<link rel="stylesheet" href="/thmz/css/bootstrap/css/bootstrap-select.css"/>
<link rel="stylesheet" href="/thmz/css/bootstrap/css/daterangepicker.css"/>
<link rel="stylesheet" href="/thmz/css/custom.min.css">
<script src="/thmz/js/dependent/bootstrap-select.js"></script>
<script src="/thmz/js/dependent/daterangepicker.js"></script>
<script src="/thmz/js/mz/refund_medicine.js"></script>
<title>退药申请</title>
<div class="row">
    <div class="col-md-12 col-sm-12 col-xs-12">
        <div class="x_panel">
            <div class="panel-body">
                <form id="formSearch" class="form-horizontal" autocomplete="off">
                    <div class="form-group col-md-12 col-sm-12 col-xs-12">
                        <div class="col-md-3 col-sm-3 col-xs-12"></div>
                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="name">姓名
                        </label>
                        <div class="col-md-2 col-sm-2 col-xs-12">
                            <input id="name" class="form-control col-md-7 col-xs-12" type="text"
                                   placeholder="姓名">
                        </div>
                        <label class="control-label col-md-2 col-sm-2 col-xs-12" for="patientId_or_cardNo">病人ID/就诊卡号
                        </label>
                        <div class="col-md-2 col-sm-2 col-xs-12">
                            <input id="patientId_or_cardNo" class="form-control col-md-7 col-xs-12" type="text"
                                   onchange="setPatientId()"
                                   placeholder="病人ID/就诊卡号">
                            <input id="patientId" type="hidden">
                        </div>
                        <div class="col-md-2 col-sm-2 col-xs-12"></div>
                    </div>
                    <div class="form-group col-md-12 col-sm-12 col-xs-12">
                        <div class="col-md-3 col-sm-3 col-xs-12"></div>
                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="serialNo">流水号
                        </label>
                        <div class="col-md-1 col-sm-1 col-xs-12">
                            <input id="serialNo" class="form-control col-md-7 col-xs-12" type="text"
                                   placeholder="流水号">
                        </div>
                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="reportrange" > 缴费日期
                        </label>
                        <div class="col-md-3 col-sm-3 col-xs-12">
                            <div id="reportrange" class="pull-right"
                                 style="background: #fff; cursor: pointer; padding: 5px 10px; border: 1px solid #ccc">
                                <i class="glyphicon glyphicon-calendar fa fa-calendar"></i>
                                <span>December 30, 2014 - January 28, 2015</span> <b class="caret"></b>
                            </div>
                        </div>
                        <!--<div class="col-md-1 col-sm-1 col-xs-12" style="text-align:left;">-->
                        <!---->
                        <!--</div>-->
                        <div class="col-md-3 col-sm-3 col-xs-12" style="text-align:left;">
                            <button type="button" style="margin-left:20px" id="btn_clean" class="btn btn-primary"
                                    title="重置"><i class="fa fa-rotate-left"></i>
                            </button>
                            <button type="button" style="margin-left:3px" id="btn_query" class="btn btn-primary"
                                    title="查询"><i class="fa fa-search"></i>
                            </button>
                            <button type="button" style="margin-left:3px" id="btn_save" class="btn btn-primary"
                                    title="退药"><i class="fa fa-check-square-o"></i>
                            </button>
                        </div>
                    </div>
                </form>
            </div>

            <div class="row">
                <div class="col-md-6 col-sm-6 col-xs-12">
                    <table id="tb_table"></table>
                </div>
                <div class="col-md-6 col-sm-6 col-xs-12">
                    <table id="tb_table_right"></table>
                </div>
            </div>
        </div>
    </div>
</div>
</div>


