<div id="page-content-wrapper">
<!-- Keep all page content within the page-content inset div! -->
  <div class="page-content inset">
<div class="row">
<div class="col-md-8">

<head>
   <!-- Direcciona al javascript para hacer las validaciones correspondientes -->
   <script type="text/javascript" src="<?php echo base_url()?>assets/dist/js/expediente.js"></script>
   <link rel="stylesheet" href="<?php echo base_url().'assets/dist/css/validacion.css'?>">
  </head>

<center><h1>Crear expediente</h1></center>

<body onload="mueveReloj()"> 
<form action="<?php echo base_url();?>expediente/administrador/expedienteA/guardar" method="POST"  name="form_reloj">


<table class="table table-striped">
    <tr class="row1">
   
    <td colspan="2"><strong>Folio</strong></td>
     
   <tr class="row2">
    <td colspan="2">
   
   <?php  

 $IdClientes= $this->uri->segment(5);


 $this->db->where('IdClientes', $IdClientes);
      $query=$this->db->get('clientes');



  ?>

<input type="text" class="form-control" id="txt_idcliente" name="Nombre"  value="<?=$IdClientes?>" maxlength='45' placeholder="Id Cliente" required readonly="readonly" >
  
  
  </tr>


  <input type="text" class="form-control" id="txt_idcliente" name="txt_idcliente"   value="<?=$IdClientes?>" maxlength='45' placeholder="Id Cliente" required readonly="readonly" style="visibility:hidden;" >

   
 <tr class="row1"><td><strong>¿Está bajo supervisión médica?</strong></td>   <td><strong>Tratamiento Médico: </strong></td></tr>
  <tr class="row2">

 <td>
     Si <input type="radio" name="SupervisionMedica" value="1"  > 
     No <input type="radio" name="SupervisionMedica" value="0"  > 
    </td>
    <td>
      Si <input type="radio" name="TratamientoMedico" value="1" onclick=" activar(true)"> 
      No <input type="radio" name="TratamientoMedico" value="0" onclick=" activar(false)" ><br> 
      ¿Cuáles? <input type="text" class="form-control" id="name1" name="CualTratamientoMedico" maxlength='11' >
    </td>
  </tr>


<tr class="row1"><td><strong>Tratamiento Quirúrgico:</strong></td><td><strong>¿Ha padecido alergías?</strong></td></tr>
  <tr class="row2">
    <td>
      Si <input type="radio" name="TratamientoQuirurgico" value="1" onclick="activarTQ(true)"> 
      No <input type="radio" name="TratamientoQuirurgico" value="0" onclick="activarTQ(false)"> <br> 
      ¿Cuál? <input type="text" class="form-control" id="name1" name="txt_cualtratqui" maxlength='45'  required="">
    </td>
    <td>
      Si <input type="radio" name="TieneAlergias" value="1" onclick="activarA(true)"> 
      No <input type="radio" name="TieneAlergias" value="0" onclick="activarA(false)"><br> 
      ¿Cuáles?<input type="text" class="form-control" id="name1" name="txt_cualalergias" maxlength='45'  required="">
    </td>
  </tr>

  <tr class="row1">
    <td colspan="2"><strong>Marque las enfermedades/afecciones que padece o ha padecido:</strong></td>
   </tr>
   <tr class="row2">
    <td colspan="2">
    
