Rapport-Laravel/resources/views/form/rapport-team3/1764044541-2eaa1965-8a71-4c...

1533 lines
132 KiB
PHP

<!DOCTYPE html>
<html lang="en">
<head>
@include('layouts.shared/title-meta', ['title' => 'Form'])
@include('layouts.shared/head-css', ['mode' => $mode ?? '', 'demo' => $demo ?? ''])
<link href="{{ asset('assets/libs/sweetalert2/sweetalert2.min.css') }}" rel="stylesheet" type="text/css" />
<link href="{{ asset('assets/libs/select2/select2.min.css') }}" rel="stylesheet" type="text/css" />
</head>
<div id="pageloader">
<img src="http://cdnjs.cloudflare.com/ajax/libs/semantic-ui/0.16.1/images/loader-large.gif" alt="processing..." />
</div>
{{-- @php
echo "<pre>";
print_r($form);
print_r($questions);
exit;
@endphp --}}
<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="{{ $form_id }}">
<input type="hidden" id="field-copd_stockist_name" name="copd_stockist_name"
value="">
<input type="hidden" id="field-copd_stockist_code" name="copd_stockist_code"
value="">
<input type="hidden" id="field-tm_hq_detail" name="tm_hq_detail" value="">
@csrf
@if ($id)
<input type="hidden" name="id" value="{{ $id }}">
@endif
{{-- @if (isset($form->manager_can_submit) && $form->manager_can_submit == true) --}}
<div class="col-md-12 mb-2">
<label for="field-tm_name" class="form-label"> Select TM Name <span
class="text-danger">*</span> </label>
<select class="form-control" id="field-tm_name" name="tm_name" required>
<option value=""> -- Select -- </option>
@foreach ($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) ? $question->value : '' }}</textarea>
@break
@case('dropdown')
@if ($question->code == 'contact_id')
{{-- <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 == $option->value ? 'selected' : '' }}
{{ isset($option->contact->msl_code) ? 'msl_code= ' . $option->contact->msl_code . ' ' : '' }}
{{ $question->code == 'contact_id' ? 'speciality= ' . (isset($option->contact->speciality) ? $option->contact->speciality : '') . ' ' : '' }}>
{{ $option->display }}</option>
@endforeach
<option value="Other">Other</option>
</select> --}}
@elseif($question->code == 'stockists_name')
<select class="form-control" id="field-{{ $question->code }}"
name="{{ $question->code }}"
{{ $question->required == 'yes' ? 'required' : '' }}>
<option value=""> -- Select -- </option>
<option value="122213"> SVS (FMSPL) NEW [Code 122213]</option>
<option value="123864"> Vasu Agencies Drugs Pvt Ltd [Code 123864]
</option>
<option value="100236"> ARVIND PHARMA DISTRIBUTORS [Code 100236]
</option>
<option value="100548"> BALAJI MEDICAL AGENCIES [Code 100548]</option>
<option value="104364"> SRI VENKATESWARA PHARMACEUTICAL DIS [Code
104364]</option>
<option value="121849"> SHREEJI DISTRIBUTORS PHARMA PVT. [Code 121849]
</option>
<option value="121858"> PHARMA PLUS DISTRIBUTORS PVT... LTD [Code
121858]</option>
<option value="103475"> PATWARI PHARMA [Code 103475]</option>
<option value="104711"> VISHNU MEDICAL HALL [Code 104711]</option>
<option value="107816"> KANAKADHARA MEDI SALES [Code 107816]</option>
<option value="104308"> SHESHADRI PHARMA DISTRIBUTORS [Code 104308]
</option>
<option value="101023"> DIVYA PHARMA DISTRIBUTORS [Code 101023]
</option>
<option value="104295"> SRI ANJANI AGENCIES [Code 104295]</option>
<option value="120882"> M/S OPTIVAL HEALTH SOLUTIONS PVT..L [Code
120882]</option>
<option value="123062"> Tata 1mg Healthcare Solutions Pvt. [Code
123062]</option>
<option value="126322"> VENKATA KRISHNA ENTERPRISES PVT.LTD [Code
126322]</option>
<option value="112918"> SIDSON PHARMA DISTRIBUTORS (OR) [Code 112918]
</option>
<option value="112920"> SIDSON PHARMA DISTRIBUTORS (WB) [Code 112920]
</option>
<option value="115227"> Jaya Surgical And Pharma Pvt.. Ltd [Code
115227]</option>
<option value="104313"> SAI PHARMA DISTRIBUTOR Pvt..LTD [Code 104313]
</option>
<option value="101941"> JYOTI MEDICAL HALL [Code 101941]</option>
<option value="119076"> KEIMED PVT.. LTD [Code 119076]</option>
<option value="102763"> MARUTHI AGENCIES [Code 102763]</option>
<option value="119032"> REGSON HEALTH CARE [Code 119032]</option>
<option value="103474"> PRAKASH PHARMA DISTRIBUTORS [Code 103474]
</option>
<option value="115184"> Sri Balaji Drugs (Hyd) [Code 115184]</option>
<option value="104296"> SAI VASU AGENCIES [Code 104296]</option>
<option value="103724"> ROYAL MEDICAL HALL ( KRDY) [Code 103724]
</option>
<option value="126289"> V KAN PHARMA SOLUTIONS PVT.LTD. [Code 126289]
</option>
<option value="125188"> P.S. GLOBAL [Code 125188]</option>
<option value="112785"> SRI VASAVI PHARMA [Code 112785]</option>
<option value="113834"> SRI BALAJI MEDICAL DISTRIBUTORS [Code 113834]
</option>
<option value="113378"> SHANTHE SAI PHARMA [Code 113378]</option>
<option value="101244"> AUROBINDO DRUGS (GNT) [Code 101244]</option>
<option value="100017"> AUROBINDO DRUGS [Code 100017]</option>
<option value="120852"> M/S.OPTIVAL HEALTH SOLUTIONS PVT LT [Code
120852]</option>
<option value="110740"> PRUDHVI AGENCIES [Code 110740]</option>
<option value="102295"> LALITHA MEDICAL DISTRIBUTORS (PTH) [Code
102295]</option>
<option value="102297"> LAKSHMI SREEDHARA MEDICALS [Code 102297]
</option>
<option value="100240"> ANNAPOORNA MEDICALS [Code 100240]</option>
<option value="123231"> GOPI KRISHNA MEDICAL DISTRIBUTORS [Code 123231]
</option>
<option value="102772"> MADHU MEDICAL ENTERPRISES [Code 102772]
</option>
<option value="126752"> SRINIVASA PHARMA DISTRIBUTORS PVT L [Code
126752]</option>
<option value="121235"> POORNIMA MEDICAL AGENCIES Pvt Ltd. [Code
121235]</option>
<option value="102768"> MALLIKARJUNA MEDICAL CORPORATION [Code 102768]
</option>
<option value="104715"> VEE & VEE DISTRIBUTORS [Code 104715]</option>
<option value="141626"> SHAAN PHARMACEUTICALS [Code 141626]</option>
<option value="117210"> A.S. PHARMA PRIVATE LIMITED (T) [Code 117210]
</option>
<option value="102732"> MODERN PHARMA COMPANY [Code 102732]</option>
<option value="122963"> SASTASUNDAR HEALTHBUDDY LTD - GUWAH [Code
122963]</option>
<option value="101926"> JHARNA MEDICAL DISTRIBUTOR [Code 101926]
</option>
<option value="103452"> PRIYA MEDICAL AGENCY [Code 103452]</option>
<option value="103172"> NEW PURAN MEDICAL AGENCY [Code 103172]</option>
<option value="104117"> S. B. AGENCY [Code 104117]</option>
<option value="116190"> A P DISTRIBUTORS [Code 116190]</option>
<option value="117520"> LAKSHMI DRUG AGENCY [Code 117520]</option>
<option value="114409"> A. S. PHARMA Pvt. Ltd ( MAX ) [Code 114409]
</option>
<option value="125099"> AMAR MEDICAL STORES [Code 125099]</option>
<option value="107814"> ARKAY MEDICOS Pvt. Ltd. [Code 107814]</option>
<option value="110692"> D C AGENCIES PVT. LTD [Code 110692]</option>
<option value="100937"> D.R. DISTRIBUTORS PVT. LTD. [Code 100937]
</option>
<option value="120705"> Johar & Sons Healthcare (West) [Code 120705]
</option>
<option value="124089"> Neelkanth Pharma Logistics Pvt Ltd [Code
124089]</option>
<option value="126903"> NEELKANTH PHARMA LOGISTICSPvt.Ltd A [Code
126903]</option>
<option value="112568"> NOVACARE HEALTHCARE SOLUTIONS Pvt. [Code
112568]</option>
<option value="112825"> SANJEEVANI ENTERPRISES (North) [Code 112825]
</option>
<option value="103931"> SHREE KRISHNA INTERNATIONAL [Code 103931]
</option>
<option value="119140"> VINAYAK ENTERPRISES [Code 119140]</option>
