<!-- vue : connexion -->
<div class="row">
<div class="col-md-6 col-md-offset-3">
<div class="login-panel panel panel-default">
<div class="panel-heading"> <h3 class="panel-title"><i class="fa fa-sign-in fa-fw"></i> Connexion</h3> </div>
<div class="panel-body">
<form role="form" method="post" target="">
<fieldset>
<div class="form-group"><input class="form-control" placeholder="Login" name="login" type="text" autofocus <?php
OutilsForm::value($login);
?>
></div>
<div class="form-group"><input class="form-control" placeholder="Mot de passe" name="password" type="password" <?php
OutilsForm::value($password);
?>
></div>
<?php
if (!is_null($info_connexion)) {
?>
<p class="text-center text-danger"><?php
echo $info_connexion;
?>
</p>
<?php
}
?>
<div class="checkbox"><label><input name="remember" type="checkbox" value="1" <?php
OutilsForm::checked($remember);
?>
>Se souvenir de moi</label></div>
?>
><?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, "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>
</div>
<div class="form-group">
<div class="col-sm-12">
<label for="bilan">Bilan</label>
<textarea rows="8" class="form-control" name="bilan" id="bilan" maxlength="512" placeholder="Bilan"><?php
echo $bilan;
?>
</textarea>
<?php
<label for="email">Adresse e-mail</label>
<input <?php
OutilsForm::disabled($email_locked);
?>
type="text" class="form-control" name="email" id="email" placeholder="Adresse e-mail" <?php
OutilsForm::value($email);
?>
>
<?php
OutilsForm::validProbleme($valid_email, "L'adresse e-mail");
?>
</div>
<div class="form-group">
<label for="subject">Sujet</label>
<input type="text" class="form-control" name="subject" id="subject" placeholder="Sujet" <?php
OutilsForm::value($subject);
?>
>
<?php
OutilsForm::validProbleme($valid_subject, "Le sujet");
?>
</div>
<div class="form-group">
<label for="captcha">Captcha</label>
<div class="form-inline">
<div class="form-group">
<span><img id="captcha-img" src="images/captcha.php" alt="Code de vérification"> </span>
<span><button type="button" class="fa fa-refresh form-control min-button" id="refresh-captcha" onclick="document.getElementById("captcha-img").src="images/captcha.php?r="+new Date().getMilliseconds();"></button></span>
</div>
<div class="form-group">