diff --git a/resources/views/form/rapport-vitalis/1782108753-7a81e2c3-5c7e-472e-8ee1-1d0ec622f6d3.blade.php b/resources/views/form/rapport-vitalis/1782108753-7a81e2c3-5c7e-472e-8ee1-1d0ec622f6d3.blade.php
new file mode 100644
index 00000000..a488a876
--- /dev/null
+++ b/resources/views/form/rapport-vitalis/1782108753-7a81e2c3-5c7e-472e-8ee1-1d0ec622f6d3.blade.php
@@ -0,0 +1,354 @@
+<!DOCTYPE html>
+<html lang="en">
+<head>
+    @include('layouts.shared/title-meta', ['title' => "Form"])
+    @include('layouts.shared/head-css', ["mode" => $mode ?? '', "demo" => $demo ?? ''])
+    <link href="{{asset('assets/libs/sweetalert2/sweetalert2.min.css')}}" rel="stylesheet" type="text/css" />
+</head>
+<div id="pageloader">
+   <img src="http://cdnjs.cloudflare.com/ajax/libs/semantic-ui/0.16.1/images/loader-large.gif" alt="processing..." />
+</div>
+<body class="loading">
+    <div class="account-pages">
+        <div class="container">
+            <div class="row justify-content-center">
+                <div class="col-md-8 col-lg-6 col-xl-5 p-0">
+                    <div class="card bg-pattern">
+                        <div class="card-body p-3 row">
+
+                            @if(Session::has('error'))<div class="alert alert-danger">{{Session::get('error')}}</div>
+                            <br>@endif
+                            @if(session('success'))<div class=" alert alert-success">{{ session('success') }}
+                            </div>
+                            <br>@endif
+                            <div class="col-8">
+                                <h4 class="page-title">{{$form->title}}</h4>
+                            </div>
+                            @if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )
+                            <div class="col-4">
+                                @if($form->link_type == 'form')
+                                <a href="/form/history" class="float-end pt-1">View History</a>
+                                @else
+                                <a href="{{url()->previous()}}" class="float-end pt-1">Back</a>
+                                @endif
+                            </div>
+                            @endif
+                            @if(isset($form->user_info))
+                            <div class="col-12">
+                                <h6>Submitted By: {{$form->user_info->name}}</h6>
+                            </div>
+                            @endif
+                            <form method="POST" action="/form/submit" id="report-form" enctype="multipart/form-data">
+                                <input type="hidden" name="form_id" value="{{$form_id}}">
+                                <input type="hidden" name="user_id" value="{{$form->user_id}}">
+                                
+                                @csrf
+                                @if($id)
+                                <input type="hidden" name="id" value="{{$id}}">
+                                @endif
+                                @if(isset($form->manager_can_submit) && $form->manager_can_submit == true)
+                                <div class="col-md-12 mb-2">
+                                    <label for="field-user_id" class="form-label"> Select User / Territory <span class="text-danger">*</span> </label>
+                                    <select class="form-control" id="field-user_id" name="user_id" required>
+                                        <option value=""> -- Select -- </option>
+                                        @foreach($form->users as $option)
+                                        <option value="{{$option->value}}" hierarchy="{{$option->hierarchy_id}}" {{isset($question->value) && $question->value == $option->value ? 'selected':''}}>{{$option->display}}</option>
+                                        @endforeach
+                                    </select>
+                                    <input type="hidden" id="field-hierarchy_id" name="hierarchy_id" value="">
+                                </div>
+                                @endif
+                                
+
+                                @foreach($questions as $question)
+                                    <div class="col-md-12 mb-2">
+                                    <label for="field-{{$question->code}}" class="form-label">{{$question->question}} {!!$question->required == 'yes' ? '<span class="text-danger">*</span>':''!!} </label>
+                                    @switch($question->type)
+                                        @case('hidden')
+                                            <input type="{{$question->type}}" id="field-{{$question->code}}" name="{{$question->code}}" value="{{isset($question->value)?$question->value:''}}">
+                                            @break
+                                        @case('text')
+                                        @case('email')
+                                        @case('tel')
+                                        @case('date')
+                                            <input type="{{$question->type}}" id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" {{$question->required == 'yes'?'required':'' }} value="{{isset($question->value)?$question->value:''}}">
+                                            @break
+                                        @case('number')
+                                            <input type="{{$question->type}}" min="0" max="9999999999" step="1" id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" {{$question->required == 'yes'?'required':'' }}  value="{{isset($question->value)?$question->value:0}}">
+                                            @break
+                                        @case('textarea')
+                                            <textarea id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" {{$question->required == 'yes'?'required':'' }}>{{isset($question->value)?$question->value:''}}</textarea>
+                                            @break
+                                        @case('dropdown')
+                                        <select class="form-control" id="field-{{ $question->code }}" name="{{ $question->code }}" {{ $question->required == 'yes' ? 'required' : '' }}>
+                                            <option value=""> -- Select -- </option>
+                                            @foreach ($question->options as $option)
