query("select id from patientForms where cart='$id_num'"); if ($db->nf() && $db->next_record()) {$_SESSION[patientid] = $last = $db->f("id");} else { $db->query("insert into `patientForms` (id,cart) values ('0','$id_num')"); $db->query("select id from `patientForms` where cart='$id_num'"); if ($db->nf() && $db->next_record()) {$_SESSION[patientid] = $last = $db->f("id");} } } // initialize local variables $map = "http://classic.mapquest.com/maps?city=Los+Angeles&state=CA&address=8631+W+3rd+St&zipcode=90048-5901&country=US&latitude=34.0736&longitude=-118.38058&geocode=ADDRESS"; // validate any incoming data require("includes/validateIncomingData.inc.php"); // reload name etc. if we have it if ($_SESSION["fname"]) {$fname = $_SESSION["fname"];} if ($_SESSION["middle"]) {$middle = $_SESSION["middle"];} if ($_SESSION["lname"]) {$fname = $_SESSION["lname"];} if ($_SESSION["dobMonth"]) {$dobm = $_SESSION["dobMonth"];} if ($_SESSION["dobDay"]) {$dobd = $_SESSION["dobDay"];} if ($_SESSION["dobYear"]) {$doby = $_SESSION["dobYear"];} // check for request to file if ($_POST["doit"] && $_POST["doit"] == "File Package Electronically") { /* if (!$_SESSION[forms][introletter]) {$headline = "Please Read and Accept the Open Access Colonoscopy Letter first ...";} else //*/ if (!$_SESSION[forms][demographics]) {$headline = "Please complete the Patient Demographics form first ...";} elseif (!$_SESSION[forms][history]) {$headline = "Please complete the Patient Medical History form first ...";} elseif (!$_SESSION[forms][privacy]) {$headline = "Please Read and Accept the Privacy Statement first ...";} elseif (!$_SESSION[forms][billing]) {$headline = "Please Read and Accept the Billing Entities Information first ...";} elseif ($_SESSION[BlueCross] && !$_SESSION[forms][anesthesia]) {$headline = "Please Read and Accept the Blue Cross Anesthesia Letter first ...";} else { $_SESSION[forms][completed] = TRUE; $db->query("update patientForms set completed='".date("Y-m-d H:i:s")."'"); include("control/downloadcheckedforms3.inc.php"); // send e-mail to Helen and Bob $db->query("select * from patientForms where id='".$_SESSION[patientid]."'"); $db->next_record(); $msg = " A new Registration has been completed online ".strtoupper($db->f("lname")).", ".ucfirst($db->f("fname"))." ".ucfirst($db->f("middle"))." DOB: ".$db->f("dobm")."-".$db->f("dobd")."-".$db->f("doby")." You can download the Registration Form from the Control Panel "; mail("bowker@inetwebinc.com","LAGASTRO Patient Registration",$msg,"From:webmaster@lagastro.org\nReply-To:webmaster@lagastro.org\nX-Mailer: PHP/".phpversion(),"-fwebmaster@lagastro.org"); if (!$debug) { mail("helenforshare@gmail.com?","Patient Online Registration",$msg,"From:webmaster@lagastro.org\nReply-To:webmaster@lagastro.org\nX-Mailer: PHP/".phpversion()."\n-fwebmaster@lagastro.org"); } } } // initialize for this page $drop_months = $drop_years = ""; $drop_dob_month = " "; if ($dobm) {$drop_dob_month = ereg_replace($dobm."'>",$dobm."' selected='selected'>",$drop_dob_month);} $drop_dob_days = ""; for ($i=1;$i<=31;$i++) {$drop_dob_days .= "";} if ($dobd) {$drop_dob_days = ereg_replace($dobd."'>",$dobd."' selected='selected'>",$drop_dob_days);} $drop_dob_years = ""; for ($i=(date("Y")-85);$i<=date("Y");$i++) {$drop_dob_years .= "";} if ($doby) {$drop_dob_years = ereg_replace(">".$doby," selected='selected'>".$doby,$drop_dob_years);} $drop_years = ereg_replace("