<option value="103104"> NIDHI ASSOCIATES PVT LTD [Code 103104]</option>
<option value="103939"> SOUTH DELHI DISTRIBUTORS [Code 103939]</option>
<option value="101266"> GUPTA TRADERS [Code 101266]</option>
<option value="112703"> Ishwar Pharmaceuticals (East) [Code 112703]
</option>
<option value="122960"> SASTASUNDAR HEALTHBUDDY LTD - NOIDA [Code
122960]</option>
<option value="120702"> Johar & Sons Healthcare (North) [Code 120702]
</option>
<option value="120431"> Johar & Sons Healthcare [Code 120431]</option>
<option value="120703"> Johar & Sons Healthcare (East) [Code 120703]
</option>
<option value="116431"> SANJIVAN UNIVERSAL PHARMACEUTICALS [Code
116431]</option>
<option value="113384"> MEDILINK (North Delhi) [Code 113384]</option>
<option value="112827"> SANJEEVANI ENTERPRISES (WEST) [Code 112827]
</option>
<option value="126902"> NEELKANTH PHARMA LOGISTICS Pvt.Ltd [Code
126902]</option>
<option value="114514"> A S PHARMA Pvt. Ltd (MAX Noida ) [Code 114514]
</option>
<option value="111651"> CAP MEDICAL AGENCIES [Code 111651]</option>
<option value="101225"> ARIHANT FINE PHARMA AGENCY [Code 101225]
</option>
<option value="104097"> SAIBABA DISTRIBUTORS [Code 104097]</option>
<option value="104514"> TRUST PHARMA DISTRIBUTION [Code 104514]
</option>
<option value="124147"> DHRUVI HEALTHCARE PRIVATE LIMITED [Code 124147]
</option>
<option value="102040"> K.B. SHAH & CO. [Code 102040]</option>
<option value="123199"> LIFECARE MEDICAL AGENCY [Code 123199]</option>
<option value="123344"> JIVISHA HEALTHCARE AGENCY [Code 123344]
</option>
<option value="114326"> K RAJ & CO. ASU [Code 114326]</option>
<option value="100451"> BRAHAM RAJ & COMPANY [Code 100451]</option>
<option value="101287"> GYANDEEP ENTERPRISES [Code 101287]</option>
<option value="102253"> LOVELY MEDICAL AGENCY [Code 102253]</option>
<option value="102637"> MOOL CHAND MEDICAL & GEN. STORE [Code 102637]
</option>
<option value="103623"> RAJIV MEDICOSE [Code 103623]</option>
<option value="103968"> S.K.MEDICAL STORE [Code 103968]</option>
<option value="112455"> SANJEEVANI ENTERPRISES [Code 112455]</option>
<option value="112494"> NOVACARE HEALTHCARE SOLUTIONS P.LTD [Code
112494]</option>
<option value="114337"> MILLENNIUM MEDISOLUTIONS PVT. LTD [Code 114337]
</option>
<option value="114845"> HIND ENTERPRISES [Code 114845]</option>
<option value="122913"> VAMGUN HEALTHCARE (RTK) [Code 122913]</option>
<option value="105979"> SIYA ENTERPRISES [Code 105979]</option>
<option value="111747"> ARYAN WELLNESS PRIVATE LIMITED [Code 111747]
</option>
<option value="111001"> JUNEJA PHARMA [Code 111001]</option>
<option value="102641"> MAYANK MEDICAL AGENCIES [Code 102641]</option>
<option value="114140"> AKSHAR PHARMACEUTICALS (KNL) [Code 114140]
</option>
<option value="101549"> HARYANA PHARMA(FBD) [Code 101549]</option>
<option value="101276"> GANDHI MEDICAL HALL [Code 101276]</option>
<option value="113102"> BHUSHAN MEDICAL AGENCY [Code 113102]</option>
<option value="114471"> AKSHAR PHARMACEUTICALS (PNP) [Code 114471]
</option>
<option value="100086"> AGGARWAL MEDICAL AGENCY(JHAJJAR) [Code 100086]
</option>
<option value="109696"> MAHAVEER MEDISALES PRIVATE LIMITED [Code
109696]</option>
<option value="109649"> FOCUS MEDISALES PVT LTD YPR [Code 109649]
</option>
<option value="110261"> FOCUS MEDISALES PVT LTD [Code 110261]</option>
<option value="109913"> Rajsons Pharma Pvt Limited [Code 109913]
</option>
<option value="113647"> AVENUES PHARMA DISTRIBUTORS PVT.LTD [Code
113647]</option>
<option value="121227"> M/S. OPTIVAL HEALTH SOLUTIONS PVT L [Code
121227]</option>
<option value="122517"> TATA 1MG HEALTHCARE SOLUTIONS PVT L [Code
122517]</option>
<option value="103750"> R S M PHARMA P LTD. [Code 103750]</option>
<option value="120693"> VIMAL PHARMA(N) [Code 120693]</option>
<option value="102799"> MOHAN & CO. [Code 102799]</option>
<option value="102795"> MEHUL AGENCIES [Code 102795]</option>
<option value="124246"> VPI MEDISALES A UNIT OF ASCENT [Code 124246]
</option>
<option value="120529"> HINDUSTAN PHARMA DISTRIBUTORS PVT L [Code
120529]</option>
<option value="103761"> RAM AGENCIES PHARMA DISTRIBUTORS [Code 103761]
</option>
<option value="123962"> VARDHMAN MEDISALES PVT LTD [Code 123962]
</option>
<option value="123964"> VARDHMAN MEDISALES PVT LTD KRP [Code 123964]
</option>
<option value="123963"> VARDHMAN MEDISALES PVT LTD YPR [Code 123963]
</option>
<option value="100567"> VAMAN PHARMA Pvt LTD J.S.S.(60) [Code 100567]
</option>
<option value="104557"> TULSI PHARMA [Code 104557]</option>
<option value="100574"> VAMAN PHARMA Pvt LTD DIRECT SUPPL [Code 100574]
</option>
<option value="100585"> VAMAN PHARMA PVT.LTD., TUMKUR(60) [Code 100585]
</option>
<option value="100543"> BETA AGENCIES & PROJECTS PVT LTD., [Code
100543]</option>
<option value="102801"> MARUTI & CO., [Code 102801]</option>
<option value="104413"> SUPREME PHARMA [Code 104413]</option>
<option value="110373"> MAHENDRA DRUG AGENCIES [Code 110373]</option>
<option value="123033"> KADLIMATTI PHARMACEUTICALS [Code 123033]
</option>
<option value="140278"> M/s. FOCUS MEDISALES PVT LTD APOLLO [Code
140278]</option>
<option value="135894"> M/s. GUDDODGI PHARMACEUTICAL [Code 135894]
</option>
<option value="141374"> M/s GRANTRAIL WHOLESALE PVT LTD NW [Code
141374]</option>
<option value="113033"> GETWELL MEDICARE SOLUTION PVT. LTD. [Code
113033]</option>
<option value="104726"> VARGHESE & COMPANY [Code 104726]</option>
<option value="104406"> NEW SUJITH PHARMA [Code 104406]</option>
<option value="107860"> Thistle Healthcare India Pvt Ltd [Code 107860]
</option>
<option value="119520"> Western healthcare solutions Pvt. L [Code
119520]</option>
<option value="105617"> BIO PHARMA [Code 105617]</option>
<option value="107828"> VICTORY MEDICAL STORES (WHOLESALE) [Code
107828]</option>
<option value="119987"> Aswas Pharma [Code 119987]</option>
<option value="124398"> Medihauxe Pharmaceuticals Pvt. Ltd [Code
124398]</option>
<option value="113778"> SRI ENTERPRISES TIRUR [Code 113778]</option>
<option value="107801"> SREE CHITHRA ENTERPRISES [Code 107801]</option>
<option value="100271"> AVIGHNA ASSOCIATES CALICUT [Code 100271]
</option>
<option value="100704"> CITY DRUGS (PTC) [Code 100704]</option>
<option value="104401"> SANTHOSH MEDICALS [Code 104401]</option>
<option value="103489"> CHALAKUDY PRIYA PHARMA (P) LTD [Code 103489]
</option>
<option value="113235"> SRI ENTERPRISES [Code 113235]</option>
<option value="102786"> MANOJ PHARMACEUTICALS [Code 102786]</option>
<option value="104397"> SABARI SYNDICATE [Code 104397]</option>
<option value="100264"> AVIGHNA ASSOCIATES ERNAKULAM [Code 100264]
</option>
<option value="100699"> CANNANORE DRUG LINES [Code 100699]</option>
<option value="100257"> AVIGHNA ASSOCIATES TRIVANDRUM [Code 100257]
</option>
<option value="100258"> AVIGHNA ASSOCIATES KOLLAM [Code 100258]
</option>
<option value="100735"> KERALA MED SERVICES CORP LTD CLT [Code 100735]
</option>
<option value="113313"> SRI ENTERPRISES PGKD [Code 113313]</option>
<option value="117816"> MEDI PHARMA [Code 117816]</option>
<option value="121433"> VEE AND VEE AGENCIES [Code 121433]</option>
<option value="108920"> DADHA PHARMA DISTRIBUTION LIMITED [Code 108920]
</option>
