40 lines
1.2 KiB
PHP
40 lines
1.2 KiB
PHP
<?php $this->titre = "Intersanté - Demande de dérogation"; ?>
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<form id="frmderogation" name="frmderogation" method="post" >
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<legend> Fiche de demande de dérogation / Exemption request </legend>
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td width="15%" > Dérogation </td>
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<td>
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<SELECT class="form-control" id="codeDerogation" NAME="codeDerogation" required autofocus style='font-size:10pt;'>
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<?php liste_options($derogation,""); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td> Motivations </td>
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<td colspan="5"><INPUT class="form-control" TYPE="text" id="observations" NAME="observations" style='font-size:10pt;' ></td>
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</tr>
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<tr>
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<td> </td>
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<td> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="Envoyer la demande / Send request" onClick="javascript:enregistrerdemandederogation();" style='font-size:10pt;' > </td>
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</tr>
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</tbody>
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</table>
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<?php if (isset($msgErreur)): ?>
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<div id ="msgErreur" class="alert alert-danger">
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<H3><?= $msgErreur ?></H3>
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</div>
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<?php endif; ?>
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</form>
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<div id ="div_wait">
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</div>
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