?? rkxzl_add.jsp
字號:
</tr>
<tr align="center" valign="middle">
<td height="20" class="TableColUp">
<div align="right">身高</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="SG" size=10/>cm
</div>
</td>
<td height="20" class="TableColUp">
<div align="right">體重</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="TZ" size=10/>kg
</div>
</td>
<td height="20" class="TableColUp"><div align="right">血型</div></td>
<td height="20">
<div align="left"><select name="XX">
<by:forby id="XX" name="DICT_XX">
<option value="${XX.NAME}">${XX.NAME }</option>
</by:forby>
</select></div>
</td>
</tr>
<tr align="center" valign="middle">
<td height="20" class="TableColUp"><div align="right">婚姻狀況</div></td>
<td height="20">
<div align="left"><select name="HYZK">
<by:forby id="HYZK" name="DICT_HYZK">
<option value="${HYZK.NAME}">${HYZK.NAME}</option>
</by:forby>
</select></div>
</td>
</tr>
<tr align="center" valign="middle">
<td height="20" class="TableColUp"><div align="right">文化程度</div></td>
<td height="20">
<div align="left"><select name="WHCD">
<by:forby id="WHCD" name="DICT_WHCD">
<option value="${WHCD.NAME}">${WHCD.NAME}</option>
</by:forby>
</select></div>
</td>
<td height="20" class="TableColUp"><div align="right">職業狀況</div></td>
<td height="20">
<div align="left"><select name="ZY">
<by:forby id="ZY" name="DICT_ZY">
<option value="${ZY.NAME}">${ZY.NAME }</option>
</by:forby>
</select></div>
</td>
</tr>
<tr align="center" valign="middle">
<td height="20" class="TableColUp">
<div align="right">與戶主關系</div>
</td>
<td height="20">
<div align="left"><select name="YHZGX" onblur="pressYHZGX()">
<by:forby id="YHZGX" name="DICT_YHZGX">
<option value="${YHZGX.NAME}">${YHZGX.NAME }</option>
</by:forby>
</select></div>
</td>
<td height="20" class="TableColUp">
<div align="right">工作單位</div>
</td>
<td height="20" colspan="3">
<div align="left">
<input type="text" name="GZDW" size="50"/><font color="red"><strong>*</strong></font>
</div>
</td>
</tr>
<tr align="center" valign="middle">
<td height="20" class="TableColUp">
<div align="right">聯系電話</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="LXDH"/>
</div>
</td>
</tr>
<tr align="center" valign="middle">
<td height="20" class="TableColUp">
<div align="right">其他聯系方式</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="QTLXFS" size="16"/>
</div>
</td>
<td height="20" class="TableColUp">
<div align="right">醫保合同號</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="YBHTH" size="16"/>
</div>
</td>
</tr>
<tr align="center" valign="middle">
<td height="20" class="TableColUp">
<div align="right">社會保險號</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="SHBXH"/>
</div>
</td>
<td height="20" class="TableColUp" nowrap>
<div align="right">醫藥費用承擔</div>
</td>
<td height="20">
<div align="left">
<select name="YLFZFFS">
<by:forby id="YLFZFFS" name="DICT_YLFZFFS">
<option value="${YLFZFFS.NAME}">${YLFZFFS.NAME}</option>
</by:forby>
</select>
</div>
</td>
<td></td>
</tr>
<tr align="center" valign="middle">
<td height="20" class="TableColUp">
<div align="right">出潮年齡</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="CCNL" size="5"/>歲
</div>
</td>
<td height="20" class="TableColUp">
<div align="right">月經周期</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="YJZQ" size=5/>天
</div>
</td>
<td height="20" class="TableColUp">
<div align="right">末次月經</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="MCYJ" size=5 />歲
</div>
</td>
</tr>
<tr align="center" valign="middle">
<td height="20" class="TableColUp">
<div align="right">胎次</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="TC" size=5/>次
</div>
</td>
<td height="20" class="TableColUp">
<div align="right">產次</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="CC" size=5/>次
</div>
</td>
<td height="20">
</td>
<td height="20">
<div align="left">
</div>
</td>
</tr>
<tr align="center" valign="middle">
<td height="20" align="right" class="TableColUp">
既往病史
</td>
<td height="20" colspan=5>
<div align="left">
<textarea cols="60" rows="5" name="JWBS"/> </textarea>
</div>
</td>
</tr>
<tr align="center" valign="middle">
<td height="20" class="TableColUp">
<div align="right">是否遷出</div>
</td>
<td><div align="left">
<select name="SFQC" onChange="QC();">
<option value="0">否</option>
<option value="1">是</option>
</select>
</div></td>
<td height="20" class="TableColUp">
<div align="right">遷出日期</div>
</td>
<td height="20">
<div align="left">
<input type="text" name="QCRQ" size="10" onClick="show_cele_date(this,'','',this,'dcDate');">
</div>
</td>
<td height="20" class="TableColUp">
<div align="right">是否死亡</div>
</td>
<td><div align="left">
<select name="SFSW" onChange="SW();">
<option value="0">否</option>
<option value="1">是</option>
</select>
</div></td>
</tr>
<tr align="center" valign="middle">
<td class="TableColUp">
<div align="right">死亡日期</div>
</td>
<td>
<div align="left">
<input type="text" name="SWRQ" size="16" onClick="show_cele_date(this,'','',this,'dcDate');">
</div>
</td>
<td class="TableColUp">
<div align="right">調查人員</div>
</td>
<td>
<div align="left">
<select name="DCRY">
<by:forby id="EMP" name="emp_list">
<option value="${EMP.NAME}"}>${EMP.NAME}</option>
</by:forby>
</select>
</div>
</td>
<td class="TableColUp">
<div align="right">調查日期</div>
</td>
<td>
<div align="left">
<input type="text" name="DCRQ" size="16" onClick="show_cele_date(this,'','',this,'dcDate');"><font color="red"><strong>*</strong></font>
</div>
</td>
</tr>
<tr>
<td colspan="6"><div> </div></td>
</tr>
<tr>
<td colspan="6">
<div align="center">
<input type="submit" name="submit" value="保 存" class="button">
<input type="button" name="button" value="返 回" class="button" onClick="location.href='<%=path%>/Selevet.do?action=RKXZL_LIST'">
</div>
</td>
</tr>
</table>
</form>
</body>
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