<option value="100270"> AVIGHNA ASSOCIATES CANANNORE [Code 100270]
</option>
<option value="102790"> MATHEVAN AGENCIES (QLN) [Code 102790]</option>
<option value="103491"> PARAGON AGENCY [Code 103491]</option>
<option value="121221"> Medi Sync Healthcare pvt.Ltd Trive [Code
121221]</option>
<option value="112086"> CENTRAL AGENCIES [Code 112086]</option>
<option value="123626"> SREE PADMAM PHARMA AND AGENCIES [Code 123626]
</option>
<option value="104554"> TELY DRUGS [Code 104554]</option>
<option value="100702"> CLASSIC AGENCIES [Code 100702]</option>
<option value="120730"> Medi Sync Healthcare pvt.Ltd. [Code 120730]
</option>
<option value="125678"> ANANDHA PHARMACY PVT LTD [Code 125678]</option>
<option value="138268"> DEVI PHARMA WELLNESS PVT LTD [Code 138268]
</option>
<option value="141556"> MEDICOTRADE DISTRIBUTOR PRIVATE LIM [Code
141556]</option>
<option value="128219"> LEO PHARMA DISTRIBUTORS [Code 128219]</option>
<option value="127590"> KERALA TRADE WINGS,CALICUT [Code 127590]
</option>
<option value="113840"> AMRITLAL& BROTHERS [Code 113840]</option>
<option value="120009"> CRYSTAL MEDICINES PVT LTD [Code 120009]
</option>
<option value="105760"> EASTERN AGENCIES HEALTHCARE PVT.LTD [Code
105760]</option>
<option value="106928"> INDIAN DRUG DISTRIBUTORS Pvt. Ltd [Code 106928]
</option>
<option value="109967"> MILTON LIFECARE PVT LTD [Code 109967]</option>
<option value="103560"> RAHUL DISTRIBUTORS PVT LTD ( MS ) [Code 103560]
</option>
<option value="111094"> PHARMA PLUS [Code 111094]</option>
<option value="115540"> G S PHARMACEUTICAL DIST. PVT.LTD [Code 115540]
</option>
<option value="103236"> NORTH WEST PHARMA HUB [Code 103236]</option>
<option value="126565"> WELLNESS FOREVER MEDICARE LTD ( MS [Code
126565]</option>
<option value="112005"> SKITES PHARMA PVT. LTD JOGESHWARI [Code 112005]
</option>
<option value="102420"> MANOHAR AGENCIES [Code 102420]</option>
<option value="117273"> GALAXYSTAR PHARMA DISTRIBUTORS Pvt [Code
117273]</option>
<option value="122520"> TATA 1MG HEALTHCARE SOLUTIONS PVT.L [Code
122520]</option>
<option value="124097"> MEHER LIFECARE PVT.LTD. (BYCULL [Code 124097]
</option>
<option value="124116"> MEHER LIFECARE PVT.LTD. MS CH [Code 124116]
</option>
<option value="103803"> SUBURBAN DRUG DISTRIBUTORS [Code 103803]
</option>
<option value="110854"> SAI KRISHNA LIFESCIENCES [Code 110854]</option>
<option value="111770"> SKITES PHARMA Pvt. LTD [Code 111770]</option>
<option value="103306"> PIONEER DISTRIBUTORS [Code 103306]</option>
<option value="103558"> RAJA MEDICAL STORES [Code 103558]</option>
<option value="126262"> NEW WELCOME AGENCIES PVT LTD [Code 126262]
</option>
<option value="112528"> NOVACARE HEALTHCARE SOLN Pvt.LTD (M [Code
112528]</option>
<option value="124127"> MEHER LIFECARE PVT LTD (NAVI MUMBAI [Code
124127]</option>
<option value="101051"> DEEPALI DRUG DISTRIBUTORS [Code 101051]
</option>
<option value="121461"> D PLUS LIFE LLP [Code 121461]</option>
<option value="103278"> S. PARIKH PHARMA [Code 103278]</option>
<option value="121424"> JINOVA HEALTHCARE [Code 121424]</option>
<option value="121531"> JINOVA HEALTHCARE (TC) [Code 121531]</option>
<option value="121529"> JINOVA HEALTHCARE (MW) [Code 121529]</option>
<option value="120543"> AMEY DISTRIBUTORS [Code 120543]</option>
<option value="135107"> ANAHAD PHARMA PVT LTD [Code 135107]</option>
<option value="138341"> VIJAYPD CEUTICAL LTD [Code 138341]</option>
<option value="139312"> MEHAK PHARMA (NH RGD SPACT MEDICARE [Code
139312]</option>
<option value="140117"> K V PHARMA DISTRIBUTORS TRADE [Code 140117]
</option>
<option value="121528"> JINOVA HEALTHCARE (MS) [Code 121528]</option>
<option value="140177"> SHREE SIMBA CHEMIST A UNIT OF ASCEN [Code
140177]</option>
<option value="141505"> WEST COAST AGENCIES (A UNIT OF HIND [Code
141505]</option>
<option value="125068"> SACHIN ENTERPRISES [Code 125068]</option>
<option value="102030"> KANNU BROTHERS [Code 102030]</option>
<option value="103883"> SHEETAL AGENCIES [Code 103883]</option>
<option value="103891"> SHREE RADHE MEDICALS [Code 103891]</option>
<option value="111799"> ISHWAR AGENCIES [Code 111799]</option>
<option value="123272"> DCARE PHARMA (ASU ) [Code 123272]</option>
<option value="104511"> TRIMURTI SALES [Code 104511]</option>
<option value="100036"> AKASH MEDICOS [Code 100036]</option>
<option value="104625"> VIVEK MEDICAL STORES(CHQ) [Code 104625]
</option>
<option value="123221"> J. JASWANTLAL & BROTHERS,AGE.DEP.(A [Code
123221]</option>
<option value="126935"> SUYASH AGENCIES [Code 126935]</option>
<option value="100923"> Dhanwantari Medical Agencies (Jalga [Code
100923]</option>
<option value="116308"> Kundan Distributors Pvt. Ltd. [Code 116308]
</option>
<option value="119062"> TAPADIYA DISTRIBUTORS (Parvati) [Code 119062]
</option>
<option value="111211"> HOSPICARE AGENCIES (Asu) [Code 111211]</option>
<option value="104509"> Tapadiya Distributors (Asu) [Code 104509]
</option>
<option value="102022"> Kirti Agencies (A,bad) [Code 102022]</option>
<option value="102017"> Kumarpal Padmsi [Code 102017]</option>
<option value="109381"> MAHAVEER AGENCIES [Code 109381]</option>
<option value="103878"> SHAH ENTERPRISES [Code 103878]</option>
<option value="104624"> VENKATESH ENTERPRISES [Code 104624]</option>
<option value="102020"> KUNDAN AGENCY [Code 102020]</option>
<option value="121997"> Khandesh Medical Agency [Code 121997]</option>
<option value="100032"> A.S. ENTERPRISES [Code 100032]</option>
<option value="101223"> FRONTIER STORES JBL [Code 101223]</option>
<option value="101606"> INDER RAJ & COMPANY INDORE [Code 101606]
</option>
<option value="102437"> MEDICAL AND GENERAL TRADERS(JABALPU [Code
102437]</option>
<option value="103093"> NARESH MEDICALS (BHOPAL) [Code 103093]</option>
<option value="103290"> PATEL MEDICAL STORES (MANDSAUR) [Code 103290]
</option>
<option value="104839"> ZEE PHARMA(UJN) [Code 104839]</option>
<option value="122267"> NEW ASHA AGENCIES [Code 122267]</option>
<option value="103574"> RAJ MEDICAL AGENCIES (GWL) [Code 103574]
</option>
<option value="122592"> RAJESH SPECIALITIES PRIVATE LIMITED [Code
122592]</option>
<option value="113350"> BASANT MEDICAL STORES [Code 113350]</option>
<option value="113612"> DRUG N DEAL [Code 113612]</option>
<option value="107784"> ANANDSHREE MEDICOSE [Code 107784]</option>
<option value="113614"> SUDHIRA PHARMACEUTICALS [Code 113614]</option>
<option value="123439"> BASUDEV PHARMACEUTICALS [Code 123439]</option>
<option value="119514"> M/s RADHAKRISHNA AGENCIES [Code 119514]
</option>
<option value="106903"> ABLY ENTERPRISES [Code 106903]</option>
<option value="107419"> SANGEETA DISTRIBUTOR [Code 107419]</option>
<option value="109869"> MAA ASSOCIATES [Code 109869]</option>
<option value="100688"> CHANDUKA AGENCIES BBSR [Code 100688]</option>
<option value="115143"> C D ASSOCIATES [Code 115143]</option>
<option value="111124"> NARAYANI AGENCIES [Code 111124]</option>
<option value="101280"> GURU NANAK MEDICOS (P) LTD. [Code 101280]
</option>
<option value="119873"> EMCO AGENCIES [Code 119873]</option>
<option value="103119"> NEW NATIONAL DRUG HOUSE [Code 103119]</option>
<option value="113993"> Dikh Medical Agencies [Code 113993]</option>
<option value="121365"> SWAMI MEDISOLUTIONS PRIVATE LIMITE [Code
121365]</option>
