216 lines
9.9 KiB
PHP
Executable File
216 lines
9.9 KiB
PHP
Executable File
<?php
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$this->titre = "INTER-SANTE - Modification Prestataire";
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$codeLanguePrestataire = $this->nettoyer($prestataire['codeLanguePrestataire']);
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?>
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<legend> <?=_("Prestataire") . " : " . $prestataire['libelle'] . " ( ".$prestataire['codePrestataireNormalise'] . " )" ?> </legend>
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<input class="sr-only" type="text" id="idPrestataire" name="idPrestataire" value="<?= $this->nettoyer($prestataire['idPrestataire']) ?>" >
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<table class="table table-responsive table-condensed" style="font-size:8pt">
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<tbody>
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<tr>
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<td width="7%" class="required"> <?= _("Nom") ?> </td>
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<td width="33%"><INPUT class="form-control majuscule" TYPE="text" id="libelle" NAME="libelle" value="<?=$this->nettoyer($prestataire['libelle'])?>" required AUTOCOMPLETE="OFF" autofocus ></td>
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<td width="7%" align="center" > <?= _("Catégorie") ?> </td>
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<td>
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<SELECT class="form-control" id="categoriePresataire" NAME="categoriePresataire" onChange="JAVASCRIPT:changeTypePrestataire()" >
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<?php liste_options($categorie, $prestataire['categoriePresataire']); ?>
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</SELECT>
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</td>
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<td width="7%" align="center" class="required">Type</td>
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<td>
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<div id="div_type_prestataire">
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<SELECT class="form-control" id="codeTypePrestataire" NAME="codeTypePrestataire" required AUTOCOMPLETE="OFF" >
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<?php liste_options($typeprestataire, $prestataire['codeTypePrestataire']); ?>
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</SELECT>
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</div>
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</td>
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</tr>
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<tr>
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<td class="required"> <?= _("Pays") ?> </td>
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<td width="33%">
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<SELECT onChange="ajaxListerVille();" class="form-control" id="codePays" NAME="codePays" required AUTOCOMPLETE="OFF" >
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<?php liste_options($pays, $prestataire["codePays"]); ?>
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</SELECT>
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</td>
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<td align="center" class="required"> <?= (isset($_SESSION['affichagedynamique']['Région'])) ? _($_SESSION['affichagedynamique']['Région']) : _("Région") ?> </td>
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<td>
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<div id="listeville">
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<SELECT onChange="ajaxListerLocalite();" class="form-control" id="codeVille" NAME="codeVille" required AUTOCOMPLETE="OFF" >
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<?php liste_options($ville,$prestataire['codeVille']); ?>
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</SELECT>
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</div>
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</td>
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<td align="center" class="required"> <?= (isset($_SESSION['affichagedynamique']['Commune'])) ? _($_SESSION['affichagedynamique']['Commune']) : _("Commune") ?> </td>
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<td>
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<div id="listelocalite">
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<SELECT class="form-control" id="codeLocalite" NAME="codeLocalite" required AUTOCOMPLETE="OFF" >
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<?php liste_options($listelocalite,$prestataire['codeLocalite']); ?>
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</SELECT>
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</div>
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</td>
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</tr>
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<tr>
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<td> <?= _("Adresse Géo") ?> </td>
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<td width="33%"><INPUT class="form-control" TYPE="text" id="adresseGeo" NAME="adresseGeo" value="<?=$this->nettoyer($prestataire['adresseGeo'])?>" ></td>
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<td align="center" class="required"> <?= _("Type Decpte") ?> </td>
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<td>
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<SELECT class="form-control" id="codeTypeDecompte" NAME="codeTypeDecompte" required AUTOCOMPLETE="OFF" >
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<?php liste_options($typedecompte, $prestataire["codeTypeDecompte"]); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("N° Sms") ?> </td>
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<td><INPUT class="form-control" TYPE="tel" id="smsGestionPrestataire" NAME="smsGestionPrestataire" value="<?=$this->nettoyer($prestataire['smsGestionPrestataire'])?>" ></td>
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</tr>
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<tr>
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<td> <?= _("Tél. Fixe") ?> </td>
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<td width="33%"><INPUT class="form-control" TYPE="tel" id="telephoneFixe" NAME="telephoneFixe" value="<?=$this->nettoyer($prestataire['telephoneFixe'])?>" ></td>
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<td align="center"> <?= _("Fax ") ?> </td>
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<td><INPUT class="form-control" TYPE="tel" id="faxPrestataire" NAME="faxPrestataire" value="<?=$this->nettoyer($prestataire['faxPrestataire'])?>" ></td>
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<td align="center"> <?= _("Cel. ") ?> </td>
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<td><INPUT class="form-control" TYPE="tel" id="telephonePortable" NAME="telephonePortable" value="<?=$this->nettoyer($prestataire['telephonePortable'])?>" ></td>
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</tr>
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<tr>
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<td align="center"> <?= _("Adresse Post") ?> </td>
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<td width="33%"><INPUT class="form-control" TYPE="text" id="adressePost" NAME="adressePost" value="<?=$this->nettoyer($prestataire['adressePost'])?>" ></td>
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<td align="center" > <?= _("Compte Cpt") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="numeroCompte" NAME="numeroCompte" value="<?=$this->nettoyer($prestataire['numeroCompte'])?>" ></td>
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<td class="required"> <?= _("Conventionné?") ?> </td>
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<td>
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<SELECT class="form-control" id="conventionne" NAME="conventionne" required AUTOCOMPLETE="OFF" >
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<?php liste_options($ouinonconvention, $prestataire["conventionne"]); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td class="required"> E-mail </td>
