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madeu_crm/src/main/resources/templates/kiosk/new-patient.html

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HTML

<!DOCTYPE html>
<html xmlns="http://www.w3.org/1999/xhtml" xmlns:th="http://www.thymeleaf.org"
xmlns:layout="http://www.ultraq.net.nz/thymeleaf/layout">
<head>
<meta charset="utf-8" />
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<title>메이드유 CRM</title>
<!-- jQuery -->
<script src="/js/web/jquery.min.js"></script>
<link rel="stylesheet" href="https://code.jquery.com/ui/1.13.2/themes/base/jquery-ui.css">
<script src="/js/web/jquery-ui.js"></script>
<script src="/js/web/signature_pad.js"></script>
<!-- Choices.js -->
<link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/choices.js/public/assets/styles/choices.min.css">
<script src="https://cdn.jsdelivr.net/npm/choices.js/public/assets/scripts/choices.min.js"></script>
<!-- CSS -->
<link rel="stylesheet" href="/css/web/font.css">
<link rel="stylesheet" href="/css/kiosk/new-patient.css">
<!--KAKAO 주소API-->
<script src="//t1.daumcdn.net/mapjsapi/bundle/postcode/prod/postcode.v2.js"></script>
</head>
<th:block layout:fragment="layout_top_script">
<script src="/js/kiosk/new-patient.js"></script>
</th:block>
<!--<th:block th:replace="/web/include/modal :: layout_modal"></th:block>-->
<th:block layout:fragment="layout_content">
<div id="newPatientForm" class="new-patient-container">
<!-- Header -->
<header class="page-header">
<h1 class="title">신규 고객 등록</h1>
</header>
<!-- Body -->
<main class="page-body">
<div class="form-grid-layout">
<!-- Column 1: Basic Info -->
<section class="form-section-card col-card">
<div class="section-title">기본 정보</div>
<!-- Name -->
<div class="form-row">
<label class="required">고객명</label>
<input type="text" name="modalUserName" placeholder="이름을 입력하세요" />
</div>
<!-- Nationality -->
<div class="form-row">
<label class="required">국적</label>
<select id="selectNationality" name="nationality">
<option value="">국적 선택</option>
</select>
</div>
<div class="form-row">
<label class="required">주민등록번호</label>
<div class="split-inputs">
<input name="modalUserRrn1" type="text" placeholder="000000" maxlength="6" />
<span class="split-divider">-</span>
<input name="modalUserRrn2" type="password" placeholder="0000000" maxlength="7" />
</div>
</div>
<!-- Identification (Dynamic) -->
<div class="form-row foreigner_box">
<label class="required">여권번호</label>
<div class="passport_number_box">
<input name="modalUserPno" type="text" placeholder="여권번호 입력" />
</div>
</div>
<!-- Birthday -->
<div class="form-row">
<label for="modalBirthday" class="required">생년월일</label>
<div class="date-input-wrapper">
<input
type="text"
id="modalBirthday"
name="modalBirthday"
placeholder="YYYYMMDD"
maxlength="10"
/>
<span class="age-text txtAge">만 0세</span>
</div>
</div>
<!-- Gender -->
<div class="form-row">
<label>성별</label>
<div class="radio-group">
<div class="radio-item">
<input type="radio" name="modalGender" id="genderF" value="F" checked />
<label for="genderF">여자</label>
</div>
<div class="radio-item">
<input type="radio" name="modalGender" id="genderM" value="M" />
<label for="genderM">남자</label>
</div>
</div>
</div>
<div class="form-row">
<label class="required">연락처</label>
<input name="modalPhoneNumber" type="tel" placeholder="010-0000-0000" />
</div>
<div class="form-row">
<label class="required">주소</label>
<div class="address-input-group" style="display: flex; gap: 8px;">
<input id="modalAddress" name="modalAddress" type="text" placeholder="주소를 검색하세요" readonly style="flex: 1; cursor: pointer;" />
<button type="button" id="btnSearchAddress" class="btn-small" style="padding: 0 15px; background: #333; color: #fff; border-radius: 4px;">검색</button>
</div>
<input id="modalAddressDetail" name="modalAddressDetail" type="text" placeholder="상세 주소를 입력하세요" style="margin-top: 8px;" />
</div>
<div class="form-row">
<label class="required">이메일</label>
<input name="email" type="text" placeholder="imadeu@naver.com" />
</div>
</section>
<!-- Column 2: Contact Info -->
<section class="form-section-card col-card">
<div class="section-title">개인정보 수집 및 이용동의</div>
<div class="form-row checkbox-row">
<label for="agreePrivacy">개인정보 수집 및 이용안내</label>
<div class="checkbox-line">
<input type="checkbox" id="agreePrivacy" name="agreePrivacy" onclick="return false;" />
<a href="#" class="consent-link" data-type="agreePrivacy">개인정보 수집 및 이용안내 동의서 보기</a>
</div>
</div>
<div class="form-row checkbox-row">
<label for="agreeProcedure">시술동의서</label>
<div class="checkbox-line">
<input type="checkbox" id="agreeProcedure" name="agreeProcedure" onclick="return false;" />
<a href="#" class="consent-link" data-type="agreeProcedure">시술 동의서 보기</a>
</div>
</div>
<div class="form-row checkbox-row">
<label for="agreeTerms">이용약관동의서</label>
<div class="checkbox-line">
<input type="checkbox" id="agreeTerms" name="agreeTerms" onclick="return false;" />
<a href="#" class="consent-link" data-type="agreeTerms">이용약관 동의서 보기</a>
</div>
</div>
<div class="form-row checkbox-row">
<label for="refusePhoto">사진촬영동의서</label>
<div class="checkbox-line">
<input type="checkbox" id="refusePhoto" name="refusePhoto" onclick="return false;" />
<a href="#" class="consent-link" data-type="refusePhoto">사진촬영 동의서 보기</a>
</div>
</div>
<!-- SMS -->
<div class="form-row">
<label>SMS 수신여부</label>
<div class="radio-group">
<div class="radio-item">
<input type="radio" name="modalSmsYn" id="smsY" value="Y" checked />
<label for="smsY"></label>
</div>
<div class="radio-item">
<input type="radio" name="modalSmsYn" id="smsN" value="N" />
<label for="smsN">아니오</label>
</div>
</div>
</div>
</section>
<!-- Column 3: Additional Info -->
<section class="form-section-card col-card">
<div class="section-title">기타 정보</div>
<!-- Channel -->
<div class="form-row">
<label>방문경로</label>
<select id="selectChannel" name="channel">
<option value="">방문경로 선택</option>
</select>
</div>
<!-- Recommender -->
<div class="form-row">
<label>추천인</label>
<div class="searchIntroUser" style="position:relative; cursor:pointer;">
<input type="text" name="modalRecommendId" placeholder="검색하여 선택하세요" readonly
style="cursor:pointer; padding-right:40px;" />
<img src="/image/web/search_B.svg" alt="search"
style="position:absolute; right:12px; top:50%; transform:translateY(-50%); width:18px;">
</div>
</div>
<!-- Etc -->
<div class="form-row">
<label>특이 사항 (시술/약물)</label>
<textarea name="modalEtc" placeholder="특이사항을 입력하세요"></textarea>
</div>
</section>
</div>
</main>
<!-- Footer -->
<footer class="page-footer">
<!-- Use project standard classes -->
<button type="button" class="cancel_btn btnCancle">취소</button>
<button type="button" class="registration_bth btnSave">등록 완료</button>
</footer>
</div>
</th:block>
<th:block layout:fragment="layout_script">
</th:block>
</html>