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| <form class="form3" method="POST" action="patients.php">
<fieldset>
<div class="cadreDeRef">
<p><input class="stop" type="submit" name="stop" value="" /></p>
<p><input class="enregistrer" type="submit" name="nouveau_patient" value="" /></p>
<p><input class="next" type="submit" name="next" value="" /></p>
<p><input class="previous" type="submit" name="previous" value="" /></p>
</div>
<br /><br /><br /><br /><br /><br /><br /><br />
<p class="trouDeBalle"><label for="nom">Nom</label><input class="fieldInput3" id="nom" type="text" name="nom" value="" /></p>
<br /><br />
<p><label for="prenom">Prenom</label><input class="fieldInput3" id="prenom" type="text" name="prenom" value="" /></p>
<br /><br />
<p><label for="date_de_naissance">Date_de_naissance</label><input class="fieldInput3" id="date_de_naissance" type="text" name="date_de_naissance" value="" /></p>
<br /><br />
<p><label for="adresse">Adresse</label><input class="fieldInput3" id="adresse" type="text" name="adresse" value="" /></p>
<br /><br />
<p><label for="code_postal2">Code_Postal</label>
<select class="fieldInput3" class="code_postalB" id="code_postal2" name="code_postal3" onchange="selectVille()">
<?php
$sql14 = "SELECT Code_Postal, Ville FROM communes";
$stmt14= $pdo->query($sql14);
while($row14 = $stmt14->fetch()) {
echo "<option value=" . $row14["Ville"] . ">" . $row14["Code_Postal"] . "</option>";
}
?>
</select></p>
<br /><br />
<p><label for="ville2">Ville</label>
<select class="fieldInput3" id="ville2" name="ville3" onchange="selectCodePostal()">
<?php
$sql1 = "SELECT Code_Postal, Ville FROM communes";
$stmt1= $pdo->query($sql1);
while($row1 = $stmt1->fetch()) {
echo "<option value=" . $row1["Code_Postal"] . ">" . $row1["Ville"] . "</option>";
}
?>
</select></p>
<br /><br />
<p><label for="sexe">Sexe</label>
<select class="fieldInput3" class="sexeA" id="sexe" name="sexe">
<option>F</option>
<option>M</option>
</select><p>
<br /><br />
<p><label for="nir">NIR</label><input class="fieldInput3" id="nir" type="text" name="NIR" value="" /></p>
<br /><br />
<p><label for="diagnostic">Diagnostic</label>
<select class="fieldInput3" id="diagnostic" name="diagnostic">
<?php
$sql2 = "SELECT * FROM diagnostic";
$stmt2= $pdo->query($sql2);
while($row2 = $stmt2->fetch()) {
echo "<option>" . $row2["Diagnostic"] . "</option>";
}
?>
</select></p>
<br /><br />
<p><label for="medecin">Medecin</label>
<select class="fieldInput3" id="medecin" name="medecin">
<?php
$sql3 = "SELECT * FROM ps";
$stmt3= $pdo->query($sql3);
while($row3 = $stmt3->fetch()) {
echo "<option value=" . $row1["Code_Postal"] . ">" . $row3["Nom"] . " " . $row3["Prenom"] . "</option>";
}
?>
</select></p>
<br /><br />
</fieldset>
</form> |
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