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hms.dentostock.com
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nurses
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Filename :
edit_fields.blade.php
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<div class="alert alert-danger d-none hide" id="editNurseErrorsBox"></div> <div class="row"> <div class="col-md-6"> <div class="form-group mb-5"> {{ Form::label('first_name', __('messages.user.first_name') . ':', ['class' => 'form-label']) }} <span class="required"></span> {{ Form::text('first_name', null, ['class' => 'form-control', 'required']) }} </div> </div> <div class="col-md-6"> <div class="form-group mb-5"> {{ Form::label('last_name', __('messages.user.last_name') . ':', ['class' => 'form-label']) }} <span class="required"></span> {{ Form::text('last_name', null, ['class' => 'form-control', 'required']) }} </div> </div> <div class="col-md-6"> <div class="form-group mb-5"> {{ Form::label('email', __('messages.user.email') . ':', ['class' => 'form-label']) }} <span class="required"></span> {{ Form::email('email', null, ['class' => 'form-control', 'required', 'id' => 'editNurseEmail']) }} </div> </div> <div class="col-md-6"> <div class="form-group mb-5"> {{ Form::label('designation', __('messages.user.designation') . ':', ['class' => 'form-label']) }} <span class="required"></span> {{ Form::text('designation', null, ['class' => 'form-control', 'required']) }} </div> </div> <div class="col-md-6"> <div class="form-group mobile-overlapping mb-5"> {{ Form::label('phone', __('messages.user.phone') . ':', ['class' => 'form-label']) }} <br> {{ Form::tel('phone', $nurse->user->phone ?? getCountryCode(), ['class' => 'form-control phoneNumber', 'id' => 'editNursePhoneNumber', 'onkeyup' => 'if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,"")']) }} {{ Form::hidden('prefix_code', null, ['class' => 'prefix_code']) }} {{ Form::hidden('country_iso', null, ['class' => 'country_iso']) }} <span class="text-success valid-msg d-none fw-400 fs-small mt-2">✓ {{ __('messages.valid') }}</span> <span class="text-danger error-msg d-none fw-400 fs-small mt-2"></span> </div> </div> <div class="col-md-3"> <div class="form-group mb-5"> {{ Form::label('gender', __('messages.user.gender') . ':', ['class' => 'form-label']) }} <span class="required"></span> <br> <div class="d-flex align-items-center"> <div class="form-check me-10"> <label class="form-label" for="editNurseMale">{{ __('messages.user.male') }}</label> {{ Form::radio('gender', '0', true, ['class' => 'form-check-input', 'id' => 'editNurseMale']) }} </div> <div class="form-check me-10"> <label class="form-label" for="editNurseFemale">{{ __('messages.user.female') }}</label> {{ Form::radio('gender', '1', false, ['class' => 'form-check-input', 'id' => 'editNurseFemale']) }} </div> </div> </div> </div> <div class="col-md-3"> <div class="form-group mb-5"> {{ Form::label('status', __('messages.common.status') . ':', ['class' => 'form-label']) }} <br> <div class="form-check form-switch"> <input class="form-check-input w-35px h-20px is-active" name="status" type="checkbox" value="1" {{ isset($user) && $user->status ? 'checked' : '' }}> </div> </div> </div> <div class="col-md-6"> <div class="form-group mb-5"> {{ Form::label('qualification', __('messages.user.qualification') . ':', ['class' => 'form-label']) }} <span class="required"></span> {{ Form::text('qualification', null, ['class' => 'form-control', 'required']) }} </div> </div> <div class="col-md-6"> <div class="form-group mb-5"> {{ Form::label('dob', __('messages.user.dob') . ':', ['class' => 'form-label']) }} {{ Form::text('dob', null, ['id' => 'editNurseBirthDate', 'class' => getLoggedInUser()->thememode ? 'bg-light nurseBirthDate form-control' : 'bg-white nurseBirthDate form-control', 'autocomplete' => 'off']) }} </div> </div> <div class="col-md-6"> <div class="form-group mb-5"> {{ Form::label('blood_group', __('messages.user.blood_group') . ':', ['class' => 'form-label']) }} {{ Form::select('blood_group', $bloodGroup, null, ['class' => 'form-select', 'id' => 'editNurseBloodGroup', 'placeholder' => __('messages.user.select_blood_group')]) }} </div> </div> <div class="form-group col-md-4 mb-5"> <div class="row2"> {{ Form::label('image', __('messages.common.profile') . ':', ['class' => 'fs-5 fw-bold mb-2 text-gray-700 d-block']) }} <div class="d-block"> <div class="image-picker"> <div class="image previewImage nursePreviewImage" id="nursePreviewImage" style="background-image: url({{ isset($user->media[0]) ? $user->image_url : asset('assets/img/avatar.png') }})"> </div> <span class="picker-edit rounded-circle text-gray-500 fs-small" title="{{ __('messages.common.change_profile') }}"> <label> <i class="fa-solid fa-pen" id="profileImageIcon"></i> <input type="file" id="editNurseProfileImage" name="image" class="image-upload d-none nurseProfileImage" accept=".png, .jpg, .jpeg, .gif" /> <input type="hidden" name="avatar_remove"> </label> </span> </div> </div> </div> </div> </div> <hr> <div class="row mt-3"> <div class="col-md-12 mb-3"> <h5>{{ __('messages.user.address_details') }}</h5> </div> <div class="col-md-6"> <div class="form-group mb-5"> {{ Form::label('address1', __('messages.user.address1') . ':', ['class' => 'form-label']) }} {{ Form::text('address1', isset($nurse->address->address1) ? $nurse->address->address1 : null, ['class' => 'form-control']) }} </div> </div> <div class="col-md-6"> <div class="form-group mb-5"> {{ Form::label('address2', __('messages.user.address2') . ':', ['class' => 'form-label']) }} {{ Form::text('address2', isset($nurse->address->address2) ? $nurse->address->address2 : null, ['class' => 'form-control']) }} </div> </div> <div class="col-md-3"> <div class="form-group mb-5"> {{ Form::label('city', __('messages.user.city') . ':', ['class' => 'form-label']) }} {{ Form::text('city', isset($nurse->address->city) ? $nurse->address->city : null, ['class' => 'form-control']) }} </div> </div> <div class="col-md-3"> <div class="form-group mb-5"> {{ Form::label('zip', __('messages.user.zip') . ':', ['class' => 'form-label']) }} {{ Form::text('zip', isset($nurse->address->zip) ? $nurse->address->zip : null, ['class' => 'form-control', 'maxlength' => '6', 'minlength' => '6']) }} </div> </div> <div class="d-flex justify-content-end"> {{ Form::submit(__('messages.common.save'), ['class' => 'btn btn-primary me-3']) }} <a href="{{ route('nurses.index') }}" class="btn btn-secondary">{{ __('messages.common.cancel') }}</a> </div> </div>