+                                            @if($question->code == 'contact_id'  && isset($option->contact->type) && $option->contact->type == 'doctor' )
+                                                    <option value="{{ $option->value }}"
+                                                        @if(isset($question->value) && $question->value == $option->value) selected @endif
+                                                            @if($question->code == 'contact_id')
+                                                                legacy_code="{{ (isset($option->contact->legacy_code) ? $option->contact->legacy_code : '') }}"
+                                                                speciality="{{ (isset($option->contact->speciality) ? $option->contact->speciality : '') }}"
+                                                            @endif
+                                                    >
+                                                        {{ $option->display }}
+                                                    </option>
+                                            @elseif($question->code != 'contact_id')
+                                                        <option value="{{ $option->value }}" {{ isset($question->value) && $question->value == $option->value ? 'selected' : '' }} {{ $question->code == 'contact_id' ? 'pcode= ' . (isset($option->contact->pcode)?$option->contact->pcode:'') . ' ' : '' }} {{ isset($question->value) && $question->value == $option->value ? 'selected' : '' }} {{ $question->code == 'contact_id' ? 'speciality= ' . (isset($option->contact->speciality) ? $option->contact->speciality :'') . ' ' : '' }} >
+                                                            {{ $option->display }}
+                                                        </option>
+                                            @endif
+                                                        
+                                            
+                                            
+                                            @endforeach
+                                           
+                                        </select>
+                                            @break
+                                        @case('checkbox')
+                                            @foreach($question->options as $option)
+                                            <div class="form-check mb-2 form-check-primary">
+                                                <input class="form-check-input" type="checkbox" id="field-{{$question->code}}-{{$option->value}}" name="{{$question->code}}[]" value="{{$option->value}}" {{isset($question->value) && $question->value != '' && in_array($option->value, $question->value) ? 'checked':''}}>
+                                                <label class="form-check-label" for="field-{{$question->code}}-{{$option->value}}">{{$option->display}}</label>
+                                            </div>
+                                            @endforeach
+                                            @break
+                                        @case('file')
+                                        @if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )
+                                             <input type="file" id="field-{{$question->code}}" name="{{$question->code}}" class="form-control" value="" {{$question->required == 'yes'?'required':'' }}>
+                                        @elseif(isset($question->value))
+                                             <img src="{{$question->value}}" class="img-fluid">
+                                        @endif
+                                            
+                                            @break
+                                        @case('multitextbox')
+                                            <div class="row">
+                                                @foreach($question->options as $option)
+                                                <div class="col-6">{{$option->display}}</div>
+                                                <div class="col-6 mb-1">
+                                                    <input type="number" id="field-{{$option->value}}" name="{{$option->value}}" class="form-control" required value="{{isset($option->val)?$option->val:0}}">
+                                                </div>
+                                                @endforeach
+                                            </div>
+                                        @break
+                                        
+                                        @case('time')
+                                            <input type="time" 
+                                                id="field-{{$question->code}}" 
+                                                name="{{$question->code}}" 
+                                                class="form-control" 
+                                                {{$question->required == 'yes' ? 'required' : ''}} 
+                                                value="{{isset($question->value) ? $question->value : ''}}">
+                                        @break
+                                        
+                                    @endswitch
+                                    </div>
+                                @endforeach
+                                @if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )
+                                <div class="text-center d-grid mt-3">
+                                    <button class="btn btn-primary" type="submit" id="submit-btn"> Submit </button>
+                                </div>
+                                @endif
+                            </form>
+
+                        </div> <!-- end card-body -->
+                    </div>
+                    <!-- end card -->
+
+                    <!-- end row -->
+
+                </div> <!-- end col -->
+            </div>
+            <!-- end row -->
+        </div>
+        <!-- end container -->
+    </div>
+    <!-- end page -->
+<style type="text/css">
+#pageloader {
+  background: rgba( 255, 255, 255, 0.8 );
+  display: none;
+  height: 100%;
+  position: fixed;
+  width: 100%;
+  z-index: 9999;
+}
+
+#pageloader img {
+  left: 50%;
+  margin-left: -32px;
+  margin-top: -32px;
+  position: absolute;
+  top: 50%;
+}
+</style>
+@include('layouts.shared/footer-script')
+<script src="{{asset('assets/libs/sweetalert2/sweetalert2.min.js')}}"></script>
