surveybuilder/SurveyBuilder/Builder/templetes/Medical_temp.js

Build surveys in the most advanced, flexable, and more moderated way, for all users to build and see.

function setupMedTemp(){document.getElementById("yourTitle").innerHTML="Medical Template";document.getElementById("UserTitle").innerHTML="Medical Template - SurveyBuilder";document.getElementById("Insert-Object").innerHTML="";let heading=document.createElement("DIV");heading.className="heading";let a=Math.random().toString(36).substring(7);heading.id=a;heading.innerHTML="<h1>Medical Template</h1>";document.getElementById("Insert-Object").appendChild(heading);let name=document.createElement("DIV");name.className="Name";let b=Math.random().toString(36).substring(7);name.id=b;name.innerHTML="<i class='fas fa-asterisk' style='color:red;'></i>First Name: <input type='text' placeholder='First Name' id='FirstName' name='FirstName' required='true'/><br/> <i class='fas fa-asterisk' style='color:red;'></i>Middle Name: <input type='text' placeholder='Middle Name' id='MName' name='MName' required='true'/><br/> <i class='fas fa-asterisk' style='color:red;'></i>Last Name: <input type='text' placeholder='Last name' id='LastName' name='LastName' required='true'/>";document.getElementById("Insert-Object").appendChild(name);let address=document.createElement("DIV");address.className="Address";let c=Math.random().toString(36).substring(7);address.id=c;let street="<i class='fas fa-asterisk' style='color:red;'></i> Street 1: <input type='text' placeholder='Street 1' id='Street' required='true'/>";let street2="Street 2: <input type='text' placeholder='Street 2' id='Street2'/>";let City="<i class='fas fa-asterisk' style='color:red;'></i> City: <input type='text' placeholder='City' id='City' required='true'/>";let State="<i class='fas fa-asterisk' style='color:red;'></i> State: <input type='text' placeholder='State' id='State' required='true'/>";let Zip="<i class='fas fa-asterisk' style='color:red;'></i> Zip Code: <input type='text' placeholder='Zip code' pattern='[0-9]{3,5}' id='Zip' required='true'/>";let Country="<i class='fas fa-asterisk' style='color:red;'></i> Country: <select id='countries-select' required='true'><option value='dnt' disabled='true'>[Do Not Touch]</option></select>";let allData=street+"<br>"+street2+"<br>"+City+"<br>"+Zip+"<br>"+Country;address.innerHTML=allData;document.getElementById("Insert-Object").appendChild(address);var selects=document.getElementById("countries-select"),arr=["Afghanistan","Albania","Algeria","Andorra","Angola","Antigua and Barbuda","Argentina","Armenia","Australia","Austria","Azerbaijan","Bahamas","Bahrain","Bangladesh","Barbados","Belarus","Belgium","Belize","Benin","Bhutan","Bolivia","Bosnia and Herzegovina","Botswana","Brazil","Brunei","Bulgaria","Burkina Faso","Burundi","Côte d'Ivoire","Cabo Verde","Cambodia","Cameroon","Canada","Central African Republic","Chad","Chile","China","Colombia","Comoros","Congo (Congo-Brazzaville)","Costa Rica","Croatia","Cuba","Cyprus","Czechia (Czech Republic)","Czechia (Czech Republic)","Denmark","Djibouti","Dominica","Dominican Republic","Ecuador","Egypt","El Salvador","Equatorial Guinea","Eritrea","Estonia","Eswatini (fmr. 'Swaziland')","Ethiopia","Fiji","Finland","France","Gabon","Gambia","Georgia","Germany","Ghana","Greece","Grenada","Guatemala","Guinea","Guinea-Bissau","Guyana","Haiti","Holy See","Honduras","Hungary","Iceland","India","Indonesia","Iran","Iraq","Ireland","Israel","Italy","Jamaica","Japan","Jordan","Kazakhstan","Kenya","Kiribati","Kuwait","Kyrgyzstan","Laos","Latvia","Lebanon","Lesotho","Liberia","Libya","Liechtenstein","Lithuania","Luxembourg","Madagascar","Malawi","Malaysia","Maldives","Mali","Malta","Marshall Islands","Mauritania","Mauritius","Mexico","Micronesia","Moldova","Monaco","Mongolia","Montenegro","Morocco","Mozambique","Myanmar (formerly Burma)","Namibia","Nauru","Nepal","Netherlands","New Zealand","Nicaragua","Niger","Nigeria","North Korea","North Macedonia","Norway","Oman","Pakistan","Palau","Palestine State","Panama","Papua New Guinea","Paraguay","Peru","Philippines","Poland","Portugal","Qatar","Romania","Russia","Rwanda","Saint Kitts and Nevis","Saint Lucia","Saint Vincent and the Grenadines","Samoa","San Marino","Sao Tome and Principe","Saudi Arabia","Senegal","Serbia","Seychelles","Sierra Leone","Singapore","Slovakia","Slovenia","Solomon Islands","Somalia","South Africa","South Korea","South Sudan","Spain","Sri Lanka","Sudan","Suriname","Sweden","Switzerland","Syria","Tajikistan","Tanzania","Thailand","Timor-Leste","Togo","Tonga","Trinidad and Tobago","Tunisia","Turkey","Turkmenistan","Tuvalu","Uganda","Ukraine","United Arab Emirates","United Kingdom","United States of America","Uruguay","Uzbekistan","Vanuatu","Venezuela","Vietnam","Yemen","Zambia","Zimbabwe"];for(var i=0;i<arr.length;i++){var options=document.createElement("OPTION");txt=document.createTextNode(arr[i]);options.appendChild(txt);options.setAttribute("value",arr[i]);selects.insertBefore(options,selects.lastChild);}
let setdisplay=prompt("Enter a number from 0-195\nUse 0 to set Default\n0 is at the top of the list");if(setdisplay==null){console.error("Medical_temp: countires was null");}
document.getElementById("countries-select").options[setdisplay].setAttribute("selected","selected");let dob=document.createElement("DIV");dob.className="Date";let d=Math.random().toString(36).substring(7);dob.id=d;dob.innerHTML="<i class='fas fa-asterisk' style='color:red;'></i>&nbsp;Enter DOB: <input required='true' type='date' name='Date' id='Date' />";document.getElementById("Insert-Object").appendChild(dob);let time=document.createElement("DIV");time.className="Time";let e=Math.random().toString(36).substring(7);time.id=e;time.innerHTML="<i class='fas fa-asterisk' style='color:red;'></i>&nbsp;Enter Time of Appointment: <input type='time' required='true' id='Time' name='Time'/>";document.getElementById("Insert-Object").appendChild(time);}