{{ Form::label('date', __('messages.ipd_patient_charges.date') . ':', ['class' => 'form-label']) }} {{ Form::text('date', null, ['placeholder'=>__('messages.ipd_patient_charges.date'),'class' => getLoggedInUser()->thememode ? 'bg-light form-control modelDataPickerzindex' : 'bg-white form-control modelDataPickerzindex', 'id' => 'ipdEditChargeDate', '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' => 'editIpdChargeTypeId', 'required', 'placeholder' => __('messages.common.choose') . ' ' . __('messages.charge_category.charge_type'), 'data-is-charge-edit' => 1]) }}

{{ Form::label('charge_category_id', __('messages.ipd_patient_charges.charge_category_id') . ':', ['class' => 'form-label']) }} {{ Form::select('charge_category_id', [null], null, ['placeholder' => __('messages.common.choose') . ' ' . __('messages.ipd_patient_charges.charge_category_id'),'class' => 'form-select select2Selector', 'id' => 'editIpdChargeCategoryId', 'required', 'disabled', 'data-is-charge-edit' => 1]) }}

{{ Form::label('charge_id', __('messages.ipd_patient_charges.charge_id') . ':', ['class' => 'form-label']) }} {{ Form::select('charge_id', [null], null, ['placeholder' => __('messages.common.choose') . ' ' . __('messages.ipd_patient_charges.charge_id'),'class' => 'form-select select2Selector', 'id' => 'editIpdChargeId', 'required', 'disabled', 'data-is-charge-edit' => 1]) }}

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

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