From 1c6810422836aaf89c9beab94fbd36267b3ce443 Mon Sep 17 00:00:00 2001
From: Ravi Gulhane <ravi@stratawiz.com>
Date: Wed, 7 Oct 2026 16:26:36 +0530
Subject: [PATCH] Capture doctor prescription units and other therapies, and
 let chemists search the doctor list.

Co-authored-by: Cursor <cursoragent@cursor.com>
---
 ...58a6-d509-4ac0-9b18-6d366a74965e.blade.php | 200 ++++++++++++++++--
 .../partials/doctor-chemist-chemist.blade.php |  16 +-
 .../partials/doctor-chemist-doctor.blade.php  |  36 +++-
 3 files changed, 219 insertions(+), 33 deletions(-)

diff --git a/resources/views/form/rapport-team3/1790230856-a5ff58a6-d509-4ac0-9b18-6d366a74965e.blade.php b/resources/views/form/rapport-team3/1790230856-a5ff58a6-d509-4ac0-9b18-6d366a74965e.blade.php
index b9d26500..c5619640 100644
--- a/resources/views/form/rapport-team3/1790230856-a5ff58a6-d509-4ac0-9b18-6d366a74965e.blade.php
+++ b/resources/views/form/rapport-team3/1790230856-a5ff58a6-d509-4ac0-9b18-6d366a74965e.blade.php
@@ -4,6 +4,7 @@
     @include('layouts.shared/title-meta', ['title' => "Doctor & Chemist Survey"])
     @include('layouts.shared/head-css', ["mode" => $mode ?? '', "demo" => $demo ?? ''])
     <link href="{{asset('assets/libs/sweetalert2/sweetalert2.min.css')}}" rel="stylesheet" type="text/css" />
+    <link href="{{ asset('assets/libs/select2/select2.min.css') }}" rel="stylesheet" type="text/css" />
     <style>
         .quick-action-form-card .form-control { font-size: 16px; }
         .survey-section { border: 1px solid #d9d9d9; border-radius: 0.25rem; margin-bottom: 0.75rem; }
@@ -74,6 +75,7 @@
 </div>
 @include('layouts.shared/footer-script')
 <script src="{{asset('assets/libs/sweetalert2/sweetalert2.min.js')}}"></script>
+<script src="{{ asset('assets/libs/select2/select2.min.js') }}"></script>
 @php
     $savedAnswers = [];
     $savedSource = null;
@@ -144,6 +146,7 @@ $(function () {
         });
         syncOtherFields();
         syncServiceFields();
+        syncProductUnits();
     }
 
     function syncOtherFields() {
@@ -178,6 +181,20 @@ $(function () {
         });
     }
 
+    function syncProductUnits() {
+        $('#doctor-fields .product-row').each(function () {
+            var row = $(this);
+            var show = row.find('.product-choice').val() === 'Yes' && !$('#doctor-fields').prop('disabled');
+            var units = row.find('.product-units');
+            units.toggle(show);
+            var input = units.find('input');
+            input.prop('required', show).prop('disabled', !show);
+            if (!show) {
+                input.val('');
+            }
+        });
+    }
+
     function fillSelect(select, contacts) {
         var current = select.value;
         select.innerHTML = '<option value="">-- Select --</option>';
@@ -193,6 +210,12 @@ $(function () {
             option.setAttribute('data-stockist-id', contact.stockist_id || '');
             select.appendChild(option);
         });
+        if (select.classList.contains('stockist-pick')) {
+            var other = document.createElement('option');
+            other.value = 'others';
+            other.textContent = 'Others';
+            select.appendChild(other);
+        }
         if (current) {
             select.value = current;
         }
@@ -212,12 +235,16 @@ $(function () {
                     return item.contact && String(item.contact.type || '').toLowerCase() === 'ebt_stockist';
                 });
                 document.querySelectorAll('#chemist-fields .rcpa-doctor').forEach(function (select) {
+                    if ($(select).data('select2')) {
+                        $(select).select2('destroy');
+                    }
                     fillSelect(select, doctors);
                 });
                 document.querySelectorAll('#chemist-fields .stockist-pick').forEach(function (select) {
                     fillSelect(select, stockists);
                 });
                 matchSavedContacts();
+                initDoctorSearch();
             },
             error: function () {
