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- <!DOCTYPE html>
- <html lang="zh-cn">
- <head>
- <meta name="viewport" content="width=device-width,minimum-scale=1.0,maximum-scale=1.0,user-scalable=no">
- <link href="{{cdn_asset('/assets/css/bootstrap.min.css')}}" rel="stylesheet">
- <title>tijian</title>
- <script type="text/javascript">
- (function (doc, win) {
- var docEl = doc.documentElement,
- resizeEvt = 'orientationchange' in window ? 'orientationchange' : 'resize',
- recalc = function () {
- var clientWidth = docEl.clientWidth;
- if (!clientWidth) return;
- if(clientWidth>=640){
- docEl.style.fontSize = '100px';
- }else{
- docEl.style.fontSize = 100 * (clientWidth / 640) + 'px';
- }
- };
- if (!doc.addEventListener) return;
- win.addEventListener(resizeEvt, recalc, false);
- doc.addEventListener('DOMContentLoaded', recalc, false);
- })(document, window);
- </script>
- <style type="text/css">
- .all{
- width: 100%;
- height: auto;
- }
- img{
- width: 50px;
- height: 50px;
- margin-top: 3px;
- }
- h3{
- text-align: center;
- }
- .all .main{
- flex-wrap: wrap;
- display: flex;
- }
- .all .input-group{
- margin:4px 6%;
- }
- .all .danxuan{
- width: 66.66%;
- margin: 4px 16.66%;
- }
- #tanchuang{
- position: fixed;
- z-index: 999;
- width: 100%;
- height: 100%;
- top: 0;
- left: 0;
- background: rgba(0,0,0,0.5);
- }
- #tanchuang .tanbox{
- width: 240px;
- height: 120px;
- background: #fff;
- position: absolute;
- left: 50%;
- top: 50%;
- margin-left: -120px;
- margin-top: -60px;
- border-radius: 15px;
- }
- .tanbox .status{
- width: 80%;
- height: 70%;
- margin: 10%;
- }
- .tanbox .status text{
- display: inline-block;
- width: 100%;
- text-align: center;
- margin-top: 10px;
- }
- .tanbox .status .title{
- display: inline-block;
- width: 100%;
- font-size: 20px;
- font-weight: 700;
- text-align: center;
- color: #f04;
- margin-top: 10px;
- }
- </style>
- </head>
- <body>
- <script type="text/javascript">
- var yan = 0;
- var countdown = 60;
- var sending = false;
- function settime(obj) { //发送验证码倒计时
- console.log(obj)
- if (countdown == 0) {
- obj.attr('disabled', false);
- obj.val("发送验证码");
- countdown = 60;
- sending = false;
- return;
- } else {
- obj.attr('disabled', true);
- obj.val("重新发送(" + countdown + ")");
- countdown--;
- }
- setTimeout(function () {
- settime(obj);
- }, 1000)
- }
- function tijiao(){
- var tanc=document.getElementById("tanchuang")
- tanc.style="display:auto;"
- var status = 0
- var tbox = document.getElementsByClassName("status");
-
- if(status==0){
- tbox[0].style="display:auto;"
- tbox[1].style="display:none;"
- tbox[2].style="display:none;"
- }else if(status==1){
- tbox[1].style="display:auto;"
- tbox[0].style="display:none;"
- tbox[2].style="display:none;"
- }else{
- tbox[1].style="display:none;"
- tbox[0].style="display:none;"
- tbox[2].style="display:auto;"
- }
- }
- function close(e){
- var id = e.id;
- console.log(id)
- if(id=='fail'){
- closebox();
- }else if(id=='yeah'){
- var tanc=document.getElementById("tanchuang")
- tanc.style="display:none;"
- }else if(id=='download'){
- var tanc=document.getElementById("tanchuang")
- tanc.style="display:none;"
- }
- }
- function closebox(){
- var tanc=document.getElementById("tanchuang")
- tanc.style="display:none;"
- }
- function phonenum() {
- var phone = '17828477741'
- var myreg=/^[1][3,4,5,7,8][0-9]{9}$/;
- if (!myreg.test(phone)) {
- console.log('错了')
- } else {
- console.log('对了')
- }
- }
- function closeyan(){
- var yanz=document.getElementById("yanz")
- yanz.style="display:none;"
- }
- function yanzhengma(){
- var yanzheng = document.getElementById("yzma")
- yanzheng.style="display:auto;"
- console.log('aaa')
- sending = true;
- var obj = $("#fasong");
- settime(obj);
- }
- </script>
- <div class="all">
- <div class="col-xs-0 col-lg-2"></div>
- <div class="col-xs-12 col-lg-8 main" style="margin: 0 auto;margin-top: 10px;">
- <div class="col-xs-12 col-lg-12 imgbox" style="width:100%;margin-bottom:20px;display: flex;height: auto;">
- <div class="col-xs-0 col-lg-2"></div>
