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https://gitlab.com/signalytic/client-external/streamline/streamline-emr.git
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alec.turner
4a89356390
An updated set of source files and initialization was provided by streamline to address issues observed during initial testing. These files have been updated in order to generate a new set of app images.
63 lines
3.8 KiB
PHP
Executable File
63 lines
3.8 KiB
PHP
Executable File
<div class="modal" id="document_modal" tabindex="-1" role="dialog" aria-labelledby="document_modal_label" aria-hidden="true">
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<div class="modal-dialog modal-lg" role="document">
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<div class="modal-content">
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<div class="modal-header">
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<h5 class="modal-title" id="debt_plan_modal_label"><b>Add Patient Document</b></h5>
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</div>
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<div class="modal-body">
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<div class="row">
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{{ Form::open(['route' => 'patient_documents.modal_store','data-toggle'=>'validator','files'=>'true']) }}
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{{--<form id="add_document_form" method="post" enctype="multipart/form-data">--}}
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<div class="col-sm-12">
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<div class="row">
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<div class="col-sm-6">
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<div class="form-group">
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{{ Form::label('patientnumber','Patient Number') }}
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{{ Form::text('patientnumber',$patient->number,['class' => 'form-control compulsory', 'required',
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'data-error'=>'','readonly'=>'true', 'id'=>'patientnumber']) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('documenttitle','Document Title') }}
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{{ Form::text('documenttitle','',['class' => 'form-control compulsory', 'required', 'data-error'=>'', 'id'=>'documenttitle' ]) }}
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('description','Description') }}
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{{ Form::textArea('description','',['class' => 'form-control', 'id'=>'description']) }}
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</div>
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</div>
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<div class="col-sm-6">
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<div class="form-group">
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{{ Form::label('documentdate','Date of document') }}
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<div class="input-group">
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{{ Form::text('documentdate','',['class' => 'form-control compulsory', 'required','readonly',
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'id'=>'documentdate']) }}
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<span class="input-group-addon"><i class="icon-calender"></i></span>
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</div>
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<div class="help-block with-errors"></div>
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</div>
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<div class="form-group">
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{{ Form::label('document','Document') }}
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{{ Form::file('document',['class' => 'form-control compulsory', 'required', 'id'=>'document']) }}
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<div class="help-block with-errors"></div>
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</div>
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</div>
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</div>
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<button type="button" class="btn btn-danger" data-dismiss="modal">Cancel Document</button>
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<button type="submit" class="btn btn-success" >Save Document</button>
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</div>
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{{--</form>--}}
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{{ Form::close() }}
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</div>
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</div>
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<div class="modal-footer">
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</div>
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</div>
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</div>
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</div> |