<?php /* Smarty version Smarty-3.1.11, created on 2025-06-21 23:54:07
         compiled from "../views/obgy/oscopic/report_add.html" */ ?>
<?php /*%%SmartyHeaderCode:91411908668571bef64fce4-19446602%%*/if(!defined('SMARTY_DIR')) exit('no direct access allowed');
$_valid = $_smarty_tpl->decodeProperties(array (
  'file_dependency' => 
  array (
    'faa7151ab6a537d0c516154c0a405f33b6e9a545' => 
    array (
      0 => '../views/obgy/oscopic/report_add.html',
      1 => 1653375082,
      2 => 'file',
    ),
  ),
  'nocache_hash' => '91411908668571bef64fce4-19446602',
  'function' => 
  array (
  ),
  'variables' => 
  array (
    'hosturl' => 0,
    'controllname' => 0,
    'patientId' => 0,
    'allDiagnosis' => 0,
    'data' => 0,
    'oscopic_operations' => 0,
    'single' => 0,
    'oscopic_required_examinations' => 0,
    'oscopic_specimens' => 0,
  ),
  'has_nocache_code' => false,
  'version' => 'Smarty-3.1.11',
  'unifunc' => 'content_68571bef710574_96724039',
),false); /*/%%SmartyHeaderCode%%*/?>
<?php if ($_valid && !is_callable('content_68571bef710574_96724039')) {function content_68571bef710574_96724039($_smarty_tpl) {?><?php if (!is_callable('smarty_modifier_date_format')) include '/home/gt4it/public_html/elsoda/_library/smarty_plg/libs/plugins/modifier.date_format.php';
?><div class="page-content-wrapper">
    <div class="page-content">
        <div class="row">
            <div class="col-md-12">
                <!-- BEGIN EXAMPLE TABLE PORTLET-->
                <div class="portlet box blue">
                    <div class="portlet-title">
                        <div class="caption">
                            <i class="fa fa-user"></i>Report
                        </div>
                    </div>
                    <div class="portlet-body">

                        <!--Begin Semen-->

                        <div class="row">

                            <div class="portlet-title tbox">
                                <div class="caption font-blue-haze col-md-6">
                                    <span class="caption-subject bold uppercase">Add new </span>
                                </div>

                            </div>

                            <div class="clearfix"></div>

                            <form action="<?php echo $_smarty_tpl->tpl_vars['hosturl']->value;?>
/controllers/<?php echo $_smarty_tpl->tpl_vars['controllname']->value;?>
.php?ac=reportAdd" class="clinick awval" method="post">

                                <input type="hidden" id="patientId" name="patientId" value="<?php echo $_smarty_tpl->tpl_vars['patientId']->value;?>
"/>

                                <div class="form-body row">

                                    <div class="col-md-3">
                                        <div class="form-group">
                                            <label class="col-md-12 control-label">Date:</label>
                                            <div class="col-md-12">
                                                <input type="text" class="form-control datepicker" required="required" value="<?php echo smarty_modifier_date_format('today','Y-m-d');?>
" name="created_at" readonly/>
                                            </div>
                                        </div>
                                    </div>

                                    <div class="col-md-3">
                                        <div class="form-group">
                                            <label class="col-md-12 control-label">Diagnosis:</label>
                                            <div class="col-md-12">
                                                <select multiple="" size="1" name="diagnosis[]" class="form-control select2me diagnosis">
                                                    <?php  $_smarty_tpl->tpl_vars['data'] = new Smarty_Variable; $_smarty_tpl->tpl_vars['data']->_loop = false;
 $_from = $_smarty_tpl->tpl_vars['allDiagnosis']->value; if (!is_array($_from) && !is_object($_from)) { settype($_from, 'array');}
foreach ($_from as $_smarty_tpl->tpl_vars['data']->key => $_smarty_tpl->tpl_vars['data']->value){
$_smarty_tpl->tpl_vars['data']->_loop = true;
?>
                                                    <option value="<?php echo $_smarty_tpl->tpl_vars['data']->value->id;?>
"><?php echo $_smarty_tpl->tpl_vars['data']->value->name;?>
</option>
                                                    <?php } ?>
                                                </select>
                                            </div>
                                        </div>
                                    </div>

                                    <div class="col-md-4">
                                        <div class="form-group">
                                            <label class="col-md-12 control-label">Diagnosis:</label>
                                            <div class="col-md-12">
                                                <input type="text" class="form-control" value="" name="diagnosis_text"/>
                                            </div>
                                        </div>
                                    </div>

                                    <div class="col-md-2">
                                        <div class="form-group">
                                            <div class="col-md-12" style="margin-top: 25px;">
                                                <label><input type="checkbox" class="form-control" value="1" name="husband"/>Husband</label>
                                            </div>
                                        </div>
                                    </div>


