EditProfile.jsp
001 <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
002 <%page contentType="text/html;charset=UTF-8" language="java" %>
003 <%taglib uri="/WEB-INF/struts-bean.tld" prefix="bean" %>
004 <%taglib uri="/WEB-INF/struts-logic.tld" prefix="logic" %>
005 <%taglib uri="/WEB-INF/struts-html.tld" prefix="html" %>
006 <%taglib uri="/WEB-INF/sslext.tld" prefix="sslext"%>
007 <%page import="com.bea.medrec.beans.AddressBean,
008                  com.bea.medrec.utils.MedRecWebAppUtils"%>
009 
010 <jsp:useBean id="patientBean" class="com.bea.medrec.beans.PatientBean" scope="session"/>
011 <%
012   AddressBean theAddressBean = patientBean.getAddress();
013 %>
014 
015 <html:html>
016 <head>
017   <html:base/>
018   <title><bean:message key="title.MedRec"/></title>
019   <link rel="stylesheet" type="text/css" HREF="stylesheet.css">
020 </head>
021 <body bgcolor="white" topmargin="0" leftmargin="0">
022 
023 <!-- START Header -->
024 <jsp:include page="Header.jsp" flush="true"/>
025 <!-- END Header -->
026 
027 <!-- START Padding for Content -->
028 <table width="100%" border="0" cellspacing="1" cellpadding="10">
029 <tr>
030   <td>
031 
032 <!-- Content -->
033 <sslext:link page="/medicalrecord.do"><span class="pagetitle-patient"><bean:message key="link.home"/></span></sslext:link> &gt;
034 <span class="pagetitle-patient"><bean:message key="page.title.patient.profile.edit"/></span>
035 <br/><br/>
036 
037 <sslext:form method="<%=MedRecWebAppUtils.getHttpMethod()%>" action="/editprofile.do" focus="firstName">
038   <table border="0" cellspacing="0" cellpadding="3">
039     <tr>
040       <td class="label"><bean:message key="FirstName"/></td>
041       <td><html:text
042             name="patientBean"
043             property="firstName"
044             size="20"
045             maxlength="60"
046             value="<%=patientBean.getFirstName()%>"
047             tabindex="1"
048           />
049       </td>
050       <td class="label"><bean:message key="Address"/>:</td>
051       <td></td>
052     </tr>
053     <tr>
054       <td></td>
055       <td align="left">
056         <html:messages id="error" property="firstName">
057           <bean:write name="error" filter="false"/>
058         </html:messages>
059       </td>
060     </tr>
061     <tr>
062       <td class="label"><bean:message key="LastName"/></td>
063       <td><html:text
064             name="patientBean"
065             property="lastName"
066             size="20"
067             maxlength="60"
068             value="<%=patientBean.getLastName()%>"
069             tabindex="2"
070           />
071       </td>
072       <td class="label"><bean:message key="Street"/></td>
073       <td><html:text
074             name="patientBean"
075             property="address.streetName1"
076             size="20"
077             maxlength="60"
078             value="<%=patientBean.getAddress().getStreetName1()%>"
079             tabindex="9"
080           />
081       </td>
082     </tr>
083     <tr>
084       <td></td>
085       <td align="left">
086         <html:messages id="error" property="lastName">
087           <bean:write name="error" filter="false"/>
088         </html:messages>
089       </td>
090       <td></td>
091       <td align="left">
092         <html:messages id="error" property="address.streetName">
093           <bean:write name="error" filter="false"/>
094         </html:messages>
095       </td>
096     </tr>
097     <tr>
098       <td class="label"><bean:message key="MiddleName"/></td>
099       <td><html:text
100             name="patientBean"
101             property="middleName"
102             size="20"
103             maxlength="60"
104             value="<%=patientBean.getMiddleName()%>"
105             tabindex="3"
106           />
107       </td>
108       <td class="label"></td>
109       <td><html:text
110             name="patientBean"
111             property="address.streetName2"
112             size="20"
113             maxlength="60"
114             value="<%=theAddressBean.getStreetName2()%>"
115             tabindex="10"
116           />
117       </td>
118     </tr>
119     <tr>
120       <td></td>
121       <td align="left">
122         <html:messages id="error" property="middleName">
123           <bean:write name="error" filter="false"/>
124         </html:messages>
125       </td>
126     </tr>
127     <tr>
128       <td class="label"><bean:message key="Gender"/></td>
129       <td><html:select property="gender"
130             value="<%=patientBean.getGender()%>"
131             tabindex="4">
132             <html:option value="1"><bean:message key="ChooseGender"/></html:option>
133             <html:option value="2">-------------</html:option>
134             <html:option value="Male"><bean:message key="Male"/></html:option>
135             <html:option value="Female"><bean:message key="Female"/></html:option>
136           </html:select>
137       </td>
138       <td class="label"><bean:message key="City"/></td>
139       <td><html:text
140             name="patientBean"
141             property="address.city"
142             size="20"
143             maxlength="60"
144             value="<%=theAddressBean.getCity()%>"
