 <!DOCTYPE html>
<html lang="zh" xmlns:th="http://www.thymeleaf.org" >
<head>
    <th:block th:include="include :: header('随访任务')" />
</head>
<style>

</style>
<script>

</script>
<body>
    <div class="ui-layout-center">
        <form class="form-horizontal" id="form-followUp-edit" th:object="${user}">
            <h4 class="form-header h4">基本信息</h4>
            <input type="hidden" id="id" name="id" th:value="${id}">
            <div class="row">

                <div class="col-sm-12">
                    <div class="form-group">
                        <!--is-required 增加星号 显示为必填-->
                        <label class="col-sm-1 control-label">预约日期：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input type="text" class="styled-input time-input-new" id="appointmentDate" placeholder="预约日期" name="appointmentDate" th:value="${appointmentDate}" required/>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">业务归属：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <select name="sex" class="styled-input" th:with="type=${@dict.getType('sys_user_sex')}" >
                                    <!--<option>所有</option>-->
                                    <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictValue}"
                                            th:selected="${dict.dictLabel} == ${gender}" ></option>
                                </select>
                                <!--<input name="gender" placeholder="请输入性别" class="styled-input" type="text" maxlength="30" th:value="${gender}" required>-->
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">任务名称：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="taskName" placeholder="请输入任务名称" class="styled-input" type="text" maxlength="30" th:value="${taskName}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">任务主题：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="taskTheme" placeholder="请输入任务主题" class="styled-input" type="text" maxlength="30" th:value="${taskTheme}" required>
                            </div>
                        </div>
                    </div>
                </div>

                <div class="col-sm-12">
                    <div class="form-group">
                        <!--is-required 增加星号 显示为必填-->
                        <label class="col-sm-1 control-label">患者姓名：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="patientName" placeholder="请输入姓名" class="styled-input" type="text" maxlength="30" th:value="${patientName}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">性别：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <select name="gender" class="styled-input" th:with="type=${@dict.getType('sys_user_sex')}" >
                                    <!--<option>所有</option>-->
                                    <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictLabel}"
                                            th:selected="${dict.dictLabel} == ${gender}" ></option>
                                </select>
                                <!--<input name="gender" placeholder="请输入性别" class="styled-input" type="text" maxlength="30" th:value="${gender}" required>-->
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">年龄：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="age" placeholder="请输入年龄" class="styled-input" type="text" maxlength="30" th:value="${age}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">随访小结：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="followUpSummary" placeholder="随访小结" class="styled-input" type="text" maxlength="30" th:value="${followUpSummary}" required>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="col-sm-12">
                    <div class="form-group">
                        <!--is-required 增加星号 显示为必填-->
                        <label class="col-sm-1 control-label">疾病：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="disease" placeholder="请输入证件类型" class="styled-input" type="text" maxlength="30" th:value="${disease}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">门店：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="storeName" placeholder="请输入证件号码" class="styled-input" type="text" maxlength="30" th:value="${storeName}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">药品通用名：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="genericName" placeholder="请输入证件号码" class="styled-input" type="text" maxlength="30" th:value="${genericName}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">商品名：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="productName" placeholder="请输入证件号码" class="styled-input" type="text" maxlength="30" th:value="${productName}" required>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="col-sm-12">
                    <div class="form-group">
                        <!--is-required 增加星号 显示为必填-->
                        <label class="col-sm-1 control-label">任务跟进人：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="taskFollower" placeholder="请输入疾病" class="styled-input" type="text" maxlength="30" th:value="${taskFollower}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">实际随访时间：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input type="text" class="styled-input time-input-new" id="actualFollowUpTime" placeholder="实际随访时间" name="actualFollowUpTime" th:value="${actualFollowUpTime}" required/>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">接通次数：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="callConnectedCount" placeholder="接通次数" class="styled-input" type="text" maxlength="30" th:value="${callConnectedCount}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">外呼次数：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="outboundCallCount" placeholder="外呼次数" class="styled-input" type="text" maxlength="30" th:value="${outboundCallCount}" required>
                            </div>
                        </div>
                    </div>
                </div>

                <div class="col-sm-12">
                    <div class="form-group">
                        <!--is-required 增加星号 显示为必填-->
                        <label class="col-sm-1 control-label">下次外呼次数：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="nextOutboundCallCount" placeholder="下次外呼次数" class="styled-input" type="text" maxlength="30" th:value="${nextOutboundCallCount}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">任务状态：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="taskStatus" placeholder="任务状态" class="styled-input" type="text" maxlength="30" th:value="${taskStatus}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">最后外呼状态：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="lastOutboundStatus" placeholder="最后外呼状态"
                                       class="styled-input" type="text" maxlength="30" th:value="${lastOutboundStatus}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">更新时间：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input type="text" class="styled-input time-input-new" id="updatedAt" placeholder="更新时间" name="updatedAt" th:value="${updateTime2}" required/>
                            </div>
                        </div>
                    </div>
                </div>


            </div>
        </form>
    </div>
    <div class="main-content">
        <div class="col-sm-offset-5 col-sm-10">
            <button type="button" class="btn btn-sm btn-primary" onclick="submitHandler()"><i class="fa fa-check"></i>保 存</button>&nbsp;
            <button type="button" class="btn btn-sm btn-danger" onclick="closeItem()"><i class="fa fa-reply-all"></i>关 闭 </button>
        </div>
    </div>
	<th:block th:include="include :: footer" />
</body>
</html>

<script>
    function submitHandler() {
        var prefix = ctx + "dtp/pmService";
        if ($.validate.form()) {
            var data = $("#form-followUp-edit").serializeArray();
            $.operate.saveTab(prefix + "/followUpEdit", data);
        }
    }
</script>
