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

@php $brandData = [ ['brand'=>'ACIVIR 200 DT', 'slug'=>'acivir_200_dt_units','pseudoId'=>'acivir_200_dt_value'], ['brand'=>'ACIVIR 400 DT', 'slug'=>'acivir_400_dt_units','pseudoId'=>'acivir_400_dt_value'], ['brand'=>'Acivir 400 DT 10s', 'slug'=>'acivir_400_dt_10s_units','pseudoId'=>'acivir_400_dt_10s_value'], ['brand'=>'ACIVIR 800 DT', 'slug'=>'acivir_800_dt_units','pseudoId'=>'acivir_800_dt_value'], ['brand'=>'Acivir 800 DT Tablets 1X10s', 'slug'=>'acivir_800_dt_tablets_1x10s_units','pseudoId'=>'acivir_800_dt_tablets_1x10s_value'], ['brand'=>'ACIVIR CREAM 10 GM', 'slug'=>'acivir_cream_10_gm_units','pseudoId'=>'acivir_cream_10_gm_value'], ['brand'=>'Advent 1000 MG', 'slug'=>'advent_1000_mg_units','pseudoId'=>'advent_1000_mg_value'], ['brand'=>"ADVENT 457 DT 6'S", 'slug'=>'advent_457_dt_6s_units','pseudoId'=>'advent_457_dt_6s_value'], ['brand'=>'Advent 457 DT Tablets', 'slug'=>'advent_457_dt_tablets_units','pseudoId'=>'advent_457_dt_tablets_value'], ['brand'=>'ADVENT 625 TABLETS 10S', 'slug'=>'advent_625_tablets_10s_units','pseudoId'=>'advent_625_tablets_10s_value'], ['brand'=>'ADVENT DROPS 10ML', 'slug'=>'advent_drops_10ml_units','pseudoId'=>'advent_drops_10ml_value'], ['brand'=>'ADVENT ES', 'slug'=>'advent_es_units','pseudoId'=>'advent_es_value'], ['brand'=>'ADVENT FORTE 457 SYP 60 ML', 'slug'=>'advent_forte_457_syp_60_ml_units','pseudoId'=>'advent_forte_457_syp_60_ml_value'], ['brand'=>'ADVENT FORTE SYP 30M', 'slug'=>'advent_forte_syp_30m_units','pseudoId'=>'advent_forte_syp_30m_value'], ['brand'=>'ADVENT KID 228.5 TAB', 'slug'=>'advent_kid_2285_tab_units','pseudoId'=>'advent_kid_2285_tab_value'], ['brand'=>'ADVENT SYP 228.5MG', 'slug'=>'advent_syp_2285mg_units','pseudoId'=>'advent_syp_2285mg_value'], ['brand'=>'ADVENT SYRUP', 'slug'=>'advent_syrup_units','pseudoId'=>'advent_syrup_value'], ['brand'=>'AZEE - 500 TABS', 'slug'=>'azee_500_tabs_units','pseudoId'=>'azee_500_tabs_value'], ['brand'=>'AZEE 100 D/S 15ML', 'slug'=>'azee_100_ds_15ml_units','pseudoId'=>'azee_100_ds_15ml_value'], ['brand'=>'AZEE 100 DT', 'slug'=>'azee_100_dt_units','pseudoId'=>'azee_100_dt_value'], ['brand'=>'AZEE 100 IP 100MG/5ML (15ML)', 'slug'=>'azee_100_ip_100mg5ml_15ml_units','pseudoId'=>'azee_100_ip_100mg5ml_15ml_value'], ['brand'=>'AZEE 100 XL DRY SYRU', 'slug'=>'azee_100_xl_dry_syru_units','pseudoId'=>'azee_100_xl_dry_syru_value'], ['brand'=>'AZEE 100 XL Liquids 30 ml (100mg/5ml)', 'slug'=>'azee_100_xl_liquids_30_ml_100mg5ml_units','pseudoId'=>'azee_100_xl_liquids_30_ml_100mg5ml_value'], ['brand'=>'AZEE 