{{ __('messages.ipd_patient_diagnosis.new_ipd_diagnosis') }}

{{ Form::open(['id'=>'addIpdDiagnosisForm']) }}
{{ Form::hidden('ipd_patient_department_id', $ipdPatientDepartment->id) }}
{{ Form::label('report_type', __('messages.ipd_patient_diagnosis.report_type').':',['class' => 'form-label']) }} {{ Form::text('report_type', null, ['class' => 'form-control','required','placeholder' => __('messages.ipd_patient_diagnosis.report_type')]) }}
{{ Form::label('report_date', __('messages.ipd_patient_diagnosis.report_date').':',['class' => 'form-label']) }} {{ Form::text('report_date', null, ['placeholder' => __('messages.ipd_patient_diagnosis.report_date'),'class' => (getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control'),'id' => 'ipdDiagnosisReportDate','autocomplete' => 'off', 'required']) }}
{{ Form::label('description', __('messages.ipd_patient_diagnosis.description').':',['class' => 'form-label']) }} {{ Form::textarea('description', null, ['placeholder' => __('messages.ipd_patient_diagnosis.description'),'class' => 'form-control', 'rows' => 4,'id'=>'ipdDiagnosisDescription']) }}
{{ Form::label('document', __('messages.ipd_patient_diagnosis.document').':',['class' => 'form-label']) }}
{{ Form::button(__('messages.common.save'), ['type'=>'submit','class' => 'btn btn-primary me-3','id'=>'ipdDiagnosisSave','data-loading-text'=>" Processing..."]) }}
{{ Form::close() }}