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- <!DOCTYPE html>
- <html>
- <head>
- <meta charset="utf-8" />
- <meta name="viewport" content="width=device-width,initial-scale=1.0, minimum-scale=1.0, maximum-scale=1.0, user-scalable=no" />
- <script src="layui/layui.all.js"></script>
- <link rel="stylesheet" href="layui/css/layui.css">
- <title></title>
- </head>
- <body style="background-color: #96d1d9;width: 26cm;height: 11cm;margin: 0 auto;">
- <div>
- <span></span>
- <div class="header" style="margin-top: 1cm;width: 24cm;">
- <div class="img">
- <img style="height: 3cm; width: 3cm;" src="{__FRAME_PATH}img/22.png" />
- </div>
- <div class="left">
- <div style="font-size: 31px;letter-spacing:4px">咸宁市遗体捐献志愿者</div>
- <!-- <div style="margin-top: 5px;text-align: center;font-size: 30px;">入会申请登记表</div> -->
- </div>
- <div class="img1">
- <img src="{__FRAME_PATH}img/11.png" alt="" style="height: 2cm; width: 10.5cm;">
- </div>
-
- </div>
- <!-- <div class="img"></div> -->
- <div class="header1" style="width: 21cm;">
- <div class="box-1">
- 制表单位:咸宁市红十字会
- </div>
- <div class="box-2">
- 填表日期:
- </div>
- <div class="box-3">
- 年 月 日
- </div>
- <!-- <div class="box-4">
-
- </div> -->
- <div class="box-5">
- <div>编号: YSQ-0{$arr.id}</div>
-
-
- </div>
- </div>
-
- <div style="margin:8px auto;">
- <table class="table table-striped table-bordered" align="center" valign="center">
- <tr>
- <td class="value" colspan="16" style="width: 21cm;padding: 32px 12px;text-indent: 40px; text-align: left;line-height: 38px;">
- 遗体捐献是服务医疗事业,造福人类的高尚行为,是“人道、博爱、奉献”精神的崇高体现。我已了解遗体捐献的基本常识和有关政策法规。我自愿登记成为遗体捐献志愿者,身故后请执行人和所有亲属尊重我的决定。
- </td>
- </tr>
- <tr>
- <td class="column" >姓名</td>
- <td class="value" colspan="2">{$arr.name}</td>
- <td class="column" style="width: 1cm;">性别</td>
- <td class="value" colspan="2">{$arr.sex}</td>
- <td class="column" style="width: 2cm;">出生年月</td>
- <td class="value" colspan="5">{$arr.birthday}</td>
- <!-- <td class="value"></td>
- <td class="column" >性别</td>
- <td class="value" colspan="1"></td>
- <td class="column">民族</td>
- <td class="value"></td>-->
- <!-- <td class="value" rowspan="3"><img class="portrait" src="img/img04.png" /></td> -->
- </tr>
- <tr>
- <td class="column">身份证号码</td>
- <td class="value" colspan="5">{$arr.card}</td>
- <td class="column" style="width: 2cm;">职业</td>
- <td class="value" colspan="2">{$arr.occupation}</td>
- <td class="column" style="width: 1.2cm;">学历</td>
- <td class="value" colspan="2">{$arr.education}</td>
- </tr>
- <tr>
- <!-- <td class="column">身份证号</td> -->
- {if strpos($arr.remark,'全部遗体') !== false}
- <td class="value" colspan="7">
- <div style="display: flex;align-items: center;justify-content: center;line-height: 38px;padding: 22px 0 0 0;">
- 我自愿捐献全部遗体(含器官组织)<div style="width: 14px;height: 14px;border: 1px solid #333333;margin-right: 5px;">√</div>;
- </div>
- <div style="display: flex;align-items: center;justify-content: center;padding-bottom: 22px;">
- 或只捐献眼角膜<div style="width: 14px;height: 14px;border: 1px solid #333333;margin-left: 5px;margin-right: 5px;line-height: 38px;"></div>;
- </div>
- </td>
- {else /}
- <td class="value" colspan="7">
- <div style="display: flex;align-items: center;justify-content: center;line-height: 38px;padding: 22px 0 0 0;">
