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<?php
include "db.php";
include "header.php";
include "sidebar.php";
$user_id=$_SESSION['id'];
$a=0;
$stmt=("SELECT * FROM `new_resume` WHERE `remark`=? AND `user`=?");
$result=$conn->query($stmt);
//mysqli_stmt_bind_param($stmt,"ss",$a,$log_id);
//$stmt->execute();
//$result=$stmt->get_result();
// $a=0;
// $select = "SELECT * FROM `new_resume` WHERE `remark`= $a ORDER BY id DESC LIMIT 1,3";
// $result = $conn->query($select);
while($row = $result->fetch_object())
{
$pdf = $row->resume;
$b = $row->id;
}
if (isset($_POST['form']))
{
//$remark=1;
//$query="UPDATE new_resume SET remark=? WHERE id=?";
//$stmt=$conn->prepare($query);
//$stmt->bind_param("ss",$remark,$b);
//$stmt->execute();
$name = $_POST['name'];
$country_1 = $_POST['country1'];
$state2 = $_POST['state2'];
$policy = $_POST['policy'];
$medicine = $_POST['medicine'];
$record =$_POST['record'];
$sex1 = $_POST['sex1'];
$zip2 = $_POST['zip2'];
$assure = $_POST['assure'];
$dosage =$_POST['dosage'];
$customer =$_POST['customer'];
$db = $_POST['db'];
$country2 =$_POST['country2'];
$p_inst = $_POST['p_inst'];
$tablets = $_POST['tablets'];
$email =$_POST['email'];
$height= $_POST['height'];
$phone2 =$_POST['phone2'];
$holder = $_POST['holder'];
$pill_rate = $_POST['pill_rate'];
$res_address = $_POST['res_address'];
$weight = $_POST['weight'];
$alcoholic = $_POST['alcoholic'];
$stm_name = $_POST['stm_name'];
$cost =$_POST['cost'];
$city1 = $_POST['city1'];
$blood = $_POST['blood'];
$smoker =$_POST['smoker'];
$stm_code = $_POST['stm_code'];
$shipping = $_POST['shipping'];
$state1 =$_POST['state1'];
$billing = $_POST['billing'];
$past_surg =$_POST['past_surg'];
$dob =$_POST['dob'];
$total =$_POST['total'];
$zip1 =$_POST['zip1'];
$shiper = $_POST['shiper'];
$diabletic =$_POST['diabletic'];
$sex2 = $_POST['sex2'];
$remark = $_POST['remark'];
$phone = $_POST['phone1'];
$city2 = $_POST['city2'];
$allergiesd =$_POST['allergiesd'];
$card = $_POST['card'];
$query = "INSERT INTO forms(name,email,country_1,state1,policy_no,medicine,record_no,sex,zip,life_assure,dosage,customer,db,country_2,p_inst,tablets,height,phone2,name_p_holder,pill_rate,res_address,weight,alcoholic,stm_name,cost,city1,blood,smoker,stm_code,shipping_cost,state,billing_name,past_surg,dob,total_amount,zip1,shiper_name,diabetic,sex2,remark,phone1,city2,allergiest,card,pdf,user_id,pdf_id)
VALUES ('".$name."', '".$email."', '".$country_1."', '".$state2."', '".$policy."', '".$medicine."', '".$record."', '".$sex1."', '".$zip2."', '".$assure."', '".$dosage."', '".$customer."', '".$db."', '".$country2."', '".$p_inst."', '".$tablets."', '".$height."', '".$phone2."', '".$holder."', '".$pill_rate."', '".$res_address."', '".$weight."', '".$alcoholic."', '".$stm_name."', '".$cost."', '".$city1."', '".$blood."', '".$smoker."', '".$stm_code."', '".$shipping."', '".$state1."', '".$billing."', '".$past_surg."', '".$dob."', '".$total."', '".$zip1."', '".$shiper."', '".$diabletic."', '".$sex2."', '".$remark."', '".$phone."', '".$city2."', '".$allergiesd."', '".$card."', '".$pdf."','".$user_id."','".$b."')";
mysqli_query($conn, $query);
}
?>
<style>
@media(max-width: 600px)
{
.hide{
display: none;
}
.hide1{
display: show;
}
}
@media(min-width: 601px)
{
.hide{
display: show;
}
.hide1{
display: none;
}
}
</style>
<style>
div.scrollmenu {
background-color: white;
overflow: auto;
white-space: nowrap;
}
div.scrollmenu a {
display: inline-block;
color: white;
text-align: center;
padding: 14px;
text-decoration: none;
}
div.scrollmenu a:hover {
background-color: white;
}
.previous {
background-color: #f1f1f1;
color: black;
}
.next {
background-color: #04AA6D;
color: white;
}
.round {
border-radius: 50%;
}
</style>
<main id="main" class="main">
<div class="pagetitle">
<h1>New Form</h1>
<nav>
<ol class="breadcrumb">
<li class="breadcrumb-item"><a href="index.php">Home</a></li>
<li class="breadcrumb-item active">Dashboard</li>
</ol>
</nav>
</div><!-- End Page Title -->
<section class="section dashboard">
<div class="row">
<!-- Left side columns -->
<div class="col-lg-12">
<div class="row">
<!-- Sales Card -->
