Skip to content

Commit

Permalink
Upload to GH
Browse files Browse the repository at this point in the history
  • Loading branch information
@besartademi
besartademi committed Nov 27, 2024
0 parents commit be4c72b
Show file tree
Hide file tree
Showing 2 changed files with 301 additions and 0 deletions.
Binary file added .DS_Store
Binary file not shown.
301 changes: 301 additions & 0 deletions index.html
Original file line number Diff line number Diff line change
@@ -0,0 +1,301 @@
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Raport Specialistik</title>
<style>
body {
font-family: Arial, sans-serif;
margin: 0;
padding: 0;
background-color: #f4f4f4;
}
.container {
max-width: 800px;
margin: 20px auto;
padding: 20px;
background-color: #fff;
border-radius: 8px;
box-shadow: 0 0 10px rgba(0, 0, 0, 0.1);
}

/* Header Section */
.header {
display: flex;
justify-content: space-between;
align-items: center;
border-bottom: 2px solid #007BFF;
padding-bottom: 10px;
margin-bottom: 20px;
}
.logo {
width: 80px;
height: 80px;
background-color: #007BFF;
border-radius: 50%;
display: flex;
align-items: center;
justify-content: center;
color: white;
font-size: 24px;
}
.header-info {
text-align: center;
font-size: 14px;
color: #333;
}
.header-info h2, .header-info p {
margin: 2px 0;
}
.contact-info {
font-size: 12px;
text-align: right;
color: #333;
}

/* Title */
.title {
font-size: 24px;
text-align: center;
margin: 20px 0;
color: #333;
}

/* Patient Information Section */
.patient-info {
margin-bottom: 20px;
}
.patient-info .name-surname {
display: flex;
gap: 20px;
}
.patient-info .name-surname div {
flex: 1;
}
.patient-info label {
display: block;
font-weight: bold;
margin-bottom: 5px;
}
.patient-info input {
width: 100%;
padding: 8px;
border: 1px solid #ccc;
border-radius: 4px;
margin-bottom: 10px;
background-color: #f9f9f9;
font-size: 16px;
}
.birthday-location {
display: flex;
gap: 20px;
}
.birthday-location div {
flex: 1;
}

/* Diagnose Section */
.diagnose-section {
margin-bottom: 20px;
}
.diagnose-section label {
font-weight: bold;
}
.diagnose-section input {
width: 100%;
padding: 8px;
border: 1px solid #ccc;
border-radius: 4px;
background-color: #f9f9f9;
font-size: 16px;
}

/* Medical Information Section */
.medical-info {
margin-top: 20px;
}
.medical-info .info-item {
display: flex;
justify-content: space-between;
align-items: center;
margin-bottom: 10px;
}
.medical-info label {
font-weight: bold;
width: 30%;
margin-right: 10px;
}
.medical-info input {
width: 65%;
padding: 5px;
text-align: left;
border: 1px solid #ccc;
border-radius: 4px;
background-color: #f9f9f9;
font-size: 14px;
}

/* Footer Section */
.footer {
display: flex;
justify-content: space-between;
align-items: flex-start;
margin-top: 30px;
font-size: 14px;
color: #333;
padding-top: 20px;
border-top: 2px solid #007BFF;
}
.footer .date-location {
text-align: left;
}
.footer .signature-section {
text-align: right;
}
.signature-line {
border-top: 1px solid #000;
width: 150px;
margin-top: 20px;
}
.signature-text {
margin-top: 5px;
font-size: 12px;
color: #666;
}
.footer .extra-text {
width: 100%;
text-align: center;
font-size: 10px;
color: #666;
margin-top: 10px;
}
</style>
</head>
<body>
<div class="container">
<!-- Header Section -->
<div class="header">
<!-- Logo -->
<div class="logo">LOGO</div>

<!-- Title and Doctor Info -->
<div class="header-info">
<h2>ORDINANCA SPECIALISTIKE PEDIATRIKE</h2>
<p>"R.H. PEDIATRIA"</p>
<p>Dr. med. Rexhep Hoxha</p>
<p>Specialist - Pediater</p>
</div>

<!-- Contact Info -->
<div class="contact-info">
<p>Mob: 044 117 605</p>
<p>Rr. Shahin Kolonja nr.10</p>
</div>
</div>

<!-- Title -->
<div class="title">RAPORT SPECIALISTIK</div>

<!-- Patient Information Section -->
<div class="patient-info">
<div class="name-surname">
<div>
<label for="patient-first-name">First Name:</label>
<input type="text" id="patient-first-name" name="patient-first-name">
</div>
<div>
<label for="patient-last-name">Last Name:</label>
<input type="text" id="patient-last-name" name="patient-last-name">
</div>
</div>

<div class="birthday-location">
<div>
<label for="birthday">Birthday:</label>
<input type="date" id="birthday" name="birthday">
</div>
<div>
<label for="location">Location:</label>
<input type="text" id="location" name="location">
</div>
</div>
</div>

<!-- Diagnose Section -->
<div class="diagnose-section">
<label for="diagnose">Diagnose:</label>
<input type="text" id="diagnose" name="diagnose">
</div>

<!-- Medical Information Section -->
<div class="medical-info">
<div class="info-item">
<label for="te">TE.</label>
<input type="text" id="te" name="te">
</div>
<div class="info-item">
<label for="pl">PL.</label>
<input type="text" id="pl" name="pl">
</div>
<div class="info-item">
<label for="gjl">GJL.</label>
<input type="text" id="gjl" name="gjl">
</div>
<div class="info-item">
<label for="pt">PT.</label>
<input type="text" id="pt" name="pt">
</div>
<div class="info-item">
<label for="gjt">GJT.</label>
<input type="text" id="gjt" name="gjt">
</div>
<div class="info-item">
<label for="pk">PK.</label>
<input type="text" id="pk" name="pk">
</div>
<div class="info-item">
<label for="par">PAR.</label>
<input type="text" id="par" name="par">
</div>
<div class="info-item">
<label for="fr">FR.</label>
<input type="text" id="fr" name="fr">
</div>
<div class="info-item">
<label for="fz">FZ.</label>
<input type="text" id="fz" name="fz">
</div>
<div class="info-item">
<label for="vaks">VAKS.</label>
<input type="text" id="vaks" name="vaks">
</div>
<div class="info-item">
<label for="gjiri">GJIRI.</label>
<input type="text" id="gjiri" name="gjiri">
</div>
</div>

<!-- Footer Section -->
<div class="footer">
<!-- Date and Location on the Left -->
<div class="date-location">
<label for="date">Date:</label>
<input type="date" id="date" name="date">
<p>Prizren</p>
</div>

<!-- Signature Section on the Right -->
<div class="signature-section">
<div class="signature-line"></div>
<p class="signature-text">Nënshkrimi dhe vula</p>
</div>
</div>

<!-- Extra Text -->
<div class="footer extra-text">
<p>NË KONTROLLË ÇDO HERË ME KËTË RAPORT MBRENDA 3 DITE</p>
</div>
</div>
</body>
</html>

0 comments on commit be4c72b

Please sign in to comment.