{php extract(dr_get_form_post_value('jkdjbmb'))}
<form action="" class="wrap mt20" method="post" name="myform" id="myform">
	{$form}
   
        <table>
            <tbody>
            <tr>
                <th>姓  名</th>
                <td>  {$mingzi}<input type="text" name="mingzi" /></td>
                <th>性  别</th>
                <td><input type="text" name="sex" /></td>
                <th>出生年月日</th>
                <td><input type="text" name="birth" /></td>
            </tr>
            <tr>
                <th>民  族</th>
                <td><input type="text" name="nation" /></td>
                <th>兴趣爱好</th>
                <td><input type="text" name="interest" /></td>
                <th>本人手机</th>
                <td><input type="text" name="phone" /></td>
            </tr>
            <tr>
                <th>现有常见病</th>
                <td><input type="text" name="illness" /></td>
                <th>近期身体情况</th>
                <td><input type="text" name="conditions" /></td>
                <th>是否介助行走</th>
                <td><input type="text" name="disease" /></td>
            </tr>
            <tr>
                <th>籍贯</th>
                <td><input type="text" name="address" /></td>
                <th>家属联系人</th>
                <td><input type="text" name="membername" /></td>
                <th>家属手机</th>
                <td><input type="text" name="memberphone" /></td>
            </tr>
            <tr>
                <th>陪同人姓名</th>
                <td><input type="text" name="peername" /></td>
                <th>性别</th>
                <td><input type="text" name="accompany" /></td>
                <th>出生年月日</th>
                <td><input type="text" name="peerbirth" /></td>
            </tr>
            <tr>
                <th>民族</th>
                <td><input type="text" name="peernation" /></td>
                <th>兴趣爱好</th>
                <td><input type="text" name="peerinterest" /></td>
                <th>本人手机</th>
                <td><input type="text" name="peerphone" /></td>
            </tr>
            <tr>
                <th>现有常见病</th>
                <td><input type="text" name="peerillness" /></td>
                <th>近期身体情况</th>
                <td><input type="text" name="peercondition" /></td>
                <th>是否介助行走</th>
                <td><input type="text" name="peerdisease" /></td>
            </tr>
            <tr>
                <th>预定公寓名称</th>
                <td><input type="text" name="peeridentity" /></td>
                <th>入住时间</th>
                <td><input type="text" name="peerallergy" /></td>
                <th>入住天数</th>
                <td><input type="text" name="peerallergen" /></td>
            </tr>
            <tr>
                <th>备注（需求）</th>
                <td colspan="6"><input type="text" name="memberaddress" /></td>
            </tr>
            </tbody>
            <tfoot>
            <tr>
               
            </tfoot>
        </table>
        <p class="mt20 t-a-c">
			
			<button type="button" onclick="dr_ajax_submit('{$post_url}', 'myform', '2000', '{$rt_url}')" class="btn green"> <i class="fa fa-save"></i> 提交内容</button>
			<button type="submit" name="jkdjbmb" value="提交">提交</button>

</p>
    </form>