<style>
    table {
        font-family: arial, sans-serif;
        border-collapse: collapse;
        width: 100%;
    }

    td, th {
        border: 1px solid #000000;
        text-align: left;
        padding: 8px;
    }

    tr:nth-child(even) {
        background-color: #dddddd;
    }
</style>
<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>Embryology Report
                        </div>
                        <div class="actions">

                            {if $patientId}

                            <a href="{$hosturl}/controllers/{$controllname}.php?ac=show&&patientid={$patientId}" class="btn btn-default btn-sm">
                                Show Reports  </a>
                            {else}
                            <a href="{$hosturl}/controllers/{$controllname}.php?ac=show" class="btn btn-default btn-sm">
                                Show Reports </a>
                            {/if}

                        </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</span>
                                </div>

                            </div>

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

                            {if $patientId}
                            <form action="{$hosturl}/controllers/{$controllname}.php?ac=addit&patientid={$patientId}" method="post" enctype="multipart/form-data">
                                {else}
                                <form action="{$hosturl}/controllers/{$controllname}.php?ac=addit" method="post" enctype="multipart/form-data">
                                    {/if}
                                    <div class="form-body">
                                        <div class="row">
                                            <label class="col-md-12 control-label">
                                                Examination
                                            </label>
                                            <br/>

                                            <div class="form-group col-md-6">
                                                <label class="col-md-4 txtl">Clinician :</label>
                                                <div class="col-md-7">
                                                    <select class="form-control"  name="clinician" data-colName="name" select-tableName="awusers"  data-id="{$one.user_id}" >
                                                        <option value="">choose</option>
                                                        {foreach  $clinician as $one}
                                                        <option value="{$one.user_id}">{$one.name}</option>
                                                        {/foreach}

                                                    </select>

                                                </div>
                                            </div>
                                            <div class="form-group col-md-6">
                                                <label class="col-md-4 txtl" >Embryologist :</label>
                                                <div class="col-md-7">
                                                    <select class="form-control" name="embryologist" data-colName="name" select-tableName="awusers"  data-id="{$one.user_id}" >
                                                        <option value="">choose</option>
                                                        {foreach  $embryologist as $one}
                                                        <option value="{$one.user_id}">{$one.name}</option>
                                                        {/foreach}
                                                    </select>
                                                </div>
                                            </div>

                                            <!--div class="form-group col-md-4">
                                                <label class="col-md-4 txtl" >Nurse :</label>
                                                <div class="col-md-7">
                                                    <select class="form-control" name="nurse" data-colName="name" select-tableName="awusers"  data-id="{$one.user_id}" >
                                                        <option value="">choose</option>
                                                        {foreach  $users as $one}
                                                        {if $one.role_id eq 6}
                                                        <option value="{$one.user_id}">{$one.name}</option>
                                                        {/if}
                                                        {/foreach}
                                                    </select>
                                                </div>
                                            </div-->

                                            <div class="form-group col-md-6">
                                                <label class="col-md-4 txtl" >Day OF Transfer :</label>
                                                <div class="col-md-7">
                                                    <!--input type="text" class="form-control  datepicker"  value="" name="day_of_transfer" /-->
                                                    <select class="form-control select2me"   id="day" name="day_of_transfer" data-placeholder="Select..." data-id="" data-colName="" data-tableName="">
                                                        <option></option>
                                                        <option value=''>--Select Day--</option>
                                                        <option value='1'>1</option>
                                                        <option value='2'>2</option>
                                                        <option value='3'>3</option>
                                                        <option value='4'>4</option>
                                                        <option value='5'>5</option>
                                                        <option value='6'>6</option>

                                                    </select>

                                                </div>
                                            </div>
                                            <div class="form-group col-md-6">
                                                <label class="col-md-4 txtl" >Date :</label>
                                                <div class="col-md-7">
                                                    <input type="text" class="form-control  datepicker"  value="" name="date"/>

                                                </div>
                                            </div>
                                            <!--div class="form-group col-md-4">
                                                <label class="col-md-4 txtl" >Anaesthetist :</label>
                                                <div class="col-md-7">
                                                    <select class="form-control" name="anaesthetist" data-colName="name" select-tableName="awusers"  data-id="{$one.user_id}" >
                                                        <option value="">choose</option>
                                                        {foreach  $users as $one}
                                                        {if $one.role_id eq 7}
                                                        <option value="{$one.user_id}">{$one.name}</option>
                                                        {/if}
                                                        {/foreach}
                                                    </select>
                                                </div>
                                            </div-->

