346 lines
13 KiB
PHP
Executable File
346 lines
13 KiB
PHP
Executable File
<?php
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$this->titre = "INTER SANTE - Ajout Adhérent";
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$dateAvenant = $_SESSION['dateAvenant_C']
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?>
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<form method="post" action="Creeradherent/ajouteradherent">
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<INPUT class="sr-only" TYPE="text" id="nomForm" name="nomForm" value="frmadherent">
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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="dateEffetSql" NAME="dateEffetSql" value="<?= $this->nettoyer($police['dateEffet']) ?>">
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<INPUT class="sr-only" TYPE="text" id="dateFinSql" NAME="dateFinSql" value="<?= $this->nettoyer($police['dateFin']) ?>">
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<INPUT class="sr-only" TYPE="text" id="codeLienParente" name="codeLienParente" value="A">
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<div id="div_age_max">
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</div>
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<div id="div_modeCalculPrime">
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</div>
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<!-- test -->
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<fieldset>
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<legend> <?= _("Informations sur l'adhérent") ?> </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%" class="required"> <?= _("Collège") ?> </td>
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<td width="40%">
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<select class="form-select" id="idCollege" NAME="idCollege" required AUTOCOMPLETE="OFF" autofocus onChange="prorater_prime_adherent(); mode_calcul_prime_college(); agemaxbeneficiaire();" >
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<?php liste_options($college,""); ?>
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</SELECT>
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</td>
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<td width="10%" align="center" class="required"> <?= _("Avenant") ?> </td>
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<td>
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<select class="form-select" id="idAvenant" NAME="idAvenant" required AUTOCOMPLETE="OFF" onChange="changer_avenant_incorporation();">
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<?php liste_options($avenant,""); ?>
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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 class="required"> <?= _("Nom Adhérent") ?> </td>
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<td><INPUT class="form-control majuscule" TYPE="text" id="nom" NAME="nom" required AUTOCOMPLETE="OFF" style="text-transform: uppercase;" onblur="javascript:recupererValeur();"></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" onblur="javascript:recupererValeur();" 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" required style='font-size:10pt;'
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onChange="javascript:controler_piece_beneficiaire();" >
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<?php liste_options($naturepiece,""); ?>
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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" TYPE="text" id="numeroPiece" NAME="numeroPiece" style='font-size:10pt;'
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onblur="javascript:controler_piece_beneficiaire();" required minlength="9" autocomplete="off" >
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</td>
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</tr>
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<tr>
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<td colspan="4" style="height:8px; background-color:white;">
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<div id="div_controle_piece"></div>
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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">
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</td>
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<td align="center"><?= _("Matricule Employé") ?></td>
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<td>
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<INPUT class="form-control majuscule" TYPE="text" id="numeroMatricule" NAME="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-select" id="sexe" NAME="sexe" required AUTOCOMPLETE="OFF" onchange="javascript:recupererValeur();">
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<?php liste_options($sexe,""); ?>
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</SELECT>
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</td>
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<td align="center" class="required"> <?= _("Date Naissance") ?> </td>
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<td>
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<INPUT class="form-control datepicker" TYPE="text" id="dateNaissance" NAME="dateNaissance" required AUTOCOMPLETE="OFF"
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onchange="javascript:controle_age_relatif($('#dateNaissance').datepicker('getDate'), $('#dateEntree').datepicker('getDate'), 'A'); prorater_prime_adherent();" onblur="javascript:recupererValeur();agemaxbeneficiaire();">
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</td>
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</tr>
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<tr>
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<td> <?= _("Groupe Sanguin") ?> </td>
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<td>
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<select class="form-select" id="codeGroupeSanguin" NAME="codeGroupeSanguin">
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<?php liste_options($groupesanguin,""); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("Situation Familiale") ?> </td>
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<td>
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<select class="form-select" id="codeSituationFamille" NAME="codeSituationFamille">
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<?php liste_options($situationfamille,""); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td> <?= _("Nombre Enfants") ?> </td>
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<td><input class="form-control" type="number" id="nombreEnfants" name="nombreEnfants" min="0" max="10" value="0"></td>
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<td align="center"> <?= _("Pays") ?> </td>
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<td>
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<SELECT onChange="ajaxListerVille();" class="form-select" id="codePays" NAME="codePays">
