26 lines
1.5 KiB
PHP
Executable File
26 lines
1.5 KiB
PHP
Executable File
<form id="formData">
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<legend id="titre_formData"><?= _("Modification des données") ?></legend>
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<INPUT class="sr-only" TYPE="text" id = "id" name = "id" value="<?=$typeaffection['id']?>">
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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">Code</td>
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<td width="10%" ><INPUT class="form-control majuscule" TYPE="text" id="codeTypeAffection" NAME="codeTypeAffection" value="<?= $this->nettoyer($typeaffection['codeTypeAffection']); ?>" disabled></td>
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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" value="<?= $this->nettoyer($typeaffection['libelle']); ?>"></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" value="<?= $this->nettoyer($typeaffection['libelleEng']); ?>"></td>
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<td width="10%" align="center"><?= _("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($ouinonplafondmodifiable,$this->nettoyer($$typeaffection['maladieChronique']),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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