| Server IP : 104.21.73.108 / Your IP : 216.73.216.59 Web Server : Apache/2 System : Linux cat167-197.static.lnwhostname.com 5.10.0-20-amd64 #1 SMP Debian 5.10.158-2 (2022-12-13) x86_64 User : paphayomho ( 1042) PHP Version : 5.6.40 Disable Function : exec,system,passthru,shell_exec,proc_close,proc_open,dl,popen,show_source,posix_kill,posix_mkfifo,posix_getpwuid,posix_setpgid,posix_setsid,posix_setuid,posix_setgid,posix_seteuid,posix_setegid,posix_uname MySQL : ON | cURL : ON | WGET : OFF | Perl : OFF | Python : OFF | Sudo : OFF | Pkexec : OFF Directory : /home/paphayomho/domains/paphayomhospital.go.th/private_html/HHC/admin/ |
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<?php include('header.php'); ?>
<?php include('session.php'); ?>
<?php $get_id = $_GET['id']; ?>
<body>
<?php include('navbar.php'); ?>
<div class="container-fluid">
<div class="row-fluid">
<?php include('sidebar_dashboard.php'); ?>
<div class="span9" id="">
<div class="row-fluid">
<!-- block -->
<div id="block_bg" class="block">
<div class="navbar navbar-inner block-header">
<div class="muted pull-left"><i class="icon-plus-sign icon-large"></i> Add Dependents</div>
<div class="muted pull-right">
<a id="return" class="btn btn-success" data-placement="left" title="Click to Return" href="members.php"><i class="icon-arrow-right icon-large"></i> Save and Finish</a>
<a id="" data-placement="left" href="edit_member.php<?php echo '?id='.$get_id; ?>"><i class="icon-arrow-left icon-large"></i> Back</a></div>
</div>
<div class="block-content collapse in">
<form id="add_dependents" class="form-signin" method="post">
<!-- span 4 -->
<div class="span4">
<input type="hidden" class="input-block-level" name="get_id" value="<?php echo $get_id; ?>">
<input type="text" class="input-block-level" name="given_name" placeholder="Given Name">
<input type="text" class="input-block-level" name="date_of_birth" placeholder="Date of Birth">
</div>
<div class="span4">
<input type="text" class="input-block-level" name="surname" placeholder="Surname">
<input type="text" class="input-block-level" name="relationship" placeholder="Relationship To Member">
<button class="btn btn-info" name="save"><i class="icon-plus-sign icon-large"></i> Add</button>
</div>
<div class="span4">
<input type="text" class="input-block-level" name="middlename" placeholder="Middlename">
</div>
</form>
<div class="span12"><hr></div>
<div id="depDIV">
<?php include('dependents_table_add.php'); ?>
</div>
<script>
jQuery(document).ready(function($){
$("#add_dependents").submit(function(e){
e.preventDefault();
var _this = $(e.target);
var formData = $(this).serialize();
$.ajax({
type: "POST",
url: "save_member_update.php",
data: formData,
success: function(html){
$.jGrowl("Dependent Successfully Added", { header: 'Dependent Added' });
/* $('#depDIV').load('dependents_table_add.php');
$(_this).find(":input").val(''); */
window.location="add_dep.php<?php echo '?id='.$get_id; ?>";
}
});
});
});
</script>
</div>
</div>
<!-- /block -->
</div>
</div>
</div>
<?php include('footer.php'); ?>
</div>
<?php include('script.php'); ?>
</body>
</html>