<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" 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>
         <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 $comboTipo; ?>
            </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 $comboCausa; ?>
           </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 $comboEntidad; ?>
           </select>
         </td>
       </tr> 
     </table>
      
     
     <table align="center" border="0">
      <tr>
         <td align = "center"> 
           <a href=menuOpciones.php?lin=<?=$s_lin?> title="Men&uacute; Principal"><img src="imagenes/btnVol.jpg"></a>
         </td>
         
         <td align="center"><input type="image" src="imagenes/btnCont.jpg"></td>     
           
      </tr>
    </table>
    <div style="diaplay:none;">
      <input style="visibility:hidden" name="lin1" id="lin1" value="<?=$s_lin?>"/>
     </div>       
   </form>
</body>
<html>