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@@ -4,55 +4,59 @@
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<?php $patients = [1,2,3,4]; ?>
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- <div class="card mt-3" moe="">
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+ <div class="row">
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+ <div class="col-6">
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+ <div class="card mt-3 d-block mb-3" moe="">
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- <div class="card-header">
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- <strong>
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- <i class="fas fa-user-plus"></i>
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- New Patient
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- </strong>
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- </div>
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- <div class="card-body">
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- <form show url="/api/client/create" class="px-3 pt-3 pb-1" redir="patients/view/[data]">
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- @if (session('message'))
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- <div class="alert alert-danger">{{ session('message') }}</div>
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- @endif
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- <div class='form-group mb-3'>
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- <label class='control-label'>Name First *</label>
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- <input class='form-control' type='text' name='nameFirst' required>
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- </div>
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- <div class='form-group mb-3'>
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- <label class='control-label'>Name Last *</label>
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- <input class='form-control' type='text' name='nameLast' value='' required>
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- </div>
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- <div class='form-group mb-3'>
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- <label class='control-label'>Sex</label>
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- <select class='form-control' name='sex' value='' >
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- <option value=''>-- Select --</option>
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- <option value='M'>M</option>
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- <option value='F'>F</option>
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- </select>
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+ <div class="card-header">
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+ <strong>
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+ <i class="fas fa-user-plus"></i>
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+ New Patient
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+ </strong>
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</div>
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- <div class='form-group mb-3'>
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- <label class='control-label'>Date Of Birth </label>
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- <input class='form-control' type='date' name='dateOfBirth'>
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+ <div class="card-body">
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+ <form show url="/api/client/create" class="px-3 pt-3 pb-1" redir="patients/view/[data]">
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+ @if (session('message'))
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+ <div class="alert alert-danger">{{ session('message') }}</div>
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+ @endif
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+ <div class='form-group mb-3'>
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+ <label class='control-label'>Name First *</label>
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+ <input class='form-control' type='text' name='nameFirst' required>
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+ </div>
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+ <div class='form-group mb-3'>
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+ <label class='control-label'>Name Last *</label>
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+ <input class='form-control' type='text' name='nameLast' value='' required>
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+ </div>
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+ <div class='form-group mb-3'>
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+ <label class='control-label'>Sex</label>
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+ <select class='form-control' name='sex' value='' >
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+ <option value=''>-- Select --</option>
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+ <option value='M'>M</option>
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+ <option value='F'>F</option>
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+ </select>
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+ </div>
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+ <div class='form-group mb-3'>
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+ <label class='control-label'>Date Of Birth </label>
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+ <input class='form-control' type='date' name='dateOfBirth'>
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+ </div>
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+ <div class='form-group mb-3'>
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+ <label class='control-label'>Cell Number </label>
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+ <input class='form-control' type='tel' name='cellNumber'>
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+ </div>
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+ <div class='form-group mb-3'>
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+ <label class='control-label'>Email Address </label>
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+ <input class='form-control' type='email' name='emailAddress'>
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+ </div>
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+ <div class='form-group mb-3'>
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+ <label class='control-label'>Medicare Number </label>
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+ <input class='form-control' type='text' name='medicareNumber'>
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+ </div>
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+ </form>
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</div>
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- <div class='form-group mb-3'>
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- <label class='control-label'>Cell Number </label>
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- <input class='form-control' type='tel' name='cellNumber'>
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+ <div class="card-footer">
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+ <button class="btn btn-primary" submit>Create New Patient</button>
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</div>
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- <div class='form-group mb-3'>
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- <label class='control-label'>Email Address </label>
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- <input class='form-control' type='email' name='emailAddress'>
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- </div>
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- <div class='form-group mb-3'>
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- <label class='control-label'>Medicare Number </label>
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- <input class='form-control' type='text' name='medicareNumber'>
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- </div>
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- </form>
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- </div>
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- <div class="card-footer">
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- <button class="btn btn-primary" submit>Create New Patient</button>
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+ </div>
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</div>
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</div>
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