@extends('layouts.main') @push('styles') @endpush @section('content')

{{ __('diagnoses.edit_diagnosis') }}

@include('clinical_data::diagnoses.menu')
@include('flash::message')
{{ Form::model($diagnosis, ['method' => 'PUT', 'route' => ['diagnoses.update',$diagnosis], 'data-toggle' => 'validator']) }}
{{ Form::label('name', __('diagnoses.diagnosis_name')) }} {{ Form::text('name', $diagnosis->name, ['class' => 'form-control compulsory', 'required']) }}
@if (!empty($errors->get('name')))
@foreach ($errors->get('name') as $message) {{ $message }} @endforeach
@endif
{{ Form::label('icd10_code', __('diagnoses.icd_10_code')) }} {{ Form::text('icd10_code', $diagnosis->icd10_code, ['class' => 'form-control']) }}

HMIS Outpatient Report (105)

{{ Form::label('outpatient_hmis_category', __('diagnoses.outpatient_hmis_category')) }} {{ Form::select('outpatient_hmis_category', $outpatient_hmis_categories, $diagnosis->outpatient_hmis_category?? '', ['class' => 'form-control compulsory', 'id'=>'outpatient_hmis_category', 'required']) }}
{{ Form::label('outpatient_hmis_category_option', __('diagnoses.hmis_outpatient_category')) }} {{ Form::select('outpatient_hmis_category_option', $outpatient_category_options, $diagnosis->outpatient_hmis_category_option?? '', ['class'=>'form-control', 'id'=>'outpatient_hmis_category_option', 'required']) }}
{{ Form::label('outpatient_dependent_option', 'Outpatient Dependent Option') }} {{ Form::select('outpatient_dependent_option', $outpatient_dependent_options, $diagnosis->outpatient_dependent_option?? '', ['class'=>'form-control', 'id'=>'outpatient_dependent_option']) }}

HMIS Inpatient Report (108)

{{ Form::label('hmis_category', __('diagnoses.hmis_category')) }} {{ Form::select('hmis_category', $inpatient_hmis_categories, $diagnosis->hmis_category, ['class' => 'form-control compulsory', 'id'=>'hmis_category_inpatient', 'required']) }}
{{ Form::label('hmis_no_inpatient', __('diagnoses.hmis_inpatient_category')) }} {{ Form::select('hmis_no_inpatient', $inpatient_category_options, $diagnosis->hmis_no_inpatient?? '', ['class'=>'form-control', 'id'=>'hmis_category_inpatient_options', 'required']) }}
{{ Form::label('dependent_option', 'Dependent Option') }} {{ Form::select('parent_dependent_option', $dependent_options, $diagnosis->dependent_option, ['class'=>'form-control', 'id'=>'parent_dependent_option']) }}
@if(is_chi_enabled())
{{ Form::label('insurance_tariffs', 'Insurance Tariffs') }} {{ Form::select('insurance_tariffs[]', $insurance_tariffs, explode(",", $diagnosis->insurance_tariffs),['id'=>'insurance_tariffs', 'multiple', 'class' => 'form-control']) }}
@endif
{{ Form::label('prompts', __('diagnoses.diagnosis_prompt')) }} {{ Form::textArea('prompts', $diagnosis->prompts, ['class'=>'form-control', 'rows' => 5]) }}
{{ Form::label('', __('diagnoses.chronic_status'), ["class"=>'col-md-12']) }}  {{ __('diagnoses.yes') }} {{ Form::radio('chronic_status', 1, ($diagnosis->chronic_status) ? true : false, ["required", 'class' => 'check form-control', 'data-radio'=>'iradio_flat-green']) }}  {{ __('diagnoses.no') }} {{ Form::radio('chronic_status', 0, ($diagnosis->chronic_status) ? false : true, ["required", 'class' => 'check form-control', 'data-radio'=>'iradio_flat-green']) }}
{{ Form::label('available', __('diagnoses.is_diagnosis_available'), ["class"=>'col-md-12']) }}  {{ __('diagnoses.yes') }} {{ Form::radio('available', 1, $diagnosis->available == 1, ["required", 'class' => 'check form-control', 'data-radio'=>'iradio_flat-green']) }}  {{ __('diagnoses.no') }} {{ Form::radio('available', 0, $diagnosis->available == 0, ["required", 'class' => 'check form-control', 'data-radio'=>'iradio_flat-green']) }}
{{ Form::label('diagnosis_category', __('diagnoses.diagnosis_category')) }} {{ Form::select('diagnosis_category', $diagnosis_categories, $diagnosis->diagnosis_category, ['class' => 'form-control']) }}
{{ Form::label('reference_areas', __('diagnoses.reference_areas')) }} reference_areas)); $reference_names_array = array_filter(explode(",", $diagnosis->reference_names)); ?> @for ($x = 0; $x < count($reference_areas_array); $x++)


{{ Form::text('reference_names[]', $reference_names_array ? $reference_names_array[$x] : '', ['class' => 'form-control', 'placeholder' => 'Reference name']) }}
{{ Form::text('reference_areas[]', $reference_areas_array ? $reference_areas_array[$x] : '', ['class' => 'form-control', 'placeholder' => 'e.g. http://google.com']) }}
@if ($x > 0) X @endif
@endfor
{{ __('diagnoses.add_more')}}
{{ Form::button(__('diagnoses.submit'),['type'=>'submit','class'=>'btn btn-success waves-effect waves-light m-r-10']) }} {{ Form::button(__('diagnoses.cancel'),['type'=>'reset','class'=>'btn btn-default waves-effect waves-light']) }} {{ Form::close() }}
@endsection @push('scripts') @endpush