<div class="container">
<div class="row">
<div class="col-md-9">

<head>
  <!-- Manda a traer el javascript para validar el formulario -->
  <script type="text/javascript" src="<?php echo base_url()?>assets/dist/js/site.js"></script>
  <link rel="stylesheet" href="<?php echo base_url().'assets/dist/css/validacion.css'?>">
</head>
<form action="<?php echo base_url();?>index.php/accionesexpediente/guardar" method="POST">


<table class="table table-striped">
<tr class="row1"><td><strong>Id Cliente:</strong></td>   <td><strong>Id Expediente </strong></td></tr>
  <tr class="row2">
    <td>
    <input type="text" class="form-control" id="name1" name="IdCliente" maxlength='11' placeholder="Id Cliente" required>
    
    </td>
    <td>
      <input type="text" class="form-control" id="name1" name="IdExpediente" maxlength='11' placeholder="Id Expediente" required>
    </td>
  </tr>
  <tr class="row1">
    <td colspan="2"><strong>Tratamiento</strong>
    </td>
  </tr>

  <tr class="row2">
    <td colspan="2">
      <label> Facial  <input type="checkbox" name="chek_tratamiento" value=" Facial " > </label> &nbsp; &nbsp;  &nbsp;
      <label>E-light <input type="checkbox" name="chek_tratamiento" value=" E-light " > </label>&nbsp; &nbsp;  &nbsp;
      <label>Reductivo<input type="checkbox" name="chek_tratamiento" value=" Reductivo " ></label> &nbsp; &nbsp;  &nbsp;
    </td>
  </tr>
  
  <tr class="row1"><td><strong>¿Está bajo supervisión médica?</strong></td>   <td><strong>Tratamiento Médico: </strong></td></tr>
  <tr class="row2">
    <td>
      Si <input type="radio" name="supmed_radio" value="1"> 
      No <input type="radio" name="supmed_radio" value="0" > 
    </td>
    <td>
      Si <input type="radio" name="tratmed_radio" value="1"> 
      No <input type="radio" name="tratmed_radio" value="0" checked="checked"><br> 
      ¿Cuáles? <input type="text" class="form-control" id="name1" name="cual_tratmed" maxlength='11' placeholder="Tratamiento Médicoo">
    </td>
  </tr>
  
  <tr class="row1"><td><strong>Tratamiento Quirúrgico:</strong></td><td><strong>¿Ha padecido alergías?</strong></td></tr>
  <tr class="row2">
    <td>
      Si <input type="radio" name="tratqui_radio" value="1"> 
      No <input type="radio" name="tratqui_radio" value="0" checked="checked"> <br> 
      ¿Cuál? <input type="text" class="form-control" id="name1" name="cual_tratqui" maxlength='11' placeholder="Tratamiento quirurjico">
    </td>
    <td>
      Si <input type="radio" name="alergias_radio" value="1"> 
      No <input type="radio" name="alergias_radio" value="0" checked="checked"><br> 
      ¿Cuáles?<input type="text" class="form-control" id="name1" name="cual_alergias" maxlength='11' placeholder="Tratamiento quirurjico">
    </td>
  </tr>

  <tr class="row1">
    <td colspan="2"><strong>Tache las enfermedades que ha padecido</strong></td>
  </tr>

  <tr class="row2">
    <td colspan="2">
      Diabetes <input type="checkbox" name="diabetes_chek" value="1">&nbsp;&nbsp;&nbsp;
      Cardiopatías <input type="checkbox" name="corazon_chek" value="1">&nbsp;&nbsp;&nbsp;
      Hipertensión <input type="checkbox" name="hipertension_chek" value="1">&nbsp;&nbsp;&nbsp;
      Hipotensión <input type="checkbox" name="hipotension_chek" value="1">&nbsp;&nbsp;&nbsp;
      Herpes <input type="checkbox" name="herpes_chek" value="1">&nbsp;&nbsp;&nbsp;
      Cáncer <input type="checkbox" name="cancer_chek" value="1">&nbsp;&nbsp;&nbsp;
      Artritis <input type="checkbox" name="artritis_chek" value="1">&nbsp;&nbsp;&nbsp;
      Hepatitis <input type="checkbox" name="hepatitis_chek" value="1">&nbsp;&nbsp;&nbsp;
    </td>
  </tr>
  
  <tr class="row1">
    <td><strong>Cirugías Plásticas</strong></td>
    <td><strong>Implantes</strong></td>
  </tr>
  <td>
      Si <input type="radio" name="cirpla_radio" value="1"> 
      No <input type="radio" name="cirpla_radio" value="0" checked="checked"> 
     
    </td>
    <td>
      Si <input type="radio" name="implantes_radio" value="1"> 
      No <input type="radio" name="implantes_radio" value="0" checked="checked"><br> 
    
    </td>
  
  <tr class="row1">
    <td><strong>Desajustes oseos</strong></td>
    <td><strong>Medicamentos en los últimos 6 meses</strong></td>
  </tr>
  <td>
      Si <input type="radio" name="desose_radio" value="1"> 
      No <input type="radio" name="desose_radio" value="0" checked="checked"> 
     
    </td>
    <td>
      Si <input type="radio" name="medicamentos_radio" value="1"> 
      No <input type="radio" name="medicamentos_radio" value="0" checked="checked"><br> 
    
    </td>
  
  <tr class="row1">
    <td colspan="2"><strong>Autorización médica</strong></td>
  </tr>
  <td>
      Si <input type="radio" name="autmed_radio" value="1"> 
      No <input type="radio" name="autmed_radio" value="0" checked="checked"> 
     
