<div id="dialog-cliente" title="Detalle de Cliente">

    <div id="divBarraBotones" class="ui-widget" style=" float:left; width:98%; margin-top:15px;"> 
        <div style="float:left;">       
            <p class="validateTips">* Campos requeridos.</p>
        </div>
        <div style="float:right;">       
            <input id="btnGuardarTABCATCLI"  type="button" value="Guardar" class="custom-button clsBtnGuardar"/> 
            <input id="btnCancelarTABCATCLI"  type="button" value="Cancelar" class="custom-button"/> 
            <input id="btnEliminarTABCATCLI"  type="button" value="Eliminar" class="custom-button clsBtnEliminar"/> 
    	</div>
	</div>

    <input type="hidden" name="txtIntCliente" id="txtIntCliente" class="ui-widget" />
	
    <div style="float:left; width:99%; height:20px; margin-bottom:-5px;"><h1 style=" padding-top:15px;">Datos del Paciente</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%;">        
			<div class="ui-widget" style=" float:left; ">        
				<h1>Nombres</h1>
				<input type="text" id="txtNombres" style="width:200px;" class="custom-combobox2" placeholder="Nombres"/>*
			</div>
			<div class="ui-widget" style=" float:left; margin-left:10px;">        
				<h1>Apellidos</h1>
				<input type="text" id="txtApellidos" style="width:200px;" class="custom-combobox2"  placeholder="Apellidos"/>*
			</div>
        
			<div class="ui-widget" style=" float:left; ">        
				<h1>Fecha de Nac.</h1>
				<input type="text" id="txtFecNac" style="width:100px;" class="custom-combobox2"  placeholder="yyyy-mm-dd"/>*
			</div>
			<div class="ui-widget" style=" float:left; margin-left:10px;">        
				<h1>Sexo</h1>
				<select id="selectSexo" class="custom-combobox2" style="width:50px;height:27px;">
					<option value="F">F</option>
					<option value="M">M</option>
				</select>*
			</div>
		</div>
		
		<div class="ui-widget" style=" float:left; width:99%;">        
			<div class="ui-widget" style=" float:left;">        
				<h1>Email</h1>
				<input type="text" id="txtEmail" style="width:200px;" class="custom-combobox2" />*
			</div>
			<div class="ui-widget" style=" float:left; margin-left:10px;">        
				<h1>Telefono</h1>
				<input type="text" id="txtTelefono" style="width:140px;" class="custom-combobox2" />*
			</div>
			<div class="ui-widget" style=" float:left; margin-left:10px;">
				<h1>Móvil</h1>
				<input type="text" id="txtMovil" style="width:140px;" class="custom-combobox2" />*
			</div>
      
			<div class="ui-widget" style=" float:left; ">
				<h1>Compa&ntilde;ia Aseguradora</h1>
				<input type="text" id="txtCompania" style="width:300px;" class="custom-combobox2" />
			</div>
			<div class="ui-widget" style=" float:left; margin-left:10px;">
				<h1>Forma de Contacto</h1>
				<select id="selectFormaContacto" class="custom-combobox2" style="width:150px;height:27px;"><option value="internet">Internet</option><option value="revista">Revista</option><option value="otra">Otra</option></select>
			</div>
		</div>
	</div>
	
	<h1 style="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;"> 
			<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. 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>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>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>País</h1>
				<select id="selectPais" class="custom-combobox2" style="width:190px;height:27px;"></select>
			</div>
			<div class="ui-widget" style=" float:left; margin-left:10px;">
				<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:10px;">
				<h1>Municipio</h1>
				<select id="selectMunicipio" class="custom-combobox2" style="width:190px;height:27px;"></select>
			</div>
		</div>
	</div>
    
	<h1 style="margin-top:15px; float:left;">Direcci&oacute;n de Facturaci&oacute;n</h1>
    <div style=" float:left; width:98%; background:#FFF; border:1px solid #CCC; border-radius:5px; padding:10px;">
        <div style="width:98%; float:left; margin-bottom:12px;">
            <input id="chkMismaDireccion" type="checkbox" onclick="ver(this)"  value="La direcci&oacute;n de facturaci&oacute;n es la misma que la de casa?" class="custom-button"/> 
            <span style="margin-left:6px;">Marcar aqui si la Direccion de Facturaci&oacute;n es la misma que la particular.</span>
    	</div>
        
        <div style="width:98%; float:left;">
            <h1>R.F.C.</h1>
            <input type="text" id="txtRfc" style="width:300px;" class="custom-combobox2" />
    	</div>
        
        <div class="ui-widget" style=" float:left; width:99%;">        
            <div class="ui-widget" style=" float:left; ">        
                <h1>Calle</h1>
                <input type="text" id="txtCalle2" style="width:200px;" class="custom-combobox2" />
            </div>
            <div class="ui-widget" style=" float:left; margin-left:10px;">        
                <h1>Num. Ext.</h1>
                <input type="text" id="txtNumExt2" style="width:60px;"  placeholder="Num. Ext." class="custom-combobox2" />
            </div>
            <div class="ui-widget" style=" float:left; margin-left:10px;">        
                <h1>Num. Int.</h1>
                <input type="text" id="txtNumInt2" style="width:60px;"  placeholder="Num. Int." class="custom-combobox2" />
            </div>
            <div class="ui-widget" style=" float:left; margin-left:10px;">        
                <h1>Colonia</h1>
                <input type="text" id="txtColonia2" 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="txtCodigoPostal2" style="width:100px;" class="custom-combobox2" />
            </div>
        </div>
    
        <div class="ui-widget" style=" float:left; width:99%;">        
            <div class="ui-widget" style=" float:left; ">
                <h1>País</h1>
                <select id="selectPais2" class="custom-combobox2" style="width:190px;height:27px;"></select>
            </div>
            <div class="ui-widget" style=" float:left; margin-left:10px;">
                <h1>Estado</h1>
                <select id="selectEstado2" class="custom-combobox2" style="width:190px;height:27px;"></select>
            </div>
            <div class="ui-widget" style=" float:left; margin-left:10px;">
                <h1>Municipio</h1>
                <select id="selectMunicipio2" class="custom-combobox2" style="width:190px;height:27px;"></select>
            </div>
        </div>
    </div>
    
	<h1 style="margin-top:15px; float:left;">Contactos</h1>
    <div style=" float:left; width:98%; background:#FFF; border:1px solid #CCC; border-radius:5px; padding:10px;">
        <div style="width:98%; float:left; margin-bottom:5px;">
            <div style="float:left;">       
                <h1>Contactos en caso de emergencia</h1>
            </div>
            <div style="float:right;">       
                <input id="btnNuevoContactoTABCATCLI"  type="button" value="Nuevo Contacto" class="custom-button"/> 
            </div>
    	</div>
        <div style="width:98%; float:left;">
			<table cellpadding="8" width="100%" border="1" bordercolor="#000000" style="border-collapse:collapse;">
            	<tr>
                    <th>Contacto</th>
                    <th>Telefono</th>
                </tr>
            	<tr>
                    <td>Omar Cruz</td>
                    <td>8762 8766</td>
                </tr>
            	<tr>
                    <td>Alberto Moreira</td>
                    <td>8762 3783</td>
                </tr>
            </table>
    	</div>
        
    </div>

</div>