    
    <label class="checkbox-inline">Cuperosis</label>
     <input type="checkbox" name="TCuperosis" class="form-check-input" value="1">
    <label class="checkbox-inline">Implantes </label>
     <input type="checkbox" name="TImplantes" class="form-check-input" value="1" > 
     <label class="checkbox-inline">Claustrofobia </label>
     <input type="checkbox" name="TClaus" class="form-check-input" value="1" >
      <label class="checkbox-inline">Diabetes </label>&nbsp;
     <input type="checkbox" name="TDiabetes" class="form-check-input" value="1">
     <label class="checkbox-inline">Hepatitis</label>
     <input type="checkbox" name="THepatitis" class="form-check-input" value="1">
     <label class="checkbox-inline">Cardiopatías </label>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="TCardio" class="form-check-input" value="1" >
     <label class="checkbox-inline">Problemas Circulatoríos</label>
     <input type="checkbox" name="PCirculatorios" class="form-check-input" value="1">
     <label class="checkbox-inline">Cicatrización queloide </label>
     <input type="checkbox" name="TCicatrizacion" class="form-check-input" value="1"></br>
     <label class="checkbox-inline">Rosácea </label>&nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="TRosacea" class="form-check-input" value="1" >
     <label class="checkbox-inline">Vitiligo</label>&nbsp;&nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="TVitiligo" class="form-check-input" value="1" >
     <label class="checkbox-inline">Hipotensión</label>&nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="THipotension" class="form-check-input" value="1" >
     <label class="checkbox-inline">Migraña</label> &nbsp;
     <input type="checkbox" name="TMigraña" class="form-check-input" value="1">
     <label class="checkbox-inline">Miomas  </label> &nbsp;
     <input type="checkbox" name="TMiomas" class="form-check-input" value="1">
     <label class="checkbox-inline">Hiportiroidismo</label>
       <input type="checkbox" name="THipo" class="form-check-input" value="1">
     <label class="checkbox-inline">Desajustes Hormonales </label>
     <input type="checkbox" name="THormonales" class="form-check-input" value="1">
     <label class="checkbox-inline">Retencion de liquidos </label>&nbsp;
     <input type="checkbox" name="TRetencion" class="form-check-input" value="1" ></br>
       <label class="checkbox-inline">Psoriasis</label>&nbsp;&nbsp;
     <input type="checkbox" name="TPso" class="form-check-input" value="1">
     <label class="checkbox-inline">Herpes </label>  &nbsp; &nbsp;&nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="THerpes" class="form-check-input" value="1" >
      <label class="checkbox-inline">Hipertensión</label>&nbsp;
     <input type="checkbox" name="THipertension" class="form-check-input" value="1">
     <label class="checkbox-inline">Quistes </label> &nbsp;&nbsp;
     <input type="checkbox" name="TQuistes" class="form-check-input" value="1" >
   <label class="checkbox-inline">Hernias </label>&nbsp;&nbsp;
     <input type="checkbox" name="THernias" class="form-check-input" value="1">
     <label class="checkbox-inline">Hipertiroidismo </label>
     <input type="checkbox" name="THiperteiro" class="form-check-input" value="1" >
     <label class="checkbox-inline">Insuficiencia Hepática</label>  &nbsp;&nbsp;
     <input type="checkbox" name="TIHepatica" class="form-check-input" value="1">
     <label class="checkbox-inline">Insuficiencia Renal </label> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp; 
     <input type="checkbox" name="IRenal" class="form-check-input" value="1"></br>
    <label class="checkbox-inline">Prótesis </label>  &nbsp;&nbsp; 
     <input type="checkbox" name="TProtesis" class="form-check-input" value="1">
              <label class="checkbox-inline">Dermatitis </label>
     <input type="checkbox" name="TDerma" class="form-check-input" value="1">
      <label class="checkbox-inline">Marcapasos  </label> &nbsp; &nbsp; 
     <input type="checkbox" name="TMarcapasos" class="form-check-input" value="1" >
      <label class="checkbox-inline">Cáncer </label>&nbsp;&nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="TCancer" class="form-check-input" value="1" >
      <label class="checkbox-inline">Artritis</label> &nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="TArtritis" class="form-check-input" value="1">
          <label class="checkbox-inline">Colesterol Alto </label>  &nbsp;
     <input type="checkbox" name="TColesterolA" class="form-check-input" value="1" >
     <label class="checkbox-inline">Problemas Auditivos </label>  &nbsp; &nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="TPAuditivos" class="form-check-input" value="1" >
     <label class="checkbox-inline">Trigliseridos Altos </label>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="TTrigliseridosA" name="TTrigliseridosA" class="form-check-input" value="1" ></br>
     <label class="checkbox-inline">Alergias</label>&nbsp;&nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="TAlergias" name="TTrigliseridosA" class="form-check-input" value="1" >
     <label class="checkbox-inline">Desajustes Óseos</label> &nbsp;&nbsp;
     <input type="checkbox" name="TOseos" class="form-check-input" value="1" >
     <label class="checkbox-inline">Acantosis nigricans</label>&nbsp;
     <input type="checkbox" name="TAcantosis" name="TTrigliseridosA" class="form-check-input" value="1" >
      <label class="checkbox-inline">Cirugías </label>&nbsp;&nbsp;
     <input type="checkbox" name="TCirugias" class="form-check-input" value="1" >
     <label class="checkbox-inline">Epilepsia </label>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="TEpilepsia" class="form-check-input" value="1" >
     <label class="checkbox-inline">Placas o metales en el cuerpo </label> 
     <input type="checkbox" name="TPlacas" class="form-check-input" value="1" ></br>
     <label class="checkbox-inline" name="TOtras">Otras </label>  &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
     <input type="checkbox" name="Otras" class="form-check-input" value="1" ><input type="text" class="form-control" " name="Cuales" maxlength='45'  placeholder="Especificar"  >&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</br>


