diff --git a/resources/views/form/history.blade.php b/resources/views/form/history.blade.php
index aac78901..9e8b8c8b 100644
--- a/resources/views/form/history.blade.php
+++ b/resources/views/form/history.blade.php
@@ -9,7 +9,7 @@
     <div class="account-pages">
         <div class="container">
 
-    <!-- start page title -->
+    <!-- start page title -->`
     <div class="row">
         <div class="col-8 p-2">
             <h4 class="page-title">{{$formname}}</h4>
diff --git a/resources/views/form/rapport-xennex/1714736141-4cdf81c6-b4d0-4c27-8790-b197973e8c03.blade.php b/resources/views/form/rapport-xennex/1714736141-4cdf81c6-b4d0-4c27-8790-b197973e8c03.blade.php
index 4e0cb881..09f0a13f 100644
--- a/resources/views/form/rapport-xennex/1714736141-4cdf81c6-b4d0-4c27-8790-b197973e8c03.blade.php
+++ b/resources/views/form/rapport-xennex/1714736141-4cdf81c6-b4d0-4c27-8790-b197973e8c03.blade.php
@@ -518,7 +518,12 @@
                     "brand": "Sylate T",
                     "sku": "Sylate 250",
                     "pts": 175.85
-                }
+                },
+                 {
+                    "brand": "Emvicure",
+                    "sku": "Emvicure",
+                    "pts": 365.83
+                },
 
 
 
diff --git a/resources/views/form/rapport-xennex/1715505619-bff0dba3-a07f-46bb-a128-029a724c60e0.blade.php b/resources/views/form/rapport-xennex/1715505619-bff0dba3-a07f-46bb-a128-029a724c60e0.blade.php
index 703d0352..d26fd3d7 100644
--- a/resources/views/form/rapport-xennex/1715505619-bff0dba3-a07f-46bb-a128-029a724c60e0.blade.php
+++ b/resources/views/form/rapport-xennex/1715505619-bff0dba3-a07f-46bb-a128-029a724c60e0.blade.php
@@ -13,7 +13,8 @@
 @php
 $brandData = [
 
-/*['brand'=>'CELOL', 'slug'=>'celol_units','pseudoId'=>'celol_value','slug2'=>'celol2'],
+/*
+['brand'=>'CELOL', 'slug'=>'celol_units','pseudoId'=>'celol_value','slug2'=>'celol2'],
 ['brand'=>'Denmab', 'slug'=>'denmab_units','pseudoId'=>'denmab_value','slug2'=>'denmab2'],
 ['brand'=>'Emanzen', 'slug'=>'emanzen_units','pseudoId'=>'emanzen_value','slug2'=>'emanzen2'],
 ['brand'=>'Ferium XT', 'slug'=>'ferium_xt_units','pseudoId'=>'ferium_xt_value','slug2'=>'ferium_xt2'],
@@ -23,7 +24,6 @@ $brandData = [
 ['brand'=>'Proxym', 'slug'=>'proxym_units','pseudoId'=>'proxym_value','slug2'=>'proxym2'],
 ['brand'=>'Ferium Injection', 'slug'=>'ferium_injection_units','pseudoId'=>'ferium_injection_value','slug2'=>'ferium_injection2'],
 
-
 */
 ['brand'=>'Galact Granules', 'slug'=>'galact_granules_units','pseudoId'=>'galact_granules_value','slug2'=>'galact_granules2'],
 ['brand'=>'Sylate', 'slug'=>'sylate_units','pseudoId'=>'sylate_value','slug2'=>'sylate2'],
@@ -37,6 +37,7 @@ $brandData = [
 ['brand'=>'Sylate T 500', 'slug'=>'sylate_t_500_units','pseudoId'=>'sylate_t_500_value','slug2'=>'sylate_t_500_2'],
 ['brand'=>'Sylate 500', 'slug'=>'sylate_500_units','pseudoId'=>'sylate_500_value','slug2'=>'sylate_500_2'],
 ['brand'=>'Sylate 250', 'slug'=>'sylate_250_units','pseudoId'=>'sylate_250_value','slug2'=>'sylate_250_2'],
+['brand'=>'Emvicure', 'slug'=>'emvicure_units','pseudoId'=>'emvicure_value','slug2'=>'emvicure2'],
 
