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<!-- BEGIN: dat-lich-kham -->
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
<!-- Popper JS -->
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.16.0/umd/popper.min.js"></script>
<!-- Latest compiled JavaScript -->
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.5.2/js/bootstrap.min.js"></script>
<script src="//cdnjs.cloudflare.com/ajax/libs/validate.js/0.13.1/validate.min.js"></script>
<div class="content">
<div class="maincon">
<div class="left">
</div>
<style type="text/css">
@media only screen and (max-width: 600px) {
.fixmodile {margin-left: 2px;}
}
@media only screen and (min-width: 1200px) {.fixmodile {margin-left: 8px;}}
.form-style-9{
max-width: 650px;
background: #FAFAFA;
padding: 30px;
margin: 50px auto;
box-shadow: 1px 1px 25px rgba(0, 0, 0, 0.35);
border-radius: 10px;
}
.form-style-9 ul{
padding:0;
margin:0;
list-style:none;
}
.form-style-9 ul li{
display: block;
margin-bottom: 10px;
min-height: 35px;
}
.form-style-9 ul li .field-style{
box-sizing: border-box;
-webkit-box-sizing: border-box;
-moz-box-sizing: border-box;
padding: 8px;
outline: none;
border: 1px solid #B0CFE0;
-webkit-transition: all 0.30s ease-in-out;
-moz-transition: all 0.30s ease-in-out;
-ms-transition: all 0.30s ease-in-out;
-o-transition: all 0.30s ease-in-out;
}.form-style-9 ul li .field-style:focus{
box-shadow: 0 0 5px #B0CFE0;
border:1px solid #B0CFE0;
}
.form-style-9 ul li .field-split{
width: 49%;
}
.form-style-9 ul li .field-full{
width: 100%;
}
.form-style-9 ul li input.align-left{
float:left;
}
.form-style-9 ul li input.align-right{
float:right;
}
.form-style-9 ul li textarea{
width: 100%;
height: 100px;
}
.form-style-9 ul li input[type="button"],
.form-style-9 ul li input[type="submit"] {
-moz-box-shadow: inset 0px 1px 0px 0px #3985B1;
-webkit-box-shadow: inset 0px 1px 0px 0px #3985B1;
box-shadow: inset 0px 1px 0px 0px #3985B1;
background-color: #216288;
border: 1px solid #17445E;
display: inline-block;
cursor: pointer;
color: #FFFFFF;
padding: 8px 18px;
text-decoration: none;
font: 12px Arial, Helvetica, sans-serif;
}
.form-style-9 ul li input[type="button"]:hover,
.form-style-9 ul li input[type="submit"]:hover {
background: linear-gradient(to bottom, #2D77A2 5%, #337DA8 100%);
background-color: #28739E;
}
.form-style-9 ul li button[type="button"], .form-style-9 ul li button[type="submit"] {
-moz-box-shadow: inset 0px 1px 0px 0px #3985B1;
-webkit-box-shadow: inset 0px 1px 0px 0px #3985B1;
box-shadow: inset 0px 1px 0px 0px #3985B1;
background-color: #216288;
border: 1px solid #17445E;
display: inline-block;
cursor: pointer;
color: #FFFFFF;
padding: 8px 18px;
text-decoration: none;
font: 12px Arial, Helvetica, sans-serif;
}
</style>
<center>
<h1>ĐẶT HẸN KHÁM BỆNH
</h1></center>
<form class="form-style-9" action="{url}/lichhen.php" method="post">
<ul>
<li>
<input type="text" name="hovaten" class="field-style field-split align-left" placeholder="Họ và tên" required/>
<input type="text" name="namsinh" class="field-style field-split align-right" placeholder="Năm sinh" required/>
</li>
<li>
<select class="field-style field-split align-left" aria-required="true" aria-invalid="false" name="gioitinh" required><option value="">Giới tính (*)</option><option value="Nam">Nam</option><option value="Nữ">Nữ</option></select>
<input type="text" name="phone" class="field-style field-split align-right" placeholder="Số điện thoại" required/>
</li>
<li>
<input type="text" name="diachi" class="field-style field-split align-left" placeholder="Địa chỉ"required />
<input type="text" name="cccd" class="field-style field-split align-right" placeholder="CCCD" required/>
</li>
<li>
<select class="field-style field-split align-left" aria-required="true" aria-invalid="false" name="loaidv" required><option value="">Loại dịch vụ (*)</option>
<option value="Tư vấn từ xa">Tư vấn từ xa</option>
<option value="Đăng ký lịch khám">Đăng ký lịch khám</option>
</select>
<select class="field-style field-split align-right fixmodile" aria-required="true" aria-invalid="false" name="lienlac" required><option value="">Có thể liên lạc qua (*)</option>
<option value="Zalo">Zalo</option>
<option value="Gọi điện">Gọi điện</option>
</select>
</li>
<li>
<select class="field-style field-split align-left" aria-required="true" aria-invalid="false" name="ngaykham" required><option value="">Ngày khám (*)</option>
<option value="{this_day1}">Hôm nay ({this_day1})</option>
<option value="{this_day2}">Ngày mai ({this_day2})</option>
<option value="{this_day3}">Ngày kia ({this_day3})</option>
</select>
<select class="field-style field-split align-right fixmodile" aria-required="true" aria-invalid="false" name="thoigiankham" required><option value="">Thời gian khám (*)</option>
<option value="07:30">07:30</option>
<option value="07:45">07:45</option>
<option value="08:00">08:00</option>
<option value="08:15">08:15</option>
<option value="08:30">08:30</option>
<option value="08:45">08:45</option>
<option value="09:00">09:00</option>
<option value="09:15">09:15</option>
<option value="09:30">09:30</option>
<option value="09:45">09:45</option>
<option value="10:00">10:00</option>
