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<div class="content-wrapper">
<!-- Content Header (Page header) -->
<section class="content-header">
<h1>
Add MedicalCenter Appoinment Details
</h1>
<ol class="breadcrumb">
<li><a href="#"><i class="fa fa-star-o" aria-hidden="true"></i>Home</a></li>
<li><a href="#">Medical Center Appoinment Appoinment Details</a></li>
<li class="active">Add Medicalcenter Appoinment</li>
</ol>
</section>
<!-- Main content -->
<section class="content">
<div class="row">
<!-- left column -->
<div class="col-md-12">
<?php
if($this->session->flashdata('message')) {
$message = $this->session->flashdata('message');
?>
<div class="alert alert-<?php echo $message['class']; ?>">
<button class="close" data-dismiss="alert" type="button">×</button>
<?php echo $message['message']; ?>
</div>
<?php
}
?>
</div>
<div class="col-md-12">
<!-- general form elements -->
<div class="box">
<div class="box-header with-border">
<h3 class="box-title">Add Medicalcenter Appoinment Details</h3>
</div>
<!-- /.box-header -->
<!-- form start -->
<form role="form" action="" method="post" data-parsley-validate="" class="validate" enctype="multipart/form-data">
<div class="box-body">
<div class="col-md-6">
<div class="form-group">
<label>Patient Name</label>
<select class="form-control select2 js-example-basic-multiple" style="width: 100%;" name="patient_id" id="patient_firstname">
<option value="none"> Select Patient </option>
<?php
$arry_select = explode(",", $data->id);
foreach($patientnamedetails as $patdetails){
?>
<option value="<?php echo $patdetails->id;?>"<?php if (in_array($patdetails->id, $arry_select))
echo 'selected'; ?> ><?php echo $patdetails->patient_firstname;?></option>
<?php
}
?>
</select>
</div>
<div class="form-group">
<label>MedicalCenter Name</label>
<select class="form-control select2 js-example-basic-multiple" style="width: 100%;" name="medical_id" id="medical_name">
<option value="none"> Select Medical Center </option>
<?php
$arry_select = explode(",", $data->id);
foreach($medicaldetails as $mdetails){
?>
<option value="<?php echo $mdetails->id;?>"<?php if (in_array($mdetails->id, $arry_select))
echo 'selected'; ?> ><?php echo $mdetails->medical_name;?></option>
<?php
}
?>
</select>
</div>
<div class="bootstrap-timepicker">
<div class="form-group">
<label>Start Time</label>
<div class="input-group">
<input type="text" name="start_time" class="form-control timepicker">
<div class="input-group-addon">
<i class="fa fa-clock-o"></i>
</div>
</div><!-- /.input group -->
</div><!-- /.form group -->
</div>
<div class="form-group has-feedback">
<label for="exampleInputEmail1">Fees </label>
<input type="text" class="form-control required" required="" name="fees" placeholder="Fees">
<span class="glyphicon form-control-feedback"></span>
</div>
<div class="form-group has-feedback">
<label for="exampleInputEmail1">Appointment Date</label>
<input type="date" class="form-control required " name="appointment_date" id="dpd1" placeholder="appointment_date" required ="" >
<span class="glyphicon form-control-feedback"></span>
</div>
<!-- /.box-body -->
<div class="box-footer">
<button type="submit" class="btn btn-primary">Submit</button>
</div>
</div>
<div class="col-md-6">
<!-- <div class="form-group">
<label>Docter Name</label>
<select class="form-control select2 js-example-basic-multiple" style="width: 100%;" name="doctor_id" id="doctor_firstname">
<?php
$arry_select = explode(",", $data->id);
foreach($doctornamedetails as $doctordetails){
?>
<option value="<?php echo $doctordetails->id;?>"<?php if (in_array($doctordetails->id, $arry_select))
echo 'selected'; ?> ><?php echo $doctordetails->doctor_firstname;?></option>
<?php
}
?>
</select>
</div>-->
<div class="form-group" id="mdoctor">
<label>Doctor Name</label>
<select class="form-control select2 js-example-basic-multiple" style="width: 100%;">
</select>
</div>
<div class="bootstrap-timepicker">
<div class="form-group">
<label>End Time</label>
<div class="input-group">
<input type="text" name="end_time" class="form-control timepicker">
<div class="input-group-addon">
<i class="fa fa-clock-o"></i>
</div>
</div><!-- /.input group -->
</div><!-- /.form group -->
</div>
<div class="form-group has-feedback">
<label for="exampleInputEmail1">Reason </label>
<input type="text" class="form-control required" required="" name="ill_reason" placeholder="ill_reason">
<span class="glyphicon form-control-feedback"></span>
</div>
</div>
</div>
</form>
</div>
<!-- /.box -->
</div>
</div>
<!-- /.row -->
</section>
<!-- /.content -->
</div>
<div class="modal fade modal-wide" id="myModalmapbmd" tabindex="-1" role="dialog" aria-labelledby="myModalLabel"
aria-hidden="true">
<div class="modal-dialog">
<div class="modal-content">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button>
<h4 class="modal-title">Select location</h4>
</div>
<div class="modal-body">
<div id='map_canvas'></div>
<div id="current">Nothing yet...</div>
<input type="hidden" id="pick-lat" />
<input type="hidden" id="pick-lng" />
</div>
<div class="modal-footer">
<button type="button" class="btn btn-default pull-left" data-dismiss="modal">Close</button>
<button type="button" class="btn btn-custom select-location">Select Location</button>
</div>
</div><!-- /.modal-content -->
</div><!-- /.modal-dialog -->
</div>
<script type="text/javascript" src="http://maps.googleapis.com/maps/api/js?sensor=false&libraries=places"></script>