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@@ -60,29 +60,40 @@ |
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<tr>
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<th width="100">家庭结构</th>
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<td>
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<input class="form-control" type="text" name="family_num"
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id="family_num" value="{$data.family_num}" placeholder="请输入家庭结构"/>
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<select class="form-control" name="family_num">
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<option value='1-2' <eq name="$data.family_num" value="1-2">selected</eq>>1-2</option>
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<option value='3-4' <eq name="$data.family_num" value="3-4">selected</eq>>3-4</option>
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<option value='5个以上' <eq name="$data.family_num" value="5个以上">selected</eq>>5个以上</option>
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</select>
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</td>
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</tr>
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<tr>
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<th width="100">职业</th>
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<td>
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<input class="form-control" type="text" name="occupation"
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id="occupation" value="{$data.occupation}" placeholder="请输入职业"/>
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<select class="form-control" name="occupation">
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<option value='职员' <eq name="$data.occupation" value="职员">selected</eq>>职员</option>
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<option value='学生' <eq name="$data.occupation" value="学生">selected</eq>>学生</option>
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<option value='自由职业' <eq name="$data.occupation" value="自由职业">selected</eq>>自由职业</option>
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<option value='企业高管' <eq name="$data.occupation" value="企业高管">selected</eq>>企业高管</option>
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<option value='其它' <eq name="$data.occupation" value="其它">selected</eq>>其它</option>
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</select>
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</td>
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</tr>
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<tr>
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<th width="100">有无吸烟酗酒史</th>
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<td>
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<input class="form-control" type="text" name="smoke_drink"
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id="smoke_drink" value="{$data.smoke_drink}" placeholder="请输入有误吸烟酗酒史"/>
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<label><input type="radio" name="smoke_drink" value="有" <eq name="$data.smoke_drink" value="有">checked</eq> />有</label>
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<label><input type="radio" name="smoke_drink" value="无" <eq name="$data.smoke_drink" value="无">checked</eq> />无</label>
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</td>
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</tr>
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<tr>
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<th width="100">出行方式</th>
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<td>
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<input class="form-control" type="text" name="going"
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id="going" value="{$data.going}" placeholder="请输入出行方式"/>
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<select class="form-control" name="going">
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<option value='公共交通' <eq name="$data.going" value="公共交通">selected</eq>>公共交通</option>
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<option value='自驾' <eq name="$data.going" value="自驾">selected</eq>>自驾</option>
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<option value='公共交通+自驾' <eq name="$data.going" value="公共交通+自驾">selected</eq>>公共交通+自驾</option>
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</select>
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</td>
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</tr>
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<tr>
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@@ -90,6 +101,8 @@ |
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<td>
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<input class="form-control" type="text" name="social"
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id="social" value="{$data.social}" placeholder="请输入有无社保"/>
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<label><input type="radio" name="social" value="有" <eq name="$data.social" value="有">checked</eq> />有</label>
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<label><input type="radio" name="social" value="无" <eq name="$data.social" value="无">checked</eq> />无</label>
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</td>
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</tr>
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<tr>
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@@ -97,34 +110,51 @@ |
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<td>
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<input class="form-control" type="text" name="year_income"
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id="year_income" value="{$data.year_income}" placeholder="请输入家庭年收入"/>
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<select class="form-control" name="year_income">
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<option value='5万以下' <eq name="$data.year_income" value="5万以下">selected</eq>>5万以下</option>
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<option value='5-15万' <eq name="$data.year_income" value="5-15万">selected</eq>>5-15万</option>
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<option value='15-25万' <eq name="$data.year_income" value="15-25万">selected</eq>>15-25万</option>
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<option value='25-35万' <eq name="$data.year_income" value="25-35万">selected</eq>>25-35万</option>
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<option value='35万以上' <eq name="$data.year_income" value="35万以上">selected</eq>>35万以上</option>
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</select>
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</td>
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</tr>
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<tr>
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<th width="100">个人年收入</th>
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<td>
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<input class="form-control" type="text" name="personage_year_income"
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id="personage_year_income" value="{$data.personage_year_income}" placeholder="请输入个人年收入"/>
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<select class="form-control" name="personage_year_income">
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<option value='50000' <eq name="$data.personage_year_income" value="50000">selected</eq>>5万以下</option>
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<option value='100000' <eq name="$data.personage_year_income" value="100000">selected</eq>>5-15万</option>
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<option value='200000' <eq name="$data.personage_year_income" value="200000">selected</eq>>15-25万</option>
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<option value='250000' <eq name="$data.personage_year_income" value="250000">selected</eq>>25-35万</option>
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<option value='350000' <eq name="$data.personage_year_income" value="350000">selected</eq>>35万以上</option>
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</select>
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</td>
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</tr>
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<tr>
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<th width="100">有无负债</th>
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<td>
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<input class="form-control" type="text" name="liabilities"
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id="liabilities" value="{$data.liabilities}" placeholder="请输入有无负债"/>
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<label><input type="radio" name="liabilities" value="有" <eq name="$data.liabilities" value="有">checked</eq> />有</label>
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<label><input type="radio" name="liabilities" value="无" <eq name="$data.liabilities" value="无">checked</eq> />无</label>
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</td>
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</tr>
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<tr>
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<th width="100">大约未还负债</th>
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<td>
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<input class="form-control" type="text" name="not_return"
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id="not_return" value="{$data.not_return}" placeholder="请输入大约未还负债"/>
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<select class="form-control" name="not_return">
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<option value='0' <eq name="$data.not_return" value="0">selected</eq>>无</option>
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<option value='100000' <eq name="$data.not_return" value="100000">selected</eq>>10-30万</option>
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<option value='150000' <eq name="$data.not_return" value="150000">selected</eq>>30-50万</option>
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<option value='750000' <eq name="$data.not_return" value="750000">selected</eq>>50-100万</option>
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<option value='1000000' <eq name="$data.not_return" value="1000000">selected</eq>>100万以上</option>
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</select>
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</td>
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</tr>
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<tr>
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<th width="100">有无家族病史</th>
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<td>
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<input class="form-control" type="text" name="family_disease"
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id="family_disease" value="{$data.family_disease}" placeholder="请输入有无家族病史"/>
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<label><input type="radio" name="family_disease" value="有" <eq name="$data.family_disease" value="有">checked</eq> />有</label>
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<label><input type="radio" name="family_disease" value="无" <eq name="$data.family_disease" value="无">checked</eq> />无</label>
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</td>
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</tr>
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<tr>
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@@ -132,6 +162,10 @@ |
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<td>
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<input class="form-control" type="text" name="safeguard"
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id="safeguard" value="{$data.safeguard}" placeholder="请输入保障"/>
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<php>$safeguard=explode(',',$data.safeguard);</php>
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<label><input type="checkbox" name="safeguard[]" value="旅游" <foreach name="$safeguard" item="s"><eq name="$s" value="旅游">checked</eq></foreach> />旅游</label>
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<label><input type="checkbox" name="safeguard[]" value="意外" <foreach name="$safeguard" item="s"><eq name="$s" value="意外">checked</eq></foreach> />意外</label>
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<label><input type="checkbox" name="safeguard[]" value="健康" <foreach name="$safeguard" item="s"><eq name="$s" value="健康">checked</eq></foreach> />健康</label>
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</td>
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</tr>
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<tr>
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