{"id":36,"date":"2023-06-11T02:18:52","date_gmt":"2023-06-11T02:18:52","guid":{"rendered":"https:\/\/www.hospital.vijayks.com.np\/?page_id=36"},"modified":"2023-06-11T03:38:19","modified_gmt":"2023-06-11T03:38:19","slug":"hospital-management-patient-registration-page","status":"publish","type":"page","link":"https:\/\/www.hospital.vijayks.com.np\/?page_id=36","title":{"rendered":"Patient Registration"},"content":{"rendered":"\r\n\r\n\t\t<style>\r\n\r\n\t\t.ragistaion_message\r\n\r\n\t\t{\r\n\r\n\t\t\ttext-align: center!important;\r\n\r\n\t\t}\r\n\r\n\t\t.patient_registraion_form {\r\n\r\n\t \r\n\r\n\t  width: 100%;\r\n\r\n\t}\r\n\r\n\t.patient_registraion_form .form-group {\r\n\r\n\t  margin-bottom: 10px;\r\n\r\n\t  margin-top: 10px;\r\n\r\n\t}\r\n\r\n\t.patient_registraion_form .form-group .form-control {\r\n\r\n\t  font-size: 16px;\r\n\r\n\t}\r\n\r\n\t\t.patient_registraion_form .form-group,.patient_registraion_form .form-group .form-control{float:left;width:100%}\r\n\r\n\t\t.patient_registraion_form .form-group .require-field{color:red;}\r\n\r\n\t\t.patient_registraion_form select.form-control,.patient_registraion_form input[type=\"file\"] {\r\n\r\n\t  padding: 0.5278em;\r\n\r\n\t   margin-bottom: 5px;\r\n\r\n\t}\r\n\r\n\t.patient_registraion_form  .radio-inline {\r\n\r\n\t\tfloat: left;\r\n\r\n\t\tmargin-bottom: 10px;\r\n\r\n\t\t margin-right: 15px;\r\n\r\n\t}\r\n\r\n\t.patient_registraion_form  .radio-inline .tog {\r\n\r\n\t\tmargin-right: 5px;\r\n\r\n\t\ttop: 10px;\r\n\r\n\t}\r\n\r\n\t.patient_registraion_form .col-sm-2.control-label {\r\n\r\n\t  line-height: 48px;\r\n\r\n\t  text-align: right;\r\n\r\n\t}\r\n\r\n\t    .patient_registraion_form .form-group .col-sm-1.5 {width: 20.667%;}\r\n\r\n\t\t.patient_registraion_form .form-group .col-sm-2 {width: 24.667%;}\r\n\r\n\t\t.patient_registraion_form .form-group .col-sm-8 {     width: 66.66666667%;}\r\n\r\n\t\t.patient_registraion_form .form-group .col-sm-7{  width: 53.33333333%;}\r\n\r\n\t\t.patient_registraion_form .form-group .col-sm-6{  width: 39.667%;}\r\n\r\n\t\t.patient_registraion_form .form-group .col-sm-1{  width: 13.33333333%;}\r\n\r\n\t\t.patient_registraion_form .form-group .col-sm-8, .patient_registraion_form .form-group .col-sm-2,.patient_registraion_form .form-group .col-sm-7,.patient_registraion_form .form-group .col-sm-1{      \r\n\r\n\t\tpadding-left: 15px;\r\n\r\n\t\t padding-right: 15px;\r\n\r\n\t\tfloat:left;}\r\n\r\n\t\t.patient_registraion_form .form-group .col-sm-8, .patient_registraion_form .form-group .col-sm-2,.patient_registraion_form .form-group .col-sm-7{\r\n\r\n\t\t\tposition: relative;\r\n\r\n\t\tmin-height: 1px;   \r\n\r\n\t\t}\r\n\r\n\r\n\r\n\t\tdiv {\r\n\r\n\t\t\tmargin-bottom:2px;\r\n\r\n\t\t}\r\n\r\n\t\t \r\n\r\n\t\tinput{\r\n\r\n\t\t\tmargin-bottom:4px;\r\n\r\n\t\t}\r\n\r\n\t\t.patient_registraion_form .col-sm-offset-2.col-sm-8 {\r\n\r\n\t  float: left;\r\n\r\n\t  margin-left: 35%;\r\n\r\n\t  margin-top: 15px;\r\n\r\n\t}\r\n\r\n\t.patient_registraion_form .form-control {\r\n\r\n\t  line-height: 30px;\r\n\r\n\t}\r\n\r\n\t\r\n\r\n\t.datepicker{\r\n\r\n\t  width: 20%!important;\r\n\r\n\t}\r\n\r\n\t.mobile_form_group\r\n\r\n\t{\r\n\r\n\t\tdisplay: flex;\r\n\r\n\t}\r\n\r\n\t\t.student_reg_error .error{color:red;}\r\n\r\n\t\t\r\n\r\n\t.entry-content > *:not(.alignwide):not(.alignfull):not(.alignleft):not(.alignright):not(.is-style-wide) {\r\n\r\n        max-width: 700px !important; \r\n\r\n        width: calc(100% - 4rem)!important;\r\n\r\n    }\r\n\r\n\t.frontend_delete_button\r\n\r\n\t{\r\n\r\n\t\ttext-align: center!important;\r\n\r\n\t\tmargin-left: 