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- <table width="100%" border="0">
- <tr>
- <td width="388" class="nomecampos">Origem:</td>
- <td width="738" >
- <select name="origem[]" id="origem[]" class="inputmenor" >
- <option value="0">SELECIONE UMA ORIGEM</option>
- <?php
- $obj = new clinica();
- $obj->selecionarbusca($busca);
- while($rowLoc=mysql_fetch_object($obj->rs)){?>
- <option value="<?php echo $rowLoc->CLINICA; ?>" <?php if($rowLoc->CODIGO == $rowLoc->origem){ ?> selected="selected" <?php } ?>><?php echo $rowLoc->CLINICA; ?></option>
- <?php } ?>
- </select>
- </td>
- </tr>
- <tr>
- <td class="nomecampos">Destino:</td>
- <td >
- <select name="destino[]" id="destino[]" class="inputmenor" >
- <option value="0">SELECIONE UM DESTINO</option>
- <?php
- $obj = new clinica();
- $obj->selecionarbusca($busca);
- while($rowLoc=mysql_fetch_object($obj->rs)){?>
- <option value="<?php echo $rowLoc->CLINICA; ?>" <?php if($rowLoc->CODIGO == $rowLoc->origem){ ?> selected="selected" <?php } ?>><?php echo $rowLoc->CLINICA; ?></option>
- <?php } ?>
- </select></td>
- </tr>
- <tr>
- <td class="nomecampos">Motivo:</td>
- <td><label>
- <textarea name="motivo[]" id="motivo[]" class="input"><?php echo $rowAcv->motivo; ?></textarea>
- </label></td>
- </tr>
- <tr>
- <td class="nomecampos">Paciente:</td>
- <td ><label>
- <input type="text" name="paciente[]" id="paciente[]" class="input" value="<?php echo $row->paciente; ?>"/>
- </label></td>
- </tr>
- <tr>
- <td align="left" class="titulo"></td>
- <td align="left" class="titulo"><br><input type="button" value="Adicionar Percurso" onClick="mais(campo.value);">
- <span class="titinterno2">Clique aqui para adicionar</span> <div id="aqui"></div></td>
- </tr>
- <div id="campos"> </div>
- </table>
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