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KANE LAZENI 2026-07-18 08:06:55 +00:00
parent 63180c643f
commit 40ed364294

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@ -11,10 +11,10 @@
<table class="table table-condensed table-responsive" style='font-size:10pt;'>
<tbody>
<tr>
<td width="10%" > <?= _("No Bénéf") ?> </td>
<td width="10%" > <?= _("No Bénéficiaire") ?> </td>
<td width="23%" ><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="numeroBeneficiaire" name="numeroBeneficiaire" autofocus AUTOCOMPLETE="OFF"></td>
<td align="center" width="10%"> <?= _("No Fam") ?> </td>
<td align="center" width="10%"> <?= _("No Famille") ?> </td>
<td width="23%" ><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="numeroAdherent" name="numeroAdherent" AUTOCOMPLETE="OFF"></td>
<td align="center" width="10%"> <?= _("Nom") ?> </td>
@ -25,7 +25,7 @@
<td> <?= _("Prénoms") ?> </td>
<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="prenomsBeneficiaire" name="prenomsBeneficiaire" AUTOCOMPLETE="OFF"></td>
<td align="center"> Tel </td>
<td align="center"> <?= _("Téléphone") ?> </td>
<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="telephonePortable" NAME="telephonePortable" AUTOCOMPLETE="OFF"></td>
<td align="center">E-mail</td>
@ -37,24 +37,24 @@
</tr>
<tr>
<td> <?= _("Bon Cons") ?> </td>
<td> <?= _("Bon Consultation") ?> </td>
<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonConsultation" name="numeroBonConsultation" placeholder="Consultation" AUTOCOMPLETE="OFF"></td>
<td align="center"> <?= _("Bon Phar") ?> </td>
<td align="center"> <?= _("Bon Pharmacie") ?> </td>
<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonOrdonnance" NAME="numeroBonOrdonnance" AUTOCOMPLETE="OFF"></td>
<td align="center"> <?= _("Bon Hospit") ?> </td>
<td align="center"> <?= _("Bon Hospitalisation") ?> </td>
<td colspan="2"><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonHospitalisation" NAME="numeroBonHospitalisation" placeholder="Hospit" AUTOCOMPLETE="OFF"></td>
</tr>
<tr>
<td> <?= _("Prescr Exam") ?> </td>
<td> <?= _("Bon Examen") ?> </td>
<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonExamen" NAME="numeroBonExamen" placeholder="Exam" AUTOCOMPLETE="OFF"></td>
<td align="center"> <?= _("Bon Opt") ?> </td>
<td align="center"> <?= _("Bon Optique") ?> </td>
<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonOptique" NAME="numeroBonOptique" placeholder="Opt" AUTOCOMPLETE="OFF"></td>
<td align="center"> <?= _("Séances Kine") ?> </td>
<td align="center"> <?= _("Séances") ?> </td>
<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonKine" NAME="numeroBonKine" placeholder="Prescript" AUTOCOMPLETE="OFF"></td>
<td><INPUT style='font-size:10pt;text-align:center;' class="form-control" type="number" id="numeroBonSeance" NAME="numeroBonSeance" placeholder="Execution KINE" AUTOCOMPLETE="OFF"></td>
</tr>
@ -70,14 +70,14 @@
<table class="table table-striped table-bordered table-hover table-condensed table-responsive" style='font-size:8pt;'>
<thead>
<tr>
<th width="8%" style="text-align: center"> <?= _("No Bénéf") ?> </th>
<th width="8%" style="text-align: center"> <?= _("No Fam") ?> </th>
<th width="8%" style="text-align: center"> <?= _("No Bénéficiaire") ?> </th>
<th width="8%" style="text-align: center"> <?= _("No Famille") ?> </th>
<th> <?= _("Nom") ?> </th>
<th> <?= _("Prénoms") ?> </th>
<th style="text-align: center"> <?= _("Lien par") ?></th>
<th style="text-align: center"> <?= _("Naiss") ?> </th>
<th style="text-align: center"> <?= _("Lien") ?></th>
<th style="text-align: center"> <?= _("Naissance") ?> </th>
<th style="text-align: center">Genre</th>
<th style="text-align: center"> <?= _("Tél") ?> </th>
<th style="text-align: center"> <?= _("Téléphone") ?> </th>
<th>E-mail</th>
<th> <?= _("Souscripteur") ?> </th>
</tr>
@ -105,7 +105,6 @@
<td><?= $this->nettoyer($beneficiaire['nomClient']) ?></td>
</tr>
<?php endforeach; ?>
</tbody>
</table>
</form>