<option value="102061"> KUL ENTERPRISES(RPR) [Code 102061]</option>
<option value="113486"> J P Pharma Solutions Pvt Ltd [Code 113486]
</option>
<option value="103347"> PANKAJ MEDICAL AGENCIES [Code 103347]</option>
<option value="102247"> LUXMI DISTRIBUTORS [Code 102247]</option>
<option value="103616"> MS R K SONS PHARMACEUTICALS DISTRIB [Code
103616]</option>
<option value="103946"> SHANKAR MEDICO [Code 103946]</option>
<option value="119899"> SAR PHARMACEUTICAL DISTRIBUTORS [Code 119899]
</option>
<option value="114973"> RADIANT ENTERPRISES [Code 114973]</option>
<option value="118941"> S M MEDICAL AGENCIES [Code 118941]</option>
<option value="118909"> Garg Pharmaceuticals [Code 118909]</option>
<option value="103257"> O P TRADERS [Code 103257]</option>
<option value="102052"> KHALSA MEDICAL AGENCY [Code 102052]</option>
<option value="135427"> RAJA BROTHERS PHARMACEUTICALS DISTR [Code
135427]</option>
<option value="101545"> HARI PHARMACEUTICALS [Code 101545]</option>
<option value="123580"> MITTAL PHARMA PRIVATE LIMITED [Code 123580]
</option>
<option value="102600"> RAJENDRA GENERAL STORE [Code 102600]</option>
<option value="141776"> DEEPMALA MEDICAL [Code 141776]</option>
<option value="116178"> M/S RADA MEDISOLUTIONS PVT LTD [Code 116178]
</option>
<option value="125768"> SHREE AMMAN PHARMA INDIA PRIVATE LI [Code
125768]</option>
<option value="105739"> R.K.PHARMA DISTRIBUTORS [Code 105739]</option>
<option value="101360"> SHRI GANESH ASSOCIATES(REG) [Code 101360]
</option>
<option value="104260"> SHRI BHAKTI MEDICALS AGENCIES PVT L [Code
104260]</option>
<option value="124441"> Palepu Pharma Distributors Private [Code
124441]</option>
<option value="121111"> OPTIVAL HEALTH SOLUTIONS PVT LTD [Code 121111]
</option>
<option value="104691"> SHANKARA MEDICINES PVT.LTD., [Code 104691]
</option>
<option value="103467"> M/S, PARM HOUSE [Code 103467]</option>
<option value="106927"> CHANDRAN ENTERPRISES [Code 106927]</option>
<option value="108171"> AADITYA PHARMEX [Code 108171]</option>
<option value="107701"> SREE SAI ENTERPRISES [Code 107701]</option>
<option value="102750"> SRI MURUGAN AGENCIES CHIDAMBARAM [Code 102750]
</option>
<option value="124451"> Muthu Pharma(A unit of Ascent Welln [Code
124451]</option>
<option value="116487"> YOGIRAM DISTRIBUTORS PVT LTD [Code 116487]
</option>
<option value="143459"> MARINAMEDS [Code 143459]</option>
<option value="143608"> SHRI GANESH ASSOCIATES PHARMA PVT L [Code
143608]</option>
<option value="110912"> MEDILINE AGENCIES (COIMBATORE) [Code 110912]
</option>
<option value="113668"> S P MEDITECH Pvt.. Ltd.. [Code 113668]</option>
<option value="121676"> KNK AGENCIES [Code 121676]</option>
<option value="124390"> Palepu Pharma Distributors pvt..ltd [Code
124390]</option>
<option value="113951"> VASAVI MEDICARE SOLUTIONS PVT..LTD. [Code
113951]</option>
<option value="104234"> SRI MEENACHI AGENCIES(MADURAI) [Code 104234]
</option>
<option value="112266"> SELVARATHNA AGENCIES [Code 112266]</option>
<option value="101937"> JOSEPH PHARMACEUTICAL(NAGERCOIL) [Code 101937]
</option>
<option value="124436"> MEDILINE AGENCIES SALEM [Code 124436]</option>
<option value="103715"> RATHNA AGENCIES Madurai [Code 103715]</option>
<option value="121693"> KNK AGENCIES TNJ [Code 121693]</option>
<option value="104240"> MEENA MEDICAL AGENCIES (TRICHY) [Code 104240]
</option>
<option value="104280"> SILVER MEDICALS [Code 104280]</option>
<option value="123304"> NISHITA MEDICARE PVT...LTD.. [Code 123304]
</option>
<option value="141373"> THULASI PHARMACIES INDIA Pvt..Ltd.. [Code
141373]</option>
<option value="111009"> MEDILINE AGENCIES (NAMAKKAL) [Code 111009]
</option>
<option value="118645"> YASH ENTERPRISES [Code 118645]</option>
<option value="112137"> NAVAANYA HEALTHCARE (ASU BLY) [Code 112137]
</option>
<option value="113798"> RUDRAPUR DRUG HOUSE (RDP) [Code 113798]
</option>
<option value="121218"> MADHAV KRIPA AGENCIES [Code 121218]</option>
<option value="100465"> B.R.ENTERPRISES AGENCIES CE [Code 100465]
</option>
<option value="102259"> L.K. DRUG HOUSE [Code 102259]</option>
<option value="112125"> NAVAANYA HEALTHCARE (ASU NOIDA) [Code 112125]
</option>
<option value="125677"> NEELKANTH PHARMA LOGISTICS PVT. LTD [Code
125677]</option>
<option value="104084"> SUN RAYS PHARMA (ASU) (CE) [Code 104084]
</option>
<option value="104048"> SATYAM DISTRIBUTORS (RT) [Code 104048]</option>
<option value="123227"> GOOD LUCK MEDICOS (N) [Code 123227]</option>
<option value="105637"> MEDWIN PHARMACEUTICALS PVT. LTD. [Code 105637]
</option>
<option value="103363"> PEE KAY PHARMA CE [Code 103363]</option>
<option value="103982"> SHREE MARUTI NANDAN PHARMACEUTICALS [Code
103982]</option>
<option value="104656"> VIKAS PHARMA AGENCIES MEERUT (CE) [Code 104656]
</option>
<option value="112025"> NAVAANYA HEALTHCARE (ASU GZB) [Code 112025]
</option>
<option value="103551"> QUALITY MEDICINE COMPANY (CE) [Code 103551]
</option>
<option value="127177"> SANSKRITI ENTERPRISES [Code 127177]</option>
<option value="108949"> BANSI MEDICINE AGENCY (New) [Code 108949]
</option>
<option value="113919"> KMA PHARMA PVT. LTD (NOIDA) [Code 113919]
</option>
<option value="100302"> AMIT MEDICAL AGENCIES MZN CE [Code 100302]
</option>
<option value="127234"> SANSKRITI ENTERPRISES MBD [Code 127234]
</option>
<option value="101208"> ESKAY MEDICINE COMPANY (CE) [Code 101208]
</option>
<option value="104089"> SHREE RAM DRUG AGENCIES (CE) [Code 104089]
</option>
<option value="103992"> SUN RAYS PHARMA (CE) [Code 103992]</option>
<option value="139906"> RENU MEDICAL AGENCIES [Code 139906]</option>
<option value="127938"> SANSKRITI ENTERPRISES HLD [Code 127938]
</option>
<option value="138084"> VINAYAK ENTERPRISES HRD [Code 138084]</option>
<option value="108725"> NEW JITENDRA AND SONS MEDICAL STORE [Code
108725]</option>
<option value="100163"> AGARWAL MEDICAL AGENCIES, ( BAHRAIC [Code
100163]</option>
<option value="101318"> GOVIND AGENCIES [Code 101318]</option>
<option value="104671"> VIJAY DISTRIBUTOR KANPUR [Code 104671]</option>
<option value="115261"> ARNOVA HEALTHCARE (LKN) [Code 115261]</option>
<option value="118842"> MODERN MEDICAL AGENCIES (GKP) [Code 118842]
</option>
<option value="121327"> B.K.DISTRIBUTORS (HRD) [Code 121327]</option>
<option value="121402"> SANGEETA & SONS [Code 121402]</option>
<option value="122925"> S.S. PHARMA TRADERS PVT LTD [Code 122925]
</option>
<option value="120699"> SRI BALAJI DISTRIBUTOR (UNO) [Code 120699]
</option>
<option value="103635"> RASTOGI DRUG AGENCIES(FZB) [Code 103635]
</option>
<option value="112811"> MAN ENTERPRISES [Code 112811]</option>
<option value="105719"> S.G.P.G.I. OF MEDICAL SCIENCE (LKO) [Code
105719]</option>
<option value="100120"> AGARWAL PHARMA , LUCKNOW [Code 100120]</option>
<option value="101230"> FRIENDS MEDICAL STORES [Code 101230]</option>
<option value="111235"> SHREE HARI ENTERPRISES [Code 111235]</option>
<option value="100149"> AGARWAL TRADERS [Code 100149]</option>
<option value="109363"> MADHU MEDISALES [Code 109363]</option>
<option value="114162"> JAI MAA DURGE MEDICAL AGENCIES [Code 114162]
</option>
<option value="102085"> KARAN PHARMA [Code 102085]</option>
<option value="100126"> AGARWAL MEDICAL STORE(RBL) [Code 100126]
</option>
<option value="122502"> S.G.MEDICINE [Code 122502]</option>
