51 lines
2.7 KiB
PHP
Executable File
51 lines
2.7 KiB
PHP
Executable File
<div id="div_facture_detail">
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<input style='text-align:center; font-size:11pt; background-color:green;color:white;' class="form-control" type="text" value= "Informations sur la consultation" disabled >
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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="7%"> No Feuille </td>
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<td width="13%"> <INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['numeroFeuilleMaladie']) ?>" readonly></td>
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<td width="7%" style='text-align:center'> date Consul </td>
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<td width="10%" ><INPUT style="font-size:9pt;" class="form-control" value="<?= dateFr($this->nettoyer($feuillemaladie['dateConsultation'])) ?>" readonly></td>
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<td width="7%" style='text-align:center'> Prestataire </td>
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<td width="25%" ><INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['prestataire']) ?>" readonly></td>
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<td width="7%" style='text-align:center'> Medecin </td>
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<td><INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['medecinConsultation']) ?>" readonly></td>
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</tr>
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<tr>
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<td > Bon Cons </td>
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<td><INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['numeroBonConsultation']) ?>" readonly></td>
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<td style='text-align:center'> Bon Ordon </td>
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<td><INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['numeroBonOrdonnance']) ?>" readonly></td>
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<td style='text-align:center'> Bon Hospit </td>
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<td><INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['numeroBonHospitalisation']) ?>" readonly></td>
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<td style='text-align:center'> Bon Opt </td>
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<td><INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['numeroBonOptique']) ?>" readonly></td>
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</tr>
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<tr>
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<td > Bon Exam </td>
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<td><INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['numeroBonExamen']) ?>" readonly></td>
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<td style='text-align:center'> Bon Kine </td>
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<td><INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['numeroBonKine']) ?>" readonly></td>
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<td style='text-align:center'> Chambre </td>
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<td><INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['numeroChambre']) ?>" readonly></td>
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<td style='text-align:center'> Rais Cons </td>
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<td><INPUT style="font-size:9pt;" class="form-control" value="<?= $this->nettoyer($feuillemaladie['raisonconsultation']) ?>" readonly></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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