{{ Form::label('patient_id', __('messages.ipd_patient.patient_id') . ':', ['class' => 'form-label']) }}
{{ Form::hidden('currency_symbol', getCurrentCurrency(), ['class' => 'currencySymbol']) }}
{{ Form::select('patient_id', $data['patients'], null, ['class' => 'form-select', 'required', 'id' => 'editOpdPatientId', 'placeholder' => __('messages.document.select_patient'), 'data-control' => 'select2']) }}
{{ Form::label('case_id', __('messages.ipd_patient.case_id') . ':', ['class' => 'form-label']) }}
{{ Form::select('case_id', [null], null, ['class' => 'form-select', 'required', 'id' => 'editOpdCaseId', 'disabled', 'data-control' => 'select2', 'placeholder' => __('messages.common.choose') . __('messages.cases')]) }}
{{ Form::hidden('patient_case_id', !empty($opdPatientDepartment->patientCase) ? $opdPatientDepartment->patientCase->case_id : '', ['class' => 'patientCaseId']) }}
{{ Form::label('opd_number', __('messages.opd_patient.opd_number') . ':', ['class' => 'form-label']) }}
{{ Form::text('opd_number', null, ['class' => 'form-control', 'readonly', 'placeholder' => __('messages.opd_patient.opd_number')]) }}
{{ Form::label('height', __('messages.ipd_patient.height') . ':', ['class' => 'form-label']) }}
{{ Form::number('height', null, ['placeholder' => __('messages.ipd_patient.height'), 'class' => 'form-control', 'max' => '7', 'step' => '.01']) }}
{{ Form::label('weight', __('messages.ipd_patient.weight') . ':', ['class' => 'form-label']) }}
{{ Form::number('weight', null, ['placeholder' => __('messages.ipd_patient.weight'), 'class' => 'form-control', 'max' => '200', 'step' => '.01']) }}
{{ Form::label('appointment_date', __('messages.opd_patient.appointment_date') . ':', ['class' => 'form-label']) }}
{{ Form::text('appointment_date', null, ['placeholder' => __('messages.opd_patient.appointment_date'), 'class' => getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control', 'id' => 'editOpdAppointmentDate', 'autocomplete' => 'off', 'required']) }}
{{ Form::label('doctor_id', __('messages.ipd_patient.doctor_id') . ':', ['class' => 'form-label']) }}
{{ Form::select('doctor_id', $data['doctors'], null, ['class' => 'form-select', 'required', 'id' => 'editOpdDoctorId', 'placeholder' => __('messages.web_home.select_doctor'), 'data-control' => 'select2']) }}
{{ Form::label('payment_mode', __('messages.ipd_payments.payment_mode') . ':', ['class' => 'form-label']) }}
{{ Form::select('payment_mode', $data['paymentMode'], null, ['class' => 'form-select', 'required', 'id' => 'editOpdPaymentMode', 'data-control' => 'select2', 'placeholder' => __('messages.common.choose') . __('messages.payment.payment')]) }}
{{ Form::label('symptoms', __('messages.ipd_patient.symptoms') . ':', ['class' => 'form-label']) }}
{{ Form::textarea('symptoms', null, ['class' => 'form-control', 'rows' => 4, 'placeholder' => __('messages.ipd_patient.symptoms')]) }}
{{ Form::label('notes', __('messages.ipd_patient.notes') . ':', ['class' => 'form-label']) }}
{{ Form::textarea('notes', null, ['class' => 'form-control', 'rows' => 4, 'placeholder' => __('messages.ipd_patient.notes')]) }}
@if (count($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'];
$fieldData = isset($opdPatientDepartment->custom_field[$fieldName]) ? $opdPatientDepartment->custom_field[$fieldName] : null;
// $datevalue =
@endphp
{{ Form::label($field['field_name'], $field['field_name'] . ':', ['class' => 'form-label']) }}
@if ($field['is_required'] == 1)
@endif
@if ($field_type == 'date' || $field_type == 'date & Time' )
{{ Form::text($fieldName, ($fieldData == 'y-m-d' ? $fieldData : null), ['id'=>$dateType,'class' => (getLoggedInUser()->thememode ? 'bg-light form-control' : '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, $fieldData, ['class' => 'form-select','placeholder' => $field['field_name'], 'data-control' => 'select2',$field['is_required'] == 1 ? 'required' : '' ]) }}
@elseif ($field_type == 'multiSelect')
{{ Form::select($fieldName.'[]', $field_values, $fieldData, ['class' => 'form-select','placeholder' => $field['field_name'], 'data-control' => 'select2', 'multiple' => true,$field['is_required'] == 1 ? 'required' : '']) }}
@else
{{ Form::$field_type($fieldName, $fieldData, ['class' => 'form-control','placeholder' => $field['field_name'],$field['is_required'] == 1 ? 'required' : '','rows' => $field_type == 'textarea' ? 4 : '' ]) }}
@endif