                 contactsReady = true;
@@ -225,7 +252,11 @@ $(function () {
         });
     }
 
+    var doctorLock = false;
     function applyDoctor(select) {
+        if (doctorLock) {
+            return;
+        }
         var row = $(select).closest('tr');
         var option = select.options[select.selectedIndex];
         var chosen = select.value;
@@ -237,22 +268,30 @@ $(function () {
                 }
             });
             if (duplicate) {
-                select.value = '';
-                option = select.options[0];
+                doctorLock = true;
+                $(select).val('').trigger('change');
+                doctorLock = false;
+                row.find('.rcpa-name, .rcpa-mobile, .rcpa-speciality, .rcpa-code').val('');
                 fail('This doctor is already selected for this product.');
+                return;
             }
         }
-        row.find('.rcpa-name').val(select.value ? option.textContent : '');
-        row.find('.rcpa-mobile').val(select.value ? (option.getAttribute('data-phone') || '') : '');
-        row.find('.rcpa-speciality').val(select.value ? (option.getAttribute('data-speciality') || '') : '');
-        row.find('.rcpa-code').val(select.value ? (option.getAttribute('data-code') || '') : '');
+        if (!chosen || !option) {
+            row.find('.rcpa-name, .rcpa-mobile, .rcpa-speciality, .rcpa-code').val('');
+            return;
+        }
+        row.find('.rcpa-name').val(option.textContent || '');
+        row.find('.rcpa-mobile').val(option.getAttribute('data-phone') || '');
+        row.find('.rcpa-speciality').val(option.getAttribute('data-speciality') || '');
+        row.find('.rcpa-code').val(option.getAttribute('data-code') || '');
     }
 
-    function applyStockist(select) {
+    function applyStockist(select, keepAddress) {
         var block = $(select).closest('.stockist-block');
         var option = select.options[select.selectedIndex];
         var chosen = select.value;
-        if (chosen) {
+        var isOther = chosen === 'others';
+        if (chosen && !isOther) {
             var duplicate = false;
             $('#chemist-fields .stockist-pick').each(function () {
                 if (this !== select && this.value === chosen) {
@@ -261,13 +300,33 @@ $(function () {
             });
             if (duplicate) {
                 select.value = '';
+                chosen = '';
+                isOther = false;
                 option = select.options[0];
                 fail('This stockist is already selected.');
             }
         }
-        block.find('.stockist-name').val(select.value ? option.textContent : '');
-        block.find('.stockist-location').val(select.value ? (option.getAttribute('data-location') || '') : '');
-        block.find('.stockist-id').val(select.value ? (option.getAttribute('data-stockist-id') || '') : '');
+        var location = block.find('.stockist-location');
+        var otherName = block.find('.stockist-other-name');
+        block.find('.stockist-other').toggle(isOther);
+        block.find('.stockist-id-wrap').toggle(!isOther);
+        location.prop('readonly', !isOther).prop('required', isOther).attr('tabindex', isOther ? null : '-1');
+        otherName.prop('required', isOther);
+        block.find('.stockist-address-label').html(isOther
+            ? 'Other Stockist Address <span class="text-danger">*</span>'
+            : 'Stockist ' + (select.getAttribute('data-slot') || '') + ' Location');
+        if (isOther) {
+            block.find('.stockist-name').val(otherName.val());
+            block.find('.stockist-id').val('');
+            if (!keepAddress) {
+                location.val('');
+            }
+            return;
+        }
+        otherName.val('').prop('required', false);
+        block.find('.stockist-name').val(chosen ? option.textContent : '');
+        location.val(chosen ? (option.getAttribute('data-location') || '') : '');
+        block.find('.stockist-id').val(chosen ? (option.getAttribute('data-stockist-id') || '') : '');
     }
 
