@extends('layouts.app')

@section('title')
    {{ __('Patient History') }}
@endsection

@section('breadcrumb')
    <div class="content-header">
        <div class="container-fluid">
            <div class="row mb-2">
                <div class="col-sm-6">
                    <h1 class="m-0 text-dark">
                        <i class="fa fa-flag"></i>
                        {{ __('Patient History') }}
                    </h1>
                </div><!-- /.col -->
                <div class="col-sm-6">
                    <ol class="breadcrumb float-sm-right">
                        <li class="breadcrumb-item"><a href="{{ route('admin.index') }}">{{ __('Home') }}</a></li>
                        <li class="breadcrumb-item"><a href="{{ route('admin.patients.index') }}">{{ __('Patients') }}</a></li>
                        <li class="breadcrumb-item active">{{ __('Patient History') }}</li>
                    </ol>
                </div><!-- /.col -->
            </div><!-- /.row -->
        </div><!-- /.container-fluid -->
    </div>
@endsection

@section('content')

        <div class="row">
            <div class="col-lg-2">
                <div class="card card-primary">
                    <div class="card-header">
                        <h5 class="text-center m-0 p-0">
                            {{ __('Avatar') }}
                        </h5>
                    </div>
                   
                    <div class="card-body m-0 p-0">
                        <div class="row">
                            <div class="col-lg-12 text-center">
                                <a href="@if (!empty($patient['avatar'])) {{ url('uploads/patient-avatar/' . $patient['avatar']) }}@else{{ url('img/avatar.png') }} @endif" data-toggle="lightbox" data-title="Avatar">
                                    <img src="@if (!empty($patient['avatar'])) {{ url('uploads/patient-avatar/' . $patient['avatar']) }}@else{{ url('img/avatar.png') }} @endif" class="img-thumbnail" id="patient_avatar" alt="">
                                </a>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
            <div class="col-lg-10">
                <div class="row">
                    <div class="col-lg-12  ml-0">
                        <div class="row">
                            <div class="card card-primary col-lg-12 p-1 m-0">
                                <div class="card-header">
                                    <h5 class="text-center m-0 p-0">
                                        {{ __('Patient Information') }}
                                    </h5>
                                </div>
                                <div class="card-body m-0 p-0">

                                    <div class="row m-2">
                                        <div class="col-lg-12">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fa fa-code"></i>
                                                        </span>
                                                    </div>
                                                    <input type="text" class="form-control" placeholder="{{ __('Patient Code') }}" name="code" id="code" @if (isset($patient)) value="{{ $patient->code }}" @elseif(old('code')) value="{{ old('code') }}" @endif readonly>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="col-lg-4">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fa">{{__('First Name')}}</i>
                                                        </span>
                                                    </div>
                                                    <input type="text" class="form-control" placeholder="{{ __('Patient\'s First Name') }}" name="name" id="name" @if (isset($patient)) value="{{ $patient->name }}" @elseif(old('name')) value="{{ old('name') }}" @endif readonly>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="col-lg-4">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fas">{{__('Middle Name')}}</i>
                                                        </span>
                                                    </div>
                                                    <input type="text" class="form-control" placeholder="{{ __('Patient\'s Middle Name') }}" name="middle_name" id="middlename" @if (isset($patient)) value="{{ $patient->middle_name }}" @elseif(old('middle_name')) value="{{ old('middle_name') }}" @endif readonly>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="col-lg-4">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fa">{{__('Last Name')}}</i>
                                                        </span>
                                                    </div>
                                                    <input type="text" class="form-control" placeholder="{{ __('Patient\'s Last Name') }}" name="last_name" id="lastname" @if (isset($patient)) value="{{ $patient->last_name }}" @elseif(old('last_name')) value="{{ old('last_name') }}" @endif readonly>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="col-lg-4">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fas">{{ __('Multiple Birth') }}</i>
                                                        </span>
                                                    </div>
                                                    <input type="number" class="form-control" placeholder="{{ __('For Multiple Birth') }}" name="birth_count" id="birth_count" @if (isset($patient)) value="{{ $patient->birth_count }}" @elseif(old('birth_count')) value="{{ old('birth_count') }}" @endif readonly>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="col-lg-4">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fas">{{ __('Age') }}</i>
                                                        </span>
                                                    </div>
                                                    <input type="text" class="form-control" placeholder="{{ __('Age ') }}" @if (isset($patient)) value="{{ $patient['age'] }}" @endif readonly >

                                                </div>
                                            </div>
                                        </div>
                                        <div class="col-lg-4">
                                            <div class="form-group">
                                                <div class="form-group">
                                                    <div class="input-group mb-3">
                                                        <div class="input-group-prepend">
                                                            <span class="input-group-text" id="basic-addon1">
                                                                <i class="fas">{{ __('Birthdate') }}</i>
                                                            </span>
                                                        </div>
                                                        <input autocomplete="off" max="2025-08-04" type="date" class="form-control dob_datepicker" placeholder="{{ __('Date of birth') }}" name="dob" id="dob" readonly @if (isset($patient))
                                                        value="{{ $patient['dob'] }}"
                                                    @elseif(old('dob'))
                                                        value="{{ old('dob') }}"
                                                        @endif readonly>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        {{-- <div class="col-lg-6">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fas fa-baby"></i>
                                                        </span>
                                                    </div>
                                                    <input type="text" class="form-control"   placeholder="{{ __('Age') }}" @if (isset($patient)) value="{{ $patient->age }}" @endif >
                                                    <input type="text" class="forrm-control"  @if (isset($patient)) value="{{ $patient->age }}" @endif >
                                                </div>
                                            </div>
                                        </div> --}}
                                        
                                        {{-- <div class="col-lg-6">
                                            <div class="form-group">
                                                <div class="input-group mb-3">

                                                    <input type="text" class="form-control" placeholder="{{ __('Age Unit') }}" @if (isset($patient)) value="{{ $patient['age_unit'] }}" @endif readonly >

