@extends('layout.master')
@section('parentPageTitle', 'Payment')
@section('title', 'Add Payment')

@section('page-style')
    <link rel="stylesheet" href="{{asset('assets/plugins/bootstrap-select/css/bootstrap-select.css')}}">
@stop

@section('content')

    <div class="row clearfix">
        <div class="col-lg-12 col-md-12 col-sm-12 ">
            <div class="card">
                <div class="header">
                    <h2><strong>Patients</strong> Information <small>Description text here...</small> </h2>
                    <ul class="header-dropdown">
                        <li class="dropdown"> <a href="javascript:void(0);" class="dropdown-toggle" data-toggle="dropdown" role="button" aria-haspopup="true" aria-expanded="false"> <i class="zmdi zmdi-more"></i> </a>
                            <ul class="dropdown-menu dropdown-menu-right slideUp float-right">
                                <li><a href="javascript:void(0);">Edit</a></li>
                                <li><a href="javascript:void(0);">Delete</a></li>
                                <li><a href="javascript:void(0);">Report</a></li>
                            </ul>
                        </li>
                        <li class="remove">
                            <a role="button" class="boxs-close"><i class="zmdi zmdi-close"></i></a>
                        </li>
                    </ul>
                </div>
                <div class="body">
                    <div class="row clearfix">
                        <div class="col-sm-12">
                            <div class="form-group">
                                <input type="number" class="form-control" placeholder="Payment Number">
                            </div>
                        </div>
                        <div class="col-sm-12">
                            <div class="form-group">
                                <input type="text" class="form-control" placeholder="Patient Name">
                            </div>
                        </div>
                        <div class="col-sm-12 ">
                            <div class="form-group">
                                <input type="text" class="form-control" placeholder="Doctor Name">
                            </div>
                        </div>                            
                    </div>
                </div>
            </div>
            <div class="card">
                <div class="header">
                    <h2><strong>Payment</strong> Information <small>Description text here...</small> </h2>
                    <ul class="header-dropdown">
                        <li class="dropdown"> <a href="javascript:void(0);" class="dropdown-toggle" data-toggle="dropdown" role="button" aria-haspopup="true" aria-expanded="false"> <i class="zmdi zmdi-more"></i> </a>
                            <ul class="dropdown-menu dropdown-menu-right slideUp float-right">
                                <li><a href="javascript:void(0);">Edit</a></li>
                                <li><a href="javascript:void(0);">Delete</a></li>
                                <li><a href="javascript:void(0);">Report</a></li>
                            </ul>
                        </li>
                        <li class="remove">
                            <a role="button" class="boxs-close"><i class="zmdi zmdi-close"></i></a>
                        </li>
                    </ul>
                </div>
                <div class="body">
                    <div class="row clearfix">                                                   
                        <div class="col-sm-12 ">
                            <div class="form-group">
                                <input type="text" class="form-control" placeholder="Payment Date">
                            </div>
                        </div>
                        <div class="col-sm-12 ">
                            <div class="form-group">
                                <input type="number" class="form-control" placeholder="Total Amount">
                            </div>
                        </div>
                        <div class="col-sm-12 ">
                            <div class="form-group">
                                <input type="number" class="form-control" placeholder="Discount">
                            </div>
                        </div>
                        <div class="col-sm-6">
                            <select class="form-control show-tick mb-2">
                                <option value="">-- Payment Method --</option>
                                <option>Cash</option>
                                <option>Cheque</option>
                                <option>Credit Card</option>
                                <option>Debit Card</option>
                                <option>Netbanking</option>
                                <option>Insurance</option>
                            </select>
                        </div>                            
                        <div class="col-sm-6">
                            <select class="form-control show-tick ">
                                <option value="">-- Payment Status --</option>
                                <option>Select Status</option>
                                <option>Complete</option>
                                <option>Pending</option>
                                <option>Partial</option>
                            </select>
                        </div>
                        <div class="col-sm-12 m-t-30">
                            <button type="submit" class="btn btn-primary btn-round">Submit</button>
                            <button type="submit" class="btn btn-default btn-round btn-simple">Cancel</button>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>

@stop