<template>
  <div class="welfare">
    <!-- form -->
    <a-form-model ref="form" layout="vertical" :model="form">
      <a-row :gutter="30">
        <a-col :xl="6" :lg="6" :sm="12">
          <a-form-model-item label="客户姓名" prop="patientName">
            <a-input
              v-model="form.patientName"
              placeholder="请输入客户姓名"
            ></a-input>
          </a-form-model-item>
        </a-col>
        <a-col :xl="4" :lg="6" :sm="12">
          <a-form-model-item label="出生日期" prop="birthday">
            <a-date-picker
              v-model="form.birthday"
              placeholder="请选择出生日期"
              value-format="YYYY-MM-DD"
            ></a-date-picker>
          </a-form-model-item>
        </a-col>
        <a-col :xl="4" :lg="6" :sm="12">
          <a-form-model-item label="保险公司" prop="payorId">
            <a-select v-model="form.payorId" placeholder="请选择保险公司">
              <a-select-option v-for="item in companyCode" :key="item.corpCode">
                {{ item.longName }}
              </a-select-option>
            </a-select>
          </a-form-model-item>
        </a-col>
        <a-col :xl="6" :lg="6" :sm="12">
          <a-form-model-item label="客户公司名称" prop="payorName">
            <a-input
              v-model="form.payorName"
              placeholder="请输入客户公司名称"
            ></a-input>
          </a-form-model-item>
        </a-col>
        <a-col :xl="6" :lg="6" :sm="12">
          <a-form-model-item label="保单卡号" prop="policyNo">
            <a-input
              v-model="form.policyNo"
              placeholder="请输入保单卡号"
            ></a-input>
          </a-form-model-item>
        </a-col>
        <a-col :xl="4" :lg="6" :sm="12">
          <a-form-model-item label="首次入保时间" prop="firstEnrollmentTime">
            <a-date-picker
              v-model="form.firstEnrollmentTime"
              placeholder="请选择首次入保时间"
              value-format="YYYY-MM-DD"
            ></a-date-picker>
          </a-form-model-item>
        </a-col>
        <a-col :xl="4" :lg="6" :sm="12">
          <a-form-model-item label="保单生效日期" prop="startDate">
            <a-date-picker
              v-model="form.startDate"
              placeholder="请选择保单生效日期"
              value-format="YYYY-MM-DD"
            ></a-date-picker>
          </a-form-model-item>
        </a-col>
        <a-col :xl="4" :lg="6" :sm="12">
          <a-form-model-item label="保单终止日期" prop="endDate">
            <a-date-picker
              v-model="form.endDate"
              placeholder="请选择保单终止日期"
              value-format="YYYY-MM-DD"
            ></a-date-picker>
          </a-form-model-item>
        </a-col>
        <a-col :xl="6" :lg="6" :sm="12">
          <a-form-model-item label="保险计划" prop="planId">
            <a-input
              v-model="form.planId"
              placeholder="请输入保险计划"
            ></a-input>
          </a-form-model-item>
        </a-col>
        <a-col :xl="6" :lg="6" :sm="12">
          <a-form-model-item label="其他备注" prop="remark">
            <a-input
              v-model="form.remark"
              placeholder="请输入备注信息"
            ></a-input>
          </a-form-model-item>
        </a-col>
        <a-col :xl="4" :lg="6" :sm="12">
          <a-form-model-item label="等待期" prop="waitingPeriod">
            <a-radio-group
              v-model="form.waitingPeriod"
              :default-value="form.waitingPeriod"
              button-style="solid"
            >
              <a-radio-button value="Y"> 是 </a-radio-button>
              <a-radio-button class="mar-left10" value="N"> 否 </a-radio-button>
            </a-radio-group>
          </a-form-model-item>
        </a-col>
        <a-col :xl="4" :lg="6" :sm="12">
          <a-form-model-item label="等待期时间" prop="waitingPeriodTime">
            <a-date-picker
              v-model="form.waitingPeriodTime"
              placeholder="请选择等待期时间"
              value-format="YYYY-MM-DD"
            ></a-date-picker>
          </a-form-model-item>
        </a-col>
        <a-col :xl="4" :lg="6" :sm="12">
          <a-form-model-item label="是否承担既往症" prop="isUndertakeAnamnesis">
            <a-radio-group
              v-model="form.isUndertakeAnamnesis"
              :default-value="form.isUndertakeAnamnesis"
              button-style="solid"
            >
              <a-radio-button value="Y"> 是 </a-radio-button>
              <a-radio-button class="mar-left10" value="N"> 否 </a-radio-button>
            </a-radio-group>
          </a-form-model-item>
        </a-col>
        <a-col :xl="24" :lg="18" :sm="12" class="none-label">
          <a-form-model-item label="button">
            <a-button class="mar-left10 text-r" type="primary"
              ><Icon name="ssidownload" :size="14" />查询
            </a-button>
          </a-form-model-item>
        </a-col>
      </a-row>
    </a-form-model>
  </div>
</template>

<script>
export default {
  data() {
    return {
      form: {},
      companyCode: [],
    };
  },
  computed: {},
  watch: {},
  methods: {},
};
</script>

<style lang="less" scoped>
.welfare {
  .pa(30, 36, 50, 39);
  background-color: #fff;
}
</style>
