{"id":8,"date":"2023-10-13T11:58:51","date_gmt":"2023-10-13T10:58:51","guid":{"rendered":"https:\/\/lemonadeclinic.net\/index.php\/hospital-management-patient-registration-page\/"},"modified":"2023-10-13T11:58:51","modified_gmt":"2023-10-13T10:58:51","slug":"hospital-management-patient-registration-page","status":"publish","type":"page","link":"https:\/\/lemonadeclinic.net\/index.php\/hospital-management-patient-registration-page\/","title":{"rendered":"Hospital Management Patient Registration Page"},"content":{"rendered":"\t\t<style>\r\n\t\t\tfooter {\r\n\t\t\t\tdisplay: none;\r\n\t\t\t}\r\n\r\n\t\t\t.registration_save_btn {\r\n\t\t\t\tborder-radius: 28px;\r\n\t\t\t\tpadding: 8px 60px !important;\r\n\t\t\t\tbackground-color: #1DB198;\r\n\t\t\t\tborder: 0px !important;\r\n\t\t\t\tcolor: #ffffff !important;\r\n\t\t\t\tfont-size: 20px !important;\r\n\t\t\t\ttext-transform: uppercase !important;\r\n\t\t\t\ttext-decoration: none !important;\r\n\t\t\t\twidth: 100%;\r\n\t\t\t\tmargin-bottom: 20%;\r\n\t\t\t}\r\n\t\t<\/style>\r\n\t\t\r\n\r\n\t\t<style>\r\n\t\tdiv.datepicker {\r\n\t\t\twidth: auto !important;\r\n\t\t}\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\t.g_label{\r\n\t\tline-height:45px !important;\r\n\t}\r\n\t.padding_left_25{\r\n\t\tpadding-left:25px !important;\r\n\t}\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\t.patient_registraion_form input[type=\"file\"]{\r\n\t\tpadding:0px !important;\r\n\t}\t\r\n\t.radio_margin{\r\n\t\tmargin-top:10px !important;\r\n\t}\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: 36px;\r\n\r\n\t  text-align: right;\r\n\r\n\t}\r\n\tfooter\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\t\t\r\n\t\t@media only screen and (max-width: 380px) and (min-width: 279px) {\r\n\t\t\t  .patient_registraion_form .form-group {\r\n\t\t\t\tmargin-bottom:0px !important;\r\n\t\t\t\tmargin-top: 0px !important;\r\n\t\t\t}\r\n\t\t\t.padding_left_25 {\r\n\t\t\t\tpadding-left: 15px !important;\r\n\t\t\t}\r\n\t\t\tbody .is-layout-constrained > :where(:not(.alignleft):not(.alignright):not(.alignfull)) {\r\n\t\t\t\t\r\n\t\t\t\tmargin-left: 0px !important;\r\n\t\t\t\t\r\n\t\t\t}\r\n\t\t\t\r\n.registration_save_btn {\r\n\tfont-size: 15px !important;\r\n}\r\n\t\t\t\r\n\t\t}\r\n\t\t\r\n\t\t@media only screen and (max-width: 649px) and (min-width: 381px) {\r\n\t\t\t.patient_registraion_form .form-group {\r\n\t\t\t\tmargin-bottom:0px !important;\r\n\t\t\t\tmargin-top: 0px !important;\r\n\t\t\t}\r\n\t\t\t.padding_left_25 {\r\n\t\t\t\tpadding-left: 15px !important;\r\n\t\t\t}\r\n\t\t\tbody .is-layout-constrained > :where(:not(.alignleft):not(.alignright):not(.alignfull)) {\r\n\t\t\t\t\r\n\t\t\t\tmargin-left: 0px !important;\r\n\t\t\t\t\r\n\t\t\t}\r\n\t\t\t\t\r\n.registration_save_btn {\r\n\tfont-size: 15px !important;\r\n}\r\n\t\t\t\r\n\t\t}\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: 27%;\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\tfooter.wp-block-template-part{\r\n\t\tmargin-top:30% !important;\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\/wp-json\/wp\/v2\/pages\/8\" method=\"post\" id=\"registration_form\" enctype=\"multipart\/form-data\">\r\n\t<!-- <script type=\"text\/javascript\"\tsrc=\"https:\/\/lemonadeclinic.net\/wp-content\/plugins\/hospital-management\/assets\/js\/jquery-3-6-0.js\"><\/script>\t -->\r\n\r\n\t<script src=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/jquery\/3.6.0\/jquery.min.js\"><\/script>\r\n\r\n\t<link rel=\"stylesheet\" type=\"text\/css\" href=\"https:\/\/lemonadeclinic.net\/wp-content\/plugins\/hospital-management\/lib\/validationEngine\/css\/validationEngine-jquery.css\" \/>\r\n\r\n\t<link rel=\"stylesheet\" type=\"text\/css\" href=\"https:\/\/lemonadeclinic.net\/wp-content\/plugins\/hospital-management\/assets\/css\/datepicker-defualt.css\" \/>\r\n\r\n\t\r\n\t<script