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Filename : 2aedd48d56138b5d2391fabb53fd8bd8.php
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<div class="row">
    <div class="col-md-3">
        <div class="form-group mb-5">
            <?php echo e(Form::label('test_name', __('messages.pathology_test.test_name').':',['class' => 'form-label'])); ?>

            <span class="required"></span>
            <?php echo e(Form::text('test_name', null, ['class' => 'form-control','required'])); ?>

        </div>
    </div>
    <div class="col-md-3">
        <div class="form-group mb-5">
            <?php echo e(Form::label('short_name', __('messages.pathology_test.short_name').':',['class' => 'form-label'])); ?>

            <span class="required"></span>
            <?php echo e(Form::text('short_name', null, ['class' => 'form-control','required'])); ?>

        </div>
    </div>
    <div class="col-md-3">
        <div class="form-group mb-5">
            <?php echo e(Form::label('test_type', __('messages.pathology_test.test_type').':',['class' => 'form-label'])); ?>

            <span class="required"></span>
            <?php echo e(Form::text('test_type', null, ['class' => 'form-control','required'])); ?>

        </div>
    </div>
    <div class="col-md-3">
        <div class="form-group mb-5">
            <?php echo e(Form::label('category_id', __('messages.pathology_test.category_name').':',['class' => 'form-label'])); ?>

            <span class="required"></span>
            <?php echo e(Form::select('category_id',$data['pathologyCategories'], null, ['class' => 'form-select pathologyCategories','required','id' => 'pathologyCategories','placeholder'=>__('messages.medicine.select_category'),'required'])); ?>

        </div>
    </div>
    <div class="col-md-3">
        <div class="form-group mb-5">
            <?php echo e(Form::label('unit', __('messages.pathology_test.unit').':',['class' => 'form-label'])); ?>

            <?php echo e(Form::number('unit', null, ['class' => 'form-control'])); ?>

        </div>
    </div>
    <div class="col-md-3">
        <div class="form-group mb-5">
            <?php echo e(Form::label('subcategory', __('messages.pathology_test.subcategory').':',['class' => 'form-label'])); ?>

            <?php echo e(Form::text('subcategory', null, ['class' => 'form-control'])); ?>

        </div>
    </div>
    <div class="col-md-3">
        <div class="form-group mb-5">
            <?php echo e(Form::label('method', __('messages.pathology_test.method').':',['class' => 'form-label'])); ?>

            <?php echo e(Form::text('method', null, ['class' => 'form-control'])); ?>

        </div>
    </div>
    <div class="col-md-3">
        <div class="form-group mb-5">
            <?php echo e(Form::label('report_days', __('messages.pathology_test.report_days').':',['class' => 'form-label'])); ?>

            <?php echo e(Form::number('report_days', null, ['class' => 'form-control'])); ?>

        </div>
    </div>
    <div class="col-md-3">
        <div class="form-group mb-5">
            <?php echo e(Form::label('charge_category_id', __('messages.pathology_test.charge_category').':',['class' => 'form-label'])); ?>

            <span class="required"></span>
            <?php echo e(Form::select('charge_category_id',$data['chargeCategories'], null, ['class' => 'form-select pChargeCategories','required','id' => 'pathologyChargeCategories','placeholder'=>__('messages.pathology_category.select_charge_category'),'required'])); ?>

        </div>
    </div>
    <div class="col-md-3">
        <div class="form-group mb-5">
            <?php echo e(Form::label('standard_charge', __('messages.pathology_test.standard_charge').':',['class' => 'form-label'])); ?>

            <span class="required"></span>
            (<b><?php echo e(getCurrencySymbol()); ?></b>)
            <?php echo e(Form::text('standard_charge', null, ['class' => 'form-control price-input pathologyStandardCharge', 'id' => 'pTestStandardCharge', 'readonly', 'required'])); ?>

        </div>
    </div>
    <div class="d-flex justify-content-end">
        <div class="form-group">
            <?php echo e(Form::submit(__('messages.common.save'), ['class' => 'btn btn-primary me-2'])); ?>

            <a href="<?php echo e(route('pathology.test.index')); ?>"
               class="btn btn-secondary me-2"><?php echo e(__('messages.common.cancel')); ?></a>
        </div>
    </div>
</div>
<?php /**PATH /home/u827283894/domains/w-manage.org/public_html/hms/resources/views/pathology_tests/fields.blade.php ENDPATH**/ ?>