53 lines
2.4 KiB
PHP
53 lines
2.4 KiB
PHP
<?php
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$this->titre = "INTER-SANTE - Montures soumises à entente préalable";
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?>
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<input class="form-control" style="text-align: center; font-size:10pt;" type="text" id="nbligne" name="nbligne" value="MONTURES SOUMISES A ENTENTE PREALABLE" readonly>
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td width="10%"> <?= _("Période du") ?> </td>
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<td width="15%"> <INPUT style='text-align:center; font-size:10pt;' class="form-control datepicker" TYPE="text" id="debut" NAME="debut" value="<?= dateLang($_SESSION['dUneSemaineAvant_C'], $_SESSION['p_lang']) ?>" required </td>
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<td width="5%" align="center"> <?= _("au") ?> </td>
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<td width="15%"> <INPUT style='text-align:center; font-size:10pt;' class="form-control datepicker" TYPE="text" id="fin" NAME="fin" value="<?= dateCouranteLang($_SESSION['p_lang']) ?>" required> </td>
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<td width="5%" align="center"> <?= _("Etat") ?> </td>
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<td>
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<SELECT class="form-control" id="codeReponseEntentePrealable" NAME="codeReponseEntentePrealable" style='font-size:10pt;'>
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<?php liste_options_consultation($reponseententeprealable, "2"); ?>
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</SELECT>
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</td>
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<td> </td>
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<td> <button style='font-size:10pt;' type="button" class="form-control btn btn-primary" onclick="javascript:listeententeprealablesmont();"><?= _("Actualiser...") ?></button> </td>
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</tr>
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</tbody>
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</table>
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<div id="div_ententeprealable">
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<table class="table table-striped table-bordered table-condensed table-responsive" style="font-size:8pt;">
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<thead>
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<tr>
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<th rowspan="2" style='text-align:center'> No </th>
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<th rowspan="2" style='text-align:center'> Date </th>
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<th rowspan="2" style='text-align:center'> <?= _("Prestataire") ?> </th>
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<th rowspan="2" colspan="2" style='text-align:center'> <?= _("Bénéficiaire") ?> </th>
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<th rowspan="2" style='text-align:center'> <?= _("Répondue le") ?> </th>
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<th rowspan="2" style='text-align:center'> <?= _("Répondue par") ?> </th>
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<th rowspan="2" style='text-align:center'> <?= _("Situation") ?> </th>
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<th colspan="2" style='text-align:center'> <?= _("Motif Réponse") ?> </th>
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</tr>
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<tr>
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<th style='text-align:center'> <?= _("Réel") ?> </th>
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<th style='text-align:center'> <?= _("A l'assuré") ?> </th>
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</tr>
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</thead>
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<tbody>
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</tbody>
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</table>
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</div>
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