type=\"text\/javascript\" src=\"https:\/\/lemonadeclinic.net\/wp-content\/plugins\/hospital-management\/lib\/validationEngine\/js\/languages\/jquery.validationEngine-en.js\"><\/script>\r\n\r\n\t<script type=\"text\/javascript\" src=\"https:\/\/lemonadeclinic.net\/wp-content\/plugins\/hospital-management\/lib\/validationEngine\/js\/jquery-validationEngine.js\"><\/script>\r\n\r\n\t<script type=\"text\/javascript\"\tsrc=\"https:\/\/lemonadeclinic.net\/wp-content\/plugins\/hospital-management\/assets\/js\/bootstrap-datepicker.js\"><\/script>\r\n\r\n\t<script type=\"text\/javascript\">\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}\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}\r\n\r\n\t\t}\r\n\t<\/script>\r\n\r\n\t<script type=\"text\/javascript\">\r\n\t\tjQuery(document).ready(function($) {\r\n\r\n\t\t\t\"use strict\";\r\n\r\n\t\t\t\r\n\t\t\t\t$('#registration_form').validationEngine({\r\n\t\t\t\t\tpromptPosition: \"bottomRight\",\r\n\t\t\t\t\tmaxErrorsPerField: 1\r\n\t\t\t\t});\r\n\r\n\t\t\t\r\n\t\t\t\/\/$('#registration_form').validationEngine({promptPosition : \"bottomRight\",maxErrorsPerField: 1});\r\n\r\n\r\n\r\n\t\t\tjQuery.fn.datepicker.defaults.format = \"dd\/mm\/yyyy\";\r\n\r\n\t\t\tjQuery('#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\r\n\r\n\t\t\t});\r\n\t\t\t\r\n\r\n\t\t\tjQuery('body').on('click', '[data-toggle=dropdown]', function() {\r\n\r\n\t\t\t\tvar opened = $(this).parent().hasClass(\"open\");\r\n\r\n\t\t\t\tif (!opened) {\r\n\r\n\t\t\t\t\t$('.btn-group').addClass('open');\r\n\r\n\t\t\t\t\t$(\"button.multiselect\").attr('aria-expanded', 'true');\r\n\r\n\t\t\t\t} else {\r\n\r\n\t\t\t\t\t$('.btn-group').removeClass('open');\r\n\r\n\t\t\t\t\t$(\"button.multiselect\").attr('aria-expanded', 'false');\r\n\r\n\t\t\t\t}\r\n\r\n\t\t\t});\r\n\r\n\r\n\r\n\t\t\t$(\"body\").on(\"click\", \".add_more_report\", function()\r\n\r\n\t\t\t\t{\r\n\r\n\t\t\t\t\t$(\".diagnosissnosis_div\").append('<div class=\"form-group diagnosis_div\"><label class=\"col-sm-2 control-label\" for=\"diagnosis\">Diagnosis Report<\/label><div class=\"col-sm-4\"><input type=\"file\" class=\"dignosisreport form-control file\" name=\"diagnosis[]\"><\/div><div class=\"col-sm-1 frontend_delete_button\"><input type=\"button\" value=\"Delete\" onclick=\"deleteParentElement(this)\" class=\"remove_cirtificate btn btn-default\"><\/div><\/div>');\r\n\r\n\t\t\t\t});\r\n\r\n\t\t\t$(\"body\").on(\"click\", \".remove_cirtificate\", function()\r\n\r\n\t\t\t\t{\r\n\r\n\t\t\t\t\talert(\"Do you really want to delete this record ?\");\r\n\r\n\t\t\t\t\t$(this).parent().parent().remove();\r\n\r\n\t\t\t\t});\r\n\r\n\t\t});\r\n\t<\/script>\r\n\r\n\t\r\n\t<input type=\"hidden\" name=\"action\" value=\"insert\" \/>\r\n\r\n\t<input type=\"hidden\" name=\"role\" value=\"patient\" \/>\r\n\r\n\t<input type=\"hidden\" name=\"patient_type\" value=\"outpatient\" \/>\r\n\r\n\r\n\r\n\t<input type=\"hidden\" name=\"user_id\" value=\"\" \/>\r\n\r\n\t<input id=\"patient_id\" type=\"hidden\" value=\"P10526\" name=\"patient_id\" \/>\r\n\r\n\r\n\r\n\t<div class=\"header\">\r\n\r\n\t\t<h3 class=\"first_hed\">Personal Information<\/h3>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"form-group margin_top_40\">\r\n\r\n\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<div class=\"col-sm-8\">\r\n\r\n\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<\/div>\r\n\r\n\t<\/div>\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label\" for=\"middle_name\">Middle Name<\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\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<\/div>\r\n\r\n\t<\/div>\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\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<div class=\"col-sm-8\">\r\n\r\n\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<\/div>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label g_label\" for=\"gender\">Gender<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t\r\n\t\t\t<label