
<div class="page-content-wrapper">
    <div class="page-content">
        <div class="row">
            <div class="col-md-12 clinick invz" id="gprinModel">
                <!-- BEGIN EXAMPLE TABLE PORTLET-->
                <div class="portlet box blue">
                    <div class="portlet-title">
                        <div class="caption">
                            <i class="fa fa-user"></i>Ultrasound Gyna
                        </div>
                    </div>
                    <div class="portlet-body all">
                        <input type="hidden" id="ultrasoundPage" value="1"/>
                        <input type="hidden" id="patientId" value="{$patientData->id}"/>
                        <input type="hidden" id="controllName" value="ultrasound"/>
                        <!---======================================================== tab1============================================================================================ ----->

                        <div class="row">
                            <div id="ultrasoundDiv">

                                <div class="row">

                                    <div class="portlet-body form">
                                        <form>
                                            <div class="form-body">
                                                <div class="col-md-6">

                                                    <div class="form-group form-md-line-input">
                                                        <label class="col-md-6 control-label" for="form_control_1">Patient Name</label>
                                                        <div class="col-md-6">
                                                            <div class="form-control form-control-static">
                                                                {$patientData->wifename}
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>

                                                <div class="col-md-6">

                                                    <div class="form-group form-md-line-input">
                                                        <label class="col-md-6 control-label" for="form_control_1">Patient ID</label>
                                                        <div class="col-md-6">
                                                            <div class="form-control form-control-static">
                                                                {$patientData->id}
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>





                                                <div class="col-md-6">
                                                    <div class="form-group form-md-line-input">
                                                        <label class="col-md-6 control-label" for="form_control_1">Date of Birth</label>
                                                        <div class="col-md-6">
                                                            <div class="form-control form-control-static">
                                                                {$patientData->dateofbirth}
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>


                                                <div class="col-md-6">
                                                    <div class="form-group form-md-line-input">
                                                        <label class="col-md-6 control-label" for="form_control_1">Referring Physican</label>
                                                        <div class="col-md-6">
                                                            <input type="text" class="form-control input-sm updateElement" id="form_control_1" placeholder="Referring Physican" data-id="{$ultrasoundData->id}" data-colName="physician" data-tableName="ultrasound" value="{$ultrasoundData->physician}">
                                                            <div class="form-control-focus">
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                                <div class="clearfix"></div>
                                                <div class="col-md-6">
                                                    <div class="form-group form-md-line-input">
                                                        <label class="col-md-6 control-label" for="form_control_1">Date of Exam</label>
                                                        <div class="col-md-6">
                                                            <input type="text" class="form-control input-sm datepicker updateElement txtc" placeholder="Date of Exam" data-id="{$ultrasoundData->id}" data-colName="edate" data-tableName="ultrasound" value="{$ultrasoundData->edate}">
                                                            <div class="form-control-focus">
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>

                                                <div class="col-md-6">
                                                    <div class="form-group">
                                                        <label class="col-md-6 control-label" for="form_control_1">Sonographer</label>
                                                        <div class="col-md-6">
                                                            <select class="form-control select2me updateElement" data-placeholder="Select..." data-id="{$ultrasoundData->id}" data-colName="sid" data-tableName="ultrasound">
                                                                <option></option>
                                                                {foreach $allSname as $sname}
                                                                <option value="{$sname.user_id}" {if $ultrasoundData->sid eq $sname.user_id}selected{/if}>{$sname.user_name}</option>
                                                                {/foreach}
                                                            </select>                                                            
                                                            <div class="form-control-focus">
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>
                                                <div class="clearfix"></div>


                                                <div class="col-md-6">
                                                    <label class="col-md-9 control-label" for="form_control_1">
                                                        Indication for scan and relevant clinical information
                                                    </label>
                                                    <div class="col-md-3">
                                                        <input type="text" class="form-control input-sm updateElement" id="form_control_1" placeholder="" data-id="{$ultrasoundData->id}" data-colName="indication" data-tableName="ultrasound" value="{$ultrasoundData->indication}">
                                                        <div class="form-control-focus">
                                                        </div>
                                                    </div>
                                                </div>
                                                <div class="clearfix"></div>

                                                <div class="col-md-6">
                                                    <label class="col-md-6 control-label" for="form_control_1">
                                                        Gestational age(W+D)
                                                    </label>
                                                    <div class="col-md-6">
                                                        <input type="text" class="form-control input-sm updateElement" id="form_control_1" placeholder="" data-id="{$ultrasoundData->id}" data-colName="gage" data-tableName="ultrasound" value="{$ultrasoundData->gage}">
                                                        <div class="form-control-focus">
                                                        </div>
                                                    </div>
                                                </div>

                                                <div class="col-md-6">
                                                    <label class="col-md-2 control-label" for="form_control_1">
                                                        Based on
                                                    </label>
                                                    <div class="col-md-10">