- 我自愿捐献全部遗体(含器官组织)<div style="width: 14px;height: 14px;border: 1px solid #333333;margin-right: 5px;"></div>;
- </div>
- <div style="display: flex;align-items: center;justify-content: center;padding-bottom: 22px;">
- 或只捐献眼角膜<div style="width: 14px;height: 14px;border: 1px solid #333333;margin-left: 5px;margin-right: 5px;line-height: 38px;">√</div>;
- </div>
- </td>
- {/if}
- <!-- <td class="column" >联系电话</td> -->
- <td class="value" colspan="5">
- <div style="display: flex;align-items: center;justify-content: center;">
- ( 请在选项<div style="width: 14px;height: 14px;border: 1px solid #333333;margin-right: 5px;margin-left: 5px;line-height: 38px;"></div>内打√ )
- </div>
- </td>
- </tr>
- </table>
- </div>
- <div style="margin:8px auto;margin-top: 6cm;">
- <table class="table table-striped table-bordered" align="center" valign="center">
- <tr>
- <td class="column1" rowspan="2">联系电话</td>
- <!-- <td class="value" >固定电话:</td> -->
- <td class="value" colspan="1" style="width: 5.8cm;text-align: left;">固定电话:{$arr.tel}</td>
- <!-- <td class="value" colspan="2" style="width: 140px;"></td> -->
- <td class="value" rowspan="2" colspan="14"style="width: 10cm;">
- <div style="display: flex; justify-content:center;margin-left:1.8cm" >
- 我指定
- <div style="border-bottom: 1px solid #333333; width: 3cm;display:flex;justify-content:center" >{$arr.zd_name}</div>为我的遗体捐献
- </div>
- <div style="text-align: left;line-height: 38px;display: flex;justify-content:center">执行人全权负责本人的遗体捐献事宜。</div>
- </td>
-
- <!-- <td class="value" colspan="12"></td> -->
- <!-- <td class="value" colspan="3">15079506035</td> -->
- </tr>
-
- <tr>
- <td class="value" colspan="1" style="width: 5.8cm;text-align: left;">移动电话:{$arr.phone}</td>
- <!-- <td class="value" colspan="2" ></td> -->
- <!-- <td class="value" colspan="3">15079506035</td> -->
- </tr>
-
- <tr>
- <td class="column1" >居住地址</td>
- <td class="value" colspan="8">
- {$arr.address}
- </td>
- </tr>
- <tr>
- <td class="column1" >捐献执行人</td>
- <td class="value" colspan="4">{$arr.executor}</td>
- <td class="column1" >身份证号</td>
- <td class="value" colspan="4">{$arr.sfz}</td>
- </tr>
- <tr >
- <td class="column1" rowspan="2" style="height: 3cm;">与捐献志愿者关系</td>
- <td class="value" rowspan="2" colspan="4">{$arr.relation}</td>
- <td class="column1" >移动电话:</td>
- <td class="value" colspan="2">{$arr.n_phone}</td>
- </tr>
- <tr>
- <!-- <td class="value" colspan="5"></td> -->
- <td class="column1" >固定电话:</td>
- <td class="value" colspan="2">{$arr.n_tel}</td>
- <!-- <td class="value" colspan="3">15079506035</td> -->
- </tr>
- <tr>
- <td class="column1" >市红十字会地址</td>
- <td class="value" colspan="4">武汉市江岸区胜利路162号</td>
- <td class="column1" >24小时捐献电话</td>
- <td class="value" colspan="4">027-82812604</td>
- </tr>
- </table>
- </div>
-
- <div class="footer">
- 我保证填写的以上信息准确真实,如发生变更或个人意愿发生变化时,及时告知登记机构。
- </div>
- </div>
- </body>
- </html>
- <script type="text/javascript" src="./js/jquery.js"></script>
- <script>
- //一般直接写在一个js文件中
- layui.use(['layer', 'form'], function() {
- var layer = layui.layer,
- form = layui.form;
- setTimeout(function() {
- $("#EleId").hide();
- }, 5000);
- });
- </script>
- <style scoped="scoped">
- .footer{
- margin-top: 0.8cm;
- width: 26cm;
- text-align: center;
- /* margin: 0 auto; */
- }
- .header{
- width: 20cm;
- margin: 0 auto;
