82 lines
3.7 KiB
PHP
82 lines
3.7 KiB
PHP
<?php
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$this->titre = "INTER-SANTE - Modifier un Barème de prise en charge";
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?>
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<legend> <?= _("Modifier un Barème de prise en charge") ?> </legend>
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<INPUT TYPE="text" class="sr-only" id = "idBaremePriseEnCharge" name = "idBaremePriseEnCharge" value="<?= $this->nettoyer($bareme['id']);?>">
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<INPUT TYPE="text" class="sr-only" id = "nomForm" name = "nomForm" value="<?= _("frmmodifierbareme");?>">
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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%" class="required AUTOCOMPLETE="OFF" text-center"> <?= _("Garant") ?> </td>
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<td colspan="3">
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<SELECT style="font-size:10pt; height:30px;" class="form-control selectpicker" data-live-search="true" id="codeGcAssureur" NAME="codeGcAssureur" required AUTOCOMPLETE="OFF" autofocus
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onChange="filtreproduit();filtreSouscripteur();" >
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<?= liste_options($garant,$this->nettoyer($bareme['codeGcAssureur']),true) ?>
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</SELECT>
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</td>
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<td width="13%" class="required AUTOCOMPLETE="OFF" text-center"> <?= _("Catégorie") ?> </td>
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<td width="30%">
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<div id="div_produit">
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<SELECT style="font-size:10pt; height:30px;" class="form-control" id="codeProduit" NAME="codeProduit"
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onChange="libelleProduitBareme(this);" required AUTOCOMPLETE="OFF" >
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<?php liste_options($produits,$this->nettoyer($bareme['codeProduit']),true); ?>
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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 width="10%" class="required" align="center"> Taux Barème </td>
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<td width="10%" >
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<select name="idTauxCouverture" id="idTauxCouverture" class="form-control" required AUTOCOMPLETE="OFF" autofocus
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onchange="libelleTauxBareme(this);majTicketModerateur();">
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<?= liste_options($taux,$this->nettoyer($bareme['idTauxCouverture']),true) ?>
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</select>
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</td>
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<td width="10%" align="center" class="required" > <?= _("Territoire") ?> </td>
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<td>
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<select name="codeTerritoire" id="codeTerritoire" class="form-control selectpicker" data-live-search="true"
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onchange="libelleTerritoireBareme(this.value);" required AUTOCOMPLETE="OFF" >
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<?= liste_options($territoire,$this->nettoyer($bareme['codeTerritoire']),true) ?>
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</select>
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</td>
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<td width="10%" align="center" > <?= _("Souscripteur") ?> </td>
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<td>
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<div id="div_souscripteur">
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<select name="numeroClient" id="numeroClient" class="form-control selectpicker" data-live-search="true"
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onchange="libelleClientBareme(this);">
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<?= liste_options($clients,$this->nettoyer($bareme['numeroClient']),false) ?>
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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 width="10%" align="center" class="required"> <?= _("Libelle") ?> </td>
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<td colspan="5"><INPUT style="font-size:10pt;" class="form-control" TYPE="text" id="libelle" NAME="libelle" value="<?= $this->nettoyer($bareme['libelle'])?>"></td>
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</tr>
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<tr>
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<td width="10%" align="center"> <?= _("Observation") ?> </td>
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<td colspan="5"><INPUT style="font-size:10pt;" class="form-control" TYPE="text" id="observationBareme" NAME="observationBareme" value="<?= $this->nettoyer($bareme['observationBareme'])?>"></td>
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</tr>
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<tr>
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<td> </td>
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<td colspan="2" > <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer") ?>" onClick="javascript:modifier_bareme();" style='font-size:10pt;' > </td>
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<td> </td>
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<td colspan="2" > <input class = "form-control btn btn-warning" type="button" value="<?= _("Fermer") ?>" onClick="javascript:retour_liste_bareme();" 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_garanties_bareme">
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</div>
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