95px;\r\n\r\n    \r\n\r\n\t}\r\n\r\n\t.diagnosis_div\r\n\r\n\t{\r\n\r\n\t\tdisplay: inline-flex;\r\n\r\n\t}\r\n\r\n\t@media (max-width: 420px){\r\n\r\n\t\t.patient_registraion_form .form-group .col-sm-2 {\r\n\r\n\t\t\twidth: 100%;\r\n\r\n\t\t\ttext-align: left;\r\n\r\n\t\t}\r\n\r\n\t\t.patient_registraion_form .form-group .col-sm-8, .patient_registraion_form .form-group .col-sm-1, .patient_registraion_form .form-group .col-sm-7{\r\n\r\n\t\t\twidth: 100%;\r\n\r\n\t\t}\r\n\r\n\t\t.patient_registraion_form .col-sm-offset-2.col-sm-8 {\r\n\r\n\t\t\tmargin: auto;\r\n\r\n\t\t}\r\n\r\n\t\t.mobile_form_group{\r\n\r\n\t\t\tdisplay: block;\r\n\r\n\t\t}\r\n\r\n\t\t#registration_form .form-group .radio-inline{\r\n\r\n\t\t\tdisplay: flex;\r\n\r\n\t\t}\r\n\r\n\t\t.datepicker {\r\n\r\n\t\t\twidth: auto !important;\r\n\r\n\t\t}\r\n\r\n\t}\r\n\r\n\t\t<\/style>\r\n\r\n\t\t\r\n\r\n\t\t<div class=\"patient_registraion_form\">\r\n\r\n\t\t<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F36\" method=\"post\" id=\"registration_form\" enctype=\"multipart\/form-data\">\r\n\t\t<!-- <script type=\"text\/javascript\"\tsrc=\"https:\/\/www.hospital.vijayks.com.np\/wp-content\/plugins\/hospital-management\/assets\/js\/jquery-3-6-0.js\"><\/script>\t -->\r\n\r\n\t\t<script src=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/jquery\/3.6.0\/jquery.min.js\"><\/script>\r\n\r\n\t\t<link rel=\"stylesheet\"\ttype = \"text\/css\" href=\"https:\/\/www.hospital.vijayks.com.np\/wp-content\/plugins\/hospital-management\/lib\/validationEngine\/css\/validationEngine-jquery.css\"\/>\t\t\r\n\r\n\t\t<link rel=\"stylesheet\"\ttype = \"text\/css\" href=\"https:\/\/www.hospital.vijayks.com.np\/wp-content\/plugins\/hospital-management\/assets\/css\/datepicker-defualt.css\"\/>\t\t\r\n\r\n\t\t\r\n\t\t<script type=\"text\/javascript\"\tsrc=\"https:\/\/www.hospital.vijayks.com.np\/wp-content\/plugins\/hospital-management\/lib\/validationEngine\/js\/languages\/jquery.validationEngine-en.js\"><\/script>\t\t\r\n\r\n\t\t<script type=\"text\/javascript\"\tsrc=\"https:\/\/www.hospital.vijayks.com.np\/wp-content\/plugins\/hospital-management\/lib\/validationEngine\/js\/jquery-validationEngine.js\"><\/script>\r\n\r\n\t\t<script type=\"text\/javascript\"\tsrc=\"https:\/\/www.hospital.vijayks.com.np\/wp-content\/plugins\/hospital-management\/assets\/js\/bootstrap-datepicker.js\"><\/script>\r\n\r\n\t\t<script type=\"text\/javascript\">\r\n\r\n\t\tfunction fileCheck(obj)\r\n\r\n\t\t{   \/\/FILE VALIDATION\r\n\r\n\t\t\t\"use strict\";\r\n\r\n\t\t\tvar fileExtension = ['pdf','doc','jpg','jpeg','png'];\r\n\r\n\t\t\tif (jQuery.inArray(jQuery(obj).val().split('.').pop().toLowerCase(), fileExtension) == -1)\r\n\r\n\t\t\t{\r\n\r\n\t\t\t\talert(\"Sorry, only JPG, JPEG, PNG, pdf, doc &amp; GIF files are allowed.\");\r\n\r\n\t\t\t\tjQuery(obj).val('');\r\n\r\n\t\t\t}\t\r\n\r\n\t\t}\r\n\r\n\t\tfunction fileCheck_image(obj)\r\n\r\n\t\t{   \/\/FILE VALIDATION\r\n\r\n\t\t\t\"use strict\";\r\n\r\n\t\t\tvar fileExtension = ['jpg','jpeg','png'];\r\n\r\n\t\t\tif (jQuery.inArray(jQuery(obj).val().split('.').pop().toLowerCase(), fileExtension) == -1)\r\n\r\n\t\t\t{\r\n\r\n\t\t\t\talert(\"Sorry, only JPG, JPEG, PNG files are allowed.