<meta charset="utf8">
<!-- BEGIN CONTENT -->
<div class="page-content-wrapper">
    <div class="page-content">
        <!-- BEGIN PAGE HEADER-- >
        <h3 class="page-title">
            {$shcontrollname}
        </h3>
        <div class="page-bar">
            <ul class="page-breadcrumb">
                {$breadcrumbs}
            </ul>
        </div>
        <!-- END PAGE HEADER-->
        <!-- BEGIN PAGE CONTENT-->
        <div class="row">
            <div class="col-md-12 ">
                <!-- BEGIN SAMPLE FORM PORTLET-->
                <div class="portlet box blue">
                    <div class="portlet-title">
                        <div class="caption">
                            <i class="fa fa-gift"></i> بيانات الزوجة
                        </div>
                        <div class="tools">
                            <a href="#" class="collapse">
                            </a>
                            <a href="#portlet-config" data-toggle="modal" class="config">
                            </a>
                            <a href="#" class="reload">
                            </a>
                            <a href="#" class="remove">
                            </a>
                        </div>
                    </div>
                    <div class="portlet-body form">
                        <form action="{$hosturl}/controllers/{$controllname}.php?ac=update" method="POST">
                            <input type="hidden" name="vId" value="{$editvisit->id}" />
                            <!--<form method="post">-->
                            <div class="form-body">
                                <div class="clinick rtl">
                                    <div class="row">
                                        <div class="col-md-3">
                                            <label for="form_control_1">اسم المريضة</label>
                                            <div class="form-group  form-md-floating-label has-info">
                                                <select  class="form-control select2me" name="patientid" id="patientid" placeholder="إختار المريضة ">
                                                    <option value=""></option>
                                                    {foreach $allPatients as $row}
                                                    <option value="{$row->id}" {if $editvisit->patientid eq $row->id} selected {/if}>{$row->wifename}</option>
                                                    {/foreach}
                                                </select>
                                            </div>
                                        </div>
                                        <div class="col-md-2">
                                            <div class="form-group form-md-line-input form-md-floating-label has-info">

                                                <input class="form-control datepicker" type="text"  name="visitdate" value="{$editvisit->visitdate}">

                                                <label  for="form_control_1">تاريخ الزيارة </label>
                                            </div>
                                        </div>
                                        <div class="col-md-3">
                                            <label for="form_control_1">نوع الكشف</label>
                                            <div class="form-group  form-md-floating-label has-info">
                                                <select class="form-control select2me" name="detectionid" id="detectionid" placeholder="إختار المريضة ">
                                                    <option value=""></option>
                                                    {foreach $allDetections as $row}
                                                    <option value="{$row->id}" {if $editvisit->detectionid eq $row->id} selected {/if}>{$row->title}</option>
                                                    {/foreach}
                                                </select>
                                            </div>
                                        </div>
                                        <div class="col-md-2">
                                            <div class="form-group form-md-line-input form-md-floating-label has-info">

                                                <input  class="form-control"  type="text" value="{$editvisit->detectionvalue}"  id="detectionvalue" name="detectionvalue">

                                                <label  for="form_control_1"> قيمة الكشف </label>
                                            </div>
                                        </div>
                                        <div class="col-md-2">
                                            <button type="submit" name="submit"  class="btn blue">تعديل</button>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </form>
                    </div>
                </div>
            </div>