23 lines
1.5 KiB
PHP
23 lines
1.5 KiB
PHP
<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" class="required">Code</td>
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<td width="10%" ><INPUT class="form-control majuscule" TYPE="text" id="codeTypeAffection" NAME="codeTypeAffection" required AUTOCOMPLETE="OFF" autofocus value="<?= $this->nettoyer($typeaffection['codeTypeAffection']); ?>" ></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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<INPUT class="form-control" TYPE="checkbox" id="maladieChronique" NAME="maladieChronique" value="<?=(($this->nettoyer($typeaffection['maladieChronique'])==0)? 0 : 1);?>"<?=(empty($this->nettoyer($typeaffection['maladieChronique']))?'':'checked');?> onclick="if (this.checked) this.value=1; else this.value=0;" >
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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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