94 lines
4.2 KiB
PHP
94 lines
4.2 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">Bacteriology 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="start_date" class="col-sm-5 col-form-label">Start Date (dd/mm/yyyy)</label>
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<input type="text" class="form-control form-control-sm col-sm-7" id="start_date" placeholder="">
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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="end_date" class="col-sm-5 col-form-label">End Date (dd/mm/yyyy)</label>
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<input type="text" class="form-control form-control-sm col-sm-7" id="end_date" placeholder="">
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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="sample_source" class="col-sm-5 col-form-label">Sample Type</label>
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<select class="form-control form-control-sm col-sm-7" id="sample_source">
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<option value="none">Select</option>
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<option>Blood Culture</option>
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<option>Urine</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="physician_name" class="col-sm-5 col-form-label">Organism</label>
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<select class="form-control form-control-sm col-sm-7" id="physician_name">
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<option value="none">Select</option>
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<option>Burkhudorial</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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