227 lines
8.4 KiB
HTML
227 lines
8.4 KiB
HTML
<!DOCTYPE html>
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<html lang="zh-cmn-Hans">
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<head>
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<meta charset="utf-8" />
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<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1" />
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<meta name ="viewport" content ="initial-scale=1, maximum-scale=3, minimum-scale=1, user-scalable=no">
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<meta name="description" content="一线希望" />
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<meta name="keywords" content="一线希望" />
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<meta name="applicable-device" content="pc,mobile" />
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<meta name="MobileOptimized" content="width" />
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<meta name="HandheldFriendly" content="true" />
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<meta name="robots" content="noarchive"/>
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<meta name="google" value="notranslate">
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<link rel="shortcut icon" type="image/ico" href="favicon.ico" />
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<title>上传患者信息-一线希望</title>
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<link rel="stylesheet" type="text/css" href="./css/swiper-bundle.min.css"/>
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<link rel="stylesheet" type="text/css" href="./css/animate.min.css"/>
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<link rel="stylesheet" type="text/css" href="./css/base.css"/>
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<link rel="stylesheet" type="text/css" href="./css/style.css"/>
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<script src="./js/jquery-3.6.0.min.js" type="text/javascript" charset="utf-8"></script>
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<script src="./js/swiper-bundle.min.js" type="text/javascript" charset="utf-8"></script>
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<script src="./js/swiper.animate1.0.3.min.js" type="text/javascript" charset="utf-8"></script>
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<script src="./js/wow.js" type="text/javascript" charset="utf-8"></script>
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<script src="./js/my-site.js" type="text/javascript" charset="utf-8"></script>
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</head>
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<body>
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<!-- 头部导航 -->
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<header class="header w100">
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<div class="head w1140">
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<!-- logo -->
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<h1 class="logo">
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<a href="index.html"><img src="images/logo.png" alt="一线希望" title="一线希望"></a>
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</h1>
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<!-- 导航 -->
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<ul class="nav">
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<li class="active"><a href="solid.html">实体瘤</a></li>
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<li><a href="blood.html">血液肿瘤</a></li>
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<li><a href="other.html">其他</a></li>
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<li><a href="operation.html">操作指南</a></li>
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</ul>
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<!-- 顶部右侧 -->
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<div class="top-right">
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<!-- 通知 -->
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<div class="notice"><a href=""><img src="images/icon/icon-notice.png" alt="通知"></a><em>15</em></div>
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<!-- 用户信息 -->
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<div class="login-registration">
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<ins><img src="images/icon/icon-user.png" alt="高高兴"></ins>
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<span><em><a href="user.html">高高兴</a></em></span>
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<em class="icon-arrow"></em>
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</div>
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<!-- 快捷菜单 -->
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<div class="open-more">
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<a href="">个人中心</a>
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<a href="">修改密码</a>
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<a href="">退出登录</a>
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</div>
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</div>
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<!-- 导航按钮 -->
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<div class="nav-bg"></div>
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<div class="head-btn">
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<i class="bar-top"></i>
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<i class="bar-cen"></i>
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<i class="bar-bom"></i>
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</div>
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</div>
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</header>
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<!-- 主体内容 -->
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<div class="main w1140 wow fadeInUp">
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<div class="survey wow fadeInUp">
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<div class="survey-left wow fadeInUp">
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<span><img src="images/avatar.png" alt="高高兴"></span>
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<section>
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<h2>高高兴</h2>
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<p>联系方式：13852526255</p>
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</section>
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</div>
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<div class="survey-right wow fadeInUp">
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<span>账户余额：<strong>5526.00</strong></span>
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<button class="withdrawal-btn">立即提现</button>
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</div>
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</div>
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<!-- 二级导航 -->
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<div class="pull-nav wow fadeInUp">
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<div class="pull-nav-swiper swiper">
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<div class="swiper-wrapper">
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<div class="swiper-slide">
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<a href="user.html">个人资料</a>
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</div>
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<div class="swiper-slide">
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<a href="upload.html" class="active">上传患者信息</a>
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</div>
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<div class="swiper-slide">
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<a href="patient.html">患者信息列表</a>
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</div>
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<div class="swiper-slide">
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<a href="withdrawal.html">提现记录</a>
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</div>
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</div>
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</div>
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</div>
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<!-- 表单 -->
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<div class="information information-upload">
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<h2>基本信息</h2>
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<ul class="information-list">
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<li class="wow fadeInUp">
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<span>患者姓名<em>*</em></span>
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<section class="select-section">
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<input name="name-initials" type="text" placeholder="患者姓名首字母" value="">
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<input name="patient-code" type="text" readonly="readonly" placeholder="生成患者代号" value="">
