-
Notifications
You must be signed in to change notification settings - Fork 1
/
Copy pathAdd_patient.html
211 lines (198 loc) · 9.19 KB
/
Add_patient.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
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8" />
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<!-- Font Awesome -->
<link rel="stylesheet" href="https://pro.fontawesome.com/releases/v5.10.0/css/all.css" integrity="sha384-AYmEC3Yw5cVb3ZcuHtOA93w35dYTsvhLPVnYs9eStHfGJvOvKxVfELGroGkvsg+p" crossorigin="anonymous" />
<!-- Bootstrap CSS -->
<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.0.1/dist/css/bootstrap.min.css" rel="stylesheet" integrity="sha384-+0n0xVW2eSR5OomGNYDnhzAbDsOXxcvSN1TPprVMTNDbiYZCxYbOOl7+AMvyTG2x" crossorigin="anonymous" />
<!-- Google Font -->
<link rel="preconnect" href="https://fonts.googleapis.com" />
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin />
<link href="https://fonts.googleapis.com/css2?family=Manrope:wght@400;600;800&display=swap" rel="stylesheet" />
<!-- End of Google Font -->
<!-- CSS -->
<link rel="stylesheet" href="assets/css/payments.css" />
<link rel="stylesheet" href="assets/css/add_patient.css" />
<script src="assets/js/sponsor_list.js" defer></script>
<title>Payments</title>
</head>
<body>
<div class="container-fluid sponsor-list">
<div class="row">
<!-- Sidebar -->
<div class="sponsor-list-sidebar col-md-6 col-lg-3 d-flex">
<div>
<div class="sponsor-list-sidebar__brand">
<header class="h5 fw-bold">
Medic<span class="sponsor-list-blue">Aid</span>
</header>
</div>
<div class="sponsor-list-sidebar__profile row align-items-center">
<img src="assets/img/emma.png" alt="single" class="col-4 img-fluid p-3" />
<div class="details col-8 ps-0">
<div class="fw-bolder">Adeeko Emmanuel</div>
<div><small>Administrator</small></div>
</div>
</div>
<nav class="sponsor-list-sidebar__nav">
<ul>
<li class="nav-item">
<a href="dashboard_overview.html" class="current-page"><i class="far fa-th-large fa-fw"></i
><span class="aid"> Dashboard</span></a
>
</li>
<li class="nav-item">
<a href="sponsor_list.html"
><i class="fas fa-users fa-fw"></i
><span class="aid"> Sponsors</span></a
>
</li>
<li class="nav-item">
<a href="med_case_admin.html"
><i class="fas fa-chart-bar fa-fw"></i
><span class="aid"> Medical Cases</span></a
>
</li>
<li class="nav-item">
<a href="patient_all_List.html"
><i class="far fa-users fa-fw"></i
><span class="aid"> Patients</span></a
>
</li>
<li class="nav-item">
<a href="payments.html"
><i class="fas fa-user fa-fw"></i
><span class="aid">Payment</span></a
>
</li>
<li class="nav-item">
<a href="#"
><i class="fas fa-user fa-fw"></i
><span class="aid">Report</span></a
>
</li>
</ul>
</nav>
<div class="sponsor-list-sidebar__learn-more">
<img src="assets/img/trio.jpg" alt="trio" class="img-fluid" />
<button type="button" class="btn btn-primary">
Learn more about COVID-19
</button>
</div>
<div class="switch sponsor-list-blue">
<div class="form-check form-switch">
<input
class="form-check-input"
type="checkbox"
id="flexSwitchCheckChecked"
checked
/>
<label class="form-check-label" for="flexSwitchCheckChecked"
>Switch to Dark Mode</label
>
</div>
</div>
</div>
<div class="sponsor-list-sidebar-mobile-overlay d-md-none"></div>
</div>
<!-- End of Sidebar-->
<!-- Right section -->
<section class="right-section col-md-6 col-lg-9 py-4 ps-3">
<div class="right-section-container">
<div
class="
right-section__top-bar
d-flex
align-items-center
justify-content-between
mb-4
"
>
<div class="col-7 col-md-4">
<div class="top-bar__search input-group">
<input
type="search"
class="form-control"
placeholder="Search Dashboard"
/>
<button class="btn btn-outline-secondary" type="button">
<i class="fas fa-search"></i>
</button>
</div>
</div>
<div class="top-bar__notification">
<a href="admin-settings.html">
<i class="fas fa-cog ps-3"></i>
</a>
<a href="notification.html"> <i class="far fa-bell sponsor-list-blue ps-3"></i></a>
<i class="sponsor-list-sidebar-toggle far fa-bars ps-3"></i>
</div>
</div>
<div class="col-md-6 col-sm-12 col-lg-7 dash_main">
<div class="row">
<div class="col-lg-6 col-md-6 col-sm-12">
<div class="head_and_p">
<h1>Dashboard</h1>
<p>Dashboard<a href=""> > Add a Patient</a></p>
</div>
</div>
<div class="col-lg-6 col-md-6 col-sm-12">
<div class="upload_btn">
<button type="button" class="btn btn-primary">Upload
in Batch</button>
</div>
</div>
</div>
<div class="row text_input">
<div class="col-lg-6 col-md-6 col-sm-12">
<div class="texts ">
<h2>Register a <span class="aid">Patient</span> for Sponsorship
</h2>
<div class="pat-info">
<img src="./assets/img/patient-info.jpg" alt="">
<p>Patient's Personal Information</p>
</div>
<i class="fas fa-circle blue_circle text-primary"> <span class="circle_icon">Medical Case
information</span></i> <br>
<i class="fas fa-circle blue_circle text-primary"> <span class="circle_icon">Medical Case
information</span></i>
</div>
</div>
<div class="col-lg-6 col-md-6 col-sm-12">
<div class="inputs">
<form>
<div class="form-row">
<div class="make-col">
<label for="">Title of plea</label>
<!-- <p>Title of plea</p> -->
<input type="text" class="form-control">
</div> <br>
<div class="make-col">
<label for="">Patient's Email address</label>
<input type="email" class="form-control" placeholder="Enter Patient's Email address">
</div><br>
<div class="make-col">
<label for="">Title of plea</label>
<!-- <p>Patient's Age</p> -->
<input type="text" class="form-control" placeholder="Enter Patient's Age">
</div>
<button class="btn btn-primary mt-3 mb-2" type="submit">Send</button> <br>
<img src="./assets/img/dash-lines.png" alt="lines" class="img-fluid">
</div>
</form>
</div>
</div>
</div>
</div>
</div>
</div>
</section>
<!-- End of right section -->
</div>
</body>
<!-- JavaScript Bundle with Popper -->
<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.0.1/dist/js/bootstrap.bundle.min.js" integrity="sha384-gtEjrD/SeCtmISkJkNUaaKMoLD0//ElJ19smozuHV6z3Iehds+3Ulb9Bn9Plx0x4" crossorigin="anonymous"></script>
</html>