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<?
include "start.php";
?>
<!DOCTYPE html>
<head>
<style>
#contactform {width:100%;font-family:'Tahoma';}
#contactform input, select {font-family:'Tahoma';}
.form {margin-left:auto;margin-right:auto;width:80%;text-align:center;}
.row {height:40px;}
.input-style {height:20px;width:400px;padding:5px;}
.select-style {height:32px;width:412px;padding:6px 2px;}
.submit {background: none repeat scroll 0 0 #3a3a3a;
color: white;
height: 52px;
padding: 10px 200px;
text-decoration: none;
width: 500px;}
.result {color:green;font-size:20px;}
</style>
</head>
<body>
<form method="post" action="" name="contactform" id="contactform">
<div class="form">
<div class="row"><h1>Formulaire de création de Médecin</h1></div>
<br><br>
<div class="row">
<select name="sexe" id="sexe" class="select-style">
<option value="Homme" selected="selected">Homme</option>
<option value="Femme">Femme</option>
</select>
</div>
<div class="row">
<select name="civilite" id="civilite" class="select-style">
<option value="Docteur" selected="selected">Docteur</option>
<option value="Professeur">Professeur</option>
<option value="Monsieur">Monsieur</option>
<option value="Madame">Madame</option>
</select>
</div>
<div class="row">
<input name="nom_fr" type="text" id="nom_fr" class="input-style" placeholder="Nom Français" />
</div>
<div class="row">
<input name="nom_he" type="text" id="nom_he" class="input-style" placeholder="Nom Hébreu" />
</div>
<div class="row">
<input name="prenom_fr" type="text" id="prenom_fr" class="input-style" placeholder="Prénom Français" />
</div>
<div class="row">
<input name="prenom_he" type="text" id="prenom_he" class="input-style" placeholder="Prénom Hébreu" />
</div>
<div class="row">
<select name="fk_specialite" id="fk_specialite" class="select-style">
<?
$res = mysql_query("SELECT * FROM doc_specialites ORDER BY id ASC");
while($val=mysql_fetch_array($res))
{?>
<option value="<?=$val['id']?>">
<?=$val['libelle']?>
</option>
<? }?>
</select>
</div>
<div class="row">
<input name="adresse" type="text" id="adresse" class="input-style" placeholder="Adresse" />
</div>
<div class="row">
<input name="cp" type="text" id="cp" class="input-style" placeholder="Code Postal" />
</div>
<div class="row">
<input name="ville" type="text" id="ville" class="input-style" placeholder="Ville" />
</div>
<div class="row">
<input name="region" type="text" id="region" class="input-style" placeholder="Région" />
</div>
<div class="row">
<input name="centre_medical" type="text" id="centre_medical" class="input-style" placeholder="Centre Médical" />
</div>
<div class="row">
<input name="waze" type="text" id="waze" class="input-style" placeholder="Waze" />
</div>
<div class="row">
<input name="tel_perso" type="text" id="tel_perso" class="input-style" placeholder="Tel Perso" />
</div>
<div class="row">
<input name="tel_fax" type="text" id="tel_fax" class="input-style" placeholder="Tel Fax" />
</div>
<div class="row">
<input name="tel_mobile" type="text" id="tel_mobile" class="input-style" placeholder="Tel Mobile" />
</div>
<div class="row">
<input name="tel_rdv" type="text" id="tel_rdv" class="input-style" placeholder="Tel RDV" />
</div>
<div class="row">
<input name="site_internet" type="text" id="site_internet" class="input-style" placeholder="Site Internet" />
</div>
<div class="row" style="height:100px;padding-top:20px;">
<div>Consultations :</div>
<?
$res = mysql_query("SELECT * FROM doc_consultations ORDER BY id ASC");
while($val=mysql_fetch_array($res))
{?><input type="checkbox" name="fk_consultation" value="<?=$val['id']?>"/><?=$val['libelle']?><? }?>
</div>
<div class="row" style="min-height: 140px;height:auto;">
<div>Horaires :</div>
<div id="jours">
<input type="checkbox" name="dimanche" id="dimanche" value= "dimanche" class="check"/> Dimanche
<div style="display:inline;">
<input type="text" name="dimanchematin" id="dimanchematin" placeholder="Matin" style="margin-left:10px"/><input type="text" name="dimanchemidi" id="dimanchemidi" placeholder= "Apres Midi" /><input type="text" name="dimanchesoir" id="dimanchesoir" placeholder= "Soir" /><br>
</div>
<input type="checkbox" name="lundi" id="lundi" value= "lundi" class="check"/> Lundi
<div style="display:inline;">
<input type="text" name="lundimatin" id="lundimatin" placeholder="Matin" style="margin-left:41px"/><input type="text" name="lundimidi" id="lundimidi" placeholder= "Apres Midi" /><input type="text" name="lundisoir" id="lundisoir" placeholder= "Soir" /><br>
</div>
<input type="checkbox" name="mardi" id="mardi" value= "mardi" class="check"/> Mardi
<div style="display:inline;">
<input type="text" name="mardimatin" id="mardimatin" placeholder="Matin" style="margin-left:41px"/><input type="text" name="mardimidi" id="mardimidi" placeholder= "Apres Midi" /><input type="text" name="mardisoir" id="mardisoir" placeholder= "Soir" /><br>
</div>
<input type="checkbox" name="mercredi" id="mercredi" value= "mercredi" class="check"/> Mercredi
<div style="display:inline;">
<input type="text" name="mercredimatin" id="mercredimatin" placeholder="Matin" style="margin-left:19px"/><input type="text" name="mercredimidi" id="mercredimidi" placeholder= "Apres Midi" /><input type="text" name="mercredisoir" id="mercredisoir" placeholder= "Soir" /><br>
</div>
<input type="checkbox" name="jeudi" id="jeudi" value= "jeudi" class="check"/> Jeudi
<div style="display:inline;">
<input type="text" name="jeudimatin" id="jeudimatin" placeholder="Matin" style="margin-left:43px"/><input type="text" name="jeudimidi" id="jeudimidi" placeholder= "Apres Midi" /><input type="text" name="jeudisoir" id="jeudisoir" placeholder= "Soir" /><br>
</div>
<input type="checkbox" name="vendredi" id="vendredi" value= "vendredi" class="check"/> Vendredi
<div style="display:inline;">
<input type="text" name="vendredimatin" id="vendredimatin" placeholder="Matin" style="margin-left:18px"/><input type="text" name="vendredimidi" id="vendredimidi" placeholder= "Apres Midi" /><input type="text" name="vendredisoir" id="vendredisoir" placeholder= "Soir" />
</div>
</div>
</div>
<div class="row" style="height:70px;padding-top:20px;">
<div>Niveau d'Hebreu :</div>
<select name="fk_niv_fr" id="fk_niv_fr" class="select-style">
<?
