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19 KiB
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19 KiB
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<view class="edit-container data-v-47b8e7b0"><view wx:if="{{a}}" class="loading-state data-v-47b8e7b0"><text class="data-v-47b8e7b0">加载中...</text></view><view wx:else class="form-wrapper data-v-47b8e7b0"><view class="form-section data-v-47b8e7b0"><text class="section-title data-v-47b8e7b0">填写就诊人信息</text><view class="form-row data-v-47b8e7b0"><view class="form-col-left data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0">姓名：</text><input class="form-input-inline data-v-47b8e7b0" placeholder="请输入姓名" maxlength="50" value="{{b}}" bindinput="{{c}}"/></view><view class="form-col-right data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0"><text class="required data-v-47b8e7b0">*</text>性别：</text><view class="gender-inline data-v-47b8e7b0"><view class="{{['gender-radio', 'data-v-47b8e7b0', e && 'active']}}" bindtap="{{f}}"><text class="radio-icon data-v-47b8e7b0">{{d}}</text><text class="data-v-47b8e7b0">男</text></view><view class="{{['gender-radio', 'data-v-47b8e7b0', h && 'active']}}" bindtap="{{i}}"><text class="radio-icon data-v-47b8e7b0">{{g}}</text><text class="data-v-47b8e7b0">女</text></view></view></view></view><view class="form-row-single data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0">证件类型：</text><text class="form-value data-v-47b8e7b0">身份证号</text></view><view class="form-row data-v-47b8e7b0"><view class="form-col-large data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0">证件号码：</text><input class="form-input-inline data-v-47b8e7b0" placeholder="需实名就诊" maxlength="18" style="width:339rpx" bindblur="{{j}}" value="{{k}}" bindinput="{{l}}"/></view><view class="form-col-small data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0">年龄：</text><input class="form-input-inline data-v-47b8e7b0" style="padding:12rpx 6rpx" disabled placeholder="" value="{{m}}" bindinput="{{n}}"/></view></view><view class="form-tip data-v-47b8e7b0">仅自己可见,会隐藏保护</view></view><view class="form-section data-v-47b8e7b0"><view class="form-row-single data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0"><text class="required data-v-47b8e7b0">*</text>就诊人体重：</text><input class="form-input-inline data-v-47b8e7b0" type="digit" placeholder="请填写体重(数值)" value="{{o}}" bindinput="{{p}}"/><text class="form-unit data-v-47b8e7b0">KG(千克)</text></view><view class="form-row-single data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0"><text class="required data-v-47b8e7b0">*</text>就诊人身高：</text><input class="form-input-inline data-v-47b8e7b0" type="digit" placeholder="请填写身高(数值)" value="{{q}}" bindinput="{{r}}"/><text class="form-unit data-v-47b8e7b0">CM(厘米)</text></view><view class="form-row-single data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0">就诊人血压(高压)：</text><input class="form-input-inline data-v-47b8e7b0" type="number" placeholder="请填写高压(数值)" value="{{s}}" bindinput="{{t}}"/><text class="form-unit data-v-47b8e7b0">mmHg</text></view><view class="form-row-single data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0">就诊人血压(低压)：</text><input class="form-input-inline data-v-47b8e7b0" type="number" placeholder="请填写低压(数值)" value="{{v}}" bindinput="{{w}}"/><text class="form-unit data-v-47b8e7b0">mmHg</text></view><view class="form-row-single data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0"><text class="required data-v-47b8e7b0">*</text>空腹血糖：</text><input class="form-input-inline data-v-47b8e7b0" type="digit" placeholder="请填写空腹血糖(数值)" required value="{{x}}" bindinput="{{y}}"/><text class="form-unit data-v-47b8e7b0">mmol/L</text></view></view><view class="form-section data-v-47b8e7b0"><view class="form-row-single data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">1、</text><text class="form-labels data-v-47b8e7b0"><text class="required data-v-47b8e7b0">*</text>发现糖尿病患病史</text><input class="form-input-inline data-v-47b8e7b0" type="text" maxlength="50" placeholder="如：5、1年、半年" value="{{z}}" bindinput="{{A}}"/></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">2、</text><text class="form-labels data-v-47b8e7b0"><text class="required data-v-47b8e7b0">*</text>当地医院诊断结果</text></view><view class="button-grid data-v-47b8e7b0"><view class="{{['grid-button', 'data-v-47b8e7b0', B && 'active']}}" bindtap="{{C}}"> 糖尿病 </view><view class="{{['grid-button', 'data-v-47b8e7b0', D && 'active']}}" bindtap="{{E}}"> 消渴病 </view></view><view class="button-grid-single data-v-47b8e7b0"><view class="{{['grid-button', 'data-v-47b8e7b0', F && 'active']}}" bindtap="{{G}}"> 糖尿病前期 </view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">3、</text><text class="form-labels data-v-47b8e7b0"><text class="required data-v-47b8e7b0">*</text>当地就诊医院名称</text></view><input class="form-input-full