     function setVisit(type) {
@@ -282,6 +341,33 @@ $(function () {
             lockDoctorPrefix();
         }
         refreshSections();
+        if (doctor) {
+            $('#chemist-fields .rcpa-doctor').each(function () {
+                if ($(this).data('select2')) {
+                    $(this).select2('destroy');
+                }
+            });
+        } else {
+            initDoctorSearch();
+        }
+    }
+
+    function initDoctorSearch() {
+        if ($('#field-visit_type').val() !== 'chemist') {
+            return;
+        }
+        $('#chemist-fields .rcpa-doctor').each(function () {
+            var field = $(this);
+            if (field.data('select2')) {
+                field.select2('destroy');
+            }
+            field.select2({
+                width: '100%',
+                dropdownParent: $('.quick-action-form-card'),
+                placeholder: '-- Select --',
+                allowClear: true
+            });
+        });
     }
 
     function lockDoctorPrefix() {
@@ -388,11 +474,34 @@ $(function () {
             selectSavedOption(select, $(select).closest('tr').find('.rcpa-name').val());
         });
         document.querySelectorAll('#chemist-fields .stockist-pick').forEach(function (select) {
-            selectSavedOption(select, $(select).closest('.stockist-block').find('.stockist-name').val());
+            var block = $(select).closest('.stockist-block');
+            var name = block.find('.stockist-name').val();
+            if (!name) {
+                return;
+            }
+            var matched = false;
+            for (var i = 0; i < select.options.length; i++) {
+                if (select.options[i].value !== 'others' && select.options[i].textContent === name) {
+                    select.value = select.options[i].value;
+                    matched = true;
+                    break;
+                }
+            }
+            if (!matched) {
+                select.value = 'others';
+                block.find('.stockist-other-name').val(name);
+                applyStockist(select, true);
+                return;
+            }
+            applyStockist(select, true);
         });
     }
 
     $('#field-doctor_name').on('input', lockDoctorPrefix);
+    $('#doctor-fields').on('change', '.product-choice', syncProductUnits);
+    $('#chemist-fields').on('input', '.stockist-other-name', function () {
+        $(this).closest('.stockist-block').find('.stockist-name').val(this.value);
+    });
     $('#field-visit_type').on('change', function () { setVisit(this.value); });
     $('#report-form').on('input change', '.survey-section :input', refreshSections);
     $('#chemist-fields').on('change', '.rcpa-doctor', function () { applyDoctor(this); refreshSections(); });
@@ -413,6 +522,20 @@ $(function () {
         return /^[A-Za-z0-9]+$/.test(value);
     }
 
+    function addressOk(value) {
+        return /^[A-Za-z0-9]+(?:[ ]+[A-Za-z0-9]+)*$/.test(value);
+    }
+
+    function therapiesFilled(root) {
+        var filled = false;
+        $(root).find('.therapy-units').each(function () {
+            if (this.value !== '') {
+                filled = true;
+            }
+        });
+        return filled;
+    }
+
     function mobileTaken(type, mobile) {
         return surveyContacts.some(function (item) {
             var contact = item.contact || {};
@@ -456,8 +579,8 @@ $(function () {
                 fail('A doctor with this mobile number already exists.');
                 return;
             }
-            if (!alphaOk($('#field-doctor_location').val().trim())) {
-                fail('Doctor location can contain letters, spaces and periods only.');
+            if (!addressOk($('#field-doctor_location').val().trim())) {
+                fail('Doctor address can contain letters, numbers and spaces only.');
                 return;
             }
             if (!/^[1-9][0-9]{5}$/.test($('#field-doctor_pincode').val())) {
@@ -472,6 +595,24 @@ $(function () {
                 fail('Enter the other specialty in letters only.');
