{{ Form::label('patient_id', __('messages.advanced_payment.patient') . ':', ['class' => 'form-label']) }} {{ Form::select('patient_id', $patients ?? [], null, ['class' => 'form-select', 'id' => 'editPatientId', 'placeholder' => __('messages.document.select_patient'), 'required', 'data-control' => 'select2']) }}

{{ Form::label('receipt_no', __('messages.advanced_payment.receipt_no') . ':', ['class' => 'form-label']) }} {{ Form::text('receipt_no', null, ['class' => 'form-control', 'id' => 'editReceiptNo', 'required', 'readonly', 'placeholder' => __('messages.advanced_payment.receipt_no')]) }}

{{ Form::label('amount', __('messages.advanced_payment.amount') . ':', ['class' => 'form-label required']) }} {{ Form::text('amount', null, ['class' => 'form-control price-input', 'id' => 'editAmount', 'required', 'onkeyup' => 'if (/\D/g.test(this.value)) this.value = this.value.replace(/\D/g,"")', 'maxlength' => '7', 'placeholder' => __('messages.advanced_payment.amount')]) }}

{{ Form::label('date', __('messages.advanced_payment.date') . ':', ['class' => 'form-label required']) }} {{ Form::text('date', null, ['class' => getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control', 'id' => 'editAdvancedPaymentDate', 'required', 'autocomplete' => 'off', 'placeholder' => __('messages.advanced_payment.date')]) }}