49 lines
2.2 KiB
PHP
Executable File
49 lines
2.2 KiB
PHP
Executable File
<?php $this->titre = "Afrikssur-Santé-Edition de bon de PEC Examen standards"; ?>
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<form id="frmconsultation" name="frmconsultation" method="post" action="Examenstandard/enregistredossier">
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<input class="sr-only" type="text" id="codeTypeBon" name="codeTypeBon" value="1" >
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<input class="sr-only" type="text" id="codePrestataire" name="codePrestataire" value="<?= $_SESSION['p_codePrestataireUtilisateur'] ?>" >
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<input class="sr-only" type="text" id="numeroBeneficiaire" name="numeroBeneficiaire" value="<?= $_SESSION['p_numeroBeneficiaire_C'] ?>" >
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<fieldset>
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<legend>Bon de PEC examen standard (non soumis à entente préalable)</legend>
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<table class="table table-responsive table-condensed">
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<tbody>
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<tr>
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<td> <?= _("Acte") ?> </td>
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<td>
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<SELECT class="form-control" id="codeActe" NAME="codeActe" required AUTOCOMPLETE="OFF" autofocus onChange="ajaxinfosacteexamen();" >
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<?php liste_options($acte,""); ?>
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</SELECT>
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</td>
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<td align="center">Couverture (%)</td>
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<td><input class="form-control" style="background-color: rgb(190,190,190);text-align: center;" type="number" id="tauxCouverture" name="tauxCouverture" value="<?= $tauxCouverture ?>" readonly ></td>
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</tr>
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<tr>
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<td height="25"></td>
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</tr>
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<tr>
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<td>Numéro Bon</td>
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<td><input class="form-control" style="text-align: center" type="number" id="numeroBon" name="numeroBon" required AUTOCOMPLETE="OFF" ></td>
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<td><input class = "form-control btn btn-primary" type="button" value="Bon sur pré-imprimé" onClick="javascript:ajaxbonexamendisponible();"></td>
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<td><input class = "form-control btn btn-primary" type="button" value="Bon sur feuille vierge" onClick="javascript:imprimerbonVierge();"></td>
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</tr>
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</tbody>
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</table>
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</fieldset>
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<div id="msgErreur" class="alert alert-danger" style="height:38px; padding:5px;" >
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<input class="sr-only" type="text" id="codeEtatBon" name="codeEtatBon" value="<?= $codeEtatBon ?>">
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<H4><?= $msgErreur ?></H4>
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</div>
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<div id="infosacte" style="display: none">
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<input type="number" id="tauxCouverture_info" name="tauxCouverture_info" value="<?= $tauxCouverture_info ?>">
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</div>
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</form>
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