class=\"radio-inline radio_margin\">\r\n\r\n\t\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 radio_margin\">\r\n\r\n\t\t\t\t<input type=\"radio\" value=\"female\" class=\"tog\" name=\"gender\"  \/>Female\r\n\t\t\t<\/label>\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label\" for=\"birth_date\">Date of birth<\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t<input id=\"birth_date\" class=\"form-control birth_date\" type=\"text\" name=\"birth_date\" value=\"\" readonly>\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"form-group mobile_form_group mb-3\" style=\"margin-bottom: 15px !important;\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label \" for=\"mobile\">Mobile<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t<div class=\"col-sm-1 padding_left_25\">\r\n\r\n\t\t\t<input type=\"text\" value=\"+92\" class=\"form-control  validate[required] onlynumber_and_plussign\" name=\"phonecode\" maxlength=\"5\">\r\n\r\n\t\t<\/div>\r\n\r\n\t\t<div class=\"col-sm-7\">\r\n\r\n\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\">\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"header\">\r\n\r\n\t\t<h3 class=\"first_hed\">Login Information<\/h3>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"form-group margin_top_40\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label \" for=\"email\">Email<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t<input id=\"email\" class=\"form-control validate[required,custom[email]] text-input\" maxlength=\"100\" type=\"text\" name=\"email\" value=\"\">\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\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<div class=\"col-sm-8\">\r\n\r\n\t\t\t<input id=\"username\" class=\"form-control validate[required,custom[username_validation]]\" type=\"text\" name=\"username\" maxlength=\"30\" value=\"\" >\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\t<div class=\"form-group\" style=\"margin-bottom: 15px !important;\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label\" for=\"password\">Password<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\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<\/div>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"header\">\r\n\r\n\t\t<h3 class=\"first_hed\">Address Information<\/h3>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"form-group margin_top_40\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label\" for=\"address\">Address<span class=\"require-field\">*<\/span><\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t<input id=\"address\" class=\"form-control validate[required,custom[address_description_validation]]\" type=\"text\" maxlength=\"150\" name=\"address\" value=\"\">\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label\" for=\"city_name\">City<\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t<input id=\"city_name\" class=\"form-control validate[custom[city_state_country_validation]]\" type=\"text\" name=\"city_name\" maxlength=\"50\" value=\"\">\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label\" for=\"state_name\">State<\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t<input id=\"state_name\" class=\"form-control validate[custom[city_state_country_validation]]\" type=\"text\" name=\"state_name\" maxlength=\"50\" value=\"\">\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label\" for=\"state_name\">Country<\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t<input id=\"country_name\" class=\"form-control validate[custom[city_state_country_validation]]\" type=\"text\" name=\"country_name\" maxlength=\"50\" value=\"\">\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label\" for=\"zip_code\">Zip Code<\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t<input id=\"zip_code\" class=\"form-control  