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

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

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

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

                        <div class="form-group">
                            {{ Form::label('non_insured_price', __('service_items.non_insured_price')) }}
                            {{ Form::number('non_insured_price', $service->non_insured_price, ['class' => 'form-control compulsory', 'required']) }}
                            <div class="help-block with-errors"></div>
                        </div>

                        @if($service->price_list_category && $service->price_list_category != '')
                            @php
                                $price_list_categories = explode(",", $service->price_list_category);
                                $price_list_prices = explode(",", $service->price_list_price);
                            @endphp

                            @for($i = 0; $i < count($price_list_categories); $i++)
                                <div class="form-group">
                                    {{ Form::label('non_insured_price', get_name($price_list_categories[$i], 'id', 'name', 'patient_categories').' Price') }}
                                    {{ Form::hidden('price_list_category_id[]', $price_list_categories[$i]) }}
                                    {{ Form::number('price_list_price[]', $price_list_prices[$i], ['class'=>'form-control price_list_price']) }}
                                </div>
                            @endfor
                        @endif

                        <div class="form-group">
                            {{ Form::label('account_id', __('service_items.chart_account_name')) }}
                            {{ Form::select('account_id', $chart_of_accounts, $service->account_id, ['class'=>'form-control compulsory', 'required']) }}
                            <div class="help-block with-errors"></div>
                        </div>
                    </div>

                    <div class="col-md-6">
                        <div class="form-group">
                            {{ Form::label('available', __('service_items.is_service_available')) }}&ensp;
                            {{ Form::radio('available', 1, $service->available == 1,  ["required", 'class' => 'check form-control', 'data-radio'=>'iradio_flat-green']) }} {{ __('service_items.yes') }} &nbsp;&nbsp;
                            {{ Form::radio('available', 0, $service->available == 0,  ["required", 'class' => 'check form-control', 'data-radio'=>'iradio_flat-green']) }} {{ __('service_items.no') }}
                            <div class="help-block with-errors"></div>
                        </div>

                        <div class="form-group">
                            {{ Form::label('description', __('service_items.description')) }}
                            {{ Form::textArea('description', $service->description, ['class'=>'form-control', 'rows' => 4]) }}
                        </div>

                        <div class="form-group">
                            {{ Form::label('type_of_service',__('service_items.type_of_service')) }}
                            <br>
                            <div>
                                {{ Form::radio('type_of_service', 'Consultation', ($service->item_type == 'Consultation'), ["required"]) }} {{ __('service_items.consultation') }}<br>
                                {{ Form::radio('type_of_service', 'Co_Payment', ($service->item_type == 'Co_Payment'), ["required"]) }} {{ __('service_items.copayment') }}<br>
                                {{ Form::radio('type_of_service', 'Service', ($service->item_type == 'Service'), ["required"]) }} {{ __('service_items.service') }}<br>
                            </div>
                            <div class="help-block with-errors"></div>
                        </div>
                    </div>
                </div>

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

    <script>
        function show(id) {
            if (document.getElementById(id).style.display == 'none') {
                document.getElementById(id).style.display = '';
            }
        }

        function hide(id) {
            document.getElementById(id).style.display = 'none';
        }
    </script>
@endpush