 
 
@@ -387,6 +388,8 @@ $brandData = [
                 let productOfP = (p * priceOfP).toFixed(2);
                 $('#field-femzact_value').val(productOfP);
 
+                
+
 
         })
 
@@ -522,6 +525,11 @@ $brandData = [
                 unit: '#field-sylate_250_units',
                 value: '#field-sylate_250_value',
                 price: 175.85
+            },
+             {
+                unit: '#field-emvicure_units',
+                value: '#field-emvicure_value',
+                price: 365.83
             }
         ];
 
diff --git a/resources/views/form/rapport-xennex/1780028714-b6b01792-de35-40b2-9d59-d2c32aad39cc.blade.php b/resources/views/form/rapport-xennex/1780028714-b6b01792-de35-40b2-9d59-d2c32aad39cc.blade.php
new file mode 100644
index 00000000..7ac9cc67
--- /dev/null
+++ b/resources/views/form/rapport-xennex/1780028714-b6b01792-de35-40b2-9d59-d2c32aad39cc.blade.php
@@ -0,0 +1,786 @@
+<!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" />
+    <link href="https://cdn.jsdelivr.net/npm/select2@4.1.0-rc.0/dist/css/select2.min.css" rel="stylesheet" />
+<style>
+
+/* =========================
+   SELECT2 CUSTOM HIGHLIGHT
+========================= */
+
+.select2-container .select2-selection--single{
+    height: 38px !important;
+    border: 1px solid #ced4da !important;
+    border-radius: 6px !important;
+    padding-top: 4px !important;
+}
+
+.select2-container--default .select2-selection--single .select2-selection__rendered{
+    line-height: 28px !important;
+}
+
+.select2-container--default .select2-selection--single .select2-selection__arrow{
+    height: 36px !important;
+}
+
+/* Dropdown option hover */
+.select2-results__option--highlighted{
+    background-color: #0d6efd !important;
+    color: white !important;
+}
+
+/* Selected option */
+.select2-results__option[aria-selected=true]{
+    background-color: #dbe9ff !important;
+    color: black !important;
+    font-weight: 600;
+}
+
+/* Search box */
+.select2-search__field{
+    border-radius: 5px !important;
+    padding: 6px !important;
+}
+
+</style>
+</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
+
+                            @php
+                            $submissions = Formhelper::getMultiformData( $form->partition, $form_id, $form->user_id);
+                            $submissions = $submissions->data->submissions;
+                            
+
+                            @endphp
+                            
+                            <form method="POST" action="/form/submit" id="report-form" enctype="multipart/form-data">
+                                <input type="hidden" name="form_id" value="{{$form_id}}">
+                                @csrf
+                                @if($id)
+                                <input type="hidden" name="id[0]" value="{{$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 $question)
+                                @if( !in_array($question->code,
+                                ["record_date","select_week","select_month"] ) )
+                                @continue;
+                                @endif
+                                <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)
+                                            <option value="{{ $option->value }}" {{ isset($question->value) && $question->value == $option->value ? 'selected' : '' }} {{ $question->code == 'contact_id' ? 'uid_number= ' . $option->contact->uid_number . ' ' : '' }}  {{ $question->code == 'doctor_name' ? 'speciality= ' . (isset($option->contact->speciality) ? $option->contact->speciality :'') . ' ' : '' }} >
+                                                {{ $option->display }}
+                                            </option>
+
+                                            @endforeach
+                                            </select>
+                                    @break
+                                    @endswitch
+                                </div>
+                                @endforeach
+                                <div class="doctor-wrapper">
+                                    
+                                    @foreach($questions as $question)
+                                     @if( in_array($question->code,
+                                    ["record_date","select_week","select_month"] ) )
+                                    @continue;
+                                    @endif
+                                    <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="{{$question->code}}[0]"
+                                            value="{{isset($question->value)?$question->value:''}}">
+                                        @break
+                                        @case('text')
+                                        @case('email')
+                                        @case('tel')
+                                        @case('date')
+                                        <input type="{{$question->type}}" id="field-{{$question->code}}"
