| xqd
@@ -103,42 +103,42 @@
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<form class="bs-example bs-example-form main" role="form">
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<div class="col-xs-12 col-lg-4 input-group input">
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<span class="input-group-addon">姓名:</span>
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- <input type="text" class="form-control" name="jname" placeholder="请输入姓名">
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+ <input type="text" class="form-control" name="name" placeholder="请输入姓名" required>
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</div>
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<div class="col-xs-12 col-lg-4 input-group input">
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<span class="input-group-addon">籍贯:</span>
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- <input type="text" class="form-control" name="jiguan" placeholder="请输入籍贯">
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+ <input type="text" class="form-control" name="native_place" placeholder="请输入籍贯" required>
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</div>
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<div class="col-xs-12 col-lg-4 input-group input">
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<span class="input-group-addon">民族:</span>
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- <input type="text" class="form-control" name="nation" placeholder="请输入民族">
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+ <input type="text" class="form-control" name="nationality" placeholder="请输入民族" required>
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</div>
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<div class="col-xs-12 col-lg-4 input-group input">
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<span class="input-group-addon">年龄:</span>
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- <input type="text" class="form-control" name="old" placeholder="请输入年龄">
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+ <input type="text" class="form-control" name="age" placeholder="请输入年龄" required>
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</div>
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<div class="col-xs-12 col-lg-4 input-group input">
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<span class="input-group-addon">职业:</span>
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- <input type="text" class="form-control" name="zhiye" placeholder="请输入职业">
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+ <input type="text" class="form-control" name="work" placeholder="请输入职业" required>
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</div>
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<div class="col-xs-12 col-lg-4 input-group input">
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<span class="input-group-addon">邮箱地址:</span>
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- <input type="text" class="form-control" name="phone" placeholder="请输入邮箱">
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+ <input type="text" class="form-control" name="email" placeholder="请输入邮箱" required>
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</div>
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<div class="col-xs-12 col-lg-6 input-group">
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<span class="input-group-addon">住址:</span>
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- <input type="text" class="form-control" name="address" placeholder="请输入住址">
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+ <input type="text" class="form-control" name="address" placeholder="请输入住址" required>
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</div>
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<div class="col-xs-12 col-lg-6 input-group" style="display: flex;">
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<span style="width: 20%;line-height: 20px;font-size: 10px;" class="input-group-addon">手机号</span>
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- <input style="width: 44%;" type="text" class="form-control" placeholder="请输入手机号">
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- <input style="width:36%;font-size: 10px;" class="btn btn-default" id="fasong" value="获取验证码" onclick="yanzhengma()"/>
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+ <input style="width: 44%;" type="text" name="mobile" class="form-control" placeholder="请输入手机号" required>
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+ <input style="width:36%;font-size: 10px;" class="btn btn-default" id="fasong" name="verify" value="获取验证码" onclick="yanzhengma()"/>
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</div>
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<div class="danxuan">
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<label for="name">性别:</label>
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<div>
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<label class="checkbox-inline">
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- <input name="sex" type="radio" value="nan">男
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+ <input name="sex" type="radio" value="nan" checked>男
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</label>
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<label class="checkbox-inline">
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<input name="sex" type="radio" value="nv">女
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| xqd
@@ -146,13 +146,13 @@
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</div>
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<label for="name">样本类型:</label>
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<div class="checkbox">
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- <label><input type="radio" value="l1" name="gender">EDTA抗凝静脉血</label>
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+ <label><input type="radio" value="l1" name="sample_type" checked>EDTA抗凝静脉血</label>
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</div>
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<div class="checkbox">
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- <label><input type="radio" value="l2" name="gender">口腔拭子</label>
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+ <label><input type="radio" value="l2" name="sample_type">口腔拭子</label>
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</div>
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<div class="checkbox">
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- <label><input type="radio" value="l3" name="gender">宫颈刷</label>
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+ <label><input type="radio" value="l3" name="sample_type">宫颈刷</label>
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</div>
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<button style="margin-left: 45%;margin-bottom: 20px;" type="submit" class="btn btn-default">提交</button>
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</div>
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