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</section>
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</li>
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<li class="wow fadeInUp">
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<span>患者性别<em>*</em></span>
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<section class="radio-section">
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<span><input type="radio" name="sex" checked="checked" value="男士" /><em class="sex checked"><ins></ins></em>男士</span>
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<span><input type="radio" name="sex" value="女士" /><em class="sex"><ins></ins></em>女士</span>
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</section>
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</li>
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<li class="wow fadeInUp">
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<span>出生日期<em>*</em></span>
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<section class="select-section">
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<select name="birth-tiem">
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<option value="">请选择出生日期</option>
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<option value="">1985年</option>
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<option value="">1986年</option>
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</select>
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<input type="text" name="age" placeholder="请输入年龄">
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</section>
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</li>
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<li class="wow fadeInUp">
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<span>患者常驻地址<em>*</em><ins class="add-btn">+</ins></span>
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<section class="select-section select-section-half">
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<select name="province">
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<option value="">四川</option>
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<option value="">上海</option>
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<option value="">广州</option>
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</select>
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<select name="city">
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<option value="">成都</option>
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<option value="">南充</option>
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<option value="">绵阳</option>
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</select>
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<input type="text" placeholder="请填写详细信息" value="">
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</section>
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</li>
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<li class="wow fadeInUp">
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<span>能接受就医城市<em>*</em><ins class="add-btn">+</ins></span>
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<section class="select-section select-section-half">
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<select name="province">
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<option value="">四川</option>
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<option value="">上海</option>
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<option value="">广州</option>
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</select>
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<select name="city">
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<option value="">成都</option>
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<option value="">南充</option>
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<option value="">绵阳</option>
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</select>
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</section>
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</li>
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</ul>
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<h2>预诊信息</h2>
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<ul class="information-list">
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<li class="wow fadeInUp">
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<span>主要诊断<em>*</em></span>
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<section class="select-section">
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<select name="first-column">
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<option value="">实体瘤</option>
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<option value="">实体瘤</option>
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<option value="">实体瘤</option>
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</select>
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<select name="second-column">
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<option value="">血液肿瘤</option>
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<option value="">血液肿瘤</option>
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<option value="">血液肿瘤</option>
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</select>
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<select name="third-column">
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<option value="">三级菜单名</option>
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<option value="">三级菜单名</option>
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<option value="">三级菜单名</option>
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</select>
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</section>
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</li>
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<li class="wow fadeInUp">
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<span>首次诊断日期<em>*</em></span>
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<section class="select-section">
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<select name="diagnosis-time">
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<option value="">请选择首次诊断日期</option>
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<option value="">1985</option>
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<option value="">1986</option>
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</select>
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</section>
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</li>
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<li class="wow fadeInUp">
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<span>详细信息<em>*</em></span>
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<section>
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<textarea name="msg" placeholder="请填写患者详细信息"></textarea>
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</section>
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</li>
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<li class="wow fadeInUp">
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<span>上传病例或者检查信息<em>*</em></span>
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<section class="upload-section">
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<span><img src="images/avatar.png" alt="病例或者检查信息"></span>
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<button><img src="images/icon/icon-add.png" alt="上传"></button>
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</section>
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</li>
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</ul>
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<button class="information-btn wow fadeInUp">确认提交</button>
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</div>
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</div>
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<!-- 尾部 -->
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<div class="footer w100 wow fadeInUp" data-wow-duration=".8s" data-wow-delay="0">
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<div class="foot w1140 wow fadeInUp">
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<div class="foot-nav">
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<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>
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</div>
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<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>
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</div>
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</div>
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<!-- 提示框 -->
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<div class="tips-box"><span></span><p></p></div>
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</body>
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</html>
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