AGE)) print "* Age required! ?> | Birthday | : | "> if(empty($BDAY)) print "* Birthday required! ?> | |||
Address | : | "> if(empty($ADDRESS)) print "* Address required! ?> | Telephone # | : | "> |
if(empty($TELNUM))
print "* Address required!
";
?>
Sex:">if(empty($SEX))
print "* Gender required!
";
?>
Pls. Check:SSS :Non Medicare :Stockholder GSIS Senior-Citizen Dependent Employee Attending Nurse:">if(empty($NURSE))
print "* Admitting/Attending Nurse required!
";
?>
$val1 = $_POST['NURSE'];
if($_POST['NURSE'] != "")
{
?>
}
?>