edit.html 6.0 KB

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  1. <form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
  2. <div class="form-group">
  3. <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
  4. <div class="col-xs-12 col-sm-8">
  5. <input id="c-user_id" data-rule="required" data-source="user/user/index" data-field="nickname" class="form-control selectpage" name="row[user_id]" type="text" value="{$row.user_id|htmlentities}">
  6. </div>
  7. </div>
  8. <div class="form-group">
  9. <label class="control-label col-xs-12 col-sm-2">{:__('Realname')}:</label>
  10. <div class="col-xs-12 col-sm-8">
  11. <input id="c-realname" class="form-control" name="row[realname]" type="text" value="{$row.realname|htmlentities}">
  12. </div>
  13. </div>
  14. <div class="form-group">
  15. <label class="control-label col-xs-12 col-sm-2">{:__('Idcard')}:</label>
  16. <div class="col-xs-12 col-sm-8">
  17. <input id="c-idcard" class="form-control" name="row[idcard]" type="text" value="{$row.idcard|htmlentities}">
  18. </div>
  19. </div>
  20. <div class="form-group">
  21. <label class="control-label col-xs-12 col-sm-2">{:__('Relation')}:</label>
  22. <div class="col-xs-12 col-sm-8">
  23. <input id="c-relation" class="form-control" name="row[relation]" type="text" value="{$row.relation|htmlentities}">
  24. </div>
  25. </div>
  26. <div class="form-group">
  27. <label class="control-label col-xs-12 col-sm-2">{:__('Mobile')}:</label>
  28. <div class="col-xs-12 col-sm-8">
  29. <input id="c-mobile" class="form-control" name="row[mobile]" type="text" value="{$row.mobile|htmlentities}">
  30. </div>
  31. </div>
  32. <div class="form-group">
  33. <label class="control-label col-xs-12 col-sm-2">{:__('Gender')}:</label>
  34. <div class="col-xs-12 col-sm-8">
  35. <select id="c-gender" data-rule="required" min="0" class="form-control selectpicker" name="row[gender]">
  36. {foreach name="genderList" item="vo"}
  37. <option value="{$key}" {in name="key" value="$row.gender"}selected{/in}>{$vo}</option>
  38. {/foreach}
  39. </select>
  40. </div>
  41. </div>
  42. <div class="form-group">
  43. <label class="control-label col-xs-12 col-sm-2">{:__('Birthday')}:</label>
  44. <div class="col-xs-12 col-sm-8">
  45. <input id="c-birthday" class="form-control" name="row[birthday]" type="number" value="{$row.birthday|htmlentities}">
  46. </div>
  47. </div>
  48. <div class="form-group">
  49. <label class="control-label col-xs-12 col-sm-2">{:__('Marital_status')}:</label>
  50. <div class="col-xs-12 col-sm-8">
  51. <div class="radio">
  52. {foreach name="maritalStatusList" item="vo"}
  53. <label for="row[marital_status]-{$key}"><input id="row[marital_status]-{$key}" name="row[marital_status]" type="radio" value="{$key}" {in name="key" value="$row.marital_status"}checked{/in} /> {$vo}</label>
  54. {/foreach}
  55. </div>
  56. </div>
  57. </div>
  58. <div class="form-group">
  59. <label class="control-label col-xs-12 col-sm-2">{:__('Allergies_status')}:</label>
  60. <div class="col-xs-12 col-sm-8">
  61. <div class="radio">
  62. {foreach name="allergiesStatusList" item="vo"}
  63. <label for="row[allergies_status]-{$key}"><input id="row[allergies_status]-{$key}" name="row[allergies_status]" type="radio" value="{$key}" {in name="key" value="$row.allergies_status"}checked{/in} /> {$vo}</label>
  64. {/foreach}
  65. </div>
  66. </div>
  67. </div>
  68. <div class="form-group">
  69. <label class="control-label col-xs-12 col-sm-2">{:__('Allergies_text')}:</label>
  70. <div class="col-xs-12 col-sm-8">
  71. <input id="c-allergies_text" class="form-control" name="row[allergies_text]" type="text" value="{$row.allergies_text|htmlentities}">
  72. </div>
  73. </div>
  74. <div class="form-group">
  75. <label class="control-label col-xs-12 col-sm-2">{:__('Familymedical_status')}:</label>
  76. <div class="col-xs-12 col-sm-8">
  77. <div class="radio">
  78. {foreach name="familymedicalStatusList" item="vo"}
  79. <label for="row[familymedical_status]-{$key}"><input id="row[familymedical_status]-{$key}" name="row[familymedical_status]" type="radio" value="{$key}" {in name="key" value="$row.familymedical_status"}checked{/in} /> {$vo}</label>
  80. {/foreach}
  81. </div>
  82. </div>
  83. </div>
  84. <div class="form-group">
  85. <label class="control-label col-xs-12 col-sm-2">{:__('Familymedical_text')}:</label>
  86. <div class="col-xs-12 col-sm-8">
  87. <input id="c-familymedical_text" class="form-control" name="row[familymedical_text]" type="text" value="{$row.familymedical_text|htmlentities}">
  88. </div>
  89. </div>
  90. <div class="form-group">
  91. <label class="control-label col-xs-12 col-sm-2">{:__('Chronicdisease_status')}:</label>
  92. <div class="col-xs-12 col-sm-8">
  93. <div class="radio">
  94. {foreach name="chronicdiseaseStatusList" item="vo"}
  95. <label for="row[chronicdisease_status]-{$key}"><input id="row[chronicdisease_status]-{$key}" name="row[chronicdisease_status]" type="radio" value="{$key}" {in name="key" value="$row.chronicdisease_status"}checked{/in} /> {$vo}</label>
  96. {/foreach}
  97. </div>
  98. </div>
  99. </div>
  100. <div class="form-group">
  101. <label class="control-label col-xs-12 col-sm-2">{:__('Chronicdisease_text')}:</label>
  102. <div class="col-xs-12 col-sm-8">
  103. <input id="c-chronicdisease_text" class="form-control" name="row[chronicdisease_text]" type="text" value="{$row.chronicdisease_text|htmlentities}">
  104. </div>
  105. </div>
  106. <div class="form-group layer-footer">
  107. <label class="control-label col-xs-12 col-sm-2"></label>
  108. <div class="col-xs-12 col-sm-8">
  109. <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
  110. </div>
  111. </div>
  112. </form>