{{ Form::label('name', __('messages.insurance.insurance') . ':', ['class' => 'form-label']) }}
{{ Form::text('name', null, ['class' => 'form-control ', 'required','placeholder'=>__('messages.insurance.insurance')]) }}
{{ Form::label('service_tax', __('messages.insurance.service_tax') . ':', ['class' => 'form-label fs-6']) }}
{{ Form::text('service_tax', null, ['class' => 'form-control service-tax price-input', 'required','placeholder'=>__('messages.insurance.service_tax')]) }}
{{ Form::label('discount', __('messages.insurance.discount') . ': ', ['class' => 'form-label']) }}
({{ __('messages.invoice.in_percentage') }}(%))
{{ Form::number('discount', null, ['id' => 'insuranceDiscountId', 'class' => 'form-control discount', 'min' => 0, 'max' => 100, 'step' => '.01', 'placeholder' => __('messages.insurance.discount')]) }}
{{ Form::label('insurance_no', __('messages.insurance.insurance_no') . ':', ['class' => 'form-label']) }}
{{ Form::text('insurance_no', null, ['class' => 'form-control', 'required','placeholder'=>__('messages.insurance.insurance_no')]) }}
{{ Form::label('insurance_code', __('messages.insurance.insurance_code') . ':', ['class' => 'form-label']) }}
{{ Form::text('insurance_code', null, ['class' => 'form-control', 'required','placeholder'=>__('messages.insurance.insurance_code')]) }}
{{ Form::label('hospital_rate', __('messages.insurance.hospital_rate') . ':', ['class' => 'form-label']) }}
{{ Form::text('hospital_rate', null, ['class' => 'form-control hospital-rate price-input', 'required','placeholder'=>__('messages.insurance.hospital_rate')]) }}
{{ Form::label('remark', __('messages.insurance.remark').(':'), ['class' => 'form-label']) }}
{{ Form::textarea('remark', null, ['class' => 'form-control', 'rows' => 4,'placeholder'=>__('messages.insurance.remark')]) }}
{{ __('messages.insurance.disease_details') }}
| # |
{{ __('messages.insurance.diseases_name') }}
|
{{ __('messages.insurance.diseases_charge') }}
|
{{ __('messages.common.action') }}
|
@if (isset($diseases))
@foreach ($diseases as $disease)
| {{ $loop->iteration }} |
{{ Form::text('disease_name[]', $disease->disease_name, ['class' => 'form-control disease-name ', 'required','placeholder' => __('messages.insurance.diseases_name')]) }}
|
{{ Form::text('disease_charge[]', $disease->disease_charge, [
'class' => 'form-control disease-charge price-input',
'required',
'placeholder' => __('messages.insurance.diseases_charge'),
]) }}
|
|
@endforeach
@else
| 1 |
{{ Form::text('disease_name[]', null, ['class' => 'form-control disease-name', 'required','placeholder' => __('messages.insurance.diseases_name')]) }}
|
{{ Form::text('disease_charge[]', null, ['class' => 'form-control disease-charge price-input', 'required','placeholder' => __('messages.insurance.diseases_charge')]) }}
|
|
@endif
|
{{ __('messages.insurance.total_amount') . ':' }} |
{{ isset($insurance) ? getCurrencySymbol() . '' . number_format($insurance->total, 2) : getCurrencySymbol() . '' . 0 }}
|
{{ Form::hidden('total', null, ['class' => 'form-control', 'id' => 'insuranceTotal_amount']) }}
{{ Form::submit(__('messages.common.save'), ['class' => 'btn btn-primary me-2', 'id' => 'insuranceSaveBtn']) }}
{{ __('messages.common.cancel') }}