order.html 6.1 KB

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  1. <!DOCTYPE html>
  2. <html lang="en">
  3. <head>
  4. <meta charset="UTF-8">
  5. <meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=0, minimum-scale=1.0, maximum-scale=1.0,viewport-fit=cover">
  6. <title></title>
  7. <link rel="stylesheet" href="../css/order.css">
  8. <style>
  9. body{
  10. padding: 0.2rem;
  11. position: relative;
  12. }
  13. </style>
  14. </head>
  15. <body>
  16. <div class="page">
  17. <p class="h1">IQQA精准术前三维评估及手术规划</p>
  18. <p style="font-size: 0.16rem;padding-left: 1rem;margin-top: 1.2rem;">请正确提交患者信息。</p>
  19. <div class="content">
  20. <div class="form">
  21. <div class="box">
  22. <div class="text">
  23. <p class="icon">*</p>
  24. 患者姓名:
  25. </div>
  26. <input id="iphone" value="" type="text" placeholder="患者姓名">
  27. </div>
  28. <div class="box">
  29. <div class="text">
  30. <p style="color: white; margin: auto 0;">*</p>
  31. 就诊医院:
  32. </div>
  33. <input style="width: 12rem;" id="" value="" type="text" placeholder="">
  34. </div>
  35. <div class="box">
  36. <div class="text">
  37. <p style="color: white; margin: auto 0;">*</p>
  38. 就诊科室:
  39. </div>
  40. <input style="width: 8rem;" id="" value="" type="text" placeholder="胸外科">
  41. </div>
  42. <div class="box">
  43. <div class="text">
  44. <p style="color: white; margin: auto 0;">*</p>
  45. 就诊医生:
  46. </div>
  47. <input style="width: 8rem;" id="" value="" type="text" placeholder="">
  48. </div>
  49. </div>
  50. <p class="h2">请告诉我们您的联系方式,使我们能够及时通知到您服务的进度。</p>
  51. <div class="form">
  52. <p id="warn" style="color: red; display: none;">手机号码必须要填写!</p>
  53. <div class="box">
  54. <div class="text">
  55. <p class="icon">*</p>
  56. 联系人:
  57. </div>
  58. <input type="text" placeholder="用户姓名">
  59. </div>
  60. <div class="box">
  61. <div class="text">
  62. <p class="icon">*</p>
  63. 联系电话:
  64. </div>
  65. <input id="iphone" value="" type="text" maxlength="11" placeholder="手机号码">
  66. </div>
  67. <div class="box">
  68. <div class="text">
  69. <p style="color: white; margin: auto 0;">*</p>
  70. 验证码:
  71. </div>
  72. <input class="code" type="text" placeholder="验证码">
  73. <button>获取验证码</button>
  74. </div>
  75. <div class="box">
  76. <div class="text">
  77. <p style="color: white; margin: auto 0;">*</p>
  78. 邮寄地址:
  79. </div>
  80. <input style="width: 8rem;" id="" value="" type="text" placeholder="">
  81. </div>
  82. </div>
  83. </div>
  84. <div>
  85. <p style="font-size: 0.85rem;">服务项目:器官三维重建&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;3900元</p>
  86. </div>
  87. <div class="button">
  88. <button id="buy">立即提交</button>
  89. </div>
  90. </div>
  91. <div class="mask" style="display: block;">
  92. <div class="shade">
  93. <div class="top">
  94. <p class="h3">技术服务自愿购买声明</p>
  95. </div>
  96. <div class="declare">
  97. <div class="declare-box">
  98. <p class="p1">《服务免责声明》</p>
  99. <p class="p2">基于医学领域的有关规定,疾病的诊断、治疗等均应以专业的临床执业医师的意见及决定为准,本服务所提供的技术服务内容仅供患者的专业诊疗医生参考使用,因此不承担因为诊断结论错误或治疗方案不当而引发的医疗纠纷和事故责任。</p>
  100. </div>
  101. <div class="declare-box">
  102. <p class="p1">《服务购买者声明和授权》</p>
  103. <p class="p2">本人为患者本人(或患者的代理人),本服务属于患者(或其代理人)自愿自费购买的第三方技术服务,并承诺所提供的信息真实可靠。本人同意并授权技术服务提供方对患者的影像数据进行存储传输及处理。</p>
  104. </div>
  105. <label class="check">
  106. <input id="check" type="checkbox">
  107. <p>已阅读并同意以上声明内容</p>
  108. </label>
  109. <div id="button" class="bottom disabled">
  110. <button>确定</button>
  111. </div>
  112. </div>
  113. </div>
  114. </div>
  115. </body>
  116. <script type="text/javascript" src="../js/jquery.min.js"></script>
  117. <script src="../js/distpicker.data.min.js"></script>
  118. <script src="../js/distpicker.min.js"></script>
  119. <script>
  120. let isMaskClick = false;// 是否允许点击弹窗确认按钮
  121. // 单选框
  122. $("#check").on('change',function(e){
  123. isMaskClick = $(e)[0].currentTarget.checked;
  124. $('.bottom').attr('class','bottom '+(isMaskClick?'':'disabled'))
  125. })
  126. $("#button").click(function(){
  127. if(!isMaskClick) return;
  128. $(".mask").css("display",'none')
  129. })
  130. // 点击跳转付款
  131. $("#buy").click(function() {
  132. $(location).attr('href', 'https://qr.95516.com/01020001/wcqr?f=ICBCqr&X=1&T=3&P=13&I=e03d925776684b4d&N=eda2cd4a81a690c8a44f6a1288309c1b&L=36ad66c7d4f1df99ad431122ec6b4d0774e38c3de3782b4392089929f8cc79095b600d358c26ac3ae82f054450ffda778601187d6463813cfdaf2738b54b60765aed8ef16cfc24ee');
  133. })
  134. </script>
  135. </html>