                 return;
             }
+            var missingUnits = false;
+            $('#doctor-fields .product-choice').each(function () {
+                if ($(this).val() !== 'Yes') {
+                    return;
+                }
+                var units = $(this).closest('.product-row').find('.product-units input').val();
+                if (units === '' || !/^\d+$/.test(units)) {
+                    missingUnits = true;
+                }
+            });
+            if (missingUnits) {
+                fail('Enter the number of units in a month for each product marked Yes. 0 is allowed.');
+                return;
+            }
+            if (!therapiesFilled('#doctor-fields')) {
+                fail('Enter at least one other therapy. 0 is allowed.');
+                return;
+            }
             var photos = ['visiting_card', 'rx_pad', 'doctor_board'];
             var hasPhoto = false;
             for (var i = 0; i < photos.length; i++) {
@@ -489,8 +630,12 @@ $(function () {
                 return;
             }
         } else {
-            if (!alphaOk($('#field-chemist_name').val().trim()) || !alphaOk($('#field-chemist_location').val().trim())) {
-                fail('Chemist name and location can contain letters, spaces and periods only.');
+            if (!alphaOk($('#field-chemist_name').val().trim())) {
+                fail('Chemist name can contain letters, spaces and periods only.');
+                return;
+            }
+            if (!addressOk($('#field-chemist_location').val().trim())) {
+                fail('Chemist address can contain letters, numbers and spaces only.');
                 return;
             }
             if (!/^[6-9][0-9]{9}$/.test($('#field-chemist_mobile').val())) {
@@ -505,14 +650,25 @@ $(function () {
                 fail('A chemist with this mobile number already exists.');
                 return;
             }
-            var missingDoctor = false;
-            $('#chemist-fields .rcpa-doctor[data-slot="1"]').each(function () {
-                if (!this.value) {
-                    missingDoctor = true;
+            var badStockist = false;
+            $('#chemist-fields .stockist-pick').each(function () {
+                if (this.value !== 'others') {
+                    return;
+                }
+                var block = $(this).closest('.stockist-block');
+                var otherName = block.find('.stockist-other-name').val().trim();
+                var otherAddress = block.find('.stockist-location').val().trim();
+                block.find('.stockist-name').val(otherName);
+                if (!addressOk(otherName) || !addressOk(otherAddress)) {
+                    badStockist = true;
                 }
             });
-            if (missingDoctor) {
-                fail('Select doctor 1 for each product.');
+            if (badStockist) {
+                fail('Other stockist name and address can contain letters, numbers and spaces only.');
+                return;
+            }
+            if (!therapiesFilled('#chemist-fields')) {
+                fail('Enter at least one other therapy. 0 is allowed.');
                 return;
             }
             var missingCharge = false;
diff --git a/resources/views/form/rapport-team3/partials/doctor-chemist-chemist.blade.php b/resources/views/form/rapport-team3/partials/doctor-chemist-chemist.blade.php
index 7c7e98ed..a52c523b 100644
--- a/resources/views/form/rapport-team3/partials/doctor-chemist-chemist.blade.php
+++ b/resources/views/form/rapport-team3/partials/doctor-chemist-chemist.blade.php
@@ -21,7 +21,7 @@ $services = ['BP Monitoring' => 'chemist_bp_monitoring','Weighing Machine' => 'c
     <div class="section-body">
         <div class="mb-2"><label class="form-label">Chemist Name <span class="text-danger">*</span></label><input type="text" class="form-control" id="field-chemist_name" name="chemist_name" data-gate required></div>