                                                        <div class="col-md-2">
                                                            <div class="md-radio-list">
                                                                <div class="md-radio">
                                                                    <input type="radio" id="lmp" name="based" class="md-radiobtn sradio" data-val="0" data-id="{$ultrasoundData->id}" data-colName="based" data-tableName="ultrasound" {if $ultrasoundData->based eq 0}checked{/if}>
                                                                    <label for="lmp">
                                                                        <span></span>
                                                                        <span class="check"></span>
                                                                        <span class="box"></span>
                                                                        LMP </label>
                                                                </div>
                                                            </div>
                                                        </div>

                                                        <div class="col-md-4">
                                                            <div class="md-radio-list">
                                                                <div class="md-radio">
                                                                    <input type="radio" id="prevus" name="based" class="md-radiobtn sradio" data-val="1" data-id="{$ultrasoundData->id}" data-colName="based" data-tableName="ultrasound" {if $ultrasoundData->based eq 1}checked{/if}>
                                                                    <label for="prevus">
                                                                        <span></span>
                                                                        <span class="check"></span>
                                                                        <span class="box"></span>
                                                                        Previous US </label>
                                                                </div>
                                                            </div>
                                                        </div>

                                                        <div class="col-md-2">
                                                            <div class="md-radio-list">
                                                                <div class="md-radio">
                                                                    <input type="radio" id="otherb" name="based" class="md-radiobtn sradio" data-val="2" data-id="{$ultrasoundData->id}" data-colName="based" data-tableName="ultrasound" {if $ultrasoundData->based eq 2}checked{/if}>
                                                                    <label for="otherb">
                                                                        <span></span>
                                                                        <span class="check"></span>
                                                                        <span class="box"></span>
                                                                        Other </label>
                                                                </div>
                                                            </div>
                                                        </div>


                                                        <div class="col-md-4" id="bother" {if $ultrasoundData->based neq 2}style="display:none"{/if}>
                                                            <input type="text" class="form-control input-sm updateElement fright wds90" id="form_control_1" placeholder="" data-id="{$ultrasoundData->id}" data-colName="otherbased" data-tableName="ultrasound" value="{$ultrasoundData->otherbased}">
                                                            <div class="form-control-focus">
                                                            </div>
                                                        </div>




                                                    </div>
                                                </div>
                                                <div class="clearfix"></div>

                                                <div class="col-md-6">
                                                    <label class="col-md-4 control-label" for="form_control_1">
                                                        Technical conditions
                                                    </label>
                                                    <div class="col-md-8">


                                                        <div class="col-md-3">
                                                            <div class="md-radio-list">
                                                                <div class="md-radio">
                                                                    <input type="radio" id="goodt" name="tcondition" class="md-radiobtn sradio" data-val="0" data-id="{$ultrasoundData->id}" data-colName="tcondition" data-tableName="ultrasound" {if $ultrasoundData->tcondition eq 0}checked{/if}>
                                                                    <label for="goodt">
                                                                        <span></span>
                                                                        <span class="check"></span>
                                                                        <span class="box"></span>
                                                                        Good </label>
                                                                </div>
                                                            </div>
                                                        </div>

                                                        <div class="col-md-4">
                                                            <div class="md-radio-list">
                                                                <div class="md-radio">
                                                                    <input type="radio" id="limitedt" name="tcondition" class="md-radiobtn sradio" data-val="1" data-id="{$ultrasoundData->id}" data-colName="tcondition" data-tableName="ultrasound" {if $ultrasoundData->tcondition eq 1}checked{/if}>
                                                                    <label for="limitedt">
                                                                        <span></span>
                                                                        <span class="check"></span>
                                                                        <span class="box"></span>
                                                                        Limited by </label>
                                                                </div>
                                                            </div>
                                                        </div>

                                                        <div class="col-md-5" id="limitcond" {if $ultrasoundData->tcondition neq 1}style="display:none"{/if}>
                                                            <input type="text" class="form-control input-sm updateElement" id="form_control_1" placeholder="" data-id="{$ultrasoundData->id}" data-colName="limit" data-tableName="ultrasound" value="{$ultrasoundData->limit}">
                                                            <div class="form-control-focus">
                                                            </div>
                                                        </div>

                                                        <div class="clearfix"></div>

                                                    </div>
                                                </div>
                                                <div class="clearfix"></div>

                                                <div class="col-md-6">
                                                    <label class="col-md-4 control-label" for="form_control_1">
                                                        Title
                                                    </label>
                                                    <div class="col-md-8">


                                                        <div class="col-md-3">
                                                            <div class="md-radio-list">
                                                                <div class="md-radio">
                                                                    <input type="radio" id="twod" name="stype" class="md-radiobtn sradio" data-val="0" data-id="{$ultrasoundData->id}" data-colName="stype" data-tableName="ultrasound" {if $ultrasoundData->stype eq 0}checked{/if}>
                                                                    <label for="twod">
                                                                        <span></span>
                                                                        <span class="check"></span>
                                                                        <span class="box"></span>
                                                                        2D </label>
                                                                </div>
                                                            </div>
                                                        </div>

