-
Notifications
You must be signed in to change notification settings - Fork 0
/
index.html
264 lines (231 loc) · 7.87 KB
/
index.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
<!DOCTYPE html>
<head>
<meta charset="utf-8" />
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<title>Patient Logbook</title>
<link rel="icon" href="./assets/icon.ico" type="image/x-icon" />
<link href="https://fonts.googleapis.com/css?family=IBM+Plex+Sans:400i" rel="stylesheet">
<link href="https://fonts.googleapis.com/css?family=Roboto&display=swap" rel="stylesheet">
<link rel="icon" href="./assets/icon.ico" type="image/x-icon" />
<style>
body {
margin: 0;
position: relative;
font-size: 20px;
font-family: 'IBM Plex Sans', sans-serif;
}
@font-face {
font-family: "samarkhan";
src: url(./font/samarkhan.ttf);
}
ul.topnav h5 {
text-decoration: none;
color: white;
padding: 0px;
margin: 0px 50px;
height: 60px;
display: inline-block;
font-family: samarkhan;
}
ul.topnav {
list-style-type: none;
width: 100%;
background-color: #f15652;
margin: 0;
top: 0;
padding: 0;
z-index: 1;
overflow: hidden;
}
ul.topnav li a {
display: block;
position: relative;
right: 0;
color: white;
text-align: center;
font-family: 'IBM Plex Sans', sans-serif;
margin: 0px;
padding: 20px 10px 20px 10px;
;
font-size: 18px;
/* height: 80px; */
text-decoration: none;
}
label {
display: inline-block;
width: 160px;
}
input {
display: inline-block;
background-color: #FFF;
height: 30px;
width: 150px;
border: 2px solid tomato;
}
ul.topnav li a:hover {
background-color: darksalmon;
}
ul.topnav li {
float: right;
}
.title {
color: black;
margin: auto;
width: 30%;
}
.container {
width: 80%;
padding-right: 45px;
padding-left: 45px;
margin-right: auto;
margin-left: auto;
}
.underline {
background-color: #f15652;
height: 3px;
width: 5%;
margin: auto
}
h1 {
font-family: 'IBM Plex Sans', sans-serif;
text-align: center;
color: #000;
font-size: 40px;
font-weight: 50;
margin: 20px 0px;
}
.button {
display: inline-block;
border: none;
outline: none;
padding: 1rem 2rem;
margin: 0;
text-decoration: none;
background: tomato;
color: #fff;
font-family: sans-serif;
font-size: 1rem;
cursor: pointer;
text-align: center;
transition: background 250ms ease-in-out, transform 150ms ease;
text-align: center;
border-radius: 5px;
margin: auto;
height: 30px;
width: 100px;
box-shadow: 0 2px 10px rgba(0, 0, 0, 0.5);
}
select {
margin: 5px 5px 5px 0px;
width: 250px;
padding: 15px 5px 15px 5px;
font-size: 16px;
border: 2px solid tomato;
-webkit-appearance: none;
-moz-appearance: none;
appearance: none;
background: url(https://image.flaticon.com/icons/svg/1098/1098150.svg);
background-repeat: no-repeat;
background-size: 30px 30px;
background-position: center right;
background-origin: content-box;
background-color: #FFF;
}
select::-ms-expand {
display: none;
/* remove default arrow on ie10 and ie11 */
}
@media screen and (min-width:0\0) {
select {
background: none\9;
padding: 5px\9;
}
}
button:hover,
button:focus {
background: #f15652;
color: #FFF;
}
button:focus {
outline: 1px solid #fff;
outline-offset: -4px;
}
button:active {
transform: scale(0.99);
}
.divider {
margin-top: auto;
margin-bottom: auto;
height: 60%;
background-color: #f15652;
}
p {
font-family: 'IBM Plex Sans', sans-serif;
text-align: center;
}
.footer {
font-size: 15px;
width: 100%;
position: fixed;
bottom: 0;
background-color: #000;
padding: 0px;
}
</style>
</head>
<body>
<ul class="topnav" id="navbar" style="background-color: #f15652">
<h5 href="#" style="font-family:samarkhan; font-weight: 400; font-size: 50px;">Patient Logbook</h5>
<li style="margin-right: 30px;"><a href="./data.php">Search</a></li>
</ul>
<div style="margin-top: 0px;">
<h1>Patient Details</h1>
<div style="height: 40px;"></div>
<div class="container;" style="padding-left: 35%;">
<!-- //padding-top:30px; -->
<div style="display: inline-block;width: 75%;">
<form id="userD" action="./connection.php" method="post">
<label for="name">Name:<span style="color: red">*</span></label>
<input type="text" name="name" id="nameInput" style="width: 250px;" required>
<br><br>
<label for="phone">Phone Number:<span style="color: red">*</span></label>
<input type="text" name="phone" id="phoneInput" style="width: 250px;" required>
<br><br>
<label for="age">Age:<span style="color: red">*</span></label>
<input type="number" name="age" id="ageInput" style="width: 250px;" required>
<br><br>
<label for="sex">Gender:<span style="color: red">*</span></label></label>
<br>
<input type="radio" name="gender" value="M" >Male
<br>
<input type="radio" name="gender" value="F" >Female
<br>
<input type="radio" name="gender" value="O" >Others
<br><br>
<label for="mh">Medical History  <span style="color: red">*</span></label>
<textarea style="border: 2px solid tomato;width: 250px;" rows="4" cols="30" id="medInput" name="med" form="userD" required></textarea>
<!-- <input type="text" name="med" id="medInput"style="width: 250px;" required> -->
<br><br>
<label for="inv">Investgations   Done:<span style="color: red">*</span></label>
<input type="text" name="inv" id="invInput"style="width: 250px;" required>
<br><br>
<label for="diag">Diagnosis:  <span style="color: red">*</span></label>
<textarea style="border: 2px solid tomato;width: 250px;" rows="4" cols="30" id="diagInput" name="diag" form="userD" required></textarea>
<!-- <input type="text" name="diag" id="diagInput"style="width: 250px;" required> -->
<!-- <input type="submit" name="submit" value="Submit"style="width: 250px;"> -->
</form>
<br><br>
<button class ="button" type="submit" form="userD" value="Submit"style="margin-left: 20%;padding-top: 16px;padding-bottom: 32px;padding-left: 64px;padding-right: 128px;" >Register</button>
</div>
<div style="height: 125px;"></div>
<footer>
<div class="footer" style="left: 0px;">
<div style="width: 40%;float:left; color: white;height: 100%;margin-left: 10%;position: relative;">
<h2
style="font-family: 'Roboto';font-weight: 400;letter-spacing: 2px;margin-bottom: 25px;margin-top: 25px;">
<span class="fas fa-heart" id="love"></span> Meenakshi Dental Medicine Center </h2>
</div>
</footer>
</body>
</body>
</html>