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registrar_paciente.php
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registrar_paciente.php
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<meta name="description" content="">
<meta name="author" content="">
<title>Clinica_Registro</title>
<!-- Custom fonts for this template-->
<link href="vendor/fontawesome-free/css/all.min.css" rel="stylesheet" type="text/css">
<link href="https://fonts.googleapis.com/css?family=Nunito:200,200i,300,300i,400,400i,600,600i,700,700i,800,800i,900,900i" rel="stylesheet">
<!-- Custom styles for this template-->
<link href="css/sb-admin-2.min.css" rel="stylesheet">
</head>
<body id="page-top">
<!-- Page Wrapper -->
<div id="wrapper">
<!-- Sidebar -->
<ul class="navbar-nav bg-gradient-primary sidebar sidebar-dark accordion" id="accordionSidebar">
<!-- Sidebar - Brand -->
<a class="sidebar-brand d-flex align-items-center justify-content-center" href="index.php">
<div class="sidebar-brand-icon rotate-n-15">
<i class="fas fa-laugh-wink"></i>
</div>
<div class="sidebar-brand-text mx-3">Clinica Odontologica<sup></sup></div>
</a>
<!-- Divider -->
<hr class="sidebar-divider my-0">
<!-- Nav Item - Inicio -->
<li class="nav-item active">
<a class="nav-link" href="index.php">
<i class="fas fa-fw fa-tachometer-alt"></i>
<span>Inicio</span></a>
</li>
<!-- Divider -->
<hr class="sidebar-divider">
<!-- Heading -->
<div class="sidebar-heading">
Menu </div>
<!-- Nav Item - Pages Collapse Menu -->
<li class="nav-item">
<a class="nav-link collapsed" href="#" data-toggle="collapse" data-target="#collapseTwo" aria-expanded="true" aria-controls="collapseTwo">
<i class="fas fa-fw fa-cog"></i>
<span>Registro Paciente</span>
</a>
<div id="collapseTwo" class="collapse" aria-labelledby="headingTwo" data-parent="#accordionSidebar">
<div class="bg-white py-2 collapse-inner rounded">
<h6 class="collapse-header">Opciones</h6>
<a class="collapse-item" href="registrar_paciente.php">Registrar</a>
</div>
</div>
</li>
<!-- Nav Item - Utilities Collapse Menu -->
<li class="nav-item">
<a class="nav-link collapsed" href="#" data-toggle="collapse" data-target="#collapseUtilities" aria-expanded="true" aria-controls="collapseUtilities">
<i class="fas fa-fw fa-wrench"></i>
<span>Asignacion de citas</span>
</a>
<div id="collapseUtilities" class="collapse" aria-labelledby="headingUtilities" data-parent="#accordionSidebar">
<div class="bg-white py-2 collapse-inner rounded">
<a class="collapse-item" href="citas.php">Citas</a>
</div>
</div>
</li>
<!-- Divider --
<hr class="sidebar-divider">
<!- Heading
<div class="sidebar-heading">
Addons
</div>
<!- Nav Item - Pages Collapse Menu -->
<li class="nav-item">
<a class="nav-link collapsed" href="#" data-toggle="collapse" data-target="#collapsePages" aria-expanded="true" aria-controls="collapsePages">
<i class="fas fa-fw fa-folder"></i>
<span>Consultas</span>
</a>
<div id="collapsePages" class="collapse" aria-labelledby="headingPages" data-parent="#accordionSidebar">
<div class="bg-white py-2 collapse-inner rounded">
<a class="collapse-item" href="observacionesform.php">Observaciones</a>
</div>
</div>
</li>
<!-- Divider -->
<hr class="sidebar-divider d-none d-md-block">
<!-- Sidebar Toggler (Sidebar) -->
<div class="text-center d-none d-md-inline">
<button class="rounded-circle border-0" id="sidebarToggle"></button>
</div>
</ul>
<!-- End of Sidebar -->
<!-- Content Wrapper -->
<div id="content-wrapper" class="d-flex flex-column">
<!-- Main Content -->
<div id="content">
<!-- Topbar -->
<nav class="navbar navbar-expand navbar-light bg-white topbar mb-4 static-top shadow">
<!-- Sidebar Toggle (Topbar) -->
<button id="sidebarToggleTop" class="btn btn-link d-md-none rounded-circle mr-3">
<i class="fa fa-bars"></i>
</button>
<!-- Topbar Navbar -->
<ul class="navbar-nav ml-auto">
<!-- Nav Item - User Information -->
<li class="nav-item dropdown no-arrow">
<a class="nav-link dropdown-toggle" href="#" id="userDropdown" role="button" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">
<span class="mr-2 d-none d-lg-inline text-gray-600 small"> Secretaria </span>
<img class="img-profile rounded-circle" src="https://source.unsplash.com/QAB-WJcbgJk/60x60">
</a>
<!-- Dropdown - User Information -->
<div class="dropdown-menu dropdown-menu-right shadow animated--grow-in" aria-labelledby="userDropdown">
<a class="dropdown-item" href="#">
<i class="fas fa-user fa-sm fa-fw mr-2 text-gray-400"></i>
Profile
</a>
<a class="dropdown-item" href="#">
<i class="fas fa-cogs fa-sm fa-fw mr-2 text-gray-400"></i>
Settings
</a>
<a class="dropdown-item" href="#">
<i class="fas fa-list fa-sm fa-fw mr-2 text-gray-400"></i>
Actividad
</a>
<div class="dropdown-divider"></div>
<a class="dropdown-item" href="#" data-toggle="modal" data-target="#logoutModal">
<i class="fas fa-sign-out-alt fa-sm fa-fw mr-2 text-gray-400"></i>
Logout
</a>
</div>
</li>
</ul>
</nav>
<!-- End of Topbar -->
<!-- Begin Page Content -->
<div class="container-fluid">
<!-- Circle Buttons -->
<div class="card shadow mb-8">