<option value="111913"> K.G.M.U. HRF [Code 111913]</option>
<option value="139790"> SHRI VISHWANATH MEDICAL AGENCY [Code 139790]
</option>
<option value="107462"> ARYAN PHARMA [Code 107462]</option>
<option value="122929"> S S PHARMA TRADERS PVT. LTD. [Code 122929]
</option>
<option value="122930"> S S PHARMA TRADERS PVT.LTD. [Code 122930]
</option>
<option value="123424"> LALITA & COMPANY [Code 123424]</option>
<option value="103145"> NITIN CHEMISTALLAHABAD [Code 103145]</option>
<option value="122978"> S S PHARMA TRADERS PVT. LTD.(AZM) [Code 122978]
</option>
<option value="122980"> S S PHARMA TRADERS PVT. LTD.(MAU) [Code 122980]
</option>
<option value="102686"> MEDICO & SURGICO VARANASI [Code 102686]
</option>
<option value="100484"> BHARAT MEDICAL AGENCY BALLIA [Code 100484]
</option>
<option value="126217"> LAZZ MEDICO Pvt.. LTD [Code 126217]</option>
<option value="110592"> M/S ALLIED [Code 110592]</option>
<option value="102273"> M.S. LIFE DRUG HOUSE PV.T LTD [Code 102273]
</option>
<option value="110364"> GHOSH MEDICAL AGENCY [Code 110364]</option>
<option value="112748"> N.R.PHARMACEUTICALS PVT.LTD. [Code 112748]
</option>
<option value="102710"> MALATI ENTERPRISE [Code 102710]</option>
<option value="121678"> M/S PEOPLES AGENCIES [Code 121678]</option>
<option value="113496"> NU SRI SHYAM PHARMACEUTICALS PVT. L [Code
113496]</option>
<option value="100507"> BASU PHARMACEUTICALS [Code 100507]</option>
<option value="110036"> KAUSHAL PHARMACEUTICALS PVT LTD [Code 110036]
</option>
<option value="107633"> SOUTHEND PHARMA Pvt. LTD [Code 107633]</option>
<option value="122958"> SASTASUNDAR HEALTHBUDDY LTD KOLKA [Code 122958]
</option>
<option value="100993"> DAS MEDICAL AGENCY [Code 100993]</option>
<option value="113147"> M/s Paul Pharmaceuticals [Code 113147]</option>
<option value="107691"> NIRAMAY DISTRIBUTORS PVT LTD [Code 107691]
</option>
<option value="107670"> KING ENTERPRISE [Code 107670]</option>
<option value="110457"> A.C.DISTRIBUTORS [Code 110457]</option>
<option value="101930"> JHANWAR MEDICAL STORES [Code 101930]</option>
<option value="107684"> MEDI WORLD [Code 107684]</option>
<option value="120684"> NEXT GEN PHARMA HWRH [Code 120684]</option>
<option value="125267"> M/s Aarush Tirupati Enterprise_KOL_ [Code
125267]</option>
<option value="120518"> MA TARA AGENCY [Code 120518]</option>
<option value="139913"> HAJRA MEDICAL AGENCY Pvt. Ltd [Code 139913]
</option>
<option value="140383"> M/S THE BRIGHT MEDICAL AGENCY [Code 140383]
</option>
<option value="143029"> M/S SUREMED BENGAL DISTRIBUTORS [Code 143029]
</option>
<option value="143374"> PHARMACY WHOLESALE DIVISION_KOL_PHA [Code
143374]</option>
<option value="143319"> M/S RAJESH MEDICAL PVt Ltd [Code 143319]
</option>
<option value="126113"> SAHA ENTERPRISE [Code 126113]</option>
<option value="121858"> PHARMA PLUS DISTRIBUTORS PVT... LTD [Code
121858]</option>
<option value="119032"> REGSON HEALTH CARE [Code 119032]</option>
<option value="111752"> KALYANI HEALTH PLUS [Code 111752]</option>
<option value="111789"> M/S.KALYANI HEALTH PLUS (NLR) [Code 111789]
</option>
<option value="100414"> AUROBINDO DRUGS (ELURU) [Code 100414]</option>
<option value="100017"> AUROBINDO DRUGS [Code 100017]</option>
<option value="101244"> AUROBINDO DRUGS (GNT) [Code 101244]</option>
<option value="125958"> VIRAJ ENTERPRISES [Code 125958]</option>
<option value="110402"> KING ENTERPRISE (PTN) [Code 110402]</option>
<option value="112173"> AAR AAR Healthcare (South) [Code 112173]
</option>
<option value="120705"> Johar & Sons Healthcare (West) [Code 120705]
</option>
<option value="112568"> NOVACARE HEALTHCARE SOLUTIONS Pvt. [Code
112568]</option>
<option value="112825"> SANJEEVANI ENTERPRISES (North) [Code 112825]
</option>
<option value="114912"> SANJEEVANI ENTERPRISES (North) DLH [Code
114912]</option>
<option value="103603"> R.K PHARMA [Code 103603]</option>
<option value="123313"> LIFECARE MEDICAL AGENCY ( NAVSARI ) [Code
123313]</option>
<option value="124147"> DHRUVI HEALTHCARE PRIVATE LIMITED [Code 124147]
</option>
<option value="123344"> JIVISHA HEALTHCARE AGENCY [Code 123344]
</option>
<option value="112455"> SANJEEVANI ENTERPRISES [Code 112455]</option>
<option value="112494"> NOVACARE HEALTHCARE SOLUTIONS P.LTD [Code
112494]</option>
<option value="122913"> VAMGUN HEALTHCARE (RTK) [Code 122913]</option>
<option value="110151"> Medi Zone Pharma [Code 110151]</option>
<option value="113778"> SRI ENTERPRISES TIRUR [Code 113778]</option>
<option value="113779"> SRI ENTERPRISES PERINTHALMANNA [Code 113779]
</option>
<option value="109967"> MILTON LIFECARE PVT LTD [Code 109967]</option>
<option value="109880"> SAINATH AGENCIES PHARMA Pvt. LTD [Code 109880]
</option>
<option value="104471"> SHREEJI DISTRIBUTORS PHARMA PVT [Code 104471]
</option>
<option value="123272"> DCARE PHARMA (ASU ) [Code 123272]</option>
<option value="102032"> KUNDAN AGENCY (ASU) [Code 102032]</option>
<option value="121789"> ANILA MEDICAL PRIVATE LIMITED [Code 121789]
</option>
<option value="101280"> GURU NANAK MEDICOS (P) LTD. [Code 101280]
</option>
<option value="102061"> KUL ENTERPRISES(RPR) [Code 102061]</option>
<option value="102062"> KUL ENTERPRISES(LDH) [Code 102062]</option>
<option value="102067"> KUL ENTERPRISES(BTD) [Code 102067]</option>
<option value="125759"> KRISHNAVI PHARMA [Code 125759]</option>
<option value="109176"> AUSHADH DISTRIBUTORS [Code 109176]</option>
<option value="123994"> DHRUVI HEALTHCARE PRIVATE LIMITED [Code 123994]
</option>
<option value="102907"> MEDPRO AGENCIES PVT LTD (TIRUVANNAM [Code
102907]</option>
<option value="102908"> MEDPRO AGENCIES PVT LTD [Code 102908]</option>
<option value="110912"> MEDILINE AGENCIES (COIMBATORE) [Code 110912]
</option>
<option value="121676"> KNK AGENCIES [Code 121676]</option>
<option value="102895"> MEDPRO AGENCIES (MADURAI) [Code 102895]
</option>
<option value="126818"> SHIV SHAKTI HEALTHCARE [Code 126818]</option>
<option value="112137"> NAVAANYA HEALTHCARE (ASU BLY) [Code 112137]
</option>
<option value="112125"> NAVAANYA HEALTHCARE (ASU NOIDA) [Code 112125]
</option>
<option value="115261"> ARNOVA HEALTHCARE (LKN) [Code 115261]</option>
<option value="111094"> PHARMA PLUS [Code 111094]</option>
<option value="122925"> S.S. PHARMA TRADERS PVT LTD [Code 122925]
</option>
<option value="123362"> ADMED HEALTHCARE(MAU) [Code 123362]</option>
<option value="121801"> PRIMEX HEALTHCARE [Code 121801]</option>
<option value="122929"> S S PHARMA TRADERS PVT. LTD. [Code 122929]
</option>
<option value="109466"> SOUTHEND PHARMA PVT LTD [Code 109466]</option>
<option value="114141"> AKSHAR PHARMACEUTICALS (HSR) [Code 114141]
</option>
<option value="114958"> AKSHAR PHARMACEUTICALS (PKL) [Code 114958]
</option>
<option value="114471"> AKSHAR PHARMACEUTICALS (PNP) [Code 114471]
</option>
<option value="114142"> AKSHAR PHARMACEUTICALS (AMB) [Code 114142]
</option>
<option value="114140"> AKSHAR PHARMACEUTICALS (KNL) [Code 114140]
</option>
<option value="121181"> Medi Sync Healthcare pvt.Ltd KTM [Code 121181]
</option>
<option value="124116"> MEHER LIFECARE PVT.LTD. MS CH [Code 124116]
</option>
<option value="124119"> MEHER LIFECARE PVT.LTD. ( TC-CH [Code 124119]
</option>
<option value="124121"> MEHER LIFECARE PVT LTD ( MW-NH-MA) [Code
