63 lines
2.6 KiB
Plaintext
63 lines
2.6 KiB
Plaintext
<view class="container">
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<view class="form-card">
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<view class="form-item">
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<text class="form-label">姓名<text class="required">*</text></text>
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<input class="form-input" value="{{form.name}}" placeholder="请输入就诊人姓名" placeholder-class="input-placeholder"
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maxlength="20" data-field="name" bindinput="onFieldInput" />
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</view>
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<view class="form-item">
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<text class="form-label">性别</text>
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<view class="sex-wrap">
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<view class="sex-tag {{form.sex === item.value ? 'sex-tag-active' : ''}}" wx:for="{{sexOptions}}" wx:key="value"
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data-sex="{{item.value}}" bindtap="onSexSelect">
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<text class="sex-text">{{item.label}}</text>
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</view>
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</view>
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</view>
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<view class="form-item">
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<text class="form-label">出生年月</text>
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<picker mode="date" value="{{form.birth}}" start="1900-01-01" end="{{today}}" bindchange="onBirthChange">
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<view class="picker-value {{form.birth ? '' : 'picker-placeholder'}}">
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{{form.birth || '请选择出生年月'}}
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</view>
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</picker>
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</view>
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<view class="form-item">
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<text class="form-label">联系电话<text class="required">*</text></text>
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<input class="form-input" value="{{form.mobile}}" type="number" placeholder="用于陪诊师联系您" placeholder-class="input-placeholder"
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maxlength="11" data-field="mobile" bindinput="onFieldInput" />
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</view>
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<view class="form-item">
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<text class="form-label">证件号</text>
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<input class="form-input" value="{{form.idnumber}}" placeholder="选填，用于医院建档取号" placeholder-class="input-placeholder"
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maxlength="30" data-field="idnumber" bindinput="onFieldInput" />
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</view>
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</view>
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<view class="form-card">
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<view class="form-item form-item-remark">
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<text class="form-label">健康备注</text>
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<textarea class="form-textarea" value="{{form.remark}}" placeholder="选填，如过敏史、慢病、行动不便等情况，便于陪诊师提前准备"
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placeholder-class="input-placeholder" maxlength="200" data-field="remark" bindinput="onFieldInput" />
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<text class="remark-count">{{form.remark.length}}/200</text>
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</view>
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</view>
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<view class="tips">
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<t-icon name="lock-on" size="26rpx" color="#B0B7C3" />
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<text class="tips-text">信息仅用于陪诊服务，我们会严格保密</text>
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</view>
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<view class="footer-bar">
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<view class="submit-btn {{saving ? 'submit-btn-disabled' : ''}}" bindtap="onSave">
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<text class="submit-btn-text">保存</text>
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</view>
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</view>
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</view>
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