data-v-47b8e7b0" placeholder="请填写当地就诊医院名称(全称)" maxlength="100" value="{{H}}" bindinput="{{I}}"/></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">4、</text><text class="form-labels data-v-47b8e7b0"><text class="required data-v-47b8e7b0">*</text>当地医院就诊时间</text></view><view class="date-input-full data-v-47b8e7b0" bindtap="{{K}}"><text class="date-icon-left data-v-47b8e7b0">🕐</text><text class="date-text data-v-47b8e7b0">{{J}}</text><text class="date-arrow data-v-47b8e7b0">›</text></view></view></view><view class="form-section data-v-47b8e7b0"><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">5、</text><text class="form-labels data-v-47b8e7b0">口腔感觉</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{L}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">6、</text><text class="form-labels data-v-47b8e7b0">饮食情况</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{M}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">7、</text><text class="form-labels data-v-47b8e7b0">每日饮水量</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{N}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">8、</text><text class="form-labels data-v-47b8e7b0">体重变化</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{O}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">9、</text><text class="form-labels data-v-47b8e7b0">脂肪肝程度</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{P}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">10、</text><text class="form-labels data-v-47b8e7b0">肢体感觉</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{Q}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">11、</text><text class="form-labels data-v-47b8e7b0">睡眠情况</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{R}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">12、</text><text class="form-labels data-v-47b8e7b0">眼睛情况</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{S}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">13、</text><text class="form-labels data-v-47b8e7b0">头部感觉</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{T}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">14、</text><text class="form-labels data-v-47b8e7b0">出汗情况</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{U}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">15、</text><text class="form-labels data-v-47b8e7b0">皮肤情况</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{V}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">16、</text><text class="form-labels data-v-47b8e7b0">小便情况</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{W}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">17、</text><text class="form-labels data-v-47b8e7b0">大便情况</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{X}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-item-block data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">18、</text><text class="form-labels data-v-47b8e7b0">腰肾情况</text></view><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{Y}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view></view><view class="form-section data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">20、</text><text class="form-labels data-v-47b8e7b0">既往史</text></view><view class="form-group data-v-47b8e7b0"><view class="button-grid-three data-v-47b8e7b0"><view wx:for="{{Z}}" wx:for-item="item" wx:key="b" class="{{['grid-button', 'data-v-47b8e7b0', item.c && 'active']}}" bindtap="{{item.d}}">{{item.a}}</view></view></view><view class="form-group data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">21、</text><text class="form-labels data-v-47b8e7b0">外伤史</text></view><view class="radio-group data-v-47b8e7b0"><view class="{{['radio-item', 'data-v-47b8e7b0', aa && 'active']}}" bindtap="{{ab}}"> 有 </view><view class="{{['radio-item', 'data-v-47b8e7b0', ac && 'active']}}" bindtap="{{ad}}"> 无 </view></view></view><view class="form-group data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">22、</text><text class="form-labels data-v-47b8e7b0">手术史</text></view><view class="radio-group data-v-47b8e7b0"><view class="{{['radio-item', 'data-v-47b8e7b0', ae && 'active']}}" bindtap="{{af}}"> 有 </view><view class="{{['radio-item', 'data-v-47b8e7b0', ag && 'active']}}" bindtap="{{ah}}"> 无 </view></view></view><view class="form-group data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">23、</text><text class="form-labels data-v-47b8e7b0">过敏史</text></view><view class="radio-group data-v-47b8e7b0"><view class="{{['radio-item', 'data-v-47b8e7b0', ai && 'active']}}" bindtap="{{aj}}"> 有 </view><view class="{{['radio-item', 'data-v-47b8e7b0', ak && 'active']}}" bindtap="{{al}}"> 无 </view></view></view><view class="form-group data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">24、</text><text class="form-labels data-v-47b8e7b0">家族病史</text></view><view