mirror of
https://gitlab.com/signalytic/client-external/streamline/streamline-emr.git
synced 2026-09-12 03:01:32 +00:00
updated streamline-setup v2
This commit is contained in:
+120
@@ -0,0 +1,120 @@
|
||||
@extends('layouts.main')
|
||||
|
||||
@push('styles')
|
||||
<link href="{{ asset('elite/bower_components/select2/select2.min.css') }}" rel="stylesheet" />
|
||||
@endpush
|
||||
|
||||
@section('content')
|
||||
|
||||
<div class="row bg-title">
|
||||
<div class="col-lg-3 col-md-4 col-sm-4 col-xs-12">
|
||||
<h4 class="page-title">{{ __('insurance_groups.edit_insurance_group') }}</h4>
|
||||
</div>
|
||||
<div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
|
||||
<ol class="breadcrumb">
|
||||
<li><a href="{{ route('home') }}">{{ __('insurance_groups.dashboard') }}</a></li>
|
||||
<li><a href="/insurance/scheme_administration">{{ __('insurance.scheme_administration') }}</a></li>
|
||||
<li><a href="/insurance_groups/">{{ __('insurance_groups.insurance_groups') }}</a></li>
|
||||
<li class="active">{{ __('insurance_groups.edit') }}</li>
|
||||
</ol>
|
||||
</div>
|
||||
</div>
|
||||
|
||||
@include('flash::message')
|
||||
|
||||
@include('insurance::insurance_groups.menu')
|
||||
|
||||
<div class="panel panel-default">
|
||||
|
||||
<div class="panel-body">
|
||||
{{ Form::model($insurance_group, ['method' => 'PUT', 'route' => ['insurance_groups.update',$insurance_group]]) }}
|
||||
|
||||
<div class="row">
|
||||
<div class="col-md-6">
|
||||
<div class="form-group">
|
||||
{{ Form::label('name', __('insurance_groups.group_name')) }}
|
||||
{{ Form::text('name', $insurance_group->name, ['class' => 'form-control compulsory', 'required']) }}
|
||||
<div class="help-block with-errors"></div>
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('contact_name', __('insurance_groups.contact_name')) }}
|
||||
{{ Form::text('contact_name', $insurance_group->contact_name, ['class' => 'form-control compulsory', 'required']) }}
|
||||
<div class="help-block with-errors"></div>
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('contact_number', __('insurance_groups.contact_number')) }}
|
||||
{{ Form::text('contact_number', $insurance_group->contact_number, ['class' => 'form-control compulsory','required']) }}
|
||||
<div class="help-block with-errors"></div>
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('group_email',__('insurance.email')) }}
|
||||
{{ Form::email('group_email', $insurance_group->contact_email,['class' => 'form-control compulsory']) }}
|
||||
<div class="help-block with-errors"></div>
|
||||
</div>
|
||||
</div>
|
||||
<div class="col-md-6">
|
||||
<div class="form-group">
|
||||
{{ Form::label('country_id',__('patients.country_of_origin')) }}
|
||||
{{ Form::select('country_id', $countries, $insurance_group->country_id, ['class' => 'form-control', 'data-error'=>'Select the country', 'required']) }}
|
||||
<div class="help-block with-errors"></div>
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('last_fees_billing_date', __('insurance.date_of_last_fees_billing')) }}
|
||||
<div class="input-group">
|
||||
{{ Form::text('last_fees_billing_date', is_null($insurance_group->last_fees_billing_date) ? '' : Carbon\Carbon::parse($insurance_group->last_fees_billing_date)->format('d-m-Y'), ['class' => 'form-control','readonly','id'=>'last_fees_billing_date']) }}
|
||||
<span class="input-group-addon"><i class="icon-calender"></i></span>
|
||||
</div>
|
||||
<div class="help-block with-errors"></div>
|
||||
</div>
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('last_fees_payment_date', __('insurance.date_of_last_fees_payment')) }}
|
||||
<div class="input-group">
|
||||
{{ Form::text('last_fees_payment_date', is_null($insurance_group->last_fees_payment_date) ? '' : Carbon\Carbon::parse($insurance_group->last_fees_payment_date)->format('d-m-Y'), ['class' => 'form-control','readonly','id'=>'last_fees_payment_date']) }}
|
||||
<span class="input-group-addon"><i class="icon-calender"></i></span>
|
||||
</div>
|
||||
<div class="help-block with-errors"></div>
|
||||
</div>
|
||||
|
||||
@php
|
||||
$group_risks_array = is_null($insurance_group->risk_ids) ? [] : explode(",", $insurance_group->risk_ids);
|
||||
@endphp
|
||||
|
||||
<div class="form-group">
|
||||
{{ Form::label('risk_id',__('insurance.risk')) }}
|
||||
{{ Form::select('risk_id[]', $chi_risks, $group_risks_array,['class' => 'form-control compulsory risk_id', 'data-error'=>'Select the risk', 'required', 'multiple']) }}
|
||||
<div class="help-block with-errors"></div>
|
||||
</div>
|
||||
</div>
|
||||
</div>
|
||||
|
||||
{{ Form::button(__('insurance_groups.submit'),['type'=>'submit','class'=>'btn btn-success waves-effect waves-light m-r-10']) }}
|
||||
{{ Form::button(__('insurance_groups.cancel'),['type'=>'reset','class'=>'btn btn-default waves-effect waves-light']) }}
|
||||
|
||||
{{ Form::close() }}
|
||||
</div>
|
||||
</div>
|
||||
@endsection
|
||||
|
||||
|
||||
@push('scripts')
|
||||
<script src="{{ asset('elite/js/validator.js') }}"></script>
|
||||
<script src="{{ asset('elite/js/mask.js') }}"></script>
|
||||
<script src="{{ asset('elite/bower_components/bootstrap-datepicker/bootstrap-datepicker.min.js') }}"></script>
|
||||
<script src="{{ asset('elite/bower_components/select2/select2.min.js') }}"></script>
|
||||
<script type="text/javascript">
|
||||
$('#last_fees_billing_date,#last_fees_payment_date').datepicker({
|
||||
autoclose: true,
|
||||
todayHighlight: true,
|
||||
format: 'dd-mm-yyyy'
|
||||
});
|
||||
|
||||
$('.risk_id').select2({
|
||||
placeholder: "Select"
|
||||
});
|
||||
</script>
|
||||
@endpush
|
||||
Reference in New Issue
Block a user