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February 12, 2017 20:32
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<?php | |
/** | |
* Template Name: Hello World | |
* Version: 0.1 | |
* Description: A basic "Hello World" PDF template showing custom PDF templates in action | |
* Author: Jake Jackson | |
* Group: Sol System | |
* License: GPLv2 | |
* Required PDF Version: 4.0-beta | |
*/ | |
/* Prevent direct access to the template (always good to include this) */ | |
if ( ! class_exists( 'GFForms' ) ) { | |
return; | |
} | |
?> | |
<!-- Any PDF CSS styles can be placed in the style tag below --> | |
<style> | |
* { | |
margin: 0; | |
padding: 0; | |
-moz-box-sizing: border-box; | |
-webkit-box-sizing: border-box; | |
box-sizing: border-box; | |
} | |
body{ | |
background-color: #ffffff; | |
height: 1035px; | |
} | |
p{ | |
font-size: 15px; | |
text-align: left; | |
line-height: 22px; | |
} | |
td{ | |
font-size: 14px; | |
line-height: 17px; | |
width: 33%; | |
} | |
.container { | |
width: 800px; /* container size */ | |
.row { | |
width: 100%; | |
float: left; | |
margin:10px; } | |
} | |
.one { | |
padding: 3px; | |
width: 33%; /* left-col size */ | |
float: left; | |
margin-right: 7px; | |
} | |
.two { | |
padding: 3px; | |
width: 33%; /* left-col size */ | |
float: none; | |
overflow: hidden; | |
margin-right: 5px; | |
} | |
.three { | |
padding: 3px; | |
width: 32.4%; /* right-col size */ | |
float: right; | |
} | |
.right { | |
padding: 6px; | |
width:25%; /* right-col size */ | |
float: right; | |
margin-left: 7px; | |
} | |
.left { | |
padding: 6px; | |
width: 25%; /* left-col size */ | |
float: left; | |
margin-right: 7px; | |
} | |
.rightcenter{ | |
padding: 6px; | |
width: 25%; /* right-col size */ | |
float: right; | |
margin-left: 7px; | |
} | |
.center { | |
padding: 6px; | |
float: none; | |
overflow: hidden; | |
} | |
html, body { margin: 0; background: #292A2B; } | |
.container { padding: 5px; margin: 0px auto; background: #ffffff; } | |
.container > div { height: 50px; background: #f2f2f2; } | |
</style> | |
<div class="container" style="height:80px;"><h3>INFORMATIONS sur le client</h3> | |
<div class="left"> | |
<h5>Nom</h5> | |
<p>{:1}</p> | |
</div> | |
<div class="right"> | |
<h5>Date de naissance</h5> | |
<p>{:11}</p> | |
</div> | |
<div class="rightcenter"> | |
<h5>Sexe</h5> | |
<p>{:3}</p> | |
</div> | |
<div class="center"><h5>Prénom</h5> | |
<p>{:2}</p> | |
</div> | |
</div> | |
<div class="container" > | |
<div class="left"> | |
<h5>Adresse</h5> | |
<p>{:34.1}</p> | |
</div> | |
<div class="right"> | |
<h5>Code Postal</h5> | |
<p>{:34.5}</p> | |
</div> | |
<div class="rightcenter"> | |
<h5>Ville</h5> | |
<p>{:34.3} </p> | |
</div> | |
<div class="center"> | |
<h5>App</h5> | |
<p> {:34.4}</p> | |
</div> | |
</div> | |
<div class="container"> | |
<div class="left"> | |
<h5>Téléphone</h5> | |
<p>{::9}</p> | |
</div> | |
<div class="right"> | |
<h5>Courriel</h5> | |
<p>{:12}</p> | |
</div> | |
<div class="rightcenter"> | |
<h5>Téléphone Travail</h5> | |
<p>{::10}</p> | |
</div> | |
<div class="center"> | |
<h5>Cellulaire</h5> | |
<p>{::8}</p> | |
</div> | |
</div> | |
<div class="container" style="height:55px;"> | |
<div class="one"> | |
<h5>1. Etes-vous actuellement sous les soins d’un médecin?</h5> | |
<p>{:14}</p> | |
</div> | |
<div class="three"> | |
<h5>Téléphone</h5> | |
<p>{:16}</p> | |
</div> | |
<div class="two"> | |
<h5>Médecin Traitant</h5> | |
<p>{:15}</p> | |
</div> | |
</div> | |
<div class="container" style="height:82px;"> | |
<div class="left" style="height:78px;"> | |
<h5>Prenez-vous des médicaments ou en avez-vous pris au cours des 6 derniers mois ?</h5> | |
<p>{:17}</p> | |
</div> | |
<div class="right" style="height:78px;"> | |
<h5>Êtes-vous enceinte?</h5> | |
<p>{:20}</p> | |
</div> | |
<div class="rightcenter" style="height:78px;" > <h5>Prenez-vous des anovulants ? (pilules anticonceptionnelles) | |
</h5> | |
<p>{:19}</p> | |
</div> | |
