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MOZAMBICO/App/Views/Elements/Request/wizard-derma.part.php

wizard-derma.part.php 8.0KB
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  1. <div class="modal fade" tabindex="-1" role="dialog" id="modal-wizard-derma-dialog">

  2.   <div class="modal-dialog modal-lg modal-95" role="document">

  3.     <div class="modal-content">

  4.       <div class="modal-header">

  5.         <h5 class="modal-title"><?php echo _('Wizard Derma'); ?></h5>

  6.         <button type="button" class="close" data-dismiss="modal" aria-label="Close">

  7.           <span aria-hidden="true">&times;</span>

  8.         </button>

  9.       </div>

  10.       <div class="modal-body">

  11. 	      <div class="row">

  12. 		      <div class="col-lg-6">

  13. 			      <div class="row">

  14. 				      <div class="col-lg-6 text-center">

  15. 					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['single']) ? 'derma-image-selected' : ''; ?>" data-type="single">

  16. 						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['single']; ?></div>

  17. 						      <img src="/images/wizards/derma/1_Singola.jpg" alt="">

  18. 						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-single" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['single']; ?>" value="single" <?php echo isset($this->view->dermaPositions['single']) ? 'checked' : ''; ?>>

  19. 						  </div>

  20. 				      </div>

  21. 				      <div class="col-lg-6 text-center">

  22. 					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['multiple-localized']) ? 'derma-image-selected' : ''; ?>" data-type="multiple-localized">

  23. 						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['multiple-localized']; ?></div>

  24. 						      <img src="/images/wizards/derma/2_Multiple_localizzate.jpg" alt="">

  25. 						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-multiple-localized" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['multiple-localized']; ?>" value="multiple-localized" <?php echo isset($this->view->dermaPositions['multiple-localized']) ? 'checked' : ''; ?>>

  26. 						  </div>

  27. 				      </div>

  28. 			      </div>

  29. 			      <div class="row">

  30. 				      <div class="col-lg-6 text-center">

  31. 					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['multiple-spread']) ? 'derma-image-selected' : ''; ?>" data-type="multiple-spread">

  32. 						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['multiple-spread']; ?></div>

  33. 						      <img src="/images/wizards/derma/3_Multiple_diffuse.jpg" alt="">

  34. 						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-multiple-spread" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['multiple-spread']; ?>" value="multiple-spread" <?php echo isset($this->view->dermaPositions['multiple-spread']) ? 'checked' : ''; ?>>

  35. 						  </div>

  36. 				      </div>

  37. 				      <div class="col-lg-6 text-center">

  38. 					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['clusted']) ? 'derma-image-selected' : ''; ?>" data-type="clusted">

  39. 						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['clusted']; ?></div>

  40. 						      <img src="/images/wizards/derma/4_A_grappolo.jpg" alt="">

  41. 						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-clusted" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['clusted']; ?>" value="clusted" <?php echo isset($this->view->dermaPositions['clusted']) ? 'checked' : ''; ?>>

  42. 						  </div>

  43. 				      </div>

  44. 			      </div>

  45. 			      <div class="row">

  46. 				      <div class="col-lg-6 text-center">

  47. 					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['metameric']) ? 'derma-image-selected' : ''; ?>" data-type="metameric">

  48. 						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['metameric']; ?></div>

  49. 						      <img src="/images/wizards/derma/5_Metamerica.jpg" alt="">

  50. 						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-metameric" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['metameric']; ?>" value="metameric" <?php echo isset($this->view->dermaPositions['metameric']) ? 'checked' : ''; ?>>

  51. 						  </div>

  52. 				      </div>

  53. 				      <div class="col-lg-6 text-center">

  54. 					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['linear']) ? 'derma-image-selected' : ''; ?>" data-type="linear">

  55. 						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['linear']; ?></div>

  56. 						      <img src="/images/wizards/derma/6_Lineare.jpg" alt="">

  57. 						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-linear" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['linear']; ?>" value="linear" <?php echo isset($this->view->dermaPositions['linear']) ? 'checked' : ''; ?>>

  58. 						  </div>

  59. 				      </div>

  60. 			      </div>

  61. 			      <div class="row">

  62. 				      <div class="col-lg-6 text-center">

  63. 					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['acral']) ? 'derma-image-selected' : ''; ?>" data-type="acral">

  64. 						      <div class="derma-title"><?php echo $this->view->dermaPositionLabels['acral']; ?></div>

  65. 						      <img src="/images/wizards/derma/7_Acrale.jpg" alt="">

  66. 						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-acral" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['acral']; ?>" value="acral" <?php echo isset($this->view->dermaPositions['acral']) ? 'checked' : ''; ?>>

  67. 						  </div>

  68. 				      </div>

  69. 				      <div class="col-lg-6 text-center">

  70. 					      <div class="derma-image-wrapper text-center <?php echo isset($this->view->dermaPositions['symmetrical']) ? 'derma-image-selected' : ''; ?>" data-type="symmetrical">

  71. 						     <div class="derma-title"><?php echo $this->view->dermaPositionLabels['symmetrical']; ?></div>

  72. 						     <img src="/images/wizards/derma/8_Simmetrica.jpg" alt="">

  73. 						      <input type="checkbox" name="data[derma_position][value][]" class="derma-position-check" id="derma-position-check-symmetrical" class="derma-position-check" data-label="<?php echo _('Position'), ': ', $this->view->dermaPositionLabels['symmetrical']; ?>" value="symmetrical" <?php echo isset($this->view->dermaPositions['symmetrical']) ? 'checked' : ''; ?>>

  74. 						  </div>

  75. 				      </div>

  76. 			      </div>

  77. 		      </div>

  78. 		      <div class="col-lg-6">

  79. 			      <div class="row">

  80. 				      <div class="col"><?php echo $this->helper->getRequestExam($this->view->exams, 'Margins', 'derma'); ?></div>

  81. 			      </div>

  82. 			      <hr>

  83. 			      <div class="row">

  84. 				      <div class="col"><?php echo $this->helper->getRequestExam($this->view->exams, 'Symptoms', 'derma'); ?></div>

  85. 			      </div>

  86. 			      <hr>

  87. 			      <div class="row">

  88. 				      <div class="col"><?php echo $this->helper->getRequestExam($this->view->exams, 'Sexual intercourse', 'derma'); ?></div>

  89. 			      </div>

  90. 			      <hr>

  91. 				  <div class="row">

  92. 				      <div class="col"><?php echo $this->helper->getRequestExam($this->view->exams, 'Other information 1', 'derma'); ?></div>

  93. 			      </div>

  94. 			      <hr>

  95. 			      <div class="row">

  96. 				    <div class="col"><?php echo $this->helper->getRequestExam($this->view->exams, 'Other information 2', 'derma'); ?></div>

  97. 			      </div>

  98. 		      </div>

  99. 	      </div>

  100.       </div>

  101.       <div class="modal-footer">

  102.       	<button type="button" class="btn btn-primary" data-dismiss="modal"><?php echo _('Done'); ?></button>

  103.       </div>

  104.     </div>

  105.   </div>

  106. </div>