108 lines
5.6 KiB
PHP
108 lines
5.6 KiB
PHP
<?php
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$this->titre = "INTER-SANTE - "._("Rechercher sinistre") ;
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?>
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<form id="frmrechercheprestation" name="frmrechercheprestation" method="post" action="Rechercheprestations/index/" style='font-size:10pt;' >
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<legend> <?= _("Critères de recherche sinistres") ?> </legend>
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<table class="table table-condensed table-responsive" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td width="10%" > <?= _("No Bénéf") ?> </td>
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<td width="23%" ><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="numeroBeneficiaire" name="numeroBeneficiaire" autofocus></td>
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<td align="center" width="10%"> <?= _("No Fam") ?> </td>
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<td width="23%" ><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="numeroAdherent" name="numeroAdherent" ></td>
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<td align="center" width="10%"> <?= _("Nom") ?> </td>
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<td colspan="2" width="24%" ><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="nomBeneficiaire" name="nomBeneficiaire" ></td>
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</tr>
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<tr>
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<td> <?= _("Prénoms") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="prenomsBeneficiaire" name="prenomsBeneficiaire"></td>
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<td align="center"> Tel </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="telephonePortable" NAME="telephonePortable"></td>
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<td align="center">E-mail</td>
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<td colspan="2" ><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="email" NAME="email"></td>
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</tr>
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<tr style='background-color:white'>
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<td colspan="7" height="10"></td>
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</tr>
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<tr>
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<td> <?= _("Bon Cons") ?> </td>
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<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonConsultation" name="numeroBonConsultation" placeholder="Consultation"></td>
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<td align="center"> <?= _("Bon Phar") ?> </td>
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<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonOrdonnance" NAME="numeroBonOrdonnance" ></td>
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<td align="center"> <?= _("Bon Hospit") ?> </td>
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<td colspan="2"><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonHospitalisation" NAME="numeroBonHospitalisation" placeholder="Hospit"></td>
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</tr>
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<tr>
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<td> <?= _("Prescr Exam") ?> </td>
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<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonExamen" NAME="numeroBonExamen" placeholder="Exam"></td>
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<td align="center"> <?= _("Bon Opt") ?> </td>
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<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonOptique" NAME="numeroBonOptique" placeholder="Opt"></td>
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<td align="center"> <?= _("Séances Kine") ?> </td>
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<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonKine" NAME="numeroBonKine" placeholder="Prescript"></td>
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<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonSeance" NAME="numeroBonSeance" placeholder="Execution KINE" ></td>
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</tr>
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<tr>
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<td><input id="lancerrecherche" name="lancerrecherche" class="sr-only" type="submit" value="<?= _("Rechercher") ?>" ></td>
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</tr>
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</tbody>
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</table>
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<input class="form-control" style="text-align: center; font-size:10pt;" type="text" id="nbassure" name="nbassure" value="<?= _("Nombre de lignes affichées :") . " ".$nbligne ?>" readonly>
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<table class="table table-striped table-bordered table-hover table-condensed table-responsive" style='font-size:8pt;'>
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<thead>
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<tr>
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<th width="8%" style="text-align: center"> <?= _("No Bénéf") ?> </th>
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<th width="8%" style="text-align: center"> <?= _("No Fam") ?> </th>
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<th> <?= _("Nom") ?> </th>
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<th> <?= _("Prénoms") ?> </th>
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<th style="text-align: center"> <?= _("Lien par") ?></th>
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<th style="text-align: center"> <?= _("Naiss") ?> </th>
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<th style="text-align: center">Genre</th>
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<th style="text-align: center"> <?= _("Tél") ?> </th>
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<th>E-mail</th>
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<th> <?= _("Souscripteur") ?> </th>
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</tr>
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</thead>
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<tbody>
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<?php foreach ($beneficiaires as $beneficiaire):
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$idBeneficiaire=$this->nettoyer($beneficiaire['idBeneficiaire']);
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$numeroBeneficiaire=$this->nettoyer($beneficiaire['numeroBeneficiaire']);
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?>
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<tr onclick="javascript:selectionner_beneficiaire(<?= $idBeneficiaire ?>,'<?= $numeroBeneficiaire ?>');"
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ondblclick="javascript:selectionner_beneficiaire(<?= $idBeneficiaire ?>,'<?= $numeroBeneficiaire ?>');prestations();" valign="top">
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<td align="center"> <input type="button" value="<?= $numeroBeneficiaire ?>" onClick="javascript:selectionner_beneficiaire(<?= $idBeneficiaire ?>,'<?= $numeroBeneficiaire ?>');prestations();"> </td>
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<td align="center"> <?= $this->nettoyer($beneficiaire['numeroAdherent']) ?></td>
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<td><?= $this->nettoyer($beneficiaire['nomBeneficiaire']) ?></td>
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<td><?= $this->nettoyer($beneficiaire['prenomsBeneficiaire']) ?></td>
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<td align="center"><?= $this->nettoyer($beneficiaire['lienparente']) ?></td>
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<td align="center"><?= dateLang($this->nettoyer($beneficiaire['dateNaissance'])) ?></td>
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<td align="center"><?= $this->nettoyer($beneficiaire['sexe']) ?></td>
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<td align="center"><?= $this->nettoyer($beneficiaire['telephonePortableAdherent']) ?></td>
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<td><?= $this->nettoyer($beneficiaire['emailAdherent']) ?></td>
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<td><?= $this->nettoyer($beneficiaire['nomClient']) ?></td>
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</tr>
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<?php endforeach; ?>
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</tbody>
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</table>
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</form>
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