radiantrh/Vue/Ajaxremplaceradherent/init.php

<div id="div_remplacement_adherent">
    <div class="card border-primary shadow-sm mb-4">
        <div class="card-body py-2 bg-light">
            <div class="row g-2 align-items-center">
                <div class="col-md-3">
                    <label class="small text-muted d-block"><?= _("Date Sortie") ?></label>
                    <div class="fw-bold"><i class="fas fa-sign-out-alt text-danger me-2"></i><?= dateLang($this->nettoyer($remplacementadherent_temp['dateSortie'])) ?></div>
                </div>
                <div class="col-md-3">
                    <label class="small text-muted d-block"><?= _("Date Remplacement") ?></label>
                    <div class="fw-bold"><i class="fas fa-exchange-alt text-primary me-2"></i><?= dateLang($this->nettoyer($remplacementadherent_temp['dateRemplacement'])) ?></div>
                </div>
                <div class="col-md-6 border-start ps-3">
                    <label class="small text-muted d-block"><?= _("Motif renseigné") ?></label>
                    <div class="text-truncate italic">" <?= $this->nettoyer($remplacementadherent_temp['motif']) ?> "</div>
                </div>
            </div>
        </div>
    </div>

    <div class="card shadow-sm mb-4">
        <div class="card-header bg-dark text-white py-2">
            <h6 class="mb-0 small"><i class="fas fa-list-check me-2"></i><?= _("Garanties et soldes à transmettre") ?></h6>
        </div>
        <div class="table-responsive">
            <table class="table table-hover table-sm mb-0" style="font-size:9.5pt;">
                <thead class="table-light">
                    <tr>
                        <th><?= _("Désignation Garantie") ?></th>
                        <th class="text-center"><?= _("Limite") ?></th>
                        <th class="text-center"><?= _("Consommé") ?></th>
                        <th class="text-center"><?= _("Solde Transférable") ?></th>
                        <th class="text-center"><?= _("Par tête") ?></th>
                    </tr>
                </thead>
                <tbody>
                    <?php foreach ($garantieadherents as $garantieadherent): 
                        $champApplication = $this->nettoyer($garantieadherent['champApplication']);
                    ?>
                        <tr>
                            <td class="fw-bold"><?= $this->nettoyer($garantieadherent['garantie'])?></td>
                            <td class="text-center"><?= format_N($this->nettoyer($garantieadherent['plafond'])) ?></td>
                            <?php if($champApplication == '1'): ?>
                                <td colspan="2" class="text-center text-muted small italic"><?= _("Application globale") ?></td>
                                <td class="text-center"><i class="fas fa-check-circle text-success"></i></td> 
                            <?php else: ?>
                                <td class="text-center text-danger"><?= format_N($this->nettoyer($garantieadherent['consommation'])) ?></td>
                                <td class="text-center fw-bold text-primary"><?= format_N($this->nettoyer($garantieadherent['solde'])) ?></td>
                                <td class="text-center"><i class="far fa-circle text-muted"></i></td> 
                            <?php endif; ?>
                        </tr>
                    <?php endforeach; ?>
                </tbody>
            </table>
        </div>
    </div>

    <div class="card border-success shadow-sm">
        <div class="card-header bg-success text-white py-2 text-center text-uppercase fw-bold">
            <i class="fas fa-user-plus me-2"></i><?= _("Identification de la Famille Entrante") ?>
        </div>
        <div class="card-body p-4">
            <div class="row g-3 mb-4">
                <div class="col-md-6">
                    <label class="form-label small fw-bold"><?= _("Nom") ?></label>
                    <input class="form-control text-uppercase border-success" type="text" id="nom" name="nom" required>
                </div>
                <div class="col-md-6">
                    <label class="form-label small fw-bold"><?= _("Prénoms") ?></label>
                    <input class="form-control border-success" type="text" id="prenoms" name="prenoms" required>
                </div>
                
