<input type="hidden" name="action" id="action" value="Edit"> <input type="hidden" name="id" id="id"
    value="<?php echo e($opto_data['items']['id']); ?>">
<input type="hidden" name="consid" id="consid" value="<?php echo e($consult_data['items']['id']); ?>">
<?php echo csrf_field(); ?>
<input type="hidden" name="MrdNo" id="MrdNo" class="form-control" placeholder="" value="<?php echo e($MrdNo); ?>"
    readonly="readonly"> <input type="hidden" name="PatientName" class="form-control" placeholder=""
    value="<?php echo e($pt_data['items']['PatientName']); ?>" readonly="readonly"> <input type="hidden" name="Age"
    class="form-control" placeholder="" value="<?php echo e($pt_data['items']['Age']); ?>" readonly="readonly"> <input
    type="hidden" name="Gender" class="form-control" placeholder="" value="<?php echo e($pt_data['items']['Gender']); ?>"
    readonly="readonly"> <input type="hidden" name="VisitNo" id="OptVisitNo" class="form-control"
    value="<?php echo e($VisitNo); ?>" placeholder="" readonly="readonly"> <input type="hidden" name="VisitDate"
    id="OptVisitDate" class="form-control" placeholder="" value="<?php echo e($VisitDate); ?>" readonly="readonly">
<div class="form-row" style="overflow-y: scroll;height:800px;">

    <div class="form-group col-md-6" style="margin-bottom: 0rem">



        <div class="row">
            <div class="col-lg-6">
                <fieldset>
                    <legend>Presenting Complaints</legend>
                    <div class="row">
                        <div class="col-md-12">
                            <div class="row">
                                <div class="col-lg-10">
                                    <textarea class="form-control txtbold" id="Complaint1" name="Complaint1" style="height: 30px"><?php echo e($opto_data['items']['Complaint1']); ?></textarea>
                                </div>
                                <div class="col-lg-1" style="padding-left: 1px;"><span
                                        class="input-group-append"><button class="btn btn-secondary" type="button"
                                            data-toggle="modal" data-target="#modal-report" id="add_button"
                                            onclick="getValue('Complaint','Complaint1')">...</button></span>
                                </div>
                            </div>
                        </div>

                    </div><br>
                    <div class="row">
                        <div class="col-md-12">
                            <div class="row">
                                <div class="col-lg-10">
                                    <textarea class="form-control txtbold" id="Complaint2" name="Complaint2" style="height: 30px"><?php echo e($opto_data['items']['Complaint2']); ?></textarea>
                                </div>
                                <div class="col-lg-1" style="padding-left: 1px;"><span
                                        class="input-group-append"><button class="btn btn-secondary" type="button"
                                            data-toggle="modal" data-target="#modal-report" id="add_button"
                                            onclick="getValue('Complaint','Complaint2')">...</button></span>
                                </div>
                            </div>
                        </div>

                    </div>


                </fieldset>
            </div>

            <div class="col-lg-6">
                <fieldset>
                    <legend>Past Ocular History</legend>
                    <div class="row">
                        <div class="col-lg-10">
                            <textarea class="form-control txtbold" id="PastHistory" rows="2" name="PastHistory" style="height: 80px;"><?php echo e($opto_data['items']['PastHistory']); ?></textarea>
                        </div>
                        <div class="col-lg-2" style="padding-left: 3px;"><span class="input-group-append"><button
                                    class="btn btn-secondary" type="button" data-toggle="modal"
                                    data-target="#modal-report" id="add_button"
                                    onclick="getValue('OcularHistory','PastHistory')">...</button></span>
                        </div>
                    </div>
                </fieldset>
            </div>

        </div>
        <div class="row">
            <div class="col-lg-12">
                <fieldset>
                    <legend>AR/Keratometry</legend>
                    <div class="table-responsive" style="overflow-x:auto">
                        <table id="report-table" class="table table-bordered table-striped mb-0">
                            <thead>
                                <tr align="center">
                                    <th width="10"></th>
                                    <th width="80" class="lblclass">SPH</th>
                                    <th width="80" class="lblclass">CYL</th>
                                    <th width="80" class="lblclass">AXIS</th>
                                    <th width="80" class="lblclass">K1</th>
                                    <th width="80" class="lblclass">AXIS</th>
                                    <th width="80" class="lblclass">K2</th>
                                    <th width="80" class="lblclass">AXIS</th>
                                    <th width="80" class="lblclass">Difference</th>
                                </tr>
                            </thead>
                            <tbody>
                                <tr>
                                    <td class="lblclass">RE</td>
                                    <td>
                                        <input type="text" list="datalist3" name="ArSrSphRe"
                                            class="form-control txtbold" id="ArSrSphRe"
                                            value="<?php echo e($opto_data['items']['ArSrSphRe']); ?>">

                                    </td>
                                    <td>
                                        <input type="text" list="datalist4" name="ArSrCylRe"
                                            class="form-control txtbold" id="ArSrCylRe"
                                            value="<?php echo e($opto_data['items']['ArSrCylRe']); ?>">

                                    </td>
                                    <td>

                                        <input type="text" class="form-control txtbold" placeholder=""
                                            name="ArSrAxisRe" id="ArSrAxisRe"
                                            value="<?php echo e($opto_data['items']['ArSrAxisRe']); ?>" style="height: 25px">
                                    </td>

                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="RefK1Re" id="RefK1Re"
                                            value="<?php echo e($opto_data['items']['RefK1Re']); ?>"
                                            oninput="calDiff('RefK1Re','RefK2Re','RefDiffRe')">
                                    </td>
                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="RefK1AxisRe" value="<?php echo e($opto_data['items']['RefK1AxisRe']); ?>"
                                            id="RefK1AxisRe">
                                    </td>
                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="RefK2Re" id="RefK2Re"
                                            oninput="calDiff('RefK1Re','RefK2Re','RefDiffRe')"
                                            value="<?php echo e($opto_data['items']['RefK2Re']); ?>">
                                    </td>
                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="RefK2AxisRe" value="<?php echo e($opto_data['items']['RefK2AxisRe']); ?>">
                                    </td>
                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="RefDiffRe" id="RefDiffRe"
                                            value="<?php echo e($opto_data['items']['RefDiffRe']); ?>">
                                    </td>
                                </tr>
                                <tr>
                                    <td class="lblclass">LE</td>
                                    <td>
                                        <input type="text" list="datalist3" name="ArSrSphLe"
                                            class="form-control txtbold" id="ArSrSphLe"
                                            value="<?php echo e($opto_data['items']['ArSrSphLe']); ?>">

                                    </td>
                                    <td>
                                        <input type="text" list="datalist4" name="ArSrCylLe"
                                            class="form-control txtbold" id="ArSrCylLe"
                                            value="<?php echo e($opto_data['items']['ArSrCylLe']); ?>">