         <div class="mb-2"><label class="form-label">Mobile Number <span class="text-danger">*</span></label><input type="text" class="form-control" id="field-chemist_mobile" name="mobile_number" inputmode="numeric" maxlength="10" data-gate required></div>
-        <div class="mb-2"><label class="form-label">Chemist Location <span class="text-danger">*</span></label><input type="text" class="form-control" id="field-chemist_location" name="chemist_location" data-gate required></div>
+        <div class="mb-2"><label class="form-label">Chemist Address <span class="text-danger">*</span></label><input type="text" class="form-control" id="field-chemist_location" name="chemist_location" data-gate required></div>
         <div class="mb-2"><label class="form-label">Chemist Pincode <span class="text-danger">*</span></label><input type="text" class="form-control" id="field-chemist_pincode" name="chemist_pincode" inputmode="numeric" maxlength="6" data-gate required></div>
         <div class="mb-2"><label class="form-label">Chemist Type <span class="text-danger">*</span></label><select class="form-control" name="chemist_type" data-gate required><option value="">-- Select --</option>@foreach($chemistTypes as $item)<option value="{{$item}}">{{$item}}</option>@endforeach</select></div>
         <div class="mb-2"><label class="form-label" for="field-chemist_manager_joint_visit">Manager (EBM) Joint Visit Status <span class="text-danger">*</span></label><select class="form-control" id="field-chemist_manager_joint_visit" name="manager_joint_visit" data-gate required><option value="">-- Select --</option><option value="Yes">Yes</option><option value="No">No</option></select></div>
@@ -45,7 +45,7 @@ $services = ['BP Monitoring' => 'chemist_bp_monitoring','Weighing Machine' => 'c
             <table class="table table-sm align-middle mb-0 rcpa-doctors">
                 <thead>
                     <tr>
-                        <th>Name</th>
+                        <th>Prescribing Dr</th>
                         <th>Mobile</th>
                         <th>Speciality</th>
                         <th>Code</th>
@@ -55,7 +55,7 @@ $services = ['BP Monitoring' => 'chemist_bp_monitoring','Weighing Machine' => 'c
                     @foreach([1, 2, 3] as $doctor)
                     <tr data-product="{{$code}}">
                         <td>
-                            <select class="form-control rcpa-doctor" data-product="{{$code}}" data-slot="{{$doctor}}" aria-label="Doctor {{$doctor}} name" @if($doctor === 1) data-gate required @endif>
+                            <select class="form-control rcpa-doctor" data-product="{{$code}}" data-slot="{{$doctor}}" aria-label="Prescribing Dr {{$doctor}}">
                                 <option value="">-- Select --</option>
                             </select>
                             <input type="hidden" name="{{$code}}_doctor_{{$doctor}}_name" class="rcpa-name">
@@ -78,9 +78,10 @@ $services = ['BP Monitoring' => 'chemist_bp_monitoring','Weighing Machine' => 'c
         @foreach([1,2] as $n)
         <div class="stockist-block mb-3" data-slot="{{$n}}">
             <div class="mb-2"><label class="form-label">Stockist {{$n}} Name</label><select class="form-control stockist-pick" data-slot="{{$n}}"><option value="">-- Select --</option></select><input type="hidden" name="stockist_{{$n}}_name" class="stockist-name"></div>
-            <div class="mb-2"><label class="form-label">Stockist {{$n}} Location</label><input type="text" class="form-control stockist-location" name="stockist_{{$n}}_location" readonly tabindex="-1"></div>
-            <div class="mb-2"><label class="form-label">Stockist {{$n}} ID</label><input type="text" class="form-control stockist-id" name="stockist_{{$n}}_id" readonly tabindex="-1"></div>
-            <div class="mb-2"><label class="form-label">Frequency of Supply</label><input type="number" min="0" step="1" class="form-control" name="stockist_{{$n}}_frequency"></div>
+            <div class="mb-2 stockist-other" style="display:none"><label class="form-label">Other Stockist Name <span class="text-danger">*</span></label><input type="text" class="form-control stockist-other-name"></div>
