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emergencyform.html
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emergencyform.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Real Happiness of Life foundation</title>
</head>
<body>
<form action="emergencycases">
<label for="name">Name : </label>
<input type="name" name="name" id="name"><br> <br>
<label for="name">Age : </label>
<input type="number" name="number" id="number"><br><br>
<label for="disease">Disease</label>
<input type="text" name="text" id="text"><br><br>
<label for="fdetails">Family Details : </label>
<textarea name="text" id="text" cols="60" rows="10"></textarea> <br>
<label for="totalcost">Total Cost :</label>
<input type="number" name="number" id="number"><br><br>
<label for="Pdetails">Patient Details : </label>
<textarea name="text" id="text" cols="60" rows="10"></textarea> <br><br>
<label for="docs">Supporting Documents : </label>
<input type="text" name="text" id="text"><br>
<input type="file" id="myFile" name="filename">
</form>
</body>
</html>