@if(isset($patientAdmission->patient_admission_id)) {{Form::hidden('patient_id',$patientAdmission->patient_admission_id)}} @endif

{{ Form::label('patient_id', __('messages.patient_admission.patient').':',['class' => 'form-label']) }} {{ Form::select('patient_id', $data['patients'], null, ['class' => 'form-select select2Selector','id' => 'admissionPatientId', 'placeholder' => __('messages.patient_admission.patient'),'data-control' => 'select2','required',isset($patientAdmission->patient_admission_id) ? 'disabled' : '']) }}

@if(Auth::user()->hasRole('Doctor')) @else

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

@endif

{{ Form::label('admission_date', __('messages.patient_admission.admission_date').':', ['class' => 'form-label']) }} {{ Form::text('admission_date', null, ['class' => 'form-control bg-white','id' => 'admissionDate','required','autocomplete' => 'off']) }}

@isset($patientAdmission)

{{ Form::label('discharge_date', __('messages.patient_admission.discharge_date').':', ['class' => 'form-label']) }} {{ Form::text('discharge_date', null, ['class' => 'form-control bg-white','id' => 'admissionDischargeDate', 'autocomplete'=>'off']) }}

@endisset

{{ Form::label('package_id', __('messages.patient_admission.package').':', ['class' => 'form-label']) }} {{ Form::select('package_id', $data['packages'], null, ['class' => 'form-select select2Selector','id' => 'admissionPackageId', 'placeholder' => __('messages.patient_admission.select_package'),'data-control' => 'select2']) }}

{{ Form::label('insurance_id', __('messages.patient_admission.insurance').':', ['class' => 'form-label']) }} {{ Form::select('insurance_id', $data['insurances'], null, ['class' => 'form-select select2Selector','id' => 'admissionInsuranceId', 'placeholder' => __('messages.patient_admission.select_insurance'),'data-control' => 'select2']) }}

{{ Form::label('bed_id', __('messages.patient_admission.bed').':', ['class' => 'form-label']) }} {{ Form::select('bed_id', $data['beds'], null, ['class' => 'form-select select2Selector','id' => 'admissionBedId', 'placeholder' => __('messages.bed.select_bed'),'data-control' => 'select2']) }}

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

{{ Form::label('agent_name', __('messages.patient_admission.agent_name').':', ['class' => 'form-label']) }} {{ Form::text('agent_name', null, ['class' => 'form-control']) }}

{{ Form::label('guardian_name', __('messages.patient_admission.guardian_name').':', ['class' => 'form-label']) }} {{ Form::text('guardian_name', null, ['class' => 'form-control']) }}

{{ Form::label('guardian_relation', __('messages.patient_admission.guardian_relation').':', ['class' => 'form-label']) }} {{ Form::text('guardian_relation', null, ['class' => 'form-control']) }}

{{ Form::label('guardian_contact', __('messages.patient_admission.guardian_contact').':', ['class' => 'form-label']) }} {{ Form::text('guardian_contact', null, ['class' => 'form-control iti phoneNumber', 'id' => 'phoneNumber', 'onkeyup' => 'if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,"")']) }} {{ Form::hidden('prefix_code',null,['class'=>'prefix_code']) }} {{ Form::hidden('country_iso', null, ['class' => 'country_iso']) }}

{{ Form::label('guardian_address', __('messages.patient_admission.guardian_address').':', ['class' => 'form-label']) }} {{ Form::text('guardian_address', null, ['class' => 'form-control']) }}

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

status)) ? 'checked' : ''}} {{ !isset($patientAdmission) ? 'checked' : '' }}>