{{ Form::label('patient_id', __('messages.ipd_patient.patient_id') . ':', ['class' => 'form-label']) }}
{{ Form::select('patient_id', $data['patients'], null, ['class' => 'form-select ipdPatientId', 'required', 'id' => 'ipdPatientId', 'placeholder' => __('messages.document.select_patient'), 'tabindex' => '1', 'data-control' => 'select2']) }}
{{ Form::label('case_id', __('messages.ipd_patient.case_id') . ':', ['class' => 'form-label required']) }}
{{ Form::select('case_id', [null], null, ['class' => 'form-select ipdDepartmentCaseId', 'id' => 'ipdDepartmentCaseId', 'disabled', 'data-control' => 'select2', 'placeholder' => __('messages.common.choose') . __('messages.cases')]) }}
{{ Form::label('ipd_number', __('messages.ipd_patient.ipd_number') . ':', ['class' => 'form-label']) }}
{{ Form::text('ipd_number', $data['ipdNumber'], ['class' => 'form-control', 'readonly', 'placeholder' => __('messages.ipd_patient.ipd_number')]) }}
{{ Form::label('height', __('messages.ipd_patient.height') . ':', ['class' => 'form-label']) }}
{{ Form::number('height', 0, ['class' => 'form-control ipdDepartmentFloatNumber', 'max' => '7', 'step' => '.01', 'tabindex' => '2', 'placeholder' => __('messages.ipd_patient.height')]) }}
{{ Form::label('weight', __('messages.ipd_patient.weight') . ':', ['class' => 'form-label']) }}
{{ Form::number('weight', 0, ['placeholder' => __('messages.ipd_patient.weight'),'class' => 'form-control ipdDepartmentFloatNumber', 'data-mask' => '##0,00', 'max' => '200', 'step' => '.01', 'tabindex' => '3']) }}
{{ Form::label('bp', __('messages.ipd_patient.bp').':', ['class' => 'form-label']) }}
{{ Form::number('bp', null, ['class' => 'form-control', 'tabindex' => '4','placeholder'=>__('messages.ipd_patient.bp')]) }}
{{ Form::label('admission_date', __('messages.ipd_patient.admission_date') . ':', ['class' => 'form-label']) }}
{{ Form::text('admission_date', null, ['placeholder' => __('messages.ipd_patient.admission_date'),'class' => getLoggedInUser()->thememode ? 'bg-light ipdAdmissionDate form-control' : 'bg-white ipdAdmissionDate form-control', 'id' => 'ipdAdmissionDate', 'autocomplete' => 'off', 'required', 'tabindex' => '5']) }}
{{ Form::label('doctor_id', __('messages.ipd_patient.doctor_id') . ':', ['class' => 'form-label']) }}
{{ Form::select('doctor_id', $data['doctors'], null, ['class' => 'form-select', 'required', 'id' => 'ipdDoctorId', 'placeholder' => __('messages.web_home.select_doctor'), 'data-control' => 'select2', 'tabindex' => '6']) }}
{{ Form::label('bed_type_id', __('messages.ipd_patient.bed_type_id') . ':', ['class' => 'form-label']) }}
{{ Form::select('bed_type_id', $data['bedTypes'], null, ['class' => 'form-select ipdBedTypeId', 'required', 'id' => 'ipdBedTypeId', 'placeholder' => __('messages.bed.select_bed_type'), 'data-control' => 'select2', 'tabindex' => '7']) }}
{{ Form::label('bed_id', __('messages.ipd_patient.bed_id') . ':', ['class' => 'form-label']) }}
{{ Form::select('bed_id', [null], null, ['class' => 'form-select bedId', 'required', 'id' => 'ipdBedId', 'disabled', 'data-control' => 'select2', 'placeholder' => __('messages.common.choose') . __('messages.bed_assign.bed')]) }}
@if ($customField >= 0)
@foreach ($customField as $field)
@php
$field_values = explode(',',$field['values']);
$dateType = ($field['field_type'] == 6) ? 'customFieldDate' : 'customFieldDateTime';
$field_type = \App\Models\AddCustomFields::FIELD_TYPE_ARR[$field['field_type']];
$fieldName = 'field'.$field['id'];
@endphp
{{ Form::label($field['field_name'], $field['field_name'] . ':', ['class' => $field['is_required'] == 1 ? 'form-label dynamic-field' : 'form-label']) }}
@if ($field['is_required'] == 1)
@endif
@if ($field_type == 'date' || $field_type == 'date & Time' )
{{ Form::text($fieldName, null, ['id'=>$dateType,'class' => getLoggedInUser()->thememode || $field['is_required'] == 1 ? 'bg-light form-control dynamic-field' : 'bg-white form-control', 'autocomplete' => 'off','placeholder'=>$field['field_name'],$field['is_required'] == 1 ? 'required' : ''])}}
@elseif ($field_type == 'toggle')
@elseif ($field_type == 'select')
{{ Form::select($fieldName, $field_values, null, ['class' => $field['is_required'] == 1 ? 'form-select dynamic-field' : 'form-select', 'placeholder' => $field['field_name'], 'data-control' => 'select2',$field['is_required'] == true ? 'required' : '']) }}
@elseif ($field_type == 'multiSelect' )
{{ Form::select($fieldName.'[]', $field_values, 0, ['class' => $field['is_required'] == 1 ? 'dynamic-field form-select ipd-multi-select' : 'form-select ipd-multi-select', 'placeholder' => $field['field_name'], 'data-control' => 'select2','multiple' => true,$field['is_required'] == 1 ? 'required' : '']) }}
@else
{{ Form::$field_type($fieldName, null, ['class' => $field['is_required'] == 1 ? 'form-control dynamic-field' : 'form-control', 'placeholder' => $field['field_name'],$field['is_required'] == 1 ? 'required' : '','rows' => $field_type == 'textarea' ? 4 : '']) }}
@endif
{{ Form::label('symptoms',__('messages.ipd_patient.symptoms').':', ['class' => 'form-label']) }}
{{ Form::textarea('symptoms', null, ['class' => 'form-control', 'rows' => 4,'placeholder'=>__('messages.ipd_patient.symptoms')]) }}
{{ Form::label('notes',__('messages.ipd_patient.notes').':', ['class' => 'form-label']) }}
{{ Form::textarea('notes', null, ['class' => 'form-control', 'rows' => 4,'placeholder'=>__('messages.ipd_patient.notes')]) }}