1000', 'slug'=>'azee_1000_units','pseudoId'=>'azee_1000_value'], ['brand'=>'AZEE 200 D/S 15ML', 'slug'=>'azee_200_ds_15ml_units','pseudoId'=>'azee_200_ds_15ml_value'], ['brand'=>'AZEE 200 IP 200MG/5ML (15ML)', 'slug'=>'azee_200_ip_200mg5ml_15ml_units','pseudoId'=>'azee_200_ip_200mg5ml_15ml_value'], ['brand'=>'AZEE 200 XL DRY SYRU', 'slug'=>'azee_200_xl_dry_syru_units','pseudoId'=>'azee_200_xl_dry_syru_value'], ['brand'=>"AZEE 200 XL Liquids 30 ml (200mg/5ml)", 'slug'=>'azee_200_xl_liquids_30_ml_200mg5ml_units','pseudoId'=>'azee_200_xl_liquids_30_ml_200mg5ml_value'], ['brand'=>"AZEE 250 TABLETS(10'S)", 'slug'=>'azee_250_tablets10s_units','pseudoId'=>'azee_250_tablets10s_value'], ['brand'=>'AZEE 250 TABS', 'slug'=>'azee_250_tabs_units','pseudoId'=>'azee_250_tabs_value'], ['brand'=>"AZEE 500 Tablets 1 x 5'S", 'slug'=>'azee_500_tablets_1_x_5s_units','pseudoId'=>'azee_500_tablets_1_x_5s_value'], ['brand'=>"AZEE 500 TABLETS 5'S", 'slug'=>'azee_500_tablets_5s_units','pseudoId'=>'azee_500_tablets_5s_value'], /* ['brand'=>'AZEE PULSE 3 TABLETS', 'slug'=>'azee_pulse_3_tablets_units','pseudoId'=>'azee_pulse_3_tablets_value'] ,*/ ['brand'=>"Bilafav M", 'slug'=>'bilafav_m_units','pseudoId'=>'bilafav_m_value'], ['brand'=>"Bilafav M ODT Adult Tablets 1x10s - 20/10", 'slug'=>'bilafav_m_odt_adult_tablets_1x10s_2010_units','pseudoId'=>'bilafav_m_odt_adult_tablets_1x10s_2010_value'], ['brand'=>"Bilafav M ODT Pedia Tablets 1X10s 10/4", 'slug'=>'bilafav_m_odt_pedia_tablets_1x10s_104_units','pseudoId'=>'bilafav_m_odt_pedia_tablets_1x10s_104_value'], ['brand'=>"Bilafav M Oral suspension", 'slug'=>'bilafav_m_oral_suspension_units','pseudoId'=>'bilafav_m_oral_suspension_value'], ['brand'=>"CIVONO 10 MG TABLETS 10'S", 'slug'=>'civono_10_mg_tablets_10s_units','pseudoId'=>'civono_10_mg_tablets_10s_value'], ['brand'=>"CIVONO 20 MG TABLETS 10'S", 'slug'=>'civono_20_mg_tablets_10s_units','pseudoId'=>'civono_20_mg_tablets_10s_value'], ['brand'=>'COREX-DX COUGH SYRUP 100ML (IP)', 'slug'=>'corex_dx_cough_syrup_100ml_ip_units','pseudoId'=>'corex_dx_cough_syrup_100ml_ip_value'], ['brand'=>'COREX-DX COUGH SYRUP 50ML (IP)', 'slug'=>'corex_dx_cough_syrup_50ml_ip_units','pseudoId'=>'corex_dx_cough_syrup_50ml_ip_value'], ['brand'=>"Cpink 200ml", 'slug'=>'cpink_200ml_units','pseudoId'=>'cpink_200ml_value'], ['brand'=>"CPINK DROPS - 15ML", 'slug'=>'cpink_drops_15ml_units','pseudoId'=>'cpink_drops_15ml_value'], ['brand'=>'CPINK SUSPENSION - 150ML', 