SDtpSjdcFollowUpStatisticsAdd.html 4.7 KB

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  1. <!DOCTYPE html>
  2. <html lang="zh" xmlns:th="http://www.thymeleaf.org" >
  3. <head>
  4. <th:block th:include="include :: header('随访统计表新增')" />
  5. <th:block th:include="include :: ztree-css" />
  6. </head>
  7. <body class="white-bg">
  8. <div class="wrapper wrapper-content animated fadeInRight ibox-content">
  9. <form id="form-SDtpSjdcFollowUpStatistics-add" class="customize-search-form">
  10. <div class="customize-form-group-container">
  11. <div class="customize-form-group">
  12. <label>跟进人:</label>
  13. <input name="follower" placeholder="跟进人" id="follower" class="styled-input" type="text">
  14. </div>
  15. <div class="customize-form-group">
  16. <label>年龄:</label>
  17. <input name="age" placeholder="年龄" id="age" class="styled-input" type="text">
  18. </div>
  19. <div class="customize-form-group">
  20. <label>性别:</label>
  21. <input name="gender" placeholder="性别" id="gender" class="styled-input" type="text">
  22. </div>
  23. <div class="customize-form-group">
  24. <label>适应症:</label>
  25. <input name="indication" placeholder="适应症" id="indication" class="styled-input" type="text">
  26. </div>
  27. <div class="customize-form-group">
  28. <label>不良反应:</label>
  29. <input name="adverseReaction" placeholder="不良反应" id="adverseReaction" class="styled-input" type="text">
  30. </div>
  31. <div class="customize-form-group">
  32. <label>用药状态:</label>
  33. <input name="medicationStatus" placeholder="用药状态" id="medicationStatus" class="styled-input" type="text">
  34. </div>
  35. <div class="customize-form-group">
  36. <label>配合度:</label>
  37. <input name="cooperationLevel" placeholder="配合度" id="cooperationLevel" class="styled-input" type="text">
  38. </div>
  39. <div class="customize-form-group">
  40. <label>永久停药:</label>
  41. <input name="permanentDiscontinuation" placeholder="永久停药" id="permanentDiscontinuation" class="styled-input" type="text">
  42. </div>
  43. <div class="customize-form-group">
  44. <label>暂停用药:</label>
  45. <input name="temporarySuspension" placeholder="暂停用药" id="temporarySuspension" class="styled-input" type="text">
  46. </div>
  47. <div class="customize-form-group">
  48. <label>既往治疗方案:</label>
  49. <input name="previousTreatmentPlan" placeholder="既往治疗方案" id="previousTreatmentPlan" class="styled-input" type="text">
  50. </div>
  51. <div class="customize-form-group">
  52. <label>目前治疗方案:</label>
  53. <input name="currentTreatmentPlan" placeholder="目前治疗方案" id="currentTreatmentPlan" class="styled-input" type="text">
  54. </div>
  55. <div class="customize-form-group">
  56. <label>生存期(天):</label>
  57. <input name="survivalPeriod" placeholder="生存期(天)" id="survivalPeriod" class="styled-input" type="text">
  58. </div>
  59. <div class="customize-form-group">
  60. <label>药品通用名:</label>
  61. <input name="genericName" placeholder="药品通用名" id="genericName" class="styled-input" type="text">
  62. </div>
  63. <div class="customize-form-group">
  64. <label>患者数:</label>
  65. <input name="patientCount" placeholder="患者数" id="patientCount" class="styled-input" type="text">
  66. </div>
  67. <div class="customize-form-group">
  68. <label>任务数:</label>
  69. <input name="taskCount" placeholder="任务数" id="taskCount" class="styled-input" type="text">
  70. </div>
  71. </div>
  72. </form>
  73. </div>
  74. <th:block th:include="include :: footer" />
  75. <th:block th:include="include :: ztree-js" />
  76. <script type="text/javascript">
  77. function submitHandler() {
  78. if ($.validate.form()) {
  79. add();
  80. }
  81. }
  82. function add() {
  83. var data = $("#form-SDtpSjdcFollowUpStatistics-add").serializeArray();
  84. $.ajax({
  85. cache : true,
  86. type : "POST",
  87. url : ctx + "dtp/sdtpsjdcfollowupstatistics/sDtpSjdcFollowUpStatisticsAdd",
  88. data : data,
  89. async : false,
  90. error : function(request) {
  91. $.modal.alertError("系统错误");
  92. },
  93. success : function(data) {
  94. $.operate.successCallback(data);
  95. }
  96. });
  97. }
  98. </script>
  99. </body>
  100. </html>