{{ Form::label('patient_id', __('messages.prescription.patient').(':'), ['class' => 'form-label']) }} {{ Form::select('patient_id',$patients, isset($medicineBill) ? $medicineBill->patient_id:null, ['class' => 'form-select','required','id' => 'prescriptionPatientId','placeholder'=> __('messages.document.select_patient')]) }}

{{ Form::hidden('patient_admission_id', null, ['id' => 'pAdmissionId']) }} {{ Form::hidden('patient_id', null, ['id' => 'billsPatientId']) }} @if(isset($medicineBill))

{{ Form::label('bill_date', __('messages.bill.bill_date').(':'),['class'=>'form-label']) }} {{ Form::text('bill_date', $medicineBill->updated_at, ['class' => (getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control'), 'id' => 'editBillDate', 'autocomplete' => 'off']) }}

@else

{{ Form::label('bill_date', __('messages.bill.bill_date').(':'),['class'=>'form-label']) }} {{ Form::text('bill_date', null, ['class' => (getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control'), 'id' => 'bill_date', 'autocomplete' => 'off']) }}

@endif

{{ Form::label('name', __('messages.case.patient').(':'),['class'=>'form-label']) }} {{ Form::text('name', null, ['class' => 'form-control', 'id' => 'name', 'readonly']) }}

{{ Form::label('email', __('messages.bill.patient_email').(':'),['class'=>'form-label']) }} {{ Form::text('email', null, ['class' => 'form-control', 'id' => 'userEmail', 'readonly']) }}

{{ Form::label('phone', __('messages.bill.patient_cell_no').(':'),['class'=>'form-label']) }} {{ Form::text('phone', null, ['class' => 'form-control', 'id' => 'userPhone', 'readonly']) }}

{{ Form::label('gender', __('messages.bill.patient_gender').(':'),['class'=>'form-label']) }}

{{ Form::radio('gender', '0', true, ['class' => 'form-check-input', 'tabindex' => '6', 'id' => 'genderMale']) }} {{ __('messages.user.male') }}

{{ Form::radio('gender', '1', false, ['class' => 'form-check-input', 'tabindex' => '7', 'id' => 'genderFemale']) }} {{ __('messages.user.female') }}

{{ Form::label('dob', __('messages.bill.patient_dob').(':'),['class'=>'form-label']) }} {{ Form::text('dob', null, ['class' => 'form-control', 'id' => 'dob', 'readonly']) }}

{{ Form::label('doctor_id', __('messages.case.doctor').(':'),['class'=>'form-label']) }} {{ Form::text('doctor_id', null, ['class' => 'form-control', 'id' => 'billDoctorId', 'readonly']) }}

{{ Form::label('admission_date', __('messages.bill.admission_date').(':'),['class'=>'form-label']) }} {{ Form::text('admission_date', null, ['class' => 'form-control', 'id' => 'admissionDate', 'readonly']) }}

{{ Form::label('discharge_date', __('messages.bill.discharge_date').(':'),['class'=>'form-label']) }} {{ Form::text('discharge_date', null, ['class' => 'form-control', 'id' => 'dischargeDate', 'readonly']) }}

{{ Form::label('package_id', __('messages.bill.package_name').(':'),['class'=>'form-label']) }} {{ Form::text('package_id', null, ['class' => 'form-control', 'id' => 'packageId', 'readonly']) }}

{{ Form::label('insurance_id', __('messages.bill.insurance_name').(':'),['class'=>'form-label']) }} {{ Form::text('insurance_id', null, ['class' => 'form-control', 'id' => 'insuranceId', 'readonly']) }}

{{ Form::label('total_days', __('messages.bill.total_days').(':'),['class'=>'form-label']) }} {{ Form::text('total_days', null, ['class' => 'form-control', 'id' => 'totalDays', 'readonly']) }}

{{ Form::label('policy_no', __('messages.bill.policy_no').(':'),['class'=>'form-label']) }} {{ Form::text('policy_no', null, ['class' => 'form-control', 'id' => 'policyNo', 'readonly']) }}

{{ __('Payment Status') . ' :' }} payment_status) == '1' ? 'checked' : '' }} id="medicineBillPaymentStatus">

@if(isset($medicineBill)) @foreach($medicineBill->saleMedicine as $medicineBillItem) @endforeach @else @endif

#	{{ __('messages.bill.item_name') }}	{{ __('messages.bill.qty') }}	{{ __('messages.bill.price') }}	{{ __('messages.bill.amount') }}	{{ __('messages.common.action') }}
{{ $loop->iteration }}	{{ Form::text('item_name[]', $medicineBillItem->medicine->name, ['class' => 'form-control itemName','required']) }}	{{ Form::number('qty[]', $medicineBillItem->medicine->sale_quantity, ['class' => 'form-control qty quantity','required']) }}	{{ Form::text('price[]', number_format($medicineBillItem->medicine->selling_price), ['class' => 'form-control decimal-number price','required']) }}	{{ number_format($medicineBillItem->medicine->sale_quantity * $medicineBillItem->medicine->selling_price) }}
1	{{ Form::text('item_name[]', null, ['class' => 'form-control itemName','required']) }}	{{ Form::number('qty[]', null, ['class' => 'form-control qty quantity','required',]) }}	{{ Form::text('price[]', null, ['class' => 'form-control decimal-number price','required']) }}

{{ getCurrencySymbol() }} {{ isset($medicineBill) ? number_format($medicineBill->amount,2) : 0 }}