<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>