<?php /* Smarty version Smarty-3.1.11, created on 2025-06-21 23:53:25
         compiled from "../views/obgy/oscopic/laparoscopic_add.html" */ ?>
<?php /*%%SmartyHeaderCode:147312483568571bc5147194-48318179%%*/if(!defined('SMARTY_DIR')) exit('no direct access allowed');
$_valid = $_smarty_tpl->decodeProperties(array (
  'file_dependency' => 
  array (
    '516c1348d8b920ffec668d8d982fa514e45d71cd' => 
    array (
      0 => '../views/obgy/oscopic/laparoscopic_add.html',
      1 => 1653375082,
      2 => 'file',
    ),
  ),
  'nocache_hash' => '147312483568571bc5147194-48318179',
  'function' => 
  array (
  ),
  'variables' => 
  array (
    'hosturl' => 0,
    'controllname' => 0,
    'patientId' => 0,
    'laparoscopic' => 0,
    'single' => 0,
    'allDiagnosis' => 0,
    'data' => 0,
  ),
  'has_nocache_code' => false,
  'version' => 'Smarty-3.1.11',
  'unifunc' => 'content_68571bc51afd81_05133810',
),false); /*/%%SmartyHeaderCode%%*/?>
<?php if ($_valid && !is_callable('content_68571bc51afd81_05133810')) {function content_68571bc51afd81_05133810($_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>Laparoscopic
                        </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=laparoscopicAdd" class="clinick awval" method="post">
                                <h5 class="note bg-green-jungle text-right"><strong>&lt;br&gt;</strong>  فى حالة الرغبة لنزول سطر جديد يرجى وضع هذا الكود  </h5>
                                <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-2">
                                        <div class="form-group">
                                            <label class="col-md-12 control-label">Templates:</label>
                                            <div class="col-md-12">
                                                <select class="form-control select2me" id="laparoscopic_template" required="required" name="template_id" data-placeholder="Select...">
                                                    <option></option>
                                                    <?php  $_smarty_tpl->tpl_vars['single'] = new Smarty_Variable; $_smarty_tpl->tpl_vars['single']->_loop = false;
 $_from = $_smarty_tpl->tpl_vars['laparoscopic']->value; if (!is_array($_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->template_name;?>
</option>
                                                    <?php } ?>
                                                </select>
                                            </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="clearfix" style="margin-bottom: 20px;"></div>

                                    <div class="form-group ">
                                        <label class="col-md-2 txtl">Entry</label>
                                        <div class="col-md-5">
                                            <input class="form-control" name="entry" placeholder="Findings" type="text">
                                        </div>
                                        <div class="col-md-5">
                                            <input class="form-control" name="entry_procedures" placeholder="Procedures" type="text">
                                        </div>
                                    </div>
                                    <div class="form-group ">
                                        <label class="col-md-2 txtl">Uterus</label>
                                        <div class="col-md-5">
                                            <input class="form-control" name="uterus" placeholder="Findings" type="text">
                                        </div>
                                        <div class="col-md-5">
                                            <input class="form-control" name="uterus_procedures" placeholder="Procedures" type="text">
                                        </div>
                                    </div>
                                    <div class="form-group ">
                                        <label class="col-md-2 txtl">Right Tube</label>
                                        <div class="col-md-5">
                                            <input class="form-control" name="right_tube" placeholder="Findings" type="text">
                                        </div>
                                        <div class="col-md-5">
                                            <input class="form-control" name="right_tube_procedures" placeholder="Procedures" type="text">
                                        </div>
                                    </div>
                                    <div class="form-group ">
                                        <label class="col-md-2 txtl">Left Tube</label>
                                        <div class="col-md-5">
                                            <input class="form-control" name="left_tube" placeholder="Findings" type="text">
                                        </div>
                                        <div class="col-md-5">
                                            <input class="form-control" name="left_tube_procedures" placeholder="Procedures" type="text">
                                        </div>
                                    </div>
                                    <div class="form-group ">
                                        <label class="col-md-2 txtl">Right Ovary</label>
                                        <div class="col-md-5">
                                            <input class="form-control" name="right_ovary" placeholder="Findings" type="text">
                                        </div>
                                        <div class="col-md-5">
                                            <input class="form-control" name="right_ovary_procedures" placeholder="Procedures" type="text">
                                        </div>
                                    </div>
                                    <div class="form-group ">
                                        <label class="col-md-2 txtl">Left Ovary</label>
                                        <div class="col-md-5">
                                            <input class="form-control" name="left_ovary" placeholder="Findings" type="text">
                                        </div>
                                        <div class="col-md-5">
                                            <input class="form-control" name="left_ovary_procedures" placeholder="Procedures" type="text">
                                        </div>
                                    </div>
                                    <div class="form-group ">
                                        <label class="col-md-2 txtl">Pelvis</label>
                                        <div class="col-md-5">
                                            <input class="form-control" name="uterosacrals" placeholder="Findings" type="text">
                                        </div>
                                        <div class="col-md-5">
                                            <input class="form-control" name="uterosacrals_procedures" placeholder="Procedures" type="text">
                                        </div>
                                    </div>
                                    <div class="form-group ">
                                        <label class="col-md-2 txtl">Other</label>
                                        <div class="col-md-5">
                                            <input class="form-control" name="peritoneum" placeholder="Findings" type="text">
                                        </div>
                                        <div class="col-md-5">
                                            <input class="form-control" name="peritoneum_procedures" placeholder="Procedures" type="text">
                                        </div>
                                    </div>
                                    <div class="form-group ">
                                        <label class="col-md-2 txtl">Recommendations</label>
                                        <div class="col-md-10">
                                            <textarea class="form-control" name="recommendations" rows="4"></textarea>
                                        </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>


<?php }} ?>