                                                </div>
                                            </div>
                                        </div> --}}
                                        <div class="col-lg-6">
                                            <div class="form-group">
                                                <div class="form-group">
                                                    <div class="input-group mb-3">
                                                        <div class="input-group-prepend">
                                                            <span class="input-group-text" id="basic-addon1">
                                                                <i class="fas">{{ __('Gender') }}</i>
                                                            </span>
                                                        </div>
                                                        <select class="form-control" name="gender" placeholder="{{ __('Gender') }}" id="gender" disabled>
                                                            <option value="" disabled selected>{{ __('Gender') }}</option>
                                                            <option value="male" @if (isset($patient) && $patient['gender'] == 'male') selected @elseif(old('gender') == 'male') selected @endif>{{ __('Male') }}</option>
                                                            <option value="female" @if (isset($patient) && $patient['gender'] == 'female') selected @elseif(old('gender') == 'female') selected @endif>{{ __('Female') }}</option>
                                                            <option value="ambiguous" @if (isset($patient) && $patient['gender'] == 'ambiguous') selected @elseif(old('gender') == 'ambiguous') selected @endif>{{ __('Ambiguous') }}</option>
                                                        </select>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="col-lg-6">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fas">{{ __('Nationality') }}</i>
                                                        </span>
                                                    </div>
                                                    <!-- <input type="text" class="form-control" placeholder="{{ __('Nationality') }}" name="nationality" id="nationality" @if (isset($patient)) value="{{ $patient->nationality }}" @elseif(old('nationality')) selected" @endif > -->
                                                    <select name="nationality" id="nationality" class="form-control" disabled>
                                                        <option disabled>-- select nationality --</option>
                                                        <option value="afghan" @if (isset($patient) && $patient['nationality'] == 'afghan') selected @elseif(old('nationality') && old('nationality') == 'afghan') selected" @endif>Afghan</option>
                                                        <option value="albanian" @if (isset($patient) && $patient['nationality'] == 'albanian') selected @elseif(old('nationality') && old('nationality') == 'albanian') selected" @endif>Albanian</option>
                                                        <option value="algerian" @if (isset($patient) && $patient['nationality'] == 'algerian') selected @elseif(old('nationality') && old('nationality') == 'algerian') selected" @endif>Algerian</option>
                                                        <option value="american" @if (isset($patient) && $patient['nationality'] == 'american') selected @elseif(old('nationality') && old('nationality') == 'american') selected" @endif>American</option>
                                                        <option value="andorran" @if (isset($patient) && $patient['nationality'] == 'andorran') selected @elseif(old('nationality') && old('nationality') == 'andorran') selected" @endif>Andorran</option>
                                                        <option value="angolan" @if (isset($patient) && $patient['nationality'] == 'angolan') selected @elseif(old('nationality') && old('nationality') == 'angolan') selected" @endif>Angolan</option>
                                                        <option value="antiguans" @if (isset($patient) && $patient['nationality'] == 'antiguans') selected @elseif(old('nationality') && old('nationality') == 'antiguans') selected" @endif>Antiguans</option>
                                                        <option value="argentinean" @if (isset($patient) && $patient['nationality'] == 'argentinean') selected @elseif(old('nationality') && old('nationality') == 'argentinean') selected" @endif>Argentinean</option>
                                                        <option value="armenian" @if (isset($patient) && $patient['nationality'] == 'armenian') selected @elseif(old('nationality') && old('nationality') == 'armenian') selected" @endif>Armenian</option>
                                                        <option value="australian" @if (isset($patient) && $patient['nationality'] == 'australian') selected @elseif(old('nationality') && old('nationality') == 'australian') selected" @endif>Australian</option>
                                                        <option value="austrian" @if (isset($patient) && $patient['nationality'] == 'austrian') selected @elseif(old('nationality') && old('nationality') == 'austrian') selected" @endif>Austrian</option>
                                                        <option value="azerbaijani" @if (isset($patient) && $patient['nationality'] == 'azerbaijani') selected @elseif(old('nationality') && old('nationality') == 'azerbaijani') selected" @endif>Azerbaijani</option>
                                                        <option value="bahamian" @if (isset($patient) && $patient['nationality'] == 'bahamian') selected @elseif(old('nationality') && old('nationality') == 'bahamian') selected" @endif>Bahamian</option>
                                                        <option value="bahraini" @if (isset($patient) && $patient['nationality'] == 'bahraini') selected @elseif(old('nationality') && old('nationality') == 'bahraini') selected" @endif>Bahraini</option>
                                                        <option value="bangladeshi" @if (isset($patient) && $patient['nationality'] == 'bangladeshi') selected @elseif(old('nationality') && old('nationality') == 'bangladeshi') selected" @endif>Bangladeshi</option>
                                                        <option value="barbadian" @if (isset($patient) && $patient['nationality'] == 'barbadian') selected @elseif(old('nationality') && old('nationality') == 'barbadian') selected" @endif>Barbadian</option>
                                                        <option value="barbudans" @if (isset($patient) && $patient['nationality'] == 'barbudans') selected @elseif(old('nationality') && old('nationality') == 'barbudans') selected" @endif>Barbudans</option>
                                                        <option value="batswana" @if (isset($patient) && $patient['nationality'] == 'batswana') selected @elseif(old('nationality') && old('nationality') == 'batswana') selected" @endif>Batswana</option>
                                                        <option value="belarusian" @if (isset($patient) && $patient['nationality'] == 'belarusian') selected @elseif(old('nationality') && old('nationality') == 'belarusian') selected" @endif>Belarusian</option>
                                                        <option value="belgian" @if (isset($patient) && $patient['nationality'] == 'belgian') selected @elseif(old('nationality') && old('nationality') == 'belgian') selected" @endif>Belgian</option>
                                                        <option value="belizean" @if (isset($patient) && $patient['nationality'] == 'belizean') selected @elseif(old('nationality') && old('nationality') == 'belizean') selected" @endif>Belizean</option>
                                                        <option value="beninese" @if (isset($patient) && $patient['nationality'] == 'beninese') selected @elseif(old('nationality') && old('nationality') == 'beninese') selected" @endif>Beninese</option>
                                                        <option value="bhutanese" @if (isset($patient) && $patient['nationality'] == 'bhutanese') selected @elseif(old('nationality') && old('nationality') == 'bhutanese') selected" @endif>Bhutanese</option>
                                                        <option value="bolivian" @if (isset($patient) && $patient['nationality'] == 'bolivian') selected @elseif(old('nationality') && old('nationality') == 'bolivian') selected" @endif>Bolivian</option>
                                                        <option value="bosnian" @if (isset($patient) && $patient['nationality'] == 'bosnian') selected @elseif(old('nationality') && old('nationality') == 'bosnian') selected" @endif>Bosnian</option>
                                                        <option value="brazilian" @if (isset($patient) && $patient['nationality'] == 'brazilian') selected @elseif(old('nationality') && old('nationality') == 'brazilian') selected" @endif>Brazilian</option>
                                                        <option value="british" @if (isset($patient) && $patient['nationality'] == 'british') selected @elseif(old('nationality') && old('nationality') == 'british') selected" @endif>British</option>
                                                        <option value="bruneian" @if (isset($patient) && $patient['nationality'] == 'bruneian') selected @elseif(old('nationality') && old('nationality') == 'bruneian') selected" @endif>Bruneian</option>
                                                        <option value="bulgarian" @if (isset($patient) && $patient['nationality'] == 'bulgarian') selected @elseif(old('nationality') && old('nationality') == 'bulgarian') selected" @endif>Bulgarian</option>
                                                        <option value="burkinabe" @if (isset($patient) && $patient['nationality'] == 'burkinabe') selected @elseif(old('nationality') && old('nationality') == 'burkinabe') selected" @endif>Burkinabe</option>
                                                        <option value="burmese" @if (isset($patient) && $patient['nationality'] == 'burmese') selected @elseif(old('nationality') && old('nationality') == 'burmese') selected" @endif>Burmese</option>
                                                        <option value="burundian" @if (isset($patient) && $patient['nationality'] == 'burundian') selected @elseif(old('nationality') && old('nationality') == 'burundian') selected" @endif>Burundian</option>