+                                            name="{{$question->code}}[0]" 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}}[0]"
+                                            class="form-control" {{$question->required == 'yes'?'required':'' }}
+                                            value="{{isset($question->value)?$question->value:0}}">
+                                        @break
+                                        @case('textarea')
+                                        <textarea id="field-{{$question->code}}" name="{{$question->code}}[0]"
+                                            class="form-control"
+                                            {{$question->required == 'yes'?'required':'' }}>{{isset($question->value)?$question->value:''}}</textarea>
+                                        @break
+                                        @case('dropdown')
+                                        @if ($question->code == 'contact_id')
+                                                            <select class="form-control" id="field-{{ $question->code }}"
+                                                                name="{{ $question->code }}[0]"
+                                                                {{ $question->required == 'yes' ? 'required' : '' }}>
+                                                                <option value=""> -- Select -- </option>
+                                                                @foreach ($question->options as $option)
+                                                                    
+                                                                    
+                                                                        <option value="{{ $option->value }}"
+                                                                            {{ isset($question->value) && $question->value == $option->value ? 'selected' : '' }}
+                                                                            @if($question->code == 'contact_id')
+                                                                                uid_number="{{ (isset($option->contact->uid_number) ? $option->contact->uid_number : '') }}"
+                                                                                speciality="{{ (isset($option->contact->speciality) ? $option->contact->speciality : '') }}"
+                                                                            @endif
+                                                                            >
+                                                                            {{ $option->display }}
+                                                                        </option>
+                                                                    
+                                                                @endforeach
+                                                            </select>
+                                        @else
+                                                            <select class="form-control" id="execution-{{ $question->code }}"
+                                                                name="{{ $question->code }}[0]"
+                                                                {{ $question->required == 'yes' ? 'required' : '' }}>
+                                                                <option value=""> -- Select -- </option>
+                                                                @foreach ($question->options as $option)
+                                                                    <option value="{{ $option->value }}"
+                                                                        {{ isset($question->value) && $question->value == $option->value ? 'selected' : '' }}>
+                                                                        {{ $option->display }}</option>
+                                                                @endforeach
+                                                            </select>
+                                            @endif
+                                        @break
+                                        @case('checkbox')
+                                        @foreach($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}}[0]" 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
+                                        @endswitch
+                                    </div>
+                                    @endforeach
+                                </div>
+                                <div id="doctor-group-wrapper">
+
+                                </div>
+                                @if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval !=
+                                'yes' ) )
+                                <div class="text-center button-list">
+                                    @if(!$id)
+                                    <button class="btn btn-primary" type="button" id="adddoctor-btn"> Add Doctor </button>
+                                    @endif
