<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1" /> 
<?php include("header.php")?>
<?php include("conexionOdo.php")?>
<?php include("select.php")?>

<table align="center">
    <form name="cedula" action="locPaciente.php" method="POST" ENCTYPE="multipart/form-data">
     <table align="center" width="960" border="0">
       <tr><td><br></td></tr>
     </table> 
     
     <table align="center" width="960">
          <tr class="camposLista">
            <td width="100%"  align="center"><span class="icon-user-plus" style="font-size:20px; color:rgba(41, 128, 185, 1);"> <span style="font-size:20px; font-family:Arial; color:#e67e22;"> CONSULTA DE URGENCIAS </span> </span></td> 
            
          </tr>
     </table>

     <table align="center" width="960" border="1">
       <tr>
          <td class="titulosTabla">PACIENTE</td>
          <td class="titulosTabla" colspan="3">CONSULTA</td>
       <tr>
              
       <tr>
         <td rowspan="3">
            <table align="center" border="0">
              <tr>
                 <td class="negritaAzul" align="center" colspan="2" >Ingrese el Tipo y No. de Identificaci&oacute;n del Paciente</td>
              </tr>
              <tr>
                 <td align="center" colspan="2">
                   <select name="tipoId" id="tipoId" style="width:200px;">
                      <option value="CC">C&eacute;dula de Ciudadania</option>
                      <option value="TI">Tarjeta de Identidad</option>
                      <option value="PP">Pasaporte</option>
                      <option value="CE">C&eacute;dula de Extranjeria</option>
                      <option value="RC">Registro Civil</option>
                   </select>
                 </td>
              </tr>
      
              <tr>
                <td colspan="3" align="center" ><input style="width:200px; height:35px;" name="identifica" type="number" size="30" maxlength="15" required/></td>
              </tr>
            </table>
         </td>
    </table>     
         

     <table align="center" width="960" border="1">
       <tr>
         <td class="titulosTabla">DATOS DEL ACOMPA&Ntilde;ANTE PARA ESTA CITA*</td>
         <td class="titulosTabla" colspan="3">CONSULTA</td>
       <tr>   
       <tr>
         <td rowspan="3">
            <table align="center" border="0">
              
              <tr>  
                <td class="negritaAzul" align="left">Acompa&ntilde;ante</td>
                <td><textarea rows="1" class="style-1" cols="35" wrap="soft" name="famResponsable" id="famResponsable"></textarea></td>
              </tr>
              <tr>  
                <td class="negritaAzul" align="left">Parentesco</td>
                <td  class="camposTabla"><textarea rows="1" class="style-1" cols="35" wrap="soft" name="parentesco" id="parentesco"></textarea></td>
              </tr>  
              <tr>  
                <td class="negritaAzul" align="left">Tel&eacute;fonos</td>
                <td  class="camposTabla"><textarea  class="style-1" rows="1" cols="35" wrap="soft" name="telPariente" id="telPariente"></textarea></td>
              </tr>
              <tr><td colspan="3" class="negrita">*Para menores de edad</td></tr>
            </table>
         </td>
         <td class="negritaAzul" align="left" colspan="2" >Seleccione el tipo de consulta</td>
         <td colspan="3" align="left">
            <select name="tipoCon" style="width:300px;" required>
              <?php echo $comboTipo1; ?>
            </select>
         </td>
       </tr>
       
       <tr>
         <td class="negritaAzul" align="left" colspan="2" >Seleccione la causa de la consulta</td>
         <td colspan="2" align="center" class="camposTabla">
           <select name="codCausa" style="width:300px" required>
            <?php echo $comboCausa1; ?>
           </select>
         </td>
       </tr>
       
       <tr>  
         <td class="negritaAzul" align="left" colspan="2" >Seleccione la entidad administradora</td>
         <td colspan="2" align="center" class="camposTabla">
           <select name="codEntidad" style="width:300px" required>
             <?php echo $comboEntidad1; ?>
           </select>
         </td>
       </tr> 
     </table>
    <div style="diaplay:none;">
      <input style="visibility:hidden" name="lin1" id="lin1" value="<?=$s_lin?>"/>
     </div>       
   </form>
</body>
<html>