50 lines
2.6 KiB
PHP
50 lines
2.6 KiB
PHP
<?php
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$this->titre = "INTER-SANTE - ". _("Fiche Assureur");
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$_SESSION['codeGcAssureur_C'] = $this->nettoyer($gc['codeGcAssureur']) ;
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?>
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<script type="text/javascript">
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</script>
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<input class="sr-only" type="text" id="idGc" name="idGc" value="<?= $this->nettoyer($gc['id']) ?>" >
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<legend> <?= _("Fiche Assureur") ?></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="10%" >Code</td>
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<td width="10%"><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="codeGcAssureur" NAME="codeGcAssureur" value="<?=$this->nettoyer($gc['codeGcAssureur'])?>" readonly></td>
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<td width="10%" align="center"><?= _("Nom") ?></td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="libelle" NAME="libelle" value="<?=$this->nettoyer($gc['libelle'])?>" readonly></td>
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<td width="10%" align="center">E-mail</td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="emailGcAssureur" NAME="emailGcAssureur" value="<?=$this->nettoyer($gc['email'])?>" readonly></td>
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</tr>
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<tr>
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<td><?= _("Tx Comm (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxFraisReel" NAME="gcTauxFraisReel" TYPE="text" value="<?= $this->nettoyer($gc['gcTauxFraisReel']) ?> " readonly ></td>
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<td align="center"><?= _("Tx Redr (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxRedressement" NAME="gcTauxRedressement" TYPE="text" value="<?= $this->nettoyer($gc['gcTauxRedressement']) ?> " readonly></td>
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<td align="center"> <?= _("Tx Tva (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxTva" NAME="gcTauxTva" TYPE="text" value="<?= $this->nettoyer($gc['gcTauxTva']) ?> " readonly></td>
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</tr>
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<tr>
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<td> <?= _("Nouv Carte") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="fraisCarteAfn" NAME="fraisCarteAfn" value="<?=format_N($this->nettoyer($gc['fraisCarteAfn']))?>" readonly></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="text" id="fraisCarteRen" NAME="fraisCarteRen" value="<?=format_N($this->nettoyer($gc['fraisCarteRen']))?>" readonly></td>
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<td align="center"> C<?= _("Carte RE-IMPR") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="fraisCarteImp" NAME="fraisCarteImp" value="<?=format_N($this->nettoyer($gc['fraisCarteImp']))?>" readonly></td>
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</tr>
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</tbody>
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</table>
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