+<script type="text/javascript">
+    jQuery(document).ready(function($){
+        // Allow only alphabets and spaces
+        $('#field-chemist_name, #field-hospital_name').on('input', function () {
+            let value = $(this).val();
+          
+            
+            value = value.replace(/[^a-zA-Z\s]/g, '');
+
+            $(this).val(value);
+        });
+
+        // Allowed only digits for these fields
+
+        $('#field-galvus_dm_vildagliptin_100_mg_dapagliflozin_10_mg_metformin_1000_mg, \
+        #field-galvus_dm_vildagliptin_100_mg_dapagliflozin_10_mg_metformin_500_mg, \
+        #field-galvus_d_vildagliptin_100_mg_dapagliflozin_10_mg')
+        .on('input', function () {
+            let value = $(this).val();
+
+            // Allow only digits (0-9)
+            value = value.replace(/[^0-9]/g, '');
+
+            $(this).val(value);
+        });
+
+
+
+        $('#field-user_id').change(function(){
+            let hierarchy = $('option:selected', this).attr('hierarchy');
+            $('#field-hierarchy_id').val(hierarchy)
+            event.preventDefault();
+            $("#pageloader").fadeIn();
+            $.ajax({
+                type: "GET",
+                url: '/form/getdoctorlist?partition={{$form->partition}}&hierarchy='+hierarchy,
+                processData: false,
+                contentType: false,
+                success: function( data ) {
+                    $("#pageloader").fadeOut();
+                    $('#field-contact_id').html('')
+                    $('#field-contact_id').append($("<option></option>").attr("value",'').text('-- Select --'));
+                    for (let itm of data) {
+                        $('#field-contact_id').append($("<option></option>").attr("value",itm.value).text(itm.display).attr("legacy_code", itm.contact.legacy_code).attr('speciality',itm.contact.speciality));
+                    }
+
+                    $('#field-contact_id').change(function() {
+                        $('#field-legacy_code').val($('option:selected', this).attr('legacy_code'))
+                    })    
+                    
+                    $('#field-contact_id').change(function() {
+                        $('#field-speciality').val($('option:selected', this).attr('speciality'))
+                    })    
+                },
+            });
+
+            console.log(hierarchy)
+        })
+
+        $('#field-contact_id').change(function() {
+                        $('#field-speciality').val($('option:selected', this).attr('speciality'))
+                    })
+        
+        $('#field-contact_id').change(function() {
+               		 $('#field-legacy_code').val($('option:selected', this).attr('legacy_code'))
+        })
+
+        $('#field-legacy_code,#field-speciality').attr('readonly',true);
+        
+    
+             
+        $('#field-sitazit_d_rx,#field-sitazit_dm_rx,#field-ziten_m_rx').on('input', function() {
+                var total=(
+                        (parseInt($('#execution-sitazit_d_rx').val())*15 ||0)+
+                        (parseInt($('#execution-sitazit_dm_rx').val())*25 ||0)+
+                        (parseInt($('#execution-ziten_m_rx').val())*35 ||0)
+                );
+
+                $('#execution-total_camp_rx').val(total)
+        })    
+
+        $('#field-file_upload').on('change', function () {
+            let file = this.files[0];
+
+            if (file) {
+                let allowedTypes = ['image/png', 'image/jpg', 'image/jpeg'];
+                let maxSize = 10 * 1024 * 1024; // 10 MB
+
+                // Type validation
+                if (!allowedTypes.includes(file.type)) {
+                    alert('Only PNG, JPG, and JPEG files are allowed.');
+                    $(this).val('');
+                    return;
+                }
+
+                // Size validation
+                if (file.size > maxSize) {
+                    alert('File size should not exceed 10 MB.');
+                    $(this).val('');
+                    return;
+                }
+            }
+        });
+
+        $(document).ready(function () {
+            $('#field-contact_id').trigger('change');
+        });
+
+        $('#field-city,#field-state,#field-departmental_head_name').on('input', function () {
+            this.value = this.value.replace(/[^a-zA-Z\s]/g, '');
+        });
+            
+
+        $('#report-form').on('submit', function(event){
+            event.preventDefault();
+            const formData = new FormData($('#report-form')[0]);
+            // Log form data to console
+            for (let [key, value] of formData.entries()) {
+                console.log(key, value);
+            }
+            $("#pageloader").fadeIn();
+            $.ajax({
+                type: "POST",
+                url: '/form/ajaxsubmit',
+                data: new FormData($('#report-form')[0]),
+                processData: false,
+                contentType: false,
+                success: function( data ) {
+                    $("#pageloader").fadeOut();
+                    if(data.status == 'success') {
+                        Swal.fire({
+                          title: 'Great!',
+                          text: 'Your data is successfully submitted!',
+                          icon: 'success'
+                        }).then(() => {
+                            location.reload(); // 🔥 page refresh here
+                                    });
+                        $('#report-form').trigger("reset");
+                    } else {
+                        Swal.fire({
+                            icon: 'error',
+                            title: 'Data not submitted',
+                            text: 'Something went wrong, please try again after some time!'
+                        })
+                    }
+                },
+            });
+        });
+
+            var today = new Date();
+            var dd = String(today.getDate()).padStart(2, '0');
+            var mm = String(today.getMonth() + 1).padStart(2, '0');
+            var yyyy = today.getFullYear();
+
+            var maxDate = yyyy + '-' + mm + '-' + dd;
+
+            // Current year ki 1st June
+            var minDate = yyyy + '-06-01';
+
+            var plandateField = document.getElementById('field-record_date');
+
+            plandateField.setAttribute('min', minDate);
+            plandateField.setAttribute('max', maxDate);
+    });
+</script>
+</body>
+
+</html>
\ No newline at end of file