<!DOCTYPE html> <html lang="zh-cmn-Hans"> <head> <meta charset="utf-8" /> <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1" /> <meta name ="viewport" content ="initial-scale=1, maximum-scale=3, minimum-scale=1, user-scalable=no"> <meta name="description" content="一线希望" /> <meta name="keywords" content="一线希望" /> <meta name="applicable-device" content="pc,mobile" /> <meta name="MobileOptimized" content="width" /> <meta name="HandheldFriendly" content="true" /> <meta name="robots" content="noarchive"/> <meta name="google" value="notranslate"> <link rel="shortcut icon" type="image/ico" href="favicon.ico" /> <title>上传患者信息-一线希望</title> <link rel="stylesheet" type="text/css" href="./css/swiper-bundle.min.css"/> <link rel="stylesheet" type="text/css" href="./css/animate.min.css"/> <link rel="stylesheet" type="text/css" href="./css/base.css"/> <link rel="stylesheet" type="text/css" href="./css/style.css"/> <script src="./js/jquery-3.6.0.min.js" type="text/javascript" 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src="images/icon/icon-user.png" alt="高高兴"></ins> <span><em><a href="user.html">高高兴</a></em></span> <em class="icon-arrow"></em> </div> <!-- 快捷菜单 --> <div class="open-more"> <a href="">个人中心</a> <a href="">修改密码</a> <a href="">退出登录</a> </div> </div> <!-- 导航按钮 --> <div class="nav-bg"></div> <div class="head-btn"> <i class="bar-top"></i> <i class="bar-cen"></i> <i class="bar-bom"></i> </div> </div> </header> <!-- 主体内容 --> <div class="main w1140 wow fadeInUp"> <div class="survey wow fadeInUp"> <div class="survey-left wow fadeInUp"> <span><img src="images/avatar.png" alt="高高兴"></span> <section> <h2>高高兴</h2> <p>联系方式：13852526255</p> </section> </div> <div class="survey-right wow fadeInUp"> <span>账户余额：<strong>5526.00</strong></span> <button class="withdrawal-btn">立即提现</button> </div> </div> <!-- 二级导航 --> <div class="pull-nav wow fadeInUp"> <div class="pull-nav-swiper swiper"> <div class="swiper-wrapper"> <div class="swiper-slide"> <a href="user.html">个人资料</a> </div> <div class="swiper-slide"> <a href="upload.html" class="active">上传患者信息</a> </div> <div class="swiper-slide"> <a href="patient.html">患者信息列表</a> </div> <div class="swiper-slide"> <a href="withdrawal.html">提现记录</a> </div> </div> </div> </div> <!-- 表单 --> <div class="information information-upload"> <h2>基本信息</h2> <ul class="information-list"> <li class="wow fadeInUp"> <span>患者姓名<em>*</em></span> <section class="select-section"> <input name="name-initials" type="text" placeholder="患者姓名首字母" value=""> <input name="patient-code" type="text" readonly="readonly" placeholder="生成患者代号" value=""> </section> </li> <li class="wow fadeInUp"> <span>患者性别<em>*</em></span> <section class="radio-section"> <span><input type="radio" name="sex" checked="checked" value="男士" /><em class="sex checked"><ins></ins></em>男士</span> <span><input type="radio" name="sex" value="女士" /><em class="sex"><ins></ins></em>女士</span> </section> </li> <li class="wow fadeInUp"> <span>出生日期<em>*</em></span> <section class="select-section"> <select name="birth-tiem"> <option value="">请选择出生日期</option> <option value="">1985年</option> <option value="">1986年</option> </select> <input type="text" name="age" placeholder="请输入年龄"> </section> </li> <li class="wow fadeInUp"> <span>患者常驻地址<em>*</em><ins class="add-btn">+</ins></span> <section class="select-section select-section-half"> <select name="province"> <option value="">四川</option> <option value="">上海</option> <option value="">广州</option> </select> <select name="city"> <option value="">成都</option> <option value="">南充</option> <option value="">绵阳</option> </select> <input type="text" placeholder="请填写详细信息" value=""> </section> </li> <li class="wow fadeInUp"> <span>能接受就医城市<em>*</em><ins class="add-btn">+</ins></span> <section class="select-section select-section-half"> <select name="province"> <option value="">四川</option> <option value="">上海</option> <option value="">广州</option> </select> <select name="city"> <option value="">成都</option> <option value="">南充</option> <option value="">绵阳</option> </select> </section> </li> </ul> <h2>预诊信息</h2> <ul class="information-list"> <li class="wow fadeInUp"> <span>主要诊断<em>*</em></span> <section class="select-section"> <select name="first-column"> <option value="">实体瘤</option> <option value="">实体瘤</option> <option value="">实体瘤</option> </select> <select name="second-column"> <option value="">血液肿瘤</option> <option value="">血液肿瘤</option> <option value="">血液肿瘤</option> </select> <select name="third-column"> <option value="">三级菜单名</option> <option value="">三级菜单名</option> <option value="">三级菜单名</option> </select> </section> </li> <li class="wow fadeInUp"> <span>首次诊断日期<em>*</em></span> <section class="select-section"> <select name="diagnosis-time"> <option value="">请选择首次诊断日期</option> <option value="">1985</option> <option value="">1986</option> </select> </section> </li> <li class="wow fadeInUp"> <span>详细信息<em>*</em></span> <section> <textarea name="msg" placeholder="请填写患者详细信息"></textarea> </section> </li> <li class="wow fadeInUp"> <span>上传病例或者检查信息<em>*</em></span> <section class="upload-section"> <span><img src="images/avatar.png" alt="病例或者检查信息"></span> <button><img src="images/icon/icon-add.png" alt="上传"></button> </section> </li> </ul> <button class="information-btn wow fadeInUp">确认提交</button> </div> </div> <!-- 尾部 --> <div class="footer w100 wow fadeInUp" data-wow-duration=".8s" data-wow-delay="0"> <div class="foot w1140 wow fadeInUp"> <div class="foot-nav"> <a href="agreement.html">合作协议</a><a href="about.html">关于我们</a><a href="feedback.html">意见反馈</a> </div> <div class="foot-record">Copyright© xxxxxxxxx.com All rights reserved<a href="https://beian.miit.gov.cn">蜀ICP备11111111号-2</a>技术支持：<a href="">大向天成</a></div> </div> </div> <!-- 提示框 --> <div class="tips-box"><span></span><p></p></div> </body> </html>