<fieldset>
<legend><?php
echo $tableHeader;
?>
</legend>
<div class="form-group">
<label class="col-lg-3 control-label">Канал госпитализации</label>
<div class="col-lg-9">
<div class="radio">
<label><input type="radio" name="channel" value="0" <?php
echo Helpers::checked(@$result['data']['form']['channel'], '0');
?>
/>План</label><br/>
<label><input type="radio" name="channel" value="1" <?php
echo Helpers::checked(@$result['data']['form']['channel'], '1');
?>
/>СМП</label>
</div>
</div>
</div>
<div class="form-group">
<label for="inputNumber" class="col-lg-3 control-label">Номер</label>
<div class="col-lg-9">
<input kl_virtual_keyboard_secure_input="on" class="form-control" id="inputNumber" placeholder="Номер" type="text" name="number" value="<?php
echo @$result['data'][$targetData]['number'];
?>
" />
</div>
</div>
?>
></td>
<td><input type="radio" class="noForm" name="reportDetails" value="23" rrrrequired="required" <?php
echo Helpers::checked(@$result['data']['form']['reportDetails'], '23');
?>
></td>
<td><input type="radio" class="noForm" name="reportDetails" value="33" rrrrequired="required" <?php
echo Helpers::checked(@$result['data']['form']['reportDetails'], '33');
?>
></td>
<td><input type="radio" class="noForm" name="reportDetails" value="43" rrrrequired="required" <?php
echo Helpers::checked(@$result['data']['form']['reportDetails'], '43');
?>
></td>
<td><input type="radio" class="noForm" name="reportDetails" value="53" rrrrequired="required" <?php
echo Helpers::checked(@$result['data']['form']['reportDetails'], '53');
?>
></td>
</tr>
</tbody>
</table>
</td>
</tr>
-->
<div class="form-group">
<div class="col-lg-10 col-lg-offset-2">
<input type="hidden" name="action" value="1">
<button type="submit" class="btn btn-primary">Сохранить</button>
</div>
</div>
</fieldset>
?>
/>1 квартал</label><br/>
<label><input type="radio" name="period" required="required" class="noForm" value="2" <?php
echo Helpers::checked(filter_input(INPUT_GET, 'period'), '2');
?>
/>2 квартал</label><br/>
<label><input type="radio" name="period" required="required" class="noForm" value="3" <?php
echo Helpers::checked(filter_input(INPUT_GET, 'period'), '3');
?>
/>3 квартал</label><br/>
<label><input type="radio" name="period" required="required" class="noForm" value="4" <?php
echo Helpers::checked(filter_input(INPUT_GET, 'period'), '4');
?>
/>4 квартал</label><br/>
<label><input type="radio" name="period" required="required" class="noForm" value="5" <?php
echo Helpers::checked(filter_input(INPUT_GET, 'period'), '5');
?>
/>год</label>
</td>
</tr>
<tr>
<td></td>
<td>
<br/>
<input type="hidden" name="integrityForm" value="1"/>
<input type="submit" value="Проверить"/>
</td>
</tr>
</tbody>
</table>
</form>
