streamline-emr/docker/statistics/Modules/ClinicalData/Resources/views/suppliers/create.blade.php

@extends('layouts.main')
@push('styles')
    <link href="{{ asset('elite/bower_components/icheck/skins/all.css') }}" rel="stylesheet">
@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">{{ __('suppliers.add_new_supplier') }}</h4>
    </div>
    <div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
        <ol class="breadcrumb">
            <li><a href="{{ route('home') }}">{{ __('suppliers.add_new_supplier') }}</a></li>
            <li><a href="/suppliers/index">{{ __('suppliers.view_suppliers') }}</a></li>
            <li class="active">{{ __('suppliers.add_new_supplier') }}</li>
        </ol>
    </div>
</div>

<div class="row">
    <div class="col-sm-12">
        <!--Flash messages at the top -->
        @include('flash::message')
        <div class="white-box">
            {{ Form::open(['route' => 'suppliers.store' , 'data-toggle' => 'validator']) }}

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

            <div class="form-group">
                {{ Form::label('company', __('suppliers.company_name'))}}
                {{ Form::text('company', '', ['class' => 'form-control']) }}
            </div>

            <div class="form-group">
                {{ Form::label('mobile_number', __('suppliers.mobile_number'))}}
                {{ Form::text('mobile_number', '', ['class' => 'form-control']) }}
            </div>

            <div class="form-group">
                {{ Form::label('available',__('suppliers.is_bed_supplier_available'), ["class"=>'col-md-12']) }}
                &nbsp;&nbsp;{{ __('suppliers.yes') }} {{ Form::radio('available', 1, false, ['class' => 'check form-control', 'data-radio'=>'iradio_flat-green']) }}
                &nbsp;&nbsp;{{ __('suppliers.no') }} {{ Form::radio('available', 0, false, ['class' => 'check form-control', 'data-radio'=>'iradio_flat-green']) }}
                <div class="help-block with-errors"></div>
            </div>   

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

            {{ Form::button(__('suppliers.save'),['type'=>'submit','class'=>'btn btn-success waves-effect waves-light m-r-10']) }}
            {{ Form::button(__('suppliers.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>
<!-- icheck -->
<script src="{{ asset('elite/bower_components/icheck/icheck.min.js') }}"></script>
<script src="{{ asset('elite/bower_components/icheck/icheck.init.js') }}"></script>
@endpush