100 lines
4.5 KiB
PHP
100 lines
4.5 KiB
PHP
<!DOCTYPE html>
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<html lang="{{ str_replace('_', '-', app()->getLocale()) }}">
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<head>
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@include('layout.header')
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</head>
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<body>
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<div class="row" id="x" style="display: none;">
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<div class="col-12">
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<span class="d-flex align-items-center purchase-popup">
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<i class="typcn typcn-delete-outline" id="bannerClose"></i>
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</span>
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</div>
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</div>
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<div class="container-scroller">
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@include('layout.navbar')
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<!-- partial -->
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@include('layout.breadscrum')
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<div class="container-fluid page-body-wrapper">
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@include('layout.sidebar')
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<!-- partial -->
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<div class="main-panel">
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<div class="content-wrapper">
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<div class="row">
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<div class="col-md-12 grid-margin stretch-card">
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<div class="card">
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<div class="card-body">
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<h4 class="card-title">Individual Report</h4>
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<div class="row">
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<div class="col-md-6">
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<div class="form-group row">
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<label for="patient_name" class="col-sm-5 col-form-label">Patient Name</label>
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<select class="form-control form-control-sm col-sm-7" id="patient_name">
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<option value="none">Select</option>
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<option>Mr A</option>
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<option>Mr B</option>
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</select>
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group row">
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<label for="labid" class="col-sm-5 col-form-label">Patient Hospital ID</label>
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<select class="form-control form-control-sm col-sm-7" id="lab_id">
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<option value="none">Select</option>
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<option>001-30082022</option>
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<option>002-30082022</option>
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</select>
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group row">
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<label for="phonenumber" class="col-sm-5 col-form-label">Phone Number</label>
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<input type="text" class="form-control form-control-sm col-sm-7" id="phone_number" placeholder="Phone number">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group row">
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<label for="exampleInputUsername2" class="col-sm-5 col-form-label">Sample Number</label>
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<select class="form-control form-control-sm col-sm-7" id="sample_number">
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<option value="">Select</option>
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<option>001-09082022</option>
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<option>002-09082022</option>
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</select>
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</div>
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</div>
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</div>
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<div class="row float-right">
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<div class="col-md-12">
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<button type="button" class="btn btn-info btn-icon-text">
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<i class="typcn typcn-eye btn-icon-prepend"></i>
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Preview
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</button>
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<button type="button" class="btn btn-info btn-icon-text">
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<i class="typcn typcn-printer btn-icon-prepend"></i>
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Print
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</button>
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<button type="button" class="btn btn-warning btn-icon-text">
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<i class="typcn typcn-refresh-outline btn-icon-prepend"></i>
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Reset
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</button>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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@include('layout.footer')
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</div>
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</div>
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</div>
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@include('layout.common_script')
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</body>
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</html>
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