76 lines
3.2 KiB
PHP
Executable File
76 lines
3.2 KiB
PHP
Executable File
<?php
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$idDemande = $this->nettoyer($demande['id']);
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$numeroDemandeRemboursement = $this->nettoyer($demande['numeroDemandeRemboursement']);
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$codeEtatDemandeRemboursement = $this->nettoyer($demande['codeEtatDemandeRemboursement']);
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$lien = $this->nettoyer($demande['lien']);
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$numeroBeneficiaire = $this->nettoyer($demande['numeroBeneficiaire']);
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$observation = $this->nettoyer($demande['observation']);
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$codeStatutPaiement = $this->nettoyer($demande['codeStatutPaiement']);
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$beneficiaire = $this->nettoyer($demande['beneficiaire']);
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$adherent = $this->nettoyer($demande['adherent']);
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$numeroAdherent = $this->nettoyer($demande['numeroAdherent']);
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$idPolice = $this->nettoyer($demande['idPolice']);
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$numeroPolice = $this->nettoyer($demande['numeroPolice']);
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if (est_anglophone()){
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$lien = $this->nettoyer($demande['lienEng']);
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}
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?>
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<div class="modal-dialog" style="max-width:70%" role="document">
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<div class="modal-content">
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<div class="modal-header">
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<button type="button" class="close" data-bs-dismiss="modal">×</button>
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<legend class="modal-title" style="text-align:center;"><?= _('Valider une demande')?></legend>
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</div>
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<div class="modal-body">
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<div id="div_motif" style="margin-top:30px; margin-bottom:30px;">
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<table class="table table-responsive table-condensed" style='font-size:12pt;'>
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<tbody>
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<tr>
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<td width="8%"> <?= _("Demande N°");?></td>
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<td colspan="3">
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<input style="font-size:10pt;" class ="form-control" type="text" value="<?= $numeroDemandeRemboursement; ?>" readonly>
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</td>
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</tr>
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<tr>
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<td > <?= _("Titulaire");?></td>
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<td >
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<input style="font-size:10pt;" class ="form-control" type="text" value="<?= $adherent."(".$numeroAdherent.")"; ?>" readonly>
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</td>
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<td style='text-align:center' width="8%"> <?= _("Patient");?></td>
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<td >
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<input style="font-size:10pt;" class ="form-control" type="text" value="<?= $beneficiaire."(".$numeroBeneficiaire.")"; ?>" readonly>
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</td>
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</tr>
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<tr>
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<td ><?= _("Etat validation");?></td >
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<td colspan="3">
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<select class="form-select form-select-sm border-primary-subtle" id="codeStatutPaiement" name="codeStatutPaiement">
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<?php liste_options($reponsedemande, $codeStatutPaiement); ?>
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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" width="8%"> <?= _("Motif");?></td>
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<td colspan="3">
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<textarea class="form-control-sm" placeholder="<?= _("Obligatoire si refus");?>" name="motifRejetRh" id="motifRejetRh" rows="5" required style="width:100%;"></textarea>
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</td>
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</tr>
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<tr>
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<td colspan="4">
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<input style="font-size:10pt;" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer") ?>" onClick="javascript:enregistrer_validation_rd(<?= $idDemande ?>);">
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</td>
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</tr>
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</tbody>
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</table>
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</div>
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</div>
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<div class="modal-footer">
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<button type="button" id="" class="btn btn-default" data-bs-dismiss="modal" ><?= _("Fermer") ?></button>
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</div>
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</div>
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</div>
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