streamline-emr/docker/streamline-src/Modules/Insurance/Resources/views/insurance_benefits/edit.blade.php

@extends('layouts.main')

@push('styles')
    <link href="{{ asset('elite/bower_components/select2/select2.min.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">{{ __('insurance_benefits.create_insurance_benefit') }}</h4>
        </div>
        <div class="col-lg-9 col-sm-8 col-md-8 col-xs-12">
            <ol class="breadcrumb">
                <li><a href="{{ route('home') }}">{{ __('insurance_groups.dashboard') }}</a></li>
                <li><a href="/insurance_benefits/">{{ __('insurance_benefits.insurance_benefits') }}</a></li>
                <li class="active">{{ __('insurance_benefits.create') }}</li>
            </ol>
        </div>
    </div>

    @include('insurance::insurance_benefits.menu')

    <div class="white-box">

        @include('flash::message')

        {{ Form::model($benefit, ['method' => 'PUT', 'route' => ['insurance_benefits.update',$benefit], 'data-toggle' => 'validator']) }}

        <div class="row">
            <div class="col-md-6">
                <div class="form-group">
                    {{ Form::label('name', __('insurance_benefits.benefit_name')) }}
                    {{ Form::text('name', $benefit->name, ['class' => 'form-control compulsory', 'required']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('waiting_period', __('insurance_benefits.waiting_period_days')) }}
                    {{ Form::number('waiting_period', $benefit->waiting_period, ['class' => 'form-control compulsory', 'required']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('annual_member_limit', __('insurance_benefits.annual_member_limit') . ' (' . __('insurance_claims.no_limit_applicable') . ')') }}
                    {{ Form::number('annual_member_limit', $benefit->annual_member_limit, ['class' => 'form-control compulsory', 'required']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('opd_percentage', __('insurance_benefits.opd_percentage') . ' (' . __('insurance_benefits.applied_to_cash_amount') . ')') }}
                    {{ Form::number('opd_percentage', $benefit->opd_percentage, ['class' => 'form-control', 'step' => '0.01']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('ward_id', __('insurance_benefits.wards_benefit_will_be_applied_to')) }}
                    {{ Form::select('ward_id[]', $wards, explode(",", $benefit->wards),['class' => 'form-control ward_id', 'data-error'=>'Select the ward', 'multiple']) }}
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    {{ Form::label('plan_id', __('insurance_benefits.plan')) }}
                    {{ Form::select('plan_id', $insurance_plans, $benefit->plan_id, ['class' => 'form-control compulsory', 'required', 'id' => 'plan_id']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('fee', __('insurance_benefits.fee')) }}
                    {{ Form::number('fee', $benefit->fee, ['class' => 'form-control compulsory', 'required']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('annual_family_limit', __('insurance_benefits.annual_family_limit') . ' (' . __('insurance_claims.no_limit_applicable') . ')') }}
                    {{ Form::number('annual_family_limit', $benefit->annual_family_limit, ['class' => 'form-control compulsory', 'required']) }}
                </div>

                <div class="form-group">
                    {{ Form::label('ipd_percentage', __('insurance_benefits.ipd_percentage') . ' (' . __('insurance_benefits.applied_to_cash_amount') . ')') }}
                    {{ Form::number('ipd_percentage', $benefit->ipd_percentage, ['class' => 'form-control', 'step' => '0.01']) }}
                </div>
            </div>
        </div>

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

        {{ Form::close() }}
    </div>
@endsection

@push('scripts')
    <script src="{{ asset('elite/bower_components/select2/select2.min.js') }}"></script>

    <script>
        $('#plan_id, .ward_id').select2({
            placeholder: "Select"
        });
    </script>
@endpush