
<div class="page-content-wrapper">
    <div class="page-content">
        <div class="row">
            <div class="col-md-12 clinick invz" id="gprinModel">
                <!-- BEGIN EXAMPLE TABLE PORTLET-->
                <div class="portlet box blue">
                    <div class="portlet-title">
                        <div class="caption">
                            <i class="fa fa-user"></i>Embryo Transfer
                        </div>
                    </div>
                    <div class="portlet-body all">
                        <input type="hidden" id="ultrasoundgynaPage" value="1"/>
                        <input type="hidden" id="patientId" value="{$patientData->id}"/>
                        <input type="hidden" value="1" id="ovum_transfer">

                        <!---======================================================== tab1============================================================================================ ----->

                        <div class="row">
                            <div class="portlet-body form">
                                <form action="{$hosturl}/controllers/{$controllname}.php?ac=addEmbryoTransfer&patientid={$patientId}" method="POST" class="form-horizontal"  id="payStudent">
                                    <div class="form-body">
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label class="col-md-3 control-label" for="form_control_1">Consultant:</label>
                                                <div class="col-md-8">
                                                    <select class="form-control select2me updateElement"  id="consultant" name="consultant" data-placeholder="Select..." data-id="" data-colName="" data-tableName="">
                                                        <option></option>
                                                        {foreach  $clinician as $one}
                                                        <option value="{$one.user_id}">{$one.name}</option>
                                                        {/foreach}
                                                    </select>
                                                    <div class="form-control-focus">
                                                    </div>
                                                </div>
                                            </div>
                                        </div>

                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label class="col-md-2 control-label" for="form_control_1">Day:</label>
                                                <div class="col-md-2">
                                                    <select class="form-control select2me updateElement" id="day" name="day" required="required" 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 class="form-control-focus">
                                                    </div>
                                                </div>
                                            </div>
                                        </div>

                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label class="col-md-3 control-label" for="form_control_1">Embryologist:</label>
                                                <div class="col-md-8">
                                                    <select class="form-control select2me updateElement" id="embryologist" name="embryologist" data-placeholder="Select..." data-id="" data-colName="" data-tableName="">
                                                        <option></option>
                                                        {foreach  $embryologist as $one}
                                                        <option value="{$one.user_id}">{$one.name}</option>
                                                        {/foreach}
                                                    </select>
                                                    <div class="form-control-focus">
                                                    </div>
                                                </div>
                                            </div>
                                        </div>



                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label class="col-md-2 control-label" for="form_control_1">Nurse:</label>
                                                <div class="col-md-8">
                                                    <select class="form-control select2me updateElement" id="nurse" name="nurse" data-placeholder="Select..." data-id="" data-colName="" data-tableName="">
                                                        <option></option>
                                                        {foreach  $nurses as $one}
                                                        <option value="{$one.user_id}">{$one.name}</option>
                                                        {/foreach}
                                                    </select>
                                                    <div class="form-control-focus">
                                                    </div>
                                                </div>
                                            </div>
                                        </div>



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


                                        <div class="col-md-6">
                                            <label class="col-md-3 control-label" for="form_control_1">
                                                No. of embryos:
                                            </label>
                                            <div class="col-md-8">
                                                <input type="text" class="form-control input-sm updateElement" id="no_of_embryos" name='no_of_embryos' placeholder="" data-id="" data-colName="" data-tableName="" value="">
                                                <div class="form-control-focus">
                                                </div>
                                            </div>
                                        </div>
                                        <div class="col-md-6">
                                            <label class="col-md-2 control-label" for="form_control_1">
                                                Quality:
                                            </label>
                                            <div class="col-md-8">
                                                <input type="text" class="form-control input-sm updateElement" id='quality' name='quality'  placeholder="" data-id="" data-colName="" data-tableName="" value="">
                                                <div class="form-control-focus">
                                                </div>
                                            </div>
                                        </div>




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




                                        <div class="col-md-6">
                                            <label class="col-md-3 control-label" for="form_control_1">
                                                Notes:
                                            </label>
                                            <div class="col-md-8">
                                                <textarea class="form-control updateElement" rows="2" id='notes' name='notes' placeholder="Enter more text" data-id="" data-colName="" data-tableName=""></textarea>
                                                <div class="form-control-focus">
                                                </div>
                                            </div>
                                        </div>




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

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

