{{ Form::label('date', __('messages.ipd_patient_charges.date') . ':', ['class' => 'form-label']) }} {{ Form::text('date', null, ['placeholder'=> __('messages.ipd_patient_charges.date') ,'class' => 'form-control modelDataPickerzindex bg-white', 'id' => 'ipdChargeDate', 'autocomplete' => 'off', 'required']) }}

{{ Form::label('charge_type_id', __('messages.ipd_patient_charges.charge_type_id') . ':', ['class' => 'form-label']) }} {{ Form::select('charge_type_id', $chargeTypes, null, ['class' => 'form-select select2Selector', 'id' => 'ipdChargeTypeId', 'required', 'placeholder' => __('messages.common.choose') . ' ' . __('messages.charge_category.charge_type'), 'data-is-charge-edit' => false]) }}

{{ Form::label('charge_category_id', __('messages.ipd_patient_charges.charge_category_id') . ':', ['class' => 'form-label required']) }} {{ Form::select('charge_category_id', [null], null, ['class' => 'form-select select2Selector', 'id' => 'ipdChargeCategoryId', 'required', 'disabled', 'data-is-charge-edit' => 0, 'placeholder' => __('messages.pathology_category.select_charge_category')]) }}

{{ Form::label('charge_id', __('messages.ipd_patient_charges.charge_id') . ':', ['class' => 'form-label']) }} {{ Form::select('charge_id', [null], null, ['class' => 'form-select select2Selector', 'id' => 'ipdChargeId', 'required', 'disabled', 'data-is-charge-edit' => 0, 'placeholder' => 'Select Code']) }}

{{ Form::label('standard_charge', __('messages.ipd_patient_charges.standard_charge') . ':', ['class' => 'form-label']) }} {{ Form::text('standard_charge', null, ['class' => 'form-control price-input', 'id' => 'ipdStandardCharge', 'readonly','placeholder' => __('messages.ipd_patient_charges.standard_charge')]) }}

{{ Form::label('applied_charge', __('messages.ipd_patient_charges.applied_charge') . ':', ['class' => 'form-label']) }} {{ Form::text('applied_charge', null, ['class' => 'form-control price-input', 'id' => 'ipdAppliedCharge', 'required','placeholder'=>__('messages.ipd_patient_charges.applied_charge')]) }}