<div class="stag-popup stag-popup-sm mcp-theme-1" stag-popup-key="prescription-popup-SUPPLY">
    <form method="POST" action="">
        <h3 class="stag-popup-title mb-2">
            <span>Supply Prescription</span>
            <a href="#" class="ml-auto text-secondary"
               onclick="return closeStagPopup()"><i class="fa fa-times-circle"></i></a>
        </h3>
        <div class="mb-2">
            <div class="row">
                <div class="col-8 pr-0">
                    <label class="text-sm text-secondary mb-1">Item</label>
                    <input type="text" class="form-control form-control-sm min-width-unset"
                           v-model="currentPrescription_SUPPLY.clinicalDetailJson.item">
                </div>
                <div class="col-4">
                    <label class="text-sm text-secondary mb-1">Quanitity</label>
                    <input type="text" class="form-control form-control-sm min-width-unset"
                           v-model="currentPrescription_SUPPLY.clinicalDetailJson.quantity">
                </div>
            </div>
        </div>
        <div class="mb-2">
            <label class="text-sm text-secondary mb-1">Memo</label>
            <input type="text" class="form-control form-control-sm min-width-unset"
                   v-model="currentPrescription_SUPPLY.clinicalDetailJson.memo">
        </div>
        <div class="d-flex align-items-center justify-content-center mt-3">
            <button type="button" class="btn btn-sm btn-primary mr-2" v-on:click.prevent="savePrescription()">Submit
            </button>
            <button type="button" class="btn btn-sm btn-default border" onclick="return closeStagPopup()">Cancel
            </button>
        </div>
    </form>
</div>
