Multiple drop down create different records for my sql

PHP
1

I have a form that insert’s into my database, in this form is three different drop down menu’s. I want to take all the data and insert a row for dropdown menu 1 (exam1), and if something is filled in on dropdown menu 2(exam2) I want to create a separate row for that with the same data (except exam2 and numberviews2 will be different.

Here is the form


<?php
session_start();
?>

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
    "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
        <title></title>
        <link rel="stylesheet" href="/req/menu/menu_style.css" type="text/css" />
        <script src='{$td_url}/req/scripts/clear.js' type='text/javascript'></script>
        <style type="text/css">

#wsbtxt1 {position: absolute; left: 192px; top: 119px; width: 248px; height: 23px; z-index: 2;}

#lblwsbfrmtext1 {position: absolute; left: 12px; top: 266px; width: 83px; height: 16px; z-index: 5;}

#wsbfrmtext1 {position: absolute; left: 122px; top: 266px; width: 151px; height: 18px; z-index: 3;}

#wsbfrmtext2 {position: absolute; left: 292px; top: 266px; width: 151px; height: 18px; z-index: 4;}

#lblwsbfrmtext4 {position: absolute; left: 322px; top: 356px; width: 101px; height: 16px; z-index: 7;}

#wsbfrmtext4 {position: absolute; left: 412px; top: 316px; width: 81px; height: 18px; z-index: 6;}

#lblwsbfrmtext5 {position: absolute; left: 12px; top: 576px; width: 164px; height: 16px; z-index: 9;}

#wsbfrmtext5 {position: absolute; left: 172px; top: 576px; width: 200px; height: 22px; z-index: 8;}

#lblwsbfrmtxtarea1 {position: absolute; left: 12px; top: 456px; width: 173px; height: 16px; z-index: 11;}

#wsbfrmtxtarea1 {position: absolute; left: 92px; top: 456px; width: 472px; height: 28px; z-index: 10;}

#wsbfrmbtn1 {position: absolute; left: 182px; top: 656px; width: 100px; height: 22px; z-index: 12;}

#wsbfrmbtn2 {position: absolute; left: 342px; top: 656px; width: 100px; height: 22px; z-index: 13;}

#wsbimg1 {position: absolute; left: 287px; top: 59px; width: 50px; height: 55px; z-index: 14;}

#lblwsbfrmcheckbox1 {position: absolute; left: 12px; top: 616px; width: 73px; height: 16px; z-index: 16;}

#wsbfrmcheckbox1 {position: absolute; left: 102px; top: 616px; width: 18px; height: 18px; z-index: 15;}

#lblwsbfrmcheckbox2 {position: absolute; left: 152px; top: 616px; width: 49px; height: 16px; z-index: 18;}

#wsbfrmcheckbox2 {position: absolute; left: 212px; top: 616px; width: 18px; height: 18px; z-index: 17;}

#lblwsbfrmselect2 {position: absolute; left: 12px; top: 316px; width: 81px; height: 16px; z-index: 26;}

#wsbfrmselect2 {position: absolute; left: 102px; top: 316px; width: 200px; height: 22px; z-index: 19;}

#lblwsbfrmselect3 {position: absolute; left: 12px; top: 356px; width: 107px; height: 16px; z-index: 27;}

#wsbfrmselect3 {position: absolute; left: 102px; top: 356px; width: 200px; height: 22px; z-index: 20;}

#lblwsbfrmselect4 {position: absolute; left: 12px; top: 396px; width: 91px; height: 16px; z-index: 28;}

#wsbfrmselect4 {position: absolute; left: 102px; top: 396px; width: 200px; height: 22px; z-index: 21;}

#wsbfrmtext3 {position: absolute; left: 412px; top: 356px; width: 81px; height: 18px; z-index: 22;}

#wsbfrmtext6 {position: absolute; left: 412px; top: 396px; width: 81px; height: 18px; z-index: 23;}

#lblwsbfrmtext7 {position: absolute; left: 412px; top: 576px; width: 129px; height: 16px; z-index: 25;}

#wsbfrmtext7 {position: absolute; left: 555px; top: 576px; width: 142px; height: 22px; z-index: 24;}

#lblwsbfrmtxtarea3 {position: absolute; left: 12px; top: 506px; width: 120px; height: 16px; z-index: 30;}

#wsbfrmtxtarea3 {position: absolute; left: 92px; top: 506px; width: 472px; height: 28px; z-index: 29;}

#lblwsbfrmtext8 {position: absolute; left: 476px; top: 268px; width: 34px; height: 16px; z-index: 32;}

#wsbfrmtext8 {position: absolute; left: 536px; top: 265px; width: 119px; height: 17px; z-index: 31;}

#wsbhru1 {position: absolute; left: 3px; top: 192px; width: 670px; height: 2px; z-index: 33;}

#wsbhru2 {position: absolute; left: 2px; top: 296px; width: 673px; height: 1px; z-index: 34;}

