106 lines
4.7 KiB
PHP
Executable File
106 lines
4.7 KiB
PHP
Executable File
<div id="div_ente_requete">
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<INPUT class="sr-only" TYPE="text" id="codePrestataire" name="codePrestataire" value="<?= $_SESSION['p_codePrestataire_C'] ?>">
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<INPUT class="sr-only" TYPE="text" id="codeTypePrestataire" name="codeTypePrestataire" value="<?= $_SESSION['p_codeTypePrestataire_C'] ?>">
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<input class="sr-only" type="text" id="codeMedecin" name="codeMedecin">
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<table class="table table-responsive table-condensed" style='font-size:7pt;'>
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<tbody>
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<tr>
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<td width="5%"> No Fam </td>
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<td colspan="3" width="13%" > <INPUT style='text-align:center; font-size:7pt;' class="form-control" TYPE="text" id="numeroAdherent" name="numeroAdherent" > </td>
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<td width="5%" align="center" > No Benef</td>
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<td width="13%"> <INPUT style='text-align:center; font-size:7pt;' class="form-control" TYPE="text" id="numeroBeneficiaire" name="numeroBeneficiaire"></td>
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<td width="5%" align="center" > <?= _("Adhérent") ?></td>
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<td colspan="3" > <INPUT style='tfont-size:7pt;' class="form-control" type="text" id="adherent" name="adherent" > </td>
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<td width="5%" align="center" > <?= _("Bénéficiaire") ?></td>
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<td colspan="3" > <INPUT style='font-size:7pt;' class="form-control" type="text" id="beneficiaire" name="beneficiaire" > </td>
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</tr>
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<tr>
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<td> <?= _("Police") ?> </td>
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<td colspan="3" > <INPUT style='text-align:center; font-size:7pt;' class="form-control" TYPE="text" id="numeroPolice" name="numeroPolice" > </td>
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<td align="center"> Cat </td>
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<td >
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<SELECT class="form-control" id="codeProduit" NAME="codeProduit" style='font-size:7pt;'>
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<?php liste_options_consultation($produit, ""); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("Etat Pol") ?> </td>
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<td>
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<SELECT class="form-control" id="codeEtatPolice" NAME="codeEtatPolice" style='font-size:7pt;'>
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<?php liste_options_consultation($etatpolice, ""); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("Lien Parenté") ?> </td>
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<td>
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<SELECT class="form-control" id="codeLienParente" NAME="codeLienParente" style='font-size:7pt;'>
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<?php liste_options_consultation($lienparente, ""); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("Etat Bénéf") ?> </td>
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<td>
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<SELECT class="form-control" id="codeEtatBeneficiaire" NAME="codeEtatBeneficiaire" style='font-size:7pt;'>
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<?php liste_options_consultation($etatbeneficiaire, ""); ?>
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</SELECT>
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</td>
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<td align="center"> Genre </td>
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<td>
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<SELECT class="form-control" id="sexe" NAME="sexe" style='font-size:7pt;'>
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<?php liste_options_consultation($sexe, ""); ?>
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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> <?= _("No Client") ?> </td>
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<td width="6%"> <INPUT style='text-align:center; font-size:7pt;' class="form-control" type="number" id="numeroClient1" name="numeroClient1" value="0" > </td>
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<td width="1%" align="center"> - </td>
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<td width="6%"> <INPUT style='text-align:center; font-size:7pt;' class="form-control" type="number" id="numeroClient2" name="numeroClient2" value="0" > </td>
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<td align="center" > <?= _("Tel") ?></td>
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<td> <INPUT style='text-align:center; font-size:7pt;' class="form-control" TYPE="text" id="telephonePortableAdherent" name="telephonePortableAdherent"></td>
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<td align="center" > <?= _("E-mail") ?></td>
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<td> <INPUT style='text-align:center; font-size:7pt;' class="form-control" TYPE="text" id="emailAdherent" name="emailAdherent"></td>
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<td align="center"> <?= _("Décès") ?> </td>
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<td>
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<SELECT class="form-control" id="decede" NAME="decede" style='font-size:7pt;'>
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<?php liste_options_consultation($ouinondecede, ""); ?>
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</SELECT>
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</td>
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<td align="center" > <?= _("Client") ?> </td>
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<td colspan="3" > <INPUT style='font-size:7pt;' class="form-control" type="text" id="nomClient" name="nomClient" > </td>
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</tr>
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<tr>
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<td> </td>
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<td colspan="5"> <button style='font-size:10pt;' type="button" class="form-control btn btn-primary" onclick="javascript:requetes_assure();"><?= _("Afficher résultats...") ?></button> </td>
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<td colspan="5">
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<input class="form-control" style="text-align: center; font-size:10pt;" type="text" id="nbligne" name="nbligne" value="Result : 0" readonly>
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</td>
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<td colspan="3"> <button style='font-size:10pt;' type="button" class="form-control btn btn-primary" onclick="javascript:requetes_assure_export();"><?= _("Exporter vers Excel...") ?></button> </td>
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</tr>
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</tbody>
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</table>
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<div id="div_detail_requete">
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</div>
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<div id="div_export_a">
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</div>
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