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hms.dentostock.com
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bills
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Filename :
fields.blade.php
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<div class="row"> {{ Form::hidden('currency_symbol', getCurrentCurrency(), ['class' => 'currencySymbol']) }} <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('patient_admission_id', __('messages.bill.admission_id').(':'),['class'=>'form-label']) }} <span class="required"></span> {{ Form::select('patient_admission_id', $patientAdmissionIds, null, ['class' => 'form-select', 'id' => 'patientAdmissionId', 'placeholder' =>__('messages.common.choose').' '. __('messages.bill.admission_id'),'data-control' => 'select2', 'required']) }} </div> {{ Form::hidden('patient_admission_id', null, ['id' => 'pAdmissionId']) }} {{ Form::hidden('patient_id', null, ['id' => 'billsPatientId']) }} @if(isset($bill)) <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('bill_date', __('messages.bill.bill_date').(':'),['class'=>'form-label']) }} <span class="required"></span> {{ Form::text('bill_date', null, ['class' => (getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control'), 'id' => 'editBillDate', 'autocomplete' => 'off']) }} </div> @else <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('bill_date', __('messages.bill.bill_date').(':'),['class'=>'form-label']) }} <span class="required"></span> {{ Form::text('bill_date', null, ['class' => (getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control'), 'id' => 'bill_date', 'autocomplete' => 'off']) }} </div> @endif <div class="col-lg-3 col-md-4 col-sm-12 mb-5 myclass"> {{ Form::label('name', __('messages.case.patient').(':'),['class'=>'form-label']) }} {{ Form::text('name', null, ['class' => 'form-control', 'id' => 'name', 'readonly']) }} </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('email', __('messages.bill.patient_email').(':'),['class'=>'form-label']) }} {{ Form::text('email', null, ['class' => 'form-control', 'id' => 'userEmail', 'readonly']) }} </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('phone', __('messages.bill.patient_cell_no').(':'),['class'=>'form-label']) }} {{ Form::text('phone', null, ['class' => 'form-control', 'id' => 'userPhone', 'readonly']) }} </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('gender', __('messages.bill.patient_gender').(':'),['class'=>'form-label']) }} <br> <div class="d-flex align-items-center mt-3"> <div class="form-check me-10 mb-0"> {{ Form::radio('gender', '0', true, ['class' => 'form-check-input', 'tabindex' => '6', 'id' => 'genderMale']) }} <label class="form-check-label" for="genderMale">{{ __('messages.user.male') }}</label> </div> <div class="form-check mb-0"> {{ Form::radio('gender', '1', false, ['class' => 'form-check-input', 'tabindex' => '7', 'id' => 'genderFemale']) }} <label class="form-check-label" for="genderFemale">{{ __('messages.user.female') }}</label> </div> </div> </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('dob', __('messages.bill.patient_dob').(':'),['class'=>'form-label']) }} {{ Form::text('dob', null, ['class' => 'form-control', 'id' => 'dob', 'readonly']) }} </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('doctor_id', __('messages.case.doctor').(':'),['class'=>'form-label']) }} {{ Form::text('doctor_id', null, ['class' => 'form-control', 'id' => 'billDoctorId', 'readonly']) }} </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('admission_date', __('messages.bill.admission_date').(':'),['class'=>'form-label']) }} {{ Form::text('admission_date', null, ['class' => 'form-control', 'id' => 'admissionDate', 'readonly']) }} </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('discharge_date', __('messages.bill.discharge_date').