{{ __('messages.ipd_patient_diagnosis.edit_ipd_diagnosis') }}

{{ Form::open(['id' => 'editIpdDiagnosisForm']) }}
{{ Form::hidden('id', null, ['id' => 'ipdDiagnosisId']) }}
{{ Form::label('report_type', __('messages.ipd_patient_diagnosis.report_type') . ':', ['class' => 'form-label']) }} {{ Form::text('report_type', null, ['placeholder' => __('messages.ipd_patient_diagnosis.report_type'),'class' => 'form-control', 'required', 'id' => 'editIpdDiagnosisReportType']) }}
{{ Form::label('report_date', __('messages.ipd_patient_diagnosis.report_date') . ':', ['class' => 'form-label']) }} {{ Form::text('report_date', null, ['placeholder' => __('messages.ipd_patient_diagnosis.report_date'),'class' => getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control', 'id' => 'editIpdDiagnosisReportDate', 'autocomplete' => 'off', 'required']) }}
{{ Form::label('description', __('messages.ipd_patient_diagnosis.description') . ':', ['class' => 'form-label']) }} {{ Form::textarea('description', null, ['placeholder' => __('messages.ipd_patient_diagnosis.description'),'class' => 'form-control', 'rows' => 4, 'id' => 'editIpdDiagnosisDescription']) }}
{{ Form::label('document', __('messages.ipd_patient_diagnosis.document') . ':', ['class' => 'form-label']) }}
{{ Form::button(__('messages.common.save'), ['type' => 'submit', 'class' => 'btn btn-primary me-2', 'id' => 'editIpdDiagnosisSave', 'data-loading-text' => " Processing..."]) }}
{{ Form::close() }}