validate[custom[onlyLetterNumber]]\" type=\"text\" maxlength=\"15\" name=\"zip_code\" value=\"\">\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"form-group\" style=\"margin-bottom: 15px !important;'\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label \" for=\"phone\">Phone<\/label>\r\n\r\n\t\t<div class=\"col-sm-8\">\r\n\r\n\t\t\t<input id=\"phone\" class=\"form-control validate[custom[phone_number]] text-input\" minlength=\"6\" maxlength=\"15\" type=\"text\" value=\"\" name=\"phone\">\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"header\">\r\n\r\n\t\t<h3 class=\"first_hed\">Other Information<\/h3>\r\n\r\n\t<\/div>\r\n\r\n\r\n\r\n\t<div class=\"form-group margin_top_40 \">\r\n\r\n\t\t<label class=\"col-sm-2 control-label\" for=\"blood_group\">Blood Group<\/label>\r\n\r\n\t\t<div class=\"col-sm-8 padding_7\">\r\n\r\n\t\t\t\r\n\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<option value=\"O+\" >O+ <\/option>\r\n\r\n\t\t\t\t\r\n\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<option value=\"A+\" >A+ <\/option>\r\n\r\n\t\t\t\t\r\n\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<option value=\"A-\" >A- <\/option>\r\n\r\n\t\t\t\t\r\n\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<option value=\"AB+\" >AB+ <\/option>\r\n\r\n\t\t\t\t\r\n\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<\/div>\r\n\r\n\t<\/div>\r\n\r\n\t\t<script type=\"text\/javascript\">\r\n    jQuery(document).ready(function($) {\r\n        \"use strict\";\r\n        $('#symptoms').multiselect({\r\n            nonSelectedText: 'Select Symptoms',\r\n            includeSelectAllOption: true,\r\n            selectAllText: 'Select all',\r\n            templates: {\r\n                button: '<button class=\"multiselect btn btn-default dropdown-toggle\" type=\"button\" data-bs-toggle=\"dropdown\" aria-expanded=\"false\"><span class=\"multiselect-selected-text\"><\/span><b class=\"caret\"><\/b><\/button>',\r\n            },\r\n            buttonContainer: '<div class=\"btn-group\" \/>'\r\n        });\r\n    });\r\n<\/script>\r\n\r\n<div class=\"form-group\">\r\n    <label class=\"col-sm-2 control-label\" for=\"symptoms\">Symptoms<\/label>\r\n    <div class=\"col-sm-8 padding_7 multiselect_validation_symptoms\">\r\n        <select class=\"form-control symptoms_list\" multiple=\"multiple\" name=\"symptoms[]\" id=\"symptoms\">\r\n            <option value=\"2925\">bb glow<\/option><option value=\"256\">botox<\/option><option value=\"107\">breast augmentation<\/option><option value=\"748\">breast lift<\/option><option value=\"737\">breast reduction<\/option><option value=\"2130\">carbon facial<\/option><option value=\"2252\">cheek filler<\/option><option value=\"523\">chemical peels<\/option><option value=\"2279\">chin filler<\/option><option value=\"2154\">cleansing<\/option><option value=\"552\">dark circles<\/option><option value=\"2427\">darmacos facial<\/option><option value=\"2131\">depigment<\/option><option value=\"283\">double chin<\/option><option value=\"335\">double chin<\/option><option value=\"130\">exosomes<\/option><option value=\"452\">eyebrow lift<\/option><option value=\"17\">fat dessolving injections<\/option><option value=\"40\">fat dessolving injections<\/option><option value=\"817\">filler<\/option><option value=\"2167\">fillers<\/option><option value=\"809\">foundation free skin<\/option><option value=\"143\">foundation free skin<\/option><option value=\"102\">glow drip<\/option><option value=\"312\">glow facial<\/option><option value=\"46\">gynae<\/option><option value=\"2465\">hair cutt<\/option><option value=\"129\">hair fall<\/option><option value=\"113\">hair prp<\/option><option value=\"525\">HIFU<\/option><option value=\"170\">HIFU<\/option><option value=\"59\">hydra<\/option><option value=\"132\">HYDRA FACIAL<\/option><option value=\"19\">hymen repair<\/option><option value=\"1852\">kybella<\/option><option value=\"683\">labiaplasty<\/option><option