                                                        <option value="cambodian" @if (isset($patient) && $patient['nationality'] == 'cambodian') selected @elseif(old('nationality') && old('nationality') == 'cambodian') selected" @endif>Cambodian</option>
                                                        <option value="cameroonian" @if (isset($patient) && $patient['nationality'] == 'cameroonian') selected @elseif(old('nationality') && old('nationality') == 'cameroonian') selected" @endif>Cameroonian</option>
                                                        <option value="canadian" @if (isset($patient) && $patient['nationality'] == 'canadian') selected @elseif(old('nationality') && old('nationality') == 'canadian') selected" @endif>Canadian</option>
                                                        <option value="cape verdean" @if (isset($patient) && $patient['nationality'] == 'cape verdean') selected @elseif(old('nationality') && old('nationality') == 'cape verdean') selected" @endif>Cape Verdean</option>
                                                        <option value="central african" @if (isset($patient) && $patient['nationality'] == 'central african') selected @elseif(old('nationality') && old('nationality') == 'central african') selected" @endif>Central African</option>
                                                        <option value="chadian" @if (isset($patient) && $patient['nationality'] == 'chadian') selected @elseif(old('nationality') && old('nationality') == 'chadian') selected" @endif>Chadian</option>
                                                        <option value="chilean" @if (isset($patient) && $patient['nationality'] == 'chilean') selected @elseif(old('nationality') && old('nationality') == 'chilean') selected" @endif>Chilean</option>
                                                        <option value="chinese" @if (isset($patient) && $patient['nationality'] == 'chinese') selected @elseif(old('nationality') && old('nationality') == 'chinese') selected" @endif>Chinese</option>
                                                        <option value="colombian" @if (isset($patient) && $patient['nationality'] == 'colombian') selected @elseif(old('nationality') && old('nationality') == 'colombian') selected" @endif>Colombian</option>
                                                        <option value="comoran" @if (isset($patient) && $patient['nationality'] == 'comoran') selected @elseif(old('nationality') && old('nationality') == 'comoran') selected" @endif>Comoran</option>
                                                        <option value="congolese" @if (isset($patient) && $patient['nationality'] == 'congolese') selected @elseif(old('nationality') && old('nationality') == 'congolese') selected" @endif>Congolese</option>
                                                        <option value="costa rican" @if (isset($patient) && $patient['nationality'] == 'costa rican') selected @elseif(old('nationality') && old('nationality') == 'costa rican') selected" @endif>Costa Rican</option>
                                                        <option value="croatian" @if (isset($patient) && $patient['nationality'] == 'croatian') selected @elseif(old('nationality') && old('nationality') == 'croatian') selected" @endif>Croatian</option>
                                                        <option value="cuban" @if (isset($patient) && $patient['nationality'] == 'cuban') selected @elseif(old('nationality') && old('nationality') == 'cuban') selected" @endif>Cuban</option>
                                                        <option value="cypriot" @if (isset($patient) && $patient['nationality'] == 'cypriot') selected @elseif(old('nationality') && old('nationality') == 'cypriot') selected" @endif>Cypriot</option>
                                                        <option value="czech" @if (isset($patient) && $patient['nationality'] == 'czech') selected @elseif(old('nationality') && old('nationality') == 'czech') selected" @endif>Czech</option>
                                                        <option value="danish" @if (isset($patient) && $patient['nationality'] == 'danish') selected @elseif(old('nationality') && old('nationality') == 'danish') selected" @endif>Danish</option>
                                                        <option value="djibouti" @if (isset($patient) && $patient['nationality'] == 'djibouti') selected @elseif(old('nationality') && old('nationality') == 'djibouti') selected" @endif>Djibouti</option>
                                                        <option value="dominican" @if (isset($patient) && $patient['nationality'] == 'dominican') selected @elseif(old('nationality') && old('nationality') == 'dominican') selected" @endif>Dominican</option>
                                                        <option value="dutch" @if (isset($patient) && $patient['nationality'] == 'dutch') selected @elseif(old('nationality') && old('nationality') == 'dutch') selected" @endif>Dutch</option>
                                                        <option value="east timorese" @if (isset($patient) && $patient['nationality'] == 'east timorese') selected @elseif(old('nationality') && old('nationality') == 'east timorese') selected" @endif>East Timorese</option>
                                                        <option value="ecuadorean" @if (isset($patient) && $patient['nationality'] == 'ecuadorean') selected @elseif(old('nationality') && old('nationality') == 'ecuadorean') selected" @endif>Ecuadorean</option>
                                                        <option value="egyptian" @if (isset($patient) && $patient['nationality'] == 'egyptian') selected @elseif(old('nationality') && old('nationality') == 'egyptian') selected" @endif>Egyptian</option>
                                                        <option value="emirian" @if (isset($patient) && $patient['nationality'] == 'emirian') selected @elseif(old('nationality') && old('nationality') == 'emirian') selected" @endif>Emirian</option>
                                                        <option value="equatorial guinean" @if (isset($patient) && $patient['nationality'] == 'equatorial guinean') selected @elseif(old('nationality') && old('nationality') == 'equatorial guinean') selected" @endif>Equatorial Guinean</option>
                                                        <option value="eritrean" @if (isset($patient) && $patient['nationality'] == 'eritrean') selected @elseif(old('nationality') && old('nationality') == 'eritrean') selected" @endif>Eritrean</option>
                                                        <option value="estonian" @if (isset($patient) && $patient['nationality'] == 'estonian') selected @elseif(old('nationality') && old('nationality') == 'estonian') selected" @endif>Estonian</option>
                                                        <option value="ethiopian" @if (isset($patient) && $patient['nationality'] == 'ethiopian') selected @elseif(old('nationality') && old('nationality') == 'ethiopian') selected" @endif>Ethiopian</option>
                                                        <option value="fijian" @if (isset($patient) && $patient['nationality'] == 'fijian') selected @elseif(old('nationality') && old('nationality') == 'fijian') selected" @endif>Fijian</option>
                                                        <option value="filipino" @if (isset($patient) && $patient['nationality'] == 'filipino') selected @elseif(old('nationality') && old('nationality') == 'filipino') selected" @elseif(old('nationality') == null && isset($patient) == false) selected @endif>Filipino</option>
                                                        <option value="finnish" @if (isset($patient) && $patient['nationality'] == 'finnish') selected @elseif(old('nationality') && old('nationality') == 'finnish') selected" @endif>Finnish</option>
                                                        <option value="french" @if (isset($patient) && $patient['nationality'] == 'french') selected @elseif(old('nationality') && old('nationality') == 'french') selected" @endif>French</option>
                                                        <option value="gabonese" @if (isset($patient) && $patient['nationality'] == 'gabonese') selected @elseif(old('nationality') && old('nationality') == 'gabonese') selected" @endif>Gabonese</option>
                                                        <option value="gambian" @if (isset($patient) && $patient['nationality'] == 'gambian') selected @elseif(old('nationality') && old('nationality') == 'gambian') selected" @endif>Gambian</option>
                                                        <option value="georgian" @if (isset($patient) && $patient['nationality'] == 'georgian') selected @elseif(old('nationality') && old('nationality') == 'georgian') selected" @endif>Georgian</option>
                                                        <option value="german" @if (isset($patient) && $patient['nationality'] == 'german') selected @elseif(old('nationality') && old('nationality') == 'german') selected" @endif>German</option>
                                                        <option value="ghanaian" @if (isset($patient) && $patient['nationality'] == 'ghanaian') selected @elseif(old('nationality') && old('nationality') == 'ghanaian') selected" @endif>Ghanaian</option>
                                                        <option value="greek" @if (isset($patient) && $patient['nationality'] == 'greek') selected @elseif(old('nationality') && old('nationality') == 'greek') selected" @endif>Greek</option>
                                                        <option value="grenadian" @if (isset($patient) && $patient['nationality'] == 'grenadian') selected @elseif(old('nationality') && old('nationality') == 'grenadian') selected" @endif>Grenadian</option>
                                                        <option value="guatemalan" @if (isset($patient) && $patient['nationality'] == 'guatemalan') selected @elseif(old('nationality') && old('nationality') == 'guatemalan') selected" @endif>Guatemalan</option>
                                                        <option value="guinea-bissauan" @if (isset($patient) && $patient['nationality'] == 'guinea-bissauan') selected @elseif(old('nationality') && old('nationality') == 'guinea-bissauan') selected" @endif>Guinea-Bissauan</option>
                                                        <option value="guinean" @if (isset($patient) && $patient['nationality'] == 'guinean') selected @elseif(old('nationality') && old('nationality') == 'guinean') selected" @endif>Guinean</option>
