insure/application/admin/view/insurance_classification/edit.html

<form id="edit-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">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" data-rule="required" class="form-control" name="row[name]" type="text" value="{$row.name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Category_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-category_id" data-rule="required" data-source="category/selectpage" data-params='{"custom[type]":"insurance_classification"}' class="form-control selectpage" name="row[category_id]" type="text" value="{$row.category_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Explain')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-explain" class="form-control" name="row[explain]" type="text" value="{$row.explain|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Sort')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-sort" class="form-control" name="row[sort]" type="number" value="{$row.sort|htmlentities}">
        </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-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>