{{ Form::hidden('currency_symbol', getCurrentCurrency(), ['class' => 'currencySymbol']) }}

{{ Form::label('patient_name', __('messages.case.patient') . ':', ['class' => 'form-label']) }} {{ Form::select('patient_id', $patients, null, ['class' => 'form-select select2Selector', 'required', 'id' => 'casePatientId', 'placeholder' => __('messages.document.select_patient'), 'data-control' => 'select2', 'required']) }}

{{ Form::label('doctor_name', __('messages.case.doctor') . ':', ['class' => 'form-label']) }} {{ Form::select('doctor_id', $doctors, null, ['class' => 'form-select select2Selector', 'required', 'id' => 'caseDoctorId', 'placeholder' => __('messages.web_home.select_doctor'), 'data-control' => 'select2', 'required']) }}

{{ Form::label('date', __('messages.case.case_date') . ':', ['class' => 'form-label']) }} {{ Form::text('date', null, ['placeholder' => __('messages.case.case_date') ,'id' => 'caseDate', 'class' => getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control', 'required', 'autocomplete' => 'off']) }}

{{ Form::label('phone', __('messages.case.phone') . ':', ['class' => 'form-label']) }}
{!! Form::tel('phone', isset($patientCase) ? $patientCase->phone ?? getCountryCode() : getCountryCode(), [ 'class' => 'form-control iti phoneNumber', 'id' => 'casePhoneNumber', ]) !!} {!! Form::hidden('prefix_code', null, ['class' => 'prefix_code']) !!}

{{ Form::label('status', __('messages.common.status') . ':', ['class' => 'form-label']) }}

status ? 'checked' : '') }}>

{{ Form::label('fee', __('messages.case.fee') . ':', ['class' => 'form-label']) }} {{ Form::text('fee', null, ['class' => 'form-control price-input price','required','placeholder'=>__('messages.case.fee')]) }}

{{ Form::label('description', __('messages.common.description').':', ['class' => 'form-label']) }} {{ Form::textarea('description', null, ['class' => 'form-control', 'rows' => 4,'placeholder'=>__('messages.case.description')]) }}

{{ Form::submit(__('messages.common.save'), ['class' => 'btn btn-primary me-2', 'id' => 'saveCaseBtn']) }} {{ __('messages.common.cancel') }}