                                                        <option value="guyanese" @if (isset($patient) && $patient['nationality'] == 'guyanese') selected @elseif(old('nationality') && old('nationality') == 'guyanese') selected" @endif>Guyanese</option>
                                                        <option value="haitian" @if (isset($patient) && $patient['nationality'] == 'haitian') selected @elseif(old('nationality') && old('nationality') == 'haitian') selected" @endif>Haitian</option>
                                                        <option value="herzegovinian" @if (isset($patient) && $patient['nationality'] == 'herzegovinian') selected @elseif(old('nationality') && old('nationality') == 'herzegovinian') selected" @endif>Herzegovinian</option>
                                                        <option value="honduran" @if (isset($patient) && $patient['nationality'] == 'honduran') selected @elseif(old('nationality') && old('nationality') == 'honduran') selected" @endif>Honduran</option>
                                                        <option value="hungarian" @if (isset($patient) && $patient['nationality'] == 'hungarian') selected @elseif(old('nationality') && old('nationality') == 'hungarian') selected" @endif>Hungarian</option>
                                                        <option value="icelander" @if (isset($patient) && $patient['nationality'] == 'icelander') selected @elseif(old('nationality') && old('nationality') == 'icelander') selected" @endif>Icelander</option>
                                                        <option value="indian" @if (isset($patient) && $patient['nationality'] == 'indian') selected @elseif(old('nationality') && old('nationality') == 'indian') selected" @endif>Indian</option>
                                                        <option value="indonesian" @if (isset($patient) && $patient['nationality'] == 'indonesian') selected @elseif(old('nationality') && old('nationality') == 'indonesian') selected" @endif>Indonesian</option>
                                                        <option value="iranian" @if (isset($patient) && $patient['nationality'] == 'iranian') selected @elseif(old('nationality') && old('nationality') == 'iranian') selected" @endif>Iranian</option>
                                                        <option value="iraqi" @if (isset($patient) && $patient['nationality'] == 'iraqi') selected @elseif(old('nationality') && old('nationality') == 'iraqi') selected" @endif>Iraqi</option>
                                                        <option value="irish" @if (isset($patient) && $patient['nationality'] == 'irish') selected @elseif(old('nationality') && old('nationality') == 'irish') selected" @endif>Irish</option>
                                                        <option value="israeli" @if (isset($patient) && $patient['nationality'] == 'israeli') selected @elseif(old('nationality') && old('nationality') == 'israeli') selected" @endif>Israeli</option>
                                                        <option value="italian" @if (isset($patient) && $patient['nationality'] == 'italian') selected @elseif(old('nationality') && old('nationality') == 'italian') selected" @endif>Italian</option>
                                                        <option value="ivorian" @if (isset($patient) && $patient['nationality'] == 'ivorian') selected @elseif(old('nationality') && old('nationality') == 'ivorian') selected" @endif>Ivorian</option>
                                                        <option value="jamaican" @if (isset($patient) && $patient['nationality'] == 'jamaican') selected @elseif(old('nationality') && old('nationality') == 'jamaican') selected" @endif>Jamaican</option>
                                                        <option value="japanese" @if (isset($patient) && $patient['nationality'] == 'japanese') selected @elseif(old('nationality') && old('nationality') == 'japanese') selected" @endif>Japanese</option>
                                                        <option value="jordanian" @if (isset($patient) && $patient['nationality'] == 'jordanian') selected @elseif(old('nationality') && old('nationality') == 'jordanian') selected" @endif>Jordanian</option>
                                                        <option value="kazakhstani" @if (isset($patient) && $patient['nationality'] == 'kazakhstani') selected @elseif(old('nationality') && old('nationality') == 'kazakhstani') selected" @endif>Kazakhstani</option>
                                                        <option value="kenyan" @if (isset($patient) && $patient['nationality'] == 'kenyan') selected @elseif(old('nationality') && old('nationality') == 'kenyan') selected" @endif>Kenyan</option>
                                                        <option value="kittian and nevisian" @if (isset($patient) && $patient['nationality'] == 'kittian and nevisian') selected @elseif(old('nationality') && old('nationality') == 'kittian and nevisian') selected" @endif>Kittian and Nevisian</option>
                                                        <option value="kuwaiti" @if (isset($patient) && $patient['nationality'] == 'kuwaiti') selected @elseif(old('nationality') && old('nationality') == 'kuwaiti') selected" @endif>Kuwaiti</option>
                                                        <option value="kyrgyz" @if (isset($patient) && $patient['nationality'] == 'kyrgyz') selected @elseif(old('nationality') && old('nationality') == 'kyrgyz') selected" @endif>Kyrgyz</option>
                                                        <option value="laotian" @if (isset($patient) && $patient['nationality'] == 'laotian') selected @elseif(old('nationality') && old('nationality') == 'laotian') selected" @endif>Laotian</option>
                                                        <option value="latvian" @if (isset($patient) && $patient['nationality'] == 'latvian') selected @elseif(old('nationality') && old('nationality') == 'latvian') selected" @endif>Latvian</option>
                                                        <option value="lebanese" @if (isset($patient) && $patient['nationality'] == 'lebanese') selected @elseif(old('nationality') && old('nationality') == 'lebanese') selected" @endif>Lebanese</option>
                                                        <option value="liberian" @if (isset($patient) && $patient['nationality'] == 'liberian') selected @elseif(old('nationality') && old('nationality') == 'liberian') selected" @endif>Liberian</option>
                                                        <option value="libyan" @if (isset($patient) && $patient['nationality'] == 'libyan') selected @elseif(old('nationality') && old('nationality') == 'libyan') selected" @endif>Libyan</option>
                                                        <option value="liechtensteiner" @if (isset($patient) && $patient['nationality'] == 'liechtensteiner') selected @elseif(old('nationality') && old('nationality') == 'liechtensteiner') selected" @endif>Liechtensteiner</option>
                                                        <option value="lithuanian" @if (isset($patient) && $patient['nationality'] == 'lithuanian') selected @elseif(old('nationality') && old('nationality') == 'lithuanian') selected" @endif>Lithuanian</option>
                                                        <option value="luxembourger" @if (isset($patient) && $patient['nationality'] == 'luxembourger') selected @elseif(old('nationality') && old('nationality') == 'luxembourger') selected" @endif>Luxembourger</option>
                                                        <option value="macedonian" @if (isset($patient) && $patient['nationality'] == 'macedonian') selected @elseif(old('nationality') && old('nationality') == 'macedonian') selected" @endif>Macedonian</option>
                                                        <option value="malagasy" @if (isset($patient) && $patient['nationality'] == 'malagasy') selected @elseif(old('nationality') && old('nationality') == 'malagasy') selected" @endif>Malagasy</option>
                                                        <option value="malawian" @if (isset($patient) && $patient['nationality'] == 'malawian') selected @elseif(old('nationality') && old('nationality') == 'malawian') selected" @endif>Malawian</option>
                                                        <option value="malaysian" @if (isset($patient) && $patient['nationality'] == 'malaysian') selected @elseif(old('nationality') && old('nationality') == 'malaysian') selected" @endif>Malaysian</option>
                                                        <option value="maldivan" @if (isset($patient) && $patient['nationality'] == 'maldivan') selected @elseif(old('nationality') && old('nationality') == 'maldivan') selected" @endif>Maldivan</option>
                                                        <option value="malian" @if (isset($patient) && $patient['nationality'] == 'malian') selected @elseif(old('nationality') && old('nationality') == 'malian') selected" @endif>Malian</option>
                                                        <option value="maltese" @if (isset($patient) && $patient['nationality'] == 'maltese') selected @elseif(old('nationality') && old('nationality') == 'maltese') selected" @endif>Maltese</option>
                                                        <option value="marshallese" @if (isset($patient) && $patient['nationality'] == 'marshallese') selected @elseif(old('nationality') && old('nationality') == 'marshallese') selected" @endif>Marshallese</option>
                                                        <option value="mauritanian" @if (isset($patient) && $patient['nationality'] == 'mauritanian') selected @elseif(old('nationality') && old('nationality') == 'mauritanian') selected" @endif>Mauritanian</option>
                                                        <option value="mauritian" @if (isset($patient) && $patient['nationality'] == 'mauritian') selected @elseif(old('nationality') && old('nationality') == 'mauritian') selected" @endif>Mauritian</option>
                                                        <option value="mexican" @if (isset($patient) && $patient['nationality'] == 'mexican') selected @elseif(old('nationality') && old('nationality') == 'mexican') selected" @endif>Mexican</option>
                                                        <option value="micronesian" @if (isset($patient) && $patient['nationality'] == 'micronesian') selected @elseif(old('nationality') && old('nationality') == 'micronesian') selected" @endif>Micronesian</option>