<div class="col-sm-8" >
<div class="card info-card sales-card" style="height: 500px;">
<div class="card-body" style="height: 550px; max-height: 82vh;overflow-y: scroll;">
<div class="card-title">
<h4 style="font-family: Times New Roman;font-size: 19px;"><b> New Form</b></h4>
</div>
<button onclick="zoomIn()" class="btn btn-danger" style="font-size: 10px;">Zoom-In</button>
<button onclick="zoomOut()" class="btn btn-dark" style="font-size: 10px;">Zoom-Out</button>
<!-- <iframe src="assets/img/<?php echo $pdf; ?>" width="100%" height="350px"></iframe> -->
<!-- <iframe src="assets/img/AnupChavhan_Resume.pdf" width="100%" height="300px"></iframe> -->
<img src="assets/img/<?php echo $pdf; ?>" id="pic" class="card-img-bottom" alt="..." style="height:auto;">
</div>
</div>
</div><!-- End Sales Card -->
<!-- Customers Card -->
<div class="col-sm-4">
<div class="card info-card customers-card hide" >
<div class="card-body" style="height: 550px; max-height: 82vh;overflow-y: scroll;">
<div class="card-title">
<h4 style="font-family: Times New Roman;font-size: 19px;"><b><center>New Form</center></b></h4>
</div>
<form method="post" >
<div class="row mb-3">
<div class="form-group" >
<input name="name" type="text" class="form-control" placeholder="Image Name">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="email" type="text" class="form-control" placeholder="Email Address ">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="state1" type="text" class="form-control" placeholder="State_1">
</div>
<div class="row mb-3">
<div class="form-group">
<input name="country1" type="text" class </div>
="form-control" placeholder="Country_1">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="height" type="text" class="form-control" placeholder="Height">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="billing" type="text" class="form-control" placeholder="Billing Name">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="state2" type="text" class="form-control" placeholder="State_2">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="phone2" type="text" class="form-control" placeholder="Phone_Number-2">
</div>
</div><div class="row mb-3">
<div class="form-group">
<input name="past_surg" type="text" class="form-control" placeholder="Past Surg">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="policy" type="text" class="form-control" placeholder="Policy number">
</div>
</div><div class="row mb-3">
<div class="form-group">
<input name="holder" type="text" class="form-control" placeholder="Name_P_Holder">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="dob" type="text" class="form-control" placeholder="DOB">
</div>
</div><div class="row mb-3">
<div class="form-group">
<input name="medicine" type="text" class="form-control" placeholder="Medicine">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="pill_rate" type="text" class="form-control" placeholder="Pill Rate">
</div>
</div><div class="row mb-3">
<div class="form-group">
<input name="total" type="text" class="form-control" placeholder="Total Amount">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="record" type="text" class="form-control" placeholder="Record No">
</div>
</div><div class="row mb-3">
<div class="form-group">
<input name="res_address" type="text" class="form-control" placeholder="Res_Address">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="zip1" type="text" class="form-control" placeholder="Zip_1">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="sex1" type="text" class="form-control" placeholder="Sex_1">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="weight" type="text" class="form-control" placeholder="Weight">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="shiper" type="text" class="form-control" placeholder="Shiper Name">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="zip2" type="text" class="form-control" placeholder="Zip_2">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="alcoholic" type="text" class="form-control" placeholder="Alcoholic">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="diabletic" type="text" class="form-control" placeholder="Diabetic">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="assure" type="text" class="form-control" placeholder="D_B_Life