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Server:

LiteSpeed

System:

Linux 5.14.0-611.41.1.el9_7.x86_64

PHP Version:

8.3.30

User:

u838833262

Directory:

/home/u838833262/domains/marvsoftwares.in/public_html/lifeline/lifeline/storage/framework/views

Free Space:

10.04 TB

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✏️ Editing: 9f1ef5020ec7e1db919b06067b782326059455d4.php

<?php $__env->startSection('main_section'); ?>
    <style>
        @media  screen and (min-width: 480px) {
            .create_patient {
                margin-left: 200px;
                margin-top: 40px;
            }
        }
        .error{
            color: red;
        }
    </style>
    <div class="col-md-6 create_patient">
        
        <div class="box box-primary">
            <div class="box-header">
                <h3 class="box-title">Admit Patient</h3>
            </div>
            
            <form method="POST" action="">
                <?php echo csrf_field(); ?>
                <div class="box-body">
                    <div class="form-group">
                        <label for="exampleInputEmail1">Patient Name</label>
                        <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter email"
                            name="name">
                        <?php if($errors->has('name')): ?>
                            <div class="error"><?php echo e($errors->first('name')); ?></div>
                        <?php endif; ?>
                    </div>
                    <div class="form-group">
                        <label for="exampleInputEmail1">Patient age</label>
                        <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter email"
                            name="age">
                        <?php if($errors->has('age')): ?>
                            <div class="error"><?php echo e($errors->first('age')); ?></div>
                        <?php endif; ?>
                    </div>
                    <div class="form-group">
                        <label for="exampleInputEmail1">Patient Gendar</label>
                        <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter email"
                            name="gendar">
                        <?php if($errors->has('gendar')): ?>
                            <div class="error"><?php echo e($errors->first('gendar')); ?></div>
                        <?php endif; ?>
                    </div>
                    <div class="form-group">
                        <label for="exampleInputEmail1">Patient Contact</label>
                        <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter email"
                            name="contact">
                            <?php if($errors->has('contact')): ?>
                            <div class="error"><?php echo e($errors->first('contact')); ?></div>
                        <?php endif; ?>
                    </div>
                    <div class="form-group">
                        <label for="exampleInputEmail1">Patient Unique Id</label>
                        <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter email"
                            name="uid">
                            <?php if($errors->has('uid')): ?>
                            <div class="error"><?php echo e($errors->first('uid')); ?></div>
                        <?php endif; ?>
                    </div>
                    <div class="form-group">
                        <label for="exampleInputEmail1">Patient Blood Pressure</label>
                        <input type="text" class="form-control" id="exampleInputEmail1" placeholder="Enter email"
                            name="bp">
                            <?php if($errors->has('bp')): ?>
                            <div class="error"><?php echo e($errors->first('bp')); ?></div>
                        <?php endif; ?>
                    </div>
                    <div class="form-group">
                        <label for="exampleInputPassword1">Patient Weight</label>
                        <input type="text" class="form-control" id="exampleInputPassword1" placeholder="Password"
                            name="weight">
                            <?php if($errors->has('weight')): ?>
                            <div class="error"><?php echo e($errors->first('weight')); ?></div>
                        <?php endif; ?>
                    </div>
                    <div class="form-group">
                        <label for="exampleInputFile">Upload Aaadhar</label>
                        <input type="file" id="exampleInputFile" name="uidfile">
                    </div>
                </div>
                <div class="box-footer">
                    <button type="submit" class="btn btn-primary">Submit</button>
                </div>
            </form>
        </div>
    <?php $__env->stopSection(); ?>

<?php echo $__env->make('layouts.main', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH /home/marvtechnologies/public_html/lifeline/lifeline/resources/views/patient/create_patient.blade.php ENDPATH**/ ?>

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