170 lines
7.1 KiB
PHP
170 lines
7.1 KiB
PHP
<?php $this->titre = "INTER-SANTE - Modification Adhérent"; ?>
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<form method="post" action="Modifieradherent/modifier/<?=$adherent['id']?>/">
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<INPUT class="sr-only" TYPE="text" id="idPolice" name="idPolice" value="<?= $_SESSION['idPolice_C'] ?>">
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<INPUT class="sr-only" TYPE="text" id="numeroPolice" name="numeroPolice" value="<?= $_SESSION['numeroPolice_C'] ?>">
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<INPUT class="sr-only" TYPE="text" id="codeEtatFacturation" name="codeEtatFacturation" value="<?=$adherent['codeEtatFacturation']?>" >
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<INPUT class="sr-only" TYPE="text" id="consommation_adherent" name="consommation_adherent" value="<?=$adherent['consommation_adherent']?>" >
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<INPUT class="sr-only" TYPE="text" id="rapport_sp_police" name="rapport_sp_police" value="<?=$adherent['rapport_sp_police']?>" >
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<INPUT class="sr-only" TYPE="text" id="idCollege" name="idCollege" value="<?=$adherent['idCollege']?>" >
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<fieldset>
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<legend><?= _("Informations sur le chef de Famille / Adhérent Numéro") . " : " . $adherent['numeroAdherent']?></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 width="10%"> <?= _("Client") ?> </td>
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<td width="40%" ><INPUT class="form-control" TYPE="text" id="nomClient" name="nomClient" value="<?= $_SESSION['nomClient_C'] ?>" readonly ></td>
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<td width="10%" align="center"> <?= _("Collège") ?> </td>
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<td width="40%" ><INPUT class="form-control" TYPE="text" value="<?=$adherent['libelleCollege']?>" readonly ></td>
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</tr>
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<tr>
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<td class="required"> <?= _("Nom Adhérent") ?> </td>
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<td><INPUT class="form-control majuscule" TYPE="text" id="nom" NAME="nom" value="<?=$adherent['nom']?>" required AUTOCOMPLETE="OFF" ></td>
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<td align="center" class="required"> <?= _("Prénoms") ?> </td>
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<td><INPUT class="form-control majuscule" TYPE="text" id="prenoms" NAME="prenoms" value="<?=$adherent['prenoms']?>" required AUTOCOMPLETE="OFF" ></td>
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</tr>
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<tr>
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<td ><?= _("Nature Pièce") ?></td>
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<td>
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<SELECT class="form-control" id="codeNaturePiece" NAME="codeNaturePiece">
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<?php liste_options($naturepiece,$adherent['codeNaturePiece'],true); ?>
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</SELECT>
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</td>
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<td align="center"><?= _("No Pièce") ?></td>
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<td>
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<INPUT class="form-control majuscule" TYPE="text" id="numeroPiece" NAME="numeroPiece" value="<?=$adherent['numeroPiece']?>" >
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</td>
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</tr>
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<tr>
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<td><?= _("No CMU") ?></td>
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<td>
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<INPUT class="form-control majuscule" TYPE="text" id="numeroCmu" NAME="numeroCmu" value="<?=$adherent['numeroCmu']?>" >
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</td>
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<td align="center"><?= _("Mle Employé") ?></td>
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<td>
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<INPUT class="form-control majuscule" TYPE="text" id="numeroMatricule" NAME="numeroMatricule" value="<?=$adherent['numeroMatricule']?>" >
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</td>
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</tr>
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<tr>
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<td class="required">Genre</td>
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<td>
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<SELECT class="form-control" id="sexe" NAME="sexe" required AUTOCOMPLETE="OFF" >
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<?php liste_options($sexe,$adherent['sexe'],true); ?>
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</SELECT>
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</td>
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<td align="center"> Naissance </td>
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<td><INPUT class="form-control datepicker" TYPE="text" id="dateNaissance" NAME="dateNaissance" value="<?= dateLang($this->nettoyer($adherent['dateNaissance'])) ?>" ></td>
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</tr>
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<tr>
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<td> <?= _("Groupe Sanguin") ?> </td>
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<td>