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<td width="33%"><INPUT class="form-control" TYPE="email" id="emailGestionPrestataire" NAME="emailGestionPrestataire" value="<?=$this->nettoyer($prestataire['emailGestionPrestataire'])?>" placeholder="E-mail obligatoire" required AUTOCOMPLETE="OFF" ></td>
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<td align="center" class="required"> <?= _("Ville Signature") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="villeSignature" NAME="villeSignature" value="<?=$this->nettoyer($prestataire['villeSignature'])?>" required AUTOCOMPLETE="OFF" ></td>
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<td align="center" class="required"> <?= _("Gestion réseau?") ?> </td>
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<td>
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<SELECT class="form-control" id="gestionreseau" NAME="gestionreseau" required AUTOCOMPLETE="OFF" >
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<?php liste_options($ouinongestionreseau, $prestataire["gestionreseau"]); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td> <?= _("Tarif Acte") ?> </td>
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<td width="33%">
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<SELECT class="form-control" id="codeTarifActe" NAME="codeTarifActe" required AUTOCOMPLETE="OFF" >
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<?php liste_options($tarifacte, $prestataire["codeTarifActe"]); ?>
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</SELECT>
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</td>
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<td align="center" > <?= _("Tarif Médic") ?> </td>
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<td>
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<SELECT class="form-control" id="codeTarifMedicament" NAME="codeTarifMedicament" required AUTOCOMPLETE="OFF" >
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<?php liste_options($tarifsmedicament, $prestataire["codeTarifMedicament"]); ?>
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</SELECT>
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</td>
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<td align="center" > <?= _("Tarif Opt") ?> </td>
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<td>
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<SELECT class="form-control" id="codeTarifOptique" NAME="codeTarifOptique" required AUTOCOMPLETE="OFF" >
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<?php liste_options($tarifsoptique, $prestataire["codeTarifOptique"]); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td> <?= _("Banque") ?> </td>
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<td width="33%">
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<SELECT class="form-control" id="codeBanque" NAME="codeBanque" required AUTOCOMPLETE="OFF" >
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<?php liste_options($banque, $prestataire["codeBanque"]); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("Code Banque") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="codeBanqueInterne" NAME="codeBanqueInterne" value="<?=$this->nettoyer($prestataire['codeBanqueInterne'])?>" ></td>
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<td align="center" > <?= _("Code Guichet") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="codeGuichet" NAME="codeGuichet" value="<?=$this->nettoyer($prestataire['codeGuichet'])?>" ></td>
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</tr>
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<tr>
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<td> <?= _("Cpte bancaire") ?> </td>
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<td width="33%"><INPUT class="form-control" TYPE="text" id="numeroCompteBancaire" NAME="numeroCompteBancaire" value="<?=$this->nettoyer($prestataire['numeroCompteBancaire'])?>" ></td>
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<td align="center"> <?= _("Clé Rib") ?> </td>
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<td> <INPUT class="form-control" TYPE="text" id="cleRib" NAME="cleRib" value="<?=$this->nettoyer($prestataire['cleRib'])?>" ></td>
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<td align="center"> Iban </td>
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<td> <INPUT class="form-control" TYPE="text" id="iban" NAME="iban" value="<?=$this->nettoyer($prestataire['iban'])?>" ></td>
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</tr>
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<tr>
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<td> <?= _("Intititulé Cpte") ?> </td>
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<td width="33%"><INPUT class="form-control" TYPE="text" id="intituleCompteBancaire" NAME="intituleCompteBancaire" value="<?=$this->nettoyer($prestataire['intituleCompteBancaire'])?>" ></td>
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<td align="center"> <?= _("Registre Comm") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="registreCommerce" NAME="registreCommerce" value="<?=$this->nettoyer($prestataire['registreCommerce'])?>" ></td>
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<td align="center"> <?= _("Langue") ?> </td>
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<td>
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<SELECT class="form-control" id="codeLangueUser" NAME="codeLangueUser" >
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<?php liste_options($langue, $codeLanguePrestataire, true); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td> <?= _("Responsable") ?> </td>
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<td width="33%"><INPUT class="form-control" TYPE="text" id="nomResponsable" NAME="nomResponsable" value="<?=$this->nettoyer($prestataire['nomResponsable'])?>" ></td>
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<td align="center"> <?= _("Correspondant") ?> </td>
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<td> <INPUT class="form-control" TYPE="text" id="nomInterlocuteur" NAME="nomInterlocuteur" value="<?=$this->nettoyer($prestataire['nomInterlocuteur'])?>" ></td>
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<td align="center"> Autre Tél. </td>
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<td> <INPUT class="form-control" TYPE="tel" id="contactInterlocuteur" NAME="contactInterlocuteur" value="<?=$this->nettoyer($prestataire['contactInterlocuteur'])?>" ></td>
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</tr>
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<tr>
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<td class="required"> <?= _("Centre Réf.?") ?> </td>
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<td>
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<SELECT class="form-control" id="centreReference" NAME="centreReference" required AUTOCOMPLETE="OFF" >
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<?php liste_options($ouinonreference, $this->nettoyer($prestataire['centreReference']),true); ?>
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</SELECT>
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</td>
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<td> </td>
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<td > <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer") ?>" onClick="javascript:enregistrer_modif_prestataire();" style='font-size:10pt;' > </td>
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<td> </td>
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<td > <input class = "form-control btn btn-warning" type="button" value="<?= _("Annuler") ?>" onClick="javascript:retour_prestataire_id();" style='font-size:9pt;' > </td>
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</tr>
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</tbody>
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</table>
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<div id="div_test">
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</div>
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