                                    </td>
                                    <td>

                                        <input type="text" class="form-control txtbold" placeholder=""
                                            name="ArSrAxisLe" id="ArSrAxisLe"
                                            value="<?php echo e($opto_data['items']['ArSrAxisLe']); ?>" style="height: 25px">
                                    </td>
                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="RefK1Le" id="RefK1Le"
                                            oninput="calDiff('RefK1Le','RefK2Le','RefDiffLe')"
                                            value="<?php echo e($opto_data['items']['RefK1Le']); ?>">
                                    </td>
                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="RefK1AxisLe" value="<?php echo e($opto_data['items']['RefK1AxisLe']); ?>">
                                    </td>
                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="RefK2Le" id="RefK2Le"
                                            oninput="calDiff('RefK1Le','RefK2Le','RefDiffLe')"
                                            value="<?php echo e($opto_data['items']['RefK2Le']); ?>">
                                    </td>
                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="RefK2AxisLe" value="<?php echo e($opto_data['items']['RefK2AxisLe']); ?>">
                                    </td>
                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="RefDiffLe" id="RefDiffLe"
                                            value="<?php echo e($opto_data['items']['RefDiffLe']); ?>">
                                    </td>
                                </tr>


                            </tbody>
                        </table>
                    </div>


                </fieldset>
            </div>
        </div>

        <div class="row">



            <div class="col-lg-7" style="padding-left: 10px;
padding-right: 4px;">
                <fieldset>
                    <legend>Previous Glasses</legend>
                    <div class="table-responsive" style="overflow-x:auto">
                        <table id="report-table" class="table table-bordered table-striped mb-0">
                            <thead>
                                <tr align="center">
                                    <th width="10" class="lblclass"></th>
                                    <th width="80" class="lblclass">SPH</th>
                                    <th width="80" class="lblclass">CYL</th>
                                    <th width="80" class="lblclass">AXIS</th>
                                    <th width="80" class="lblclass">ADD</th>
                                    <th width="80" class="lblclass">VA</th>
                                </tr>
                            </thead>
                            <tbody>
                                <tr>
                                    <td class="lblclass">RE</td>
                                    <td>
                                        <input type="text" list="datalist3" name="PgSphRe"
                                            class="form-control txtbold" id="PgSphRe"
                                            value="<?php echo e($opto_data['items']['PgSphRe']); ?>">


                                    </td>
                                    <td>
                                        <input type="text" list="datalist4" name="PgCylRe"
                                            class="form-control txtbold" id="PgCylRe"
                                            value="<?php echo e($opto_data['items']['PgCylRe']); ?>">




                                    </td>
                                    <td><input type="text" class="form-control txtbold" placeholder=""
                                            name="PgAxisRe" value="<?php echo e($opto_data['items']['PgAxisRe']); ?>"></td>
                                    <td>
                                        <input type="text" list="datalist5" name="PgNearAddRe"
                                            class="form-control txtbold" id="PgNearAddRe"
                                            value="<?php echo e($opto_data['items']['PgNearAddRe']); ?>">

                                    </td>
                                    <td>
                                        <input type="text" list="datalist1" name="OgRe"
                                            class="form-control txtbold" id="OgRe"
                                            value="<?php echo e($opto_data['items']['OgRe']); ?>">

                                    </td>
                                </tr>
                                <tr>
                                    <td class="lblclass">LE</td>
                                    <td>
                                        <input type="text" list="datalist3" name="PgSphLe"
                                            class="form-control txtbold" id="PgSphLe"
                                            value="<?php echo e($opto_data['items']['PgSphLe']); ?>">

                                    </td>
                                    <td>
                                        <input type="text" list="datalist4" name="PgCylLe"
                                            class="form-control txtbold" id="PgCylLe"
                                            value="<?php echo e($opto_data['items']['PgCylLe']); ?>">

                                    </td>
                                    <td>

                                        <input type="text" class="form-control txtbold" placeholder=""
                                            name="PgAxisLe" value="<?php echo e($opto_data['items']['PgAxisLe']); ?>">
                                        <div class="clearfix"></div>
                                    </td>
                                    <td>
                                        <input type="text" list="datalist5" name="PgNearAddLe"
                                            class="form-control txtbold" id="PgNearAddLe"
                                            value="<?php echo e($opto_data['items']['PgNearAddLe']); ?>">


                                    </td>
                                    <td>
                                        <input type="text" list="datalist1" name="OgLe"
                                            class="form-control txtbold" id="OgLe"
                                            value="<?php echo e($opto_data['items']['OgLe']); ?>">

                                    </td>
                                </tr>
                            </tbody>
                        </table>
                    </div>

                    <label class="form-label lblclass">Color Vision</label>
                    <input class="form-control txtbold" name="ColorVision" id="ColorVision"
                        value="<?php echo e($opto_data['items']['ColorVision']); ?>">

                </fieldset>
            </div>

            <div class="col-lg-5" style="padding-left: 2px;">
                <fieldset>
                    <legend></legend>

                    <div class="table-responsive" style="overflow-x:auto">
                        <table id="report-table" class="table table-bordered table-striped mb-0">
                            <?php if($opto_data['items']['IopReTime'] != ''): ?>
                                <?php $IopReTime = $opto_data['items']['IopReTime'];?>
                            <?php else: ?>
                                <?php $IopReTime = "mm of Hg @ ".date('h:i a');?>
                            <?php endif; ?>

                            <tbody>
                                
                                <tr>
                                    <td class="lblclass">NCT/RT</td>
                                    <td>
                                        <div class="input-group">

                                            <input type="text" class="form-control txtbold" placeholder="RE"
                                                name="IopNctRe" id="IopNctRe"
                                                value="<?php echo e($opto_data['items']['IopNctRe']); ?>"
                                                oninput="getOptoValue('IopNctRe','connvre')">


                                        </div>

                                    </td>

                                    <td>
                                        <div class="input-group">

                                            <input type="text" class="form-control txtbold" placeholder="LE"
                                                name="IopNctLe" id="IopNctLe"
                                                value="<?php echo e($opto_data['items']['IopNctLe']); ?>"
                                                oninput="getOptoValue('IopNctLe','connvle')">


                                        </div>

                                    </td>

                                </tr>
                                <?php if($opto_data['items']['IopLeTime'] != ''): ?>
                                    <?php $IopLeTime = $opto_data['items']['IopLeTime'];?>
                                <?php else: ?>
                                    <?php $IopLeTime = "mm of Hg @ ".date('h:i a');?>
                                <?php endif; ?>
                                <tr>
                                    <td class="lblclass">AT</td>
                                    <td>
                                        <div class="input-group">
                                            <input type="text" class="form-control txtbold" placeholder="RE"
                                                name="IopAtRe2" id="IopAtRe2"
                                                value="<?php echo e($opto_data['items']['IopAtRe2']); ?>"
                                                oninput="getOptoValue('IopAtRe2','conatre')">