      Si marcó alguna de las enfermedades/afecciones anteriores favor de describir la situación actual:
      <textarea class="form-control" rows="6" id="name1" name="TComentarios" required="" required=""  ></textarea>
    </td></tr>

<tr class="row1">
  <td colspan="2"><strong>Marque los medicamentos que ha ingerido en los ultimos 6 meses:</strong></td>
  </tr>
  <tr class="row2">
  <td colspan="2">
  <label class="checkbox-inline">Antiacnéticos</label> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
  <input type="checkbox" id="Antiacneticos" name="Antiacneticos" value="1">
  <label class="checkbox-inline">Corticoides</label> &nbsp;&nbsp;&nbsp;&nbsp;
  <input type="checkbox" id="Corticoides" name="Corticoides" value="1">
  <label class="checkbox-inline">Antihistamínicos </label> &nbsp;&nbsp;&nbsp;&nbsp;
  <input type="checkbox" name="Antihi" value="1" >
  <label class="checkbox-inline">Antiarrítmicos </label>&nbsp;&nbsp;&nbsp;&nbsp;
  <input type="checkbox" name="Antirritmicos" value="1" >
  <label class="checkbox-inline">Naturistas</label> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
  <input type="checkbox"  name="Naturistas" value="1">
    <label class="checkbox-inline">Medicamentos orales para deabetes </label>
  <input type="checkbox" name="MOrales" value="1" ></br>
  <label class="checkbox-inline">Antidepresivos </label>&nbsp;&nbsp;&nbsp;&nbsp; 
  <input type="checkbox" name="Antidepresivos" value="1" >
    <label class="checkbox-inline">Analgésicos</label> &nbsp;&nbsp;&nbsp;
  <input type="checkbox"  name="Analgesicos" value="1" >
    <label class="checkbox-inline">Vitaminas </label>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
  <input type="checkbox" name="Vitaminas" value="1" >
  <label class="checkbox-inline">Homeopáticos </label>&nbsp;&nbsp;&nbsp;
  <input type="checkbox" name="Homeo" value="1">
    <label class="checkbox-inline">Antibióticos </label>&nbsp;&nbsp;&nbsp;&nbsp;
  <input type="checkbox" name="Antibiotico" value="1" > 
    <label class="checkbox-inline">Estimulantes de Pigmentación </label> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  
  <input type="checkbox" name="Pigmentacion" value="1" ></br>
  <label class="checkbox-inline">Otros </label>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
  <input type="checkbox" name="Otros" value="1">
  <label class="checkbox-inline">Medicamentos para epilepsia </label>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
  <input type="checkbox" name="MEpilepcia" value="1" >
 </br></br>
      Si marcó alguno de los medicamentos anteriores favor de describir la cantidad,periodicidad y fecha de última toma:
      <textarea class="form-control" rows="6" id="name1" name="Observaciones" required=""  > </textarea>
  </tr>