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<?php liste_options($pays, $codePays); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td > <?= (isset($_SESSION['affichagedynamique']['Région / District'])) ? _($_SESSION['affichagedynamique']['Région / District']) : _("Région / District") ?> </td>
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<td>
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<div id="listeville" >
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<SELECT onChange="ajaxListerLocalite();" class="form-select" id="codeVille" NAME="codeVille">
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<?php liste_options($ville, $codeVille); ?>
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</SELECT>
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</div>
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</td>
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<td align="center"> <?= (isset($_SESSION['affichagedynamique']['Commune'])) ? _($_SESSION['affichagedynamique']['Commune']) : _("Commune") ?> </td>
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<td>
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<div id="listelocalite" >
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<select class="form-select" id="codeLocalite" NAME="codeLocalite">
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<?php liste_options($localite, $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> <?= _("Indicatif") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="prefixePaiementMobile" NAME="prefixePaiementMobile" value="<?= $_SESSION['indicatifTelephone'] ?>"></td>
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<td align="center"> <?= _("Mobile Paiement") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="mobilePaiement" NAME="mobilePaiement" value=""></td>
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</tr>
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<tr>
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<td class="required"> <?= _("Tél Portable") ?> </td>
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<td>
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<INPUT class="form-control" TYPE="tel" id="telephonePortable" value="<?= $_SESSION['indicatifTelephone'] ?>" NAME="telephonePortable" placeholder="Tél portable obligatoire" required AUTOCOMPLETE="OFF" >
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</td>
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<td align="center"> <?= _("Téléphone Fixe") ?> </td>
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<td><INPUT class="form-control" TYPE="tel" id="telephonFixe" NAME="telephonFixe"></td>
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</tr>
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<tr>
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<td class="required"> <?= _("Date Entrée") ?> </td>
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<td>
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<div id="div_date_avenant" >
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<INPUT class="form-control datepicker" TYPE="text" id="dateEntree" NAME="dateEntree" value="<?= dateLang($_SESSION['dateAvenant_C']) ?>" required AUTOCOMPLETE="OFF"
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onChange="controle_effet_assure(); prorater_prime_adherent();">
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</div>
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</td>
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<td align="center">E-mail</td>
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<td><INPUT class="form-control" TYPE="email" id="email" NAME="email" placeholder="E-mail" ></td>
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</tr>
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<tr>
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<td > <?= _("Date Souscription") ?> </td>
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<td>
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<INPUT class="form-control datepicker" TYPE="text" id="dateSouscription" NAME="dateSouscription">
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</td>
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<td align="center"> <?= _("No Bulletin Santé") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="numeroBs" NAME="numeroBs" TYPE="text" value=""></td>
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</tr>
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<tr>
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<td> <?= _("Prorata Prime?") ?> </td>
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<td>
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<select class="form-select" id="prorata" NAME="prorata" required AUTOCOMPLETE="OFF" onChange="prorater_prime_adherent();">
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<?php liste_options($ouinonprorata,"1",true); ?>
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</SELECT>
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</td>
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<td align="center"><?= _("Tarif Actes") ?></td>
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<td >
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<select name="codeTarifActe" id="codeTarifActe" class="form-control selectpicker" data-live-search="true">
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<?= liste_options($tarifActe,"", false) ?>
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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 > <?= _("Seuil RD (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="seuilRdAdherent" NAME="seuilRdAdherent" TYPE="number" value="0" min="0" max="100"></td>
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<td align="center"><?= _("VIP") ?></td>
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<td>
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<select class="form-select" id="vip" NAME="vip">
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<?php liste_options($ouinonvip,"0",true); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td> <?= _("Ancien No Assuré") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="ancienNumeroAssure" NAME="ancienNumeroAssure" TYPE="text" value=""></td>
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<td align="center"> <?= _("Type Remboursement") ?> </td>
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<td >
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<SELECT style="font-size:10pt;" class="form-select" id="codeTypeRemboursement" NAME="codeTypeRemboursement">
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<?php liste_options($typeremboursement,"RDTP",true); ?>
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</SELECT>
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</td>
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</tr>
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<?php if($aRembouser=="AP"):?>