+            <div class="mb-2"><label class="form-label stockist-address-label">Stockist {{$n}} Location</label><input type="text" class="form-control stockist-location" name="stockist_{{$n}}_location" readonly tabindex="-1"></div>
+            <div class="mb-2 stockist-id-wrap"><label class="form-label">Stockist {{$n}} ID</label><input type="text" class="form-control stockist-id" name="stockist_{{$n}}_id" readonly tabindex="-1"></div>
+            <div class="mb-2"><label class="form-label">Frequency of Supply (No. of times in a Month)</label><input type="number" min="0" step="1" class="form-control" name="stockist_{{$n}}_frequency"></div>
         </div>
         @endforeach
     </div>
@@ -89,8 +90,9 @@ $services = ['BP Monitoring' => 'chemist_bp_monitoring','Weighing Machine' => 'c
 <div class="survey-section">
     <button type="button" class="section-head">Other therapies</button>
     <div class="section-body">
+        <p class="text-muted">Enter at least one. 0 is allowed. <span class="text-danger">*</span></p>
         @foreach($therapies as $label => $code)
-        <div class="mb-2"><label class="form-label">{{$label}}</label><input type="number" min="0" step="1" class="form-control" name="{{$code}}"></div>
+        <div class="mb-2"><label class="form-label">{{$label}}</label><input type="number" min="0" step="1" class="form-control therapy-units" name="{{$code}}"></div>
         @endforeach
     </div>
 </div>
diff --git a/resources/views/form/rapport-team3/partials/doctor-chemist-doctor.blade.php b/resources/views/form/rapport-team3/partials/doctor-chemist-doctor.blade.php
index bb2f16b8..e99b748b 100644
--- a/resources/views/form/rapport-team3/partials/doctor-chemist-doctor.blade.php
+++ b/resources/views/form/rapport-team3/partials/doctor-chemist-doctor.blade.php
@@ -17,7 +17,7 @@ $products = ['Asthalin Inhaler' => 'asthalin_inhaler','Asthalin Rotacap' => 'ast
         <div class="mb-2" id="wrap-other_degree" style="display:none"><label class="form-label">Other Degree <span class="text-danger">*</span></label><input type="text" class="form-control" id="field-other_degree" name="other_degree" disabled></div>
         <div class="mb-2"><label class="form-label">Specialty <span class="text-danger">*</span></label><select class="form-control" id="field-specialty" name="specialty" data-gate required><option value="">-- Select --</option>@foreach($specialties as $item)<option value="{{$item}}">{{$item}}</option>@endforeach</select></div>
         <div class="mb-2" id="wrap-other_specialty" style="display:none"><label class="form-label">Other Specialty <span class="text-danger">*</span></label><input type="text" class="form-control" id="field-other_specialty" name="other_specialty" disabled></div>
-        <div class="mb-2"><label class="form-label">Doctor Location <span class="text-danger">*</span></label><input type="text" class="form-control" id="field-doctor_location" name="doctor_location" data-gate required></div>
+        <div class="mb-2"><label class="form-label">Doctor Address <span class="text-danger">*</span></label><input type="text" class="form-control" id="field-doctor_location" name="doctor_location" data-gate required></div>
         <div class="mb-2"><label class="form-label">Doctor Pincode <span class="text-danger">*</span></label><input type="text" class="form-control" id="field-doctor_pincode" name="doctor_pincode" inputmode="numeric" maxlength="6" data-gate required></div>
         <div class="mb-2"><label class="form-label">Doctor Type <span class="text-danger">*</span></label><select class="form-control" id="field-doctor_type" name="doctor_type" data-gate required><option value="">-- Select --</option>@foreach($doctorTypes as $item)<option value="{{$item}}">{{$item}}</option>@endforeach</select></div>
         <div class="mb-2"><label class="form-label">No. of Total Patients Seen in a Day <span class="text-danger">*</span></label><select class="form-control" name="total_patients" data-gate required><option value="">-- Select --</option>@foreach($bands as $item)<option value="{{$item}}">{{$item}}</option>@endforeach</select></div>