<div class="card-header py-12">
<h6 class="m-0 font-weight-bold text-primary"> Registrar Paciente </h6>
</div>
<div class="card-body">
<form method="POST" action="Cregistrarpaciente.php">
<div class="col-md-6 mb-3">
<label for="nombres"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Nombres</font>
</font></label>
<input type="text" class="form-control" id="nombres" name="nombres" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="apellidos"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Apellidos</font>
</font></label>
<input type="text" class="form-control" id="apellidos" name="apellidos" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="fecha_nacimiento"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Fecha Nacimiento</font>
</font></label>
<input type="date" class="form-control" id="fecha_nacimiento" name="fecha_nacimiento" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="genero"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Genero</font>
</font></label>
<input type="text" class="form-control" id="genero" name="genero" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="direccion"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Direccion</font>
</font></label>
<input type="text" class="form-control" id="direccion" name="direccion" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="correo"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Correo </font>
</font></label>
<input type="text" class="form-control" id="correo" name="correo" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="telefono"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Numero de telefono</font>
</font></label>
<input type="is_numeric" class="form-control" id="telefono" name="telefono" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="dui"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">DUI</font>
</font></label>
<input type="is_numeric" class="form-control" id="dui" name="dui" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="nit"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">NIT</font>
</font></label>
<input type="is_numeric" class="form-control" id="nit" name="nit" placeholder="" value="" required>
</div>
<h5 class="m-0 font-weight-bold text-primary">
</h5>
<div class="col-md-6 mb-3">
<label for="responsableNombre"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Responsable Nombre</font>
</font></label>
<input type="text" class="form-control" id="responsableNombre" name="responsableNombre" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="responsablecontacto"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Responsable contacto</font>
</font></label>
<input type="is_numeric" class="form-control" id="responsablecontacto" name="responsablecontacto" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="alergias"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Alergia</font>
</font></label>
<input type="text" class="form-control" id="alergias" name="alergias" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="medicamentos"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">Medicamentos</font>
</font></label>
<input type="text" class="form-control" id="medicamentos" name="medicamentos" placeholder="" value="" required>
</div>
<div class="col-md-6 mb-3">
<label for="fechaRegistro"><font style="vertical-align: inherit;">
<font style="vertical-align: inherit;">fecha Registro </font>
</font></label>
<input type="date" class="form-control" id="fechaRegistro" name="fechaRegistro" placeholder="" value="" required>
</div>
<h5 class="m-0 font-weight-bold text-primary">
<div class="col-md-6 mb-3">
<button type="submit" name="guardar" class="btn btn-primary">Guardar datos</button>
</form>
<!-- Footer -->
<footer class="sticky-footer bg-white">
<div class="container my-auto">
<div class="copyright text-center my-auto">
<span>Clinica © Your Website 2019</span>
</div>
</div>
</footer>
<!-- End of Footer -->
</div>
<!-- End of Content Wrapper -->
</div>
<!-- End of Page Wrapper -->
<!-- Scroll to Top Button-->
<a class="scroll-to-top rounded" href="#page-top">
<i class="fas fa-angle-up"></i>
</a>
<!-- Logout Modal-->
<div class="modal fade" id="logoutModal" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<h5 class="modal-title" id="exampleModalLabel">Ready to Leave?</h5>
<button class="close" type="button" data-dismiss="modal" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
</div>
<div class="modal-body">Select "Logout" below if you are ready to end your current session.</div>
<div class="modal-footer">
<button class="btn btn-secondary" type="button" data-dismiss="modal">Cancel</button>
<a class="btn btn-primary" href="login.html">Logout</a>
</div>
</div>
</div>
</div>
<!-- Bootstrap core JavaScript-->
<script src="vendor/jquery/jquery.min.js"></script>
<script src="vendor/bootstrap/js/bootstrap.bundle.min.js"></script>
<!-- Core plugin JavaScript-->
<script src="vendor/jquery-easing/jquery.easing.min.js"></script>
<!-- Custom scripts for all pages-->
<script src="js/sb-admin-2.min.js"></script>
</body>
</html>