<option value="10:15">10:15</option>
<option value="10:30">10:30</option>
<option value="10:45">10:45</option>
<option value="11:00">11:00</option>
<option value="11:15">11:15</option>
<option value="11:30">11:30</option>
<option value="11:45">11:45</option>
<option value="12:00">12:00</option>
<option value="12:15">12:15</option>
<option value="12:30">12:30</option>
<option value="12:45">12:45</option>
<option value="13:00">13:00</option>
<option value="13:15">13:15</option>
<option value="13:30">13:30</option>
<option value="13:45">13:45</option>
<option value="14:00">14:00</option>
<option value="14:15">14:15</option>
<option value="14:30">14:30</option>
<option value="14:45">14:45</option>
<option value="15:00">15:00</option>
<option value="15:15">15:15</option>
<option value="15:30">15:30</option>
<option value="15:45">15:45</option>
<option value="16:00">16:00</option>
<option value="16:15">16:15</option>
</select>
</li>
<li>
<textarea name="tinhtrangbenh" class="field-style" placeholder="Mô tả triệu chứng (*)..." required></textarea>
</li>
<li><input class="field-style field-split align-left" type="text" value="" name="captcha" id="captcha" placeholder="Nhập mã xác nhận" required/>
<input class="field-style field-split align-right" style="width: 100px" id="captcha" src="{url}/data/captcha" type="image" name="captcha"></li>
<li>
<input type="hidden" value="send" name="guithongtin" />
<p class="progress-demo"><button type="submit" class="btn btn-success load1" data-style="expand-left"><span class="ladda-label">Cập nhật</span></button></p>
</li>
</ul>
<script>
(function () {
validate.extend(validate.validators.datetime, {
parse: function (value, options) {
return +moment.utc(value);
},
format: function (value, options) {
var format = options.dateOnly ? "YYYY-MM-DD" : "YYYY-MM-DD hh:mm:ss";
return moment.utc(value).format(format);
},
});
const constraints = {
email: {
presence: true,
email: {
message: 'Please enter valid email'
},
},
password: {
presence: true,
length: {
minimum: 8,
},
},
"confirm-password": {
presence: true,
equality: {
attribute: "password",
message: "^The passwords does not match",
},
},
name: {
presence: {
message: "Name is required",
allowEmpty: false,
},
length: {
minimum: 3,
maximum: 20,
},
exclusion: {
within: ["nickolas", "ellen"],
message: "'%{value}' is not allowed"
}
},
phone: {
presence: true,
length: {
minimum: 10,
maximum: 11,
},
format: {
pattern: "[0-9]+",
message: "can only contain a-z and 0-9",
},
},
birthday: {
presence: true,
datetime: {
dateOnly: true,
earliest: moment.utc().subtract(20, 'years'),
latest: moment.utc().subtract(18, 'years'),
message: "^Your age must be over 18 and less than 20"
}
},
size: {
inclusion: {
within: ["small", "medium", "large"],
message: "^We're currently out of %{value}"
}
}
}
$('#form').submit((e) => {
e.preventDefault()
let errors = validate($('#form'), constraints) || {}
$('#error-name').html(errors.name)
$('#error-size').html(errors.size)
$('#error-email').html(errors.email)
$('#error-password').html(errors.password)
$('#error-confirm-password').html(errors['confirm-password'])
$('#error-phone').html(errors.phone)
$('#error-birthday').html(errors.birthday)
})
$('#email').blur(() => {
let error = validate.single($('#email').val(), constraints.email) || [''];
$('#error-email').html(error[0])
})
$('#name').blur(() => {
let error = validate.single($('#name').val(), constraints.name) || [''];
console.log(error)
$('#error-name').html(error[0])
})
$('#size').blur(() => {
let error = validate.single($('#size').val(), constraints.size) || [''];
console.log(error)
$('#error-size').html(error[0])
})
$('#password').blur(() => {
let error = validate.single($('#password').val(), constraints.password) || [''];
$('#error-password').html(error[0])
})
$('#confirm-password').blur(() => {
let constraintsConfirm = {
confirmPassword: {
presence: true,
equality: {
attribute: "password",
message: "^The passwords does not match",
},
}
}
let confirmPassword = $('#confirm-password').val();
let password = $('#password').val()
let error = validate({confirmPassword, password}, constraintsConfirm) || {};
console.log(error)
$('#error-confirm-password').html(error.confirmPassword)
})
$('#phone').blur(() => {
let error = validate.single($('#phone').val(), constraints.phone) || [''];
$('#error-phone').html(error[0])
})
$('#birthday').change(() => {
let error = validate.single($('#birthday').val(), constraints.birthday) || [''];
$('#error-birthday').html(error[0])
})
})();
</script>
<script src="https://benhviendkkvcampha.vn/adminvn/templates/js/spin.min.js"></script>
<script src="https://benhviendkkvcampha.vn/adminvn/templates/js/ladda.min.js"></script>
<script>
// Bind normal buttons
Ladda.bind( 'div:not(.progress-demo) button', { timeout: 9000 } );
// Bind progress buttons and simulate loading progress
Ladda.bind( '.progress-demo button', {
callback: function( instance ) {
var progress = 0;
var interval = setInterval( function() {
progress = Math.min( progress + Math.random() * 0.1, 1 );
instance.setProgress( progress );
if( progress === 1 ) {
instance.stop();
clearInterval( interval );
}
}, 9000 );
}
} );
</script>
</form>
<!-- END: dat-lich-kham -->