Amoy2
/
sr-iHealthwx


			
				
					
						
						
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							<!DOCTYPE html>
<html>
	<head>
		<meta charset="UTF-8">
		<title>自助建档</title>
		<meta name="author" content="yihu.com" />
        <meta name="format-detection" content="telephone=no" />
        <meta name="viewport" content="width=device-width, initial-scale=1.0, minimum-scale=1.0, maximum-scale=1.0, user-scalable=0" />
        <meta name="apple-mobile-web-app-capable" content="yes" />
        <meta name="apple-mobile-web-app-status-bar-style" content="black" />
        <link rel="stylesheet" type="text/css" href="../../../css/mui.min.css">
        <link rel="stylesheet" type="text/css" href="../../../css/mui.picker.css">
        <link rel="stylesheet" type="text/css" href="../../../css/cross.css" />
		<link rel="stylesheet" type="text/css" href="../../../css/cross.ui.css" />
		<link rel="stylesheet" type="text/css" href="../../../css/select-committee.css"/>
        <link rel="stylesheet" type="text/css" href="../css/zizhujiandang.css" />
	</head>
	<body>
        <div class="main">
        	<div class="re-info">
        		<div></div>
		        <div>您暂未建立居民档案，无法申请签约，请填写您的相关信息，系统将自动为您建档并向医生提交签约申请</div>
		    </div>
            <ul class="c-list">
                <li>
                    <div class="c-list-key">
                        <span>建档人</span>
                    </div>
                    <div class="c-list-info">
                        <p class="zz-name" id='name'></p> 
                    </div>
                </li>
                <li class="n-list-cover">
                    <div class="n-list-key w3em">身份证号</div>
                    <div class="n-list-info pl10 mui-input-row">
                        <input id="idcard" value="" type="text" class="c-input width-100 c-t-right maginTen" placeholder="请输入居民身份证号" readonly="readonly" maxlength="18" />
                    </div>
                </li> 
                <li class="n-list-cover">
                    <div class="n-list-key w3em">医保卡号</div>
                    <div class="n-list-info pl10 mui-input-row">
                        <input id="ssc" value="" type="text" class="c-input width-100 c-t-right maginTen" placeholder="请输入医保卡号" readonly="readonly"/>
                    </div>
                </li> 
                <li class="n-list-cover" id="sex" data-code="" data-name=""> 
                    <div class="n-list-key w3em"><i class="required"></i>性别</div>
                    <div class="n-list-info pl10 mui-input-row"> 
                        <select name="" id="sexs" class="c-hide"></select>
                        <span class="dl-input-icon"></span>
                    </div>
                </li>
                <li class="n-list-cover" id="Birthday">
                    <div class="n-list-key w3em"><i class="required"></i>出生日期</div>
                    <div class="n-list-info pl10 mui-input-row"> 
                        <input value="" type="text" readonly="readonly" class="c-input width-100 c-t-right"/>
                        <span class="dl-input-icon"></span>
                    </div>  
                </li>
                <li class="n-list-cover" id="phonenum">
                    <div class="n-list-key w3em"><i class="required"></i>手机号码</div>
                    <div class="n-list-info pl10 mui-input-row">
                        <input  value="" type="text" class="c-input width-100 c-t-right maginTen mui-input-clear" placeholder="请输入居民手机号码" maxlength="11" />
                    </div>
                </li> 
                <li class="n-list-cover" id="address">
                    <div class="n-list-key w3em"><i class="required"></i>户口所在地</div>
                    <div class="n-list-info pl10 mui-input-row"> 
                        <input data-code="" value="" type="text" readonly="readonly" class="select-input c-input width-100 c-t-right" placeholder="请选择居民户口所在地"/>
                        <span class="dl-input-icon"></span>
                    </div>
                </li>
                <li class="n-list-cover" id="national" data-code="" data-name=""> 
                    <div class="n-list-key w3em"><i class="required"></i>民族</div>
                    <div class="n-list-info pl10 mui-input-row"> 
                        <select name="" id="nation" class="c-hide"></select>
                        <span class="dl-input-icon"></span>
                    </div>
                </li>
                <li class="n-list-cover" id="marry" data-code="" data-name="">
                    <div class="n-list-key w3em"><i class="required"></i>婚姻状况</div>
                    <div class="n-list-info pl10 mui-input-row"> 
                        <select name="" id="marryed" class="c-hide"></select> 
                        <span class="dl-input-icon"></span>
                    </div>
                </li> 
                <li class="n-list-cover" id="Blood_type" data-code="" data-name="">
                    <div class="n-list-key w3em"><i class="required"></i>血型</div>  
                    <div class="n-list-info pl10 mui-input-row"> 
                        <select name="" id="Bloodtype" class="c-hide"></select> 
                        <span class="dl-input-icon"></span>
                    </div>
                </li>
                <li class="n-list-cover" id="selectType">
                    <div class="n-list-key w3em"><i class="required"></i>所属居委会</div> 
                    <div class="n-list-info pl10 mui-input-row"> 
                        <input id="committee" data-jwcode="" data-name="" data-code="" type="text" class="c-input width-100 c-t-right" readonly="readonly"  placeholder="请选择您的户口所在社区"/>
                    	<span class="dl-input-icon"></span>
                    </div>
                </li>
                <li class="n-list-cover" id="Present_Address">
                    <div class="n-list-key w3em"><i class="required"></i>现住址</div>
                    <div class="n-list-info pl10 mui-input-row"> 
                        <input value="" type="text" class="c-input width-100 c-t-right mui-input-clear"placeholder="请填写您当前的居住地址" maxlength="30"/>
                    </div>
                </li>
            </ul>
            <div class="zz-foot">
            	<div class="detail btn">详细信息采集</div>
            	<div class="submit btn" id="next_step">直接提交</div>
            </div>
        </div>
        <script src="../../../js/jquery/2.1.3/jquery.js"></script>
        <script type="text/javascript" src="../../../js/mui.min.js"></script> 
        <script type="text/javascript" src="../../../js/mui.picker.js"></script>
        <link rel="stylesheet" type="text/css" href="../../../widget/artDialog/6.0.5/css/ui-dialog.min.css" />
        <script src="../../../widget/artDialog/6.0.5/js/dialog-plus.min.js" type="text/javascript" charset="utf-8"></script>
        <link rel="stylesheet" type="text/css" href="../../../widget/mobiscroll/2.17.1/css/mobiscroll.css"/>
        <script src="../../../widget/mobiscroll/2.17.1/js/mobiscroll.js" type="text/javascript" charset="utf-8"></script>
        <script src="../../../js/es6-promise.js" type="text/javascript" charset="utf-8"></script>
        <script src="../../../js/underscore.js" type="text/javascript" charset="utf-8"></script>
        <script type="text/javascript" src="../../../js/common_http.js" ></script>
		<script type="text/javascript" src="../../../js/weixin_common.js" ></script>
	    <script src="../../../js/select-committee.js"></script>
        <script type="text/javascript" src="../js/zizhujiandang.js"></script>
	</body>
</html>