#wsbhru3 {position: absolute; left: 2px; top: 436px; width: 672px; height: 2px; z-index: 35;}

#wsbhru4 {position: absolute; left: 2px; top: 246px; width: 675px; height: 2px; z-index: 36;}

#wsbhru5 {position: absolute; left: 2px; top: 556px; width: 673px; height: 2px; z-index: 37;}

#lblwsbfrmtext9 {position: absolute; left: 163px; top: 208px; width: 146px; height: 24px; z-index: 39;}

#wsbfrmtext9 {position: absolute; left: 295px; top: 206px; width: 146px; height: 22px; z-index: 38;}

#wsbnavbar1 {position: absolute; left: 60px; top: 10px; width: 533px; height: 35px; z-index: 40;}

#wsbtxt2 {position: absolute; left: 189px; top: 148px; width: 248px; height: 23px; z-index: 41;}

#container {position:relative; margin: 0 auto; width: 677px; height: 682px; text-align:left;}

#inner-container {position: relative; width: 677px; height: 682px;}

body {text-align: center;}

</style>
        <script type='text/javascript'>
        
        //clears default value of text fields
function clearDefault(el) {
  if (el.defaultValue==el.value) el.value = ""
}
        </script>
        
    </head>
    <body id="ifldasb13">
        <div id="container">
            <div id="inner-container">
                <div id="menu">
    <ul>
       <li><a href="" target="_self" title="Radiology Requisition Form"><span>Radiology Requisition Form</span></a></li>
       <li><a href="" target="_self" title="Export/Print Log"><span>Export/Print Log</span></a></li>
       <li><a href="" target="_self" title="Logout"><span>Logout</span></a></li>
    </ul>
</div>
                <img id="wsbimg1" src="/images/req/logo.GIF" alt="" width="141" height="157" />
                <div id="wsbtxt1">
                    <p align="center"><strong>Radiology Requisition</strong></p>
                   </div>
						<div id="wsbtxt2">
							<p align="center"><?php echo"Welcome:" .$_SESSION["myusername"]?></p>
							</div>                   
                    <br><br><br><br><br><br>
                <hr id="wsbhru1" />
                <form id="Radiology Requisition Form" name="Radiology Requisition Form" method="post" action="RRFsubmit.php">
                    <label id="lblwsbfrmtext9" for="wsbfrmtext9">Date of Exam:</label>
                    <input type="text" id="wsbfrmtext9" name="dateofexam" value="MM-DD-YYYY" ONFOCUS="clearDefault(this)" />
                    <label id="lblwsbfrmtext1" for="wsbfrmtext1">Patient&nbsp;Name</label>
                    <input id="wsbfrmtext1" name="PNF" type=text value="First" ONFOCUS="clearDefault(this)" />
                    <input id="wsbfrmtext2" name="PNL" type=text value="Last" ONFOCUS="clearDefault(this)" />
                    <label id="lblwsbfrmtext8" for="wsbfrmtext8">DOB:</label>
                    <input type="text" id="wsbfrmtext8" name="dob" value="MM-DD-YYYY" ONFOCUS="clearDefault(this)" />
                    <label id="lblwsbfrmselect2" for="wsbfrmselect2">Exam # 1</label>
                    <select id="wsbfrmselect2" name="exam1">
                    		<option value="" selected="yes"></option>
                        <option value="Abdomen">Abdomen</option>
                        <option value="Chest">Chest</option>
                        <option value="RT Hand">RT Hand</option>
                    </select>
                    <label id="lblwsbfrmselect3" for="wsbfrmselect3">Exam # 2</label>
                    <select id="wsbfrmselect3" name="exam2">
                    <option value="" selected="yes"></option>
                        <option value="Abdomen">Abdomen</option>
                        <option value="Chest">Chest</option>
                        <option value="RT Hand">RT Hand</option>
                    </select>
                      <label id="lblwsbfrmselect4" for="wsbfrmselect4">Exam # 3</label>
                    <select id="wsbfrmselect4" name="exam3">
                   		<option value="" selected="yes"></option>
                        <option value="Abdomen">Abdomen</option>
                        <option value="Chest">Chest</option>
                        <option value="RT Hand">RT Hand</option>
                    </select>
                    <label id="lblwsbfrmtext4" for="wsbfrmtext4"># of views</label>
                    <input type="text" id="wsbfrmtext4" name="numberviews1" />
                    <input type="text" id="wsbfrmtext3" name="numberviews2" />
						  <input type="text" id="wsbfrmtext6" name="numberviews3" />                    
                    <label id="lblwsbfrmtxtarea1" for="wsbfrmtxtarea1">History</label>
                    <textarea id="wsbfrmtxtarea1" name="History" cols="1" rows="1"></textarea>
                    <label id="lblwsbfrmtxtarea3" for="wsbfrmtxtarea3">Notes</label>
                    <textarea id="wsbfrmtxtarea3" name="Notes" cols="1" rows="1"></textarea>
                    <label id="lblwsbfrmtext5" for="wsbfrmtext5">Ordering Physician</label>
                    <input type="text" id="wsbfrmtext5" name="orderingphysician" />
                    <label id="lblwsbfrmtext7" for="wsbfrmtext7">Contact Phone</label>
                    <input type="text" id="wsbfrmtext7" name="ContactPhone" />
                    <label id="lblwsbfrmcheckbox1" for="wsbfrmcheckbox1">Stat Read</label>
                    <input type="checkbox" id="wsbfrmcheckbox1" name="STATREAD" value="yes" />
                    <label id="lblwsbfrmcheckbox2" for="wsbfrmcheckbox2">Priors</label>
                    <input type="checkbox" id="wsbfrmcheckbox2" name="priors" value="yes" />
                    <input type="submit" id="wsbfrmbtn1" name="Submit" value="Send to" />
                    <input type="reset" id="wsbfrmbtn2" name="Cancel" value="Cancel" />
                </form>
                <hr id="wsbhru4" />
                <hr id="wsbhru2" />
                <hr id="wsbhru3" />
                <hr id="wsbhru5" />
            </div>
        </div>
    </body>
    <br><br><br>
    
