<div id="dialog-hospital" title="Detalle de Hospital">
  
    <div id="divFiltros" class="ui-widget" style=" float:left; width:98%; margin-top:15px;"> 
        <div style="float:left;">       
            <p class="validateTips">* Todos los campos son requeridos.</p>
        </div>
        <div style="float:right;">       
            <input id="btnGuardarTABCATHOS"  type="button" value="Guardar" class="custom-button clsBtnGuardar"/> 
            <input id="btnCancelarTABCATHOS"  type="button" value="Cancelar" class="custom-button"/> 
            <input id="btnEliminarTABCATHOS"  type="button" value="Eliminar" class="custom-button clsBtnEliminar"/> 
    	</div>
	</div>
    
    <input type="hidden" name="txtIntHospital" id="txtIntHospital" class="ui-widget" />
    
    <div style="float:left; width:99%; height:20px; margin-bottom:-5px;"><h1 style=" padding-top:15px;">Datos del Hospital</h1></div>
  	<div style=" float:left; margin-top:15px; width:98%; background:#FFF; border:1px solid #CCC; border-radius:5px; padding:10px;">
        <div class="ui-widget" style=" float:left; width:99%; ">          
            <h1>Hospital</h1>
            <input type="text" id="txtHospital" style="width:400px;" class="custom-combobox2" />*
        </div>
        <div class="ui-widget" style=" float:left; width:99%;">        
            <h1>Telefono</h1>
            <input type="text" id="txtTelefono" style="width:140px;" class="custom-combobox2" />*
        </div>
	</div>

	<h1 style="float:left; width:99%; margin-top:15px; float:left;">Direcci&oacute;n Particular</h1>
	<div style=" float:left; width:98%; background:#FFF; border:1px solid #CCC; border-radius:5px; padding:10px;">
		<div class="ui-widget" style=" float:left; padding-top:10px;"> 
			<div class="ui-widget" style=" float:left; ">        
				<h1>Calle</h1>
				<input type="text" id="txtCalle" style="width:200px;" class="custom-combobox2" />*
			</div>
			<div class="ui-widget" style=" float:left; margin-left:10px;">        
				<h1>Num. Int.</h1>
				<input type="text" id="txtNumInt" style="width:60px;"  placeholder="Num. Int." class="custom-combobox2" />
			</div>
			<div class="ui-widget" style=" float:left; margin-left:10px;">        
				<h1>Num. Ext.</h1>
				<input type="text" id="txtNumExt" style="width:60px;"  placeholder="Num. Ext." class="custom-combobox2" />*
			</div>
			<div class="ui-widget" style=" float:left; margin-left:10px;">        
				<h1>Colonia</h1>
				<input type="text" id="txtColonia" style="width:200px;" class="custom-combobox2" />
			</div>
			<div class="ui-widget" style=" float:left; margin-left:10px;">
				<h1>Código Postal</h1>
				<input type="text" id="txtCodigoPostal" style="width:100px;" class="custom-combobox2" />
			</div>
		</div>
		
		<div class="ui-widget" style=" float:left;  background:none; width:99%;">        
			<div class="ui-widget" style=" float:left; ">
				<h1>Pais</h1>
				<select id="selectPais" class="custom-combobox2" style="width:190px;height:27px;"></select>
			</div>
			<div class="ui-widget" style=" float:left; margin-left:8px;"">
				<h1>Estado</h1>
				<select id="selectEstado" class="custom-combobox2" style="width:190px;height:27px;"></select>
			</div>
			<div class="ui-widget" style=" float:left; margin-left:8px;"">
				<h1>Municipio</h1>
				<select id="selectMunicipio" class="custom-combobox2" style="width:190px;height:27px;"></select>
			</div>
		</div>
	</div>

</div>