Add existing layout to PHP project(repost)

Add the attached layout to the PHP project that is visible at? <[login to view URL]>. It is a website that is used for selecting Therapy websites. Includes the following change to the functionality: 1) when an combobox is selected, hide the combobox and show the text of the chosen option instead. Show a link 'undo' to the right of the text of the chosen option. When the 'undo' link is clicked the combobox is shown again (and the chose option undone).