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<tr>
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<td > <?= _("RIB pour RD") ?> </td>
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<td>
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<INPUT class="form-control" TYPE="text" id="rib" NAME="rib" style='font-size:10pt;' >
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</td>
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<td align="center"> <?= _("Mode Paiement RD") ?> </td>
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<td>
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<select class="form-select" id="codeModePaiement" NAME="codeModePaiement" style='font-size:10pt;' >
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<?php liste_options($modepaiement,""); ?>
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</SELECT>
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</td>
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</tr>
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<?php elseif($aRembouser=="CLI"):?>
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<tr>
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<td colspan="4">
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<input class="form-control" style='text-align:center; font-size:11pt; background-color:#027BE3;color:white;' type="text" value="<?= _("BENEFICIAIRE DE REMBOURSEMENT DIRECT"); ?>" disabled >
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</td>
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</tr>
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<tr>
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<td class="required"> <?= _("Bénéficiaire") ?> </td>
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<td >
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<INPUT class="sr-only" TYPE="text" id="beneficiaireReglement" NAME="beneficiaireReglement" value="<?= $souscripteurRD["beneficiaireReglement"]?>" >
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<INPUT class="form-control majuscule" TYPE="text" style='font-size:10pt;' value="<?= $souscripteurRD["beneficiaireReglement"]?>" disabled>
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</td>
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<td align="center" class="required"> <?= _("Lien Parenté") ?> </td>
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<td>
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<INPUT class="sr-only" TYPE="text" id="codeLienBeneficiaire" NAME="codeLienBeneficiaire" value="<?= $souscripteurRD["codeLienBeneficiaire"]?>" >
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<select class="form-select" disabled style='font-size:10pt;'>
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<?php liste_options($lienbeneficiaire,$souscripteurRD["codeLienBeneficiaire"],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 class="required"> <?= _("Mode Paiement") ?> </td>
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<td>
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<INPUT class="sr-only" TYPE="text" id="codeModePaiement" NAME="codeModePaiement" value="<?= $souscripteurRD["codeModePaiement"]?>" >
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<select class="form-select" disabled style='font-size:10pt;' >
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<?php liste_options($modepaiement,$souscripteurRD["codeModePaiement"],true); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("En vigueur") ?> </td>
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<td>
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<INPUT class="sr-only" TYPE="text" id="enVigueur" NAME="enVigueur" value="1" >
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<SELECT style='font-size:10pt;' class="form-select" disabled>
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<?php liste_options($ouinonenvigueur, "1",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 > <?= _("Téléphone Portable") ?> </td>
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<td>
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<INPUT class="form-control" TYPE="text" id="telephoneMobile" NAME="telephoneMobile" style='font-size:10pt;' value="<?= $souscripteurRD["telephoneMobile"]?>" readonly>
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</td>
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<td align="center"> <?= _("RIB") ?> </td>
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<td>
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<INPUT class="form-control" TYPE="text" id="rib" NAME="rib" style='font-size:10pt;' value="<?= $souscripteurRD["rib"]?>" readonly>
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</td>
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</tr>
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<?php endif;?>
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<tr>
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<td> <?= _("Adresse Géograph") ?> </td>
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<td ><INPUT class="form-control" TYPE="text" id="adresseGeo" NAME="adresseGeo"></td>
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<td align="center"> <?= _("Adresse Postale") ?> </td>
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<td><INPUT class="form-control" TYPE="text" id="adressePostale" NAME="adressePostale"></td>
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</tr>
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<tr>
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<td colspan="2"> </td>
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<td ><input style="text-align:center;color:red;" class="form-control" type="text" id="agepersonne" name="agepersonne" value="Age : 0" readonly ></td>
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<td> </td>
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</tr>
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<tr>
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<td colspan="4">
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<div id="div_existance"></div>
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</td>
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</tr>
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<tr>
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<td colspan="6" ><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="div_prime">
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</div>
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<div id="div_beneficiaire_remboursement" class="modal fade">
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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:30px; padding:5px;" >
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<H4><?= $msgErreur ?></H4>
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</div>
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<?php endif; ?>
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