93 lines
4.6 KiB
PHP
Executable File
93 lines
4.6 KiB
PHP
Executable File
<?php
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// $this->titre = "INTER-SANTE - Modification Dossier Remboursement Classique";
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$numeroLotDecompte = $dossierpolice['numeroLotDecompte'];
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$idDossierClassiquePolice = $_SESSION['idDossierClassiquePolice'];
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$regle = $dossierpolice['regle'];
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$dateReclamation = dateLang($this->nettoyer($dossierpolice['dateReclamation']));
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?>
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<input class="sr-only" type="text" id="idDossierClassiquePolice" name="idDossierClassiquePolice" value="<?= $idDossierClassiquePolice ?>" >
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<input class="sr-only" type="text" id="regle" name="regle" value="<?= $regle ?>" >
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<legend>
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<?= _("Modifications Bordéreau de remboursement classique") . " => " . _("ID Bordéreau") . " : " . $idDossierClassiquePolice . " => " . _("Date réclamation") . " : " . $dateReclamation ?>
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</legend>
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<table class="table table-responsive table-condensed" style='font-size:9pt;'>
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<tbody>
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<tr>
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<td width="10%" > <?= _("Date réclamation") ?> </td>
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<td width="23%" > <INPUT style='font-size:9pt; text-align:center;' class="form-control" TYPE="text" value="<?= dateLang($this->nettoyer($dossierpolice['dateReclamation'])) ?>" readonly> </td>
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<td align="center" > Observations </td>
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<td colspan="3" ><INPUT style='font-size:9pt;' class="form-control" TYPE="text" value="<?= $dossierpolice['observations'] ?>" readonly ></td>
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</tr>
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<tr>
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<td colspan="6"> <input style='text-align:center; font-size:11pt; background-color:green !important; color:white;' class="form-control" type="text" value= "<?= _("Informations sur le paiement proposées par le bénéficiaire") ?>" disabled > </td>
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</tr>
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<tr>
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<td> <?= _("Mode Paiement") ?> </td>
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<td > <INPUT style='font-size:9pt; text-align:center;' class="form-control" TYPE="text" value="<?= $dossierpolice['modepaiementBeneficiaire'] ?>" readonly > </td>
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<td align="center"> <?= _("Banque Bénéf") ?> </td>
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<td> <INPUT style='font-size:9pt; text-align:center;' class="form-control" TYPE="text" value="<?= $dossierpolice['banqueBeneficiaire'] ?>" readonly > </td>
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<td align="center"> <?= _("No Cpte Bénéf") ?> </td>
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<td > <INPUT style='font-size:9pt; text-align:center;' class="form-control" TYPE="text" value="<?= $dossierpolice['numeroCompteBeneficiaire'] ?>" readonly > </td>
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</tr>
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</tbody>
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</table>
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<input style='text-align:center; font-size:11pt; font-weight: bold; background-color:#f5deb3; color:#a0522d;' class="form-control" type="text" value= "<?= _("Nouvelles informations sur la demande de remboursement classique") ?>" readonly >
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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> Observations </td>
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<td colspan="5"> <INPUT id="observations" NAME="observations" style='font-size:9pt;' class="form-control" TYPE="text" value="<?= $dossierpolice['observations'] ?>" ></td>
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</tr>
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<tr>
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<td colspan="6"> <input style='text-align:center; font-size:11pt; background-color:green !important; color:white;' class="form-control" type="text" value= "<?= _("Informations sur le paiement proposées par le bénéficiaire") ?>" disabled > </td>
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</tr>
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<tr>
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<td width="10%"> <?= _("Mode Paiement") ?> </td>
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<td width="23%" >
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<select class="form-select" id="codeModePaiementDemande" NAME="codeModePaiementDemande" required style='font-size:9pt;' >
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<?php liste_options($modepaiement, $dossierpolice['codeModePaiementDemande']); ?>
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</SELECT>
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</td>
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<td width="10%" align="center" ><?= _("Banque Bénéf") ?> </td>
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<td width="24%" >
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<SELECT style='font-size:9pt;' class="form-select" id="codeBanqueBeneficiaire" NAME="codeBanqueBeneficiaire" required>
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<?php liste_options($banque, $dossierpolice['codeBanqueBeneficiaire']); ?>
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</SELECT>
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</td>
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<td width="10%" align="center" > <?= _("No Cpte Bénéf") ?> </td>
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<td > <INPUT style='font-size:9pt;' class="form-control" TYPE="text" id="numeroCompteBeneficiaire" NAME="numeroCompteBeneficiaire" value="<?= $dossierpolice['numeroCompteBeneficiaire'] ?>" required> </td>
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</tr>
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<tr>
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<td> </td>
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<td colspan="5"> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer les Modifications") ?>" onClick="enregistrermodificationsdossierclassique_police();" style='font-size:10pt;' > </td>
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</tr>
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</tbody>
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</table>
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<?php if (isset($msgErreur)): ?>
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<div id ="msgErreur" 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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<div id="div_test">
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</div>
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