<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <title>增加</title>

    <link rel="stylesheet" href="/static/layui/css/layui.css">
</head>
<body>
<a href="huanzhe">返回患者信息页</a>
<div class="layui-main">
    <div class="site-content">
        <br><br>
        <h1 class="site-h1">添加信息</h1>
        <br><br>
        <form class="layui-form" action="insert_gen?type=huanzhe" method="post">
            <div class="layui-form-item">
                <label class="layui-form-label">身份证号</label>
                {% if mark == '0' %}
                    <div class="layui-input-block">
                        <input type="text" name="a" required lay-verify="required" placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% else %}
                    <div class="layui-input-block">
                        <input type="text" name="a" value="{{ detail.shenfenzhenghao }}" required lay-verify="required"
                               placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% endif %}
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">姓名</label>
                {% if mark == '0' %}
                    <div class="layui-input-block">
                        <input type="text" name="b" required lay-verify="required" placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% else %}
                    <div class="layui-input-block">
                        <input type="text" name="b" value="{{ detail.xingming }}" required lay-verify="required"
                               placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% endif %}
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">性别</label>
                {% if mark == '0' %}
                    <div class="layui-input-block">
                        <input type="text" name="c" required lay-verify="required" placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% else %}
                    <div class="layui-input-block">
                        <input type="text" name="c" value="{{ detail.xingbie }}" required lay-verify="required"
                               placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% endif %}
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">年龄</label>
                {% if mark == '0' %}
                    <div class="layui-input-block">
                        <input type="text" name="d" required lay-verify="required" placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% else %}
                    <div class="layui-input-block">
                        <input type="text" name="d" value="{{ detail.nianling }}" required lay-verify="required"
                               placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% endif %}
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">籍贯</label>
                {% if mark == '0' %}
                    <div class="layui-input-block">
                        <input type="text" name="e" required lay-verify="required" placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% else %}
                    <div class="layui-input-block">
                        <input type="text" name="e" value="{{ detail.jiguan }}" required lay-verify="required"
                               placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% endif %}
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">患者号</label>
                {% if mark == '0' %}
                    <div class="layui-input-block">
                        <input type="text" name="f" required lay-verify="required" placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% else %}
                    <div class="layui-input-block">
                        <input type="text" name="f" value="{{ detail.huanzhehao }}" required lay-verify="required"
                               placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% endif %}
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">房间位置</label>
                {% if mark == '0' %}
                    <div class="layui-input-block">
                        <input type="text" name="g" required lay-verify="required" placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% else %}
                    <div class="layui-input-block">
                        <input type="text" name="g" required value="{{ detail.fangjianweizhi }}" lay-verify="required"
                               placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% endif %}
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">入院时间</label>
                {% if mark == '0' %}
                    <div class="layui-input-block">
                        <input type="text" name="h" required lay-verify="required" placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% else %}
                    <div class="layui-input-block">
                        <input type="text" name="h" required value="{{ detail.ruyuanshijian }}" lay-verify="required"
                               placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% endif %}
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label">家属联系方式</label>
                {% if mark == '0' %}
                    <div class="layui-input-block">
                        <input type="text" name="phone" required lay-verify="required" placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% else %}
                    <div class="layui-input-block">
                        <input type="text" name="phone" required value="{{ detail.jiashulianxitianhua }}" required
                               lay-verify="required" placeholder="请输入"
                               autocomplete="off"
                               class="layui-input">
                    </div>
                {% endif %}
            </div>
            <div class="layui-form-item">
                <div class="layui-input-block">
                    <button class="layui-btn" lay-submit lay-filter="formDemo">立即提交</button>
                    <button type="reset" class="layui-btn layui-btn-primary">重置</button>
                </div>
            </div>
        </form>
    </div>
</div>
<script src="/static/layui/layui.js"></script>
<script>
    layui.use('form', function () {
        var form = layui.form;
    });
</script>
</body>
</html>