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index.html
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<html>
<head>
<!-- Latest compiled and minified CSS -->
<link rel="stylesheet" href="css/bootstrap.css">
<link rel="stylesheet" href="css/bootstrap-theme.css">
<link rel="stylesheet" href="css/nobleep.css">
<!-- Latest compiled and minified JavaScript -->
<script src="http://code.jquery.com/jquery-latest.js"></script>
<script src="js/bootstrap.min.js"></script>
<!-- List !-->
<script src="//cdnjs.cloudflare.com/ajax/libs/list.js/1.2.0/list.min.js"></script>
</head>
<body>
<!-- Fixed navbar -->
<nav class="navbar navbar-inverse navbar-fixed-top">
<div class="container">
<div class="navbar-header">
<button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-target="#navbar" aria-expanded="false" aria-controls="navbar">
<span class="sr-only">Toggle navigation</span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
<a class="navbar-brand" href="#">BleeFree</a>
</div>
<div id="navbar" class="navbar-collapse collapse">
<ul class="nav navbar-nav">
<li class="active"><a href="#">Add</a></li>
<li><a href="list.html">View</a></li>
</ul>
</div><!--/.nav-collapse -->
</div>
</nav>
<div class="container">
<br><br><br>
<h2>Add Task</h2>
<form id="addtask" action="https://powerful-dawn-95782.herokuapp.com/job/create" method="post">
<!-- "https://powerful-dawn-95782.herokuapp.com/job/create"
http://posttestserver.com/post.php
-->
<input type="text" hidden="true" name="location" value="hospital">
<div id="team">
<div class="btn-label">Select Team</div>
<div class="btn-group" data-toggle="buttons">
<label class="btn btn-default">
<input type="radio" name="team_id" value="1" id="medicine">Gastro
</label>
<label class="btn btn-default">
<input type="radio" name="team_id" value="2" id="surgery">Cardiology
</label>
<label class="btn btn-default">
<input type="radio" name="team_id" value="3" id="specialities">Repiratory
</label>
</div>
</div>
<br><br>
<div id="">
<div class="btn-label">Ward</div>
<input type="text" class="form-control" name="ward">
</div>
Bed
<input class="form-control" name="bed" maxlength="4">
Patient Initials
<input class="form-control" name="patient_id" maxlength="4">
<br><br>
<div id="">
<div class="btn-label">Urgency</div>
<div class="btn-group" data-toggle="buttons">
<label class="btn btn-lg btn-danger">
<input type="radio" name="urgency" value="1">High
</label>
<label class="btn btn-lg btn-warning">
<input type="radio" name="urgency" value="2">Med
</label>
<label class="btn btn-lg btn-info">
<input type="radio" name="urgency" value="3">Low
</label>
</div>
<br><br><br>
<div id="">
<div class="btn-label">Select Task</div>
<div class="" data-toggle="buttons">
<label class="btn btn-default col-sm-12">
<input type="radio" name="creator_comment" value="Drug Chart">Drug Chart
</label>
<label class="btn btn-default col-sm-12">
<input type="radio" name="creator_comment" value="Cannula">Cannula
</label>
<label class="btn btn-default col-sm-12">
<input type="radio" name="creator_comment" value="warfarin">Warfarin Prescription
</label>
<label class="btn btn-default col-sm-12">
<input type="radio" name="creator_comment" value="Family">Update Family
</label>
<label class="btn btn-default col-sm-12">
<input type="radio" name="creator_comment" value="Prescribe">Prescribe Meds
</label>
</div>
</div>
<br>
<br>
Or Other...
<input type="text" name="creator_comment" class="form-control">
<br>
My Name
<input type="text" name="creator_name" class="form-control" placeholder="">
<br><br>
<button class="btn btn-lg btn-success" id="submit">Submit</button>
</form>
</div>
<script type="text/javascript">
$( document ).ready(function() {
$("#task").hide();
$("#submit").on("click", function(){
$("#addtask")submit();
});
});
</script>
</body>
</html>