{{ Form::label('diagnosis_name', __('diagnoses.diagnosis_name')) }} {{ Form::text('diagnosis_name', '', ['class' => 'form-control compulsory', 'id'=>'diagnosis_name']) }}

{{ Form::label('icd10_code', __('diagnoses.icd_10_code')) }} {{ Form::text('icd10_code', '', ['class' => 'form-control','id'=>'icd10_code']) }}

{{ Form::label('hmis_no_outpatient', __('diagnoses.hmis_out_patient_number')) }} {{ Form::text('hmis_no_outpatient', '', ['class'=>'form-control','id'=>'hmis_no_outpatient']) }}

{{ Form::label('hmis_no_inpatient', __('diagnoses.hmis_inpatient_category')) }} {{ Form::text('hmis_no_inpatient', '', ['class'=>'form-control','id'=>'hmis_no_inpatient']) }}

{{ Form::label('hmis_category', __('diagnoses.hmis_category')) }} {{ Form::select('hmis_category', $hmis_categories, '', ['class' => 'form-control','id'=>'hmis_category']) }}

{{ Form::label('diagnosis_prompts', __('diagnoses.diagnosis_prompt')) }} {{ Form::textArea('diagnosis_prompts', '', ['class'=>'form-control','id'=>'diagnosis_prompts', 'rows' => 5]) }}

{{ Form::label('', __('diagnoses.chronic_status'), ["class"=>'col-md-12']) }}  {{ __('diagnoses.yes') }} {{ Form::radio('chronic_status', 1, false, ['class' => 'check', 'id' => 'chronic_yes']) }}  {{ __('diagnoses.no') }} {{ Form::radio('chronic_status', 0, false, ['class' => 'check', 'id' => 'chronic_no']) }}