Assure">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="stm_name" type="text" class="form-control" placeholder="STM Name">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="sex2" type="text" class="form-control" placeholder="Sex_2">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="dosage" type="text" class="form-control" placeholder="Dosage">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="cost" type="text" class="form-control" placeholder="Cost">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="remark" type="text" class="form-control" placeholder="Remark">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="customer" type="text" class="form-control" placeholder="Customer Name">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="city1" type="text" class="form-control" placeholder="City_1">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="phone1" type="text" class="form-control" placeholder="Phone_Number 1">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="db" type="text" class="form-control" placeholder="D_Birth">
</div>
</div> <div class="row mb-3">
<div class="form-group">
<input name="blood" type="text" class="form-control" placeholder="Blood GP">
</div>
</div> <div class="row mb-3">
<div class="form-group">
<input name="city2" type="text" class="form-control" placeholder="City_2">
</div>
</div> <div class="row mb-3">
<div class="form-group">
<input name="country2" type="text" class="form-control" placeholder="Country_2">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="smoker" type="text" class="form-control" placeholder="Smoker">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="allergiesd" type="text" class="form-control" placeholder="Allergisd">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="p_inst" type="text" class="form-control" placeholder="P_Inst">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="stm_code" type="text" class="form-control" placeholder="STM Code">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="card" type="text" class="form-control" placeholder="Card Name">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="tablets" type="text" class="form-control" placeholder="Tablets">
</div>
</div>
<div class="row mb-3">
<div class="form-group">
<input name="shipping" type="text" class="form-control" placeholder="Shipping Cost">
</div>
</div>
<div class="text-center">
<button type="submit" name="form" class="btn btn-primary" style="background-image:linear-gradient( rgba(252,37,103,1) 0%, rgba(250,38,151,1) );">Submit</button>
</div>
</form>
</div>
</div>
</div><!-- End Customers Card -->
<!-- Customers Card -->
<div class="col-sm-4">
<div class="card info-card customers-card hide1" >
<div class="card-body" style="">
<form method="post" >
<div class="scrollmenu">
<a href="#home">
<input name="name" type="text" class="form-control" placeholder="Image Name">
</a>
<a href="#news">
<input name="email" type="text" class="form-control" placeholder="Email Address ">
</a>
<a href="#contact">
<input name="state1" type="text" class="form-control" placeholder="State_1">
</a>
<a href="#about">
<input name="country1" type="text" class="form-control" placeholder="Country_1">
</a>
<a href="#support">
<input name="height" type="text" class="form-control" placeholder="Height">
</a>
<a href="#blog">
<input name="billing" type="text" class="form-control" placeholder="Billing Name">
</a>
<a href="#tools">
<input name="state2" type="text" class="form-control" placeholder="State_2">
</a>
<a href="#base">
<input name="phone2" type="text" class="form-control" placeholder="Phone_Number-2">
</a>
<a href="#custom">
<input name="past_surg" type="text" class="form-control" placeholder="Past Surg">
</a>
<a href="#more">
<input name="policy" type="text" class="form-control" placeholder="Policy number">
</a>
<a href="#logo">
<input name="holder" type="text" class="form-control" placeholder="Name_P_Holder">
</a>
<a href="#friends">