                                        </div>

                                    </td>


                                    <td>
                                        <div class="input-group">
                                            <input type="text" class="form-control txtbold" placeholder="LE"
                                                name="IopAtLe2" id="IopAtLe2"
                                                value="<?php echo e($opto_data['items']['IopAtLe2']); ?>"
                                                oninput="getOptoValue('IopAtLe2','conatle')">

                                        </div>

                                    </td>


                                </tr>
                                <tr>
                                    <td colspan="3"> <input type="text" class="form-control txtbold"
                                            placeholder="" name="IopReTime" id="IopReTime"
                                            value="<?php echo e($IopReTime); ?>" style="font-size: 13px;"></td>
                                </tr>
                                <tr>
                                    <td class="lblclass">Roplas</td>
                                    <td><select class="form-control txtbold" name="IopAtRe" style="height:35px;">
                                    <option value="" selected>...</option>
                                            <option value="-VE" <?php if($opto_data['items']['IopAtRe'] == '-VE'){?>selected <?php } ?>>-VE
                                            </option>
                                            <option value="+VE" <?php if($opto_data['items']['IopAtRe'] == '+VE'){?>selected <?php } ?>>+VE
                                            </option>
                                        </select>

                                    </td>
                                    <td><select class="form-control txtbold" name="IopAtLe" style="height:35px;">
                                    <option value="" selected>...</option>
                                    <option value="-VE" <?php if($opto_data['items']['IopAtLe'] == '-VE'){?>selected <?php } ?>>-VE
                                            </option>
                                            <option value="+VE" <?php if($opto_data['items']['IopAtLe'] == '+VE'){?>selected <?php } ?>>+VE
                                            </option>
                                        </select>

                                    </td>

                                </tr>

                            </tbody>
                        </table>
                    </div>
                </fieldset>
            </div>
        </div>

        <div class="row">
            <div class="col-lg-12">
                <fieldset>
                    <legend>Refraction </legend>
                    <div class="table-responsive" style="overflow-x:auto">
                        <table id="report-table" class="table table-bordered table-striped mb-0">
                            <thead>
                                <tr align="center">
                                    <th width="10"></th>
                                    <th width="80" class="lblclass">SPH</th>
                                    <th width="80" class="lblclass">CYL</th>
                                    <th width="80" class="lblclass">AXIS</th>
                                    <th width="80" class="lblclass">ADD</th>
                                    <th width="80" class="lblclass">V.A</th>
                                    <th width="80" class="lblclass">N.V</th>
                                    <th width="80" class="lblclass">Pin</th>
                                </tr>
                            </thead>
                            <tbody>
                                <tr>
                                    <td class="lblclass">RE</td>
                                    <td>
                                        <input type="text" list="datalist3" name="SrSphRe"
                                            class="form-control txtbold" id="SrSphRe"
                                            value="<?php echo e($opto_data['items']['SrSphRe']); ?>"
                                            oninput="corrRef('SrSphRe','CrSrSphRe')">

                                    </td>
                                    <td>
                                        <input type="text" list="datalist4" name="SrCylRe"
                                            class="form-control txtbold" id="SrCylRe"
                                            value="<?php echo e($opto_data['items']['SrCylRe']); ?>"
                                            oninput="axisComp('SrCylRe','SrAxisRe'),corrRef('SrCylRe','CrSrCylRe')">

                                    </td>
                                    <td>

                                        <input type="text" class="form-control txtbold" placeholder=""
                                            name="SrAxisRe" id="SrAxisRe"
                                            value="<?php echo e($opto_data['items']['SrAxisRe']); ?>" style="height: 25px"
                                            oninput="corrRef('SrAxisRe','CrSrAxisRe')">
                                    </td>
                                    <td>
                                        <input type="text" list="datalist5" name="SrNearAddRe"
                                            class="form-control txtbold" id="SrNearAddRe"
                                            value="<?php echo e($opto_data['items']['SrNearAddRe']); ?>"
                                            oninput="corrRef('SrNearAddRe','CrSrNearAddRe')">


                                    </td>
                                    <td>
                                        <input type="text" list="datalist1" name="SrVaGlassRe"
                                            class="form-control txtbold" id="SrVaGlassRe"
                                            value="<?php echo e($opto_data['items']['SrVaGlassRe']); ?>"
                                            oninput="getOptoValue('SrVaGlassRe','convare'),corrRef('SrVaGlassRe','CrSrVaGlassRe')">


                                    </td>
                                    <td>
                                        <input type="text" list="datalist2" name="SrNvRe"
                                            class="form-control txtbold" id="SrNvRe"
                                            value="<?php echo e($opto_data['items']['SrNvRe']); ?>"
                                            oninput="corrRef('SrNvRe','CrSrNvRe')">

                                    </td>
                                    <td>
                                        <input type="text" name="SrPinRe" class="form-control txtbold"
                                            id="SrPinRe" value="<?php echo e($opto_data['items']['SrPinRe']); ?>">

                                    </td>
                                </tr>
                                <tr>
                                    <td class="lblclass">LE</td>
                                    <td>
                                        <input type="text" list="datalist3" name="SrSphLe"
                                            class="form-control txtbold" id="SrSphLe"
                                            value="<?php echo e($opto_data['items']['SrSphLe']); ?>"
                                            oninput="corrRef('SrSphLe','CrSrSphLe')">

                                    </td>
                                    <td>
                                        <input type="text" list="datalist4" name="SrCylLe"
                                            class="form-control txtbold" id="SrCylLe"
                                            value="<?php echo e($opto_data['items']['SrCylLe']); ?>"
                                            oninput="axisComp('SrCylLe','SrAxisLe'),corrRef('SrCylLe','CrSrCylLe')">

                                    </td>
                                    <td>

                                        <input type="text" class="form-control txtbold" placeholder=""
                                            name="SrAxisLe" id="SrAxisLe"
                                            value="<?php echo e($opto_data['items']['SrAxisLe']); ?>" style="height: 25px"
                                            oninput="corrRef('SrAxisLe','CrSrAxisLe')">
                                        <div class="clearfix"></div>
                                    </td>
                                    <td>
                                        <input type="text" list="datalist5" name="SrNearAddLe"
                                            class="form-control txtbold" id="SrNearAddLe"
                                            value="<?php echo e($opto_data['items']['SrNearAddLe']); ?>"
                                            oninput="corrRef('SrNearAddLe','CrSrNearAddLe')">


                                    </td>
                                    <td>
                                        <input type="text" list="datalist1" name="SrVaGlassLe"
                                            class="form-control txtbold" id="SrVaGlassLe"
                                            value="<?php echo e($opto_data['items']['SrVaGlassLe']); ?>"
                                            oninput="getOptoValue('SrVaGlassLe','convale'),corrRef('SrVaGlassLe','CrSrVaGlassLe')">


