Файловый менеджер

?? Файловый менеджер

Файловый менеджер - Редактировать - /home/dava/domains/medica.dava.digital/public_html/storage/framework/views/a4e9e86e5c86dc682a12b4b1be16c805262ac215.php

Назад
<?php $__env->startSection('title'); ?> <?php echo e(__('sentence.New Patient')); ?> <?php $__env->stopSection(); ?> <?php $__env->startSection('content'); ?> <div class="row justify-content-center"> <div class="col-md-10"> <div class="card shadow mb-4"> <div class="card-header py-3"> <h6 class="m-0 font-weight-bold text-primary"><?php echo e(__('sentence.New Patient')); ?></h6> </div> <div class="card-body"> <form method="post" action="<?php echo e(route('patient.create')); ?>" enctype="multipart/form-data"> <?php echo csrf_field(); ?> <div class="form-row"> <div class="form-group col-md-6"> <label for="inputEmail4"><?php echo e(__('sentence.Full Name')); ?><font color="red"></font></label> <input type="text" class="form-control" id="Name" name="name"> </div> <div class="form-group col-md-6"> <label for="inputPassword4"><?php echo e(__('sentence.Email Adress')); ?><font color="red"></font></label> <input type="email" class="form-control" id="Email" name="email"> </div> </div> <div class="form-row"> <div class="form-group col-md-6"> <label for="inputAddress2"><?php echo e(__('sentence.Phone')); ?></label> <input type="text" class="form-control" id="Phone" name="phone"> </div> <div class="form-group col-md-6"> <label for="inputAddress"><?php echo e(__('sentence.Birthday')); ?><font color="red"></font></label> <input type="date" class="form-control" id="Birthday" name="birthday" autocomplete="off"> </div> </div> <div class="form-row"> <div class="form-group col-md-12"> <label for="inputAddress2"><?php echo e(__('sentence.Address')); ?></label> <input type="text" class="form-control" id="Address" name="adress"> </div> </div> <div class="form-row"> <div class="form-group col-md-6"> <label for="inputCity"><?php echo e(__('sentence.Gender')); ?><font color="red"></font></label> <select class="form-control" name="gender" id="Gender"> <option value="Male"><?php echo e(__('sentence.Male')); ?></option> <option value="Female"><?php echo e(__('sentence.Female')); ?></option> </select> </div> <div class="form-group col-md-6"> <label for="inputZip"><?php echo e(__('sentence.Blood Group')); ?></label> <select class="form-control" name="blood" id="Blood"> <option value="Unknown"><?php echo e(__('sentence.Unknown')); ?></option> <option value="A+">A+</option> <option value="A-">A-</option> <option value="B+">B+</option> <option value="B-">B-</option> <option value="O+">O+</option> <option value="O-">O-</option> <option value="AB+">AB+</option> <option value="AB-">AB-</option> </select> </div> </div> <div class="form-row"> <div class="form-group col-md-6"> <label for="inputAddress2"><?php echo e(__('sentence.Patient Weight')); ?></label> <input type="text" class="form-control" id="Weight" name="weight"> </div> <div class="form-group col-md-6"> <label for="inputAddress"><?php echo e(__('sentence.Patient Height')); ?><font color="red"></font></label> <input type="text" class="form-control" id="height" name="height"> </div> </div> <div class="form-row"> <div class="form-group col-md-6"> <label for="inputState"><?php echo e(__('sentence.Image')); ?></label> <label for="file-upload" class="custom-file-upload"> <i class="fa fa-cloud-upload"></i> Select Image to Upload </label> <input type="file" class="form-control" id="file-upload" name="image"> </div> </div> <div class="form-group row"> <div class="col-sm-9"> <button type="submit" class="btn btn-primary"><?php echo e(__('sentence.Save')); ?></button> </div> </div> </form> </div> </div> </div> </div> <?php $__env->stopSection(); ?> <?php $__env->startSection('header'); ?> <style type="text/css"> input[type="file"] { display: none; } .custom-file-upload { border: 1px solid #ccc; display: inline-block; padding: 6px 12px; cursor: pointer; } </style> <?php $__env->stopSection(); ?> <?php $__env->startSection('footer'); ?> <?php $__env->stopSection(); ?> <?php echo $__env->make('layouts.master', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /PATH /home/dava/domains/medica.dava.digital/public_html/resources/views/patient/create.blade.php ENDPATH*/ ?>