<input type="hidden" id="row_id" value="{$updatedate.id}"/>
<input type="hidden" id="embryoslab" value="{$embryoslab_id}">

<div class="row" style="background: #e0f0d5; padding-left: 9px;">

    <div class="col-md-6">
        <div class="form-group ">
            <label class="col-md-4 control-label" for="form_control_1">Referred Dr :</label>
            <div class="col-md-8">
                <input type="text" class="form-control " value="{$ref_dr}" readonly/>
            </div>
        </div>
    </div>

    <div class="col-md-6">
        <div class="form-group ">
            <label class="col-md-4 control-label" for="form_control_1">Date :</label>
            <div class="col-md-6">
                <input type="text" id="date" 
                       class="form-control  datepicker updateEmbryoLab"  
                       value='{if $updatedate.date eq "0000-00-00"}{$smarty.now|date_format:"%Y-%m-%d"}{else}{$updatedate.date}{/if}'  
                       name="date" data-colName="date" data-tableName="embryoslab" />
            </div>
        </div>
    </div>

    <div class="col-md-12">
        <div class="form-group ">
            <label class="col-md-2 control-label" for="form_control_1">History :</label>
            <div class="col-md-9">
                <textarea class="form-control updateEmbryoLab txtc " data-colName="history" 
                          data-tableName="embryoslab" rows="1" >
                    {$updatedate.history}  
                </textarea>
            </div>
        </div>
    </div>
</div>

<hr style="margin: 5px 0;">

<div class="row" style="background: #e0f0d5;padding-left: 9px;">

    <div class="col-md-12">
        <label class="col-md-2 control-label" for="form_control_1">
            Sperm Source : 
        </label>

        <div class="col-md-2">
            <div class="md-radio-list">
                <div class="md-radio">
                    <input type="radio" id="Ejaculate" name="sperm_source" 
                           class="md-radiobtn sradio updateEmbryoLab" value="0" 
                           data-colName="sperm_source" data-tableName="embryoslab" 
                           {if $updatedate.sperm_source eq 0 && $updatedate.sperm_source neq ""}checked{/if}>
                    <label for="Ejaculate">
                        <span></span>
                        <span class="check"></span>
                        <span class="box"></span>
                        Ejaculate</label>
                </div>
            </div>
        </div>

        <div class="col-md-2">
            <div class="md-radio-list">
                <div class="md-radio">
                    <input type="radio" id="Frozen" name="sperm_source" class="md-radiobtn sradio updateEmbryoLab" value="1" data-colName="sperm_source" data-tableName="embryoslab" {if $updatedate.sperm_source eq 1  && $updatedate.sperm_source neq ""}checked{/if}>
                    <label for="Frozen">
                        <span></span>
                        <span class="check"></span>
                        <span class="box"></span>
                        Frozen ejaculate </label>
                </div>
            </div>
        </div>

        <div class="col-md-2 wds18">
            <div class="md-radio-list">
                <div class="md-radio">
                    <input type="radio" id="Aspiration" name="sperm_source" class="md-radiobtn updateEmbryoLab" value="2" data-colName="sperm_source" data-tableName="embryoslab" {if $updatedate.sperm_source eq 2  && $updatedate.sperm_source neq ""}checked{/if}>
                    <label for="Aspiration">
                        <span></span>
                        <span class="check"></span>
                        <span class="box"></span>
                        Testicular Aspiration</label>
                </div>
            </div>
        </div>

        <div class="col-md-2">
            <div class="md-radio-list">
                <div class="md-radio">
                    <input type="radio" id="biopsy" name="sperm_source" class="md-radiobtn updateEmbryoLab" value="3" data-colName="sperm_source" data-tableName="embryoslab" {if $updatedate.sperm_source eq 3  && $updatedate.sperm_source neq ""}checked{/if}>
                    <label for="biopsy">
                        <span></span>
                        <span class="check"></span>
                        <span class="box"></span>
                        Testicular biopsy</label>
                </div>
            </div>
        </div>