                                                        <option value="moldovan" @if (isset($patient) && $patient['nationality'] == 'moldovan') selected @elseif(old('nationality') && old('nationality') == 'moldovan') selected" @endif>Moldovan</option>
                                                        <option value="monacan" @if (isset($patient) && $patient['nationality'] == 'monacan') selected @elseif(old('nationality') && old('nationality') == 'monacan') selected" @endif>Monacan</option>
                                                        <option value="mongolian" @if (isset($patient) && $patient['nationality'] == 'mongolian') selected @elseif(old('nationality') && old('nationality') == 'mongolian') selected" @endif>Mongolian</option>
                                                        <option value="moroccan" @if (isset($patient) && $patient['nationality'] == 'moroccan') selected @elseif(old('nationality') && old('nationality') == 'moroccan') selected" @endif>Moroccan</option>
                                                        <option value="mosotho" @if (isset($patient) && $patient['nationality'] == 'mosotho') selected @elseif(old('nationality') && old('nationality') == 'mosotho') selected" @endif>Mosotho</option>
                                                        <option value="motswana" @if (isset($patient) && $patient['nationality'] == 'motswana') selected @elseif(old('nationality') && old('nationality') == 'motswana') selected" @endif>Motswana</option>
                                                        <option value="mozambican" @if (isset($patient) && $patient['nationality'] == 'mozambican') selected @elseif(old('nationality') && old('nationality') == 'mozambican') selected" @endif>Mozambican</option>
                                                        <option value="namibian" @if (isset($patient) && $patient['nationality'] == 'namibian') selected @elseif(old('nationality') && old('nationality') == 'namibian') selected" @endif>Namibian</option>
                                                        <option value="nauruan" @if (isset($patient) && $patient['nationality'] == 'nauruan') selected @elseif(old('nationality') && old('nationality') == 'nauruan') selected" @endif>Nauruan</option>
                                                        <option value="nepalese" @if (isset($patient) && $patient['nationality'] == 'nepalese') selected @elseif(old('nationality') && old('nationality') == 'nepalese') selected" @endif>Nepalese</option>
                                                        <option value="new zealander" @if (isset($patient) && $patient['nationality'] == 'new zealander') selected @elseif(old('nationality') && old('nationality') == 'new zealander') selected" @endif>New Zealander</option>
                                                        <option value="ni-vanuatu" @if (isset($patient) && $patient['nationality'] == 'ni-vanuatu') selected @elseif(old('nationality') && old('nationality') == 'ni-vanuatu') selected" @endif>Ni-Vanuatu</option>
                                                        <option value="nicaraguan" @if (isset($patient) && $patient['nationality'] == 'nicaraguan') selected @elseif(old('nationality') && old('nationality') == 'nicaraguan') selected" @endif>Nicaraguan</option>
                                                        <option value="nigerien" @if (isset($patient) && $patient['nationality'] == 'nigerien') selected @elseif(old('nationality') && old('nationality') == 'nigerien') selected" @endif>Nigerien</option>
                                                        <option value="north korean" @if (isset($patient) && $patient['nationality'] == 'north korean') selected @elseif(old('nationality') && old('nationality') == 'north korean') selected" @endif>North Korean</option>
                                                        <option value="northern irish" @if (isset($patient) && $patient['nationality'] == 'northern irish') selected @elseif(old('nationality') && old('nationality') == 'northern irish') selected" @endif>Northern Irish</option>
                                                        <option value="norwegian" @if (isset($patient) && $patient['nationality'] == 'norwegian') selected @elseif(old('nationality') && old('nationality') == 'norwegian') selected" @endif>Norwegian</option>
                                                        <option value="omani" @if (isset($patient) && $patient['nationality'] == 'omani') selected @elseif(old('nationality') && old('nationality') == 'omani') selected" @endif>Omani</option>
                                                        <option value="pakistani" @if (isset($patient) && $patient['nationality'] == 'pakistani') selected @elseif(old('nationality') && old('nationality') == 'pakistani') selected" @endif>Pakistani</option>
                                                        <option value="palauan" @if (isset($patient) && $patient['nationality'] == 'palauan') selected @elseif(old('nationality') && old('nationality') == 'palauan') selected" @endif>Palauan</option>
                                                        <option value="panamanian" @if (isset($patient) && $patient['nationality'] == 'panamanian') selected @elseif(old('nationality') && old('nationality') == 'panamanian') selected" @endif>Panamanian</option>
                                                        <option value="papua new guinean" @if (isset($patient) && $patient['nationality'] == 'papua new guinea') selected @elseif(old('nationality') && old('nationality') == 'papua new guinea') selected" @endif>Papua New Guinean</option>
                                                        <option value="paraguayan" @if (isset($patient) && $patient['nationality'] == 'paraguayan') selected @elseif(old('nationality') && old('nationality') == 'paraguayan') selected" @endif>Paraguayan</option>
                                                        <option value="peruvian" @if (isset($patient) && $patient['nationality'] == 'peruvian') selected @elseif(old('nationality') && old('nationality') == 'peruvian') selected" @endif>Peruvian</option>
                                                        <option value="polish" @if (isset($patient) && $patient['nationality'] == 'polish') selected @elseif(old('nationality') && old('nationality') == 'polish') selected" @endif>Polish</option>
                                                        <option value="portuguese" @if (isset($patient) && $patient['nationality'] == 'portuguese') selected @elseif(old('nationality') && old('nationality') == 'portuguese') selected" @endif>Portuguese</option>
                                                        <option value="qatari" @if (isset($patient) && $patient['nationality'] == 'qatari') selected @elseif(old('nationality') && old('nationality') == 'qatari') selected" @endif>Qatari</option>
                                                        <option value="romanian" @if (isset($patient) && $patient['nationality'] == 'romanian') selected @elseif(old('nationality') && old('nationality') == 'romanian') selected" @endif>Romanian</option>
                                                        <option value="russian" @if (isset($patient) && $patient['nationality'] == 'russian') selected @elseif(old('nationality') && old('nationality') == 'russian') selected" @endif>Russian</option>
                                                        <option value="rwandan" @if (isset($patient) && $patient['nationality'] == 'rwandan') selected @elseif(old('nationality') && old('nationality') == 'rwandan') selected" @endif>Rwandan</option>
                                                        <option value="saint lucian" @if (isset($patient) && $patient['nationality'] == 'saint lucian') selected @elseif(old('nationality') && old('nationality') == 'saint lucian') selected" @endif>Saint Lucian</option>
                                                        <option value="salvadoran" @if (isset($patient) && $patient['nationality'] == 'salvadoran') selected @elseif(old('nationality') && old('nationality') == 'salvadoran') selected" @endif>Salvadoran</option>
                                                        <option value="samoan" @if (isset($patient) && $patient['nationality'] == 'samoan') selected @elseif(old('nationality') && old('nationality') == 'samoan') selected" @endif>Samoan</option>
                                                        <option value="san marinese" @if (isset($patient) && $patient['nationality'] == 'san marinese') selected @elseif(old('nationality') && old('nationality') == 'san marinese') selected" @endif>San Marinese</option>
                                                        <option value="sao tomean" @if (isset($patient) && $patient['nationality'] == 'sao tomean') selected @elseif(old('nationality') && old('nationality') == 'sao tomean') selected" @endif>Sao Tomean</option>
                                                        <option value="saudi" @if (isset($patient) && $patient['nationality'] == 'saudi') selected @elseif(old('nationality') && old('nationality') == 'saudi') selected" @endif>Saudi</option>
                                                        <option value="scottish" @if (isset($patient) && $patient['nationality'] == 'scottish') selected @elseif(old('nationality') && old('nationality') == 'scottish') selected" @endif>Scottish</option>
                                                        <option value="senegalese" @if (isset($patient) && $patient['nationality'] == 'senegalese') selected @elseif(old('nationality') && old('nationality') == 'senegalese') selected" @endif>Senegalese</option>
                                                        <option value="serbian" @if (isset($patient) && $patient['nationality'] == 'serbian') selected @elseif(old('nationality') && old('nationality') == 'serbian') selected" @endif>Serbian</option>
                                                        <option value="seychellois" @if (isset($patient) && $patient['nationality'] == 'seychellois') selected @elseif(old('nationality') && old('nationality') == 'seychellois') selected" @endif>Seychellois</option>
                                                        <option value="sierra leonean" @if (isset($patient) && $patient['nationality'] == 'sierra leonean') selected @elseif(old('nationality') && old('nationality') == 'sierra leonean') selected" @endif>Sierra Leonean</option>
                                                        <option value="singaporean" @if (isset($patient) && $patient['nationality'] == 'singaporean') selected @elseif(old('nationality') && old('nationality') == 'singaporean') selected" @endif>Singaporean</option>