145             tabindex="11"
146           />
147       </td>
148     </tr>
149     <tr>
150       <td></td>
151       <td align="left">
152         <html:messages id="error" property="gender">
153           <bean:write name="error" filter="false"/>
154         </html:messages>
155       </td>
156       <td></td>
157       <td align="left">
158         <html:messages id="error" property="address.city">
159           <bean:write name="error" filter="false"/>
160         </html:messages>
161       </td>
162     </tr>
163     <tr>
164       <td class="label"><bean:message key="DOB"/><br/><font size=1pt>(mm/dd/yyyy)</font></td>
165       <td><html:text
166             name="patientBean"
167             property="dob"
168             size="10"
169             maxlength="10"
170             value="<%=patientBean.getDob()%>"
171             tabindex="5"
172           />
173       </td>
174       <td class="label"><bean:message key="State"/></td>
175       <td><html:text
176             name="patientBean"
177             property="address.state"
178             size="20"
179             maxlength="40"
180             value="<%=theAddressBean.getState()%>"
181             tabindex="12"
182           />
183       </td>
184     </tr>
185     <tr>
186       <td></td>
187       <td align="left">
188         <html:messages id="error" property="dob">
189           <bean:write name="error" filter="false"/>
190         </html:messages>
191       </td>
192       <td></td>
193       <td align="left">
194         <html:messages id="error" property="address.state">
195           <bean:write name="error" filter="false"/>
196         </html:messages>
197       </td>
198     </tr>
199     <tr>
200       <td class="label"><bean:message key="SSN"/><br/><font size=1pt>(xxxxxxxxx)</font></td>
201       <td><html:text
202             name="patientBean"
203             property="ssn"
204             size="9"
205             maxlength="9"
206             value="<%=patientBean.getSsn()%>"
207             tabindex="6"
208           />
209       </td>
210       <td class="label"><bean:message key="Zip"/></td>
211       <td><html:text
212             name="patientBean"
213             property="address.zipCode"
214             size="20"
215             maxlength="10"
216             value="<%=theAddressBean.getZipCode()%>"
217             tabindex="13"
218           />
219       </td>
220     </tr>
221     <tr>
222       <td></td>
223       <td align="left">
224         <html:messages id="error" property="ssn">
225           <bean:write name="error" filter="false"/>
226         </html:messages>
227       </td>
228       <td></td>
229       <td align="left">
230         <html:messages id="error" property="address.zipCode">
231           <bean:write name="error" filter="false"/>
232         </html:messages>
233       </td>
234     </tr>
235     <tr>
236       <td class="label"><bean:message key="Phone"/><br/><font size=1pt>(xxx-xxx-xxxx)</font></td>
237       <td><html:text
238             name="patientBean"
239             property="phone"
240             size="12"
241             maxlength="12"
242             value="<%=patientBean.getPhone()%>"
243             tabindex="7"
244           />
245       </td>
246       <td class="label"><bean:message key="Country"/></td>
247       <td><html:text
248             name="patientBean"
249             property="address.country"
250             size="20"
251             maxlength="40"
252             value="<%=theAddressBean.getCountry()%>"
253             tabindex="14"
254           />
255       </td>
256     </tr>
257     <tr>
258       <td></td>
259       <td align="left">
260         <html:messages id="error" property="phone">
261           <bean:write name="error" filter="false"/>
262         </html:messages>
263       </td>
264       <td></td>
265       <td align="left">
266         <html:messages id="error" property="address.country">
267           <bean:write name="error" filter="false"/>
268         </html:messages>
269       </td>
270     </tr>
271     <tr>
272       <td class="label"><bean:message key="Email"/></td>
273       <td><html:text
274               name="patientBean"
275               property="email"
276               size="20"
277               maxlength="40"
278               value="<%=patientBean.getEmail()%>"
279               readonly="true"
280               styleClass="row1"
281               tabindex="8"
282 
283            />
284         </td>
285     </tr>
286     <tr>
287       <td></td>
288       <td align="left">
289         <html:messages id="error" property="email">
290           <bean:write name="error" filter="false"/>
291         </html:messages>
292       </td>
293     </tr>
294     <tr>
295       <td></td>
296       <td>
297         <br/>
298         <html:submit property="action" styleClass="profileButton">
299           <bean:message key="button.Save"/>
300         </html:submit>
301         <html:submit property="action">
302           <bean:message key="button.Cancel"/>
303         </html:submit>
304       </td>
305     </tr>
306   </table>
307 </sslext:form>
308 
309 <!-- Content END -->
310 <!-- End Padding for Content -->
311   </tr>
312 </table>
313 </body>
314 </html:html>