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67 lines
2.0 KiB
67 lines
2.0 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>修改</title>
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</head>
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<body>
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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">修改信息</h1>
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<br><br>
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<form class="layui-form" action="alter" method="post">
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<input type="hidden" name = 'patient_id' value="{{Patient.patient_id}}">
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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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<div class="layui-input-block">
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<input type="text" name="name" required lay-verify="required" placeholder="请输入省份" autocomplete="off"
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class="layui-input" value="{{Patient.name}}">
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</div>
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">治疗点</label>
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<div class="layui-input-block">
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<input type="number" name="treatment_point_id" required lay-verify="required" placeholder="请输入城市"
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autocomplete="off"
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class="layui-input" value="{{Patient.treatment_point_id}}">
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</div>
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">电话</label>
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<div class="layui-input-block">
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<input type="number" name="phone" required lay-verify="required" placeholder="请输入" autocomplete="off"
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class="layui-input" value="{{Patient.phone}}">
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</div>
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">地区编号</label>
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<div class="layui-input-block">
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<input type="number" name="area_id" required lay-verify="required" placeholder="请输入城市" autocomplete="off"
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class="layui-input" value="{{Patient.area_id}}">
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</div>
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</div>
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<div class="layui-form-item">
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<label class="layui-form-label">城市编号</label>
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<div class="layui-input-block">
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<input type="number" name="city_id" required lay-verify="required" placeholder="请输入人数"
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autocomplete="off" class="layui-input" value="{{Patient.city_id}}">
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</div>
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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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</body>
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</html>
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