diff --git a/resources/views/form/rapport-dc/1775810563-29887e6c-dfe1-45cc-8dcd-2da516810bec.blade.php b/resources/views/form/rapport-dc/1775810563-29887e6c-dfe1-45cc-8dcd-2da516810bec.blade.php
index a27f8825..86479449 100644
--- a/resources/views/form/rapport-dc/1775810563-29887e6c-dfe1-45cc-8dcd-2da516810bec.blade.php
+++ b/resources/views/form/rapport-dc/1775810563-29887e6c-dfe1-45cc-8dcd-2da516810bec.blade.php
@@ -247,18 +247,48 @@
             $('#report-form').append('<input type="hidden" class="dynamic-hidden" name="'+ $('#field-glipiq_dose').val() +'" value="1">')
         })*/
 
-        $('#field-glipiq_dose').on('change', function () {
-    $('#report-form input.dynamic-hidden').remove();
+      
+            const penOnlyValues = ["1.7 mg", "2.4 mg"];
+
+            function updateDoseOptions() {
+                const isPen = $("#field-glipiq_formulation").val() === "Pen";
+
+                $("#field-glipiq_dose option").each(function () {
+                    if (penOnlyValues.includes($(this).val())) {
+                        $(this).prop("hidden", !isPen).prop("disabled", !isPen);
+                    }
+                });
+
+                if (!isPen && penOnlyValues.includes($("#field-glipiq_dose").val())) {
+                    $("#field-glipiq_dose").val("");
+                }
+            }
+
+        
+            updateDoseOptions();
+
+        
+            $("#field-glipiq_formulation").on("change", updateDoseOptions);
 
-    let fieldName = $('#field-glipiq_dose').val().replace(/\./g, '_');
 
-    $('#report-form').append(
-        '<input type="hidden" class="dynamic-hidden" name="' + fieldName + '" value="1">'
-    );
-});
 
         $('#report-form').on('submit', function(event){
             event.preventDefault();
+            const rawDose = $('#field-glipiq_dose').val() || '';
+            const doseSlug = rawDose.toString().toLowerCase().trim().replace(/[.\s]+/g, '_').replace(/[^a-z0-9_]/g, '');
+            
+            if($('#field-glipiq_formulation').val()==='Vial'){
+                $('#report-form').append('<input type="hidden" name="'+doseSlug+'" value="'+$("#field-count_of_rx").val()+'"  />');
+            }
+            else if($('#field-glipiq_formulation').val()==='Pen'){
+                $('#report-form').append('<input type="hidden" name="'+doseSlug+'" value="'+$("#field-count_of_rx").val()+'"  />');
+
+            }
+            else{
+                $('#report-form').append('<input type="hidden" name="'+doseSlug+'" value="0"  />');
+
+            }
+
             $("#pageloader").fadeIn();
             $.ajax({
                 type: "POST",
@@ -298,22 +328,22 @@
 
             var plandateField = document.getElementById('field-record_date');
 
-plandateField.addEventListener('change', function () {
-    var today = new Date().toISOString().split('T')[0];
+            plandateField.addEventListener('change', function () {
+                var today = new Date().toISOString().split('T')[0];
 
-    if (this.value > today) {
-        var field = this;
+                if (this.value > today) {
+                    var field = this;
 
-        Swal.fire({
-            icon: 'error',
-            title: 'Invalid Date',
-            text: 'Future dates are not allowed',
-        }).then(() => {
-            field.value = today;   // reset AFTER swal closes
-            field.blur();          // force UI refresh (important for mobile)
-        });
-    }
-});
+                    Swal.fire({
+                        icon: 'error',
+                        title: 'Invalid Date',
+                        text: 'Future dates are not allowed',
+                    }).then(() => {
+                        field.value = today;   // reset AFTER swal closes
+                        field.blur();          // force UI refresh (important for mobile)
+                    });
+                }
+            });
     });
 </script>