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- <form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Doctor_id')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-doctor_id" data-rule="required" data-source="doctor/index" class="form-control selectpage" name="row[doctor_id]" type="text" value="">
- </div>
- </div>
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Log_type')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-log_type" data-rule="required" class="form-control" name="row[log_type]" type="number" value="0">
- </div>
- </div>
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Before')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-before" data-rule="required" class="form-control" step="0.01" name="row[before]" type="number" value="0.00">
- </div>
- </div>
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Change_value')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-change_value" data-rule="required" class="form-control" step="0.01" name="row[change_value]" type="number" value="0.00">
- </div>
- </div>
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Remain')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-remain" data-rule="required" class="form-control" step="0.01" name="row[remain]" type="number" value="0.00">
- </div>
- </div>
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Table')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-table" data-rule="required" class="form-control" name="row[table]" type="text" value="">
- </div>
- </div>
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Table_id')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-table_id" data-rule="required" data-source="table/index" class="form-control selectpage" name="row[table_id]" type="text" value="">
- </div>
- </div>
- <div class="form-group">
- <label class="control-label col-xs-12 col-sm-2">{:__('Remark')}:</label>
- <div class="col-xs-12 col-sm-8">
- <input id="c-remark" data-rule="required" class="form-control" name="row[remark]" type="text" value="">
- </div>
- </div>
- <div class="form-group layer-footer">
- <label class="control-label col-xs-12 col-sm-2"></label>
- <div class="col-xs-12 col-sm-8">
- <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
- </div>
- </div>
- </form>
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