                                                        <option value="slovakian" @if (isset($patient) && $patient['nationality'] == 'slovakian') selected @elseif(old('nationality') && old('nationality') == 'slovakian') selected" @endif>Slovakian</option>
                                                        <option value="slovenian" @if (isset($patient) && $patient['nationality'] == 'slovenian') selected @elseif(old('nationality') && old('nationality') == 'slovenian') selected" @endif>Slovenian</option>
                                                        <option value="solomon islander" @if (isset($patient) && $patient['nationality'] == 'solomon islander') selected @elseif(old('nationality') && old('nationality') == 'solomon islander') selected" @endif>Solomon Islander</option>
                                                        <option value="somali" @if (isset($patient) && $patient['nationality'] == 'somali') selected @elseif(old('nationality') && old('nationality') == 'somali') selected" @endif>Somali</option>
                                                        <option value="south african" @if (isset($patient) && $patient['nationality'] == 'south african') selected @elseif(old('nationality') && old('nationality') == 'south african') selected" @endif>South African</option>
                                                        <option value="south korean" @if (isset($patient) && $patient['nationality'] == 'south korean') selected @elseif(old('nationality') && old('nationality') == 'south korean') selected" @endif>South Korean</option>
                                                        <option value="spanish" @if (isset($patient) && $patient['nationality'] == 'spanish') selected @elseif(old('nationality') && old('nationality') == 'spanish') selected" @endif>Spanish</option>
                                                        <option value="sri lankan" @if (isset($patient) && $patient['nationality'] == 'sri lankan') selected @elseif(old('nationality') && old('nationality') == 'sri lankan') selected" @endif>Sri Lankan</option>
                                                        <option value="sudanese" @if (isset($patient) && $patient['nationality'] == 'sudanese') selected @elseif(old('nationality') && old('nationality') == 'sudanese') selected" @endif>Sudanese</option>
                                                        <option value="surinamer" @if (isset($patient) && $patient['nationality'] == 'surinamer') selected @elseif(old('nationality') && old('nationality') == 'surinamer') selected" @endif>Surinamer</option>
                                                        <option value="swazi" @if (isset($patient) && $patient['nationality'] == 'swazi') selected @elseif(old('nationality') && old('nationality') == 'swazi') selected" @endif>Swazi</option>
                                                        <option value="swedish" @if (isset($patient) && $patient['nationality'] == 'swedish') selected @elseif(old('nationality') && old('nationality') == 'swedish') selected" @endif>Swedish</option>
                                                        <option value="swiss" @if (isset($patient) && $patient['nationality'] == 'swiss') selected @elseif(old('nationality') && old('nationality') == 'swiss') selected" @endif>Swiss</option>
                                                        <option value="syrian" @if (isset($patient) && $patient['nationality'] == 'syrian') selected @elseif(old('nationality') && old('nationality') == 'syrian') selected" @endif>Syrian</option>
                                                        <option value="taiwanese" @if (isset($patient) && $patient['nationality'] == 'taiwanese') selected @elseif(old('nationality') && old('nationality') == 'taiwanese') selected" @endif>Taiwanese</option>
                                                        <option value="tajik" @if (isset($patient) && $patient['nationality'] == 'tajik') selected @elseif(old('nationality') && old('nationality') == 'tajik') selected" @endif>Tajik</option>
                                                        <option value="tanzanian" @if (isset($patient) && $patient['nationality'] == 'tanzanian') selected @elseif(old('nationality') && old('nationality') == 'tanzanian') selected" @endif>Tanzanian</option>
                                                        <option value="thai" @if (isset($patient) && $patient['nationality'] == 'thai') selected @elseif(old('nationality') && old('nationality') == 'thai') selected" @endif>Thai</option>
                                                        <option value="togolese" @if (isset($patient) && $patient['nationality'] == 'togolese') selected @elseif(old('nationality') && old('nationality') == 'togolese') selected" @endif>Togolese</option>
                                                        <option value="tongan" @if (isset($patient) && $patient['nationality'] == 'tongan') selected @elseif(old('nationality') && old('nationality') == 'tongan') selected" @endif>Tongan</option>
                                                        <option value="trinidadian or tobagonian" @if (isset($patient) && $patient['nationality'] == 'trinidadian or tobagonian') selected @elseif(old('nationality') && old('nationality') == 'trinidadian or tobagonian') selected" @endif>Trinidadian or Tobagonian</option>
                                                        <option value="tunisian" @if (isset($patient) && $patient['nationality'] == 'tunisian') selected @elseif(old('nationality') && old('nationality') == 'tunisian') selected" @endif>Tunisian</option>
                                                        <option value="turkish" @if (isset($patient) && $patient['nationality'] == 'turkish') selected @elseif(old('nationality') && old('nationality') == 'turkish') selected" @endif>Turkish</option>
                                                        <option value="tuvaluan" @if (isset($patient) && $patient['nationality'] == 'tuvaluan') selected @elseif(old('nationality') && old('nationality') == 'tuvaluan') selected" @endif>Tuvaluan</option>
                                                        <option value="ugandan" @if (isset($patient) && $patient['nationality'] == 'ugandan') selected @elseif(old('nationality') && old('nationality') == 'ugandan') selected" @endif>Ugandan</option>
                                                        <option value="ukrainian" @if (isset($patient) && $patient['nationality'] == 'ukrainian') selected @elseif(old('nationality') && old('nationality') == 'ukrainian') selected" @endif>Ukrainian</option>
                                                        <option value="uruguayan" @if (isset($patient) && $patient['nationality'] == 'uruguayan') selected @elseif(old('nationality') && old('nationality') == 'uruguayan') selected" @endif>Uruguayan</option>
                                                        <option value="uzbekistani" @if (isset($patient) && $patient['nationality'] == 'uzbekistani') selected @elseif(old('nationality') && old('nationality') == 'uzbekistani') selected" @endif>Uzbekistani</option>
                                                        <option value="venezuelan" @if (isset($patient) && $patient['nationality'] == 'venezuelan') selected @elseif(old('nationality') && old('nationality') == 'venezuelan') selected" @endif>Venezuelan</option>
                                                        <option value="vietnamese" @if (isset($patient) && $patient['nationality'] == 'vietnamese') selected @elseif(old('nationality') && old('nationality') == 'vietnamese') selected" @endif>Vietnamese</option>
                                                        <option value="welsh" @if (isset($patient) && $patient['nationality'] == 'welsh') selected @elseif(old('nationality') && old('nationality') == 'welsh') selected" @endif>Welsh</option>
                                                        <option value="yemenite" @if (isset($patient) && $patient['nationality'] == 'yemenite') selected @elseif(old('nationality') && old('nationality') == 'yemenite') selected" @endif>Yemenite</option>
                                                        <option value="zambian" @if (isset($patient) && $patient['nationality'] == 'zambian') selected @elseif(old('nationality') && old('nationality') == 'zambian') selected" @endif>Zambian</option>
                                                        <option value="zimbabwean" @if (isset($patient) && $patient['nationality'] == 'zimbabwean') selected @elseif(old('nationality') && old('nationality') == 'zimbabwean') selected" @endif>Zimbabwean</option>
                                                    </select>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="col-lg-6">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fas">{{ __('Mother\'s Name') }}</i>
                                                        </span>
                                                    </div>
                                                    <input type="text" class="form-control" placeholder="{{ __('Mother\'s Name') }}" name="mother_name" id="mother_name" @if (isset($patient)) value="{{ $patient->mother_name }}"  @endif readonly>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="col-lg-6">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fas">{{ __('Guardian\'s Name') }}</i>
                                                        </span>
                                                    </div>
                                                    <input type="text" class="form-control" placeholder="{{ __('Guardian\'s Name') }}" name="guardian_name" id="guardian_name" @if (isset($patient)) value="{{ $patient->guardian_name }}"  @endif readonly>
                                                </div>
                                            </div>
                                        </div>
                                        {{-- <div class="col-lg-6">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                         
                                                            <strong>+63</strong>
                                                        </span>
                                                    </div>
                                                    <input type="number" maxlength="10" class="form-control" placeholder="{{ __('Contact Number') }}" name="phone" id="phone" @if (isset($patient)) value="{{ substr($patient->phone, 3) }}"  @endif readonly>
                                                </div>
                                            </div>
                                        </div>  --}}
                                        @if(isset($phones))

