templates/default/ppi_update.tpl

   1 {app_header}
   2
   3 <center>
   4         <form action="{actionurl}" method="POST">
   5         <input type=hidden name=interviewer value={interviewer}>
   6         <input type=hidden name=elder value={elder}>
   7         <input type=hidden name=companionship value={companionship}>
   8         <input type=hidden name=eqpresppi value={eqpresppi}>
   9         <table border="0" width="60%" cellspacing="2" cellpadding="2">
  10                 <tr>
  11                         <td align="center" bgcolor="#c9c9c9"><font face="{font}"><b>{lang_action}:&nbsp;{name}</b></font></td>
  12                 </tr>
  13                 <tr>
  14                         <td align="left"><font face="{font}"><b>Name:</b>&nbsp;
  15                         <input type=text size="30" name="name" value="{name}" READONLY></td>
  16                 </tr>
  17                 <tr>
  18                         <td align="left"><font face="{font}"><b>Interviewer:</b>&nbsp;
  19                         <select name="interviewer" disabled>
  20 <!-- BEGIN interviewer_list -->
  21                         <option value={interviewer}>{interviewer_name}</option>
  22 <!-- END interviewer_list -->
  23                         </select>
  24                 </tr>
  25                 <tr>
  26                         <td align="left"><font face="{font}"><b>Date:</b>&nbsp;
  27                         {cal_date}
  28                         </td>
  29                 </tr>
  30                 <tr>
  31                         <td align="left"><font face="{font}"><b>Notes:</b></font></td>
  32                 </tr>
  33                 <tr>
  34                         <td align="left"><font face="{font}" size="{font_size}">
  35                         <textarea cols="60" rows="10" name="notes" wrap="virtual" {readonly}>{notes}</textarea></font></td>
  36                 </tr>
  37         </table>
  38
  39 <!-- BEGIN add -->
  40         <table width="70%" border="0" cellspacing="2" cellpadding="2" align=left>
  41                 <tr valign="bottom">
  42                         <td height="50" align="right">
  43                                 <font face="{font}"><input type="submit" name="addnote" value="{lang_save}"></font></td>
  44                         <td height="50" align="center">
  45                                 <font face="{font}"><input type="reset" name="reset" value="{lang_reset}"></font></form></td>
  46                         <td height="50" align="center">
  47                                 <form action="{done_action}" method="POST">
  48                                 <font face="{font}"><input type="submit" name="done" value="{lang_done}"></font></form></td>
  49                 </tr>
  50         </table>
  51 </center>
  52 <!-- END add -->
  53
  54 <!-- BEGIN edit -->
  55         <table width="50%" border="0" cellspacing="2" cellpadding="2" align=left>
  56                 <tr valign="bottom" align="left">
  57                         <td height="50" align="right" valign="middle">
  58                                 <font face="{font}"><input type="submit" name="editnote" value="{lang_save}"></font>
  59                                 </form></td>
  60                         <td height="50" align="center" valign="middle">
  61                                 <form action="{done_action}" method="POST">
  62                                 <font face="{font}"><input type="submit" name="done" value="{lang_done}"></font></form></td>
  63                 </tr>
  64         </table>
  65 </center>
  66
  67 <!-- END edit -->
  68
  69 <!-- END form -->
  70
  71