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

{{ __('cancer_protocol.add_cancer_protocol') }}

@include('cancer::cancer_protocol.menu') @include('flash::message')
{{ Form::open(['route' => 'cancer_protocol.store', 'data-toggle' => 'validator']) }}

Protocol Details

{{ Form::label('name', "Protocol Name") }} {{ Form::text('name', '', ['class' => 'form-control compulsory', 'required']) }}
{{ Form::label('name', "Protocol Billing Type") }}
{{ Form::radio('protocol_billing_type', 0, false, ["required", "onclick" => "show('protocol_cost_div');"]) }}  Umbrella Cost    {{ Form::radio('protocol_billing_type', 1, false, ["required", "onclick" => "hide('protocol_cost_div');"]) }}  Bill Per Drug


{{ Form::label('pre_chemo_comments', 'Comments') }} {{ Form::textarea('pre_chemo_comments', '', ['class' => 'form-control compulsory', 'required', 'rows' => '5']) }}

Drug
Route
Factor
Dose
Duration(Separate with commas)
Instructions
{{ Form::hidden('pre_chemo_row_counter[]', 0) }}
{{ Form::select('pre_chemo_drug_id[]', $drugs, '', ['class' => 'form-control compulsory drugs_id_class', 'id' => 'pre_chemo_drug_id_0', 'onchange' => 'drugs_details(0, this.value, \'pre_chemo\')', 'required']) }}
{{ Form::select('pre_chemo_drug_route[]', $drug_routes, '', ['class' => 'form-control compulsory', 'required']) }}
{{ Form::select('pre_chemo_drug_factor_id[]', $factors, '', ['class' => 'form-control compulsory', 'onchange' => 'check_factor(0, \'pre_chemo\')', 'required', 'id' => 'pre_chemo_drug_factor_id_0']) }}
{{ Form::number('pre_chemo_drug_dose[]', '', ['class' => 'form-control compulsory', 'min' => 0, 'required', 'step' => 0.0001]) }}
{{ Form::textarea('pre_chemo_drug_duration[]', '', ['class' => 'form-control compulsory', 'rows' => '3', 'required']) }}
{{ Form::textarea('pre_chemo_drug_instructions[]', '', ['class' => 'form-control', 'rows' => '3']) }}
Add Drug

{{ Form::label('chemo_comments', 'Comments') }} {{ Form::textarea('chemo_comments', '', ['class' => 'form-control compulsory', 'required', 'rows' => '5']) }}

Drug
Route
Factor
Dose
Duration(Separate with commas)
Instructions
{{ Form::hidden('chemo_row_counter[]', 0) }}
{{ Form::select('chemo_drug_id[]', $drugs, '', ['class' => 'form-control compulsory drugs_id_class', 'id' => 'chemo_drug_id_0', 'onchange' => 'drugs_details(0, this.value, \'chemo\')', 'required']) }}
{{ Form::select('chemo_drug_route[]', $drug_routes, '', ['class' => 'form-control compulsory', 'required']) }}
{{ Form::select('chemo_drug_factor_id[]', $factors, '', ['class' => 'form-control compulsory', 'onchange' => 'check_factor(0, \'chemo\')', 'required', 'id' => 'chemo_drug_factor_id_0']) }}
{{ Form::number('chemo_drug_dose[]', '', ['class' => 'form-control compulsory', 'min' => 0, 'required', 'step' => 0.0001]) }}
{{ Form::textarea('chemo_drug_duration[]', '', ['class' => 'form-control compulsory', 'rows' => '3', 'required']) }}
{{ Form::textarea('chemo_drug_instructions[]', '', ['class' => 'form-control', 'rows' => '3']) }}
Add Drug

{{ Form::label('post_chemo_comments', 'Comments') }} {{ Form::textarea('post_chemo_comments', '', ['class' => 'form-control compulsory', 'required', 'rows' => '5']) }}

Drug
Route
Factor
Dose
Duration(Separate with commas)
Instructions
{{ Form::hidden('post_chemo_row_counter[]', 0) }}
{{ Form::select('post_chemo_drug_id[]', $drugs, '', ['class' => 'form-control compulsory drugs_id_class', 'id' => 'post_chemo_drug_id_0', 'onchange' => 'drugs_details(0, this.value, \'post_chemo\')', 'required']) }}
{{ Form::select('post_chemo_drug_route[]', $drug_routes, '', ['class' => 'form-control compulsory', 'required']) }}
{{ Form::select('post_chemo_drug_factor_id[]', $factors, '', ['class' => 'form-control compulsory', 'onchange' => 'check_factor(0, \'post_chemo\')', 'required', 'id' => 'post_chemo_drug_factor_id_0']) }}
{{ Form::number('post_chemo_drug_dose[]', '', ['class' => 'form-control compulsory', 'min' => 0, 'required', 'step' => 0.0001]) }}
{{ Form::textarea('post_chemo_drug_duration[]', '', ['class' => 'form-control compulsory', 'rows' => '3', 'required']) }}
{{ Form::textarea('post_chemo_drug_instructions[]', '', ['class' => 'form-control', 'rows' => '3']) }}
Add Drug
{{ Form::button(__('cancer_protocol.submit'),['type'=>'submit','class'=>'btn btn-success btn-rounded waves-effect waves-light m-r-10']) }} {{ Form::button(__('cancer_protocol.cancel'),['type'=>'reset','class'=>'btn btn-default btn-rounded waves-effect waves-light']) }} {{ Form::close() }}
@endsection @push('scripts') @endpush