{{ Form::label('patient_id', __('messages.advanced_payment.patient').(':'), ['class' => 'form-label']) }} {{ Form::select('patient_id', $patients ?? [], null, ['class' => 'form-select', 'id' => 'editPatientId','placeholder' => 'Select Patient', 'required','data-control' => 'select2']) }}

{{ Form::label('receipt_no', __('messages.advanced_payment.receipt_no').(':'),['class' => 'form-label']) }} {{ Form::text('receipt_no', null, ['class' => 'form-control','id'=> 'editReceiptNo','required','readonly']) }}

{{ Form::label('amount', __('messages.advanced_payment.amount').(':'),['class' => 'form-label required']) }} {{ Form::text('amount', null, ['class' => 'form-control price-input','id'=> 'editAmount','required', 'onkeyup' => 'if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,"")', 'maxlength' => '7']) }}

{{ Form::label('date', __('messages.advanced_payment.date').(':'),['class' => 'form-label required']) }} {{ Form::text('date', null, ['class' => (getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control'),'id' => 'editAdvancedPaymentDate','required','autocomplete' => 'off']) }}