<!--pages/prescription/addsite/addsite.wxml-->
<answer id='answer'></answer>
<view class="wrap">
	<form bindsubmit="formSubmit">
		<view class="order-num">
				<text>收货人</text>
				<input type="text" name="name" value='{{name}}' bindinput="name" placeholder="请输入收货人姓名" placeholder-style="color:#CECECE;" maxlength="30"></input>
		</view>
		<view class="order-num">
				<text>联系方式</text>
				<input type="number" name="phone" value='{{phone}}'  placeholder="请输入手机号" placeholder-style="color:#CECECE;" maxlength="11"></input>
		</view>
		<view class="order-num">
				<text>收货地址</text>
				<picker mode="region" name="take_over" bindchange="bindRegionChange" value="{{take_over}}" custom-item="{{customItem}}">
					<view class="picker {{take_over[0]=='请选择'?'color':''}}">
						{{take_over[0]}}{{take_over[0]=="北京市"||take_over[0]=="天津市"||take_over[0]=="上海市"||take_over[0]=="重庆市"?'':take_over[1]}}{{take_over[2]}}
						<image class="picker-img" src="/images/more.png"></image>
					</view>
				</picker>			
		</view>
		<view class="order-nums">
				<text>详细地址</text>
		</view>
		<view class="order-num">
				<textarea type="text" name="detail_address" value='{{detail_address}}' placeholder="街道、楼牌号等" placeholder-style="color:#CECECE;"></textarea>
		</view>
		<button class="btn" formType="submit">保存并使用</button>
	</form>
	
</view>