                                        <div class="col-lg-12">
                                            <div class="form-group">
                                                <label>{{ __('Contact Number') }}</label>
                                                {{-- <input class="form-control" id="phone" @if (isset($group) && isset($group['patient'])) value="{{ $group['patient']['phone'] }}" @endif readonly> --}}
                                                
                                                <select name="" id="phone" placeholder="{{ __('Phone') }}" class="form-control select2 rounded-0" multiple required disabled>
                                                    <option value="" disabled>{{ __('Phones') }}</option>
                                                @foreach ($phones as $phone)
                                                    <option value="{{ $phone->id }}" selected>{{ $phone->phone }}</option>
                                                    @endforeach
                                                </select>
                                                {{-- @php
                                                //  foreach ($phones as $phone){
                                                //     dd($phone->phone, $phone->patient_id);
                                                //  }
                                                dd($phones);
                                                @endphp --}}
                                                
                                            </div>
                                        </div>
                                        @endif
                                        <div class="col-lg-12">
                                            <div class="form-group">
                                                <div class="input-group mb-3">
                                                    <div class="input-group-prepend">
                                                        <span class="input-group-text" id="basic-addon1">
                                                            <i class="fas">{{ __('Email Address') }}</i>
                                                        </span>
                                                    </div>
                                                    <input type="email" class="form-control" placeholder="{{ __('Email Address') }}" name="email" id="email" @if (isset($patient)) value="{{ $patient->email }}"  @endif readonly>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                    @if(isset($patient) && session('branch_id') == 3)
                                        <div class="row">
                                            <div class="col-lg-12">
                                                <div class="card-header"> 
                                                    <h3 class="card-title">{{ __('Metabolic Registry')}} </h3>
                                                </div>
                                                <div class="row m-2">
                                                    <div class="col-sm-12 increments">
                                                        <div class="input-group control-group">
                                                            <!-- <input type="text" name="metabolic_registry" id="metabolic_registry" placeholder="Metabolic Registry" class="form-control mr-2" /> -->
                                                            <select name="metabolic_registry" id="metabolic_registry" class="form-control">
                                                                <option value="" selected disabled>Metabolic Registry</option>
                                                                <option value="1" @if($patient['metabolic_registry'] == 1) selected @endif>Positive</option>
                                                                <option value="2" @if($patient['metabolic_registry'] == 2) selected @endif>Negative</option>
                                                                <option value="3" @if($patient['metabolic_registry'] == 3) selected @endif>Inconclusive</option>
                                                            </select>
                                                            <input type="date" name="metabolic_registry_date" id="metabolic_registry_date" class="form-control mr-2" value="{{$patient->metabolic_registry_date}}">
                                                            <select name="metabolic_registry_disorder" id="metabolic_registry_disorder" class="form-control select2">
                                                                <option value="" selected></option>
                                                                @foreach($metabolic_registry_disorders as $disorder)
                                                                    <option value="{{ $disorder->id }}" @if($disorder['id'] == $patient['metabolic_registry_disorder']) selected @endif>{{ $disorder->disorder }}</option>
                                                                @endforeach
                                                            </select>
                                                            {{-- <a href="{{ route('admin.requisitions.create',['id'=>$patient->id]) }}" class="btn btn-primary btn-sm">
                                                                <i class="fa fa-plus"></i> {{ __('Create Invoice') }}
                                                            </a> --}}
                                                        </div>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                    @endif
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>

