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<? require("testa.php");?>
<? echo gettext ("New patient");?>
<?PHP
// START DEMO
// $esitob = pg_Exec($conn, "SELECT * FROM anagrafica;");
// if (!$esito) {
// echo "Si è verificato un errore.\n";
// exit;
// } // Errore interrogazione database
// $nume = pg_NumRows($esitob); //inizia l'output tabelare della query
//
// if ($nume > 10) {
// echo "Hai raggiunto il massimo di pazienti inseribili. Cancellane qualcuno.";
// exit;
// }
//
// STOP DEMO
?>
<FORM METHOD="post" ACTION="anagraficainsert.php">
<TABLE Border="0" ALIGN="CENTER">
<TR>
<TD><? echo gettext ("Today's date:");?></TD>
<TD><INPUT NAME="data" SIZE=10 VALUE="<? print (date ("d/m/Y"));?>">
</TR>
<TR>
<TD><? echo gettext ("Surname:");?></TD>
<TD><INPUT NAME="cognome">
<TD><? echo gettext ("Name:");?></TD>
<TD><INPUT NAME="nome">
<TD><? echo gettext ("Sex:");?></TD>
<TD><SELECT NAME="sesso">
<OPTION VALUE="M">M
<OPTION VALUE="F">F
</SELECT>
</TD>
</TR>
<TR>
<TD><? echo gettext ("City of birth:");?></TD>
<TD><INPUT NAME="natoa"></TD>
<TD><? echo gettext ("birthdate:");?></TD>
<TD><INPUT NAME="datanascita" SIZE=10> <? echo gettext ("dd/mm/yyyy");?></TD>
</TR>
<TR>
<TD><? echo gettext ("Address:");?></TD>
<TD><INPUT NAME="residenza"></TD>
</TR>
<TR>
<TD><? echo gettext ("ZIP:");?></TD>
<TD><INPUT NAME="cap" SIZE=8 VALUE="001"></TD>
<TD><? echo gettext ("City:");?></TD>
<TD><INPUT NAME="citta"></TD>
</TR>
<TR>
<TD><? echo gettext ("Job:");?></TD>
<TD><INPUT NAME="professione"></TD>
</TR>
<TR>
<TD><? echo gettext ("Address 2:");?></TD>
<TD><INPUT NAME="recapito"></TD>
</TR>
<TR>
<TD><? echo gettext ("Phone:");?></TD>
<TD><INPUT NAME="telefono"></TD>
</TR>
<TR>
<TD><? echo gettext ("Referred by:");?></TD>
<TD><INPUT NAME="presentato"></TD>
</TR>
</TABLE>
<? echo "<INPUT TYPE=\"submit\" VALUE=\"";?><? echo gettext ("Submit");?><? echo "\">";?>
<INPUT TYPE="reset" VALUE="Reset">
</FORM>
<? include("piede.php");?>
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