                                    </td>
                                    <td>
                                        <input type="text" list="datalist2" name="SrNvLe"
                                            class="form-control txtbold" id="SrNvLe"
                                            value="<?php echo e($opto_data['items']['SrNvLe']); ?>"
                                            oninput="getOptoValue('SrNvLe','connvle'),corrRef('SrNvLe','CrSrNvLe')">

                                    </td>
                                    <td>
                                        <input type="text" name="SrPinLe" class="form-control txtbold"
                                            id="SrPinLe" value="<?php echo e($opto_data['items']['SrPinLe']); ?>">

                                    </td>
                                </tr>
                                <tr>
                                    <td colspan="2"> <input type="checkbox" class="" id="PrintCrRef"
                                            name="PrintCrRef" value="1" <?php if($opto_data['items']['PrintCrRef'] == 1) {?> checked
                                            <?php } ?>
                                            style="transform: scale(1);margin-left: 10px;margin-right: 10px;">
                                        <label for="PrintCrRef">PRINT</label>
                                    </td>
                                </tr>
                            </tbody>
                        </table>
                    </div>


                </fieldset>
            </div>
        </div>



        <div class="row">
            <div class="col-lg-12">
                <div id="accordion">
                    <div class="card mb-2">
                        <div class="card-header"><a class="d-flex justify-content-between text-dark"
                                data-toggle="collapse" aria-expanded="true" href="#accordion-1">DETAIL FINDINGS<div
                                    class="collapse-icon"></div>
                            </a></div>
                        <div id="accordion-1" class="collapse show" data-parent="#accordion">
                            <div class="table-responsive" style="overflow-x:auto">
                                <table id="report-table" class="table table-bordered table-striped mb-0">
                                    <thead>
                                        <tr>
                                            <th width="5">
                                                <!-- <label class="custom-control custom-checkbox"><input
                                            type="checkbox" class="custom-control-input" value="1"
                                            id="ChkBeNormal" name="ChkBeNormal" onclick="chkbe_normal()"
                                            >
                                        <span class="custom-control-label">Bilateral Same</span></label> -->
                                            </th>
                                            <th width="250">
                                                <label class="custom-control custom-checkbox"><input type="checkbox"
                                                        class="custom-control-input" value="1" id="ChkReNormal"
                                                        name="ChkReNormal" onclick="chkre_normal()">
                                                    <span class="custom-control-label">RE</span></label>

                                            </th>
                                            <th width="250">
                                                <label class="custom-control custom-checkbox"><input type="checkbox"
                                                        class="custom-control-input" value="1" id="ChkLeNormal"
                                                        name="ChkLeNormal" onclick="chkle_normal()">
                                                    <span class="custom-control-label">LE</span></label>
                                            </th>
                                        </tr>
                                    </thead>
                                    <tbody>
                                        <!--<?php if($consult_data['items']['DfFe'] != 1): ?>
<?php $ReOcMov = 'Normal'; ?>
<?php else: ?>
<?php $ReOcMov = $consult_data['items']['ReOcMov']; ?>
<?php endif; ?>
                            <tr>
                                <td>Ocular Movement</td>
                                <td><input class="form-control datalist" list="ocmre" name="ReOcMov"
                                        id="ReOcMov" value="<?php echo e($ReOcMov); ?>"
                                        oninput="copyValueLe('ReOcMov','LeOcMov')">
                                    <datalist id="ocmre">
                                        <?php
foreach($json_data['JsonData']['OcularMov'] as $result) {?>
                                        <option value="<?php echo $result['Values']; ?>">
                                            <?php } ?>
                                    </datalist>
                                </td>

                                <?php if($consult_data['items']['DfFe'] != 1): ?>
<?php $LeOcMov = 'Normal'; ?>
<?php else: ?>
<?php $LeOcMov = $consult_data['items']['LeOcMov']; ?>
<?php endif; ?>

                                <td><input class="form-control" list="ocmle" name="LeOcMov" id="LeOcMov"
                                        value="<?php echo e($LeOcMov); ?>"><datalist id="ocmle">
                                        <?php
foreach($json_data['JsonData']['OcularMov'] as $result) {?>
                                        <option value="<?php echo $result['Values']; ?>">
                                            <?php } ?>
                                    </datalist></td>
                            </tr>-->



                                        <tr>
                                            <?php if($consult_data['items']['DfFe'] != 1): ?>
                                                <?php $ReLids = ''; ?>
                                            <?php else: ?>
                                                <?php $ReLids = $consult_data['items']['ReLids']; ?>
                                            <?php endif; ?>
                                            <td>Lids Adnexa</td>
                                            <td><input class="form-control" list="lidsre" name="ReLids"
                                                    id="ReLids" value="<?php echo e($ReLids); ?>"
                                                    oninput="copyValueLe('ReLids','LeLids')"><datalist id="lidsre">
                                                    <?php
foreach($json_data['JsonData']['Lids'] as $result) {?>
                                                    <option value="<?php echo $result['Values']; ?>">
                                                        <?php } ?>

                                                </datalist></td>

                                            <?php if($consult_data['items']['DfFe'] != 1): ?>
                                                <?php $LeLids = ''; ?>
                                            <?php else: ?>
                                                <?php $LeLids = $consult_data['items']['LeLids']; ?>
                                            <?php endif; ?>

                                            <td><input class="form-control" list="lidsle" name="LeLids"
                                                    id="LeLids" value="<?php echo e($LeLids); ?>"><datalist
                                                    id="lidsle">
                                                    <?php
foreach($json_data['JsonData']['Lids'] as $result) {?>
                                                    <option value="<?php echo $result['Values']; ?>">
                                                        <?php } ?>
                                                </datalist></td>
                                        </tr>
                                        <tr>

                                            <?php if($consult_data['items']['DfFe'] != 1): ?>
                                                <?php $ReConj = ''; ?>
                                            <?php else: ?>
                                                <?php $ReConj = $consult_data['items']['ReConj']; ?>
                                            <?php endif; ?>

                                            <td>Surface</td>
                                            <td><input class="form-control" list="conjre" name="ReConj"
                                                    id="ReConj" value="<?php echo e($ReConj); ?>"
                                                    oninput="copyValueLe('conjre','LeConj')"><datalist id="conjre">
                                                    <?php
foreach($json_data['JsonData']['Conjunctiva'] as $result) {?>
                                                    <option value="<?php echo $result['Values']; ?>">
                                                        <?php } ?>
                                                </datalist></td>

                                            <?php if($consult_data['items']['DfFe'] != 1): ?>
                                                <?php $LeConj = ''; ?>
                                            <?php else: ?>
                                                <?php $LeConj = $consult_data['items']['LeConj']; ?>
                                            <?php endif; ?>
                                            <td><input class="form-control" list="conjle" name="LeConj"
                                                    id="LeConj" value="<?php echo e($LeConj); ?>"><datalist
                                                    id="conjle">
                                                    <?php
foreach($json_data['JsonData']['Conjunctiva'] as $result) {?>
                                                    <option value="<?php echo $result['Values']; ?>">
                                                        <?php } ?>
                                                </datalist></td>
                                        </tr>
                                        <!--<tr>