\");\r\n\r\n\t\t\t\tjQuery(obj).val('');\r\n\r\n\t\t\t}\t\r\n\r\n\t\t}\r\n\r\n\t\t<\/script>\r\n\r\n\t\t<script type=\"text\/javascript\">\r\n\r\n\t\tjQuery(document).ready(function($){\r\n\r\n\t\t\t\"use strict\";\r\n\r\n\t\t \r\n\t\t\t\t\t$('#registration_form').validationEngine({promptPosition : \"bottomRight\",maxErrorsPerField: 1});\r\n\r\n\t\t\t\t\t\r\n\t\t \/\/$('#registration_form').validationEngine({promptPosition : \"bottomRight\",maxErrorsPerField: 1});\r\n\r\n\r\n\r\n\t\t jQuery.fn.datepicker.defaults.format =\"yyyy-mm-dd\";\r\n\r\n\t\t jQuery('.birth_date').datepicker({\r\n\r\n\t\t\t\tendDate: '+0d',\r\n\r\n\t\t\t\tautoclose: true\r\n\r\n\t\t\t\t \r\n\r\n\t\t   }); \r\n\r\n\t\t   jQuery('body').on('click', '[data-toggle=dropdown]', function() {\r\n\r\n\t\t\tvar opened = $(this).parent().hasClass(\"open\");\r\n\r\n\t\t\tif (! opened) {\r\n\r\n\t\t\t$('.btn-group').addClass('open');\r\n\r\n\t\t\t$(\"button.multiselect\").attr('aria-expanded', 'true');\r\n\r\n\t\t\t} else {\r\n\r\n\t\t\t$('.btn-group').removeClass('open');\r\n\r\n\t\t\t$(\"button.multiselect\").attr('aria-expanded', 'false');\r\n\r\n\t\t\t}\r\n\r\n\t\t\t}); \r\n\r\n\t\t\t\r\n\r\n\t\t\t $(\"body\").on(\"click\", \".add_more_report\", function()\r\n\r\n\t\t\t{\r\n\r\n\t\t\t\t$(\".diagnosissnosis_div\").append('<div class=\"form-group diagnosis_div\"><label class=\"col-sm-2 control-label\" for=\"diagnosis\">Diagnosis Report<\/label><div class=\"col-sm-4\"><input type=\"file\" class=\"dignosisreport form-control file\" name=\"diagnosis[]\"><\/div><div class=\"col-sm-1 frontend_delete_button\"><input type=\"button\" value=\"Delete\" onclick=\"deleteParentElement(this)\" class=\"remove_cirtificate btn btn-default\"><\/div><\/div>');\r\n\r\n\t\t\t});\t\t\t\t\r\n\r\n\t\t\t$(\"body\").on(\"click\", \".remove_cirtificate\", function()\r\n\r\n\t\t\t{\r\n\r\n\t\t\t\talert(\"Do you really want to delete this record ?\");\r\n\r\n\t\t\t\t$(this).parent().parent().remove();\r\n\r\n\t\t\t});\r\n\r\n\t\t} );\r\n\r\n\t\t<\/script>\r\n\r\n\t  \r\n\t\t<input type=\"hidden\" name=\"action\" value=\"insert\" \/>\r\n\r\n\t\t<input type=\"hidden\" name=\"role\" value=\"patient\"  \/>\r\n\r\n\t\t<input type=\"hidden\" name=\"patient_type\" value=\"outpatient\" \/>\r\n\r\n\t\t\r\n\r\n\t\t<input type=\"hidden\" name=\"user_id\" value=\"\"  \/>\r\n\r\n\t\t<input id=\"patient_id\" type=\"hidden\" value=\"P10626\" name=\"patient_id\" \/>\r\n\r\n\t\t\r\n\r\n\t\t<div class=\"header\">\t\r\n\r\n\t\t\t<h3 class=\"first_hed\">Personal Information<\/h3>\r\n\r\n\t\t<\/div>\t\r\n\r\n\t\t\r\n\r\n\t\t<div class=\"form-group margin_top_40\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"first_name\">First Name<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"first_name\" class=\"form-control validate[required,custom[onlyLetter_specialcharacter]] text-input\" maxlength=\"50\" type=\"text\" value=\"\" name=\"first_name\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"middle_name\">Middle Name<\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"middle_name\" class=\"form-control validate[custom[onlyLetter_specialcharacter]]\" maxlength=\"50\" type=\"text\"  value=\"\" name=\"middle_name\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"last_name\">Last Name<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"last_name\" class=\"form-control validate[required,custom[onlyLetter_specialcharacter]] text-input\" maxlength=\"50\" type=\"text\"  value=\"\" name=\"last_name\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"gender\">Gender<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\r\n\t\t\t\t<label class=\"radio-inline\">\r\n\r\n\t\t\t     <input type=\"radio\" value=\"male\" class=\"tog\" name=\"gender\"   checked='checked'\/>Male\r\n\t\t\t    <\/label>\r\n\r\n\t\t\t    <label class=\"radio-inline\">\r\n\r\n\t\t\t      <input type=\"radio\" value=\"female\" class=\"tog\" name=\"gender\"  \/>Female \r\n\r\n\t\t\t    <\/label>\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"birth_date\">Date of birth<\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"birth_date\" class=\"form-control birth_date\" type=\"text\"  name=\"birth_date\"\r\n\r\n\t\t\t\tvalue=\"\" readonly>\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\t\t\r\n\r\n\r\n\r\n\t\t<div class=\"form-group mobile_form_group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label \" for=\"mobile\">Mobile<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t\t<div class=\"col-sm-1\">\r\n\r\n\t\t\t<input type=\"text\" value=\"+977\"  class=\"form-control  validate[required] onlynumber_and_plussign\" name=\"phonecode\" maxlength=\"5\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"col-sm-7\">\r\n\r\n\t\t\t\t<input id=\"mobile\" class=\"form-control validate[required,custom[phone_number]] text-input\" minlength=\"6\" maxlength=\"15\" type=\"text\" value=\"\" name=\"mobile\">\t\t\t\t\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\r\n\r\n\t\t<div class=\"header\">\t\r\n\r\n\t\t\t<h3 class=\"first_hed\">Login Information<\/h3>\r\n\r\n\t\t<\/div>\t\r\n\r\n\r\n\r\n\t\t<div class=\"form-group margin_top_40\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label \" for=\"email\">Email<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"email\" class=\"form-control validate[required,custom[email]] text-input\" maxlength=\"100\" type=\"text\"  name=\"email\" \r\n\r\n\t\t\t\tvalue=\"\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"username\">User Name<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"username\" class=\"form-control validate[required,custom[username_validation]]\" type=\"text\"  name=\"username\" maxlength=\"30\"\r\n\r\n\t\t\t\tvalue=\"\" >\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"password\">Password<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"password\" class=\"form-control validate[required,minSize[8]]\" type=\"password\"  name=\"password\" maxlength=\"12\" value=\"\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\t\t\r\n\r\n\r\n\r\n\t\t<div class=\"header\">\t\r\n\r\n\t\t\t<h3 class=\"first_hed\">Address Information<\/h3>\r\n\r\n\t\t<\/div>\t\r\n\r\n\r\n\r\n\t\t<div class=\"form-group margin_top_40\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"address\">Address<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"address\" class=\"form-control validate[required,custom[address_description_validation]]\" type=\"text\" maxlength=\"150\"  name=\"address\" \r\n\r\n\t\t\t\tvalue=\"\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"city_name\">City<\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"city_name\" class=\"form-control validate[custom[city_state_country_validation]]\" type=\"text\"  name=\"city_name\" maxlength=\"50\"\r\n\r\n\t\t\t\tvalue=\"\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"state_name\">State<\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"state_name\" class=\"form-control validate[custom[city_state_country_validation]]\" type=\"text\"  name=\"state_name\" maxlength=\"50\"\r\n\r\n\t\t\t\tvalue=\"\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"state_name\">Country<\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"country_name\" class=\"form-control validate[custom[city_state_country_validation]]\" type=\"text\"  name=\"country_name\" maxlength=\"50\"\r\n\r\n\t\t\t\tvalue=\"\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"zip_code\">Zip Code<\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"zip_code\" class=\"form-control  