?>
><?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");
?>