                                    <div class="clearfix" style="margin-bottom: 20px;"></div>

                                    <div class="form-group ">
                                        <label class="col-md-3 txtl">Operation</label>
                                        <div class="col-md-9">
                                            <!--<select class="form-control oscopic-select" required="required" name="operation_id" id="operation_id" data-placeholder="Select..."
                                                    data-select-tableName="oscopic_operations" data-colName="name">
                                                <option></option>
                                                <?php  $_smarty_tpl->tpl_vars['single'] = new Smarty_Variable; $_smarty_tpl->tpl_vars['single']->_loop = false;
 $_from = $_smarty_tpl->tpl_vars['oscopic_operations']->value; if (!is_array($_from) && !is_object($_from)) { settype($_from, 'array');}
foreach ($_from as $_smarty_tpl->tpl_vars['single']->key => $_smarty_tpl->tpl_vars['single']->value){
$_smarty_tpl->tpl_vars['single']->_loop = true;
?>
                                                <option value="<?php echo $_smarty_tpl->tpl_vars['single']->value->id;?>
"><?php echo $_smarty_tpl->tpl_vars['single']->value->name;?>
</option>
                                                <?php } ?>
                                                <option value="delete-options-select" class="delete-options-select">Delete</option>
                                            </select>-->
                                            <input type="text" class="form-control" name="operation_text"/>
                                        </div>
                                    </div>

                                    <div class="form-group ">
                                        <label class="col-md-3 txtl">Required Examination</label>
                                        <div class="col-md-9">
                                            <!--<select class="form-control oscopic-select" required="required" name="required_examination_id" id="required_examination_id" data-placeholder="Select..."
                                                    data-select-tableName="oscopic_required_examinations" data-colName="name">
                                                <option></option>
                                                <?php  $_smarty_tpl->tpl_vars['single'] = new Smarty_Variable; $_smarty_tpl->tpl_vars['single']->_loop = false;
 $_from = $_smarty_tpl->tpl_vars['oscopic_required_examinations']->value; if (!is_array($_from) && !is_object($_from)) { settype($_from, 'array');}
foreach ($_from as $_smarty_tpl->tpl_vars['single']->key => $_smarty_tpl->tpl_vars['single']->value){
$_smarty_tpl->tpl_vars['single']->_loop = true;
?>
                                                <option value="<?php echo $_smarty_tpl->tpl_vars['single']->value->id;?>
"><?php echo $_smarty_tpl->tpl_vars['single']->value->name;?>
</option>
                                                <?php } ?>
                                                <option value="delete-options-select" class="delete-options-select">Delete</option>
                                            </select>-->
                                            <input type="text" class="form-control" name="required_examination_text"/>
                                        </div>
                                    </div>

                                    <div class="form-group ">
                                        <label class="col-md-3 txtl">Specimen</label>
                                        <div class="col-md-9">
                                            <!--<select class="form-control oscopic-select" required="required" name="specimen_id" id="specimen_id" data-placeholder="Select..."
                                                    data-select-tableName="oscopic_specimens" data-colName="name">
                                                <option></option>
                                                <?php  $_smarty_tpl->tpl_vars['single'] = new Smarty_Variable; $_smarty_tpl->tpl_vars['single']->_loop = false;
 $_from = $_smarty_tpl->tpl_vars['oscopic_specimens']->value; if (!is_array($_from) && !is_object($_from)) { settype($_from, 'array');}
foreach ($_from as $_smarty_tpl->tpl_vars['single']->key => $_smarty_tpl->tpl_vars['single']->value){
$_smarty_tpl->tpl_vars['single']->_loop = true;
?>
                                                <option value="<?php echo $_smarty_tpl->tpl_vars['single']->value->id;?>
"><?php echo $_smarty_tpl->tpl_vars['single']->value->name;?>
</option>
                                                <?php } ?>
                                                <option value="delete-options-select" class="delete-options-select">Delete</option>
                                            </select>-->
                                            <input type="text" class="form-control" name="specimen_text"/>
                                        </div>
                                    </div>

                                </div>

                                <div class="form-actions">
                                    <div class="row">
                                        <div class="col-md-offset-2 col-md-10">
                                            <a class="btn default" href="<?php echo $_smarty_tpl->tpl_vars['hosturl']->value;?>
/controllers/<?php echo $_smarty_tpl->tpl_vars['controllname']->value;?>
.php?ac=index&patientid=<?php echo $_smarty_tpl->tpl_vars['patientId']->value;?>
">Cancel</a>
                                            <button class="btn blue" type="submit">Submit</button>

                                        </div>
                                    </div>
                                </div>
                            </form>

                        </div>
                    </div>
                </div>
            </div>

        </div>
    </div>
</div>


<style>
    .delete-options-select {
        background: #a10;
        color: #fff;
        font-weight: 700;
        text-align: center;
        font-size: 14px;
    }
</style>

<div class="bootbox modal fade bootbox-alert in" tabindex="-1" role="dialog" aria-hidden="false" id="edit_model">
    <div class="modal-dialog">
        <div class="modal-content">
            <div class="modal-header">
                <button type="button" class="close" data-dismiss="modal" aria-hidden="true"></button>
                <h4 class="modal-title"> Edit </h4>
            </div>
            <div class="modal-body">
                <div class="portlet-body form">
                    <form action="" method="post" class="form-horizontal emptyform">
                        <div class="form-body">
                            <!------===========================================------->
                            <div>
                                <div id="async_data_container" class=""></div>
                            </div>

                            <div class="modal-footer">
                                <button type="button" id="close-edit-model" class="btn default" data-dismiss="modal">Close</button>
                            </div>
                        </div>
                    </form>
                </div>
            </div>
            <!-- /.modal-content -->
        </div>
    </div>
</div>
<?php }} ?>