mirror of
https://gitlab.com/signalytic/client-external/streamline/streamline-emr.git
synced 2026-09-12 11:11:31 +00:00
resolved conflicts
This commit is contained in:
Executable
+167
@@ -0,0 +1,167 @@
|
||||
<div class="modal" id="debt_plan_modal" tabindex="-1" role="dialog" aria-labelledby="debt_plan_modal_label" aria-hidden="true">
|
||||
<div class="modal-dialog modal-lg" role="document">
|
||||
<div class="modal-content">
|
||||
<div class="modal-header">
|
||||
<h5 class="modal-title" id="debt_plan_modal_label"><b>{{ __('patient_finance.debt_plan') }}</b></h5>
|
||||
</div>
|
||||
<div class="modal-body">
|
||||
<div class="row">
|
||||
<div class="col-sm-6">
|
||||
<div class="form-group">
|
||||
{{ Form::label('staff_guarantor_amount_owed',__('patient_finance.amount_owed')) }}
|
||||
{{ Form::number('staff_guarantor_amount_owed','',['class' => 'form-control compulsory','readonly','id'=>'staff_guarantor_amount_owed']) }}
|
||||
</div>
|
||||
<div class="form-group">
|
||||
{{ Form::label('date_of_bill',__('patient_finance.date_of_bill')) }}
|
||||
<div class="input-group">
|
||||
{{--{{ Form::text('date_of_bill','',['class' => 'form-control compulsory', 'required','readonly','id'=>'date_of_bill']) }}--}}
|
||||
{{ Form::text('date_of_bill','',['class' => 'form-control compulsory', 'required','id'=>'date_of_bill']) }}
|
||||
<span class="input-group-addon"><i class="icon-calender"></i></span>
|
||||
</div>
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('guarantor_to_pay_modal',__('patient_finance.guarantor_to_pay')) }}
|
||||
{{ Form::number('guarantor_to_pay_modal',0,['class' => 'form-control compulsory', 'required','id'=>'guarantor_to_pay_modal']) }}
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('patient_to_pay_modal',__('patient_finance.balance_to_pay')) }}
|
||||
{{ Form::number('patient_to_pay_modal','',['class' => 'form-control compulsory','id'=>'patient_to_pay_modal','readonly']) }}
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('payment_arrangement',__('patient_finance.arrangement_for_balance')) }}
|
||||
{{ Form::select('payment_arrangement',$payment_arrangement,'',['class' => 'form-control compulsory','required','id'=>'payment_arrangement']) }}
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('guarantor_type','Guarantor Type') }}
|
||||
<br>
|
||||
{{ Form::radio('guarantor_type', 1, false, ['class' => 'guarantor_type']) }} Staff
|
||||
{{ Form::radio('guarantor_type', 0, false, ['class' => 'guarantor_type']) }} Non staff
|
||||
</div>
|
||||
</div>
|
||||
<div class="col-md-6">
|
||||
<div class="form-group" id="staff-guarantor-div">
|
||||
{{ Form::label('staff_guarantor_modal',__('patient_finance.staff_guarantor')) }}
|
||||
{{ Form::select('staff_guarantor_modal[]',$staff_guarantors,'',['class' => 'form-control compulsory','required','id'=>'staff_guarantor_modal', 'multiple' => 'true']) }}
|
||||
</div>
|
||||
|
||||
<div class="form-group" id="non-staff-guarantor-div" style="display: none;">
|
||||
{{ Form::label('staff_guarantor_modal',__('patient_finance.non_staff_guarantor')) }}
|
||||
{{ Form::select('non_staff_guarantor_modal[]',$non_staff_guarantors,'',['class' => 'form-control compulsory','required','id'=>'non_staff_guarantor_modal', 'multiple' => 'true']) }}
|
||||
<small><a href="#" id="addNewNonStaffGuarantor">{{__('patient_finance.add_new')}}</a></small>
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
<div id="first_installment_date_div">
|
||||
{{ Form::label('first_installment_date',__('patient_finance.first_installment_date')) }}
|
||||
<div class="input-group">
|
||||
{{ Form::text('first_installment_date','',['class' => 'form-control compulsory', 'required','readonly','id'=>'first_installment_date']) }}
|
||||
<span class="input-group-addon"><i class="icon-calender"></i></span>
|
||||
</div>
|
||||
</div>
|
||||
|
||||
<div id="second_installment_date_div" style="display: none;">
|
||||
{{ Form::label('second_installment_date',__('patient_finance.second_installment_date')) }}
|
||||
<div class="input-group">
|
||||
{{ Form::text('second_installment_date','',['class' => 'form-control compulsory' ,'readonly','id'=>'second_installment_date']) }}
|
||||
<span class="input-group-addon"><i class="icon-calender"></i></span>
|
||||
</div>
|
||||
</div>
|
||||
|
||||
<div id="third_installment_date_div" style="display: none;">
|
||||
{{ Form::label('third_installment_date',__('patient_finance.third_installment_date')) }}
|
||||
<div class="input-group">
|
||||
{{ Form::text('third_installment_date','',['class' => 'form-control compulsory','readonly','id'=>'third_installment_date']) }}
|
||||