                                                        <div class="col-md-4">
                                                            <div class="md-radio-list">
                                                                <div class="md-radio">
                                                                    <input type="radio" id="tfd" name="stype" class="md-radiobtn sradio" data-val="1" data-id="{$ultrasoundData->id}" data-colName="stype" data-tableName="ultrasound" {if $ultrasoundData->stype eq 1}checked{/if}>
                                                                    <label for="tfd">
                                                                        <span></span>
                                                                        <span class="check"></span>
                                                                        <span class="box"></span>
                                                                        3D/4D </label>
                                                                </div>
                                                            </div>
                                                        </div>
                                                        <div class="clearfix"></div>

                                                    </div>
                                                </div>
                                                <div class="clearfix"></div>
                                                <div class="col-md-12">
                                                    <div class="col-md-8">


                                                        <div class="col-md-2">
                                                            <div class="md-radio-list">
                                                                <div class="md-radio">
                                                                    <input type="radio" id="single" name="babyno" class="md-radiobtn sradio" data-val="1" data-id="{$ultrasoundData->id}" data-colName="babyno" data-tableName="ultrasound" {if $ultrasoundData->babyno eq 1}checked{/if}>
                                                                    <label for="single">
                                                                        <span></span>
                                                                        <span class="check"></span>
                                                                        <span class="box"></span>
                                                                        Singleton </label>
                                                                </div>
                                                            </div>
                                                        </div>

                                                        <div class="col-md-2">
                                                            <div class="md-radio-list">
                                                                <div class="md-radio">
                                                                    <input type="radio" id="twinz" name="babyno" class="md-radiobtn sradio" data-val="2" data-id="{$ultrasoundData->id}" data-colName="babyno" data-tableName="ultrasound" {if $ultrasoundData->babyno eq 2}checked{/if}>
                                                                    <label for="twinz">
                                                                        <span></span>
                                                                        <span class="check"></span>
                                                                        <span class="box"></span>
                                                                        Twinz </label>
                                                                </div>
                                                            </div>
                                                        </div>

                                                        <div class="col-md-2">
                                                            <div class="md-radio-list">
                                                                <div class="md-radio">
                                                                    <input type="radio" id="many" name="babyno" class="md-radiobtn sradio" data-val="3" data-id="{$ultrasoundData->id}" data-colName="babyno" data-tableName="ultrasound" {if $ultrasoundData->babyno neq 1 && $ultrasoundData->babyno neq 2}checked{/if}>
                                                                    <label for="many">
                                                                        <span></span>
                                                                        <span class="check"></span>
                                                                        <span class="box"></span>
                                                                        Chorionicity </label>
                                                                </div>
                                                            </div>
                                                        </div>
                                                        <div class="col-md-3" id="babyNo" {if $ultrasoundData->babyno eq 1 || $ultrasoundData->babyno eq 2}style="display:none"{/if}>
                                                            <input type="text" class="form-control input-sm updateElement wds75 fright" id="babyNotxt" placeholder="" data-id="{$ultrasoundData->id}" data-colName="babyno" data-tableName="ultrasound" value="{$ultrasoundData->babyno}">
                                                            <div class="form-control-focus">
                                                            </div>
                                                        </div>

                                                        <div class="clearfix"></div>

                                                    </div>
                                                </div>
                                                <input type="hidden" id="model_count" value="{$detailCount}"/>
                                                <div class="row hidPrint" id="mainForm">
                                                    {assign var = i value=1}
                                                    {foreach $ultrasoundDetail as $detail}
                                                    <a class="btn btn-default btn-sm showMod" {if $i > 2}style="margin-left: 30px;"{/if} data-id="{$detail->id}">
                                                        <i class="fa fa-plus"></i> Baby{$i}</a>
                                                    {if $i >1}
                                                    <button type="button" class="btn btn-xs red fright removeMsg" style="position: absolute; margin-left: -5px;height:29px;" data-tableName="ultrasounddetail" data-id="{$detail->id}"><i class="fa fa-close"></i></button>
                                                    {/if}



                                                    {assign var = i value = $i+1}
                                                    {/foreach}
                                                </div>

                                            </div>

                                            <div class="row">
                                                <div class="col-md-offset-2 col-md-10 hidPrint">
                                                    <a href="{$hosturl}/controllers/ultrasound.php?ac=index&patientid={$patientData->id}" class="btn default">Cancel</a>
                                                    <button type="button" id="doneBtn" class="btn blue" data-id="{$ultrasoundData->id}">Save</button>
                                                </div>
                                                <br>
                                            </div>
                                        </form>
                                    </div>

                                </div>
                                <div class="clearfix"></div>

                            </div>
                        </div>

                        <div class="clearfix"></div>




                    </div>



                </div>
                <div id="yy"></div>
            </div>
        </div>
    </div>
</div>
<div class="clearfix"></div>
<div id="vvv"></div>