NINS_CODE/bahmni_config/openmrs/apps/customDisplayControl/views/admissionForm.html

<style>
    html,
    body,
    .main-container {
        height: 96.5% !important;
        min-height: 96.5% !important;
        margin: 0 auto;
        padding: 4px;
        width: 97%;
    }

    .bdForm {
        height: 2%;
        width: 100%;
        font-size: 10px;
        margin-top: 2px;
    }

    .header-style {
        height: 10%;
        width: 100%;
        margin-top: 0px;
    }

    .left-header {
        width: 14%;
        float: left;
        margin-top: 5px;
    }

    .middle-header {
        width: 68%;
        height: 100%;
        float: left;
        text-align: center;
        font-size: 18px;
    }

    .right-header {
        width: 16%;
        float: left;
    }

    .address-style {
        height: 100%;
        width: 100%;
        margin-bottom: 0px;
        margin-top: 5px;
    }

    .address-left {
        height: 100%;
        width: 65%;
        font-size: 16px;
        float: left;
        line-height: 1.6;
    }

    .address-right {
        height: 100%;
        width: 34%;
        float: right;
    }

    .body-style {
        height: 100%;
        width: 100%;
        margin-bottom: 0px;
        line-height: 2.0;
        /* border-bottom: 1px solid black; */
    }

    .patientStaticInfo {
        width: 100%;
        overflow: hidden;
    }

    .signInfo {
        width: 100%;
        height: 10%;

        margin-top: 2px;
    }

    .signInfoLeft {
        width: 30%;
        height: 100%;
        float: left;
    }

    .signInfoRight {
        width: 35%;
        height: 100%;
        float: right;
        text-align: left;
        /* padding-right: 50px; */
    }

    table,
    th,
    td {
        border: 1px solid black;
    }

    table {
        border-collapse: collapse;
    }


    #barcode {
        width: 4cm;
        margin-top: 0px;
        padding-left: 0px;
        float: right;
    }
</style>
<div class="main-container">
    <div class="address-style">
        <div class="address-left">
            <span class="label_tag" style="font-size: 14px;">নাম: </span>
            <span style="text-transform: capitalize;font-size: 14px;">{{patient.givenName + (patient.middleName ? (" " +
                patient.middleName) : "") + (patient.familyName ? (" " + patient.familyName) : "")}}</span>
            <span class="label_tag" style="font-size: 14px;"> &nbsp; পিতা/স্বামীর নাম: </span>
            <span style="font-size: 14px;">{{patient.fatherName.value}} </span><br>

            <span class="label_tag" style="font-size: 14px;">লিঙ্গ: </span>
            <span style="font-size: 14px;">{{patient.gender}}</span>
            <span class="label_tag" style="font-size: 14px;">&nbsp;বয়স: </span>
            <span style="font-size: 14px;">{{patient.age != 0 ? patient.age + ' Y ': ''}}</span>
            <!-- <span>{{patient.age.months != 0 ? patient.age.months + ' M ': ''}}</span>
            <span>{{patient.age.days != 0 ? patient.age.days + ' D ': ''}}</span> -->
            <span class="label_tag" style="font-size: 14px;">&nbsp; মোবাইল নাম্বার: </span>
            <span style="font-size: 14px;">{{patient.phoneNumber.value}}</span><br>

            <span class="label_tag" style="font-size: 14px;">পেশা: </span>
            <span style="font-size: 14px;">{{patient.occupation.value.display.split(',')[1]}} </span>
            <span ng-if="!patient.occupation.value" style="font-size: 14px;">&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                &nbsp;&nbsp;&nbsp;&nbsp;</span>
            <span class="label_tag" style="font-size: 14px;">&nbsp; ধর্ম: </span>
            <span>{{patient.religion.value.split(',')[1]}} </span><br>
            <span class="label_tag" style="font-size: 14px;">ঠিকানা (বর্তমান): </span>
            <span style="text-transform: capitalize;font-size: 14px;">
                {{address.address1 ? address.address1 + "," : ""}}
                {{patient.address.address3 ? patient.address.address3 + "," : ""}}
                {{address.address4 ? address.address4 + "," : ""}}
                {{address.address5 ? address.address5 + "," : ""}}
                {{address.countyDistrict ? address.countyDistrict + "," : ""}}
                {{address.stateProvince}}
            </span>
        </div>
        <div class="address-right" style="float: right; margin-right:0px">