'slug'=>'cpink_suspension_150ml_units','pseudoId'=>'cpink_suspension_150ml_value'], ['brand'=>"FAROBACT 200", 'slug'=>'farobact_200_units','pseudoId'=>'farobact_200_value'], ['brand'=>"FAROBACT 200 TABS 1 x 10 S", 'slug'=>'farobact_200_tabs_1_x_10_s_units','pseudoId'=>'farobact_200_tabs_1_x_10_s_value'], ['brand'=>'Farobact 300 ER TABLETS', 'slug'=>'farobact_300_er_tablets_units','pseudoId'=>'farobact_300_er_tablets_value'], ['brand'=>"FAROBACT 300 ER TABS 10 S", 'slug'=>'farobact_300_er_tabs_10_s_units','pseudoId'=>'farobact_300_er_tabs_10_s_value'], /* ['brand'=>"Farobact Dry Syrup", 'slug'=>'farobact_dry_syrup_units','pseudoId'=>'farobact_dry_syrup_value'] ,*/ ['brand'=>'FLOMIST AQ. 100MD', 'slug'=>'flomist_aq_100md_units','pseudoId'=>'flomist_aq_100md_value'], ['brand'=>'Flomist F 240 MD', 'slug'=>'flomist_f_240_md_units','pseudoId'=>'flomist_f_240_md_value'], ['brand'=>"Flomist F 27.5 MCG 120 MD", 'slug'=>'flomist_f_275_mcg_120_md_units','pseudoId'=>'flomist_f_275_mcg_120_md_value'], ['brand'=>"IBUGESIC PLUS TABLETS 20'S", 'slug'=>'ibugesic_plus_tablets_20s_units','pseudoId'=>'ibugesic_plus_tablets_20s_value'], ['brand'=>"IBUGESIC PLUS TABLETS 20'S IP", 'slug'=>'ibugesic_plus_tablets_20s_ip_units','pseudoId'=>'ibugesic_plus_tablets_20s_ip_value'], ['brand'=>"OMNIX 100 D/S", 'slug'=>'omnix_100_ds_units','pseudoId'=>'omnix_100_ds_value'], ['brand'=>"OMNIX 100 DRY SYRUP", 'slug'=>'omnix_100_dry_syrup_units','pseudoId'=>'omnix_100_dry_syrup_value'], ['brand'=>'OMNIX 100 DT TAB', 'slug'=>'omnix_100_dt_tab_units','pseudoId'=>'omnix_100_dt_tab_value'], ['brand'=>"OMNIX 200 DT TAB", 'slug'=>'omnix_200_dt_tab_units','pseudoId'=>'omnix_200_dt_tab_value'], ['brand'=>"OMNIX 50 DRY SYRUP", 'slug'=>'omnix_50_dry_syrup_units','pseudoId'=>'omnix_50_dry_syrup_value'], ['brand'=>'OMNIX 50 DT', 'slug'=>'omnix_50_dt_units','pseudoId'=>'omnix_50_dt_value'], ['brand'=>'OMNIX CV 200 TAB', 'slug'=>'omnix_cv_200_tab_units','pseudoId'=>'omnix_cv_200_tab_value'], ['brand'=>"OMNIX O", 'slug'=>'omnix_o_units','pseudoId'=>'omnix_o_value'], ['brand'=>"Emeset 4 ODT/India/1 X 10'S", 'slug'=>'emeset_4_odtindia1_x_10s_units','pseudoId'=>'emeset_4_odtindia1_x_10s_value'], ['brand'=>"EMESET 4MG (10'S)", 'slug'=>'emeset_4mg_10s_units','pseudoId'=>'emeset_4mg_10s_value'], ['brand'=>"EMESET 8MG (10'S)", 'slug'=>'emeset_8mg_10s_units','pseudoId'=>'emeset_8mg_10s_value'], ['brand'=>"EMESET SYRUP", 'slug'=>'emeset_syrup_units','pseudoId'=>'emeset_syrup_value'], ['brand'=>'EMESET SYRUP STRAWBERRY 30 ML', 