Embed

<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Patient Registration</title>
    <style>
        /* Same styles as provided */
        body {
            font-family: 'Arial', sans-serif;
            background-color: #f9f9f9;
            margin: 0;
            padding: 0;
            display: flex;
            justify-content: center;
            align-items: center;
            height: 100vh;
        }
        .container {
            width: 600px;
            background: #ffffff;
            border-radius: 10px;
            box-shadow: 0 4px 8px rgba(0, 0, 0, 0.1);
            padding: 40px;
        }
        .container h1 {
            font-size: 28px;
            color: #333333;
            text-align: center;
            margin-bottom: 30px;
        }
        label {
            display: block;
            margin-top: 20px;
            font-size: 16px;
            color: #555555;
        }
        input, select {
            width: 100%;
            padding: 12px;
            margin-top: 8px;
            font-size: 16px;
            border: 1px solid #dddddd;
            border-radius: 5px;
        }
        button {
            width: 100%;
            padding: 15px;
            background-color: #4CAF50;
            color: white;
            border: none;
            border-radius: 5px;
            font-size: 18px;
            margin-top: 30px;
            cursor: pointer;
        }
        button:hover {
            background-color: #45a049;
        }
        .patient-id {
            margin-top: 30px;
            padding: 15px;
            text-align: center;
            background-color: #f0f8ff;
            color: #00008b;
            font-size: 18px;
            border-radius: 5px;
        }
        @media (max-width: 768px) {
            .container {
                width: 90%;
                padding: 20px;
            }
        }
    </style>
</head>
<body>
    <div class="container">
        <h1>Basic Information</h1>
        <form id="patientForm">
            <label for="gender">Gender</label>
            <select id="gender" name="gender" required>
                <option value="Male">Male</option>
                <option value="Female">Female</option>
            </select>
            <label for="age">Age</label>
            <input type="number" id="age" name="age" placeholder="Enter your age" required>
            <label for="dob">Date of Birth</label>
            <input type="date" id="dob" name="dob" required>
            <button type="submit">Submit</button>
        </form>
        <div class="patient-id" id="patientIDSection">
            
        </div>
    </div>

    <script>
        const form = document.getElementById('patientForm');
        const patientIDSection = document.getElementById('patientIDSection');

        form.addEventListener('submit', async (e) => {
            e.preventDefault();

            // Collect form data and convert to plain text
            const formData = new URLSearchParams();
            formData.append('gender', document.getElementById('gender').value);
            formData.append('age', document.getElementById('age').value);
            formData.append('dob', document.getElementById('dob').value);

            try {
                // Send form data as plain text to Google Apps Script Web App
                const response = await fetch('https://script.google.com/macros/s/AKfycbxWwzdCXK2fMWJ72efFJpBPZ151K1ab_OgNLOF9SJafDu9FI5F7ZqXa6QL5R31LEOIn/exec', {
                    method: 'POST',
                    mode: 'cors',
                    headers: {
                        'Content-Type': 'text/plain'
                    },
                    body: formData.toString() // Plain text format
                });

                // Parse JSON response
                const result = await response.json();

                // Display Patient ID
                if (result.success) {
                    patientIDSection.textContent = `Patient Identification Number: ${result.patientID}`;
                } else {
                    patientIDSection.textContent = 'Error generating Patient ID. Please try again.';
                }
            } catch (error) {
                console.error('Error:', error);
                patientIDSection.textContent = 'An error occurred. Please try again.';
            }
        });
    </script>
</body>
</html>