    </td>
    
  <tr class="row1">
    <td colspan="2"><strong>Diagnóstico y observaciones</strong></td>
  </tr>
  <tr class="row2">
    <td colspan="2" align="center"> <textarea class="form-control" rows="6" id="name1" name="diayobs"  ></textarea></td>
  </tr>
  
  <tr class="row1">
    <td colspan="2"><strong>Corporal</strong></td>
  </tr>
  <tr><td colspan="2">
    <table class="table table-striped">
          <table class="table table-striped"><tr>
            <th>Fecha</th>
            <th>Espalda</th>
            <th>Busto</th>
            <th>Abdomen</th>
            <th>Cintura</th>
            <th>C. alta</th>
            <th>C. baja</th>
            <th>P. Der.</th>
            <th>P. Izq.</th>
            <th>B. Der.</th>
            <th>B. Izq</th>
            <th>Peso</th>
          </tr>
    
    <tr class="row2">
      <td><a id="button_date_red"><input name="fecha_r" id="fecha_r" type="text" style="width: 100%"></a></td>
      <td><input type="text" style="width: 100%" name="espalda"></td>
      <td><input type="text" style="width: 100%" name="busto"></td>
      <td><input type="text" style="width: 100%" name="abdomen"></td>
      <td><input type="text" style="width: 100%" name="cintura"></td>
      <td><input type="text" style="width: 100%" name="calta"></td>
      <td><input type="text" style="width: 100%" name="cbaja"></td>
      <td><input type="text" style="width: 100%" name="pder"></td>
      <td><input type="text" style="width: 100%" name="pizq"></td>
      <td><input type="text" style="width: 100%" name="bder"></td>
      <td><input type="text" style="width: 100%" name="bizq"></td>
      <td><input type="text" style="width: 100%" name="peso"></td>
    </tr>
  </table></table></td></tr>
  <tr class="row1">
    <td colspan="2"><strong>E-light</strong></td>
  </tr>
  <tr><td colspan="2"><table>
    
        <table class="table table-striped"><tr>
          <th>Sesión</th>
          <th>Zona</th>
          <th>Potencia</th>
          <th>Disparos</th>
          <th>Observaciones</th>
        </tr>
      
    <tr class="row2">
      <td><input type="text" style="width: 100%" name="sesion_e"></td>
      <td><input type="text" style="width: 100%" name="zona_e"></td>
      <td><input type="text" style="width: 100%" name="potencia_e"></td>
      <td><input type="text" style="width: 100%" name="disparos_e"></td>
      <td><input type="text" style="width: 100%" name="observaciones_e"></td>
    </tr>
  </table></table></td></tr>
  
  <tr class="row1">
    <td colspan="2"><strong>Facial</strong></td>
  </tr>
  <tr><td colspan="2"><table>
    
       <table class="table table-striped"><tr>
          <th>Fecha</th>
          <th>Tratamiento</th>
          <th>Productos</th>
        </tr>
      
    <tr class="row2">
      <td><a id="fecha_f_button"><input type="text" style="width: 100%" name="fecha_f" id="fecha_f"></a></td>
      <td><input type="text" style="width: 100%" name="trafac"></td>
      <td><input type="text" style="width: 100%" name="profac"></td>
    </tr>
  </table></table></td></tr>
  <!--<tr class="row1" align="left">
    <td>Sintoma</td>
  </tr>
  <tr class="row2" align="center">
    <td><textarea class="width100" cols="15" rows="3" name="sintoma"></textarea><br></td>
  </tr>
  
  <tr class="row1" align="left">
    <td>Padecimiento</td>
  </tr>
  <tr class="row2" align="center">
    <td><textarea class="width100" cols="15" rows="1" name="padecimiento"></textarea></td>
  </tr>
  
  <tr class="row1" align="left">
    <td>Grado</td>
  </tr>
  <tr class="row2" align="center">
    <td><table border=0 cellspacing=0 cellpadding=0 width=80%>
 <tr>
  <td style="text-align: right;">1</td><td><input name="grado" value="1" type="radio"></td>
  <td style="text-align: right;">2</td><td><input name="grado" value="2" type="radio"></td>
  <td style="text-align: right;">3</td><td><input name="grado" value="3" type="radio"></td>
  <td style="text-align: right;">4</td><td><input name="grado" value="4" type="radio"></td>
  <td style="text-align: right;">5</td><td><input name="grado" value="5" type="radio"></td>
  <td style="text-align: right;">6</td><td><input name="grado" value="6" type="radio"></td>
  <td style="text-align: right;">7</td><td><input name="grado" value="7" type="radio"></td>
  <td style="text-align: right;">8</td><td><input name="grado" value="8" type="radio"></td>
  <td style="text-align: right;">9</td><td><input name="grado" value="9" type="radio"></td>
  <td style="text-align: right;">10</td><td><input name="grado" value="10" type="radio"></td>
 <tr>
</table>
<br></td>
  </tr>-->
  
  <tr class="row1" align="left"> <td colspan="2">
      <strong>Historia</strong></td>
  </tr> 
<tr class="row2" align="center">
    <td colspan="2"> 
    <textarea class="form-control" rows="6" id="name1" name="historia"  > </textarea>
        <br>
    </td>
</tr>
<tr class="" align="center"> 
    <td class="row1" colspan="2" rowspan="1"> 
        <button type="submit" class="btn btn-primary">Guardar</button>
  <a href="<?php echo base_url();?>clientes/administrador/clienteA/editar?>"><button type="button" class="btn btn-primary">Cancelar</button></a>
</form>
    </td> 

 </tr> 
</table>
</div>
</div>
</div>
