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resident_add_form.php
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<?php include 'server/server.php' ?>
<!DOCTYPE html>
<html lang="en">
<head>
<?php include 'templates/header.php' ?>
<title>Resident - Masili Health Service System</title>
</head>
<body>
<div class="wrapper">
<?php include 'templates/main-header.php' ?>
<?php include 'templates/sidebar.php' ?>
<div class="main-panel">
<div class="content">
<div class="page-inner">
<div class="row mt--2">
<div class="col-md-12">
<?php include 'templates/loading_screen.php' ?>
<div class="card">
<div class="card-header">
<div class="card-head-row">
<div class="card-title">
<h1>
<a href="resident.php" class="text-primary">RESIDENT</a> > <strong class="text-default">CREATE</strong></h1>
</div>
</div>
</div>
<div class="card-body">
<form method="POST" action="resident_add_record.php">
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="first_name">First Name</label>
<input type="text" class="form-control mb-1" id="first_name" name="first_name" required>
</div>
<div class="form-group">
<label for="middle_name">Middle Name</label>
<input type="text" class="form-control mb-1" id="middle_name" name="middle_name" required>
</div>
<div class="form-group">
<label for="last_name">Last Name</label>
<input type="text" class="form-control mb-1" id="last_name" name="last_name" required>
</div>
<div class="form-group">
<label for="age">Age</label>
<input type="number" class="form-control" id="age" name="age" required>
</div>
<div class="form-group">
<label>Birthdate:</label>
<input type="date" class="form-control" name="birthdate" id="date" required>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="civil_status">Civil Status</label>
<select class="form-control" id="civil_status" name="civil_status" required>
<option selected="true" disabled="disabled">--</option>
<option>SINGLE</option>
<option>MARRIED</option>
<option>WIDOWED</option>
</select>
</div>
<div class="form-group">
<label for="gender">Gender</label>
<select class="form-control" id="gender" name="gender" required>
<option selected="true" disabled="disabled">--</option>
<option>MALE</option>
<option>FEMALE</option>
</select>
</div>
<div class="form-group">
<label for="purok">Purok</label>
<select class="form-control" id="purok" name="purok" required>
<option selected="true" disabled="disabled">--</option>
<option>PUROK 1</option>
<option>PUROK 2</option>
<option>PUROK 3</option>
<option>PUROK 4</option>
<option>PUROK 5</option>
<option>PUROK 6</option>
<option>PUROK 7</option>
<option>PUROK 8</option>
<option>PUROK 9</option>
</select>
</div>
<div class="form-group">
<label for="voterstatus">Voterstatus</label>
<select class="form-control" id="voter" name="voterstatus" required>
<option selected="true" disabled="disabled">--</option>
<option>Yes</option>
<option>No</option>
</select>
</div>
<div class="form-group">
<button type="submit" class="btn btn-primary mt-2 mb-2">Create</button>
</div>
</div>
</div>
</form>
</div>
<!-- end of medicine table -->
</div>
</div>
</div>
</div>
</div>
<!-- Main Footer -->
<?php include 'templates/main-footer.php' ?>
<!-- End Main Footer -->
</div>
</div>
<?php include 'templates/footer.php' ?>
<script src="assets/js/plugin/datatables/datatables.min.js"></script>
<style>
.text-primary, .text-primary a{
color: #1c9790 !important;
}
.btn-primary, .btn-primary:hover, .btn-primary:focus, .btn-primary:disabled{
background: #1c9790 !important;
border-color: #1c9790 !important;
}
.text-primary:hover, .text-primary a:hover{
color: #1c9790 !important;
}
</style>
</body>
</html>