validate[custom[onlyLetterNumber]]\" type=\"text\" maxlength=\"15\"  name=\"zip_code\" \r\n\r\n\t\t\t\tvalue=\"\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label \" for=\"phone\">Phone<\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input id=\"phone\" class=\"form-control validate[custom[phone_number]] text-input\" minlength=\"6\" maxlength=\"15\" type=\"text\" value=\"\" name=\"phone\">\t\t\t\t\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\r\n\r\n\t\t<div class=\"header\">\t\r\n\r\n\t\t\t<h3 class=\"first_hed\">Other Information<\/h3>\r\n\r\n\t\t<\/div>\r\n\r\n\r\n\r\n\t\t<div class=\"form-group margin_top_40\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"blood_group\">Blood Group<\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t\r\n\t\t\t\t<select id=\"blood_group\" class=\"form-control \" name=\"blood_group\">\r\n\r\n\t\t\t\t<option value=\"\">Select Blood Group<\/option>\r\n\r\n\t\t\t\t\r\n\t\t\t\t\t\t<option value=\"O+\" >O+ <\/option>\r\n\r\n\t\t\t\t\r\n\t\t\t\t\t\t<option value=\"O-\" >O- <\/option>\r\n\r\n\t\t\t\t\r\n\t\t\t\t\t\t<option value=\"A+\" >A+ <\/option>\r\n\r\n\t\t\t\t\r\n\t\t\t\t\t\t<option value=\"B+\" >B+ <\/option>\r\n\r\n\t\t\t\t\r\n\t\t\t\t\t\t<option value=\"A-\" >A- <\/option>\r\n\r\n\t\t\t\t\r\n\t\t\t\t\t\t<option value=\"B-\" >B- <\/option>\r\n\r\n\t\t\t\t\r\n\t\t\t\t\t\t<option value=\"AB+\" >AB+ <\/option>\r\n\r\n\t\t\t\t\r\n\t\t\t\t\t\t<option value=\"AB-\" >AB- <\/option>\r\n\r\n\t\t\t\t\r\n\t\t\t<\/select>\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t\r\n\t\t\t<div class=\"form-group\">\r\n\r\n\t\t\t\t<label class=\"col-sm-2 control-label\" for=\"symptoms\">Symptoms<\/label>\r\n\r\n\t\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t\t\t<select class=\"form-control symptoms_list \" multiple=\"multiple\" name=\"symptoms[]\" id=\"symptoms\">\t\t\t\t\t\r\n\r\n\t\t\t\t\t\t\t\t\t\t\t\r\n\r\n\t\t\t\t\t\t<\/select>\r\n\r\n\t\t\t\t\t\t<br>\t\t\t\t\t\r\n\r\n\t\t\t\t\t<\/div>\t\t\t\t\t\r\n\r\n\t\t\t<\/div>\t\r\n\r\n\t\t<div class=\"diagnosissnosis_div\">\r\n\r\n\t\t\t<div class=\"form-group\">\r\n\r\n\t\t\t\t<label class=\"col-sm-2 control-label\" for=\"diagnosis\">Diagnosis Report<\/label>\r\n\r\n\t\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t\t<input type=\"file\" class=\"form-control file dignosisreport\" onchange=\"fileCheck(this);\" name=\"diagnosis[]\">\r\n\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\t\r\n\r\n\t\t<\/div>\r\n\r\n\t\t<div class=\"form-group\">\t\t\t\r\n\r\n\t\t\t<div class=\"col-sm-2\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input type=\"button\" value=\"Add More Report\"   name=\"add_more_report\" class=\"add_more_report btn btn-default\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t\t<input type=\"hidden\"  name=\"doctor\" value=\"\">\r\n\r\n\t\t\t\r\n\r\n\t\t<div class=\"form-group\">\r\n\r\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"photo\">Image<\/label>\r\n\r\n\t\t\t\r\n\r\n\t\t\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\t<input type=\"file\" class=\"form-control file\" name=\"hmgt_user_avatar\" onchange=\"fileCheck_image(this);\"  >\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t\t\r\n\r\n\t\t\t<\/div>\t\r\n\r\n\t\t\t<div class=\"col-sm-offset-2 col-sm-8\">\r\n\r\n        \t\r\n\r\n        \t<input type=\"submit\" value=\"Patient Registration\" name=\"registration_front_patient\" class=\"btn registration_save_btn btn-success\"\/>\r\n\r\n        <\/div>\r\n\r\n    <\/form>\r\n\r\n\t<\/div>\r\n\r\n    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