(':'),['class'=>'form-label']) }} {{ Form::text('discharge_date', null, ['class' => 'form-control', 'id' => 'dischargeDate', 'readonly']) }} </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('package_id', __('messages.bill.package_name').(':'),['class'=>'form-label']) }} {{ Form::text('package_id', null, ['class' => 'form-control', 'id' => 'packageId', 'readonly']) }} </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('insurance_id', __('messages.bill.insurance_name').(':'),['class'=>'form-label']) }} {{ Form::text('insurance_id', null, ['class' => 'form-control', 'id' => 'insuranceId', 'readonly']) }} </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('total_days', __('messages.bill.total_days').(':'),['class'=>'form-label']) }} {{ Form::text('total_days', null, ['class' => 'form-control', 'id' => 'totalDays', 'readonly']) }} </div> <div class="col-lg-3 col-md-4 col-sm-12 mb-5"> {{ Form::label('policy_no', __('messages.bill.policy_no').(':'),['class'=>'form-label']) }} {{ Form::text('policy_no', null, ['class' => 'form-control', 'id' => 'policyNo', 'readonly']) }} </div> </div> <div class="com-sm-12"> <div class="col-lg-12 col-md-12 col-sm-12 d-flex justify-content-end mb-4"> <button type="button" class="btn btn-primary text-star" id="addBillItem"> {{ __('messages.invoice.add') }}</button> </div> <div class="table-responsive-sm"> <table class="table table-striped" id="billTbl"> <thead> <tr class="text-start text-muted fw-bolder fs-7 text-uppercase gs-0"> <th class="text-center">#</th> <th class="required">{{ __('messages.bill.item_name') }}</th> <th class="required">{{ __('messages.bill.qty') }}</th> <th class="required">{{ __('messages.bill.price') }}</th> <th class="text-right">{{ __('messages.bill.amount') }}</th> <th class="text-center"> {{ __('messages.common.action') }} </th> </tr> </thead> <tbody class="bill-item-container text-gray-600 fw-bold"> @if(isset($bill)) @foreach($bill->billItems as $billItem) <tr> <td class="text-center item-number">{{ $loop->iteration }}</td> <td class="table__item-desc"> {{ Form::text('item_name[]', $billItem->item_name, ['class' => 'form-control itemName','required']) }} </td> <td class="table__qty"> {{ Form::number('qty[]', $billItem->qty, ['class' => 'form-control qty quantity','required']) }} </td> <td> {{ Form::text('price[]', number_format($billItem->price), ['class' => 'form-control price-input price','required']) }} </td> <td class="amount text-right itemTotal">{{ number_format($billItem->amount) }} </td> <td class="text-center"> <i class="fa fa-trash text-danger delete-bill-add-item pointer"></i> </td> </tr> @endforeach @else <tr> <td class="text-center item-number">1</td> <td class="table__item-desc"> {{ Form::text('item_name[]', null, ['class' => 'form-control itemName','required']) }} </td> <td class="table__qty"> {{ Form::number('qty[]', null, ['class' => 'form-control qty quantity','required',]) }} </td> <td> {{ Form::text('price[]', null, ['class' => 'form-control price-input price','required']) }} </td> <td class="amount text-right itemTotal"> </td> <td class="text-center"> <i class="fa fa-trash text-danger delete-invoice-item pointer"></i> </td> </tr> @endif </tbody> </table> </div> <div class="col-lg-3 col-md-4 col-sm-4 float-right p-0"> <table class="w-100"> <tbody class="bill-item-footer"> <tr> <td class="form-label text-right">{{ __('messages.bill.total_amount').(':') }}</td> <td class="text-right"> <span id="totalPrice" class="price">{{ isset($bill) ? getCurrencySymbol() . '' . number_format($bill->amount,2) : getCurrencySymbol() . '' . 0 }}</span> </td> </tr> </tbody> </table> </div> </div> <!-- Total Amount Field --> {{ Form::hidden('total_amount', null, ['class' => 'form-control', 'id' => 'totalAmount']) }} <!-- Submit Field --> <div class="float-end"> {{ Form::submit(__('messages.common.save'), ['class' => 'btn btn-primary me-2','id' => 'billSave']) }} <a href="{{ route('bills.index') }}" class="btn btn-secondary">{{ __('messages.common.cancel') }}</a> </div>