| xqd
@@ -29,14 +29,29 @@
|
|
|
height: auto;
|
|
|
}
|
|
|
img{
|
|
|
- width: 60px;
|
|
|
- height: 60px;
|
|
|
+ width: 50px;
|
|
|
+ height: 50px;
|
|
|
margin-top: 3px;
|
|
|
- margin-left: 20px;
|
|
|
+ margin-left: 10px;
|
|
|
}
|
|
|
h3{
|
|
|
text-align: center;
|
|
|
}
|
|
|
+ .all .main{
|
|
|
+ flex-wrap: wrap;
|
|
|
+ display: flex;
|
|
|
+ }
|
|
|
+ .all .input{
|
|
|
+ /*width: 40%;*/
|
|
|
+ margin:4px 6%;
|
|
|
+ }
|
|
|
+ .all .input-group{
|
|
|
+ margin:4px 6%;
|
|
|
+ }
|
|
|
+ .all .danxuan{
|
|
|
+ width: 66.66%;
|
|
|
+ margin: 4px 16.66%;
|
|
|
+ }
|
|
|
</style>
|
|
|
</head>
|
|
|
<body>
|
| xqd
@@ -90,71 +105,73 @@
|
|
|
}
|
|
|
</script>
|
|
|
<div class="all">
|
|
|
- <div class="col-xs-0 col-lg-2"></div>
|
|
|
- <div class="col-xs-12 col-lg-8" style="margin: 0 auto;border:1px solid #999;margin-top: 10px;">
|
|
|
- <div class="imgbox" style="width:100%;display: flex;height: auto;">
|
|
|
- <img src="{{cdn_asset('/assets/img/logo2.png')}}">
|
|
|
- <h3 style="width: 70%;">健康体检服务知情同意书</h3>
|
|
|
- </div>
|
|
|
-
|
|
|
- <!-- <form class="bs-example bs-example-form" role="form"> -->
|
|
|
- <div class="input-group">
|
|
|
- <span class="input-group-addon">姓名:</span>
|
|
|
- <input type="text" class="form-control" name="jname" placeholder="请输入姓名">
|
|
|
- </div>
|
|
|
- <div class="input-group">
|
|
|
- <span class="input-group-addon">籍贯:</span>
|
|
|
- <input type="text" class="form-control" name="jiguan" placeholder="请输入籍贯">
|
|
|
- </div>
|
|
|
- <div class="input-group">
|
|
|
- <span class="input-group-addon">民族:</span>
|
|
|
- <input type="text" class="form-control" name="nation" placeholder="请输入民族">
|
|
|
- </div>
|
|
|
- <div class="input-group">
|
|
|
- <span class="input-group-addon">年龄:</span>
|
|
|
- <input type="text" class="form-control" name="old" placeholder="请输入年龄">
|
|
|
- </div>
|
|
|
- <div class="input-group">
|
|
|
- <span class="input-group-addon">职业:</span>
|
|
|
- <input type="text" class="form-control" name="zhiye" placeholder="请输入职业">
|
|
|
- </div>
|
|
|
- <div class="input-group">
|
|
|
- <span class="input-group-addon">住址:</span>
|
|
|
- <input type="text" class="form-control" name="address" placeholder="请输入住址">
|
|
|
- </div>
|
|
|
- <div class="input-group">
|
|
|
- <span class="input-group-addon">邮箱地址:</span>
|
|
|
- <input type="text" class="form-control" name="phone" placeholder="请输入邮箱">
|
|
|
- </div>
|
|
|
- <div class="input-group" style="display: flex;">
|
|
|
- <span style="width: 20%;" class="input-group-addon">手机号</span>
|
|
|
- <input style="width: 50%;" type="text" class="form-control" placeholder="请输入手机号">
|
|
|
- <button class="btn btn-default">获取验证码</button>
|
|
|
- </div>
|
|
|
- <label for="name">性别:</label>
|
|
|
- <div>
|
|
|
- <label class="checkbox-inline">
|
|
|
- <input name="sex" type="radio" value="nan">男
|
|
|
- </label>
|
|
|
- <label class="checkbox-inline">
|
|
|
- <input name="sex" type="radio" value="nv">女
|
|
|
- </label>
|
|
|
- </div>
|
|
|
- <label for="name">样本类型:</label>
|
|
|
- <div class="checkbox">
|
|
|
- <label><input type="radio" value="l1" name="gender">EDTA抗凝静脉血</label>
|
|
|
- </div>
|
|
|
- <div class="checkbox">
|
|
|
- <label><input type="radio" value="l2" name="gender">口腔拭子</label>
|
|
|
- </div>
|
|
|
- <div class="checkbox">
|
|
|
- <label><input type="radio" value="l3" name="gender">宫颈刷</label>
|
|
|
+ <div class="col-xs-0 col-lg-2"></div>
|
|
|
+ <div class="col-xs-12 col-lg-8 main" style="margin: 0 auto;margin-top: 10px;">
