@extends('layout.mainlayout')
@section('content')
    @component('components.breadcrumb')
        @slot('title')
            Add Billing
        @endslot
        @slot('li_1')
            Add Billing
        @endslot
    @endcomponent
   <!-- Page Content -->
   <div class="content">
    <div class="container">

        <div class="row">
            <div class="col-lg-4 col-xl-3 theiaStickySidebar">
            
                <!-- Profile Widget -->
                <div class="card widget-profile pat-widget-profile">
                    <div class="card-body">
                        <div class="pro-widget-content">
                            <div class="profile-info-widget">
                                <a href="#" class="booking-doc-img">
                                    <img src="{{URL::asset('assets/img/patients/patient.jpg')}}" alt="User Image">
                                </a>
                                <div class="profile-det-info">
                                    <h3><a href="{{url('patient-profile')}}">Richard Wilson</a></h3>
                                    <div class="patient-details">
                                        <h5><b>Patient ID :</b> PT0016</h5>
                                        <h5 class="mb-0"><i class="fas fa-map-marker-alt"></i> Newyork, USA</h5>
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="patient-info">
                            <ul>
                                <li>Phone <span>+1 952 001 8563</span></li>
                                <li>Age <span>38 Years, Male</span></li>
                                <li>Blood Group <span>AB+</span></li>
                            </ul>
                        </div>
                    </div>
                </div>
                <!-- /Profile Widget -->
                
            </div>

            <div class="col-lg-8 col-xl-9">
                <div class="card">
                    <div class="card-header">
                        <h4 class="card-title mb-0">Add Billing</h4>
                    </div>
                    <div class="card-body">
                        <div class="row">
                            <div class="col-sm-6">
                                <div class="biller-info">
                                    <h4 class="d-block">Dr. Darren Elder</h4>
                                    <span class="d-block text-sm text-muted">Dentist</span>
                                    <span class="d-block text-sm text-muted">Newyork, United States</span>
                                </div>
                            </div>
                            <div class="col-sm-6 text-sm-end">
                                <div class="billing-info">
                                    <h4 class="d-block">1 November 2023</h4>
                                    <span class="d-block text-muted">#INV0001</span>
                                </div>
                            </div>
                        </div>
                        
                        <!-- Add Item -->
                        <div class="add-more-item text-end">
                            <a href="javascript:void(0);" class="add-items"><i class="fas fa-plus-circle"></i> Add Item</a>
                        </div>
                        <!-- /Add Item -->
                        
                        <!-- Billing Item -->
                        <div class="card card-table">
                            <div class="card-body">
                                <div class="table-responsive">
                                    <table class="table table-hover table-center add-table-items">
                                        <thead>
                                            <tr>													
                                                <th>Title</th>					
                                                <th>Amount</th>		
                                                <th class="custom-class"></th>
                                            </tr>
                                        </thead>
                                        <tbody>
                                            <tr class="test">			
                                                <td>	
                                                    <input type="text" class="form-control">
                                                </td>
                                                <td>
                                                    <input type="text" class="form-control">
                                                </td>							
                                                <td>
                                                    <a href="javascript:void(0)" class="btn bg-danger-light trash remove-btn"><i class="far fa-trash-alt"></i></a>															
                                                </td>
                                            </tr>
                                            <tr class="test">								
                                                <td>	
                                                    <input type="text" class="form-control">
                                                </td>
                                                <td>
                                                    <input type="text" class="form-control">
                                                </td>							
                                                <td>
                                                    <a href="javascript:void(0)" class="btn bg-danger-light trash remove-btn"><i class="far fa-trash-alt"></i></a>															
                                                </td>
                                            </tr>
                                        </tbody>
                                    </table>
                                </div>
                            </div>
                        </div>
                        <!-- /Billing Item -->
                        
                        <!-- Signature -->
                        <div class="row">
                            <div class="col-md-12 text-end">
                                <div class="signature-wrap">
                                    <div class="signature">
                                        Click here to sign
                                    </div>
                                    <div class="sign-name">
                                        <p class="mb-0">( Dr. Darren Elder )</p>
                                        <span class="text-muted">Signature</span>
                                    </div>
                                </div>
                            </div>
                        </div>
                        <!-- /Signature -->
                        
                        <!-- Submit Section -->
                        <div class="row">
                            <div class="col-md-12">
                                <div class="submit-section">
                                    <button type="submit" class="btn btn-primary submit-btn">Save</button>
                                    <button type="reset" class="btn btn-secondary submit-btn">Clear</button>
                                </div>
                            </div>
                        </div>
                        <!-- /Submit Section -->
                        
                    </div>
                </div>
            </div>
        </div>

    </div>

</div>		
<!-- /Page Content -->
@endsection