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

{{ __('patient_documents.upload') }} @if(isset($patient->last_name)){{$patient->last_name}}'s @endif {{ __('patient_documents.document') }}

@include('patients::allergies.header')
@include('flash::message') @foreach ($errors->all() as $error)
{{ $error }}
@endforeach
{{ Form::open(['route' => 'patient_documents.store','data-toggle'=>'validator','files'=>'true']) }}
{{ Form::label('patientnumber',__('patient_documents.patient_number')) }} {{ Form::text('patientnumber',$patient->number,['class' => 'form-control compulsory', 'required', 'data-error'=>'','readonly'=>'true']) }}
{{ Form::label('documenttitle',__('patient_documents.document_title')) }} {{ Form::text('documenttitle','',['class' => 'form-control compulsory', 'required', 'data-error'=>'']) }}
{{ Form::label('description',__('patient_documents.description')) }} {{ Form::textArea('description','',['class' => 'form-control']) }}
{{ Form::label('documentdate',__('patient_documents.date_of_document')) }}
{{ Form::text('documentdate',date('d/m/Y'),['class' => 'form-control compulsory', 'required','readonly','id'=>'datepicker-autoclose']) }}
{{ Form::label('document',__('patient_documents.document')) }} {{ Form::file('document',['class' => 'form-control compulsory', 'required']) }}

{{ Form::button(__('patient_documents.submit'),['type'=>'submit','class'=>'btn btn-success waves-effect waves-light m-r-10']) }} {{ Form::button(__('patient_documents.cancel'),['type'=>'reset','class'=>'btn btn-default waves-effect waves-light']) }}
{{ Form::close() }}
@endsection @push('scripts') @endpush