{{ 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, ['id'=>'caseDate','class ' => 'form-control bg-white','required', 'autocomplete' => 'off']) }}

{{ Form::label('phone', __('messages.case.phone').':', ['class' => 'form-label']) }}
{!! Form::tel('phone', null, ['class' => 'form-control iti phoneNumber', 'id' => 'phoneNumber', 'onkeyup' => 'if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,"")', 'tabindex' => '5']) !!}
{{ Form::hidden('prefix_code',null,['class'=>'prefix_code']) }} {{ Form::hidden('country_iso', null, ['class' => 'country_iso']) }}

{{ 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']) }}

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