<span class="input-group-addon"><i class="icon-calender"></i></span>
|
||||
</div>
|
||||
</div>
|
||||
|
||||
<div id="fourth_installment_date_div" style="display: none;">
|
||||
{{ Form::label('fourth_installment_date',__('patient_finance.fourth_installment_date')) }}
|
||||
<div class="input-group">
|
||||
{{ Form::text('fourth_installment_date','',['class' => 'form-control compulsory','readonly','id'=>'fourth_installment_date']) }}
|
||||
<span class="input-group-addon"><i class="icon-calender"></i></span>
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('comment',__('patient_finance.comment')) }}
|
||||
{{ Form::textarea('comment','',['class' => 'form-control','id'=>'comment']) }}
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('authorised_by_temp',__('patient_finance.authorised_by')) }}
|
||||
{{ Form::text('authorised_by_temp',auth()->user()->username,['class' => 'form-control compulsory','readonly']) }}
|
||||
{{ Form::hidden('authorised_by',auth()->user()->id,['id'=>'authorised_by']) }}
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
<div class="modal-footer">
|
||||
<button type="button" class="btn btn-danger" data-dismiss="modal">{{ __('patient_finance.cancel_button') }}</button>
|
||||
<button type="button" class="btn btn-success" id="save_debt_plan">{{ __('patient_finance.save_changes') }}</button>
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
|
||||
<div class="modal" id="new_non_staff_guarantor_modal" tabindex="-1" role="dialog" aria-labelledby="new_non_staff_guarantor_modal_label" aria-hidden="true">
|
||||
<div class="modal-dialog modal-lg" role="document">
|
||||
<div class="modal-content">
|
||||
<div class="modal-header">
|
||||
<h5 class="modal-title" id="new_non_staff_guarantor_modal_label"><b>{{ __('patient_finance.add_new_non_staff_guarantor') }}</b></h5>
|
||||
</div>
|
||||
<div class="modal-body">
|
||||
<div class="row">
|
||||
<div class="col-sm-6">
|
||||
<div class="form-group">
|
||||
{{ Form::label('non_staff_guarantor_first_name',__('patients.first_name')) }}
|
||||
{{ Form::text('non_staff_guarantor_first_name','',['class' => 'form-control compulsory','id'=>'non_staff_guarantor_first_name']) }}
|
||||
</div>
|
||||
<div class="form-group">
|
||||
{{ Form::label('non_staff_guarantor_date_of_birth',__('patients.date_of_birth')) }}
|
||||
<div class="input-group">
|
||||
{{ Form::text('non_staff_guarantor_date_of_birth','',['class' => 'form-control compulsory', 'required','id'=>'non_staff_guarantor_date_of_birth']) }}
|
||||
<span class="input-group-addon"><i class="icon-calender"></i></span>
|
||||
</div>
|
||||
</div>
|
||||
<div class="form-group">
|
||||
{{ Form::label('non_staff_guarantor_gender',__('patients.gender')) }}
|
||||
<br>
|
||||
{{ Form::radio('non_staff_guarantor_gender', 1, false, ['class' => 'non_staff_guarantor_gender']) }} Male
|
||||
{{ Form::radio('non_staff_guarantor_gender', 2, false, ['class' => 'non_staff_guarantor_gender']) }} Female
|
||||
</div>
|
||||
<div class="form-group">
|
||||
{{ Form::label('non_staff_guarantor_contact',__('patients.phone')) }}
|
||||
{{ Form::text('non_staff_guarantor_contact','',['class' => 'form-control compulsory','id'=>'non_staff_guarantor_contact']) }}
|
||||
</div>
|
||||
</div>
|
||||
|
||||
<div class="col-md-6">
|
||||
<div class="form-group">
|
||||
{{ Form::label('non_staff_guarantor_last_name',__('patients.last_name')) }}
|
||||
{{ Form::text('non_staff_guarantor_last_name','',['class' => 'form-control compulsory','id'=>'non_staff_guarantor_last_name']) }}
|
||||
</div>
|
||||
<div class="form-group">
|
||||
@php $marital_status = $marital_statuses = \DB::table('marital_statuses')->pluck("name", "id")->toArray(); @endphp
|
||||
{{ Form::label('non_staff_guarantor_marital_status',__('patients.marital_status')) }}
|
||||
{{ Form::select('non_staff_guarantor_marital_status',$marital_status,'',['class' => 'form-control compulsory','id'=>'non_staff_guarantor_marital_status']) }}
|
||||
</div>
|
||||
<div class="form-group">
|
||||
{{ Form::label('non_staff_guarantor_residence','Residence') }}
|
||||
{{ Form::text('non_staff_guarantor_residence','',['class' => 'form-control compulsory','id'=>'non_staff_guarantor_residence']) }}
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
<div class="modal-footer">
|
||||
<button type="button" class="btn btn-danger" data-dismiss="modal">{{ __('patient_finance.cancel') }}</button>
|
||||
<button type="button" class="btn btn-success" id="save_new_non_staff_guarantor">{{ __('patient_finance.save') }}</button>
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
Reference in New Issue
Block a user