streamline-emr/docker/statistics/Modules/ClinicalData/Resources/views/symptoms/edit.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">{{ __('symptoms.edit_symptom') }}</h4>
    </div>
    <div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
        <ol class="breadcrumb">
            <li><a href="{{ route('home') }}">{{ __('symptoms.dashboard') }}</a></li>
            <li><a href="{{ route('clinical_data.index') }}">{{ __('symptoms.clinical_data_home') }}</a></li>
            <li><a href="{{ route('symptoms.index') }}">{{ __('symptoms.symptoms') }}</a></li>
            <li class="active">{{ __('symptoms.edit') }}</li>
        </ol>
    </div>
</div>

@include('clinical_data::symptoms.menu')

<div class="row">
    <div class="col-sm-12">
        <!--Flash messages at the top -->
        @include('flash::message')
        <div class="white-box">
            {{ Form::model($symptom, ['method' => 'PUT', 'route' => ['symptoms.update',$symptom] , 'data-toggle' => 'validator']) }}

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

            <div class="form-group">
                {{ Form::label('prompts', __('symptoms.prompt')) }}
                {{ Form::textArea('prompts', $symptom->prompts, ['class' => 'form-control', 'rows' => 5]) }}
            </div>

            <div class="form-group">
                {{ Form::label('reference_text', __('symptoms.reference_text')) }}
                {{ Form::textArea('reference_text', $symptom->reference_text, ['class'=>'form-control', 'rows' => 5]) }}
            </div>

            <div class="form-group">
                {{ Form::label('reference_link', __('symptoms.reference_link')) }}
                {{ Form::url('reference_link', $symptom->reference_link, ['class'=>'form-control', 'rows' => 5, 'placeholder' => 'eg http://www.google.com']) }}
            </div>

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

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