Current File : /home/inlingua/public_html/sensoriumpsychologists.com/diagnostics/admin/designs/ac_1.php

<div class="col-md-12">
<select name="type_select" class="form-control" onchange="show_hide_func(this.value)" style="width:auto;">
	<option value="">-Select Type-</option>
	<option>Paragraph</option>
</select>
</div>
<form method="post" onsubmit="return validate_form_1()">
<div class="col-xs-12" id="paragraph_1_div" style="display:none;margin-top:10px;">
		<div>
        	<select name="week" id="week" class="form-control" style="width:auto;display:inline-block;">
            	<option value="">-Select Week-</option>
            	<option value="1">1st Week</option>
            	<option value="2">2nd Week</option>
            	<option value="3">3rd Week</option>
            	<option value="4">4th Week</option>
            	<option value="5">5th Week</option>
            </select>
        	<select name="day" id="day" class="form-control" style="width:auto;display:inline-block;">
            	<option value="">-Select Day-</option>
            	<option value="1">1st Day</option>
            	<option value="2">2nd Day</option>
            	<option value="3">3rd Day</option>
            	<option value="4">4th Day</option>
            	<option value="5">5th Day</option>
            	<option value="6">6th Day</option>
            	<option value="7">7th Day</option>
            </select>
        </div>
          <div class="box box-primary" style="margin-top:10px;">
            <div class="box-body">
            	
                <div class="form-group">
                	<label>Paragraph</label>
                    <textarea name="paragraph_1" id="paragraph_1" class="form-control" rows="10"></textarea>
                </div>
            </div>
          </div>
          <div class="box box-primary">
            <div class="box-body">
                <div class="form-group">
                	<h3>One Word Answer</h3>
                	<label>Title</label>
                    <input type="text" name="one_word_title_1" id="one_word_title_1" class="form-control" value="A. Give one word answer:" />
                </div>
                <div id="question_div_1_1">
                    <div class="form-group">
                        <label>Question</label>
                        <input type="text" name="question_1_1[]" class="form-control" value="" />
                    </div>
                </div>
                <div>
                	<input type="button" class="btn btn-warning" value="+ Add More" onClick="add_func('1','1')" />
                </div>
            </div>
          </div>
            
          <div class="box box-primary">
            <div class="box-body">
                <div class="form-group">
                	<h3>Fill in the blanks</h3>
                    <div style="color:#F00;">
                    	Instructions:<br>
                        Please type blank_here wherever you want a blank
                    </div>
                	<label>Title</label>
                    <input type="text" name="blanks_title_1" id="blanks_title_1" class="form-control" value="B. Fill in the blanks:" />
                </div>
                <div id="question_div_1_2">
                    <div class="form-group">
                        <label>Question</label>
                        <input type="text" name="question_1_2[]" class="form-control" value="" />
                    </div>
                </div>
                <div>
                	<input type="button" class="btn btn-warning" value="+ Add More" onClick="add_func('1','2')" />
                </div>
            </div>
          </div>
          
          <div class="box box-primary">
            <div class="box-body">
                <div class="form-group">
                	<h3>True/False</h3>
                	<label>Title</label>
                    <input type="text" name="true_false_title_1" id="true_false_title_1" class="form-control" value="C. Select True or False:" />
                </div>
                <div id="question_div_1_3">
                    <div class="form-group">
                        <label>Question</label>
                        <input type="text" name="question_1_3[]" class="form-control" value="" />
                    </div>
                </div>
                <div>
                	<input type="button" class="btn btn-warning" value="+ Add More" onClick="add_func('1','3')" />
                </div>
            </div>
            <!-- /.box-body --> 
            
          </div>
          <!-- /.box --> 
      
          <input type="submit" class="btn btn-success" name="submit_type_1" value="Add Treatment Now" />&nbsp;
          <a href="treatment_week_day.php?code=<?php echo($_GET['code']."&std=".$_GET['std']."&month=".$_GET['month']);?>"><div class="btn btn-danger">Cancel</div></a>    
</div>
</form>
        
<script>
function add_func(section,q_no)
{
	var to_update="#question_div_"+section+"_"+q_no;
	if(section=="1")
	{
		if((q_no=="1")||(q_no=="2")||(q_no=="3"))
		{
			var name="question_"+section+"_"+q_no+"[]";
			var content="<div class=\"form-group\"><label>Question</label><input type=\"text\" name=\""+name+"\" class=\"form-control\" /></div>";
			$(to_update).append(content);
			return true;
		}
	}
}
function show_hide_func(val)
{
	if(val=="Paragraph")
	{
		$("#paragraph_1_div").show(300);
	}
	else
	{
		$("#paragraph_1_div").hide();
	}
}
function validate_form_1()
{
	if($("#week").val()=="")
	{
		$("#error_msg_string_ajax").html("Error : Please select Week...");
		$("#blackout_error_ajax,#error_msg_div_ajax").css({'visibility':'visible'});
		return false;
	}
	if($("#day").val()=="")
	{
		$("#error_msg_string_ajax").html("Error : Please select Day...");
		$("#blackout_error_ajax,#error_msg_div_ajax").css({'visibility':'visible'});
		return false;
	}
	if($("#paragraph_1").val()=="")
	{
		$("#error_msg_string_ajax").html("Error : Please enter Paragraph...");
		$("#blackout_error_ajax,#error_msg_div_ajax").css({'visibility':'visible'});
		return false;
	}
	
	var ans=confirm("Add Now?");
	if(ans==true)
	{
		$("#blackout").css({'visibility':'visible'});
		return true;
	}
	else
	{
		return false;
	}
}
</script>