85 lines
4.6 KiB
PHP
Executable File
85 lines
4.6 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 modal-lg" role="document">
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<div class="modal-content shadow-lg border-0">
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<div class="modal-header bg-light border-bottom">
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<h5 class="modal-title fw-bold text-primary">
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<i class="fas fa-check-circle me-2"></i><?= _('Valider une demande') ?>
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</h5>
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<button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button>
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</div>
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<div class="modal-body p-4">
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<div id="div_motif">
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<div class="mb-4">
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<label class="form-label small fw-bold text-muted text-uppercase"><?= _("Référence de la demande") ?></label>
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<div class="input-group shadow-sm">
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<span class="input-group-text bg-white"><i class="fas fa-hashtag text-primary"></i></span>
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<input class="form-control fw-bold bg-white" type="text" value="<?= $numeroDemandeRemboursement; ?>" readonly>
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</div>
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</div>
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<div class="row g-3 mb-4">
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<div class="col-md-6">
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<label class="form-label small fw-bold text-muted text-uppercase"><?= _("Titulaire (Adhérent)") ?></label>
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<div class="input-group">
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<span class="input-group-text bg-light"><i class="fas fa-user-shield"></i></span>
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<input class="form-control small" type="text" value="<?= $adherent." (".$numeroAdherent.")"; ?>" readonly>
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</div>
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</div>
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<div class="col-md-6">
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<label class="form-label small fw-bold text-muted text-uppercase"><?= _("Patient (Bénéficiaire)") ?></label>
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<div class="input-group">
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<span class="input-group-text bg-light"><i class="fas fa-user"></i></span>
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<input class="form-control small" type="text" value="<?= $beneficiaire." (".$numeroBeneficiaire.")"; ?>" readonly>
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</div>
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</div>
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</div>
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<hr class="text-muted opacity-25">
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<div class="row g-3">
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<div class="col-12">
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<label class="form-label fw-bold"><?= _("Décision de validation") ?> <span class="text-danger">*</span></label>
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<select class="form-select border-primary" id="codeStatutPaiementAjax" name="codeStatutPaiementAjax">
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<?php liste_options($reponsedemande, $codeStatutPaiement); ?>
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</select>
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</div>
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<div class="col-12">
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<label class="form-label fw-bold"><?= _("Motif ou Observation") ?></label>
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<textarea class="form-control"
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placeholder="<?= _("Saisissez ici le motif (obligatoire en cas de refus)..."); ?>"
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name="motifRejetRh"
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id="motifRejetRh"
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rows="4"></textarea>
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</div>
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</div>
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</div>
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</div>
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<div class="modal-footer bg-light">
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<button type="button" class="btn btn-outline-secondary px-4" data-bs-dismiss="modal"><?= _("Annuler") ?></button>
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<button type="button" class="btn btn-primary px-5 shadow" onClick="javascript:enregistrer_validation_rd(<?= $idDemande ?>);">
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<i class="fas fa-save me-2"></i><?= _("Enregistrer la décision") ?>
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</button>
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</div>
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</div>
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</div>
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