<div class="center" style="height:78px;"> | |
<h5>Si oui, lesquels ?</h5> | |
<p>{:18}</p> | |
</div> | |
</div> | |
<div class="container" style="height:82px;"> | |
<div class="left" style="height:78px;"> | |
<h5>Tension artérielle (pression) ?</h5> | |
<p>{:23}</p> | |
</div> | |
<div class="right" style="height:78px;"> | |
<h5>Etes-vous atteint(e) du syndrome d’immuno-déficience acquise (SIDA)?</h5> | |
<p>{:26}</p> | |
</div> | |
<div class="rightcenter" style="height:78px;" > <h5>Avez-vous déjà subi des traitements de radiothérapie et/ou chimiothérapie (tumeur)? | |
</h5> | |
<p>{:25}</p> | |
</div> | |
<div class="center" style="height:78px;"> | |
<h5>Fumez-vous ?</h5> | |
<p>{:24}</p> | |
</div> | |
</div> | |
<div class="container" style="height:120px;"> | |
<div class="left" style="height:110px;"> | |
<h5>Avez-vous des prothèses articulaires (hanches,genoux etc.)?</h5> | |
<p>{:27}</p> | |
</div> | |
<div class="right" style="height:110px;"> | |
<h5>Produits</h5> | |
<p>{:28.1}{:28.2}</p> | |
<p>{:28.3}{:28.4}</p> | |
<p>{:28.5}{:28.6}</p> | |
<p>{:28.7}{:28.8}</p> | |
</div> | |
<div class="rightcenter" style="height:110px;" > | |
<h5>Avez-vous déjà fait une réaction aux produits suivant ?</h5> | |
<p>{:28}</p> | |
<p>{:28.7}{:28.8}</p> | |
<p>{:28.7}{:28.8}</p> | |
</div> | |
<div class="center" style="height:110px;"> | |
<h5>Avez-vous des restrictions alimentaires (Diète, personnelles ou religieuses)? Si oui,lesquels ?</h5> | |
<p>{:29}</p> | |
</div> | |
</div> | |
<div class="container" style="height:260px;"><h3>Avez-vous souffert ou souffrez-vous de ?</h3> | |
<div class="row" style="height:250px;"> | |
<table style="width:100%"> | |
<tr> | |
<td>{(Saignements prolongés):22.3}</td> | |
<td>{(Fièvre rhumatismale):22.2}</td> | |
<td>{(Maladies de la peau):22.16}</td> | |
</tr> | |
<tr> | |
<td>{(Anémie):22.4}</td> | |
<td>{(Ulcère d’estomac):22.9} </td> | |
<td>{(Problèmes oculaires (yeux)):22.17}</td> | |
</tr> | |
<tr> | |
<td>{(Sinusite ou rhumes fréquents):22.5}</td> | |
<td>{(Problèmes du foie (hépatite : A, B, C, cirrhose, etc.)):22.11}</td> | |
<td>{(Arthrite):22.18}</td> | |
</tr> | |
<tr> | |
<td>{(Tuberculose ou problèmes pulmonaires):22.6}</td> | |
<td>{(Troubles du rein):22.12}</td> | |
<td>{(Diabète):22.14} </td> | |
</tr> | |
<tr> | |
<td>{(Troubles digestifs):22.7}</td> | |
<td>{(Infection transmissibles sexuellement (I.T.S.)):22.13}</td> | |
<td>{(Épilepsie):22.19}</td> | |
</tr> | |
<tr> | |
<td>{(Ostéoporose):22.8}</td> | |
<td>{(Troubles thyroïdiens):22.15}</td> | |
<td>{ (Trouble nerveux):22.21}</td> | |
</tr> | |
<tr> | |
<td>{ (Maux de tête fréquents):22.22}</td> | |
<td>{ (Etourdissements, évanouissements):22.23}</td> | |
<td>{ (Maux d’oreilles):22.24}</td> | |
</tr> | |
<tr> | |
<td>{ (Rhume des foins):22.25}</td> | |
<td>{ (Asthme):22.26}</td> | |
<td>{ (Troubles cardiaques (infarctus, angine, problèmes valvulaires, souffle)):22.1} | |
</td> | |
</tr> | |
</table> | |
</div> | |
</div> | |
<div class="container" style="height:100px;"> | |
<div class="left" style="height:90px;"> | |
<h5>Avez-vous déjà été hospitalisé et/ou subi des interventions chirurgicales autres que dentaire ?</h5> | |
<p>oui</p></div> | |
<div class="right" style="height:90px;"> | |
<h5>Date et explications</h5> | |
<p></p></div> | |
<div class="rightcenter" style="height:90px;" > | |
<h5>Date et explications</h5> | |
<p>Oui</p></div> | |
<div class="center" style="height:90px;"> | |
<h5>Date et explications</h5> | |
<p>Parent</p></div> | |
</div> | |
<div class="container" style="height:100px;"><h3>PRÉCAUTION</h3> | |
<div class="row" style="height:100px;"><p>{:33}</p> | |
</div> | |
</div> | |
<div class="container" style="height:200px;"> | |
<div class="one"> | |
<h5>Patient</h5> | |
<p> </p> | |
</div> | |
<div class="three"> | |
<h5>Date </h5> | |
<p> </p> | |
</div> | |
<div class="two"> | |
<h5>Periodontist</h5> | |
<p> </p> | |
</div> | |
</div> | |
<?php |
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