57 lines
2.4 KiB
PHP
57 lines
2.4 KiB
PHP
<?php
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$this->titre = "INTER-SANTE - ". _("Activation Gestion confiée");
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?>
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<legend> <?= _("Activation Gestion confiée") ?> </legend>
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<input class="sr-only" type="text" id="idPolice" name="idPolice" value="<?= $_SESSION['idPolice_C'] ?>" >
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td width="10%" ><?= _("Assureur") ?> </td>
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<td>
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<SELECT style='font-size:10pt;' onChange="choisir_gc_assureur();" class="form-control" id="codeGcAssureur" NAME="codeGcAssureur" autofocus>
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<?php liste_options($gc,""); ?>
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</SELECT>
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</td>
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</tr>
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</tbody>
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</table>
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<div id="div_gc">
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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="10%" > <?= _("Tx Comm (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxFraisReel" NAME="gcTauxFraisReel" TYPE="text" ></td>
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<td width="10%" align="center"><?= _("Tx Redr (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxRedressement" NAME="gcTauxRedressement" TYPE="text" ></td>
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<td width="10%" align="center"> <?= _("Tx Tva (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxTva" NAME="gcTauxTva" TYPE="text" ></td>
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</tr>
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<tr>
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<td> <?= _("Carte AFN") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteAfn" NAME="fraisCarteAfn" ></td>
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<td align="center"> <?= _("Carte REN") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteRen" NAME="fraisCarteRen" ></td>
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<td align="center"> <?= _("Carte RE-IMPR") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteImp" NAME="fraisCarteImp" ></td>
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</tr>
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<tr>
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<td> </td>
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<td colspan="3"> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer") ?>" onClick="javascript:creer_gc_police();" style='font-size:10pt;' > </td>
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<td> </td>
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<td colspan="1"> <input class = "form-control btn btn-warning" type="button" value="<?= _("Annuler") ?>" onClick="javascript:retour_liste_gc_police();" style='font-size:9pt;' > </td>
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</tr>
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</tbody>
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</table>
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</div>
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