{{ Form::hidden('ipd_patient_department_id', $ipdPatientDepartment->id) }}

{{ Form::label('header_note', __('messages.ipd_patient_prescription.header_note') . ':', ['class' => 'form-label']) }} {{ Form::textarea('header_note', null, ['placeholder' => __('messages.ipd_patient_prescription.header_note'),'class' => 'form-control', 'rows' => 4]) }}

#	{{ __('messages.ipd_patient_prescription.category_id') }}	{{ __('messages.ipd_patient_prescription.medicine_id') }}	{{ __('messages.ipd_patient_prescription.dosage') }}	{{ __('messages.purchase_medicine.dose_duration') }}	{{ __('messages.medicine_bills.dose_interval') }}	{{ __('messages.prescription.time') }}	{{ __('messages.ipd_patient_prescription.instruction') }}
1	{{ Form::select('category_id[]', $medicineCategories, null, ['class' => 'form-select ipdCategoryId select2Selector', 'required', 'placeholder' => __('messages.medicine.select_category'), 'data-id' => '1']) }}	{{ Form::select('medicine_id[]', [null], null, ['class' => 'form-select medicineId select2Selector custom-selector', 'disabled', 'data-medicine-id' => '1', 'required', 'placeholder' => __('messages.medicine_bills.select_medicine')]) }}	{{ Form::text('dosage[]', null, ['placeholder' => __('messages.ipd_patient_prescription.dosage'),'class' => 'form-control dosage', 'required', 'onkeypress' => 'return avoidSpace(event);']) }}	{{ Form::select('day[]', \App\Models\Prescription::DOSE_DURATION, null, ['placeholder' => __('messages.purchase_medicine.dose_duration'),'class' => 'form-select select2Selector ipdDoseDuration']) }}	{{ Form::select('dose_interval[]', \App\Models\Prescription::DOSE_INTERVAL, null, ['placeholder' => __('messages.medicine_bills.dose_interval'),'class' => 'form-select select2Selector ipdDoseInterval']) }}	{{ Form::select('time[]', \App\Models\Prescription::MEAL_ARR, null, ['placeholder' => __('messages.prescription.time'),'class' => 'form-select prescriptionMedicineMealId']) }}	{{ Form::textarea('instruction[]', null, ['placeholder' => __('messages.ipd_patient_prescription.instruction'),'class' => 'form-control instruction', 'rows' => 1, 'required', 'onkeypress' => 'return avoidSpace(event);']) }}

{{ Form::label('footer_note', __('messages.ipd_patient_prescription.footer_note') . ':', ['class' => 'form-label']) }} {{ Form::textarea('footer_note', null, ['class' => 'form-control', 'rows' => 4]) }}