Amoy2
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sr-iHealthwx


			
				
					
						
						
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    <title>开始签约</title>
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<body style="overflow-x: hidden;"> 
	<div class="bottom-title"></div>
	<div class="c-main">
		<ul class="c-list c-border-tb mt10">
	        <li style="padding: 10px 15px 5px 0;">
	            <div class="n-list-key c-909090 c-f14">签约社区</div>
	            <div class="n-list-info c-t-right c-333 c-f14" id="hospitalName"></div>
	        </li>
	        <li style="padding: 0 15px 10px 0; border-top: none;">
	            <div class="n-list-key c-909090 c-f14">签约医生</div>
	            <div class="n-list-info c-t-right c-333 c-f14" id="doctorName"></div>
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		<ul class="n-list edit-list c-border-tb mt10">
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	            <div id="name_label" class="n-list-key c-909090 c-f14">姓&#x3000;&#x3000;名</div>
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	                <input type="text" class="c-input width-100 c-t-right c-333 c-f14" id="name" readonly="readonly" />
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	        </li>
			<li class="n-list-cover">
				<div class="n-list-key c-909090 c-f14"><i class="required" style="display: none;"></i>身份证号</div>
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					<input type="text" class="c-input width-100 c-t-right c-333 c-f14" maxlength="18" id="idcard" placeholder="请输入身份证号" readonly="readonly" style="pointer-events: none;"/>
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	        <li class="n-list-cover">
	            <div class="n-list-key c-909090 c-f14">医保卡号</div>
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	                <input type="text" class="c-input width-100 c-t-right c-333 c-f14" id="ssc" placeholder="未获取到关联医保卡号" readonly="readonly" />
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	            <div class="n-list-key c-909090 c-f14">医疗保险号</div>
	            <div class="n-list-info pl10">
	                <input type="text" class="c-input width-100 c-t-right c-333 c-f14" id="medicareNumber"/>
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	            <div class="n-list-key c-909090 c-f14">手机号码</div>
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	            </div>
	        </li>
	        <li class="n-list-cover ss-list" id="selectType">
	            <div class="n-list-key c-909090 c-f14">所属居委会</div>
	            <div class="n-list-info c-t-right c-333 c-f14">
	            	<input class="ss-value" id="committee" data-code="" data-jwcode="" type="text" readonly="readonly"/>
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	        <li class="n-list-cover ptb5">
	            <div class="n-list-key c-909090 c-f14">变更医生原因</div>
	            <div class="n-list-info pl10 c-t-right">
	                <span class="select-box">
	                    <input type="text" class="c-333 c-f14 mr25" placeholder="请选择变更医生原因" id="reason"/>
	                    <span class="arrow-d"></span>
	                </span>
	                
	            </div>
	        </li>  
	    </ul>
	    <div class="plr10 mt15 pb20" onclick="submitSign()">
	        <a href="javascript:;" style="font-size: 18px;" class="c-btn c-btn-full c-btn-4dcd70 border-radius-rounded">提交</a>
		    <div class="div-family-remark" style="font-size: 14px;margin-top: 10px; color: red;display: none;
		            ">备注：<span class="userName"></span>可关注城市爱健康公众号，注册账号后直接与家庭医生互动，享受家庭医生健康服务</div>
	    </div>
	    
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