Mini Shell

Direktori : /home/funerariamayer/www/cms/
Upload File :
Current File : /home/funerariamayer/www/cms/cad-obituario.php

<div class="content-wrapper">
<?
$cod_empresa = $_SESSION['cod_empresa_user'];

?>
  <!-- Content Header (Page header) -->
  <section class="content-header">
    <h1>
      Obitu&aacute;rio
      <small>Preview</small>
    </h1>

  </section>


<div class="box-body">
  <div class="row">
  <div class="col-md-12">
  <div class="form-group">
  <form name="frm_cad_obituario" action="gravar-obituario" method="POST">

<div class="col-md-12">
  <div class="col-md-2">
         <label> Nome </label>
  </div>
  <div class="col-md-6">
         <input type="text" name="nome" class="form-control" placeholder="ex:Fulano de Tal">
  </div>
  <div class="col-md-4"> &nbsp; </div>
</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Data Nascimento</label>
  </div>
  <div class="col-md-2">
         <input type="date" name="data_nascimento" class="form-control" placeholder="Enter ..." onchange="calcula_idade()">
  </div>

  <div class="col-md-8"> &nbsp; </div>
</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Data Falecimento</label>
  </div>
  <div class="col-md-2">
         <input type="date" name="data_falecimento" class="form-control" placeholder="Enter ..." onchange="calcula_idade()">
  </div>

  <div class="col-md-8"> &nbsp; </div>
</div>

<script>
function calcula_idade()
{
var dataInicio = new Date(document.frm_cad_obituario.data_nascimento.value);
var dataFim = new Date(document.frm_cad_obituario.data_falecimento.value);
var diffMilissegundos = dataFim - dataInicio;
var diffSegundos = diffMilissegundos / 1000;
var diffMinutos = diffSegundos / 60;
var diffHoras = diffMinutos / 60;
var diffDias = diffHoras / 24;
var diffMeses = diffDias / 30;
var diffAnos = diffDias / 365;

document.frm_cad_obituario.idade.value = parseInt(diffAnos) ;
}
</script>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Idade</label>
  </div>
  <div class="col-md-1">
         <input type="text" name="idade" class="form-control" placeholder="">
  </div>
  <div class="col-md-10"> &nbsp; </div>
</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Vel&oacute;rio Local</label>
  </div>
  <div class="col-md-6">
         <input type="text" name="local_velorio" class="form-control" placeholder="">
  </div>
  <div class="col-md-4"> &nbsp; </div>
</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Vel&oacute;rio Data</label>
  </div>
  <div class="col-md-2">
         <input type="date" name="data_velorio" class="form-control" placeholder="Enter ...">
  </div>

  <div class="col-md-1" style="text-align:right">
         <label> Hora</label>
  </div>
  <div class="col-md-2">
         <input type="time" name="hora_velorio" class="form-control" placeholder="Enter ...">
  </div>

  <div class="col-md-5"> &nbsp; </div>
</div>




<div class="col-md-12">
  <div class="col-md-2">
         <label> Sepultamento Local</label>
  </div>
  <div class="col-md-6">
         <input type="text" name="local_sepultamento" class="form-control" placeholder="">
  </div>
  <div class="col-md-4"> &nbsp; </div>
</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Sepultamento Data</label>
  </div>
  <div class="col-md-2">
         <input type="date" name="data_sepultamento" class="form-control" placeholder="Enter ...">
  </div>

  <div class="col-md-1" style="text-align:right">
         <label> Hora</label>
  </div>
  <div class="col-md-2">
         <input type="time" name="hora_sepultamento" class="form-control" placeholder="Enter ...">
  </div>

  <div class="col-md-5"> &nbsp; </div>
</div>



<div class="col-md-12">
  <div class="col-md-2">
         <label> Cidade</label>
  </div>
  <div class="col-md-6">
         <input type="text" name="cidade" class="form-control" placeholder="">
  </div>
  <div class="col-md-4"> &nbsp; </div>
</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Bairro</label>
  </div>
  <div class="col-md-6">
         <input type="text" name="bairro" class="form-control" placeholder="">
  </div>
  <div class="col-md-4"> &nbsp; </div>
</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Filia&ccedil;&atilde;o </label>
  </div>
  <div class="col-md-6">
         <input type="text" name="filiacao" class="form-control" placeholder="">
  </div>
  <div class="col-md-4"> &nbsp; </div>
</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Filhos</label>
  </div>
  <div class="col-md-6">
         <input type="text" name="filhos" class="form-control" placeholder="">
  </div>
  <div class="col-md-4"> &nbsp; </div>
</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> C&ocirc;njuge </label>
  </div>
  <div class="col-md-6">
         <input type="text" name="conjuge" class="form-control" placeholder="">
  </div>
  <div class="col-md-4"> &nbsp; </div>
</div>



<div class="col-md-12">
  <div class="col-md-2">
         <label> Mensagem </label>
  </div>
  <div class="col-md-6">
         <textarea name="descricao" rows="8" cols="80" style="width:auto;resize:none"></textarea>
  </div>
  <div class="col-md-4"> &nbsp; </div>

</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Missa 7 dia</label>
  </div>
  <div class="col-md-6">
         <input type="text" name="local_setimo" class="form-control" placeholder="">
  </div>
  <div class="col-md-4"> &nbsp; </div>
</div>


<div class="col-md-12">
  <div class="col-md-2">
         <label> Sepultamento Data</label>
  </div>
  <div class="col-md-2">
         <input type="date" name="data_setimo" class="form-control" placeholder="Enter ...">
  </div>

  <div class="col-md-1" style="text-align:right">
         <label> Hora</label>
  </div>
  <div class="col-md-2">
         <input type="time" name="hora_setimo" class="form-control" placeholder="Enter ...">
  </div>

  <div class="col-md-4"> &nbsp; </div>
</div>





<div class="col-md-8">
        <div style="padding:10px">
          <button type="submit" class="btn btn-default">Cancel</button>
          <button type="submit" class="btn btn-info pull-right">Salvar</button>
        </div>
</div>
  </form>
  </div>
  </div>
  </div>
</div>

</div>


Zerion Mini Shell 1.0