@extends('layouts.app')

@section('styles')

@endsection

@section('content')

<!-- PAGE-HEADER -->
<div class="page-header">
    <h1 class="page-title">Patient Story</h1>
    <div>
        <ol class="breadcrumb">
            <li class="breadcrumb-item"><a href="javascript:void(0)">Dashboard</a></li>
            <li class="breadcrumb-item active"><a href="javascript:void(0)">Patient Story</a></li>

        </ol>
    </div>
</div>
<!-- PAGE-HEADER END -->



<!-- Row -->

<div class="row row-sm">
    <div class="col-lg-12">
        <div class="card">

            <div class="card-header">
                <h3 class="card-title">Add Patient Story</h3>
                <a class="btn btn-primary  btn-sm btn-right" href="{{ route('back.patientstory.index') }}"><i class="fa fa-chevron-left"></i> {{ __('Back') }}</a>
            </div>
            <div class="card-body">


                <div class="row">
                    <div class="col-lg-12 col-md-12">
                        <div class="card">

                            <div class="card-body">
                                <form method="POST" action="{{ route('back.patientstory.store') }}" class="myform" enctype="multipart/form-data">
                                   
                                    @csrf

                                    @include('alerts.alerts')


                                    <div class="form-group">

                                        



									
                                        

                                        <div class="col-xl-12 mb-3">
                                        <label for="name">{{ __('Name') }} *</label>
                        <input type="text" name="name" class="form-control item-name"
                            id="name" placeholder="{{ __('Enter Name') }}"
                            value="{{ old('name') }}" >

                                        </div>

                                        <div class="col-xl-12 mb-3">
                                        <label for="slug">{{ __('Age') }} *</label>
                        <input type="number" name="age" class="form-control"
                            id="age" placeholder="{{ __('Enter Age') }}"
                            value="{{ old('age') }}" >

                                        </div>

                                        <div class="col-xl-12 mb-3">
                                        <label for="diagnosis_short">{{ __('Diagnosis Name') }} * <span>( Fill . if value is not available )</span></label>
                        <input type="text" name="diagnosis_short" class="form-control item-name"
                            id="diagnosis_short" placeholder="{{ __('Enter Diagnosis Name') }}"
                            value="{{ old('diagnosis_short') }}" >

                                        </div>

                                        <div class="col-xl-12 mb-3">
                                        <label for="diagnosis">{{ __('Diagnosis') }} *  <span>( Fill . if value is not available )</span></label>
                        <input type="text" name="diagnosis" class="form-control item-name"
                            id="diagnosis" placeholder="{{ __('Enter Diagnosis') }}"
                            value="{{ old('diagnosis') }}" >

                                        </div>

                                       

                                        
                                       


                                        
                                    </div>

                                    <div class="card">
                <div class="card-body">
                    <div class="form-group pb-0  mb-0">
                        <label>{{ __('Medical Report') }} </label> 
                    </div>
                    <div class="form-group pb-0 pt-0 mt-0 mb-0">
                        <div id="gallery-images" class="" style="margin-bottom:50px">
                            <div class="d-block gallery_image_view">
                            </div>
                        </div>
                    </div>
                    <div class="form-group position-relative ">
                        <label class="file">
                            <input type="file"  accept="image/*"  name="galleries[]" id="gallery_file" aria-label="File browser example" accept="image/*" multiple>
                            <span class="file-custom text-left">{{ __('Upload Image...') }}</span>
                        </label>
                        <br>
                        
                    </div>
                </div>
            </div>


                                    
                                   
                                    <div class="form-group">
										<button type="submit"
											class="btn btn-secondary ">{{ __('Create') }}
                                        </button>
									</div>
                                   
                                </form>
                            </div>
                        </div>
                    </div>
                </div>


            </div>


        </div>

    </div>
</div>

<!-- End Row -->






@endsection

@section('scripts')

@endsection