{"id":1824,"date":"2016-06-16T14:15:30","date_gmt":"2016-06-16T12:15:30","guid":{"rendered":"https:\/\/geneinfo.rs\/biogena-registracija\/"},"modified":"2021-12-09T14:38:34","modified_gmt":"2021-12-09T13:38:34","slug":"biogena-registration","status":"publish","type":"page","link":"https:\/\/geneinfo.rs\/en\/biogena-registration\/","title":{"rendered":"Biogena Registracija Klijenta"},"content":{"rendered":"\n    <style>\n\t.patient_registraion_form {\n  float: left;\n  width: 100%;\n}\n.patient_registraion_form .form-group {\n  margin-bottom: 10px;\n  margin-top: 10px;\n}\n.patient_registraion_form .form-group .form-control {\n  font-size: 16px;\n}\n\t.patient_registraion_form .form-group,.patient_registraion_form .form-group .form-control{float:left;width:100%}\n\t.patient_registraion_form .form-group .require-field{color:red;}\n\t.patient_registraion_form select.form-control,.patient_registraion_form input[type=\"file\"] {\n  padding: 0.5278em;\n   margin-bottom: 5px;\n}\n.patient_registraion_form  .radio-inline {\n    float: left;\n    margin-bottom: 10px;\n    margin-top: 10px;\n\t margin-right: 15px;\n}\n.patient_registraion_form  .radio-inline .tog {\n    margin-right: 5px;\n}\n.patient_registraion_form .col-sm-2.control-label {\n  line-height: 48px;\n  text-align: right;\n}\n\t.patient_registraion_form .form-group .col-sm-2 {width: 24.667%;}\n\t.patient_registraion_form .form-group .col-sm-8 {     width: 66.66666667%;}\n\t.patient_registraion_form .form-group .col-sm-7{  width: 53.33333333%;}\n\t.patient_registraion_form .form-group .col-sm-1{  width: 13.33333333%;}\n\t.patient_registraion_form .form-group .col-sm-8, .patient_registraion_form .form-group .col-sm-2,.patient_registraion_form .form-group .col-sm-7,.patient_registraion_form .form-group .col-sm-1{      \n\tpadding-left: 15px;\n\t padding-right: 15px;\n\tfloat:left;}\n\t.patient_registraion_form .form-group .col-sm-8, .patient_registraion_form .form-group .col-sm-2,.patient_registraion_form .form-group .col-sm-7{\n\t\tposition: relative;\n    min-height: 1px;   \n\t}\n\n    div {\n        margin-bottom:2px;\n    }\n     \n    input{\n        margin-bottom:4px;\n    }\n\t.patient_registraion_form .col-sm-offset-2.col-sm-8 {\n  float: left;\n  margin-left: 35%;\n  margin-top: 15px;\n}\n.patient_registraion_form .form-control {\n  line-height: 30px;\n}\n\t.student_reg_error .error{color:red;}\n    <\/style>\n    \n\t<div class=\"patient_registraion_form\">\n    <form action=\"\/en\/wp-json\/wp\/v2\/pages\/1824\" method=\"post\" enctype=\"multipart\/form-data\">\t<script type=\"text\/javascript\">\njQuery(document).ready(function() {\n\t\n\tjQuery('#birth_date').datepicker({\n\t\t  changeMonth: true,\n\t        changeYear: true,\n\t        yearRange:'-65:+0',\n\t        onChangeMonthYear: function(year, month, inst) {\n\t           jQuery(this).val(month + \"\/\" + year);\n\t        }\n                    \n                }); \n} );\n<\/script>\n\t  \t\t<input type=\"hidden\" name=\"action\" value=\"insert\">\n\t\t<input type=\"hidden\" name=\"role\" value=\"patient\"  \/>\n\t\t<input type=\"hidden\" name=\"patient_type\" value=\"outpatient\"  \/>\n\t\t\n\t\t<input type=\"hidden\" name=\"user_id\" value=\"\"  \/>\n\t\t<input id=\"patient_id\" type=\"hidden\" \n\t\t\t\tvalue=\"P10526\" name=\"patient_id\">\n\t\t\n\t\t<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"first_name\">First Name<\/label>\n\t\t\t<div class=\"col-sm-8\">\n\t\t\t\t<input id=\"first_name\" class=\"form-control validate[custom[onlyLetterSp]] text-input\" type=\"text\" value=\"\" name=\"first_name\">\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"last_name\">Last Name<\/label>\n\t\t\t<div class=\"col-sm-8\">\n\t\t\t\t<input id=\"last_name\" class=\"form-control validate[custom[onlyLetterSp]] text-input\" type=\"text\"  value=\"\" name=\"last_name\">\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"gender\">Gender<span class=\"require-field\">*<\/span><\/label>\n\t\t\t<div class=\"col-sm-8\">\n\t\t\t\t\t\t\t<label class=\"radio-inline\">\n\t\t\t     <input type=\"radio\" value=\"male\" class=\"tog validate[required]\" name=\"gender\"   checked='checked'\/>Male\t\t\t    <\/label>\n\t\t\t    <label class=\"radio-inline\">\n\t\t\t      <input type=\"radio\" value=\"female\" class=\"tog validate[required]\" name=\"gender\"  \/>Female \n\t\t\t    <\/label>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"birth_date\">Date of birth<span class=\"require-field\">*<\/span><\/label>\n\t\t\t<div class=\"col-sm-8\">\n\t\t\t\t\t\t\t\t<select name=\"birth_date\" id=\"birth_date\" class=\"form-control validate[required]\">\n\t\t\t\t\t\t\t\t\t\t\t<option value=\"2026\">2026<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2025\">2025<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2024\">2024<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2023\">2023<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2022\">2022<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2021\">2021<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2020\">2020<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2019\">2019<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2018\">2018<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2017\">2017<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2016\">2016<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2015\">2015<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2014\">2014<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2013\">2013<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2012\">2012<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2011\">2011<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2010\">2010<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2009\">2009<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2008\">2008<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2007\">2007<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2006\">2006<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2005\">2005<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