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@@ -6,12 +6,18 @@
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<span class="mx-2 text-secondary">|</span>
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<div moe>
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<a start show class="">Send SMS</a>
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- <form url="/api/clientInfoLine/create">
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- <input type="hidden" name="clientUid" value="{{ $patient->uid }}">
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- <input type="hidden" name="category" value="rx">
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- <div class="mb-2"><input type="text" class="form-control form-control-sm" name="contentText" value="" placeholder="Medication"></div>
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+ <form url="/api/clientSms/createOutgoing" right class="mcp-theme-1">
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+ <input type="hidden" name="uid" value="{{ $patient->uid }}">
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+ <div class="mb-2">
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+ <label for="" class="text-sm text-secondary mb-1">Cell Number</label>
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+ <input type="text" class="form-control form-control-sm" name="cellNumber" value="{{$patient->cell_number}}">
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+ </div>
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+ <div class="mb-2">
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+ <label for="" class="text-sm text-secondary mb-1">Message</label>
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+ <textarea type="text" class="form-control form-control-sm" name="message"></textarea>
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+ </div>
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<div class="d-flex align-items-center">
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- <button class="btn btn-sm btn-primary mr-2" submit>Save</button>
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+ <button class="btn btn-sm btn-primary mr-2" submit>Send</button>
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<button class="btn btn-sm btn-default mr-2 border" cancel>Cancel</button>
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</div>
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</form>
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