Patient
ABHA
@csrf
Patient Full Name
*
-Title-
@foreach($account_title as $list)
id) !!}>{{ $list->name }} - {{ $list->gender->name ?? '' }}
@endforeach
This field is required.
{{--
--}}
Age/Years(DOB)
*
{{--
--}} {{--
Years
--}}
-Select Year-
@php $currentYear = date('Y'); @endphp @for($year = 0; $year <= 100; $year++)
{!! $year !!} - {!! $currentYear - $year !!}
@endfor
Months(MM)
@foreach(months() as $key => $value)
{!! $value !!}
@endforeach
Days(DD)
@for($day = 1; $day <= 31; $day++)
{!! $day !!}
@endfor
Hours(HH)
@for($hour = 0; $hour <= 24; $hour++)
{!! $hour !!}
@endfor
The date of birth or age are required.
Phone no
*
This field is required.
Date of Birth
*
This field is required.
Whatsapp no
Blood Group
-Select-
@foreach($bloodGroup as $list)
{{$list->group}}
@endforeach
Marital Status
-Select-
@foreach($maritalStatus as $list)
{{$list->name}}
@endforeach
This field is required.
Email
Country
Select Country
@foreach($country as $list)
id) !!}>{{$list->name}}
@endforeach
State
This field is required.
City
+
This field is required.
Address
PIN/Postal code
@if($redirect_back == 'ipd_admission')
Next Of Kin (Relatives Name)
*
This field is required.
Relation Type
*
Select Relation Ship
@foreach($types as $type)
{!! $type->relation_name !!}
@endforeach
This field is required.
Relation Phone no
*
@if ($errors->has('relation_phone'))
{{ $errors->first('relation_phone') }}
@endif
This field is required.
@endif
@csrf
Mobile No
Verify Mobile No
@if($country_id) @endif