+                                    <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%;
+    }
+
+    .doctor-wrapper {
+        border: 1px solid #ccc;
+        padding: 20px;
+        border-radius: 10px;
+        margin-bottom: 20px;
+    }
+    </style>
+    @include('layouts.shared/footer-script')
+    <script src="https://cdn.jsdelivr.net/npm/select2@4.1.0-rc.0/dist/js/select2.min.js"></script>
+    <script src="{{asset('assets/libs/sweetalert2/sweetalert2.min.js')}}"></script>
+    <script type="text/javascript">
+    jQuery(document).ready(function($) {
+        $('#field-record_date').attr(
+            'max',
+            new Date().toISOString().split('T')[0]
+        );
+        
+        $('#field-contact_id').on('change',function(){
+            $('#field-uid_number').val($(this).find(":selected").attr("uid_number"));
+        })
+
+        $('#field-contact_id').on('change',function(){
+            $('#field-speciality').val($(this).find(":selected").attr("speciality"));
+        })
+      
+        $('#field-uid_number,#field-speciality').attr('readonly',true);
+
+        function initializeSelect2() {
+
+            $('select[id^="field-contact_id"]').select2({
+                width: '100%',
+                placeholder: '-- Select Doctor --'
+            });
+
+            $('#field-user_id').select2({
+                width: '100%',
+                placeholder: '-- Select User / Territory --'
+            });
+
+            $('select[id^="execution-"]').select2({
+                width: '100%'
+            });
+        }
+
+        initializeSelect2();
+        preventDuplicateDoctors();
+
+
+       
+        /* function preventDuplicateDoctors() {
+
+            let selectedValues = [];
+
+            // Get all selected doctor values
+            $('select[id^="field-contact_id"]').each(function () {
+
+                let value = $(this).val();
+
+                if (value) {
+                    selectedValues.push(value);
+                }
+
+            });
+
+            // Apply duplicate prevention
+            $('select[id^="field-contact_id"]').each(function () {
+
+                let currentSelect = $(this);
+                let currentValue = currentSelect.val();
+
+                currentSelect.find('option').each(function () {
+
+                    let option = $(this);
+                    let optionValue = option.val();
+
+                    if (!optionValue) return;
+
+                    // Remove old text
+                    let cleanText = option.text().replace(' (Already Added)', '');
+
+                    if (
+                        selectedValues.includes(optionValue) &&
+                        optionValue !== currentValue
+                    ) {
+
+                        option.prop('disabled', true);
+                        option.text(cleanText + ' (Already Added)');
+
+                    } else {
+
+                        option.prop('disabled', false);
+                        option.text(cleanText);
+
+                    }
+
+                });
+
+                // 🔥 IMPORTANT
+                currentSelect.select2('destroy');
+
+                currentSelect.select2({
+                    width: '100%',
+                    placeholder: '-- Select Doctor --'
+                });
+
+            });
+
+        } */
+
+        function preventDuplicateDoctors() {
+
+            let selectedValues = [];
+
+            // Collect selected values
+            $('select[id^="field-contact_id"]').each(function () {
+
+                let value = $(this).val();
+
+                if (value) {
+                    selectedValues.push(value);
+                }
+
+            });
+
+            $('select[id^="field-contact_id"]').each(function () {
+
+                let currentSelect = $(this);
+                let currentValue = currentSelect.val();
+
+                currentSelect.find('option').each(function () {
+
+                    let option = $(this);
+                    let optionValue = option.val();
+
+                    if (!optionValue) return;
+
+                    // remove previous label
+                    let cleanText = option.text().replace(' (Already Added)', '');
+
+                    // IMPORTANT:
+                    // keep currently selected option enabled
+                    if (
+                        selectedValues.includes(optionValue) &&
+                        optionValue !== currentValue
+                    ) {
+
+                        option.prop('disabled', true);
+                        option.text(cleanText + ' (Already Added)');
+
+                    } else {
+
+                        option.prop('disabled', false);
+                        option.text(cleanText);
+
+                    }
+
+                });
+
+                // refresh select2 safely
+                if (currentSelect.hasClass("select2-hidden-accessible")) {
+                    currentSelect.select2('destroy');
+                }
+
+                currentSelect.select2({
+                    width: '100%',