class="radio-group data-v-47b8e7b0"><view class="{{['radio-item', 'data-v-47b8e7b0', am && 'active']}}" bindtap="{{an}}"> 有 </view><view class="{{['radio-item', 'data-v-47b8e7b0', ao && 'active']}}" bindtap="{{ap}}"> 无 </view></view></view><view class="form-group data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">25、</text><text class="form-labels data-v-47b8e7b0">妊娠哺乳史</text></view><view class="radio-group data-v-47b8e7b0"><view class="{{['radio-item', 'data-v-47b8e7b0', aq && 'active']}}" bindtap="{{ar}}"> 有 </view><view class="{{['radio-item', 'data-v-47b8e7b0', as && 'active']}}" bindtap="{{at}}"> 无 </view></view></view></view><view class="form-section data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">26、</text><text class="form-labels data-v-47b8e7b0">舌苔照片</text></view><view class="upload-layout data-v-47b8e7b0"><view class="upload-left data-v-47b8e7b0"><view wx:if="{{av}}" class="image-list data-v-47b8e7b0"><view wx:for="{{aw}}" wx:for-item="img" wx:key="d" class="image-preview data-v-47b8e7b0"><image src="{{img.a}}" mode="widthFix" class="preview-image data-v-47b8e7b0"/><view class="image-actions data-v-47b8e7b0"><text class="action-btn data-v-47b8e7b0" bindtap="{{img.b}}">预览</text><text class="action-btn delete data-v-47b8e7b0" bindtap="{{img.c}}">删除</text></view></view></view><view wx:if="{{ax}}" class="upload-btn-single data-v-47b8e7b0" bindtap="{{az}}"><uni-icons wx:if="{{ay}}" class="data-v-47b8e7b0" u-i="47b8e7b0-0" bind:__l="__l" u-p="{{ay}}"></uni-icons></view></view></view></view><view class="form-section data-v-47b8e7b0"><view class="form-label-block data-v-47b8e7b0"><text class="form-label-number data-v-47b8e7b0">27、</text><text class="form-labels data-v-47b8e7b0">检查报告</text></view><text class="form-label-tip data-v-47b8e7b0">请上传线下就诊检查报告、病历、彩超等彩像科检查图片</text><view class="upload-layout data-v-47b8e7b0"><view class="upload-left data-v-47b8e7b0"><view wx:if="{{aA}}" class="image-list data-v-47b8e7b0"><view wx:for="{{aB}}" wx:for-item="img" wx:key="d" class="image-preview data-v-47b8e7b0"><image src="{{img.a}}" mode="widthFix" class="preview-image data-v-47b8e7b0"/><view class="image-actions data-v-47b8e7b0"><text class="action-btn data-v-47b8e7b0" bindtap="{{img.b}}">预览</text><text class="action-btn delete data-v-47b8e7b0" bindtap="{{img.c}}">删除</text></view></view></view><view wx:if="{{aC}}" class="upload-btn-single data-v-47b8e7b0" bindtap="{{aE}}"><uni-icons wx:if="{{aD}}" class="data-v-47b8e7b0" u-i="47b8e7b0-1" bind:__l="__l" u-p="{{aD}}"></uni-icons></view></view></view></view><view class="form-section data-v-47b8e7b0"><view class="form-group data-v-47b8e7b0"><text class="form-label data-v-47b8e7b0">备注</text><block wx:if="{{r0}}"><textarea class="form-textarea data-v-47b8e7b0" placeholder="请输入备注" maxlength="500" value="{{aF}}" bindinput="{{aG}}"/></block></view></view><view class="button-fixed data-v-47b8e7b0"><view class="agreement-section data-v-47b8e7b0"><view class="agreement-radio-group data-v-47b8e7b0"><view class="radio-option data-v-47b8e7b0" bindtap="{{aO}}"><view class="{{['radio-icon', 'data-v-47b8e7b0', aI && 'checked']}}"><view wx:if="{{aH}}" class="radio-dot data-v-47b8e7b0"></view></view><text class="radio-label data-v-47b8e7b0">是</text><view class="radio-option data-v-47b8e7b0" bindtap="{{aL}}"><view class="{{['radio-icon', 'data-v-47b8e7b0', aK && 'checked']}}"><view wx:if="{{aJ}}" class="radio-dot data-v-47b8e7b0"></view></view><text class="radio-label data-v-47b8e7b0">否</text></view><text class="agreement-text data-v-47b8e7b0"> 我已阅读并同意 <text class="agreement-link data-v-47b8e7b0" catchtap="{{aM}}">《互联网诊疗知情同意书》</text> 及 <text class="agreement-link data-v-47b8e7b0" catchtap="{{aN}}">《中药委托加工和配送协议》</text></text></view></view></view><button class="btn btn-submit data-v-47b8e7b0" bindtap="{{aQ}}" disabled="{{aR}}">{{aP}}</button></view></view><view wx:if="{{aS}}" class="date-picker-overlay data-v-47b8e7b0"><view class="date-picker-container data-v-47b8e7b0"><view class="date-picker-header data-v-47b8e7b0"><text class="date-btn-cancel data-v-47b8e7b0" bindtap="{{aT}}">取消</text><text class="date-btn-confirm data-v-47b8e7b0" bindtap="{{aU}}">确定</text></view><block wx:if="{{r0}}"><picker-view value="{{aY}}" bindchange="{{aZ}}" class="date-picker-view data-v-47b8e7b0"><picker-view-column class="data-v-47b8e7b0"><view wx:for="{{aV}}" wx:for-item="year" wx:key="b" class="picker-item data-v-47b8e7b0">{{year.a}}</view></picker-view-column><picker-view-column class="data-v-47b8e7b0"><view wx:for="{{aW}}" wx:for-item="month" wx:key="b" class="picker-item data-v-47b8e7b0">{{month.a}}</view></picker-view-column><picker-view-column class="data-v-47b8e7b0"><view wx:for="{{aX}}" wx:for-item="day" wx:key="b" class="picker-item data-v-47b8e7b0">{{day.a}}</view></picker-view-column></picker-view></block></view></view></view> |