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signup3.htm
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<!DOCTYPE html>
<html lang="zh-Hant" class="no-js">
<head>
<meta name="robots" content="noindex" />
<!-- 使用 noindex 禁止 Google 搜尋建立索引，套版時請工程師刪掉這行 -->
<meta charset="utf-8" />
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<meta name="viewport" content="width=device-width, initial-scale=1" />
<title>臺北市社區疫苗接種系統</title>
<!--HTML5 Shim and Respond.js IE8 support of HTML5 elements and media queries [if lt IE 9]>
<script src="js/html5shiv.js"></script>
<script src="js/respond.min.js"></script>
<![endif]-->
<!-- slick css-->
<link rel="stylesheet" type="text/css" href="vendor/slick/slick.css" />
<link rel="stylesheet" type="text/css" href="vendor/slick/slick-theme.css" />
<!-- fancybox -->
<link rel="stylesheet" href="vendor/fancybox/fancybox.css" />
<!-- hyUI css -->
<link rel="stylesheet" href="css/hyui.css" />
<!-- favicon -->
<link href="images/favicon.png" rel="icon" type="image/x-icon" />
</head>
<body>
<!-- 直接跳主內容區 -->
<a class="goCenter" href="#center" tabindex="1">按Enter到主內容區</a>
<!-- wrapper Start -->
<div class="wrapper">
<!-- header Start -->
<header class="header">
<div class="container">
<a class="accesskey" href="#aU" id="aU" accesskey="U" title="網站標題" tabindex="2">:::</a>
<h1>
<a href="index.htm"><img src="images/logo.png" alt="臺北市社區疫苗接種系統" /></a>
</h1>
<!-- navigation Start -->
<nav class="navigation" role="navigation" aria-label="個人資訊">
<!-- Search Start -->
<div class="searchblock">
<button type="button" class="searchbtn">個人資訊</button>
<div class="searchcontent">
<div class="search">
<ul>
<li>
<button class="btn"><i class="i_man"></i>個人資訊</button>
</li>
<li>
<button class="btn"><i class="i_edit"></i>修改密碼</button>
</li>
<li>
<button class="btn"><i class="i_edit"></i>更新簽名檔</button>
</li>
<li>
<button class="btn btn-logout"><i class="i_logout"></i>登出系統</button>
</li>
</ul>
</div>
</div>
</div>
<!-- Search End -->
</nav>
<!-- navigation End -->
<!-- menu Start -->
<nav class="menu" role="navigation" aria-label="Header的導航列">
<ul>
<li>
<a href="#">所有場次</a>
<ul>
<li><a href="#">第二層選單</a></li>
<li>
<a href="#">第二層選單</a>
<ul>
<li><a href="#">第三層選單</a></li>
<li><a href="#">第三層選單</a></li>
</ul>
</li>
<li><a href="#">第二層選單</a></li>
<li><a href="#">第二層選單</a></li>
</ul>
</li>
<li>
<a href="#">今日場次</a>
</li>
<li>
<a href="#">釘選場次報名列表</a>
</li>
<li>
<a href="#">釘選場次接種列表</a>
</li>
</ul>
</nav>
<!-- menu End -->
<!-- noscript -->
<noscript>
您的瀏覽器不支援JavaScript語法，JavaScript語法並不影響內容的陳述。您可使用按鍵盤上的Ctrl鍵+ (+)鍵放大/(-)鍵縮小來改變字型大小；回到上一頁可使用瀏覽器提供的 Alt+左方向鍵(←) 快速鍵功能；列印可使用瀏覽器提供的(Ctrl+P)功能。您的瀏覽器，不支援script語法，若您的瀏覽器無法支援請點選此超連結
<a href="#">網站導覽</a>
</noscript>
</div>
</header>
<!-- header End -->
<!-- main Start -->
<div id="center" class="main innerpage">
<!-- 內頁新增一個classname-->
<a class="accesskey" href="#ac" id="ac" accesskey="C" title="主要內容區">:::</a>
<div class="container">
<!-- 左側 -->
<div class="left_block hidden"></div>
<!-- 主要內容區 -->
<div class="center_block">
<h2 class="title">醫師評估</h2>
<!-- function_panel -->
<div class="function_panel">
<!-- function功能區塊 start-->
<div class="function">
<ul>
<li class="back2"><a href="javascript:history.back()">回上一頁</a></li>
</ul>
</div>
