Form to create printable page and store data in mysql

Please see the attached PDF File. It will make it much easier to explain. Basically I need a standard HTML form that when filled out and submitted it does 2 things. Stores that info into a mysql database and then pops up exactly like the attached PDF file all filled out and ready to print. 1. HTML form that inserts data into mysql database 2. A page that can pull info from that database by unique ID and display it's info as a printable page EXACTLY like the attached PDF file. Does not HAVE to be in pdf format but it can be it that makes it easier. 3. A page that can pull up an entry in the database so the administrator can edit the information and save it 4. A browse page so that you could at any time pull up a list of each item saved in the database. Next to each item it would have an [EDIT] button and a [PRINT] button. The edit button would be the link to the above edit page. And the print button would be a link to the print page with that items data filled out. 5. A Search page. Probably only need to fields to be searchable. Social Security Number and Last Name. It would then display the results just like the browse page with the edit and print buttons next to each result. If it needs to stay PDF format in order to print correctly that is fine, if it can be done with layers or tables that is also ok. If you can get it to print out EXACTLY like it looks in that form then it does not need to be actual PDF. But it is VERY important that it print out just like that. More than one of these forms will be entered into the database for the SAME patient (same social, last name ETC). So that may or may not need to be considered when setting up the database scheme. This has a very short deadline. Monday Evening PST. Please do not bid if you can't meet this deadline. Thank You!

## Deliverables

1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done.

2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables):

a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment.

b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request.

3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement).

## Platform

Platform: Windows 2003 Server Standard Edition Language: PHP - Latest Version Database: MYSQL - Latest Version PHP and MYSQL are not installed on the server as of yet so the application will need to work with the latest versions of each.

Engineering Microsoft MySQL PHP Software Architecture Software Testing Windows Desktop

Project ID: #3527849

About the project