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@@ -20,19 +20,37 @@ foreach($dxInfoLines as $line) {
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<input type="hidden" name="clientUid" value="{{ $patient->uid }}">
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<input type="hidden" name="category" value="dx">
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<input type="hidden" name="IsCurrent" value="1">
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- <div class="mb-2"><input type="text" class="form-control form-control-sm" name="ICD" value="" placeholder="ICD"></div>
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- <div class="mb-2"><input type="text" class="form-control form-control-sm" name="contentText" value="" placeholder="Title"></div>
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<div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1" >ICD</label>
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+ <input type="text" class="form-control form-control-sm" name="ICD" value="">
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+ </div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1" >Title</label>
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+ <input type="text" class="form-control form-control-sm" name="contentText" value="">
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+ </div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1" >Chronic or Acute (select one)</label>
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<select name="Chronic or Acute" class="form-control form-control-sm pl-1">
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- <option value="">Chronic or Acute (select one)</option>
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<option value="Chronic">Chronic</option>
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<option value="Acute">Acute</option>
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</select>
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</div>
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- <div class="mb-2"><input type="text" class="form-control form-control-sm" name="Prognosis" value="" placeholder="Prognosis"></div>
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- <div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="History" value="" placeholder="History"></textarea></div>
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- <div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="Treatment Goal" value="" placeholder="Treatment Goal"></textarea></div>
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- <div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="Treatment Plan" value="" placeholder="Treatment Plan"></textarea></div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1" >Prognosis</label>
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+ <input type="text" class="form-control form-control-sm" name="Prognosis" value="">
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+ </div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1" >History</label>
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+ <textarea type="text" class="form-control form-control-sm" name="History" value="""></textarea>
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+ </div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1" >Treatment Goal</label>
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+ <textarea type="text" class="form-control form-control-sm" name="Treatment Goal" value=""></textarea>
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+ </div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1" >Treatment Plan</label>
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+ <textarea type="text" class="form-control form-control-sm" name="Treatment Plan" value="" ></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" type="button" submit>Save</button>
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<button class="btn btn-sm btn-default mr-2 border" type="button" cancel>Cancel</button>
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@@ -56,12 +74,12 @@ foreach($dxInfoLines as $line) {
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</form>
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</div>
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</div>
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- <table class="table table-striped table-sm table-bordered mb-0">
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+ <table class="table table-striped table-sm table-bordered mb-0" style="table-layout:fixed">
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<thead>
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<tr>
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<th class="px-2 text-secondary">Title</th>
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<th class="px-2 text-secondary">ICD</th>
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- <th class="px-2 text-secondary w-60px">Chr/Act</th>
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+ <th class="px-2 text-secondary w-100px">Chr/Act</th>
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<th class="px-2 text-secondary">Prognosis</th>
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<th class="px-2 text-secondary">History</th>
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<th class="px-2 text-secondary">Goal</th>
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@@ -84,19 +102,32 @@ foreach($dxInfoLines as $line) {
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<input type="hidden" name="clientUid" value="{{ $patient->uid }}">
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<input type="hidden" name="category" value="dx">
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<input type="hidden" name="IsCurrent" value="0">
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- <div class="mb-2"><input type="text" class="form-control form-control-sm" name="ICD" value="" placeholder="ICD"></div>
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- <div class="mb-2"><input type="text" class="form-control form-control-sm" name="contentText" value="" placeholder="Title"></div>
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<div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1">ICD</label>
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+ <input type="text" class="form-control form-control-sm" name="ICD" value="" placeholder=""></div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1">Title</label>
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+ <input type="text" class="form-control form-control-sm" name="contentText" value="" placeholder=""></div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1"></label>
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<select name="Chronic or Acute" class="form-control form-control-sm pl-1">
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<option value="">Chronic or Acute (select one)</option>
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<option value="Chronic">Chronic</option>
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<option value="Acute">Acute</option>
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</select>
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</div>
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- <div class="mb-2"><input type="text" class="form-control form-control-sm" name="Prognosis" value="" placeholder="Prognosis"></div>
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- <div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="History" value="" placeholder="History"></textarea></div>
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- <div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="Treatment Goal" value="" placeholder="Treatment Goal"></textarea></div>
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- <div class="mb-2"><textarea type="text" class="form-control form-control-sm" name="Treatment Plan" value="" placeholder="Treatment Plan"></textarea></div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1">Prognosis</label>
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+ <input type="text" class="form-control form-control-sm" name="Prognosis" value="" placeholder=""></div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1">History</label>
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+ <textarea type="text" class="form-control form-control-sm" name="History" value="" placeholder=""></textarea></div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1">Treatment Goal</label>
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+ <textarea type="text" class="form-control form-control-sm" name="Treatment Goal" value="" placeholder=""></textarea></div>
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+ <div class="mb-2">
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+ <label for="" class="control-label text-sm mb-1">Treatment Plan</label>
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+ <textarea type="text" class="form-control form-control-sm" name="Treatment Plan" value="" placeholder=""></textarea></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" type="button" submit>Save</button>
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<button class="btn btn-sm btn-default mr-2 border" type="button" cancel>Cancel</button>
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