            <span class="label_tag" style="float:right; font-size: 14px"><b>Patient ID :</b>
                {{patient.identifier}}</span><br>
            <span class="label_tag" style="float:right; font-size: 14px"><b>Date: {{curDate |
                    bahmniDateTime}}</b></span>

        </div>
    </div>
    <!-- <div class="roomAssignment">
      <span>{{observations[1].complexData.data.name}}</span>
  </div> -->

    <div class="body-style">
        <div class="patientStaticInfo">
            <!-- <span style="font-size: 14px;">রোগীর স্থায়ী ঠিকানা: </span> -->
            
            <!-- <span style="font-size: 14px;">স্থায়ী:  .....................................................................................................................................................................</span><br> -->
            <span style="font-size: 14px;">নিকট/ স্থানীয় আত্মীয়ের নাম: 
                <span ng-if="patient.RelativeName.length !== 0">{{patient.RelativeName.value}}</span> 
    
            </span>
            
            <span style="font-size: 14px;">   মোবাইল নং: {{patient.relativeMobileNumber.value}}</span>
            <span style="font-size: 14px;">আত্মীয়ের ঠিকানা: {{patient.relativeAddress.value}}</span>
        
            <span style="font-size: 14px;">ভর্তির তারিখ ও সময়: {{visitSummary.startDateTime |
                bahmniDateTime}}&nbsp;</span>
            <span style="font-size: 14px;">ছুটি দেওয়ার তারিখ: </span>
            <span>................................................</span>
            <span style="font-size: 14px;">সময়: </span>
            <span>...............................................</span>
            <span style="font-size: 14px;">রোগ: </span>
            <span ng-if="obsDiagnosis.length!==0">
                <span ng-repeat="obsGroup in obsDiagnosis">
                    <span style="font-size: 14px;"><b>{{obsGroup.codedAnswer.name? obsGroup.codedAnswer.name : obsGroup.latestDiagnosis.freeTextAnswer}}</b>, </span>
                </span>
            </span> 
            <span ng-if="obsDiagnosis.length === 0">
                <span>.............................................</span>
            </span>           
            <span style="font-size: 14px;">বিভাগে&nbsp;</span>
            <span style="font-size: 14px;"><b>{{bedDetails.wardName}} ,</b>&nbsp;</span>
            <span style="font-size: 14px;"><b>{{bedDetails.physicalLocationName}}</b>&nbsp;</span>
            <span style="font-size: 14px;"> ওয়ার্ডে ভাড়ায় / বিনা ভাড়ায়</span>
            <span>.......................................</span><span style="font-size: 14px;">
                এর অধীনে ভর্তি করা হইলো।</span>

        </div>
        <br>
        <br>
        <div class="signInfo" style="margin-top:2px">
            <div class="signInfoLeft">
                <br><br><span style="font-size: 14px;">কেবিন/ শয্যা নম্বর : </span>
                <span style="font-size: 14px;"><b>{{bedDetails.bedNumber}}</b></span><br><br>
            </div>
            <div class="signInfoRight">
                <span style="font-size: 14px;">স্বাক্ষর : </span>
                <span>......................................................</span><br>
                <div>

                    <span style="font-size: 14px; ">নাম : </span>
                    <span style="font-size: 14px;">{{providerName}}</span><br>

                </div>
                <div>
                    <span style="font-size: 14px;">পদবী : </span>
                    <span style="font-size: 14px;">{{providerDesignation}}</span><br>
                </div>
            </div>
        </div>


    </div>


</div>
<div style="border-top: 1px solid black;margin-top: 90px;">
    <br>
    <span style="font-size: 14px;float:left;">সংক্ষিপ্ত ইতিহাস: </span>
</div>
<script type="text/javascript" src="/bahmni_config/openmrs/apps/JsBarcode.all.min.js"></script>
<script>
    (function () {
        JsBarcode("#barcode").init();
    })();
</script>