271 lines
15 KiB
PHP
271 lines
15 KiB
PHP
@extends('layouts.vertical', ['page_title' => 'Edit'])
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@section('css')
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<link href="{{ URL::asset('assets/libs/flatpickr/flatpickr.min.css')}}" rel="stylesheet" type="text/css" />
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<link href="{{ URL::asset('assets/libs/dropify/dropify.min.css')}}" rel="stylesheet" type="text/css" />
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@endsection
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@section('content')
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<!-- Start Content-->
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<div class="container-fluid">
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<form method="post" id="form-availiblity" enctype="multipart/form-data">
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<!-- start page title -->
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<div class="row">
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<div class="col-12">
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<div class="page-title-box">
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<div class="page-title-right">
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<button type="submit" class="btn btn-secondary float-right">Submit</button>
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</div>
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<h4 class="page-title">{{$item['request_type']}}</h4>
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</div>
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</div>
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</div>
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<!-- end page title -->
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@if(session()->has('message'))
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<div class="alert alert-success">
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{{ session()->get('message')}}
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</div>
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@endif
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<div class="row">
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<div class="col-xl-12">
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<div class="card">
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<div class="card-body">
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@csrf
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<div class="row">
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<div class="col-md-6">
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<div class="form-group">
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<label for="emp_id">Emp ID of TM</label>
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<input type="text" id="emp_id" name="emp_id" class="form-control" value="{{$item['emp_id']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="emp_name">Name of TM</label>
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<input type="text" id="emp_name" name="emp_name" class="form-control" value="{{$item['emp_name']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="emp_phone">TM Mobile Number</label>
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<input type="text" id="emp_phone" name="emp_phone" class="form-control" value="{{$item['emp_phone']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="emp_email">TM Email ID</label>
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<input type="text" id="emp_email" name="emp_email" class="form-control" value="{{$item['emp_email']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="abm_name">ABM Name</label>
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<input type="text" id="abm_name" name="abm_name" class="form-control" value="{{$item['abm_name']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="rbm_name">RBM Name</label>
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<input type="text" id="rbm_name" name="rbm_name" class="form-control" value="{{$item['rbm_name']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="msl_code">MSL CODE of Dr</label>
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<input type="text" id="msl_code" name="msl_code" class="form-control" value="{{$item['msl_code']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="request_letter">Upload Request Letter</label>
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<input type="file" id="request_letter" name="request_letter" class="form-control" value="{{$item['request_letter']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="patient_name">Patient Name</label>
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<input type="text" id="patient_name" name="patient_name" class="form-control" value="{{$item['emp_id']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="patient_phone">Patient Mobile Number</label>
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<input type="text" id="patient_phone" name="patient_phone" class="form-control" value="{{$item['patient_phone']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="doctor_name">Dr Name</label>
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<input type="text" id="doctor_name" name="doctor_name" class="form-control" value="{{$item['doctor_name']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="doctor_phone">Doctor Mobile Number</label>
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<input type="text" id="doctor_phone" name="doctor_phone" class="form-control" value="{{$item['doctor_phone']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="doctor_speciality">Speciality</label>
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<input type="text" id="doctor_speciality" name="doctor_speciality" class="form-control" value="{{$item['doctor_speciality']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="no_of_nebulizer">No of Nebulizer</label>
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<input type="text" id="no_of_nebulizer" name="no_of_nebulizer" class="form-control" value="{{$item['no_of_nebulizer']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="value_of_parcel">Value of the Parcel</label>
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<input type="text" id="value_of_parcel" name="value_of_parcel" class="form-control" value="{{$item['value_of_parcel']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="team">Team</label>
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<input type="text" id="team" name="team" class="form-control" value="{{isset($item['team']) ? $item['team'] : ''}}">
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</div>
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</div>
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@if($item['request_type'] != 'Cipla to Doctor')
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<div class="col-md-12">
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<h5>Pickup Address</h5>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="pickup_type">Clinic / Hospital / Home Name</label>
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<input type="text" id="pickup_type" name="pickup_type" class="form-control" value="{{$item['pickup_type']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="pickup_building">Building Name </label>
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<input type="text" id="pickup_building" name="pickup_building" class="form-control" value="{{$item['pickup_building']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="pickup_line_1">Address line 1</label>
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<input type="text" id="pickup_line_1" name="pickup_line_1" class="form-control" value="{{$item['pickup_line_1']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="pickup_line_2">Address line 2</label>
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<input type="text" id="pickup_line_2" name="pickup_line_2" class="form-control" value="{{$item['pickup_line_2']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="pickup_landmark">Landmark</label>
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<input type="text" id="pickup_landmark" name="pickup_landmark" class="form-control" value="{{$item['pickup_landmark']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="pickup_state">State</label>
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<input type="text" id="pickup_state" name="pickup_state" class="form-control" value="{{$item['pickup_state']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="pickup_city">City</label>
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<input type="text" id="pickup_city" name="pickup_city" class="form-control" value="{{$item['pickup_city']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="pickup_pin_code">Pin Code</label>
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<input type="text" id="pickup_pin_code" name="pickup_pin_code" class="form-control" value="{{$item['pickup_pin_code']}}">
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</div>
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</div>
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@endif
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<div class="col-md-12">
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<h5>Drop Address</h5>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="address_type">Clinic / Hospital / Home Name</label>
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<input type="text" id="address_type" name="address_type" class="form-control" value="{{$item['address_type']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="address_building">Building Name </label>
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<input type="text" id="address_building" name="address_building" class="form-control" value="{{$item['address_building']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="address_line_1">Address line 1</label>
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<input type="text" id="address_line_1" name="address_line_1" class="form-control" value="{{$item['address_line_1']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="address_line_2">Address line 2</label>
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<input type="text" id="address_line_2" name="address_line_2" class="form-control" value="{{$item['address_line_2']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="address_landmark">Landmark</label>
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<input type="text" id="address_landmark" name="address_landmark" class="form-control" value="{{$item['address_landmark']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="address_state">State</label>
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<input type="text" id="address_state" name="address_state" class="form-control" value="{{$item['address_state']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="address_city">City</label>
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<input type="text" id="address_city" name="address_city" class="form-control" value="{{$item['address_city']}}">
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</div>
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</div>
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<div class="col-md-6">
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<div class="form-group">
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<label for="address_pin_code">Pin Code</label>
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<input type="text" id="address_pin_code" name="address_pin_code" class="form-control" value="{{$item['address_pin_code']}}">
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</div>
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</div>
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</div> <!-- end card-body -->
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</div> <!-- end card-->
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</div> <!-- end col -->
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</div>
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</form>
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</div>
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@endsection
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@section('script')
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<script src="{{ URL::asset('assets/libs/flatpickr/flatpickr.min.js')}}"></script>
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<script src="{{ URL::asset('assets/libs/dropify/dropify.min.js')}}"></script>
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<script type="text/javascript">
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$(document).ready(function(){
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$('.date-picker').flatpickr();
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$('.datetime-picker').flatpickr({
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enableTime: true,
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dateFormat: "Y-m-d H:i"
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});
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$('.dropify').dropify({
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messages: {
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'default': 'Drag and drop a file here or click',
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'replace': 'Drag and drop or click to replace',
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'remove': 'Remove',
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'error': 'Ooops, something wrong appended.'
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},
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error: {
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'fileSize': 'The file size is too big (1MB max).'
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}
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});
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});
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</script>
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@endsection |