{{ Form::label('date', __('messages.ipd_patient_charges.date').':',['class' => 'form-label']) }} {{ Form::text('date', null, ['class' => 'form-control modelDataPickerzindex bg-white','id' => 'ipdChargeDate','autocomplete' => 'off', 'required']) }}

{{ Form::label('charge_type_id', __('messages.ipd_patient_charges.charge_type_id').':',['class' => 'form-label']) }} {{ Form::select('charge_type_id', $chargeTypes, null, ['class' => 'form-select select2Selector', 'id' => 'ipdChargeTypeId', 'required','placeholder'=>'Select Charge Type', 'data-is-charge-edit' => false]) }}

{{ Form::label('charge_category_id', __('messages.ipd_patient_charges.charge_category_id').':',['class' => 'form-label required']) }} {{ Form::select('charge_category_id', [null], null, ['class' => 'form-select select2Selector', 'id' => 'ipdChargeCategoryId', 'required', 'disabled', 'data-is-charge-edit' => 0, 'placeholder'=>'Select Charge Category']) }}

{{ Form::label('charge_id', __('messages.ipd_patient_charges.charge_id').':',['class' => 'form-label']) }} {{ Form::select('charge_id', [null], null, ['class' => 'form-select select2Selector', 'id' => 'ipdChargeId', 'required', 'disabled', 'data-is-charge-edit' => 0, 'placeholder'=>'Select Code']) }}

{{ Form::label('standard_charge', __('messages.ipd_patient_charges.standard_charge').':',['class' => 'form-label']) }} {{ Form::text('standard_charge', null, ['class' => 'form-control price-input','id' => 'ipdStandardCharge', 'readonly']) }}

{{ Form::label('applied_charge', __('messages.ipd_patient_charges.applied_charge').':',['class' => 'form-label']) }} {{ Form::text('applied_charge', null, ['class' => 'form-control price-input','id' => 'ipdAppliedCharge', 'required']) }}