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

@extends('layouts.main')

@section('title', '| Add Drug Route')

@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">New Company</h4>
    </div>
    <div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
        <ol class="breadcrumb">
            <li><a href="{{ route('home') }}">Dashboard</a></li>
            <li><a href="/companies/">Companies</a></li>
            <li class="active">Register</li>
        </ol>
    </div>
    <!-- /.col-lg-12 -->
</div>

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

@include('flash::message')

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

    <div class="panel-body">
        {{ Form::open(['route' => 'companies.store','data-toggle'=>'validator']) }}

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

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

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

        {{ Form::button('Submit',['type'=>'submit','class'=>'btn btn-success btn-rounded waves-effect waves-light m-r-10']) }}
        {{ Form::button('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>
@endpush