</html>

Here is the Submit script

 
<?php 
session_start();

// Connects to your Database 

 mysql_connect("","","") or die(mysql_error()); 
 mysql_select_db("RadReq") or die(mysql_error()); 

 //This code runs if the form has been submitted

 if (isset($_POST['Submit'])) { 

 //This makes sure they did not leave any fields blank

 if (!$_POST['dateofexam'] | !$_POST['PNF'] | !$_POST['PNL'] | !$_POST['dob'] | !$_POST['exam1'] | !$_POST['numberviews1'] | !$_POST['History'] | !$_POST['orderingphysician'] | !$_POST['ContactPhone']) {

 		die('You did not complete all of the required fields') ;

 	}

// now we insert it into the database

 	$Location= $_SESSION["myusername"];
 	$dateofexam=mysql_real_escape_string($_POST['dateofexam']);
 	$PNF=mysql_real_escape_string($_POST['PNF']);
	$PNL=mysql_real_escape_string($_POST['PNL']);
	$dob=mysql_real_escape_string($_POST['dob']);
	$exam1=mysql_real_escape_string($_POST['exam1']);
	$numberviews1=mysql_real_escape_string($_POST['numberviews1']);
	$exam2=mysql_real_escape_string($_POST['exam2']);
	$numberviews2=mysql_real_escape_string($_POST['numberviews2']);
	$exam3=mysql_real_escape_string($_POST['exam3']);
	$numberviews3=mysql_real_escape_string($_POST['numberviews3']);
	$History=mysql_real_escape_string($_POST['History']);
	$Notes=mysql_real_escape_string($_POST['Notes']);
	$orderingphysician=mysql_real_escape_string($_POST['orderingphysician']);
	$ContactPhone=mysql_real_escape_string($_POST['ContactPhone']);
	$STATREAD=mysql_real_escape_string($_POST['STATREAD']);
	$priors=mysql_real_escape_string($_POST['priors']);
	
	$query="INSERT INTO formdata (Location,dateofexam,Pfirstname,Plastname,dob,examtype,views,history,notes,orderingphysician,contactphone,statread,priors) Values ('$Location','$dateofexam','$PNF','$PNL','$dob','$exam1','$numberviews1','$History','$Notes','$orderingphysician','$ContactPhone','$STATREAD','$priors')";	
    mysql_query($query) or die('Error, insert query failed'); }
	 	
	?>
	<html>
	<head>
<strong>Submitting....
<br>You will automatically be redirected back to the Form,<br>
Thank You</strong>
<meta http-equiv="refresh" content="2; URL=rrform.php">
</head>
</html>
2

I have tried adding this part of code to the script


   if (isset($_POST['exam2'])) {$query2="INSERT INTO formdata (Location,dateofexam,Pfirstname,Plastname,dob,examtype,views,history,notes,orderingphysician,contactphone,statread,priors) Values ('$Location','$dateofexam','$PNF','$PNL','$dob','$exam2','$numberviews2','$History','$Notes','$orderingphysician','$ContactPhone','$STATREAD','$priors')";	
    mysql_query($query) or die('Error, insert query failed'); }
   if (isset($_POST['exam3'])) {$query3="INSERT INTO formdata (Location,dateofexam,Pfirstname,Plastname,dob,examtype,views,history,notes,orderingphysician,contactphone,statread,priors) Values ('$Location','$dateofexam','$PNF','$PNL','$dob','$exam3','$numberviews3','$History','$Notes','$orderingphysician','$ContactPhone','$STATREAD','$priors')";	
    mysql_query($query) or die('Error, insert query failed'); }

but it just takes the exam 1 information and makes three records (rows)