124121]</option>
<option value="124133"> MEHER LIFECARE Pvt Ltd (TW-NH-SNP) [Code
124133]</option>
<option value="112528"> NOVACARE HEALTHCARE SOLN Pvt.LTD (M [Code
112528]</option>
<option value="112530"> NOVACARE HEALTHCARE SOLN Pvt.LTD (M [Code
112530]</option>
<option value="112538"> NOVACARE HEALTHCARE SOLN Pvt.LTD (N [Code
112538]</option>
<option value="124124"> MEHER LIFECARE Pvt LTD MW NH RUSHI [Code
124124]</option>
<option value="111211"> HOSPICARE AGENCIES (Asu) [Code 111211]</option>
<option value="112043"> AUSHADH DISTRIBUTORS (JODHPUR) [Code 112043]
</option>
<option value="113639"> AUSHADH DISTRIBUTORS KOTA (NEW) [Code 113639]
</option>
<option value="119140"> VINAYAK ENTERPRISES [Code 119140]</option>
<option value="107633"> SOUTHEND PHARMA Pvt. LTD [Code 107633]</option>
<option value="112502"> NOVACARE HEALTHCARE SOLUTIONS P.LTD [Code
112502]</option>
<option value="119230"> NOVACARE HEALTHCARE SOLUTIONS P.LTD [Code
119230]</option>
<option value="100271"> AVIGHNA ASSOCIATES CALICUT [Code 100271]
</option>
<option value="123491"> CHINI AGENCIES (KANPUR) [Code 123491]</option>
<option value="123361"> ADMED HEALTHCARE (BALLIA) [Code 123361]
</option>
<option value="107670"> KING ENTERPRISE [Code 107670]</option>
<option value="122324"> REGSON HEALTH CARE (W) NEW [Code 122324]
</option>
<option value="113235"> SRI ENTERPRISES [Code 113235]</option>
<option value="104509"> Tapadiya Distributors (Asu) [Code 104509]
</option>
<option value="122075"> PRIMEX HEALTHCARE BHADOHI [Code 122075]
</option>
<option value="122694"> ADMED HEALTHCARE [Code 122694]</option>
<option value="122779"> ADMED HEALTHCARE (PTG) [Code 122779]</option>
<option value="124129"> MEHER LIFECARE PVT. LTD (PUNE APOLL [Code
124129]</option>
<option value="121424"> JINOVA HEALTHCARE [Code 121424]</option>
<option value="121529"> JINOVA HEALTHCARE (MW) [Code 121529]</option>
<option value="124100"> MEHER LIFECARE PVT LTD (MC-NH-AA) [Code 124100]
</option>
<option value="120702"> Johar & Sons Healthcare (North) [Code 120702]
</option>
<option value="122699"> Johar & Sons Healthcare (Stephen) [Code 122699]
</option>
<option value="122616"> Chintamani Medical Agency [Code 122616]
</option>
<option value="123199"> LIFECARE MEDICAL AGENCY [Code 123199]</option>
<option value="111010"> MEDILINE AGENCIES (DHARMAPURI) [Code 111010]
</option>
<option value="124436"> MEDILINE AGENCIES SALEM [Code 124436]</option>
<option value="122935"> S.S. PHARMA TRADERS PVT LTD BAHRAIC [Code
122935]</option>
<option value="112869"> AAR AAR HEALTHCARE (BATRA) [Code 112869]
</option>
<option value="112560"> Novacare Healthcare Solutions Pvt. [Code
112560]</option>
<option value="121790"> ANILA MEDICAL PRIVATE LIMITED (BPL) [Code
121790]</option>
<option value="102605"> MODERN DRUG DISTRIBUTORS [Code 102605]</option>
<option value="112559"> NOVACARE HEALTHCARE SOLUTIONS Pvt. [Code
112559]</option>
<option value="123131"> EAST DRUG MARCHANTS PVT. LTD. [Code 123131]
</option>
<option value="122930"> S S PHARMA TRADERS PVT.LTD. [Code 122930]
</option>
<option value="120431"> Johar & Sons Healthcare [Code 120431]</option>
<option value="111284"> KING ENTERPRISE PURNIA [Code 111284]</option>
<option value="100257"> AVIGHNA ASSOCIATES TRIVANDRUM [Code 100257]
</option>
<option value="100258"> AVIGHNA ASSOCIATES KOLLAM [Code 100258]
</option>
<option value="100264"> AVIGHNA ASSOCIATES ERNAKULAM [Code 100264]
</option>
<option value="100265"> AVIGHNA ASSOCIATES KOTTAYAM [Code 100265]
</option>
<option value="100270"> AVIGHNA ASSOCIATES CANANNORE [Code 100270]
</option>
<option value="100266"> AVIGHNA ASSOCIATES MANJERY [Code 100266]
</option>
<option value="100267"> AVIGHNA ASSOCIATES TRUR [Code 100267]</option>
<option value="111941"> AVIGHNA ASSOCIATES PERINTHALMANNA [Code 111941]
</option>
<option value="126599"> MAA TARA ENTERPRISES [Code 126599]</option>
<option value="126149"> VIRAJ ENTERPRISES SAMASTIPUR [Code 126149]
</option>
<option value="120703"> Johar & Sons Healthcare (East) [Code 120703]
</option>
<option value="112527"> NOVACARE HEALTHCARE SOLN Pvt.LTD (M [Code
112527]</option>
<option value="124127"> MEHER LIFECARE PVT LTD (NAVI MUMBAI [Code
124127]</option>
<option value="112109"> NAVAANYA HEALTHCARE (ASU MRT) [Code 112109]
</option>
<option value="111235"> SHREE HARI ENTERPRISES [Code 111235]</option>
<option value="113227"> AUROBINDO DRUGS (RAJAHMUNDRY) [Code 113227]
</option>
<option value="121221"> Medi Sync Healthcare pvt.Ltd Trive [Code
121221]</option>
<option value="113610"> AUSHADH DISTRIBUTORS (UDAIPUR) [Code 113610]
</option>
<option value="112025"> NAVAANYA HEALTHCARE (ASU GZB) [Code 112025]
</option>
<option value="121847"> PHARMA PLUS DISTRIBUTORS PVT... LTD [Code
121847]</option>
<option value="112293"> KALYANI HEALTH PLUS (ATP) [Code 112293]
</option>
<option value="100567"> VAMAN PHARMA Pvt LTD J.S.S.(60) [Code 100567]
</option>
<option value="102063"> KUL ENTERPRISES (JAL) [Code 102063]</option>
<option value="102069"> KUL ENTERPRISES (ASR) [Code 102069]</option>
<option value="112396"> NAVAANYA HEALTHCARE (ASU MATHURA) [Code 112396]
</option>
<option value="125942"> PREM ENTERPRISES [Code 125942]</option>
<option value="104612"> AUROBINDO DRUGS (VSP) [Code 104612]</option>
<option value="112827"> SANJEEVANI ENTERPRISES (WEST) [Code 112827]
</option>
<option value="113313"> SRI ENTERPRISES PGKD [Code 113313]</option>
<option value="126848"> AIOCD PHARMA LTD-TC-NH-SK [Code 126848]
</option>
<option value="124120"> MEHER LIFECARE PVT LTD ( MW-NH-RM) [Code
124120]</option>
<option value="112526"> NOVACARE HEALTHCARE SOLN Pvt.LTD (A [Code
112526]</option>
<option value="114901"> VAMAN PHARMA Pvt LTD HCG KOLKATTA [Code 114901]
</option>
<option value="100585"> VAMAN PHARMA PVT.LTD., TUMKUR(60) [Code 100585]
</option>
<option value="100574"> VAMAN PHARMA Pvt LTD DIRECT SUPPL [Code 100574]
</option>
<option value="120730"> Medi Sync Healthcare pvt.Ltd. [Code 120730]
</option>
<option value="127177"> SANSKRITI ENTERPRISES [Code 127177]</option>
<option value="112536"> NOVACARE HEALTHCARE SOLN Pvt.LTD (T [Code
112536]</option>
<option value="126875"> Sanvedana Health Care Pvt Ltd (Asu) [Code
126875]</option>
<option value="121531"> JINOVA HEALTHCARE (TC) [Code 121531]</option>
<option value="127357"> MEHAK PHARMA ASU [Code 127357]</option>
<option value="101575"> VAMAN PHARMA Pvt... LTD HUBLI [Code 101575]
</option>
<option value="100578"> VAMAN PHARMA Pvt. LTD.,SMG(60) [Code 100578]
</option>
<option value="114904"> VAMAN PHARMA Pvt LTD HCG HUBLI [Code 114904]
</option>
<option value="115045"> ARNOVA HEALTHCARE (RBL) [Code 115045]</option>
<option value="124118"> MEHER LIFECARE PVT LTD MC CH [Code 124118]
</option>
<option value="124126"> MEHER LIFECARE Pvt. LTD (NASHIK APO [Code
124126]</option>
<option value="119262"> KUL ENTERPRISES(KANGRA) [Code 119262]</option>
<option value="100263"> AVIGHNA ASSOCIATES MOOVATTUPUZHA [Code 100263]
</option>
<option value="122971"> S S PHARMA TRADERS PVT.LTD.(SLT) [Code 122971]
</option>
<option value="118565"> KUNDAN DISTRIBUTORS PVT LTD (ASU) [Code 118565]
</option>
<option value="100268"> AVIGHNA ASSOCIATES PALAKKAD [Code 100268]
</option>
<option value="121693"> KNK AGENCIES TNJ [Code 121693]</option>
