169 lines
7.3 KiB
PHP
Executable File
169 lines
7.3 KiB
PHP
Executable File
<?php
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$this->titre = "INTER SANTE - Nouveau centre de gestion";
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?>
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<script type="text/javascript">
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</script>
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<legend > <?= _("Nouveau centre de gestion") ?> </legend>
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<table class="table table-responsive table-condensed" style='font-size:9pt;'>
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<tbody>
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<tr>
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<td width="13%" class="required">Code</td>
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<td width="10%"><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="codeSociete" NAME="codeSociete" value="" required AUTOCOMPLETE="OFF" onchange="javascript:test_code(this,this.value); recherchecodesociete();"></td>
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<td width="10%" align="center" class="required"> <?= _("Type") ?> </td>
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<td >
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<select class="form-control selectpicker" data-live-search="true" id="codeTypeSociete" NAME="codeTypeSociete" required AUTOCOMPLETE="OFF">
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<?php liste_options($typeSociete, ""); ?>
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</SELECT>
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</td>
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<td width="10%" align="center" class="required"> <?= _("Nom") ?> </td>
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<td colspan="3"><INPUT style='font-size:9pt; text-transform: uppercase;' class="form-control" TYPE="text" id="nomCentreGestion" NAME="nomCentreGestion" value="" required AUTOCOMPLETE="OFF" ></td>
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</tr>
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<tr>
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<td width="10%" ><?= _("Adresse Géographique") ?></td>
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<td colspan="3"><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="adresseGeoSociete" NAME="adresseGeoSociete" value=""></td>
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<td width="10%" align="center"> <?= _("Adresse Postale") ?> </td>
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<td colspan="3"><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="adressePostSociete" NAME="adressePostSociete" value=""></td>
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</tr>
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<tr>
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<td class="required"> <?= _("Pays") ?> </td>
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<td colspan="3">
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<SELECT onChange="liste_villes();" class="form-control selectpicker" data-live-search="true" id="codePays" NAME="codePays" required AUTOCOMPLETE="OFF">
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<?php liste_options($pays, ""); ?>
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</SELECT>
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</td>
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<td align="center" class="required"> <?= _("Ville") ?> </td>
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<td colspan="3">
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<div id="div_ville">
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<select class="form-control selectpicker" data-live-search="true" id="ville" NAME="ville" required AUTOCOMPLETE="OFF">
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<?php liste_options($villes, ""); ?>
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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 > <?= _("Téléphone Fixe") ?> </td>
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<td colspan="3"><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="telephoneSociete" NAME="telephoneSociete" value="" ></td>
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<td align="center"> Fax </td>
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<td colspan="3"><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="faxSociete" NAME="faxSociete" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("Téléphone Mobile") ?> </td>
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<td colspan="3"><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="portable" NAME="portable" value="" ></td>
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<td class="required" align="center"> <?= _("E-mail Centre") ?> </td>
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<td colspan="3"><INPUT style='font-size:9pt;' class="form-control" TYPE="email" id="emailSociete" NAME="emailSociete" value="" required AUTOCOMPLETE="OFF"></td>
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</tr>
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<tr>
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<td > <?= _("Responsable") ?> </td>
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<td colspan="3"><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="nomResponsable" NAME="nomResponsable" value="" ></td>
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<td align="center"> <?= _("Sigle") ?> </td>
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<td colspan="3"><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="sigleSociete" NAME="sigleSociete" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("E-mail Médécin Conseil") ?> </td>
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<td colspan="7" ><INPUT style='font-size:9pt;' class="form-control" TYPE="email" id="emailMedecinConseil" NAME="emailMedecinConseil" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("E-mail Bons") ?> </td>
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<td colspan="7" ><INPUT style='font-size:9pt;' class="form-control" TYPE="email" id="emailGestionBon" NAME="emailGestionBon" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("E-mail Comptabilité") ?> </td>
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<td colspan="7" ><INPUT style='font-size:9pt;' class="form-control" TYPE="email" id="emailCcomptabilite" NAME="emailCcomptabilite" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("E-mail Dérogation") ?> </td>
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<td colspan="7" ><INPUT style='font-size:9pt;' class="form-control" TYPE="email" id="emailDerogation" NAME="emailDerogation" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("E-mail Accord") ?> </td>
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<td colspan="7" ><INPUT style='font-size:9pt;' class="form-control" TYPE="email" id="emailAccordPrealable" NAME="emailAccordPrealable" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("E-mail Fraude") ?> </td>
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<td colspan="7" ><INPUT style='font-size:9pt;' class="form-control" TYPE="email" id="emailFraudeFinger" NAME="emailFraudeFinger" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("E-mail Tout") ?> </td>
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<td colspan="7" ><INPUT style='font-size:9pt;' class="form-control" TYPE="email" id="email_standard" NAME="email_standard" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("E-mail Réponse") ?> </td>
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<td colspan="5" ><INPUT style='font-size:9pt;' class="form-control" TYPE="email" id="email_reply" NAME="email_reply" value="" ></td>
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<td align="center"> <?= _("Code Préfixe Police") ?> </td>
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<td><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="codePrefixePolice" NAME="codePrefixePolice" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("SMS Médécin Conseil") ?> </td>
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<td colspan="3" ><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="smsMedecinConseil" NAME="smsMedecinConseil" value="" ></td>
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<td align="center"> <?= _("SMS Bons") ?> </td>
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<td colspan="3" ><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="smsGestionBon" NAME="smsGestionBon" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("SMS Dérogation") ?> </td>
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<td colspan="3" ><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="smsDerogation" NAME="smsDerogation" value="" ></td>
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<td align="center"> <?= _("SMS Accord") ?> </td>
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<td colspan="3" ><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="smsAccordPrealable" NAME="smsAccordPrealable" value="" ></td>
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</tr>
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<tr>
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<td> <?= _("Langue") ?> </td>
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<td>
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<SELECT style="font-size:9pt;" class="form-select" id="codeLangueUser" NAME="codeLangueUser" >
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<?php liste_options($langue, $codeLangueSociete, true); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("Indicatif Tél") ?> </td>
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<td><INPUT class="form-control" style='font-size:9pt;' TYPE="text" id="indicatifTelephone" NAME="indicatifTelephone" value="" ></td>
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<td align="center"> <?= _("S/P Alert") ?> </td>
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<td><INPUT style='font-size:9pt;' class="form-control" TYPE="number" id="spMax" NAME="spMax" value="0" min="0" max="100"></td>
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<td align="center"> <?= _("Carte AFN") ?> </td>
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<td><INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="fraisCarteAN" NAME="fraisCarteAN" value="0" ></td>
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</tr>
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<tr>
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<td> </td>
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<td colspan="3"> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer") ?>" onClick="javascript:creer_centre_gestion();" style='font-size:9pt;' > </td>
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<td> </td>
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<td colspan="3"> <input class = "form-control btn btn-warning" type="button" value="<?= _("Annuler") ?>" onClick="javascript:afficher_parametresgeneraux();" style='font-size:9pt;' > </td>
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</tr>
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</tbody>
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</table>
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