@@ -35,10 +35,38 @@ $products = ['Asthalin Inhaler' => 'asthalin_inhaler','Asthalin Rotacap' => 'ast
 </div>
 
 <div class="survey-section">
-    <button type="button" class="section-head">Is the Doctor Prescriber of our Products?</button>
+    <button type="button" class="section-head">Doctor Prescription (No. of Units in a Month)</button>
     <div class="section-body">
         @foreach($products as $label => $code)
-        <div class="mb-2"><label class="form-label">{{$label}} <span class="text-danger">*</span></label><select class="form-control" name="{{$code}}" data-gate required><option value="">-- Select --</option><option value="Yes">Yes</option><option value="No">No</option></select></div>
+        <div class="mb-2 product-row">
+            <label class="form-label">{{$label}} <span class="text-danger">*</span></label>
+            <select class="form-control product-choice" name="{{$code}}" data-gate required><option value="">-- Select --</option><option value="Yes">Yes</option><option value="No">No</option></select>
+            <div class="mt-2 product-units" style="display:none">
+                <label class="form-label">No. of Units in a Month <span class="text-danger">*</span></label>
+                <input type="number" min="0" step="1" class="form-control" name="{{$code}}_units" disabled>
+            </div>
+        </div>
+        @endforeach
+    </div>
+</div>
+
+<div class="survey-section">
+    <button type="button" class="section-head">Other therapies</button>
+    <div class="section-body">
+        <p class="text-muted">Enter at least one. 0 is allowed. <span class="text-danger">*</span></p>
+        @foreach([
+            'Nebulization No. of Respules per Month (all included)' => 'neb_respules',
+            'Foracort Inhaler No. of Units per Month' => 'foracort_inhaler_units',
+            'Foracort Rotacaps No. of Units per Month' => 'foracort_rotacaps_units',
+            'Asthalin Syrup No. of Units per Month' => 'asthalin_syrup_units',
+            'Levolin Syrup No. of Units per Month' => 'levolin_syrup_units',
+            'Deriphyllin No. of Units per Month' => 'deriphyllin_units',
+            'Beclomethasone Tablet No. of Units per Month' => 'beclomethasone_units',
+            'Methylprednisolone Tablet No. of Units per Month' => 'methylprednisolone_units',
+            'Prednisolone Tablet No. of Units per Month' => 'prednisolone_units',
+            'Cough Syrups No. of Units per Month' => 'cough_syrups_units',
+        ] as $label => $code)
+        <div class="mb-2"><label class="form-label">{{$label}}</label><input type="number" min="0" step="1" class="form-control therapy-units" name="{{$code}}"></div>
         @endforeach
     </div>
 </div>
@@ -46,7 +74,7 @@ $products = ['Asthalin Inhaler' => 'asthalin_inhaler','Asthalin Rotacap' => 'ast
 <div class="survey-section">
     <button type="button" class="section-head">Upload photos</button>
     <div class="section-body">
-        <p class="text-muted">Upload one of visiting card, Rx pad or doctor board. JPG, JPEG or PNG, max 10 MB.</p>
+        <p class="text-muted">Upload one of visiting card, Rx pad or doctor board. JPG, JPEG or PNG, max 10 MB. <span class="text-danger">*</span></p>
         <div class="mb-2"><label class="form-label">Visiting Card</label><input type="file" class="form-control" id="field-visiting_card" name="visiting_card" accept=".jpg,.jpeg,.png,image/jpeg,image/png" capture="environment"></div>
         <div class="mb-2"><label class="form-label">Rx Pad</label><input type="file" class="form-control" id="field-rx_pad" name="rx_pad" accept=".jpg,.jpeg,.png,image/jpeg,image/png" capture="environment"></div>
         <div class="mb-2"><label class="form-label">Doctor Board</label><input type="file" class="form-control" id="field-doctor_board" name="doctor_board" accept=".jpg,.jpeg,.png,image/jpeg,image/png" capture="environment"></div>