'slug'=>'emeset_syrup_strawberry_30_ml_units','pseudoId'=>'emeset_syrup_strawberry_30_ml_value'], ['brand'=>"OFLOX 100mg REDIUSE 60ML", 'slug'=>'oflox_100mg_rediuse_60ml_units','pseudoId'=>'oflox_100mg_rediuse_60ml_value'], ['brand'=>"OFLOX 200 TAB (10'S)", 'slug'=>'oflox_200_tab_10s_units','pseudoId'=>'oflox_200_tab_10s_value'], ['brand'=>"OFLOX 400 10'S", 'slug'=>'oflox_400_10s_units','pseudoId'=>'oflox_400_10s_value'], ['brand'=>'OFLOX 50MG REDIUSE 60ML', 'slug'=>'oflox_50mg_rediuse_60ml_units','pseudoId'=>'oflox_50mg_rediuse_60ml_value'], /* ['brand'=>"OFLOX EYE DROPS", 'slug'=>'oflox_eye_drops_units','pseudoId'=>'oflox_eye_drops_value'] ,*/ ['brand'=>"OFLOX OZ TABLETS IP", 'slug'=>'oflox_oz_tablets_ip_units','pseudoId'=>'oflox_oz_tablets_ip_value'], ['brand'=>"OFLOX REDIUSE", 'slug'=>'oflox_rediuse_units','pseudoId'=>'oflox_rediuse_value'], ['brand'=>"OFLOX-200 MG 10's TABLETS (IP)", 'slug'=>'oflox_200_mg_10s_tablets_ip_units','pseudoId'=>'oflox_200_mg_10s_tablets_ip_value'], ['brand'=>"OFLOX-400 MG 10's TABLETS (IP)", 'slug'=>'oflox_400_mg_10s_tablets_ip_units','pseudoId'=>'oflox_400_mg_10s_tablets_ip_value'], ['brand'=>'EMSET R 10 x 10 TABLETS', 'slug'=>'emset_r_10_x_10_tablets_units','pseudoId'=>'emset_r_10_x_10_tablets_value'], ['brand'=>"Montair AB Tablet", 'slug'=>'montair_ab_tablet_units','pseudoId'=>'montair_ab_tablet_value'], ['brand'=>"Pansec 80 MG Tablets", 'slug'=>'pansec_80_mg_tablets_units','pseudoId'=>'pansec_80_mg_tablets_value'], ['brand'=>"PANSEC D SR CAPSULES 15'S", 'slug'=>'pansec_d_sr_capsules_15s_units','pseudoId'=>'pansec_d_sr_capsules_15s_value'], ['brand'=>"PANSEC TABLETS 15'S", 'slug'=>'pansec_tablets_15s_units','pseudoId'=>'pansec_tablets_15s_value'], ['brand'=>"PANSEC-L CAPSULES", 'slug'=>'pansec_l_capsules_units','pseudoId'=>'pansec_l_capsules_value'] ]; @endphp @php $submissions = Formhelper::getMultiformData($form->partition, $form_id, $form->user_id); /* $submission = null; if(isset($submissions->data->submissions) && count($submissions->data->submissions) > 0) { $submission = $submissions->data->submissions[1]; $formdata = $submission->formdata ?? (object)[]; } else { $formdata = []; } */ $formdata = null; if (!empty($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)?$question->value:''}}"> @break @case('number') required == 'yes'?'required':'' }} value="{{isset($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	Units	Value
{{ $brand['brand'] }}

@break @endswitch

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

@endif

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