                                            <div class="clearfix"></div>
                                            <hr>
                                            <div class="form-group col-md-12">
                                                <table>
                                                    <thead>
                                                        <tr>
                                                            <th>
                                                                Sperm Source
                                                            </th>
                                                            <th>
                                                                Count
                                                            </th>
                                                            <th>
                                                                Motility
                                                            </th>
                                                            <th>
                                                                Morphology
                                                            </th>
                                                        </tr>
                                                    </thead>
                                                    <tbody>
                                                        <tr>
                                                            <td>
                                                                <input type="text" class="form-control" name="sperm_source"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="count"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="motility"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="morphology"/>
                                                            </td>
                                                        </tr>
                                                    </tbody>

                                                </table>


                                            </div>
                                            <div class="clearfix"></div>
                                            <hr>
                                            <div class="form-group col-md-12">
                                                <table>
                                                    <thead>
                                                        <tr>
                                                            <th>
                                                                Oocyte retrieved
                                                            </th>
                                                            <th>
                                                                MII
                                                            </th>
                                                            <th>
                                                                MI
                                                            </th>
                                                            <th>
                                                                GV
                                                            </th>
                                                            <th>
                                                                Atretic
                                                            </th>
                                                            <th>
                                                                Other
                                                            </th>
                                                        </tr>
                                                    </thead>
                                                    <tbody>
                                                        <tr>
                                                            <td>
                                                                <input type="text" class="form-control " name="oocyte_retrived"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="mii"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="mi"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="gv"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="atretic"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="empty_follicle"/>
                                                            </td>

                                                        </tr>
                                                    </tbody>

                                                </table>


                                            </div>
                                            <div class="clearfix"></div>
                                            <hr>
                                            <div class="form-group col-md-12">
                                                <table>
                                                    <thead>

                                                        <tr>
                                                            <th rowspan="2">
                                                                Fertilized
                                                            </th>
                                                            <th  rowspan="2">
                                                                Cleavage
                                                            </th>
                                                            <th  colspan="2">
                                                                Embryo Transfer
                                                            </th>
                                                            <th  colspan="3">
                                                                Embryo Freezing
                                                            </th>


                                                        </tr>
                                                        <tr>
                                                            <th>
                                                                Stage
                                                            </th>
                                                            <th>
                                                                Grade
                                                            </th>
                                                            <th>
                                                                No Of Embryos
                                                            </th>
                                                            <th>
                                                                No Of Straws
                                                            </th>
                                                            <th>
                                                                Day of Freezing
                                                            </th>
                                                        </tr>
                                                    </thead>
                                                    <tbody>
                                                        <tr>
                                                            <td>
                                                                <input type="text" class="form-control" name="fertilized_egg"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="cleavage"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="embryo_transfer_stage"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="embryo_transfer_grade"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="embryo_freezing_embryos"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="embryo_freezing_straws"/>
                                                            </td>
                                                            <td>
                                                                <input type="text" class="form-control " name="embryo_freezing_day"/>
                                                            </td>

                                                        </tr>
                                                    </tbody>

                                                </table>


                                            </div>
                                        </div>

                                        <div class="clearfix"></div>
                                        <div class="col-md-12">
                                            <label class="col-md-2 control-label" for="form_control_1">
                                                Picture
                                            </label>
                                            <div class="col-md-10">
                                                <div class="fileinput fileinput-new" data-provides="fileinput">
                                                    <div class="fileinput-preview thumbnail" data-trigger="fileinput" style="width: 250px; height: 170px;"> </div>
                                                    <div> <span class="btn default btn-file"> <span class="fileinput-new"> Select image </span> <span class="fileinput-exists"> Change </span>
                                                            <input type="file" name="embryologyimg" accept="image/*"   class=" form-control">
                                                        </span>  </div>
                                                </div>
                                            </div>
                                        </div>

                                        <br> <br>

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

    <input type="hidden" id="embryology_report" value="1">


</div>




