<?php 
echo '<font size=1 color="#000099" face="verdana,arial">' . $batch_nr . '</font>&nbsp;<br>';
echo "<img src='" . $root_path . "classes/barcode/image.php?code={$batch_nr}&style=68&type=I25&width=145&height=40&xres=2&font=5' border=0>";
?>
      </td>
		<td class=fva2_ml10><div   class=fva2_ml10><font size=3 color="#0000ff"><b><?php 
echo $LDRequestOf . $formtitle;
?>
</b></font>
		<br>
		<?php 
echo $LDWithMatchTest . " " . $LDByBloodBank;
echo '<br>' . $LDYes . '&nbsp;';
printRadioButton('match_sample', 1);
echo '&nbsp;' . $LDNo . '&nbsp;';
printRadioButton('match_sample', 0);
?>
	  </td>
    </tr>
  
		
		<tr  valign="top" bgcolor="<?php 
echo $bgc1;
?>
" >
        <td valign="bottom" align="right">
		
		<!-- Block for bloodgroup, Rh-factor, Kell  -->
		<table border=0 cellspacing=0 cellpadding=2 bgcolor="#000000" width=100%>
        <tr>
          <td>
echo $bgc1;
?>
" valign="top">	    
	<td align="right" ><font size=1 color="#cc0000" face="verdana,arial">
	<?php 
echo $LDImmuneSupp;
?>
</td>	
	<td colspan=2><?php 
printRadioButton('immune_supp', 1);
?>
 <?php 
echo $LDYes;
?>
	<?php 
printRadioButton('immune_supp', 0);
?>
 <?php 
echo $LDNo;
?>
<br>
    </td>
	</tr>	
		
	  <tr bgcolor="#fff3f3" valign="top">
    <td colspan=3><font size=2 color="#ee6666" face="verdana,arial"><b><?php 
echo $LDFillLabOnly;
?>
</b></td>
  </tr>
	
      <td align="right"><div class=fva2_ml10><?php 
echo $LDPregnantPossible;
?>
 &nbsp;<?php 
echo $LDYes;
?>
</td>
      <td><font size=2 face="verdana,arial">&nbsp;<?php 
printRadioButton('if_pregnant', 1);
?>
&nbsp;<?php 
echo $LDNo;
?>

	  &nbsp;<?php 
printRadioButton('if_pregnant', 0);
?>

	  </td>
    </tr>
  </table>
  &nbsp;<br>
		
  </td>
</tr>
		 
	<tr bgcolor="<?php 
echo $bgc1;
?>
">
		<td colspan=2><div class=fva2_ml10><?php 
Esempio n. 4
0
?>
" method="post">
                <?php 
printInput("number", "patient_insee", "Numéro INSEE", true);
?>
                <?php 
printInput("text", "patient_firstName", "Prénom du patient", true);
?>
                <?php 
printInput("text", "patient_lastName", "Nom du patient", true);
?>
                <?php 
printInput("date", "patient_dateOfBirth", "Date de naissance", true);
?>
                <?php 
printRadioButton("patient_sex", "Sexe", array("F" => "Femme", "M" => "Homme", "O" => "Autre"), true);
?>
                <?php 
printInput("number", "patient_size", "Taille (cm)", true);
?>
                <?php 
printInput("number", "patient_weight", "Poids (kg)", true);
?>
                <?php 
printCountryDropDownList("patient_countryOfResidence", "Pays de résidence", true);
?>
                <?php 
printNextButton();
?>
            </form>
        </div>