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

@extends('layouts.main')

@push('styles')
    <link href="{{ asset('/elite/bower_components/datatables/jquery.dataTables.min.css') }}" rel="stylesheet" type="text/css" />
    <link href="{{ asset('elite/tables/css/buttons.dataTables.min.css') }}" rel="stylesheet" type="text/css" />
@endpush

@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_benefits.edit_tariff') }}</h4>
        </div>
        <div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
            <ol class="breadcrumb">
                <li><a href="{{ route('home') }}">{{ __('insurance_groups.dashboard') }}</a></li>
                <li><a href="/insurance_tariffs/view_tariffs">{{ __('insurance_benefits.insurance_tariffs') }}</a></li>
                <li class="active">{{ __('insurance_benefits.create') }}</li>
            </ol>
        </div>
    </div>

    @include('insurance::insurance_benefits.menu')

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

        <h3>{{ __('insurance_benefits.insurance_benefit') }}: {{ $benefit->name }}</h3>
        <h4>{{ __('insurance_benefits.item_type') }}: {{ [1 => 'Services', 2 => 'Procedures', 3 => 'Investigations', 4 => 'Drugs', 5 => 'Sundries'][$item_type] }}</h4>
        <h4>{{ __('insurance_benefits.item_name') }}: {{ $item_name }}</h4>

        <hr>

        {{ Form::open(['route' => 'insurance_tariffs.update_tariff']) }}

        {{ Form::hidden('tariff_id', $tariff->id, ['id' => 'benefit_id']) }}

        <div class="row">
            <div class="col-md-6">
                <div class="form-group">
                    {{ Form::label('name', __('insurance_benefits.tariff_name')) }}
                    {{ Form::text('name', $tariff->name, ['class' => 'form-control compulsory', 'required']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('cash_price', __('insurance_benefits.cash_price')) }}
                    {{ Form::number('cash_price', $item_cash_price, ['class' => 'form-control', 'readonly']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('co_payment', __('insurance_benefits.co_payment')) }}
                    {{ Form::number('co_payment', $co_payment, ['class' => 'form-control', 'readonly']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('ipd_co_payment', __('insurance_benefits.ipd_co_payment')) }}
                    {{ Form::number('ipd_co_payment', $ipd_co_payment, ['class' => 'form-control', 'readonly']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('age_limit', __('insurance_benefits.age_limit')) }}
                    @php $age_limits = explode(",", $tariff->age_limit); @endphp

                    <div class="row">
                        <div class="col-md-6">
                            <div class="form-group">
                                {{ Form::label('age_limit_start',__('insurance_benefits.start')) }}
                                {{ Form::number('age_limit_start', $age_limits[0],['class' => 'form-control compulsory']) }}
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                {{ Form::label('age_limit_end',__('insurance_benefits.end')) }}
                                {{ Form::number('age_limit_end', $age_limits[1],['class' => 'form-control compulsory']) }}
                            </div>
                        </div>
                    </div>
                </div>

                <div class="form-group">
                    {{ Form::label('age_type', __('insurance_benefits.age_type')) }}
                    {{ Form::select('age_type', [0 => 'Days', 1 => 'Months', 2 => 'Years'], $tariff->age_type, ['class' => 'form-control compulsory', 'required']) }}
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    {{ Form::label('gender', __('insurance_benefits.gender')) }}
                    {{ Form::select('gender', [0 => 'All', 1 => 'Male', 2 => 'Female'], $tariff->gender, ['class' => 'form-control compulsory', 'required']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('authorisation', __('insurance_benefits.authorisation')) }}

                    <br><br>

                    {{ Form::radio('authorisation', 1, $tariff->authorisation == 1, ['required']) }} Yes &nbsp;&nbsp;
                    {{ Form::radio('authorisation', 0, $tariff->authorisation == 0, ['required']) }} No
                </div>

                <div class="form-group">
                    {{ Form::label('tariff_price', __('insurance_benefits.tariff_price')) }}
                    {{ Form::number('tariff_price', $tariff->tariff_price, ['class' => 'form-control compulsory', 'required']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('ipd_tariff_price', __('insurance_benefits.ipd_tariff_price')) }}
                    {{ Form::number('ipd_tariff_price', $tariff->ipd_tariff_price, ['class' => 'form-control compulsory', 'required']) }}
                </div>
            </div>
        </div>

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

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

@push('scripts')

    <script></script>
@endpush