{{ __('messages.ipd_payments.edit_ipd_payment') }}

{{ Form::open(['id' => 'editIpdPaymentForm']) }} {{ Form::hidden('currency_symbol', getCurrentCurrency(), ['class' => 'currencySymbol']) }}
@if ($ipdPatientDepartment->bill)
{{ __('messages.bill.note_Bill') }}
@endif
{{ Form::hidden('id', null, ['id' => 'ipdPaymentId']) }} {{ Form::hidden('ipd_patient_department_id', $ipdPatientDepartment->id) }}
{{ Form::label('amount', __('messages.ambulance_call.amount') . ':', ['class' => 'form-label']) }}
{{ Form::text('amount', null, ['placeholder' => __('messages.ambulance_call.amount'),'class' => 'form-control price-input', 'id' => 'editIpdPaymentAmount', 'required']) }}
{{ getCurrencySymbol() }}
{{ Form::label('date', __('messages.ipd_patient_charges.date') . ':', ['class' => 'form-label']) }} {{ Form::text('date', null, ['placeholder' => __('messages.ipd_patient_charges.date'),'class' => 'form-control bg-white', 'id' => 'editIpdPaymentDate', 'autocomplete' => 'off', 'required']) }}
{{ Form::label('charge_type_id', __('messages.ipd_payments.payment_mode') . ':', ['class' => 'form-label']) }} {{ Form::select('payment_mode', getIpdPaymentTypes(), null, ['placeholder' => __('messages.ipd_payments.payment_mode'),'class' => 'form-select select2Selector', 'id' => 'editIpdPaymentModeId', 'required', 'placeholder' => __('messages.common.choose') . ' ' . __('messages.purchase_medicine.payment_mode')]) }}
{{ Form::label('document', __('messages.ipd_patient_diagnosis.document') . ':', ['class' => 'form label']) }}
{{ Form::label('notes', __('messages.ipd_patient.notes') . ':', ['class' => 'form-label']) }} {{ Form::textarea('notes', null, ['placeholder' => __('messages.ipd_patient.notes'),'class' => 'form-control ', 'rows' => 4, 'id' => 'editIpdPaymentNote']) }}
{{ Form::button(__('messages.common.save'), ['type' => 'submit', 'class' => 'btn btn-primary me-3', 'id' => 'btnEditIpdPaymentSave', 'data-loading-text' => " Processing..."]) }}
{{ Form::close() }}