streamline-emr/docker/_streamline-src/resources/views/hospital_information/edit.blade.php

@extends('layouts.main')

@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">{{ __('hospital_information.hospital_information') }}</h4>
    </div>
    <div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
        <ol class="breadcrumb">
            <li><a href="{{ route('home') }}">{{ __('hospital_information.dashboard') }}</a></li>
            <li><a href="/hospital_information/edit">{{ __('hospital_information.hospital_information') }}</a></li>
            <li class="active">{{ __('hospital_information.edit') }}</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::model($hospital_information, ['method' => 'PUT', 'route' => ['hospital_information.update',$hospital_information], 'data-toggle' => 'validator', 'files' => true]) }}

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

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

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

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

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

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

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

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

                    <div class="form-group">
                        {{ Form::label('pdf_print_header', __('hospital_information.print_header')) }}
                        {{ Form::file('pdf_print_header', null) }}
                        <br>
                        <a href="/hospital_information/remove_print_banner">Remove current print banner</a>
                    </div>

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

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

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

                    <div class="form-group">
                        {{ Form::label('financial_year_start_date', 'Start Month Of Financial Year') }}
                        {{--{{ Form::month('financial_year_start_date', $hospital_information->financial_year_start_date, ['class' => 'form-control compulsory', 'required']) }}--}}
                        <select id="month" name="financial_year_start_date" class = "form-control compulsory">
                            <option value="">-- Select --</option>
                            <option value="01" @if($hospital_information->financial_year_start_date == "1")selected @endif>January</option>
                            <option value="02" @if($hospital_information->financial_year_start_date == "2")selected @endif>February</option>
                            <option value="03" @if($hospital_information->financial_year_start_date == "3")selected @endif>March</option>
                            <option value="04" @if($hospital_information->financial_year_start_date == "4")selected @endif>April</option>
                            <option value="05" @if($hospital_information->financial_year_start_date == "5")selected @endif>May</option>
                            <option value="06" @if($hospital_information->financial_year_start_date == "6")selected @endif>June</option>
                            <option value="07" @if($hospital_information->financial_year_start_date == "7")selected @endif>July</option>
                            <option value="08" @if($hospital_information->financial_year_start_date == "8")selected @endif>August</option>
                            <option value="09" @if($hospital_information->financial_year_start_date == "9")selected @endif>September</option>
                            <option value="10" @if($hospital_information->financial_year_start_date == "10")selected @endif>October</option>
                            <option value="11" @if($hospital_information->financial_year_start_date == "11")selected @endif>November</option>
                            <option value="12" @if($hospital_information->financial_year_start_date == "12")selected @endif>December</option>
                        </select>
                        <div class="help-block with-errors"></div>
                    </div>

                    <div class="form-group">
                        {{ Form::label('back_date', 'Back Dating Cutoff Days') }}
                        {{ Form::number('back_date', $hospital_information->back_date, ['class' => 'form-control compulsory', 'required', 'min' => 1]) }}
                        <div class="help-block with-errors"></div>
                    </div>

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

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

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

                    <div class="form-group">
                        {{ Form::label('app_version', __('hospital_information.app_version')) }}
                        {{ Form::number('app_version', $hospital_information->app_version, ['class' => 'form-control compulsory', 'required', 'step' => 0.1]) }}
                        <div class="help-block with-errors"></div>
                    </div>

                    <div class="form-group">
                        {{ Form::label('patient_number_abbr', __('hospital_information.patient_number_abbr')) }}
                        {{ Form::text('patient_number_abbr', $hospital_information->patient_number_abbr, ['class' => 'form-control compulsory', 'required', 'max'=>'3']) }}
                        <div class="help-block with-errors"></div>
                    </div>

                    <div class="form-group">
                        {{ Form::label('logo', __('hospital_information.system_logo')) }}
                        {{ Form::file('logo', null) }}
                        {{ Form::text('current_logo', $hospital_information->logo, ['class' => 'form-control', 'hidden']) }}
                    </div>
                    <div class="form-group">
                        {{ Form::label('stamp', __('hospital_information.stamp')) }}
                        {{ Form::file('stamp', null) }}
                        {{ Form::text('current_stamp', $hospital_information->stamp, ['class' => 'form-control', 'hidden']) }}
                    </div>
                    <div class="form-group">
                        {{ Form::label('lab_stamp', __('hospital_information.lab_stamp')) }}
                        {{ Form::file('lab_stamp', null) }}
                        {{ Form::text('current_lab_stamp', $hospital_information->lab_stamp, ['class' => 'form-control', 'hidden']) }}
                    </div>
                </div>
            </div>

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