- margin-top: 2cm;
- display: flex;
- /* justify-content: center; */
- align-items: center;
- margin-top: 25px;
- color: #eb3223;
- margin-bottom: 1cm;
- letter: spacing 2;
- }
- .header .img{
-
- margin-left:1.24cm;
- margin-right:0.3cm;
- width: 3cm;
- height: 3cm;
-
- }
- .header .img1{
- margin-left: 0.5cm;
- }
- .header1{
- font-size: 18px;
- /* margin-top: 134px; */
- width: 1080px;
- /* height: 40px; */
- margin: 0 auto;
- display: flex;
- /* justify-content: space-around; */
- }
- .header1 .box-2{
- margin-left: 1.2cm;
- }
- .header1 .box-5{
- display: flex;
- margin-left: 1cm;
- /* width: 200px; */
- /* border-bottom: 1px solid #333; */
- }
- .header1 .box-5 .box-6{
- width: 4.2cm;
- border-bottom: 1px solid #333;
- }
- .table {
- border-collapse: collapse;
- border-spacing: 0;
- background-color: transparent;
- display: table;
- max-width: 100%;
- margin: 0 auto;
- }
- .table td {
- height: 44px;
- text-align: center;
- vertical-align: middle;
- font-size: 18px;
- font-family: 'Arial Normal', 'Arial';
- color: #333333;
- padding: 4px 12px;
- }
- .table-bordered {
- border: 1px solid #ddd;
- }
- * {
- margin: 0px;
- padding: 0px;
- }
- .info{
- width: 800px;
- margin: 0 auto;
- display: flex;
- justify-content: space-between;
- margin-top: 12px;
- font-size:16px;
- }
- .date{
- display: flex;
- justify-content: flex-end;
- }
- .gap{
- display: block;
- height: 4px;
- width: 26px;
- }
- .column {
- width: 2.5cm;
- height: 30px;
- border: 1px solid #333;
- background: #ebc5ad;
- }
- .column1 {
- width: 145px;
- height: 25px;
- border: 1px solid #333;
- background: #ebc5ad;
- }
- .box{
- border: 1px solid #333;
- }
- .column01{
- width: 100px;
- height: 15px;
- border: 1px solid #333;
- /* background: #f1f1f1; */
- }
- .checkbox{
- width: 20px;
- height: 15px;
- border: 1px solid #333;
-
- /* justify-content: center; */
- }
- .box01{
- margin-right: 3px;
- margin-left: 3px;
- }
- .tpl{
- width: 50px !important;
- height: 15px;
- border: 1px solid #333;
- background: #f1f1f1;
- }
- .tpl01{
- width: 50px !important;
- height: 15px;
- border: 1px solid #333;
- }
- .title{
- font-size: 18px !important;
- font-weight: bold;
- }
- .value {
- width: 2cm;
- height: 30px;
- border: 1px solid #333;
- }
- .value1-tip{
- border: 1px solid #333;
- }
- .value1{
- width:110px;
- display: inline-block;
- }
- .value9{
- width:550px;
- display: inline-block;
- text-align: left;
- }
- .value2{
- width:550px;
- display: inline-block;
- text-align: left;
- }
- .value3{
- width:610px;
- display: inline-block;
- text-align: left;
- }
- .value4{
- padding: 8px 0px;
- }
- .value5{
- padding-right: 180px;
- text-align: right;
- }
- .value6{
- text-align: right;
- padding: 8px 45px;
- }
- .value7{
- text-align: right;
- padding-right: 180px;
- padding-top: 10px;
- }
- .value8{
- text-align: right;
- padding: 8px 45px;
- }
- .tp{
- width: 60px;
- display: inline-block;
- }
-
- .cameraCheckBoxTop{
- margin-right: 8px;
- width: 15px;
- height: 15px;
- }
- .portrait {
- width: 100px;
- height: 100px;
- }
- .button-dayin{
- background-color: #FF0000;
- color: #FFFFFF;
- width: 200px;
- padding: 20px 0px;
- margin: 50px auto;
- text-align: center;
- font-size: 30px;
- }
- </style>
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