@extends('adminlte::page') @section('title', 'Iassis ORL') @section('content_header')

Επεξεργασία Ασθενή

@stop @section('content')
{!! Form::model($patient,['method' => 'POST', 'action'=>['PatientController@edit',$patient->id]]) !!}
{!! Form::label('lastname', 'Επώνυμο:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('lastname',null,['class'=>'form-control input-sm','required'=>'required']) !!}
{!! Form::label('firstname', 'Όνομα:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('firstname',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('Address', 'Διέυθυνση:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('address',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('city', 'Πόλη:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('city','ΚΑΛΑΜΑΤΑ',['class'=>'form-control input-sm']) !!}
{!! Form::label('tk', 'ΤΚ:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('tk',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('amka', 'ΑΜΚΑ:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('amka',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('birthdate', 'Ημ. Γέννησης:',['class'=>'col-sm-2 col-form-label']) !!}
{{ Form::date('birthdate', null, ['class' => 'form-control input-sm']) }}
{!! Form::label('phone', 'Τηλέφωνο:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('phone',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('mobile', 'Κινητό:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('mobile',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('email', 'Email:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('email',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('tameio', 'Ταμείο:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('tameio',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('origin', 'Προέλευση:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('origin',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('parapompi', 'Παραπομπή:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('parapompi',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('gp', 'GP:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('gp',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('smoking', 'Smoking:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('smoking',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('eth', 'Eth:',['class'=>'col-sm-2 col-form-label']) !!}
{!! Form::text('eth',null,['class'=>'form-control input-sm']) !!}
{!! Form::label('tameio_aeroporia', 'Ταμειο Αεροπ.:',['class'=>'col-sm-3 input-group-sm']) !!}
{!! Form::radio('tameio_aeroporia', 'ΝΑΙ') !!} ΝΑΙ   {!! Form::radio('tameio_aeroporia', 'ΟΧΙ') !!} ΟΧΙ
{!! Form::label('history', 'Ιστορικό:',['class'=>'col-sm-2 input-group-sm']) !!}
{!! Form::textarea('history',null,['class'=>'form-control', 'rows'=>6]) !!}
{!! Form::label('history_drug', 'Drug History - Drug Allergy:',['class'=>'col-sm-2 input-group-sm']) !!}
{!! Form::textarea('history_drug',null,['class'=>'form-control', 'rows'=>6]) !!}
{!! Form::label('comments', 'Παρατηρήσεις:',['class'=>'col-sm-2 input-group-sm']) !!}
{!! Form::textarea('comments',null,['class'=>'form-control', 'rows'=>3]) !!}
{!! Form::close() !!}
@stop @section('css') @stop @section('js') @stop