24 lines
960 B
PHP
Executable File
24 lines
960 B
PHP
Executable File
<form id="formData">
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<legend id="titre_formData"><?= _("Ajouter des données") ?></legend>
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<table class="table table-responsive table-condensed">
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<tbody>
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<tr>
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<td width="5%" align="center" class="required"><?= _("Libellé") ?></td>
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<td width="25%" ><INPUT class="form-control majuscule" TYPE="text" id="libelle" NAME="libelle" required AUTOCOMPLETE="OFF" ></td>
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<td width="10%" align="center"><?= _("Libellé Eng") ?></td>
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<td width="25%" ><INPUT class="form-control majuscule" TYPE="text" id="libelleEng" NAME="libelleEng"></td>
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<td width="10%" align="right">Maladie Chronique</td>
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<td width="5%">
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<select name="maladieChronique" id="maladieChronique" class="form-select">
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<?= liste_options($ouinonoptionnelle,'1',true) ?>
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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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</form>
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