<!-- BEGIN CONTENT -->
<div class="page-content-wrapper">
    <div class="page-content">
        <!-- BEGIN PAGE HEADER-->
        <h3 class="page-title">
            {$shcontrollname}
        </h3>
        <div class="page-bar">
            <ul class="page-breadcrumb">
                {$breadcrumbs}
            </ul>
        </div>
        <!-- END PAGE HEADER-->
        <!-- BEGIN PAGE CONTENT-->
        <div class="row">
            <div class="col-md-12">
                <div class="portlet light bg-inverse">
                    <div class="portlet-body form">
                        <!-- BEGIN FORM-->
                        <form action="{$hosturl}/controllers/{$controllname}.php?ac=sendrequest" method="post"  id="request_form" class="clinick">
                            <div class="form-body">
                                
                                <input type="hidden" id="userId" name="userId" value="{$userId}">
                                <input type="hidden" id="requestId" name="requestId" value="{$request->id}">
                    
                                <div class="form-group form-md-line-input">
                                    
                                    <label class="col-md-2 control-label" for="form_1">Request Title</label>
                                    
                                    <div class="col-md-10">
                                        <input type="text" class="form-control update" id="form_1" placeholder="Enter Request name" name="title" data-tableName ="brequests" data-control ="requests"  value="{$request->title}" required="required">
                                        <div class="form-control-focus">
                                        </div>
                                    </div>
                                </div>

                                <div class="form-group form-md-line-input">
                                    <label class="col-md-2 control-label" for="form_2">Content</label>
                                    <div class="col-md-10">
                                        <textarea class="form-control update" id="form_2" rows="6" placeholder="Enter Content" name="details" data-tableName ="brequests" data-control ="requests" required="required">
                                            {$request->details}
                                        </textarea>
                                        <div class="form-control-focus"></div>
                                    </div>
                                </div>

                            </div>
                            <div class="form-actions">
                                <div class="row">
                                    <div class="col-md-offset-3 col-md-4">
                                        <button type="submit" class="btn green ">Send</button>
                                        <button type="button" class="btn default cancel" data-controll="{$controllname}" data-do="showall">Cancel</button>
                                    </div>
                                </div>
                            </div>
                        </form>
                        <!-- END FORM-->
                    </div>
                </div>
            </div>
        </div>
        <!-- END PAGE CONTENT-->
    </div>
</div>
<!-- END CONTENT -->