<option value="114303"> AKSHAR PHARMACEUTICALS (YNR) [Code 114303]
</option>
<option value="126955"> M/s. Medibel Healthcare Pvt Ltd [Code 126955]
</option>
<option value="112537"> NOVACARE HEALTHCARE SOLN Pvt.LTD (T [Code
112537]</option>
<option value="109175"> MAHARASHTRA SAFE CHEMISTS AND DIST [Code
109175]</option>
<option value="123999"> VAMGUN HEALTHCARE (FBD) [Code 123999]</option>
<option value="107782"> SOUTHEND PHARMA [Code 107782]</option>
<option value="109881"> SAINATH AGENCIES PHARMA PVT LTD [Code 109881]
</option>
<option value="110507"> KING ENTERPRISE (Siliguri) [Code 110507]
</option>
<option value="114326"> K RAJ & CO. ASU [Code 114326]</option>
<option value="124122"> MEHER LIFECARE PVT LTD ( MC-NH-KE) [Code
124122]</option>
<option value="125584"> KNK AGENCIES TIRUNELVELI [Code 125584]</option>
<option value="112126"> M/S.KALYANI HEALTH PLUS (KDP) [Code 112126]
</option>
<option value="122972"> S S PHARMA TRADERS PVT. LTD.(BALLIA [Code
122972]</option>
<option value="100580"> VAMAN PHARMA Pvt LTD KOLAR(60) [Code 100580]
</option>
<option value="127234"> SANSKRITI ENTERPRISES MBD [Code 127234]
</option>
<option value="126847"> AIOCD PHARMA LTD-TC-NH-SLM [Code 126847]
</option>
<option value="112567"> Novacare Healthcare Solutions Pvt.L [Code
112567]</option>
<option value="123269"> EAST DRUG MARCHANTS PVT. LTD DURGAP [Code
123269]</option>
<option value="123265"> EAST DRUG MARCHANTS PVT. LTD BERHAM [Code
123265]</option>
<option value="138205"> VRS ENTERPRISES [Code 138205]</option>
<option value="111308"> KING ENTERPRISE DBG [Code 111308]</option>
<option value="139315"> MAANVAR HEALTHCARE [Code 139315]</option>
<option value="122977"> S S PHARMA TRADERS PVT.LTD.(PTG) [Code 122977]
</option>
<option value="126921"> Sanvedana Healthcare Pvt. Ltd (Sata [Code
126921]</option>
<option value="102070"> KUL ENTERPRISES(HSP) [Code 102070]</option>
<option value="122978"> S S PHARMA TRADERS PVT. LTD.(AZM) [Code 122978]
</option>
<option value="123363"> ADMED HEALTHCARE(AZM) [Code 123363]</option>
<option value="127443"> VAMGUN HEALTHCARE (PKL) [Code 127443]</option>
<option value="122974"> S S PHARMA TRADERS PVT. LTD.(GHAZIP [Code
122974]</option>
<option value="121796"> ANILA MEDICAL PRIVATE LIMITED (MND) [Code
121796]</option>
<option value="114914"> SANJEEVANI ENTERPRISES (EAST) DLH [Code 114914]
</option>
<option value="111232"> AAR AAR Healthcare [Code 111232]</option>
<option value="111012"> MEDILINE AGENCIES (HOSUR) [Code 111012]
</option>
<option value="110339"> PRAAFUSION ENTERPRISES [Code 110339]</option>
<option value="108912"> SHREEJI DISTRIBUTORS PHARMA PVT [Code 108912]
</option>
<option value="123221"> J. JASWANTLAL & BROTHERS,AGE.DEP.(A [Code
123221]</option>
<option value="127942"> SANSKRITI ENTERPRISES KSH [Code 127942]
</option>
<option value="112394"> NAVAANYA HEALTHCARE (ASU HAPUR) [Code 112394]
</option>
<option value="124098"> MEHER LIFECARE Pvt LTD C H [Code 124098]
</option>
<option value="124138"> MEHER LIFECARE PVT.LTD TC NH VP [Code 124138]
</option>
<option value="100583"> VAMAN PHARMA PVT LTD DAVANGERE [Code 100583]
</option>
<option value="109882"> SAINATH AGENCIES (PHARMA) PVT LTD [Code 109882]
</option>
<option value="124135"> MEHER LIFECARE PVT. LTD MC NH MD [Code 124135]
</option>
<option value="112108"> NAVAANYA HEALTHCARE (ASU MBD) [Code 112108]
</option>
<option value="126272"> PREM ENTERPRISES (BOKARO) [Code 126272]
</option>
<option value="109173"> MAHARASHTRA SAFE CHEMISTS AND DIST [Code
109173]</option>
<option value="121528"> JINOVA HEALTHCARE (MS) [Code 121528]</option>
<option value="138257"> VRS ENTERPRISES, BASTI [Code 138257]</option>
<option value="140305"> Bhagirath Distributors (Asu) [Code 140305]
</option>
<option value="128223"> East Drug Marchants PVT. LTD MALDA [Code
128223]</option>
<option value="126255"> PREM ENTERPRISES DHN [Code 126255]</option>
<option value="141005"> M/s MEDIZONE PHARMA HBL [Code 141005]</option>
<option value="122914"> VAMGUN HEALTHCARE (BWN) [Code 122914]</option>
<option value="113744"> AUROBINDO DRUGS (BHVRM) [Code 113744]</option>
<option value="123754"> JIVISHA HEALTHCARE AGENCY ANAND [Code 123754]
</option>
<option value="112915"> SOUTHEND PHARMA PVT.LTD. [Code 112915]</option>
<option value="121846"> PHARMA PLUS DISTRIBUTORS PVT... LTD [Code
121846]</option>
<option value="124136"> MEHER LIFECARE PVT.LTD MS NH MD [Code 124136]
</option>
<option value="122976"> S S PHARMA TRADERS PVT.LTD.(JNP) [Code 122976]
</option>
<option value="111009"> MEDILINE AGENCIES (NAMAKKAL) [Code 111009]
</option>
<option value="122937"> S.S. PHARMA TRADERS PVT LTD AYODHY [Code
122937]</option>
<option value="122980"> S S PHARMA TRADERS PVT. LTD.(MAU) [Code 122980]
</option>
<option value="122933"> S.S. PHARMA TRADERS PVT LTD BASTI [Code 122933]
</option>
<option value="142087"> BRAMHANI ENTERPRISES [Code 142087]</option>
<option value="122938"> S.S. PHARMA TRADERS PVT LTD SDN [Code 122938]
</option>
<option value="139789"> MAANVAR HEALTHCARE (ABR) [Code 139789]</option>
<option value="126846"> AIOCD PHARMA LTD TC NH MPL [Code 126846]
</option>
<option value="127938"> SANSKRITI ENTERPRISES HLD [Code 127938]
</option>
<option value="143029"> M/S SUREMED BENGAL DISTRIBUTORS [Code 143029]
</option>
<option value="123009"> S.S. PHARMA TRADERS PVT LTD LKO [Code 123009]
</option>
<option value="138084"> VINAYAK ENTERPRISES HRD [Code 138084]</option>
<option value="143196"> SUREMED BENGAL BAHARAMPUR [Code 143196]
</option>
<option value="140051"> EAST DRUG MARCHANTS PVT. LTD. [Code 140051]
</option>
<option value="143097"> SUREMED BENGAL DIST TAMLUK [Code 143097]
</option>
<option value="143233"> SUREMED BENGAL DISTRIBUTORS MALDA [Code 143233]
</option>
<option value="100582"> VAMAN PHARMA Pvt... LTD BIJAPUR [Code 100582]
</option>
<option value="143459"> MARINAMEDS [Code 143459]</option>
<option value="143156"> SUREMED BENGAL DIST BURDWAN [Code 143156]
</option>
<option value="139348"> NAVAANYA HEALTHCARE DLH [Code 139348]</option>
<option value="122319"> VINAYAK ENTERPRISES RKE [Code 122319]</option>
<option value="143630"> SUREMED BENGAL DISTRIBUTORS SILIGU [Code
143630]</option>
<option value="140311"> Manish Agencies (Asu) [Code 140311]</option>
<option value="111790"> M/S.KALYANI HEALTH PLUS (ONG) [Code 111790]
</option>
<option value="123268"> EAST DRUG MARCHANTS PVT. LTD MIDNAP [Code
123268]</option>
<option value="121241"> Medi Sync Healthcare pvt.Ltd [Code 121241]
</option>
<option value="100273"> AVIGHNA ASSOCIATES KASARGOD [Code 100273]
</option>
<option value="144176"> R K & SONS [Code 144176]</option>
<option value="Other"> Other </option>
</select>
@else
<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' : '' }}>
{{ $option->display }}</option>
@endforeach
</select>
@endif
@break
@case('radio')
@foreach ($question->options as $option)
<div class="form-check mb-2 form-check-success">
<input class="form-check-input" type="radio"
name="{{ $question->code }}"
id="field-{{ $question->code }}_{{ $option->value }}"
value="{{ $option->value }}">
<label class="form-check-label"
for="field-{{ $question->code }}_{{ $option->value }}">{{ $option->display }}</label>
</div>
@endforeach
@break
@case('radiometrix')
@php
// Decode the first option's value to use as heading labels
