

<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>instruction
                        </div>
                    </div>
                    <div class="portlet-body">

                        <!--Begin Semen-->

                        <div class="row">


                            <div class="portlet-title tbox">
                                <div class="caption font-green-haze col-md-6">
                                    <span class="caption-subject bold uppercase">Edit instruction</span>
                                </div>

                            </div>

                            <div class="clearfix"></div>
                            {if $patientId}
                            <form action="{$hosturl}/controllers/{$controllname}.php?ac=updateit&patientid={$patientId}" method="post" class="form-horizontal">
                            {else}
                            <form action="{$hosturl}/controllers/{$controllname}.php?ac=updateit" method="post" class="form-horizontal">
                            {/if}
                                <div class="form-body">


                                    <div class="form-group form-md-line-input">
                                        <label class="col-md-2 control-label" style="text-align: left;" for="form_control_1">File Name</label>
                                        <div class="col-md-10">
                                            <input type="text" class="form-control" id="form_control_1" placeholder="Enter Name" name="name"  value="{$editElement->name}">
                                            <div class="form-control-focus">
                                            </div>

                                        </div>
                                    </div>

                                    <div class="form-group form-md-line-input">
                                        <label class="col-md-2 control-label" style="text-align: left;" for="form_control_1">Content</label>
                                        <div class="col-md-10">
                                            <textarea class="form-control has-info ckeditor" rows="3" placeholder="Enter more text" name="content" required>{$editElement->content}</textarea>
                                            <div class="form-control-focus">
                                            </div>
                                        </div>
                                    </div>

                                    <input type="hidden" id="id" name="id" value="{$editElement->id}" />

                                </div>




                                <div class="form-actions">
                                    <div class="row">
                                        <div class="col-md-offset-2 col-md-10">
                                         
                                            {if $patientId}
                                            <a class="btn default" href="{$hosturl}/controllers/{$controllname}.php?ac=show&patientid={$patientId}">Cancel</a>
                                            {else}
                                            <a class="btn default" href="{$hosturl}/controllers/{$controllname}.php?ac=show">Cancel</a>
                                            {/if}
                                            <button type="submit" class="btn blue">Submit</button>
                                        </div>
                                    </div>
                                </div>
                            </form>

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