|
|
|
+ <div class="imgbox" style="width:90%;margin: 4px 5%;margin-bottom:20px;display: flex;height: auto;">
|
|
|
+ <img src="{{cdn_asset('/assets/img/logo.jpg')}}">
|
|
|
+ <h3 style="width: 70%;">健康体检服务知情同意书</h3>
|
|
|
+ </div>
|
|
|
+
|
|
|
+ <form class="bs-example bs-example-form" role="form">
|
|
|
+ <div class="col-xs-12 col-lg-4 input-group input">
|
|
|
+ <span class="input-group-addon">姓名:</span>
|
|
|
+ <input type="text" class="form-control" name="jname" placeholder="请输入姓名">
|
|
|
+ </div>
|
|
|
+ <div class="col-xs-12 col-lg-4 input-group input">
|
|
|
+ <span class="input-group-addon">籍贯:</span>
|
|
|
+ <input type="text" class="form-control" name="jiguan" placeholder="请输入籍贯">
|
|
|
+ </div>
|
|
|
+ <div class="col-xs-12 col-lg-4 input-group input">
|
|
|
+ <span class="input-group-addon">民族:</span>
|
|
|
+ <input type="text" class="form-control" name="nation" placeholder="请输入民族">
|
|
|
+ </div>
|
|
|
+ <div class="col-xs-12 col-lg-4 input-group input">
|
|
|
+ <span class="input-group-addon">年龄:</span>
|
|
|
+ <input type="text" class="form-control" name="old" placeholder="请输入年龄">
|
|
|
+ </div>
|
|
|
+ <div class="col-xs-12 col-lg-4 input-group input">
|
|
|
+ <span class="input-group-addon">职业:</span>
|
|
|
+ <input type="text" class="form-control" name="zhiye" placeholder="请输入职业">
|
|
|
+ </div>
|
|
|
+ <div class="col-xs-12 col-lg-4 input-group input">
|
|
|
+ <span class="input-group-addon">邮箱地址:</span>
|
|
|
+ <input type="text" class="form-control" name="phone" placeholder="请输入邮箱">
|
|
|
+ </div>
|
|
|
+ <div class="col-xs-12 col-lg-6 input-group">
|
|
|
+ <span class="input-group-addon">住址:</span>
|
|
|
+ <input type="text" class="form-control" name="address" placeholder="请输入住址">
|
|
|
+ </div>
|
|
|
+ <div class="col-xs-12 col-lg-6 input-group" style="display: flex;">
|
|
|
+ <span style="width: 20%;line-height: 20px;font-size: 10px;" class="input-group-addon">手机号</span>
|
|
|
+ <input style="width: 44%;" type="text" class="form-control" placeholder="请输入手机号">
|
|
|
+ <input style="width:36%;font-size: 10px;" class="btn btn-default" id="fasong" value="获取验证码" onclick="yanzhengma()"/>
|
|
|
+ </div>
|
|
|
+ <div class="danxuan">
|
|
|
+ <label for="name">性别:</label>
|
|
|
+ <div>
|
|
|
+ <label class="checkbox-inline">
|
|
|
+ <input name="sex" type="radio" value="nan">男
|
|
|
+ </label>
|
|
|
+ <label class="checkbox-inline">
|
|
|
+ <input name="sex" type="radio" value="nv">女
|
|
|
+ </label>
|
|
|
+ </div>
|
|
|
+ <label for="name">样本类型:</label>
|
|
|
+ <div class="checkbox">
|
|
|
+ <label><input type="radio" value="l1" name="gender">EDTA抗凝静脉血</label>
|
|
|
+ </div>
|
|
|
+ <div class="checkbox">
|
|
|
+ <label><input type="radio" value="l2" name="gender">口腔拭子</label>
|
|
|
+ </div>
|
|
|
+ <div class="checkbox">
|
|
|
+ <label><input type="radio" value="l3" name="gender">宫颈刷</label>
|
|
|
+ </div>
|
|
|
+ <button style="margin-left: 45%;margin-bottom: 20px;" type="submit" class="btn btn-default">提交</button>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ </form>
|
|
|
</div>
|
|
|
- <button style="margin-left: 45%;margin-bottom: 20px;" class="btn btn-default" onclick="javascript:window.location.href='tijian.html'">提交</button>
|
|
|
</div>
|
|
|
- <!-- </form> -->
|
|
|
-</div>
|
|
|
-</div>
|
|
|
<!-- jQuery (Bootstrap 的 JavaScript 插件需要引入 jQuery) -->
|
|
|
<script src="{{cdn_asset('/assets/js/jquery-3.2.1.js')}}"></script>
|
|
|
<script src="{{cdn_asset('/assets/js/bootstrap.min.js')}}"></script>
|