<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-users"></i>Termination report
                        </div>
                    </div>
                    <div class="portlet-body all">
                        <input type="hidden" id="terminationreport" value="1"/>
                        <input type="hidden" id="tdate" value="{$today}">
                        <input type="hidden" id="controllName" value="termination"/>
                        <!--Begin Semen-->

                        <div class="row">
                            <!--div class="row clinick posre">
                                <div class="col-md-2">

                                </div>
                                <div class="col-md-3">
                                    <div class="form-group form-md-line-input form-md-floating-label has-info">
                                        <input type="text" class="form-control datepicker today txtc" id="fromdate" value="{$today}"/>
                                        <label for="form_control_1">Date from: </label>
                                    </div>
                                </div>
                                <div class="col-md-2">

                                </div>
                                <div class="col-md-3">
                                    <div class="form-group form-md-line-input form-md-floating-label has-info">
                                        <input type="text" class="form-control datepicker tomoro txtc" id="todate" value="{$today}"/>
                                        <label for="form_control_1">Date to: </label>
                                    </div>
                                </div>

                            </div-->
                            <div class="row clinick posre">
                                <div class="col-md-2">

                                </div>
                                <div class="col-md-3">
                                    <select class="select2me txtc" style="width: 100%" id="terminationType">
                                        <option>choose</option>
                                        {foreach $allphobstericterminate as $data}
                                        <option value="{$data->id}">{$data->name}</option>
                                        {/foreach}
                                    </select>
                                </div>
                                <div class="col-md-2">

                                </div>
                                <div class="col-md-3">

                                </div>

                            </div>
                        </div>

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

                        <div class="portlet box white">
                            <div class="portlet-title">
                                <div class="actions">
                                    <a class="btn btn-default btn-sm" id="printf">
                                        <i class="fa fa-print"></i> Print </a>

                                </div>
                            </div>

                            <div class="portlet-body form" id="expectedDiv" style="margin: 0px 8px;">
                                <table class="table table-hover portlet light bg-inverse " id="repTable">
                                    <thead>
                                        <tr>
                                            <th>No.</th>
                                            <th>
                                                Patient Name
                                            </th>
                                            <th>
                                                Husband Name
                                            </th>
                                            <th>Date</th>
                                        </tr>
                                    </thead>
                                    <tbody>
                                        <tr colspan="4"> No Data</tr>
                                    </tbody>
                                </table>
                            </div>
                        </div>

                    </div>

                </div>

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

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