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<SELECT class="form-control" id="codeGroupeSanguin" NAME="codeGroupeSanguin">
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<?php liste_options($groupesanguin,$adherent['codeGroupeSanguin'],true); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("Sit. Famille") ?> </td>
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<td>
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<SELECT class="form-control" id="codeSituationFamille" NAME="codeSituationFamille">
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<?php liste_options($situationfamille,$adherent['codeSituationFamille'],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> <?= _("Nb Enfants") ?> </td>
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<td><input class="form-control" type="number" id="nombreEnfants" name="nombreEnfants" min="0" max="10" value="<?= $adherent['nombreEnfants'] ?>"></td>
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<td align="center"> <?= _("Pays") ?> </td>
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<td>
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<SELECT onChange="ajaxListerVille();" class="form-control" id="codePays" NAME="codePays">
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<?php liste_options($pays,$adherent['codePays'],true); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td> <?= (isset($_SESSION['affichagedynamique']['Région / District'])) ? _($_SESSION['affichagedynamique']['Région / District']) : _("Région / District") ?> </td>
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<td>
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<div id="listeville">
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<SELECT onChange="ajaxListerLocalite();" class="form-control" id="codeVille" NAME="codeVille">
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<?php liste_options($ville, $adherent['codeVille'] ); ?>
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</SELECT>
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</div>
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</td>
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<td align="center"> <?= (isset($_SESSION['affichagedynamique']['Commune'])) ? _($_SESSION['affichagedynamique']['Commune']) : _("Commune") ?> </td>
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<td>
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<div id="listelocalite">
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<SELECT class="form-control" id="codeLocalite" NAME="codeLocalite">
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<?php liste_options($localite, $adherent['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><INPUT class="form-control" TYPE="text" id="adresseGeo" NAME="adresseGeo" value="<?= $adherent['adresseGeo'] ?>"></td>
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<td align="center"> <?= _("Adresse Post") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="adressePostale" NAME="adressePostale" value="<?= $adherent['adressePostale'] ?>"></td>
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</tr>
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<tr>
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<td> <?= _("Tél Port") ?> </td>
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<td>
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<INPUT class="form-control" TYPE="tel" id="telephonePortable" NAME="telephonePortable" value="<?= $adherent['telephonePortable'] ?>" >
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</td>
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<td align="center"> <?= _("Tél Fixe") ?> </td>
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<td><INPUT class="form-control" TYPE="tel" id="telephonFixe" NAME="telephonFixe" value="<?= $adherent['telephonFixe'] ?>"></td>
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</tr>
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<tr>
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<td> <?= _("Entrée") ?> </td>
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<td><INPUT class="form-control datepicker" TYPE="text" id="dateEntree" NAME="dateEntree" value="<?= dateLang($this->nettoyer($adherent['dateEntree'])) ?>" disabled></td>
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<td align="center">E-mail</td>
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<td>
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<INPUT class="form-control" TYPE="email" id="email" NAME="email" value="<?= $adherent['email'] ?>"
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</td>
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</tr>
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<tr>
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<td> <?= _("S / P Police") ?> </td>
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<td><INPUT class="form-control" TYPE="text" value="<?= $this->nettoyer($adherent['rapport_sp_police']) ?>" readonly></td>
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<td></td>
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<td><input class = "form-control btn btn-primary" type="submit" value="<?= _("Enregistrer") ?>" /></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="infottc" style="display: none">
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<input type="text" id="primeTtc_info" name="primeTtc_info" >
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</div>
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</form>
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<?php if (isset($msgErreur)): ?>
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<div class="alert alert-danger" style="height:38px; padding:5px;" >
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<H4><?= $msgErreur ?></H4>
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</div>
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<?php endif; ?>
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