Upload Lab Report
{!! Form::open(['route' => $routePrefix . 'lab-patient-report.store', 'method' => 'post', 'enctype' => 'multipart/form-data', 'id' => 'form-lab-report']) !!}
{!! Form::label('patient_id', __('Select Patient') ) !!} *
{!! Form::select(
'patient_id',
$patientsList->prepend('- Select Patient -', ''),
null,
['class' => 'form-control patient-select select2', 'data-required' => 'true']
) !!}
{{ $errors->first('patient_id') }}
{!! Form::label('doctor_id', __('Doctor') ) !!} *
{!! Form::select(
'doctor_id',
$doctorsList->prepend('- Select Doctor -', ''),
null,
['class' => 'form-control select2', 'data-required' => 'true']
) !!}
{{ $errors->first('doctor_id') }}
{!! Form::label('report_type', __('Report Type')) !!} *
{!! Form::select(
'report_type',
$reportTypesList->prepend('- Select Report Type -', ''),
null,
['class' => 'form-control select2', 'data-required' => 'true']
) !!}
{{ $errors->first('report_type') }}
{!! Form::label('report_name', __('Report Name') ) !!} *
{!! Form::text('report_name', null, ['class' => 'form-control', 'placeholder' => 'e.g., Blood Test, X-Ray, ECG', 'data-required' => 'true', 'autocomplete' => 'off']) !!}
{{ $errors->first('report_name') }}
{!! Form::label('test_date', __('Test Date') ) !!} *
{!! Form::text('test_date', null, [
'class' => 'form-control date_time_picker',
'placeholder' => 'Select Date',
'data-required' => 'true',
'autocomplete' => 'off',
]) !!}
{{ $errors->first('test_date') }}
{!! Form::label('report_files', __('Upload Report Files')) !!}
Allowed formats: PDF, DOC, DOCX, JPG, PNG (Max 10 MB each).
{{ $errors->first('report_files') }}
{{ $errors->first('report_files.*') }}
{{--
Allowed formats: PDF, DOC, DOCX, JPG, PNG (Max 10 MB each).
{{ $errors->first('report_files') }}
{{ $errors->first('report_files.*') }} --}}
Drag & Drop files here
or
{!! Form::file('report_files[]', [ 'id' => 'report_files', 'class' => 'form-control', 'accept' => '.pdf,.doc,.docx,.jpg,.jpeg,.png', 'multiple' => true, 'data-required' => 'true' ]) !!}
{!! Form::label('remarks', __('Remarks')) !!}
{!! Form::textarea('remarks', null, ['class' => 'form-control', 'rows' => 4, 'placeholder' => 'Add any remarks about the report...']) !!}
{{ $errors->first('remarks') }}
{!! Form::label('status', __('Status')) !!}
{!! Form::select('status', ['1' => 'Active', '0' => 'Inactive'], 1, ['class' => 'form-control']) !!}
{{-- {!! Form::submit(__('Upload Report'), ['class' => 'btn btn-primary']) !!} --}}
Cancel
{!! Form::close() !!}