+                    placeholder: '-- Select Doctor --'
+                });
+
+                // VERY IMPORTANT FOR EDIT MODE
+                currentSelect.val(currentValue).trigger('change.select2');
+
+            });
+
+        }
+
+        
+        // Hide fields initially
+        $('#field-no_of_rx,#field-no_of_strips,#field-total_value').parent().hide();
+
+        $('#field-no_of_rx,#field-no_of_strips,#field-total_value')
+            .attr('required', false);
+
+        // Show when dr_converted = Yes
+        $('#execution-dr_converted').on('change', function(){
+
+            let value = $(this).val();
+
+            if(value === 'Yes'){
+
+                $('#field-no_of_rx,#field-no_of_strips,#field-total_value')
+                    .parent().show();
+
+                $('#field-no_of_rx,#field-no_of_strips,#field-total_value')
+                    .attr('required', true);
+
+            }else{
+
+                $('#field-no_of_rx,#field-no_of_strips,#field-total_value')
+                    .parent().hide();
+
+                $('#field-no_of_rx,#field-no_of_strips,#field-total_value')
+                    .attr('required', false);
+            }
+
+        });
+
+        $('#field-total_value').attr('readonly', true);
+
+        $('#field-no_of_strips').on('change keyup', function(){
+
+            let strips = parseFloat($('#field-no_of_strips').val() || 0);
+
+            let ptsValue = 365.83;
+
+            let total = strips * ptsValue;
+
+            $('#field-total_value').val(total.toFixed(2));
+
+        });
+
+        $(document).on('change', 'select[id^="field-contact_id"]', function () {
+
+            let selectedOption = $(this).find(':selected');
+
+            let id = $(this).attr('id').split('-').pop(); // get doctor_count dynamically
+
+            $('#field-uid_number-' + id).val(selectedOption.attr('uid_number'));
+            $('#field-speciality-' + id).val(selectedOption.attr('speciality'));
+
+            preventDuplicateDoctors();
+        });
+   
+        
+
+        
+        var doctor_count = 0
+        let numberOfSubmission=0;
+        console.log("Number of Submission : ",numberOfSubmission);
+        $('#adddoctor-btn').click(function() {
+            let doctorName=$('#field-contact_id').html();
+
+            console.log("Doctor Name : ",doctorName);
+            doctor_count++;
+            numberOfSubmission=numberOfSubmission+1;
+            console.log("Number of Submission : ",numberOfSubmission);
+            
+            let empty_doctor = `
+            
+            <div class="doctor-wrapper"><button type="button" class="btn btn-danger btn-remove float-end" style="margin-top:-25px; margin-right:-25px"><i class="mdi mdi-close"></i></button>
+                                        @foreach($questions as $question)
+                                        @if( in_array($question->code,
+                                            ["record_date","select_week","select_month"] ) )
+                                            @continue;
+                                        @endif
+                                        
+                                        <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}}-${doctor_count}" name="{{$question->code}}[${doctor_count}]" value="{{isset($question->value)?$question->value:''}}">
+                                                @break
+                                            @case('text')
+                                            @case('file')
+                                            @case('email')
+                                            @case('tel')
+                                            @case('date')
+                                                <input type="{{$question->type}}" id="field-{{$question->code}}-${doctor_count}" name="{{$question->code}}[${doctor_count}]" 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-{{$question->code}}-${doctor_count}" name="{{$question->code}}[${doctor_count}]" class="form-control" {{$question->required == 'yes'?'required':'' }}  value="{{isset($question->value)?$question->value:0}}">
+                                                @break
+                                            @case('dropdown')
+                                                <select class="form-control" id="field-{{$question->code}}-${doctor_count}" name="{{$question->code}}[${doctor_count}]" {{$question->required == 'yes'?'required':'' }}>
+                                                    @if($question->code=='contact_id')
+                                                    ${doctorName}
+                                                    @else
+                                                    <option value=""> -- Select -- </option>
+                                            @foreach($question->options as $option)
+                                            <option value="{{ $option->value }}" {{ isset($question->value) && $question->value == $option->value ? 'selected' : '' }} {{ $question->code == 'contact_id' ? 'uid_number= ' . $option->contact->uid_number . ' ' : '' }}  {{ $question->code == 'contact_id' ? 'speciality= ' . (isset($option->contact->speciality) ? $option->contact->speciality :'') . ' ' : '' }} >
