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index.php
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<!DOCTYPE html>
<html lang="en">
<head>
<title>COVID-19 DETECTOR</title>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="style.css">
<script src="myscript1.js"></script>
<script src="myscript2.js"></script>
<style>
body
{
background-image:url("covid.jpg");
background-size:100%;
}
h1
{
border:10px solid green;
background-color:orange;
}
h1:hover
{
transform:scale(1.1);
background-color:cyan;
}
.details
{
margin:10px;
padding:20px;
border:5px solid grey;
}
#legend
{
color:brown;
}
h3
{
color:Pink;
}
.button
{
display: inline-block;
border-radius: 4px;
background-color: #f4511e;
border: none;
color: #FFFFFF;
text-align: center;
font-size: 18px;
padding: 20px;
width: 250px;
transition: all 0.5s;
cursor: pointer;
margin: 5px;
}
.button span
{
cursor: pointer;
display: inline-block;
position: relative;
transition: 0.5s;
}
.button span:after
{
content: '\00bb';
position: absolute;
opacity: 0;
top: 0;
right: -20px;
transition: 0.5s;
}
.button:hover span
{
padding-right: 25px;
}
.button:hover span:after
{
opacity: 1;
right: 0;
}
</style>
</head>
<body>
<nav class="navbar navbar-inverse">
<div class="container-fluid">
<div class="navbar-header">
<a class="navbar-brand" href="#">Covid-19 Detector</a>
</div>
<ul class="nav navbar-nav">
<li class="active"><a href="#">Home</a></li>
<li><a href="contact.php">Contact Us</a></li>
</ul>
</div>
</nav>
<h1 align="center">COVID-19 DETECTOR</h1>
<form class="details" method="post" action="">
<fieldset>
<legend><h3 id="legend">Details</h3></legend>
<br>
<br>
<label><h3>Patient's Name:-</h3></label>  
<input type="text" placeholder="First Name" name="fn">  
<input type="text" placeholder="Middle Name" name="mn">  
<input type="text" placeholder="Last Name" name="ln">
<br>
<label><h3>Age:-</h3></label>  
<input type="number" placeholder="In Yrs" name="age">
<br>
<label><h3>Cough:-</label>  
<input type="radio" name="cy" value="Yes">  Yes  <input type="radio" name="cy" value="No">  No</h3>
<label><h3>Fever:-</label>  </h3>
<input type="number" placeholder="in celsius" name="temp"><h3>`C</h3>
<label><h3>Body Pain:-</label>  
<input type="radio" name="py" value="Yes">  Yes  <input type="radio" name="py" value="No">  No</h3>
<label><h3>Runny Nose:-</label>  
<input type="radio" name="ry" value="Yes">  Yes  <input type="radio" name="ry" value="No">  No</h3>
<label><h3>Difficulty in Breathing:-</label>  
<input type="radio" name="no" value="Normal">  Normal  <input type="radio" name="no" value="Moderate">  Moderate  <input type="radio" name="no" value="Critical">  Critical</h3>
<br>
<label><h3>Visited abroad within 90 days:-</label>  
<input type="radio" name="ay" value="Yes">  Yes  <input type="radio" name="ay" value="No">  No</h3>
<label><h3>If yes, Then Country Name:-</label>  </h3>
<input type="text" placeholder="country" name="cnt">
<br>
<center>
<br>
<input type="submit" class="button" style="vertical-align:middle" value="Submit" name="submit" formaction="output.php">
<br>
<input type="reset" class="button" style="vertical-align:middle" value="Reset">
</center>
</fieldset>
</form>
</body>
</html>