@extends('layout.mainlayout')
@section('content')
    @component('components.breadcrumb')
        @slot('title')
            Edit Prescription
        @endslot
        @slot('li_1')
            Edit Prescription
        @endslot
    @endcomponent
    <!-- Page Content -->
    <div class="content">
        <div class="container">
            <div class="row">
                <div class="col-md-5 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="javascript:;" 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-md-7 col-lg-8 col-xl-9">
                    <div class="card">
                        <div class="card-header">
                            <h4 class="card-title mb-0">Edit Prescription</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:;"><i class="fa fa-plus-circle"></i> Add More</a>
                            </div>
                            <!-- /Add Item -->

                            <!-- Prescription Item -->
                            <div class="card card-table">
                                <div class="card-body">
                                    <div class="table-responsive">
                                        <table class="table table-hover table-center">
                                            <thead>
                                                <tr>
                                                    <th style="width: 200px">Name</th>
                                                    <th style="width: 100px">Quantity</th>
                                                    <th style="width: 100px">Days</th>
                                                    <th style="width: 100px;">Time</th>
                                                    <th style="width: 80px;"></th>
                                                </tr>
                                            </thead>
                                            <tbody>
                                                <tr>
                                                    <td>
                                                        <input class="form-control" value="Amoxapine" type="text">
                                                    </td>
                                                    <td>
                                                        <input class="form-control" type="text" value="2">
                                                    </td>
                                                    <td>
                                                        <input class="form-control" value="2 Days" type="text">
                                                    </td>
                                                    <td>
                                                        <div class="form-check form-check-inline">
                                                            <label class="form-check-label">
                                                                <input class="form-check-input" type="checkbox"> Morning
                                                            </label>
                                                        </div>
                                                        <div class="form-check form-check-inline">
                                                            <label class="form-check-label">
                                                                <input class="form-check-input" type="checkbox"> Afternoon
                                                            </label>
                                                        </div>
                                                        <div class="form-check form-check-inline">
                                                            <label class="form-check-label">
                                                                <input class="form-check-input" type="checkbox"> Evening
                                                            </label>
                                                        </div>
                                                        <div class="form-check form-check-inline">
                                                            <label class="form-check-label">
                                                                <input class="form-check-input" type="checkbox"> Night
                                                            </label>
                                                        </div>
                                                    </td>
                                                    <td>
                                                        <a href="javascript:;" class="btn bg-danger-light trash"><i
                                                                class="far fa-trash-alt"></i></a>
                                                    </td>
                                                </tr>
                                                <tr>
                                                    <td>
                                                        <input class="form-control" type="text" value="Benazepril">
                                                    </td>
                                                    <td>
                                                        <input class="form-control" type="text" value="2">
                                                    </td>
                                                    <td>
                                                        <input class="form-control" value="1 Days" type="text">
                                                    </td>
                                                    <td>
                                                        <div class="form-check form-check-inline">
                                                            <label class="form-check-label">
                                                                <input class="form-check-input" type="checkbox"> Morning
                                                            </label>
                                                        </div>
                                                        <div class="form-check form-check-inline">
                                                            <label class="form-check-label">
                                                                <input class="form-check-input" type="checkbox"> Afternoon
                                                            </label>
                                                        </div>
                                                        <div class="form-check form-check-inline">
                                                            <label class="form-check-label">
                                                                <input class="form-check-input" type="checkbox"> Evening
                                                            </label>
                                                        </div>
                                                        <div class="form-check form-check-inline">
                                                            <label class="form-check-label">
                                                                <input class="form-check-input" type="checkbox"> Night
                                                            </label>
                                                        </div>
                                                    </td>
                                                    <td>
                                                        <a href="javascript:;" class="btn bg-danger-light trash"><i
                                                                class="far fa-trash-alt"></i></a>
                                                    </td>
                                                </tr>
                                            </tbody>
                                        </table>
                                    </div>
                                </div>
                            </div>
                            <!-- /Prescription 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