streamline-emr/docker/streamline-src/Modules/Insurance/Resources/views/chi_plan/edit.blade.php

@extends('layouts.main')

@push('styles')
    <link href="{{ asset('elite/bower_components/bootstrap-datepicker/bootstrap-datepicker.min.css') }}" rel="stylesheet" type="text/css" />
    <link href="{{ asset('elite/bower_components/select2/select2.min.css') }}" rel="stylesheet"/>
@endpush

@section('title', '| Edit Plan')

@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">{{ __('insurance.create_chi_plan') }}</h4>
    </div>
    <div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
        <ol class="breadcrumb">
            <li><a href="{{ url('insurance') }}">{{ __('insurance.home') }}</a></li>
            <li><a href="{{ route('community_health_insurance_plan.index') }}">{{ __('insurance.chi_plan') }}</a></li>
            <li class="active">{{ __('insurance.create_chi_plan') }}</li>
        </ol>
    </div>
    <!-- /.col-lg-12 -->
</div>

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

@include('flash::message')

<div class="panel panel-default" style="border-radius: 5px;">

    <div class="panel-body">
        {{ Form::model($chi_plan, ['method' => 'PUT', 'route' => ['community_health_insurance_plan.update',$chi_plan]]) }}

        <div class="row">
            <div class="col-sm-6">
                <div class="form-group">
                    {{ Form::label('name', __('insurance.name')) }}
                    {{ Form::text('name', $chi_plan->name, ['class' => 'form-control compulsory', 'required']) }}
                    <div class="help-block with-errors"></div>
                </div>

                <div class="form-group">
                    {{ Form::label('plan_start_date', __('insurance.start_date')) }}
                    <div class="input-group">
                        {{ Form::text('plan_start_date',date_format(date_create($chi_plan->plan_start_date), 'd-m-Y'),['class' => 'form-control compulsory','readonly','id'=>'plan_start_date']) }}
                        <span class="input-group-addon"><i class="icon-calender"></i></span>
                    </div>
                    <div class="help-block with-errors"></div>
                </div>

                <div class="form-group">
                    {{ Form::label('plan_end_date', __('insurance.end_date')) }}
                    <div class="input-group">
                        {{ Form::text('plan_end_date',date_format(date_create($chi_plan->plan_end_date), 'd-m-Y'),['class' => 'form-control compulsory','readonly','id'=>'plan_end_date']) }}
                        <span class="input-group-addon"><i class="icon-calender"></i></span>
                    </div>
                    <div class="help-block with-errors"></div>
                </div>

                <div class="form-group">
                    {{ Form::label('is_authorization_required', __('insurance.is_authorization_required')) }}
                    {{ Form::select('is_authorization_required', ['' => '-- Select --', 1 => 'Yes', 0 => 'No'], $chi_plan->is_authorized_required, ['class' => 'form-control compulsory', 'required']) }}
                    <div class="help-block with-errors"></div>
                </div>
            </div>
            <div class="col-sm-6">
                <div class="form-group">
                    {{ Form::label('plan_fee', __('insurance.plan_fee')) }}
                    {{ Form::number('plan_fee', $chi_plan->plan_fee, ['class' => 'form-control compulsory', 'required']) }}
                    <div class="help-block with-errors"></div>
                </div>

                <div class="form-group">
                    {{ Form::label('member_annual_limit', __('insurance.overall_annual_limit_for_member') . ' (' . __('insurance_claims.no_limit_applicable') . ')') }}
                    {{ Form::number('member_annual_limit', $chi_plan->member_annual_limit, ['class' => 'form-control compulsory', 'required']) }}
                    <div class="help-block with-errors"></div>
                </div>

                <div class="form-group">
                    {{ Form::label('family_annual_limit', __('insurance.overall_annual_limit_for_family') . ' (' . __('insurance_claims.no_limit_applicable') . ')') }}
                    {{ Form::number('family_annual_limit', $chi_plan->family_annual_limit, ['class' => 'form-control compulsory', 'required']) }}
                    <div class="help-block with-errors"></div>
                </div>

                <div class="form-group">
                    {{ Form::label('membership_card_color', __('insurance.membership_card_color')) }}
                    {{ Form::select('membership_card_color', ['' => '-- Select --', 'green' => 'Green', 'blue' => 'Blue'], $chi_plan->membership_card_color, ['class' => 'form-control compulsory', 'required']) }}
                    <div class="help-block with-errors"></div>
                </div>
            </div>
        </div>

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

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


@push('scripts')
<script src="{{ asset('elite/js/validator.js') }}"></script>
<script src="{{ asset('elite/bower_components/select2/select2.min.js') }}"></script>
<script src="{{ asset('elite/bower_components/bootstrap-datepicker/bootstrap-datepicker.min.js') }}"></script>

<script type="text/javascript">
    $('#plan_start_date').datepicker({
        autoclose: true,
        todayHighlight: true,
        format: 'dd-mm-yyyy'
    });

    $('#plan_end_date').datepicker({
        autoclose: true,
        todayHighlight: true,
        format: 'dd-mm-yyyy'
    });
</script>
@endpush