?> ><?php echo $unMedicament['MED_NOMCOMMERCIAL'] . " (" . $unMedicament['MED_DEPOTLEGAL'] . ")"; ?> </option><?php } ?> </select> <?php OutilsForm::validProbleme($valid["choixMedicament"], "Le médicament"); ?> </td> <td> <input type="number" min="1" max="500" class="form-control" name="<?php echo OutilsMultidataForm::genererName($multidataParam, "qteOfferte"); ?> " placeholder="Quantité offerte" <?php OutilsForm::value($qteOfferte); ?> > <?php OutilsForm::validProbleme($valid["qteOfferte"], "La quantité offerte"); ?> </td> <td> <a class="btn btn-default" onclick='multidataPop(<?php echo '"' . $multidataParam["id"] . '","' . $multidataParam["place"] . '"'; ?> );'><i class="fa fa-minus-circle fa-fw"></i> Supprimer</a> </td> <!-- fin de la vue : compte-rendu/ajax-saisie-echantillons.multidata.form -->
<option <?php OutilsForm::selectedCompose($choixMotif, $unMotifId); ?> ><?php echo $unMotifInfo; ?> </option><?php } ?> <option <?php OutilsForm::selectedCompose($choixMotif, "autre-saisie"); ?> >Autre, preciser</option> </select> <?php OutilsForm::validProbleme($valid["choixMotif"], "La motif choisi"); ?> </div> <div class="col-sm-6"> <label for="motifAutre">Autre motif</label> <input <?php OutilsForm::disabled(!$motifAutreActive); ?> type="text" class="form-control" name="motifAutre" id="motifAutre" placeholder="Motif..." <?php OutilsForm::value($motifAutre); ?> > <?php OutilsForm::validProblemePourNombreDeCaractere($valid["motifAutre"], "Le motif", strlen($motifAutre), 2, 128); ?> </div>
<select class="form-control" name="question" id="question"> <option <?php OutilsForm::selectedCompose($question, "question"); ?> >Question</option> <option <?php OutilsForm::selectedCompose($question, "remarque"); ?> >Remarque</option> <option <?php OutilsForm::selectedCompose($question, "erreur"); ?> >Erreur/Bug</option> </select> <?php OutilsForm::validProbleme($valid_question, "Question/Remarque/Bug"); ?> </div> <div class="form-group"> <label for="message">Message</label> <textarea rows="8" class="form-control" name="message" id="message" maxlength="512" placeholder="Message"><?php echo $message; ?> </textarea> <?php OutilsForm::validProblemePourNombreDeCaractere($valid_message, "Le message", strlen($message), 3, 512); ?> </div> <?php OutilsForm::implanterFormulaireId("contact"); ?>