        <div class="col-lg-3 d-none ">
            <div class="form-group">
                <label for="filter_patient">{{ __('Patient') }}</label>
                <select name="filter_patient" id="filter_patient" class="form-control">
                    @isset($_GET['id'])
                        <option value="{{ $patient['id'] }}" selected>{{ $patient['name'] . ' ' . $patient['last_name'] }}</option>
                    @endisset
                </select>
            </div>
        </div>

            <div class="col-lg-18 mt-3 ml-0">
               
                    <div class="card card-primary card-outline">
                        <div class="card-header">
                            <!-- <h3 class="card-title">{{ __('Laboratory Reports table') }}</h3> -->
                        </div>
                        <!-- /.card-header -->
                        <div class="card-body">
                        
                            <div class="row">
                                <div class="col-lg-12 table-responsive">
                                    <table id="medical_reports_table2" class="table table-striped table-bordered" width="100%">
                                        <thead>
                                            <tr>
                                                <th width="10px">
                                                    <input type="checkbox" class="check_all" name="" id="">
                                                </th>
                                                <th width="10px">#</th>
                                               
                                                <th width="">{{ __('Name') }}</th>
                                                <th width="">{{ __('last') }}</th>
                                                <th width="">{{ __('Gender') }}</th>
                                                <th width="">{{ __('Age') }}</th>
                                                <th width="">{{ __('Laboratory') }}</th>
                                                <th width="">{{ __('Tests') }}</th>
                                                <th width="">{{ __('Sample Collection Date') }}</th>
                                                <th width="">{{ __('Test Due Date') }}</th>
                                                <th width="">{{ __('Institution') }}</th>
                                                <th width="">{{ __('Date Created') }}</th>
                                                <th width="">{{ __('Created By') }}</th>
                                                <th class="text-center" width="">{{ __('Done') }}</th>
                                                <th class="text-center" width="50px">{{ __('Signed') }}</th>
                                                <th class="text-center" width="">{{ __('Signed By') }}</th>
                                                <th class="text-center" width="">{{ __('Date Signed') }}</th>
                                                <th width="50px" >{{ __('Action') }}</th>
                                            

                                            </tr>
                                        </thead>
                                        <tbody>

                                        </tbody>
                                    </table>
                                </div>
                            </div>
                        </div>
                        <!-- /.card-body -->
                    </div> 
  
               
            </div>
        @endsection
        @section('scripts')
            <script>
                var can_delete =
                    @can('delete_medical_report')
                        true
                    @else
                        false
                    @endcan ;
                var can_view =
                    @can('view_medical_report')
                        true
                    @else
                        false
                    @endcan ;
            </script>
            <script src="{{ url('js/admin/medical_reports6.js?8') }}"></script>
        @endsection