@include('layouts.shared/title-meta', ['title' => "Form"]) @include('layouts.shared/head-css', ["mode" => $mode ?? '', "demo" => $demo ?? ''])

@php $brandData = [ ['brand'=>'ERDOSTYNE CAPSULE 10s', 'slug'=>'erdostyne_capsule_rx','pseudoId'=>'erdostyne_capsule_value'], ['brand'=>'Erdostyne Suspension', 'slug'=>'erdostyne_suspension_rx','pseudoId'=>'erdostyne_suspension_value'], ['brand'=>'Montair LC Adult 15s', 'slug'=>'montair_lc_adult_rx','pseudoId'=>'montair_lc_adult_value'], ['brand'=>'MONTAIR LC KID SYP', 'slug'=>'montair_lc_kid_syp_rx','pseudoId'=>'montair_lc_kid_syp_value'], ['brand'=>'MONTAIR LC KID TAB 10s', 'slug'=>'montair_lc_kid_tab_10s_rx','pseudoId'=>'montair_lc_kid_tab_10s_value'], ['brand'=>'FURAMIST NASAL SPRAY', 'slug'=>'furamist_nasal_spray_rx','pseudoId'=>'furamist_nasal_spray_value'], ['brand'=>'FURAMIST AZ NASAL SP', 'slug'=>'furamist_az_nasal_sp_rx','pseudoId'=>'furamist_az_nasal_sp_value'], ['brand'=>'Furamist Oxy 70 MD Nasal Spray', 'slug'=>'furamist_oxy_70_md_nasal_spray_rx','pseudoId'=>'furamist_oxy_70_md_nasal_spray_value'], ['brand'=>'FURAMIST 240MTD', 'slug'=>'furamist_240mtd_rx','pseudoId'=>'furamist_240mtd_value'], ['brand'=>'LEVOLIN SYRUP 100ML', 'slug'=>'levolin_syrup_100ml_rx','pseudoId'=>'levolin_syrup_100ml_value'], ['brand'=>'Levolin Plus Jr 100ml Oral Liquid', 'slug'=>'levolin_plus_jr_100ml_oral_liquid_rx','pseudoId'=>'levolin_plus_jr_100ml_oral_liquid_value'], ['brand'=>'LEVOLIN PLUS JR 60ML (IP)', 'slug'=>'levolin_plus_jr_60ml_ip_rx','pseudoId'=>'levolin_plus_jr_60ml_ip_value'], ['brand'=>'LEVOLIN PLUS (MANGO FLAVOUR ) 100 ML', 'slug'=>'levolin_plus_mango_flavour_100_ml_rx','pseudoId'=>'levolin_plus_mango_flavour_100_ml_value'], ['brand'=>'MONTAIR 10 (15s)', 'slug'=>'montair_10_15s_rx','pseudoId'=>'montair_10_15s_value'], ['brand'=>'MONTAIR 4MG 15 TAB', 'slug'=>'montair_4mg_15_tab_rx','pseudoId'=>'montair_4mg_15_tab_value'], ['brand'=>'MONTAIR 5MG 15 TAB', 'slug'=>'montair_5mg_15_tab_rx','pseudoId'=>'montair_5mg_15_tab_value'], ['brand'=>'Nicogum Freshmint 2mg - 16 Nicotine Gums', 'slug'=>'nicogum_freshmint_2mg_16_nicotine_gums_rx','pseudoId'=>'nicogum_freshmint_2mg_16_nicotine_gums_value'], ['brand'=>'Nicogum Freshmint 2mg - 48 Nicotine Gums', 'slug'=>'nicogum_freshmint_2mg_48_nicotine_gums_rx','pseudoId'=>'nicogum_freshmint_2mg_48_nicotine_gums_value'], ['brand'=>'Nicogum Freshmint 4mg - 16 Nicotine Gums', 'slug'=>'nicogum_freshmint_4mg_16_nicotine_gums_rx','pseudoId'=>'nicogum_freshmint_4mg_16_nicotine_gums_value'], ['brand'=>'Nicogum Freshmint 4mg - 48 Nicotine Gums', 'slug'=>'nicogum_freshmint_4mg_48_nicotine_gums_rx','pseudoId'=>'nicogum_freshmint_4mg_48_nicotine_gums_value'], ]; $submissions = Formhelper::getMultiformData($form->partition, $form_id, $form->user_id); $formdata = null; if (!empty($submissions->data->submissions)) { foreach ($submissions->data->submissions as $submission) { if ($submission->id == $id) { $formdata = $submission->formdata ?? null; break; } } } @endphp

@if(Session::has('error'))

{{Session::get('error')}}

@endif @if(session('success'))

{{ session('success') }}

@endif

{{$form->title}}

@if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )

@if($form->link_type == 'form') View History @else Back @endif

@endif @if(isset($form->user_info))

Submitted By: {{$form->user_info->name}}

@endif

@csrf @if($id) @endif @if(isset($form->manager_can_submit) && $form->manager_can_submit == true)

Select User / Territory *

@endif @foreach($questions as $question)

{{$question->question}} {!!$question->required == 'yes' ? '*':''!!} @switch($question->type) @case('hidden') @break @case('text') @case('email') @case('tel') @case('date') required == 'yes'?'required':'' }} value="{{isset($question->value)?$question->value:''}}" {{$question->code == 'legacy_code' ? 'readonly' : ''}}> @break @case('number') required == 'no'?'required':'' }} value="{{isset($question->value)?$question->value:0}}"> @break @case('textarea') @break @case('dropdown') @break @case('checkbox') @foreach($question->options as $option)

value) && $question->value != '' && in_array($option->value, $question->value) ? 'checked':''}}> {{$option->display}}

@endforeach @break @case('file') @if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) ) required == 'yes'?'required':'' }}> @elseif(isset($question->value))

@endif @break @case('multitextbox')

@foreach($brandData as $brand) @endforeach

Brand	Number of Rx
{{ $brand['brand'] }}

@break @endswitch

@endforeach @if(!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes' ) )

@endif

@include('layouts.shared/footer-script')