streamline-emr/docker/streamline-src/Modules/ClinicalData/Resources/views/referral_hospitals/create.blade.php

@extends('layouts.main')

@section('title', '| Add Referral Hospital')

@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">{{ __('referral_hospitals.add_referral_hospital') }}</h4>
    </div>
    <div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
        <ol class="breadcrumb">
            <li><a href="{{ route('home') }}">{{ __('referral_hospitals.dashboard') }}</a></li>
            <li><a href="/referral_hospitals/index">{{ __('referral_hospitals.referral_hospital') }}</a></li>
            <li class="active">{{ __('referral_hospitals.create') }}</li>
        </ol>
    </div>
</div>

<div class="row">
    <div class="col-sm-12">
        @include('clinical_data::referral_hospitals.menu')
    </div>
</div>

<div class="row">
    <div class="col-sm-12">
        @include('flash::message')
        <div class="white-box">        

            {{ Form::open(['route' => 'referral_hospitals.store','data-toggle' => 'validator']) }}

            <div class="form-group">
                {{ Form::label('name', __('referral_hospitals.hospital_name')) }}
                {{ Form::text('name', '', ['class' => 'form-control compulsory' , 'required']) }}
                <div class="help-block with-errors"></div>
            </div>

            {{ Form::button(__('referral_hospitals.submit'),['type'=>'submit','class'=>'btn btn-success waves-effect waves-light m-r-10']) }}
            {{ Form::button(__('referral_hospitals.cancel'),['type'=>'reset','class'=>'btn btn-default waves-effect waves-light']) }}

            {{ Form::close() }}
        </div>
    </div>
</div>
@endsection

@push('scripts')
<script src="{{ asset('elite/js/validator.js') }}"></script>
@endpush