                                <?php if($consult_data['items']['DfFe'] != 1): ?>
<?php $ReCornea = 'Bright and Clear'; ?>
<?php else: ?>
<?php $ReCornea = $consult_data['items']['ReCornea']; ?>
<?php endif; ?>
                                <td>Cornea</td>
                                <td><input class="form-control" list="corre" name="ReCornea" id="ReCornea"
                                        value="<?php echo e($ReCornea); ?>"
                                        oninput="copyValueLe('ReCornea','LeCornea')"><datalist id="corre">
                                        <?php
foreach($json_data['JsonData']['Cornea'] as $result) {?>
                                        <option value="<?php echo $result['Values']; ?>">
                                            <?php } ?>
                                    </datalist> </td>


                                <?php if($consult_data['items']['DfFe'] != 1): ?>
<?php $LeCornea = 'Bright and Clear'; ?>
<?php else: ?>
<?php $LeCornea = $consult_data['items']['LeCornea']; ?>
<?php endif; ?>
                                <td><input class="form-control" list="corle" name="LeCornea" id="LeCornea"
                                        value="<?php echo e($LeCornea); ?>"><datalist id="corle">
                                        <?php
foreach($json_data['JsonData']['Cornea'] as $result) {?>
                                        <option value="<?php echo $result['Values']; ?>">
                                            <?php } ?>
                                    </datalist></td>
                            </tr>
                            <tr>
                                <td>Cornea Remark</td>
                                <td><textarea class="form-control" id="ReCorneaRemark" name="ReCorneaRemark" rows="2"
                                    oninput="copyValueLe('ReCorneaRemark','LeCorneaRemark')"><?php echo e($consult_data['items']['ReCorneaRemark']); ?></textarea>
                                </td>
                                <td><textarea class="form-control" id="LeCorneaRemark" name="LeCorneaRemark" rows="2"><?php echo e($consult_data['items']['LeCorneaRemark']); ?></textarea>
                                </td>
                            </tr>-->
                                        <tr>

                                            <?php if($consult_data['items']['DfFe'] != 1): ?>
                                                <?php $ReAntChamber = ''; ?>
                                            <?php else: ?>
                                                <?php $ReAntChamber = $consult_data['items']['ReAntChamber']; ?>
                                            <?php endif; ?>
                                            <td>Ant. Chamber</td>
                                            <td><input class="form-control" list="antchbre" name="ReAntChamber"
                                                    id="ReAntChamber" value="<?php echo e($ReAntChamber); ?>"
                                                    oninput="copyValueLe('ReAntChamber','LeAntChamber')"><datalist
                                                    id="antchbre">
                                                    <?php
foreach($json_data['JsonData']['AntChamber'] as $result) {?>
                                                    <option value="<?php echo $result['Values']; ?>">
                                                        <?php } ?>
                                                </datalist></td>


                                            <?php if($consult_data['items']['DfFe'] != 1): ?>
                                                <?php $LeAntChamber = ''; ?>
                                            <?php else: ?>
                                                <?php $LeAntChamber = $consult_data['items']['LeAntChamber']; ?>
                                            <?php endif; ?>
                                            <td><input class="form-control" list="antchble" name="LeAntChamber"
                                                    id="LeAntChamber" value="<?php echo e($LeAntChamber); ?>"><datalist
                                                    id="antchble">
                                                    <?php
foreach($json_data['JsonData']['AntChamber'] as $result) {?>
                                                    <option value="<?php echo $result['Values']; ?>">
                                                        <?php } ?>
                                                </datalist></td>
                                        </tr>
                                        <!--<tr>


                                <?php if($consult_data['items']['DfFe'] != 1): ?>
<?php $ReIris = 'Colour and Pattern Normal'; ?>
<?php else: ?>
<?php $ReIris = $consult_data['items']['ReIris']; ?>
<?php endif; ?>
                                <td>Iris</td>
                                <td><input class="form-control" list="irisre" name="ReIris" id="ReIris"
                                        value="<?php echo e($ReIris); ?>" oninput="copyValueLe('ReIris','LeIris')"><datalist
                                        id="irisre">
                                        <?php
foreach($json_data['JsonData']['Iris'] as $result) {?>
                                        <option value="<?php echo $result['Values']; ?>">
                                            <?php } ?>
                                    </datalist></td>


                                <?php if($consult_data['items']['DfFe'] != 1): ?>
<?php $LeIris = 'Colour and Pattern Normal'; ?>
<?php else: ?>
<?php $LeIris = $consult_data['items']['LeIris']; ?>
<?php endif; ?>
                                <td><input class="form-control" list="irisle" name="LeIris" id="LeIris"
                                        value="<?php echo e($LeIris); ?>">
                                    <datalist id="irisle">
                                        <?php
foreach($json_data['JsonData']['Iris'] as $result) {?>
                                        <option value="<?php echo $result['Values']; ?>">
                                            <?php } ?>
                                    </datalist>
                                </td>
                            </tr>
                            <tr>

                                <?php if($consult_data['items']['DfFe'] != 1): ?>
<?php $RePupil = 'NSRL'; ?>
<?php else: ?>
<?php $RePupil = $consult_data['items']['RePupil']; ?>
<?php endif; ?>
                                <td>Pupil</td>
                                <td><input class="form-control" list="pupilre" name="RePupil" id="RePupil"
                                        value="<?php echo e($RePupil); ?>"
                                        oninput="copyValueLe('RePupil','LePupil')"><datalist id="pupilre">
                                        <?php
foreach($json_data['JsonData']['Pupil'] as $result) {?>
                                        <option value="<?php echo $result['Values']; ?>">
                                            <?php } ?>
                                    </datalist></td>


                                <?php if($consult_data['items']['DfFe'] != 1): ?>
<?php $LePupil = 'NSRL'; ?>
<?php else: ?>
<?php $LePupil = $consult_data['items']['LePupil']; ?>
<?php endif; ?>
                                <td><input class="form-control" list="pupille" name="LePupil" id="LePupil"
                                        value="<?php echo e($LePupil); ?>"><datalist id="pupille">
                                        <?php
foreach($json_data['JsonData']['Pupil'] as $result) {?>
                                        <option value="<?php echo $result['Values']; ?>">
                                            <?php } ?>
                                    </datalist></td>
                            </tr>
                           -->
                                        <tr>

