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186 lines
8.5 KiB
186 lines
8.5 KiB
5 years ago
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<!DOCTYPE html>
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<html lang="en">
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<head>
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<meta charset="UTF-8">
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<title>增加</title>
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<link rel="stylesheet" href="/static/layui/css/layui.css">
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</head>
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<body>
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<a href="huanzhe">返回患者信息页</a>
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<div class="layui-main">
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<div class="site-content">
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<br><br>
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<h1 class="site-h1">添加信息</h1>
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<br><br>
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<form class="layui-form" action="insert_gen?type=huanzhe" method="post">
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<div class="layui-form-item">
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<label class="layui-form-label">身份证号</label>
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{% if mark == '0' %}
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<div class="layui-input-block">
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<input type="text" name="a" required lay-verify="required" placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% else %}
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<div class="layui-input-block">
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<input type="text" name="a" value="{{ detail.shenfenzhenghao }}" required lay-verify="required"
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placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% endif %}
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">姓名</label>
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{% if mark == '0' %}
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<div class="layui-input-block">
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<input type="text" name="b" required lay-verify="required" placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% else %}
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<div class="layui-input-block">
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<input type="text" name="b" value="{{ detail.xingming }}" required lay-verify="required"
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placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% endif %}
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">性别</label>
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{% if mark == '0' %}
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<div class="layui-input-block">
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<input type="text" name="c" required lay-verify="required" placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% else %}
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<div class="layui-input-block">
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<input type="text" name="c" value="{{ detail.xingbie }}" required lay-verify="required"
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placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% endif %}
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">年龄</label>
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{% if mark == '0' %}
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<div class="layui-input-block">
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<input type="text" name="d" required lay-verify="required" placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% else %}
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<div class="layui-input-block">
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<input type="text" name="d" value="{{ detail.nianling }}" required lay-verify="required"
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placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% endif %}
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">籍贯</label>
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{% if mark == '0' %}
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<div class="layui-input-block">
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<input type="text" name="e" required lay-verify="required" placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% else %}
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<div class="layui-input-block">
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<input type="text" name="e" value="{{ detail.jiguan }}" required lay-verify="required"
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placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% endif %}
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">患者号</label>
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{% if mark == '0' %}
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<div class="layui-input-block">
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<input type="text" name="f" required lay-verify="required" placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% else %}
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<div class="layui-input-block">
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<input type="text" name="f" value="{{ detail.huanzhehao }}" required lay-verify="required"
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placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% endif %}
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">房间位置</label>
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{% if mark == '0' %}
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<div class="layui-input-block">
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<input type="text" name="g" required lay-verify="required" placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% else %}
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<div class="layui-input-block">
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<input type="text" name="g" required value="{{ detail.fangjianweizhi }}" lay-verify="required"
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placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% endif %}
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">入院时间</label>
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{% if mark == '0' %}
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<div class="layui-input-block">
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<input type="text" name="h" required lay-verify="required" placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% else %}
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<div class="layui-input-block">
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<input type="text" name="h" required value="{{ detail.ruyuanshijian }}" lay-verify="required"
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placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% endif %}
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">家属联系方式</label>
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{% if mark == '0' %}
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<div class="layui-input-block">
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<input type="text" name="phone" required lay-verify="required" placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% else %}
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<div class="layui-input-block">
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<input type="text" name="phone" required value="{{ detail.jiashulianxitianhua }}" required
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lay-verify="required" placeholder="请输入"
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autocomplete="off"
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class="layui-input">
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</div>
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{% endif %}
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</div>
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<div class="layui-form-item">
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<div class="layui-input-block">
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<button class="layui-btn" lay-submit lay-filter="formDemo">立即提交</button>
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<button type="reset" class="layui-btn layui-btn-primary">重置</button>
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</div>
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</div>
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</form>
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</div>
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</div>
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<script src="/static/layui/layui.js"></script>
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<script>
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layui.use('form', function () {
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var form = layui.form;
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});
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</script>
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</body>
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</html>
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