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

</style>
<script>

</script>
<body>
    <div class="ui-layout-center">
        <form class="form-horizontal" id="form-server-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">姓名：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="name" placeholder="请输入姓名" class="styled-input" type="text" maxlength="30" th:value="${name}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">性别：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <select name="sex" class="styled-input" th:with="type=${@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">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="${age}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">手机号：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="phoneNumber" placeholder="请输入手机号" class="styled-input" type="text" maxlength="30" th:value="${phoneNumber}" 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">证件类型：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="documentType" placeholder="请输入证件类型" class="styled-input" type="text" maxlength="30" th:value="${documentType}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">证件号码：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="documentNumber" placeholder="请输入证件号码" class="styled-input" type="text" maxlength="30" th:value="${documentNumber}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">实名状态：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <select name="realNameStatus" class="styled-input" th:with="type=${@dict.getType('sys_real_yes_no')}">
                                    <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictValue}"
                                            th:selected="${dict.dictLabel}==${realNameStatus}"></option>
                                </select>
                                <!--<input name="realNameStatus" placeholder="实名状态" class="styled-input" type="text" maxlength="30" th:value="${realNameStatus}" required>-->
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">上翻状态：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <select name="flipStatus" class="styled-input" th:with="type=${@dict.getType('sys_up_yes_no')}" >
                                    <!--<option>所有</option>-->
                                    <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictValue}"
                                            th:selected="${dict.dictLabel} == ${flipStatus}" ></option>
                                </select>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="col-sm-12">
                    <div class="form-group">
                        <!--is-required 增加星号 显示为必填-->
                        <label class="col-sm-1 control-label">疾病：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="disease" placeholder="请输入疾病" class="styled-input" type="text" maxlength="30" th:value="${disease}" 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="请输入药品通用名" class="styled-input" type="text" maxlength="30" th:value="${genericName}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">商品名：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="productName" placeholder="请输入商品名" class="styled-input" type="text" maxlength="30" th:value="${productName}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">MDM编码：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="mdmCode" placeholder="MDM编码" class="styled-input" type="text" maxlength="30" th:value="${mdmCode}" 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">厂家：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="manufacturer" placeholder="请输入厂家" class="styled-input" type="text" maxlength="30" th:value="${manufacturer}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">门店：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="storeName" placeholder="请输入门店" class="styled-input" type="text" maxlength="30" th:value="${storeName}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">档案创建人：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="archiveCreator" placeholder="档案创建人" class="styled-input" type="text" maxlength="30" th:value="${archiveCreator}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">档案完善人：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="archiveCompleter" placeholder="档案完善人" class="styled-input" type="text" maxlength="30" th:value="${archiveCompleter}" 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">是否接受随访：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <select name="acceptFollowUp" class="styled-input" th:with="type=${@dict.getType('sys_select_yes_no')}">
                                    <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictValue}"
                                            th:selected="${dict.dictLabel}==${acceptFollowUp}"></option>
                                </select>
                                <!--<input name="acceptFollowUp" placeholder="是否接受随访" class="styled-input" type="text" maxlength="30" th:value="${acceptFollowUp}" required>-->
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">随访跟进人：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input name="followUpPerson" placeholder="随访跟进人" class="styled-input" type="text" maxlength="30" th:value="${followUpPerson}" required>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">档案是否完善：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <select name="archiveCompleteStatus" class="styled-input" th:with="type=${@dict.getType('sys_doc_yes_no')}">
                                    <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictValue}"
                                            th:selected="${dict.dictLabel}==${archiveCompleteStatus}"></option>
                                </select>
                                <!--<input name="archiveCompleteStatus" placeholder="档案是否完善" class="styled-input" type="text" maxlength="30" th:value="${archiveCompleteStatus}" required>-->
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">有无慈善援助：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <select name="charityAssistance" class="styled-input" th:with="type=${@dict.getType('sys_salvation_yes_no')}">
                                    <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictValue}"
                                            th:selected="${dict.dictLabel}==${charityAssistance}"></option>
                                </select>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="col-sm-12">
                    <div class="form-group">
                        <!--is-required 增加星号 显示为必填-->
                        <label class="col-sm-1 control-label">是否参加共建项目：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <select name="joinProject" class="styled-input" th:with="type=${@dict.getType('sys_select_yes_no')}">
                                    <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictValue}"
                                            th:selected="${dict.dictLabel}==${joinProject}"></option>
                                </select>
                                <!--<input name="joinProject" placeholder="是否参加共建项目" class="styled-input" type="text" maxlength="30" th:value="${joinProject}" required>-->
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">随访状态：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <select name="followUpStatus" class="styled-input" th:with="type=${@dict.getType('sys_follow_up_visit')}">
                                    <option th:each="dict : ${type}" th:text="${dict.dictLabel}" th:value="${dict.dictValue}"
                                            th:selected="${dict.dictLabel}==${joinProject}"></option>
                                </select>
                            </div>
                        </div>
                        <label class="col-sm-1 control-label">更新时间：</label>
                        <div class="col-sm-2" >
                            <div class="input-group">
                                <input type="text" class="styled-input time-input-new" id="updateTime" placeholder="更新时间" name="updateTime" th:value="${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-server-edit").serializeArray();
            /*var status = $("input[id='status']").is(':checked') == true ? 0 : 1;
            var roleIds = $.form.selectCheckeds("role");
            var postIds = $.form.selectSelects("post");
            data.push({"name": "status", "value": status});
            data.push({"name": "roleIds", "value": roleIds});
            data.push({"name": "postIds", "value": postIds});*/
            $.operate.saveTab(prefix + "/archivesEdit", data);
        }
    }
</script>
