79 lines
3.2 KiB
PHP
79 lines
3.2 KiB
PHP
<div class="modal-dialog">
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<div style='width:800px;' class="modal-content">
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<div class="modal-header">
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<button type="button" class="close" data-bs-dismiss="modal">×</button>
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<legend class="modal-title text-center" id="user"><?= _("Nouveau Praticien") ?></legend>
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</div>
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<div style='width:100%;' class="modal-body">
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<form id="formModal">
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td width="10%" > <?= _("Nom") ?> </td>
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<td width="40%"><INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="nom" NAME="nom" required AUTOCOMPLETE="OFF" autofocus ></td>
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<td width="10%" align="center" > <?= _("Prénoms") ?> </td>
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<td colspan="3" ><INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="prenoms" NAME="prenoms" required AUTOCOMPLETE="OFF" ></td>
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</tr>
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<tr>
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<td> <?= _("Corporation") ?> </td>
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<td>
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<SELECT style="font-size:10pt;" class="form-select" id="codeMetier" NAME="codeMetier" required AUTOCOMPLETE="OFF" autofocus >
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<?php liste_options($metier,""); ?>
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</SELECT>
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</td>
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<td width="10%" align="center"> <?= _("Téléphone") ?> </td>
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<td colspan="3"><INPUT style='font-size:10pt;' class="form-control" TYPE="tel" id="telephone" NAME="telephone" ></td>
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</tr>
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<tr>
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<td> <?= _("Spécialité") ?> </td>
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<td>
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<SELECT style="font-size:10pt;" class="form-select" id="codeSpecialite" NAME="codeSpecialite" autofocus >
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<?php liste_options($specialite,""); ?>
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</SELECT>
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</td>
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<td align="center"> E-mail </td>
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<td colspan="3"><INPUT style='font-size:10pt;' class="form-control" TYPE="email" id="email" NAME="email" placeholder="E-mail" ></td>
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</tr>
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<tr>
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<td > Adresse </td>
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<td ><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="adresse" NAME="adresse" ></td>
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<td align="center"> <?= _("No Ordre") ?> </td>
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<td>
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<INPUT style='font-size:10pt;' class="form-control" type="text" id="noOrdreMedecin" name="noOrdreMedecin"
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onChange="this.value=supprimer_espace_string(this.value);">
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</td>
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<td align="center" width="5%"> Genre</td>
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<td>
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<SELECT style='font-size:10pt;' class="form-control" id="sexe" NAME="sexe" required AUTOCOMPLETE="OFF" >
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<?php liste_options($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 colspan="6"> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer") ?>" onClick="javascript:creer_praticien();" style='font-size:10pt;' > </td>
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</tr>
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</tbody>
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</table>
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<div id="div_unicite_medecin">
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<INPUT class="sr-only" TYPE="text" id="unicitemedecin" NAME="unicitemedecin" value="0" >
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</div>
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</form>
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</div>
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<div class="modal-footer">
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<button type="button" id="btn-fermer-modal" class="btn btn-default" data-bs-dismiss="modal">Fermer</button>
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</div>
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</div>
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</div>
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