                <div class="col-md-3">
                    <label class="form-label small text-muted"><?= _("Nature Pièce") ?></label>
                    <select class="form-select" id="codeNaturePiece" name="codeNaturePiece">
                        <?php liste_options($naturepiece,""); ?>
                    </select>
                </div>
                <div class="col-md-3">
                    <label class="form-label small text-muted"><?= _("N° Pièce") ?></label>
                    <input class="form-control" type="text" id="numeroPiece" name="numeroPiece">
                </div>
                <div class="col-md-2">
                    <label class="form-label small text-muted"><?= _("Sexe") ?></label>
                    <select class="form-select" id="sexe" name="sexe">
                        <?php liste_options($sexe,""); ?>
                    </select>
                </div>
                <div class="col-md-4">
                    <label class="form-label small fw-bold"><?= _("Date Naissance") ?></label>
                    <div class="input-group">
                        <input class="form-control datepicker" type="text" id="dateNaissance" name="dateNaissance" onchange="controle_age($('#dateNaissance').datepicker('getDate'), 'A')">
                        <span class="input-group-text bg-light text-danger fw-bold" id="age_badge">Age: 0</span>
                    </div>
                </div>
            </div>

            <hr>

            <div class="row g-3 mb-4">
                <div class="col-md-3">
                    <label class="form-label small text-muted"><?= _("Groupe Sanguin") ?></label>
                    <select class="form-select" id="codeGroupeSanguin" name="codeGroupeSanguin">
                        <?php liste_options($groupesanguin,""); ?>
                    </select>
                </div>
                <div class="col-md-3">
                    <label class="form-label small text-muted"><?= _("Situation Familiale") ?></label>
                    <select class="form-select" id="codeSituationFamille" name="codeSituationFamille">
                        <?php liste_options($situationfamille,""); ?>
                    </select>
                </div>
                <div class="col-md-2">
                    <label class="form-label small text-muted"><?= _("Nb Enfants") ?></label>
                    <input class="form-control" type="number" id="nombreEnfants" name="nombreEnfants" min="0" value="0">
                </div>
                <div class="col-md-4">
                    <label class="form-label small text-muted"><?= _("Pays") ?></label>
                    <select class="form-select" id="codePays" name="codePays">
                        <?php liste_options($pays, $_SESSION['codePaysSociete']); ?>
                    </select>
                </div>

                <div class="col-md-6">
                    <label class="form-label small text-muted"><?= _("Adresse Géographique") ?></label>
                    <input class="form-control form-control-sm" type="text" id="adresseGeo" name="adresseGeo">
                </div>
                <div class="col-md-6">
                    <label class="form-label small text-muted"><?= _("Adresse Postale") ?></label>
                    <input class="form-control form-control-sm" type="text" id="adressePostale" name="adressePostale">
                </div>

                <div class="col-md-4">
                    <label class="form-label small text-muted"><?= _("Téléphone Portable") ?></label>
                    <input class="form-control" type="tel" id="telephonePortable" name="telephonePortable" value="<?= $_SESSION['indicatifTelephone'] ?>">
                </div>
                <div class="col-md-4">
                    <label class="form-label small text-muted"><?= _("E-mail") ?></label>
                    <input class="form-control" type="email" id="email" name="email" placeholder="exemple@mail.com">
                </div>
                <div class="col-md-4">
                    <label class="form-label small text-muted"><?= _("Frais de Carte") ?></label>
                    <div class="input-group">
                        <input class="form-control border-primary fw-bold" type="text" id="fraisCarte" name="fraisCarte" value="<?=$adherentremplacanttemp['fraisCarte']?>">
                        <span class="input-group-text">CFA</span>
                    </div>
                </div>
            </div>

            <div class="row mt-4">
                <div class="col-12">
                    <button type="button" class="btn btn-success w-100 py-3 fw-bold shadow-sm" onclick="javascript:enregistrer_remplacement_adherent();">
                        <i class="fas fa-save me-2"></i> <?= _("VALIDER ET ENREGISTRER LE REMPLACEMENT") ?>
                    </button>
                </div>
            </div>
        </div>
    </div>
</div>