68 lines
3.5 KiB
PHP
Executable File
68 lines
3.5 KiB
PHP
Executable File
<?php $this->titre = "Intersanté - Consulter une entente préalable Monture"; ?>
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<form >
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<INPUT class="sr-only" TYPE="text" id="idDemandeententeprealable" name="idDemandeententeprealable" value="<?= $this->nettoyer($ententeprealable['idDemandeententeprealable']) ?>">
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<INPUT class="sr-only" TYPE="text" id="prestataire" name="prestataire" value="<?= $this->nettoyer($ententeprealable['prestataire']) ?>">
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<INPUT class="sr-only" TYPE="text" id="beneficiaire" name="beneficiaire" value="<?= $this->nettoyer($ententeprealable['beneficiaire']) ?>">
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<INPUT class="sr-only" TYPE="text" id="numeroBeneficiaire" name="numeroBeneficiaire" value="<?= $this->nettoyer($ententeprealable['numeroBeneficiaire']) ?>">
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<legend> Consulter une entente préalable Monture </legend>
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td width="10%" > Numéro </td>
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<td width="20%"> <INPUT id="numeroEntentePrealable" name="numeroEntentePrealable" class="form-control" TYPE="text" style='font-size:10pt;' value="<?= $this->nettoyer($ententeprealable['numeroEntentePrealable']) ?>" readonly> </td>
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<td width="10%" align="center"> Monture </td>
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<td colspan="3"> <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="Monture Uniquement / Eyeglasses Frame Only" readonly> </td>
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</tr>
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<tr>
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<td> Date </td>
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<td> <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= dateheureFr($this->nettoyer($ententeprealable['dateSysteme'])) ?>" readonly> </td>
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<td align="center"> Prestataire </td>
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<td colspan="3"> <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= $this->nettoyer($ententeprealable['prestataire']) ?>" readonly> </td>
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</tr>
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<tr>
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<td> Bénéficiaire </td>
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<td colspan="5"><INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= $this->nettoyer($ententeprealable['beneficiaire']) ?>" readonly> </td>
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</tr>
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<tr>
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<td> Répondu le </td>
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<td> <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= dateheureFr($this->nettoyer($ententeprealable['dateReponse'])) ?>" readonly> </td>
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<td align="center"> Réponse </td>
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<td> <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= $this->nettoyer($ententeprealable['reponsentEnteprealable']) ?>" readonly> </td>
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<td align="center"> Par </td>
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<td> <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= $this->nettoyer($ententeprealable['responsableAccord']) ?>" readonly> </td>
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</tr>
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<tr>
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<td> Motif </td>
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<td colspan="5"><INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= $this->nettoyer($ententeprealable['motifRefusAssure']) ?>" readonly> </td>
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</tr>
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<tr>
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<td> Prix proposé </td>
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<td> <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= format_N($this->nettoyer($ententeprealable['prixPrestataire'])) ?>" readonly> </td>
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<td align="center"> Prix Accordé </td>
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<td> <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= format_N($this->nettoyer($ententeprealable['prixAccorde'])) ?>" readonly> </td>
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<td align="center" > TM </td>
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<td> <INPUT class="form-control" TYPE="text" style='font-size:10pt;' value="<?= $this->nettoyer($ententeprealable['tm']) ?>" readonly> </td>
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</tr>
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</tbody>
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</table>
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</form>
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<div id ="div_wait">
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</div>
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