+                                                {{ $option->display }}
+                                            </option>
+                                            @endforeach
+                                                    @endif
+                                                </select>
+                                                @break
+                                        @endswitch
+                                        </div>
+                                    @endforeach </div>`;
+            
+
+            $('#doctor-group-wrapper').append(empty_doctor)
+            
+            $('#field-contact_id-'+doctor_count).select2({
+               
+                width: '100%',
+                placeholder: '-- Select Doctor --'
+            });
+             preventDuplicateDoctors();
+
+
+            $('select[id^="execution-"]').select2({
+                width: '100%'
+            });
+
+                                     
+            
+           
+            setTimeout(() => {
+                    $('#field-uid_number-'+doctor_count).attr('readonly',true);
+                    $('#field-speciality-'+doctor_count).attr('readonly',true);
+                    let fields =
+                $('#field-no_of_rx-' + doctor_count +
+                ',#field-no_of_strips-' + doctor_count +
+                ',#field-total_value-' + doctor_count);
+
+            fields.parent().hide();
+
+            fields.attr('required', false);
+            $('#field-dr_converted-' + doctor_count).on('change', function(){
+
+            let value = $(this).val();
+
+            if(value === 'Yes'){
+
+                fields.parent().show();
+
+                fields.attr('required', true);
+
+            }else{
+
+                fields.parent().hide();
+
+                fields.attr('required', false);
+            }
+
+        });
+                $('#field-total_value-' + doctor_count).attr('readonly', true);
+
+        $('#field-no_of_strips-' + doctor_count)
+        .on('change keyup', function(){
+
+            let strips =
+                parseFloat($('#field-no_of_strips-' + doctor_count).val() || 0);
+
+            let ptsValue = 365.83;
+
+            let total = strips * ptsValue;
+
+            $('#field-total_value-' + doctor_count)
+                .val(total.toFixed(2));
+
+        });
+                                
+               
+            }, 500);
+
+            
+            
+
+            if ($('.doctor-wrapper').length >= 10) {
+                $('#adddoctor-btn').hide();
+            } else {
+                $('#adddoctor-btn').show();
+            }
+            
+
+            $('.btn-remove').unbind();
+            $('.btn-remove').click(function() {
+                // $(this).closest('.doctor-wrapper').find('select').select2('destroy');
+                $(this).closest('.doctor-wrapper').find('select').each(function () {
+
+                if ($(this).hasClass('select2-hidden-accessible')) {
+                    $(this).select2('destroy');
+                }
+
+            });
+                $(this).closest('.doctor-wrapper').remove();
+                numberOfSubmission--;
+                doctor_count--
+                preventDuplicateDoctors();
+                console.log("New Number of Submission : ",numberOfSubmission);
+                console.log("Number of doctors : ",doctor_count);
+                $('#adddoctor-btn').show();
+            })
+
+            
+
+
+
+
+        })
+
+
+        
+
+        $('#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("uid_number", itm.contact.uid_number).attr("speciality", itm.contact.speciality));
+                    }
+
+                    $('#field-contact_id').change(function() {
+                        $('#field-uid_number').val($('option:selected', this).attr('uid_number'))
+                    })  
+                    
+                    $('#field-contact_id').change(function() {
+                        $('#field-speciality').val($('option:selected', this).attr('speciality'))
+                    }) 
+                     
+                },
+            });
+
+            console.log(hierarchy)
+        })
+
+
+        $('#report-form').on('submit', function(event) {
+            event.preventDefault();
+            // if (numberOfSubmission !=10) {
+            //         alert(`You must submit 10  Doctors for Ciphaler , Current Doctors : ${numberOfSubmission+1}`);
+            //         return; 
+            // }
+
+            
+
+            $("#pageloader").fadeIn();
+            $.ajax({
+                type: "POST",
+                url: '/form/ajaxsubmitmultiple',
+                data: new FormData($('#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!'
+                        })
+                    }
+                },
+            });
+        });
+
+    });
+    </script>
+</body>
+
+</html>