$res = mysql_query("SELECT * FROM doc_niveau_fr ORDER BY id ASC");
while($val=mysql_fetch_array($res))
{?>
<option value="<?=$val['id']?>">
<?=$val['libelle']?>
</option>
<? }?>
</select>
</div>
<div class="row" style="width: 600px; margin-right: auto; margin-left: auto; height: 400px;">
<div> C V :</div>
<br>
<textarea class="ckeditor" name="editor1" id="editor1" rows="3"></textarea>
</div>
<div class="row">
<div id="refresh" class="result" style="display:none;"> Création en cours...</div>
<div id="result" class="result" style="display:none;"></div>
<Br><a href="javascript:;" class="submit" id="submit"> Enregistrer</a>
<br><br>
</div>
</div>
</form>
<script src="js/jquery-1.11.0.js"></script>
<script type="text/javascript" src="js/ckeditor/ckeditor.js"></script>
<script type="text/javascript">
$(document).ready(function() {
var editor = CKEDITOR.replace('editor1');
$('#submit').click(function() {
var nom_fr = document.getElementById('nom_fr').value;
var nom_he = document.getElementById('nom_he').value;
var prenom_fr = document.getElementById('prenom_fr').value;
var prenom_he = document.getElementById('prenom_he').value;
var fk_specialite = document.getElementById('fk_specialite').value;
var adresse = document.getElementById('adresse').value;
var cp = document.getElementById('cp').value;
var ville = document.getElementById('ville').value;
var region = document.getElementById('region').value;
var centre_medical = document.getElementById('centre_medical').value;
var waze = document.getElementById('waze').value;
if( $('#dimanche').is(':checked') ){
var dimanche = '';
dimanche += $('#dimanchematin').val() + " | ";
dimanche += $('#dimanchemidi').val() + " | ";
dimanche += $('#dimanchesoir').val();
}
if( $('#lundi').is(':checked') ){
var lundi = '';
lundi += $('#lundimatin').val() + " | ";
lundi += $('#lundimidi').val() + " | ";
lundi += $('#lundisoir').val();
}
if( $('#mardi').is(':checked') ){
var mardi = '';
mardi += $('#mardimatin').val() + " | ";
mardi += $('#mardimidi').val() + " | ";
mardi += $('#mardisoir').val();
}
if( $('#mercredi').is(':checked') ){
var mercredi = '';
mercredi += $('#mercredimatin').val() + " | ";
mercredi += $('#mercredimidi').val() + " | ";
mercredi += $('#mercredisoir').val();
}
if( $('#jeudi').is(':checked') ){
var jeudi = '';
jeudi += $('#jeudimatin').val() + " | ";
jeudi += $('#jeudimidi').val() + " | ";
jeudi += $('#jeudisoir').val();
}
if( $('#vendredi').is(':checked') ){
var vendredi = '';
vendredi += $('#vendredimatin').val() + " | ";
vendredi += $('#vendredimidi').val() + " | ";
vendredi += $('#vendredisoir').val();
}
var tel_perso = document.getElementById('tel_perso').value;
var tel_fax = document.getElementById('tel_fax').value;
var tel_mobile = document.getElementById('tel_mobile').value;
var tel_rdv = document.getElementById('tel_rdv').value;
var sexe = document.getElementById('sexe').value;
var site_internet = document.getElementById('site_internet').value;
var civilite = document.getElementById('civilite').value;
var editeur = editor.getData();
var fk_niv_fr = document.getElementById('fk_niv_fr').value;
$.post("submit.php", { nom_fr : nom_fr , nom_he : nom_he , prenom_fr : prenom_fr , prenom_he : prenom_he , fk_specialite : fk_specialite , adresse : adresse , cp : cp , ville : ville , region : region , centre_medical : centre_medical , waze : waze , tel_perso : tel_perso , tel_fax : tel_fax , tel_mobile : tel_mobile , tel_rdv : tel_rdv , sexe : sexe , site_internet : site_internet, civilite : civilite , fk_niv_fr : fk_niv_fr , editeur : editeur , dimanche : dimanche , lundi : lundi, mardi : mardi , mercredi : mercredi, jeudi : jeudi, vendredi : vendredi}, function(data)
{
$("#refresh").fadeIn();
$("#refresh").delay( 1000 ).fadeOut();
$("#result").delay( 1800 ).html( data ).fadeIn();
$("#result").delay( 4000 ).fadeOut();
});
});
/* $(".check").click(function () {
var div = $(this).val();
$("#"+div).slideToggle("slow");
}); */
});
</script>
</body>
</html>