                                            <?php if($consult_data['items']['DfFe'] != 1): ?>
                                                <?php $ReLens = ''; ?>
                                            <?php else: ?>
                                                <?php $ReLens = $consult_data['items']['ReLens']; ?>
                                            <?php endif; ?>
                                            <td>Lens</td>
                                            <td>
                                                <input class="form-control" list="lensre" name="ReLens"
                                                    id="ReLens" value="<?php echo e($ReLens); ?>"
                                                    oninput="copyValueLe('ReLens','LeLens')">
                                                <datalist id="lensre">
                                                    <?php
foreach($json_data['JsonData']['Lens'] as $result) {?>
                                                    <option value="<?php echo $result['Values']; ?>">
                                                        <?php } ?>
                                                </datalist>
                                            </td>

                                            <?php if($consult_data['items']['DfFe'] != 1): ?>
                                                <?php $LeLens = ''; ?>
                                            <?php else: ?>
                                                <?php $LeLens = $consult_data['items']['LeLens']; ?>
                                            <?php endif; ?>
                                            <td>
                                                <input class="form-control" list="lensle" name="LeLens"
                                                    id="LeLens" value="<?php echo e($LeLens); ?>">

                                                <datalist id="lensle">
                                                    <?php
foreach($json_data['JsonData']['Lens'] as $result) {?>
                                                    <option value="<?php echo $result['Values']; ?>">
                                                        <?php } ?>
                                                </datalist>
                                            </td>
                                        </tr>


                                        <!--  <tr>
                                <td>Lens 2</td>
                                <td><input class="form-control" list="lensre2" name="ReLens2" id="ReLens2"
                                        value="<?php echo e($consult_data['items']['ReLens2']); ?>"
                                        oninput="copyValueLe('ReLens2','LeLens2')"><datalist id="lensre2">
                                        <?php
foreach($json_data['JsonData']['Lens2'] as $result) {?>
                                        <option value="<?php echo $result['Values']; ?>">
                                            <?php } ?>
                                    </datalist></td>
                                <td><input class="form-control" list="lensle2" name="LeLens2" id="LeLens2"
                                        value="<?php echo e($consult_data['items']['LeLens2']); ?>"><datalist id="lensle2">
                                        <?php
foreach($json_data['JsonData']['Lens2'] as $result) {?>
                                        <option value="<?php echo $result['Values']; ?>">
                                            <?php } ?>
                                    </datalist></td>
                            </tr>-->
                                        <tr>
                                            <?php if($consult_data['items']['DfFe'] != 1): ?>
                                                <?php $ReNlp = ''; ?>
                                            <?php else: ?>
                                                <?php $ReNlp = $consult_data['items']['ReNlp']; ?>
                                            <?php endif; ?>
                                            <td>Fundus</td>
                                            <td><input class="form-control" list="NLPRE" name="ReNlp"
                                                    id="ReNlp" value="<?php echo e($ReNlp); ?>"
                                                    oninput="copyValueLe('ReNlp','LeNlp')">
                                                <datalist id="NLPRE">
                                                    <?php
foreach($json_data['JsonData']['NLP'] as $result) {?>
                                                    <option value="<?php echo $result['Values']; ?>">
                                                        <?php } ?>
                                                </datalist>
                                            </td>


                                            <?php if($consult_data['items']['DfFe'] != 1): ?>
                                                <?php $LeNlp = ''; ?>
                                            <?php else: ?>
                                                <?php $LeNlp = $consult_data['items']['LeNlp']; ?>
                                            <?php endif; ?>
                                            <td><input class="form-control" list="NLPLE" name="LeNlp"
                                                    id="LeNlp" value="<?php echo e($LeNlp); ?>"><datalist
                                                    id="NLPLE">
                                                    <?php
foreach($json_data['JsonData']['NLP'] as $result) {?>
                                                    <option value="<?php echo $result['Values']; ?>">
                                                        <?php } ?>
                                                </datalist></td>
                                        </tr>
                                        <!-- <tr>
                                <td>Remark</td>
                                <td colspan="2"><textarea class="form-control" id="CouncRemark" name="CouncRemark" placeholder="Remark"><?php echo e($consult_data['items']['CouncRemark']); ?></textarea>
                                </td>
                            </tr>-->
                                    </tbody>
                                </table>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>