        <div class="col-md-2 wds14">
            <div class="md-radio-list">
                <div class="md-radio">
                    <input type="radio" id="Frozenbiopsy" name="sperm_source" class="md-radiobtn updateEmbryoLab" value="4" data-colName="sperm_source" data-tableName="embryoslab" {if $updatedate.sperm_source eq 4  && $updatedate.sperm_source neq ""}checked{/if}>
                    <label for="Frozenbiopsy">
                        <span></span>
                        <span class="check"></span>
                        <span class="box"></span>
                        Frozen biopsy </label>
                </div>
            </div>
        </div>

    </div>

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

    <div class="col-md-12">
        <label class="col-md-2 control-label" for="form_control_1">
            Semen Parameters : 
        </label>

        <label class="col-md-1 control-label" for="form_control_1">
            Count:
        </label>
        <div class="col-md-2">
            <input type="text" name="count" class="form-control input-sm updateEmbryoLab" 
                   id="form_control_1" placeholder="" value="{$updatedate.semen_count}" 
                   data-colName="semen_count" data-tableName="embryoslab">
            <div class="form-control-focus"></div>
        </div>

        <label class="col-md-1 control-label" for="form_control_1">
            Motility:
        </label>
        <div class="col-md-2">
            <input type="text" name="motility" class="form-control input-sm updateEmbryoLab" 
                   id="form_control_1" placeholder=""  value="{$updatedate.semen_motililty}" 
                   data-colName="semen_motililty" data-tableName="embryoslab">
            <div class="form-control-focus"></div>
        </div>

        <label class="col-md-1 control-label" for="form_control_1">
            Morphology:
        </label>
        <div class="col-md-2">
            <input type="text" name="morphology" class="form-control input-sm updateEmbryoLab" 
                   id="form_control_1" placeholder="" value="{$updatedate.semen_morphology}" 
                   data-colName="semen_morphology" data-tableName="embryoslab">
            <div class="form-control-focus"></div>
        </div>

    </div>

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

    <div class="col-md-12">
        <label class="col-md-2 control-label" for="form_control_1">
            Semen Processing : 
        </label>

        <div class="col-md-3">
            <div class="md-radio-list">
                <div class="md-radio">
                    <input type="radio" id="Densitygradient" name="semen_processing" data-tableName="embryoslab"
                           class="md-radiobtn updateEmbryoLab" value="0" data-colName="semen_processing" 
                           {if $updatedate.semen_processing eq 0 && $updatedate.semen_processing neq ""}checked{/if}>
                    <label for="Densitygradient">
                        <span></span>
                        <span class="check"></span>
                        <span class="box"></span>
                        Density gradient</label>
                </div>
            </div>
        </div>

        <div class="col-md-3">
            <div class="md-radio-list">
                <div class="md-radio">
                    <input type="radio" id="Spermwash" name="semen_processing"  data-tableName="embryoslab"
                           class="md-radiobtn updateEmbryoLab" value="2" data-colName="semen_processing" 
                           {if $updatedate.semen_processing eq 2 && $updatedate.semen_processing neq ""}checked{/if}>
                    <label for="Spermwash">
                        <span></span>
                        <span class="check"></span>
                        <span class="box"></span>
                        Swim up</label>
                </div>
            </div>
        </div>

        <div class="col-md-3">
            <div class="md-radio-list">
                <div class="md-radio">
                    <input type="radio" id="Spermwash" name="semen_processing"  data-tableName="embryoslab"
                           class="md-radiobtn updateEmbryoLab" value="1" data-colName="semen_processing" 
                           {if $updatedate.semen_processing eq 1 && $updatedate.semen_processing neq ""}checked{/if}>
                    <label for="Spermwash">
                        <span></span>
                        <span class="check"></span>
                        <span class="box"></span>
                        Sperm wash</label>
                </div>
            </div>
        </div>

    </div>

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

    <div class="col-md-12">
        <label class="col-md-1 control-label" for="form_control_1">
            Notes:
        </label>
        <div class="col-md-11">
            <textarea class="form-control updateEmbryoLab txtc" rows="1" id='notes' name='notes' 
                      placeholder="Enter more text" data-id="" data-colName="mine_notes" 
                      data-tableName="embryoslab">{$updatedate.mine_notes}</textarea>
            <div class="form-control-focus"></div>
        </div>
    </div>

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

<hr style="margin: 5px 0;">