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- <form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Doctor_id')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-doctor_id" data-rule="required" data-source="doctor/index" disabled data-field="nickname" class="form-control selectpage" name="row[doctor_id]" type="text" value="{$row.doctor_id|htmlentities}">
- </div>
- </div>
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Realname')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-realname" data-rule="required" class="form-control" name="row[realname]" type="text" value="{$row.realname|htmlentities}">
- </div>
- </div>
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Pay_no')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-pay_no" data-rule="required" class="form-control" name="row[pay_no]" type="text" value="{$row.pay_no|htmlentities}">
- </div>
- </div>
- <div class="form-group layer-footer">
- <label class="control-label col-xs-12 col-sm-2"></label>
- <div class="col-xs-12 col-sm-8">
- <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
- </div>
- </div>
- </form>
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