        <div class="row">
            <div class="col-lg-12">
                <fieldset>
                    <legend>Medical History</legend>
                    <div class="row">
                        <div class="col-lg-12">
                            <table width="723" class="table table-bordered table-striped mb-0" id="report-table">
                                <thead>
                                    <tr>
                                        <th width="113" class="lblclass"><input type="checkbox" value="DM"
                                                name="ChkDm" id="ChkDm" <?php if($opto_data['items']['ChkDm'] == 'DM') {?> checked
                                                <?php } ?>> DM</th>
                                        <th width="128" class="lblclass"><input type="checkbox" value="HT"
                                                name="ChkHt" <?php if($opto_data['items']['ChkHt'] == 'HT') {?> checked <?php } ?>> HT
                                        </th>
                                        <th width="109" class="lblclass"><input type="checkbox" value="C.A.D"
                                                name="ChkCad" <?php if($opto_data['items']['ChkCad'] == 'C.A.D') {?> checked <?php } ?>>
                                            C.A.D</th>
                                        <th width="146" class="lblclass"><input type="checkbox" value="Prost."
                                                name="ChkProst" <?php if($opto_data['items']['ChkProst'] == 'Prost.') {?> checked <?php } ?>>
                                            Prostate</th>
                                        <th width="88" class="lblclass"><input type="checkbox" value="COPD"
                                                name="ChkCopd" <?php if($opto_data['items']['ChkCopd'] == 'COPD') {?> checked <?php } ?>>
                                            C.O.P.D</th>
                                        <th width="111" class="lblclass"><input type="checkbox" name="ChkOther"
                                                value="Other" <?php if($opto_data['items']['ChkOther'] == 'Other') {?> checked <?php } ?>>
                                            Others</th>
                                    </tr>
                                </thead>
                                <tbody>
                                    <tr>
                                        <td><input class="form-control txtbold" name="DmFrom" id="dmtext"
                                                value="<?php echo e($opto_data['items']['DmFrom']); ?>">
                                        </td>
                                        <td><input class="form-control txtbold" name="HtFrom" id="dmtext2"
                                                value="<?php echo e($opto_data['items']['HtFrom']); ?>">
                                        </td>
                                        <td><input class="form-control txtbold" name="CadFrom" id="dmtext5"
                                                value="<?php echo e($opto_data['items']['CadFrom']); ?>">
                                        </td>
                                        <td><input class="form-control txtbold" name="ProstFrom" id="dmtext3"
                                                value="<?php echo e($opto_data['items']['ProstFrom']); ?>">
                                        </td>
                                        <td><input class="form-control txtbold" name="CopdFrom" id="dmtext4"
                                                value="<?php echo e($opto_data['items']['CopdFrom']); ?>">
                                        </td>
                                        <td><input class="form-control txtbold" name="OtherFrom" id="dmtext6"
                                                value="<?php echo e($opto_data['items']['OtherFrom']); ?>">
                                        </td>
                                    </tr>
                                    <tr>
                                        <td>
                                            <select class="form-control txtbold" name="DmPeriod" id="DmPeriod"
                                                style="height:35px;">
                                                <option selected="" value="">...
                                                </option>
                                                <option value="Days" <?php if($opto_data['items']['DmPeriod'] == 'Days') {?> selected="selected"
                                                    <?php } ?>>Days</option>
                                                <option value="Months" <?php if($opto_data['items']['DmPeriod'] == 'Months') {?> selected="selected"
                                                    <?php } ?>>Months</option>
                                                <option value="Years" <?php if($opto_data['items']['DmPeriod'] == 'Years') {?> selected="selected"
                                                    <?php } ?>>Years</option>
                                            </select>
                                        </td>
                                        <td>
                                            <select class="form-control txtbold" name="HtPeriod" id="HtPeriod"
                                                style="height:35px;">
                                                <option selected="" value="">...
                                                </option>
                                                <option value="Days" <?php if($opto_data['items']['HtPeriod'] == 'Days') {?> selected="selected"
                                                    <?php } ?>>Days</option>
                                                <option value="Months" <?php if($opto_data['items']['HtPeriod'] == 'Months') {?> selected="selected"
                                                    <?php } ?>>Months</option>
                                                <option value="Years" <?php if($opto_data['items']['HtPeriod'] == 'Years') {?> selected="selected"
                                                    <?php } ?>>Years</option>
                                            </select>
                                        </td>
                                        <td>
                                            <select class="form-control txtbold" name="CadPeriod" id="CadPeriod"
                                                style="height:35px;">
                                                <option selected="" value="">...
                                                </option>
                                                <option value="Days" <?php if($opto_data['items']['CadPeriod'] == 'Days') {?> selected="selected"
                                                    <?php } ?>>Days</option>
                                                <option value="Months" <?php if($opto_data['items']['CadPeriod'] == 'Months') {?> selected="selected"
                                                    <?php } ?>>Months</option>
                                                <option value="Years" <?php if($opto_data['items']['CadPeriod'] == 'Years') {?> selected="selected"
                                                    <?php } ?>>Years</option>
                                            </select>
                                        </td>
                                        <td>
                                            <select class="form-control txtbold" name="ProstPeriod" id="ProstPeriod"
                                                style="height:35px;">
                                                <option selected="" value="">...
                                                </option>
                                                <option value="Days" <?php if($opto_data['items']['ProstPeriod'] == 'Days') {?> selected="selected"
                                                    <?php } ?>>Days</option>
                                                <option value="Months" <?php if($opto_data['items']['ProstPeriod'] == 'Months') {?> selected="selected"
                                                    <?php } ?>>Months</option>
                                                <option value="Years" <?php if($opto_data['items']['ProstPeriod'] == 'Years') {?> selected="selected"
                                                    <?php } ?>>Years</option>
                                            </select>
                                        </td>
                                        <td>
                                            <select class="form-control txtbold" name="CopdPeriod" id="CopdPeriod"
                                                style="height:35px;">
                                                <option selected="" value="">...
                                                </option>
                                                <option value="Days" <?php if($opto_data['items']['CopdPeriod'] == 'Days') {?> selected="selected"
                                                    <?php } ?>>Days</option>
                                                <option value="Months" <?php if($opto_data['items']['CopdPeriod'] == 'Months') {?> selected="selected"
                                                    <?php } ?>>Months</option>
                                                <option value="Years" <?php if($opto_data['items']['CopdPeriod'] == 'Years') {?> selected="selected"
                                                    <?php } ?>>Years</option>
                                            </select>
                                        </td>
                                        <td>
                                            <select class="form-control txtbold" name="OtherPeriod" id="OtherPeriod"
                                                style="height:35px;">
                                                <option selected="" value="">...
                                                </option>
                                                <option value="Days" <?php if($opto_data['items']['OtherPeriod'] == 'Days') {?> selected="selected"
                                                    <?php } ?>>Days</option>
                                                <option value="Months" <?php if($opto_data['items']['OtherPeriod'] == 'Months') {?> selected="selected"
                                                    <?php } ?>>Months</option>
                                                <option value="Years" <?php if($opto_data['items']['OtherPeriod'] == 'Years') {?> selected="selected"
                                                    <?php } ?>>Years</option>
                                            </select>
                                        </td>
                                    </tr>
                                </tbody>
                            </table>
                        </div>
                        <div class="col-lg-12">
                            <table width="700" class="table table-bordered table-striped mb-0" id="report-table">
                                <thead>
                                    <tr>
                                        <!-- <th width="167">Addictions</th> -->
                                        <th width="217" class="lblclass">Allergy History</th>
                                        <th width="300" class="lblclass">Medical History
                                        </th>
                                    </tr>
                                </thead>
                                <tbody>
                                    <tr>

                                        <td>
                                            <textarea class="form-control txtbold" id="AllergyHistory" rows="2" name="AllergyHistory"
                                                style="height:47px;"><?php echo e($opto_data['items']['AllergyHistory']); ?></textarea>
                                        </td>
                                        <td>
                                            <textarea class="form-control txtbold" id="MedicalHistory" rows="2" name="MedicalHistory"
                                                style="height:47px;"><?php echo e($opto_data['items']['MedicalHistory']); ?></textarea>
                                        </td>
                                    </tr>
                                </tbody>
                            </table>
                        </div>
                    </div>
                </fieldset>
            </div>
        </div>



    </div>
    <div class="form-group col-md-6" style="margin-bottom: 0rem">

        <fieldset>
            <legend>Diagnosis</legend>
            <div class="row">
                <div class="col-lg-11">
                    <textarea class="form-control" id="Diagnosis" name="Diagnosis" style="height:80px;"><?php echo e($consult_data['items']['Diagnosis']); ?></textarea>
                </div>
                <div class="col-lg-1" style="padding-left: 5px;"><span class="input-group-append"><button
                            class="btn btn-secondary" type="button" data-toggle="modal" data-target="#modal-report"
                            id="add_button" onclick="getValue('Diagnosis','Diagnosis')">...</button></span>
                </div>
            </div>
        </fieldset>



        <fieldset style="height:50px;">
            <legend>Investigation</legend>
            <div class="row">
                <div class="col-lg-9">
                    <div class="form-group">
                        <input type="text" class="form-control" placeholder="" name="InvStName" id="InvStName"
                            value="<?php echo e($consult_data['items']['InvStName']); ?>" <?php if($UserId != 58): ?> readonly <?php endif; ?>>

                    </div>
                </div>
                <div class="col-lg-2">
                    <div class="form-group">
                    <input type="text" class="form-control" placeholder="Amount" name="InvStAmount"
    id="InvStAmount" value="<?php echo e($consult_data['items']['Amount']); ?>"
    <?php if($UserId != 58): ?> readonly <?php endif; ?>>


