@extends('layouts.blank')

@push('stylesheets')

@endpush

@push('inline-scripts')
    @if(isset($sel_branches))
    var branches = null;
    @else
    var branches = [];
    @endif

   

    
@endpush

@push('scripts')
    <script src="{{ asset("js/patient.js") }}"></script>
@endpush

@section('main_container')

    <!-- page content -->
    <div class="right_col" role="main">
         <div class="">
            <div class="page-title">             
            </div>

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

            {!! Form::open(array('route' => array('patient_report.store'), 'class' => 'form-horizontal form-label-left', 'method' => 'POST')) !!}
                  
                <div class="row">
                    <div class="col-md-12 col-xs-12">
                        <div class="x_panel">
                            <div class="row">                        
                                <!-- <div class="col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label for="company">Company Name</label>
                                        {!! Form::select('company[]',  $companies, null, array('id' => 'company', 'class' => 'form-control' ,'multiple' => 'multiple' ,'data-placeholder' => 'SELECT DIVISION')) !!}
                                    </div>
                                </div>
                                <div class="col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label for="company">Branch Name</label>
                                        {!! Form::select('branch[]',$sel_branches, null, array('id' => 'branch', 'class' => 'form-control' ,'multiple' => 'multiple' ,'data-placeholder' => 'SELECT A BRANCH...')) !!}
                                    </div>
                                </div> -->
                                  <div class="col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label for="date_from">Date From</label>
                                        {!! Form::text('date_from',$date_from,array('class' => 'form-control', 'id' => 'date_from')) !!}
                                    </div>                                    
                                </div>
                                <div class="col-md-3 col-xs-12">
                                    <div class="form-group">
                                        <label for="date_to">Date To</label>
                                         {!! Form::text('date_to',$date_to,array('class' => 'form-control', 'id' => 'date_to')) !!}
                                    </div>                                
                                </div>        

                               
                                            
                            </div>                    
                           
                            <!-- <div class="row">                                
                                <div class="col-md-12 col-xs-12">
                                    <div class="form-group">
                                        <label for="keywords">Search</label>
                                        {!! Form::text('keyword',null,array('class' => 'form-control', 'id' => 'keyword')) !!}
                                    </div>
                                    
                                </div>
                            </div> -->
                            <div class="row">
                                <div class="col-md-3 col-xs-12">
                                    <!-- <div class="btn-group">
                                        <button type="submit" class="btn btn-success" value="1" name="submit">Process</button>
                                    </div>  --> 
                                    <div class="btn-group">
                                        <button type="submit" class="btn btn-primary" value="2" name="submit">Download</button>
                                    </div>  
                                </div>

                                <div class="col-md-3 col-xs-12">
                                    
                                </div>

                            </div>
                        </div>
                    </div>
                </div>  
            {!! Form::close() !!}
          </div>
    </div>
    <!-- /page content -->
@endsection