<!-- function功能區塊 end-->
</div>
<!-- function_panel -->
<!-- formBox star -->
<div class="formBox">
<form action="">
<div class="btn_grp">
<button class="btn btn-submit btn-card" data-fancybox="" data-type="iframe" data-src="i_check.htm">讀取卡片</button>
<button class="btn btn-submit btn-hand" data-fancybox="" data-type="iframe" data-src="i_enter.htm">手動輸入</button>
</div>
</form>
</div>
<!-- formBox end -->
<!-- pagesearch star -->
<div class="pagesearch">
<form action="">
<div class="items2">
<div class="form_grp form_inline">
<label for="username">身分證統一編號/統一證號：</label>
<input name="username" type="text" placeholder="請輸入證號" />
</div>
</div>
<div class="items2">
<div class="form_grp form_inline">
<label for="username">報名序號：</label>
<input name="username" type="text" placeholder="請輸入報名序號" />
<button class="btn btn-blue">查詢</button>
</div>
</div>
</form>
</div>
<!-- pagesearch end -->
<!-- adSlider star -->
<div class="adSlider">
<div>
<!-- int5 star -->
<div class="int5">
<div class="items1">
<div class="peopleBox2">
<div class="n_title">王大明<span class="num">12號</span></div>
<ul>
<li>A123456789(北市)｜0470110 (66歲)｜0912345678</li>
<li>接種意願：肺鏈,流感</li>
</ul>
</div>
</div>
<div class="items3">
<ul class="flow">
<li class="active">完成報到</li>
<li>尚未評估</li>
<li>尚未接種</li>
</ul>
</div>
</div>
<!-- int5 end -->
</div>
<div>
<!-- int5 star -->
<div class="int5">
<div class="items1">
<div class="peopleBox2">
<div class="n_title">蘇小小<span class="num">15號</span></div>
<ul>
<li>A123456789(北市)｜0470110 (66歲)｜0912345678</li>
<li>接種意願：肺鏈,流感</li>
</ul>
</div>
</div>
<div class="items3">
<ul class="flow">
<li class="active">完成報到</li>
<li class="active">完成評估</li>
<li>尚未接種</li>
</ul>
</div>
</div>
<!-- int5 end -->
</div>
<div>
<!-- int5 star -->
<div class="int5">
<div class="items1">
<div class="peopleBox2">
<div class="n_title">王大明<span class="num">12號</span></div>
<ul>
<li>A123456789(北市)｜0470110 (66歲)｜0912345678</li>
<li>接種意願：肺鏈,流感</li>
</ul>
</div>
</div>
<div class="items3">
<ul class="flow">
<li class="active">完成報到</li>
<li class="active">完成評估</li>
<li class="active">完成接種</li>
</ul>
</div>
</div>
<!-- int5 end -->
</div>
</div>
<!-- adSlider end -->
<!-- detail_ct -->
<div class="detail_ct">
<div class="s_title">請確認接種者的健康狀況是否可接種</div>
<!-- condition -->
<div class="condition">
<!-- form -->
<form action="" class="form_grid">
<!-- subBlock -->
<div class="subBlock">
<div class="form_grp">
<div class="warning"><img src="images/basic/icon_warning.svg" alt="" />可接種資格僅供參考，請依照實際情況由醫師判斷是否符合資格</div>
<div class="form_inline">
<label for="username" class="form_title">可接種資格：</label>
<div class="form_content">央PPV,流感</div>
</div>
<label for="username" class="form_title">接種紀錄：</label>
<div class="form_content">
<div class="table_wrapper">
<table>
<tr>
<th>接種日期</th>
<th>疫苗劑次</th>
</tr>
<tr>
<td>1111001</td>
<td>13PCV-1</td>
</tr>
<tr>
<td>1111001</td>
<td>FLU-1</td>
</tr>
</table>
</div>
</div>
</div>
</div>
<!-- subBlock end-->
<div class="form_grp form_inline">
<label for="username" class="form_title">評估醫師：</label>
<div class="form_content">陳明白</div>
</div>
<div class="form_grp">
<!-- subBlock2 -->
<div class="subBlock2">
<div class="form_inline">
<label for="selectSample" class="form_title">身分別：</label>
<div class="form_content"> </div>
