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prescription.html
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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html><head>
<title></title>
</head>
<body style="background-image: url(images/background4.jpg);">
<br>
<br>
<form method="post" action="generateprescription.php"><big><big>PRESCRIPTION :<br>
<br>
</big></big>
<table width:="50%">
<tbody>
<tr>
<td>Doctor Name : <br>
</td>
<td><input name="doc_name" type="text"><br>
</td>
</tr>
<tr>
<td>Patient ID : <br>
</td>
<td><input name="id" type="text"><br>
</td>
</tr>
<tr>
<td>Medicine : <br>
</td>
<td><textarea cols="30" rows="3" name="medicine"></textarea><br>
</td>
</tr>
<tr>
<td>Dosage : <br>
</td>
<td>
<input name="dose" type="checkbox"> Morning<br>
<input name="dose" type="checkbox"> Afternoon<br>
<input name="dose" type="checkbox"> Night<br>
</td>
</tr>
<tr>
<td>Diagnosis :<br>
</td>
<td><textarea cols="30" rows="3" name="diagnosis"></textarea><br>
</td>
</tr>
<tr>
<td>Additional Instructions :<br>
</td>
<td><textarea cols="30" rows="3" name="instructions"></textarea> </td>
</tr>
</tbody>
</table>
<br>
<br>
<input name="submit" value="Generate Prescription" type="submit"> <input name="reset" value="RESET" type="reset"> <big><big><br>
</big></big></form>
</body>
</html>