Note > Bill > Remove service-location, modifier & num units

resources/views/app/patient/note/dashboard.blade.php

@@ -232,15 +232,6 @@
                                 <div class="mb-2">
                                     <input type="text" name="reason2" placeholder="Reason 2" class="form-control form-control-sm">
                                 </div>
-                                <div class="mb-2">
-                                    <input type="text" name="serviceLocation" placeholder="Service Location" class="form-control form-control-sm">
-                                </div>
-                                <div class="mb-2">
-                                    <input type="text" name="modifier" placeholder="Modifier" class="form-control form-control-sm">
-                                </div>
-                                <div class="mb-2">
-                                    <input type="number" name="numberOfUnits" placeholder="Number of Units" class="form-control form-control-sm">
-                                </div>
                                 <div class="">
                                     <button class="btn btn-primary btn-sm" submit>Submit</button>
                                     <button class="btn btn-default border btn-sm" cancel>Cancel</button>
@@ -407,15 +398,6 @@
                                 <div class="mb-2">
                                     <input type="text" name="reason2" placeholder="Reason 2" class="form-control form-control-sm">
                                 </div>
-                                <div class="mb-2">
-                                    <input type="text" name="serviceLocation" placeholder="Service Location" class="form-control form-control-sm">
-                                </div>
-                                <div class="mb-2">
-                                    <input type="text" name="modifier" placeholder="Modifier" class="form-control form-control-sm">
-                                </div>
-                                <div class="mb-2">
-                                    <input type="number" name="numberOfUnits" placeholder="Number of Units" class="form-control form-control-sm">
-                                </div>
                                 <div class="">
                                     <button class="btn btn-primary btn-sm" submit>Submit</button>
                                     <button class="btn btn-default border btn-sm" cancel>Cancel</button>