value=\"981\">labiaplasty<\/option><option value=\"33\">laser<\/option><option value=\"34\">laser<\/option><option value=\"2229\">lip filler<\/option><option value=\"1726\">lip tint<\/option><option value=\"1758\">lip tint<\/option><option value=\"1757\">microbladding<\/option><option value=\"1154\">microneedling meso<\/option><option value=\"2098\">mole removal<\/option><option value=\"2242\">mole removal<\/option><option value=\"1916\">mommy makeover<\/option><option value=\"1459\">nipple rejuvination<\/option><option value=\"2426\">party makeup<\/option><option value=\"5577\">peptide facial<\/option><option value=\"1723\">photo facial<\/option><option value=\"8950\">pico laser<\/option><option value=\"2236\">PRF<\/option><option value=\"1944\">private part peel<\/option><option value=\"501\">private part whitening<\/option><option value=\"1639\">profilo<\/option><option value=\"465\">prp<\/option><option value=\"455\">puffy eyes<\/option><option value=\"3282\">Q Switch<\/option><option value=\"453\">rhinoplasty<\/option><option value=\"2312\">salon service<\/option><option value=\"2482\">saloon service<\/option><option value=\"3369\">scarlet<\/option><option value=\"597\">scarlet<\/option><option value=\"14\">skin<\/option><option value=\"97\">slimming drip<\/option><option value=\"2476\">stretch marks<\/option><option value=\"36\">threads<\/option><option value=\"137\">threads<\/option><option value=\"62\">veginal tightening<\/option><option value=\"5729\">veginal whitening laser<\/option><option value=\"2451\">veginismis<\/option><option value=\"8256\">wart removal<\/option><option value=\"6990\">wart removal<\/option><option value=\"2415\">wax<\/option><option value=\"18\">weight<\/option><option value=\"1073\">weight gain<\/option><option value=\"487\">weight gain<\/option>        <\/select>\r\n    <\/div>\r\n<\/div>\r\n\r\n\r\n\t<div class=\"diagnosissnosis_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=\"diagnosis\">Diagnosis Report<\/label>\r\n\r\n\t\t\t<div class=\"col-sm-8 padding_7\">\r\n\r\n\t\t\t\t<input type=\"file\" class=\"form-control file dignosisreport\" onchange=\"fileCheck(this);\" name=\"diagnosis[]\">\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t<\/div>\r\n\r\n\t<\/div>\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\t\t<div class=\"col-sm-2\">\r\n\r\n\t\t<\/div>\r\n\r\n\t\t<div class=\"col-sm-8 padding_7\">\r\n\r\n\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<\/div>\r\n\r\n\t<\/div>\r\n\r\n\t<input type=\"hidden\" name=\"doctor\" value=\"\">\r\n\r\n\r\n\r\n\t<div class=\"form-group\">\r\n\r\n\t\t<label class=\"col-sm-2 control-label\" for=\"photo\">Image<\/label>\r\n\r\n\r\n\r\n\t\t<div class=\"col-sm-8 padding_7\">\r\n\r\n\t\t\t<input type=\"file\" class=\"form-control file\" name=\"hmgt_user_avatar\" onchange=\"fileCheck_image(this);\">\r\n\r\n\t\t<\/div>\r\n\r\n\r\n\r\n\t<\/div>\r\n\r\n\t<div class=\"col-sm-offset-2 col-sm-8\">\r\n\r\n\r\n\r\n\t\t<input type=\"submit\" value=\"Patient Registration\" name=\"registration_front_patient\" class=\"btn registration_save_btn btn-success\" \/>\r\n\r\n\t<\/div>\r\n\r\n\t<\/form>\r\n\r\n\t<\/div>\r\n\r\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/lemonadeclinic.net\/index.php\/wp-json\/wp\/v2\/pages\/8","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lemonadeclinic.net\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/lemonadeclinic.net\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/lemonadeclinic.net\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lemonadeclinic.net\/index.php\/wp-json\/wp\/v2\/comments?post=8"}],"version-history":[{"count":0,"href":"https:\/\/lemonadeclinic.net\/index.php\/wp-json\/wp\/v2\/pages\/8\/revisions"}],"wp:attachment":[{"href":"https:\/\/lemonadeclinic.net\/index.php\/wp-json\/wp\/v2\/media?parent=8"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}