- <img class="col-xs-3 col-lg-1" src="{{cdn_asset('/assets/img/logo.jpg')}}">
- <h3 class="col-lg-8">健康体检服务知情同意书</h3>
- </div>
-
- <form class="bs-example bs-example-form main" role="form">
- <div class="col-xs-12 col-lg-4 input-group input">
- <span class="input-group-addon">姓名:</span>
- <input type="text" class="form-control" name="name" placeholder="请输入姓名" required>
- </div>
- <div class="col-xs-12 col-lg-4 input-group input">
- <span class="input-group-addon">籍贯:</span>
- <input type="text" class="form-control" name="native_place" placeholder="请输入籍贯" required>
- </div>
- <div class="col-xs-12 col-lg-4 input-group input">
- <span class="input-group-addon">民族:</span>
- <input type="text" class="form-control" name="nationality" placeholder="请输入民族" required>
- </div>
- <div class="col-xs-12 col-lg-4 input-group input">
- <span class="input-group-addon">年龄:</span>
- <input type="text" class="form-control" name="age" placeholder="请输入年龄" required>
- </div>
- <div class="col-xs-12 col-lg-4 input-group input">
- <span class="input-group-addon">职业:</span>
- <input type="text" class="form-control" name="work" placeholder="请输入职业" required>
- </div>
- <div class="col-xs-12 col-lg-4 input-group input">
- <span class="input-group-addon">邮箱地址:</span>
- <input type="text" class="form-control" name="email" placeholder="请输入邮箱" required>
- </div>
- <div class="col-xs-12 col-lg-6 input-group">
- <span class="input-group-addon">住址:</span>
- <input type="text" class="form-control" name="address" placeholder="请输入住址" required>
- </div>
- <div class="col-xs-12 col-lg-12 input-group" style="display: flex;flex-wrap: wrap;">
- <div class="col-xs-12 col-lg-6 input-group" style="display: flex;margin:4px 0;">
- <span style="width: 20%;line-height: 20px;font-size: 10px;" class="input-group-addon">手机号</span>
- <input style="width: 44%;" type="text" name="phone" class="form-control" placeholder="请输入手机号" required>
- <input style="width:36%;font-size: 10px;" class="btn btn-default" id="fasong" value="获取验证码" onclick="yanzhengma()"/>
- </div>
- <div id="yzma" class="col-xs-12 col-lg-4 input-group" style="margin:4px 0;display: none;">
- <input style="width: 100%;" type="text" name="yzma" class="form-control" placeholder="请输入验证码" required>
- </div>
- </div>
- <div class="danxuan">
- <label for="name">性别:</label>
- <div>
- <label class="checkbox-inline">
- <input name="sex" type="radio" value="nan" checked>男
- </label>
- <label class="checkbox-inline">
- <input name="sex" type="radio" value="nv">女
- </label>
- </div>
- <label for="name">样本类型:</label>
- <div class="checkbox">
- <label><input type="radio" value="l1" name="sample_type" checked>EDTA抗凝静脉血</label>
- </div>
- <div class="checkbox">
- <label><input type="radio" value="l2" name="sample_type">口腔拭子</label>
- </div>
- <div class="checkbox">
- <label><input type="radio" value="l3" name="sample_type">宫颈刷</label>
- </div>
- <button style="margin-left: 45%;margin-bottom: 20px;" type="button" onclick="tijiao()" class="btn btn-default">提交</button>
- </div>
- </div>
- <div id="tanchuang" style="display: none;">
- <div class="tanbox">
- <div style="width: 20px;height: 20px;text-align: center;position: absolute;top: -5px;right: -5px;background: #f04;border-radius: 20px;" onclick="closebox()">X</div>
- <div class="status b0">
- <text class="title">提交失败!!</text>
- <text style="font-size: 10px;color: #999;">请重新提交!!</text>
- </div>
- <div class="status b1">
- <text class="title">提交成功!!</text>
- <button class="btn btn-default" id="yeah" type="button" onclick="close(this)">下一页!</button>
- </div>
- <div class="status b2">
- <text class="title">下载****!!</text>
- <button class="btn btn-default" id="download" type="button" onclick="close(this)">下载!</button>
- </div>
- </div>
- </div>
- </form>
- </div>
- </div>
- <!-- jQuery (Bootstrap 的 JavaScript 插件需要引入 jQuery) -->
- <script src="{{cdn_asset('/assets/js/jquery-3.2.1.js')}}"></script>
- <script src="{{cdn_asset('/assets/js/bootstrap.min.js')}}"></script>
- </body>
- </html>
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