<view class="{{['add-patient', virtualHostClass]}}" style="{{virtualHostStyle}}" hidden="{{virtualHostHidden || false}}" id="{{M}}"><view class="form-card"><view class="section-title">基本信息</view><view class="form-item"><text class="label required">姓名</text><input type="text" placeholder="请输入就诊人姓名" maxlength="20" value="{{a}}" bindinput="{{b}}"/></view><view class="form-item"><text class="label required">证件类型</text><picker mode="selector" range="{{d}}" value="{{e}}" bindchange="{{f}}"><view class="picker"><text>{{c}}</text><text class="iconfont icon-arrow-right"></text></view></picker></view><view class="form-item"><text class="label required">证件号码</text><input type="idcard" placeholder="{{g}}" maxlength="{{h}}" bindblur="{{i}}" value="{{j}}" bindinput="{{k}}"/><text wx:if="{{l}}" class="error">{{m}}</text></view><view class="form-item"><text class="label required">与本人关系</text><picker mode="selector" range="{{o}}" value="{{p}}" bindchange="{{q}}"><view class="picker"><text>{{n}}</text><text class="iconfont icon-arrow-right"></text></view></picker></view></view><view class="form-card"><view class="section-title">就诊卡信息</view><view class="card-options"><view class="{{['option-item', r && 'active']}}" bindtap="{{s}}"><text class="radio"></text><text>绑定已有就诊卡</text></view><view class="{{['option-item', t && 'active']}}" bindtap="{{v}}"><text class="radio"></text><text>办理新就诊卡</text></view></view><block wx:if="{{w}}"><view class="form-item"><text class="label required">就诊卡号</text><input type="text" placeholder="请输入就诊卡号" maxlength="12" value="{{x}}" bindinput="{{y}}"/></view><view class="form-item"><text class="label required">手机号码</text><input type="number" placeholder="请输入办卡时预留的手机号" maxlength="11" value="{{z}}" bindinput="{{A}}"/></view><view class="form-item verify-code"><text class="label required">验证码</text><input type="number" placeholder="请输入验证码" maxlength="6" value="{{B}}" bindinput="{{C}}"/><button class="send-btn" disabled="{{E}}" bindtap="{{F}}">{{D}}</button></view></block><block wx:else><view class="form-item"><text class="label required">手机号码</text><input type="number" placeholder="请输入手机号码" maxlength="11" value="{{G}}" bindinput="{{H}}"/></view><view class="notice"><text class="dot"></text><text>新办就诊卡需要到医院自助机或服务台激活后才能使用</text></view></block></view><view class="form-card"><view class="switch-item"><text>设为默认就诊人</text><switch checked="{{I}}" bindchange="{{J}}" color="#0f95b0"/></view></view><view class="bottom-bar"><button class="submit-btn primary-btn" disabled="{{K}}" bindtap="{{L}}">保存</button></view></view>
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