$headings =
count($question->options) > 0
? json_decode($question->options[0]->value)
: [];
@endphp
{{-- Matrix Wrapper with Horizontal Scroll on Small Screens --}}
<div class="table-responsive">
<div class="d-table w-100">
{{-- Table Headers --}}
<div class="d-table-row font-weight-bold">
<div class="d-table-cell p-2" style="width: 150px;"></div>
{{-- Placeholder for row labels --}}
@foreach ($headings as $head)
<div class="d-table-cell text-center p-2">{{ $head }}
</div>
@endforeach
</div>
{{-- Table Rows --}}
@foreach ($question->options as $option)
@php $nn = json_decode($option->value); @endphp
<div class="d-table-row align-middle">
<div class="d-table-cell font-weight-bold p-2"
style="width: 150px;">
{{ $option->display }}
</div>
@foreach ($nn as $value)
<div class="d-table-cell text-center p-2">
<input type="radio"
id="field-{{ $option->display }}-{{ $value }}"
name="{{ $question->code }}[{{ $option->display }}]"
value="{{ $value }}"
class="form-check-input"
{{ isset($question->display) && $option->display != $option->display ? 'checked' : '' }}>
</div>
@endforeach
</div>
@endforeach
</div>
</div>
@break
@case('checkbox')
@foreach ($question->options as $option)
<div class="form-check mb-2 form-check-primary ms-2">
<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) ? $option->val : 0 }}">
</div>
@endforeach
</div>
@break
@endswitch
</div>
@endforeach
@if (!isset($form->is_approval) || (isset($form->is_approval) && $form->is_approval != 'yes'))
<div class="text-center d-grid mt-3">
<button class="btn btn-primary" type="submit" id="submit-btn"> Submit
</button>
</div>
@endif
</form>
</div> <!-- end card-body -->
</div>
<!-- end card -->
<!-- end row -->
</div> <!-- end col -->
</div>
<!-- end row -->
</div>
<!-- end container -->
</div>
<!-- end page -->
<style type="text/css">
#pageloader {
background: rgba(255, 255, 255, 0.8);
display: none;
height: 100%;
position: fixed;
width: 100%;
z-index: 9999;
}
#pageloader img {
left: 50%;
margin-left: -32px;
margin-top: -32px;
position: absolute;
top: 50%;
}
.form-label {
font-weight: bold;
font-size: 16px;
}
.select2-container .select2-selection--single {
height: 38px !important;
padding: 5px 10px;
border: 1px solid #ced4da;
}
.select2-container--default .select2-selection--single .select2-selection__rendered {
line-height: 30px !important;
}
.select2-container--default .select2-selection--single .select2-selection__arrow {
height: 36px !important;
}
</style>
@include('layouts.shared/footer-script')
<script src="{{ asset('assets/libs/sweetalert2/sweetalert2.min.js') }}"></script>
<script src="{{ asset('assets/libs/select2/select2.min.js') }}"></script>
<script type="text/javascript">
jQuery(document).ready(function($) {
$('#field-tm_name').change(function() {
let hierarchy = $('option:selected', this).attr('hierarchy');
$('#field-hierarchy_id').val(hierarchy)
event.preventDefault();
$.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) {
console.log(itm)
if (typeof itm.contact.type !== "undefined") {
if (itm.contact.type == 'doctor') {
$('#field-contact_id').append($("<option></option>")
.attr("value", itm.value)
.attr("msl_code", itm.contact.msl_code)
.attr("speciality", itm.contact.speciality)
.text(itm.display));
}
}
}
$('#field-contact_id').append($("<option></option>").attr("value",
'Other').text('Other'));
},
});
console.log(hierarchy)
})
$('#report-form').on('submit', function(event) {
const f1 = parseInt($('#field-foracort_0_point_5_mg_supplied_units').val(), 10) || 0;
const f2 = parseInt($('#field-foracort_1mg_supplied_units').val(), 10) || 0;
const f3 = parseInt($('#field-glycohale_1ml_supplied_units').val(), 10) || 0;
if (f1 === 0 && f2 === 0 && f3 === 0) {
event.preventDefault();
Swal.fire({
icon: 'warning',
title: 'Missing Information',
text: 'Please fill at least one of the supplied units fields before submitting.',
});
return false;
}
event.preventDefault();
$("#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'
})
$('#report-form').trigger("reset");
} else {
Swal.fire({
icon: 'error',
title: data.hasOwnProperty('message') ?
'You are not mapped to any position code' :
'Data not submitted',
text: data.hasOwnProperty('message') ?
'for resolution please email Position code, L1 Manager and L2 Manager details to support1@stratawiz.com' :
'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();
today = yyyy + '-' + mm + '-' + dd;
var plandateField = document.getElementById('field-record_date');
plandateField.setAttribute('max', today);
});
</script>
<script>
$(document).ready(function() {
$('#field-stockists_name').select2({
placeholder: "Select Stockist",
allowClear: true,
width: '100%'
});
$('#field-contact_id').change(function() {
$('#field-doctor_msl_code').val($('option:selected', this).attr('msl_code'))
})
$('#field-contact_id').change(function() {
$('#field-speciality').val($('option:selected', this).attr('speciality'))
})
$('#field-other_stockists_name').closest('.col-md-12').hide();
$('#field-other_stockists_code').closest('.col-md-12').hide();
// Remove required initially
$('#field-other_stockists_name').prop('required', false);
$('#field-other_stockists_code').prop('required', false);
$('#field-stockists_name').on('change', function() {
const selected = $(this).find('option:selected');
const value = selected.val();
const text = selected.text();
if (value === 'Other') {
// Show "Other" fields
$('#field-other_stockists_name').closest('.col-md-12').show();
$('#field-other_stockists_code').closest('.col-md-12').show();
// Make them required
$('#field-other_stockists_name').prop('required', true);
$('#field-other_stockists_code').prop('required', true);
// Clear hidden fields
$('#field-copd_stockist_name').val('');
$('#field-copd_stockist_code').val('');
} else {
// Hide other fields
$('#field-other_stockists_name').closest('.col-md-12').hide();
$('#field-other_stockists_code').closest('.col-md-12').hide();
// Remove required
$('#field-other_stockists_name').prop('required', false);
$('#field-other_stockists_code').prop('required', false);
// Clear other fields
$('#field-other_stockists_name').val('');
$('#field-other_stockists_code').val('');
// Set hidden fields from dropdown selection
$('#field-copd_stockist_name').val(text.trim());
$('#field-copd_stockist_code').val(value);
}
});
// $('#field-doctor_msl_code').prop('readonly', true)
// $('#field-speciality').prop('readonly', true)
$('#field-other_doctor_name').closest('.col-md-12').hide();
$('#field-contact_id').on('change', function() {
if ($(this).val() === 'Other') {
$('#field-other_doctor_name').closest('.col-md-12').show();
// $('#field-doctor_msl_code').prop('readonly', false)
// $('#field-speciality').prop('readonly', false)
} else {
$('#field-other_doctor_name').closest('.col-md-12').hide();
$('#field-other_doctor_name').val('');
// $('#field-doctor_msl_code').prop('readonly', true)
// $('#field-speciality').prop('readonly', true)
}
});
$('.form-label[for="field-tm_name"]').closest('.col-md-12')
.insertAfter($('.form-label[for="field-record_date"]').closest('.col-md-12'));
$('#field-tm_name').change(function() {
const selected = $(this).find('option:selected');
const value = selected.val();
const text = selected.text();
$('#field-tm_hq_detail').val(text.trim());
});
});
</script>
</body>
</html>