</div>
<label for="selectSample" class="form_title">肺鏈：</label>
<div class="form_content">
<select name="" id="selectSample">
<option value="">請選擇</option>
<option value="">選項二</option>
<option value="">選項三</option>
<option value="">選項四</option>
</select>
</div>
<label for="selectSample" class="form_title"><abbr class="necessary" title="為必填(選)欄位,不能為空白。">*</abbr>流感：</label>
<div class="form_content">
<select name="" id="selectSample">
<option value="">F03B 滿 50 歲以上成人社區/企業接種站/到宅接種</option>
<option value="">選項二</option>
<option value="">選項三</option>
<option value="">選項四</option>
</select>
</div>
</div>
<!-- subBlock2 end-->
</div>
<div class="form_grp">
<label for="username" class="form_title"><abbr class="necessary" title="為必填(選)欄位,不能為空白。">*</abbr>經過評估後請選擇可接種的疫苗類型：</label>
<div class="form_content">
<div class="check_grp form_inline">
<label class="checkbox"><input type="checkbox" name="" value="" />央PPV</label>
<label class="checkbox"><input type="checkbox" name="" value="" checked="" />流感</label>
<label class="checkbox nobtn"><input type="checkbox" name="" value="" />不可接種</label>
</div>
</div>
</div>
<div class="form_grp">
<label for="textareaSample1" class="form_title">備註說明：</label>
<div class="form_content">
<textarea id="textareaSample1" rows="3">請填寫說明（限100字以內）</textarea>
</div>
</div>
<div class="form_grp">
<label for="username" class="form_title"><abbr class="necessary" title="為必填(選)欄位,不能為空白。">*</abbr>醫師簽名：</label>
<div class="form_content">
<div class="sign">
<img src="images/sign2.png" alt="簽名" />
</div>
<!-- <button type="button" class="btn btn-blue signbtn" data-fancybox="" data-type="iframe" data-src="i_sign.htm">簽名</button> -->
</div>
</div>
<div class="btn_grp">
<button class="btn btn-reset">返回列表</button>
<button class="btn btn-reset">退回重新選擇接種意願</button>
<button class="btn btn-reset">重置</button>
<button class="btn btn-submit" data-fancybox="" data-type="iframe" data-src="i_finish.htm">完成評估</button>
<button class="btn btn-submit" data-fancybox="" data-type="iframe" data-src="i_finish.htm">完成評估，接續下一號</button>
</div>
</form>
<!-- form end -->
</div>
<!-- condition end-->
</div>
<!-- detail_ct end-->
</div>
</div>
</div>
<!-- footer Start-->
<footer>
<div class="container">
<a class="accesskey" href="#aZ" id="aZ" accesskey="Z" title="頁尾區">:::</a>
<div class="footer_info">
<div class="infoblock">
<p class="Copyright">版權所有 臺北市政府衛生局 地址：110204 臺北市信義區市府路1號</p>
</div>
</div>
</div>
</footer>
<!-- footer End -->
</div>
<a href="javascript:;" class="scrollToTop">回頁首</a>
<!-- JQ -->
<script src="js/jquery-3.6.0.min.js"></script>
<!-- 外掛 plugin js -->
<script src="vendor/jquery.easing.min.js"></script>
<!-- ease -->
<script src="vendor/slick/slick.min.js "></script>
<!-- slick -->
<script src="vendor/lazyload/lazyload.js"></script>
<!-- lazyload -->
<script src="vendor/picturefill/picturefill.min.js" async></script>
<!-- picturefill -->
<script src="vendor/scrolltable/jquery.scroltable.min.js"></script>
<!-- scrolltable -->
<!-- fancybox -->
<script src="vendor/fancybox/fancybox.umd.js"></script>
<script>
Fancybox.bind('[data-fancybox]', {
//
});
</script>
<!-- hyUI -->
<script src="js/hyui.js"></script>
<!-- 客製js -->
<script src="js/customize.js"></script>
</body>
</html>