{{ Form::label('patient_admission_id', __('messages.bill.admission_id').(':'),['class'=>'form-label required fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::select('patient_admission_id', $patientAdmissionIds, null, ['class' => 'form-select form-select-solid fw-bold', 'id' => 'patientAdmissionId', 'placeholder' => 'Select Admission Id','data-control' => 'select2', 'required']) }}

{{ Form::hidden('patient_admission_id', null, ['id' => 'pAdmissionId']) }} {{ Form::hidden('patient_id', null, ['id' => 'patientId']) }} @if(isset($bill))

{{ Form::label('bill_date', __('messages.bill.bill_date').(':'),['class'=>'form-label required fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('bill_date', null, ['class' => 'form-control form-control-solid', 'id' => 'editBillDate', 'autocomplete' => 'off']) }}

@else

@endif

{{ Form::label('name', __('messages.case.patient').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('name', null, ['class' => 'form-control form-control-solid', 'id' => 'name', 'readonly']) }}

{{ Form::label('email', __('messages.bill.patient_email').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('email', null, ['class' => 'form-control form-control-solid', 'id' => 'userEmail', 'readonly']) }}

{{ Form::label('phone', __('messages.bill.patient_cell_no').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('phone', null, ['class' => 'form-control form-control-solid', 'id' => 'userPhone', 'readonly']) }}

{{ Form::label('gender', __('messages.bill.patient_gender').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }}
{{ __('messages.user.male') }} {{ Form::radio('gender', '0', true, ['class' => 'form-check-input', 'tabindex' => '6']) }} {{ __('messages.user.female') }} {{ Form::radio('gender', '1', false, ['class' => 'form-check-input', 'tabindex' => '7']) }}

{{ Form::label('dob', __('messages.bill.patient_dob').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('dob', null, ['class' => 'form-control form-control-solid', 'id' => 'dob', 'readonly']) }}

{{ Form::label('doctor_id', __('messages.case.doctor').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('doctor_id', null, ['class' => 'form-control form-control-solid', 'id' => 'doctorId', 'readonly']) }}

{{ Form::label('admission_date', __('messages.bill.admission_date').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('admission_date', null, ['class' => 'form-control form-control-solid', 'id' => 'admissionDate', 'readonly']) }}

{{ Form::label('discharge_date', __('messages.bill.discharge_date').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('discharge_date', null, ['class' => 'form-control form-control-solid', 'id' => 'dischargeDate', 'readonly']) }}

{{ Form::label('package_id', __('messages.bill.package_name').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('package_id', null, ['class' => 'form-control form-control-solid', 'id' => 'packageId', 'readonly']) }}

{{ Form::label('insurance_id', __('messages.bill.insurance_name').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('insurance_id', null, ['class' => 'form-control form-control-solid', 'id' => 'insuranceId', 'readonly']) }}

{{ Form::label('total_days', __('messages.bill.total_days').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('total_days', null, ['class' => 'form-control form-control-solid', 'id' => 'totalDays', 'readonly']) }}

{{ Form::label('policy_no', __('messages.bill.policy_no').(':'),['class'=>'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('policy_no', null, ['class' => 'form-control form-control-solid', 'id' => 'policyNo', 'readonly']) }}

@if(isset($bill)) @foreach($bill->billItems as $billItem) @endforeach @else @endif

#	{{ __('messages.bill.item_name') }}	{{ __('messages.bill.qty') }}	{{ __('messages.bill.price') }}	{{ __('messages.bill.amount') }}
{{ $loop->iteration }}	{{ Form::text('item_name[]', $billItem->item_name, ['class' => 'form-control itemName form-control-solid','required']) }}	{{ Form::number('qty[]', $billItem->qty, ['class' => 'form-control qty quantity form-control-solid','required']) }}	{{ Form::text('price[]', number_format($billItem->price), ['class' => 'form-control price-input price form-control-solid','required']) }}	{{ number_format($billItem->amount) }}
1	{{ Form::text('item_name[]', null, ['class' => 'form-control itemName form-control-solid','required']) }}	{{ Form::number('qty[]', null, ['class' => 'form-control qty quantity form-control-solid','required',]) }}	{{ Form::text('price[]', null, ['class' => 'form-control price-input price form-control-solid','required']) }}

{{ getCurrencySymbol() }} {{ isset($bill) ? number_format($bill->amount,2) : 0 }}