<input name="dob" type="date" class="form-control" placeholder="DOB">
</a>
<a href="#partners">
<input name="medicine" type="text" class="form-control" placeholder="Medicine">
</a>
<a href="#people">
<input name="pill_rate" type="text" class="form-control" placeholder="Pill Rate">
</a>
<a href="#work">
<input name="total" type="text" class="form-control" placeholder="Total Amount">
</a>
<a href="">
<input name="record" type="text" class="form-control" placeholder="Record No">
</a>
<a href="">
<input name="res_address" type="text" class="form-control" placeholder="Res_Address">
</a>
<a href="">
<input name="zip1" type="text" class="form-control" placeholder="Zip_1">
</a>
<a href="">
<input name="sex1" type="text" class="form-control" placeholder="Sex_1">
</a>
<a href="">
<input name="weight" type="text" class="form-control" placeholder="Weight">
</a>
<a href="">
<input name="shiper" type="text" class="form-control" placeholder="Shiper Name">
</a>
<a href="">
<input name="zip2" type="text" class="form-control" placeholder="Zip_2">
</a>
<a href="">
<input name="alcoholic" type="text" class="form-control" placeholder="Alcoholic">
</a>
<a href="">
<input name="diabletic" type="text" class="form-control" placeholder="Diabetic">
</a>
<a href="">
<input name="assure" type="text" class="form-control" placeholder="D_B_Life Assure">
</a>
<a href="">
<input name="stm_name" type="text" class="form-control" placeholder="STM Name">
</a>
<a href="">
<input name="sex2" type="text" class="form-control" placeholder="Sex_2">
</a>
<a href="">
<input name="dosage" type="text" class="form-control" placeholder="Dosage">
</a>
<a href="">
<input name="cost" type="text" class="form-control" placeholder="Cost">
</a>
<a href="">
<input name="remark" type="text" class="form-control" placeholder="Remark">
</a>
<a href="">
<input name="customer" type="text" class="form-control" placeholder="Customer Name">
</a>
<a href="">
<input name="city1" type="text" class="form-control" placeholder="City_1">
</a>
<a href="">
<input name="phone1" type="text" class="form-control" placeholder="Phone_Number 1">
</a>
<a href="">
<input name="db" type="text" class="form-control" placeholder="D_Birth">
</a>
<a href="">
<input name="blood" type="text" class="form-control" placeholder="Blood GP">
</a>
<a href="">
<input name="city2" type="text" class="form-control" placeholder="City_2">
</a>
<a href="">
<input name="country2" type="text" class="form-control" placeholder="Country_2">
</a>
<a href="">
<input name="smoker" type="text" class="form-control" placeholder="Smoker">
</a>
<a href="">
<input name="allergiesd" type="text" class="form-control" placeholder="Allergisd">
</a>
<a href="">
<input name="p_inst" type="text" class="form-control" placeholder="P_Inst">
</a>
<a href="">
<input name="stm_code" type="text" class="form-control" placeholder="STM Code">
</a>
<a href="">
<input name="card" type="text" class="form-control" placeholder="Card Name">
</a>
<a href="">
<input name="tablets" type="text" class="form-control" placeholder="Tablets">
</a>
<a href="">
<input name="shipping" type="text" class="form-control" placeholder="Shipping Cost">
</a>
<a href="">
<button type="submit" name="form" class="btn btn-primary" style="background-image: linear-gradient( 99.4deg, rgba(247,0,0,1) 0.8%, rgba(10,35,104,1) 99.4% );">Submit</button>
</a>
</div>
</form>
</div>
</div>
</div>
<!--
<div class="col-sm-4 ">
<div class="card info-card customers-card hide" >
<div class="card-body" style="height: 550px; max-height: 82vh;overflow-y: scroll;">
<div class="card-title">
<h4 style="font-family: Times New Roman;font-size: 19px;"><b><center>New Form</center></b></h4>
<h1>hdjskjsk</h1>
</div>
</div></div></div> -->
</div>
</div><!-- End Left side columns -->
</div>
</section>
</main><!-- End #main -->
<script>
function zoomIn() {
var pic = document.getElementById("pic");
var width = pic.clientWidth;
pic.style.width = width + 100 + "px";
}
function zoomOut() {
var pic = document.getElementById("pic");
var width = pic.clientWidth;
pic.style.width = width - 100 + "px";
}
</script>
<?php
include "footer.php";
?>