    </td></tr>
  

  <tr class="row1">
    <td><strong>Cirugías</strong></td>
    <td><strong>Implantes</strong></td>
  </tr>
  <td>
      Si <input type="radio" name="CirugiasPlasticas" value="1" onclick="activarCP(true)"> 
      No <input type="radio" name="CirugiasPlasticas" value="0" onclick="activarCP(false)"> <br>
       ¿Cuál? <input type="text" class="form-control" id="name1" name="txt_cirpla" maxlength='45'  required="">
    </td>
    <td>
      Si <input type="radio" name="Implantes" value="1" onclick="activarI(true)"> 
      No <input type="radio" name="Implantes" value="0" onclick="activarI(false)"><br> 
      ¿Cuál? <input type="text" class="form-control" id="name1" name="txt_cualimplantes" maxlength='45'  required="">
    </td>
  
  <tr class="row1">
    <td><strong>Desajustes oseos</strong></td>
    <td><strong>Medicamentos en los últimos 6 meses</strong></td>
  </tr>
  <td>
      Si <input type="radio" name="DesajustesOseos" value="1" onclick="activarDO(true)"> 
      No <input type="radio" name="DesajustesOseos" value="0" onclick="activarDO(false)"> <br>
      ¿Cuál? <input type="text" class="form-control" id="name1" name="txt_cualdes" maxlength='45'  required="" >
    </td>
    <td>
      Si <input type="radio" name="MedicamentosUltimosMeses" value="1" onclick="activarM(true)"> 
      No <input type="radio" name="MedicamentosUltimosMeses" value="0" onclick="activarM(false)"><br> 
      ¿Cuál? <input type="text" class="form-control" id="name1" name="CualesMedicamentos" maxlength='45'  >
    </td>
  
  <tr class="row1">
    <td><strong>Autorización médica</strong></td>
  </tr>
  <td>
      Si <input type="radio" name="AutorizaciónMedica" value="1" onclick="activarMed(true)"> 
      No <input type="radio" name="AutorizaciónMedica" value="0" onclick="activarMed(false)"></br> 
      Detalles autorización<input type="text" class="form-control" id="name1" name="CualMedico" maxlength='45'  >
     
    </td>
    
  <tr class="row1">
    <td colspan="2"><strong>Diagnóstico y observaciones</strong></td>
  </tr>
  <tr class="row2">
    <td colspan="2" align="center"> <textarea class="form-control" rows="6" id="name1" name="txt_diayobs"   required=""></textarea></td>
  </tr>

  
  <tr class="row1" align="left"> <td colspan="2">
      <strong>Historia</strong></td>
  </tr> 
<tr class="row2" align="center">
    <td colspan="2"> 
    <textarea class="form-control" rows="6" id="name1" name="txt_historia"  required=""> </textarea>
        <br>
    </td>
</tr>


  </table>

<button type="submit" class="btn btn-primary">Guardar</button>
  
<a href="<?php echo base_url();?>clientes/administrador/clienteA"> <button type="button" class="btn btn-danger">Cancelar</button></a>
<?php $jo=$this->session->userdata('IdUsuarios')?>

   <input type="text" class="form-control" name="usuario" value="<?=$jo?>" maxlength='11'  required readonly="readonly" style="visibility:hidden;">
<?php $time = time();  date("d-m-Y H:i:s", $time); 
?>
 <input type="text" class="form-control" id="Time" name="Time" value="<?=date("d-m-Y H:i:s", $time);?>"   style="visibility:hidden;" >
  <?php $time = time();  date("d-m-Y", $time);?>
 <input type="text" class="form-control" id="Time" name="Time" value="<?=date("d-m-Y", $time);?>"   style="visibility:hidden;" >
  <input type="text" name="reloj" size="10" style="visibility:hidden;" > 
</form>
</div>
</div>
</div>
</div>
</body>
</html>


