Using Bootstrap, create the following: 1. A webpage that requests a patient in a doctors office...

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Question

Using Bootstrap, create the following: 1. A webpage that requests a patient in a doctors office...

Using Bootstrap, create the following:

1. A webpage that requests a patient in a doctors office to enter typical information that a new patient must provide. Personal information (such as name, address, and ?), other doctor information (such as a specialist), medical information (such as history of illnesses and surgeries) and medicines (such as over-the-counter and perscriptions).

2. The Form must include textboxes, dropdown lists, radio buttons and check boxes to accept the information.

3. Submit the form (in the form tag line) to: http://www.littleoceanwaves.com/returnvalues.php

4. The form must include at least two alerts as shown in this module.

Test your form. Make sure it submits all the data to the web page (#3). The returnvalues webpage should show you what you ALL of what was submitted.

5. Test to make sure the form properly resizes at full size and smart phone size.

engineering Computer-Science

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Answer 1

Answer #1

<!DOCTYPE html>
<html lang="en">
<head>
<title>Hospital</title>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.4.1/css/bootstrap.min.css">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.16.0/umd/popper.min.js"></script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.4.1/js/bootstrap.min.js"></script>
</head>
<body>

<div class="container">
<h2>Patent form</h2>
<form action="http://www.littleoceanwaves.com/returnvalues.php" method="post">
<div class="form-group">
<label for="name">Name:</label>
<input type="text" class="form-control" id="name" placeholder="Enter name" name="name">
</div>
   <div class="form-group">
   <label for="name">Have you came before to this Hospital:</label>
       <label class="radio-inline"><input type="radio" name="old_patient" checked>Yes</label>
       <label class="radio-inline"><input type="radio" name="old_patient">No</label>
   </div>
   <div class="form-group">
       <label for="sex">Sex:</label>
       <select class="form-control" id="sex">
           <option>Male</option>
           <option>Female</option>
           <option>Other</option>
       </select>
   </div>
   <div class="form-group">
<label for="age">Age:</label>
<input type="text" class="form-control" id="age" placeholder="Enter age" name="age">
</div>
   <div class="form-group">
<label for="address">Address:</label>
<input type="text" class="form-control" id="address" placeholder="Enter address" name="address">
</div>
   <div class="form-group">
<label for="pervious_doctor">Pervious Doctor:</label>
<input type="text" class="form-control" id="pervious_doctor" placeholder="Enter pervious doctor information" name="pervious_doctor">
</div>
   <div class="form-group">
<label for="past_illness">Past Illness:</label>
<input type="text" class="form-control" id="past_illness" placeholder="Enter past illness information" name="past_illness">
</div>
   <div class="form-group">
<label for="medicine_taken">Medicine Taken:</label>
<input type="text" class="form-control" id="medicine_taken" placeholder="Enter medicine taken information" name="medicine_taken">
</div>
   <div class="form-group">
   <label for="Disease">Disease:</label>
       <label class="checkbox-inline"><input type="checkbox" value="Diabatics" name="disease">Diabatics</label>
       <label class="checkbox-inline"><input type="checkbox" value="Heart Problem" name="disease">Heart Problem</label>
   </div>
<button type="submit" class="btn btn-primary">Submit</button>
</form>
</div>

</body>
</html>

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Answer 2

Using Bootstrap, create the following: 1. A webpage that requests a patient in a doctors office...

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