2004\">2004<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2003\">2003<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2002\">2002<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2001\">2001<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"2000\">2000<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1999\">1999<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1998\">1998<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1997\">1997<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1996\">1996<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1995\">1995<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1994\">1994<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1993\">1993<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1992\">1992<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1991\">1991<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1990\">1990<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1989\">1989<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1988\">1988<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1987\">1987<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1986\">1986<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1985\">1985<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1984\">1984<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1983\">1983<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1982\">1982<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1981\">1981<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1980\">1980<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1979\">1979<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1978\">1978<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1977\">1977<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1976\">1976<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1975\">1975<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1974\">1974<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1973\">1973<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1972\">1972<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1971\">1971<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1970\">1970<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1969\">1969<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1968\">1968<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1967\">1967<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1966\">1966<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1965\">1965<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1964\">1964<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1963\">1963<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"1962\">1962<\/option>\n\t\t\t\t\t\t\t\t\t\t<\/select>\n\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"symptoms\">Symptoms<\/label>\n\t\t\t<div class=\"col-sm-8\">\n\t\t\t\t<textarea id=\"symptoms\" class=\"form-control\" name=\"symptoms\"> <\/textarea>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!--<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"medicine\">Medicine<span class=\"require-field\">*<\/span><\/label>\n\t\t\t<div class=\"col-sm-8\">\n\t\t\t\t<textarea id=\"medicine\" class=\"form-control validate[required]\" name=\"medicine\"> <\/textarea>\n\t\t\t<\/div>\n\t\t<\/div>-->\n\t\t<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"diagnosis\">Diagnosis Report<\/label>\n\t\t\t<div class=\"col-sm-8\">\n\t\t\t\t<input type=\"file\" class=\"form-control file\" name=\"diagnosis\">\n\t\t\t<\/div>\t\t\t\n\t\t<\/div>\n\t\t<input type=\"hidden\"  name=\"doctor\" value=\"\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label \" for=\"mobile\">Mobile<\/label>\n\t\t\t<div class=\"col-sm-1\">\n\t\t\t\n\t\t\t<input type=\"text\" readonly value=\"+381\"  class=\"form-control\" name=\"phonecode\">\n\t\t\t<\/div>\n\t\t\t<div class=\"col-sm-7\">\n\t\t\t\t<input id=\"mobile\" class=\"form-control validate[custom[phone]] text-input\" type=\"text\"  name=\"mobile\" \n\t\t\t\tvalue=\"\">\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label \" for=\"email\">Email<span class=\"require-field\">*<\/span><\/label>\n\t\t\t<div class=\"col-sm-8\">\n\t\t\t\t<input id=\"email\" class=\"form-control validate[required,custom[email]] text-input\" type=\"text\"  name=\"email\" \n\t\t\t\tvalue=\"\">\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"username\">User Name<span class=\"require-field\">*<\/span><\/label>\n\t\t\t<div class=\"col-sm-8\">\n\t\t\t\t<input id=\"username\" class=\"form-control validate[required]\" type=\"text\"  name=\"username\" \n\t\t\t\tvalue=\"\" >\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"form-group\">\n\t\t\t<label class=\"col-sm-2 control-label\" for=\"password\">Password<span class=\"require-field\">*<\/span><\/label>\n\t\t\t<div class=\"col-sm-8\">\n\t\t\t\t<input id=\"password\" class=\"form-control validate[required]\" type=\"password\"  name=\"password\" value=\"\">\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"col-sm-offset-2 col-sm-8\">\n        \t\n        \t<input type=\"submit\" value=\"Patient Registration\" name=\"registration_front_patient\" class=\"btn btn-default\"\/>\n        <\/div>\n    <\/form>\n\t<\/div>\n    \n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-blog.php","meta":[],"_links":{"self":[{"href":"https:\/\/geneinfo.rs\/en\/wp-json\/wp\/v2\/pages\/1824"}],"collection":[{"href":"https:\/\/geneinfo.rs\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/geneinfo.rs\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/geneinfo.rs\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/geneinfo.rs\/en\/wp-json\/wp\/v2\/comments?post=1824"}],"version-history":[{"count":1,"href":"https:\/\/geneinfo.rs\/en\/wp-json\/wp\/v2\/pages\/1824\/revisions"}],"predecessor-version":[{"id":1825,"href":"https:\/\/geneinfo.rs\/en\/wp-json\/wp\/v2\/pages\/1824\/revisions\/1825"}],"wp:attachment":[{"href":"https:\/\/geneinfo.rs\/en\/wp-json\/wp\/v2\/media?parent=1824"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}