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37 lines
1.3 KiB
Plaintext
37 lines
1.3 KiB
Plaintext
<form bindsubmit="submitForm">
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<view class="cu-form-group margin-top">
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<view class="title">申请类型</view>
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<picker bindchange="PickerChange" value="{{index}}" range="{{picker}}" name="type">
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<view class="picker">
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{{index?picker[index]:'请选择'}}
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</view>
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</picker>
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</view>
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<view class="cu-form-group margin-top">
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<view class="title">病案号</view>
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<input placeholder="请输入病案号" name="mrNumber"></input>
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</view>
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<view class="cu-form-group">
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<view class="title">患者姓名</view>
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<input placeholder="请输入患者姓名" name="patientName"></input>
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</view>
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<view class="cu-form-group">
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<view class="title">就诊次数</view>
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<input type="number" placeholder="请输入患者就诊次数" name="times"></input>
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</view>
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<view class="cu-form-group">
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<view class="title">出院日期</view>
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<picker mode="date" value="{{date}}" bindchange="DateChange" name="dischargeDate">
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<view class="picker">
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{{date}}
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</view>
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</picker>
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</view>
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<view class="cu-form-group" wx:if="{{index==0}}">
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<view class="title">收货地址</view>
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<input placeholder="请输入收货地址" name="address" value="{{address}}"></input>
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</view>
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<button class="cu-btn round shadow-blur button-hover block bg-blue margin-tb-lg lg" form-type="submit">提交</button>
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</form>
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