                    </div>
                </div>
                <div class="col-lg-1" style="padding-left: 5px;">
                    <span class="input-group-append">
                        <button class="btn btn-secondary" type="button" onclick="investigationLists()"
                            id="invst_add_button">...</button>
                    </span>
                </div>
            </div>
        </fieldset>

        <?php echo $__env->make('opd/incedittreatments', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?>

        <fieldset>
            <legend>Advice</legend>
            <div class="row">


            </div>
            <div class="row" style="padding-top:10px;">
                <div class="col-lg-12">
                    <textarea class="form-control" id="Advice" name="Advice" style="height: 160px;"><?php echo e($consult_data['items']['Advice']); ?></textarea>
                </div>
                <!-- <div class="col-lg-1" style="padding-left: 20px;"><span class="input-group-append"><button
                            class="btn btn-secondary" type="button" data-toggle="modal"
                            data-target="#modal-report-inst"
                            onclick="addNewSpecInst('CmbPlanOfMang','PlanOfMang')">+</button></span>
                </div>
                <div class="col-lg-1" style="padding-left: 1px;">
                    <span class="input-group-append"><button class="btn btn-secondary" type="button"
                            data-toggle="modal" data-target="#modal-report" id="add_button"
                            onclick="getValue('Advice','Advice')">...</button></span>
                </div> -->

            </div>
        </fieldset>


        <fieldset>
            <legend>Remark</legend>
            <div class="row">
                <div class="col-lg-10">
                    <textarea class="form-control" id="ReferTo" name="ReferTo" style="height: 80px"><?php echo e($consult_data['items']['ReferTo']); ?></textarea>

                </div>
                <div class="col-lg-1"><span class="input-group-append"><button class="btn btn-secondary"
                            type="button" data-toggle="modal" data-target="#modal-report" id="add_button"
                            onclick="getValue('ReferTo','ReferTo')">...</button></span>
                </div>

            </div>

        </fieldset>



        <div class="form-group col-md-12" style="margin-bottom: 0rem">
            <div class="row" style="padding-top: 15px;">

                <div class="col-md-3">

                    <div class="form-group">
                        <label class="floating-label" for="gender">Review
                            After</label>
                        <div class="input-group">

                            <input type="number" id="ReviewDay" name="ReviewDay"
                                value="<?php echo e($consult_data['items']['ReviewDay']); ?>" class="form-control"
                                placeholder="" required min="0" oninput="getAppDate2()"
                                style="height: 39px;">
                            <select class="form-control" style="width: 100%;margin-top: 3px !important;height: 36px;"
                                data-allow-clear="true" name="Review" id="Review"
                                onchange="getAppDate(this.value)">
                                <!-- <option value="" selected="">...</option> -->
                                <option value="days" <?php if($consult_data['items']['Review'] == 'days') {?> selected <?php } ?>>
                                    Days
                                </option>
                                <option value="month" <?php if($consult_data['items']['Review'] == 'month') {?> selected <?php } ?>>
                                    Month
                                </option>
                                <option value="year" <?php if($consult_data['items']['Review'] == 'year') {?> selected <?php } ?>>
                                    Year
                                </option>


                            </select>
                        </div>
                    </div>

                </div>

                <?php if($consult_data['items']['AppointDate'] != ''): ?>
                    <?php $ReviewDate = $consult_data['items']['AppointDate']; ?>
                <?php else: ?>
                    <?php $ReviewDate = date('Y-m-d'); ?>
                <?php endif; ?>
                <div class="col-md-2" style="padding-top: 10px;">
                    <div class="form-group">
                        <label class="floating-label" for="Name">On
                            Date
                            <span class="text-danger">*</span></label>
                        <input type="date" id="AppointDate" name="ReviewDate" value="<?php echo e($ReviewDate); ?>"
                            class="form-control" placeholder="" onchange="getReviewDays(this.value)"
                            style="height: 30px;">
                        <span style="color:red;display:none;" id="sundayerrormsg">Sunday</span>
                        <span style="color:#11e311;" id="alldaymsg"></span>
                    </div>

                </div>



                <div class="col-md-5">
                    <div class="form-group">
                        <label class="floating-label" for="gender">Speciality Clinic</label>
                        <div class="input-group">

                            <select class="form-control"
                                style="width: 100%;margin-top: 3px !important;height: 36px;" data-allow-clear="true"
                                name="ClinicName" id="ClinicName" onchange="getSpecConsultant(this.value)">
                                <option value="" selected="">...</option>
                                <?php $__currentLoopData = $clinicnameList; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $result): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                    <option value="<?php echo e($result->ClinicName); ?>" <?php if($consult_data['items']['ClinicName'] == $result->ClinicName) {?> selected
                                        <?php } ?>>
                                        <?php echo e($result->ClinicName); ?>

                                    </option>
                                <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>


                            </select>
                            <select class="form-control"
                                style="width: 100%;margin-top: 3px !important;height: 36px;" data-allow-clear="true"
                                name="SpecDocName" id="SpecDocName">
                                <option value="" selected="">...</option>
                                <?php $__currentLoopData = $clinicdocnameList; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $result): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                    <option value="<?php echo e($result->Name); ?>" <?php if($consult_data['items']['SpecDocName'] == $result->Name) {?> selected
                                        <?php } ?>>
                                        <?php echo e($result->Name); ?>

                                    </option>
                                <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>


                            </select>
                            <span class="input-group-append">
                                <button class="btn btn-secondary" type="button" data-toggle="modal"
                                    data-target="#modal-report-spec" id="add-spec-clinic"
                                    onclick="addNewSpClinic()">+</button>
                            </span>

                        </div>
                    </div>
                </div>

                <div class="col-md-2">
                    <div class="form-group">
                        <label class="floating-label" for="gender">Time</label>
                        <input type="time" id="AppTime" name="AppTime"
                            value="<?php echo e($consult_data['items']['AppTime']); ?>" class="form-control" placeholder=""
                            style="height: 39px;">
                    </div>
                </div>


            </div>
            <span style="color:red;">(exclusive sunday)</span>
        </div>


        <input type="hidden" id="saveprintval" value="1">
        <input type="hidden" id="savebtnval" value="savecoun">
        <div class="row">
            <div class="col-md-4">
                <div class="form-group">
                    <label class="floating-label" for="gender">Language</label>
                    <select class="form-control" name="Language" id="Language" style="height: 35px;">
                        <option value="Marathi" <?php if($consult_treat_data['items']['Language'] == 'Marathi'){?> selected <?php } ?>>Marathi</option>
                        <option value="Hindi" <?php if($consult_treat_data['items']['Language'] == 'Hindi'){?> selected <?php } ?>>Hindi</option>
                    </select>
                </div>
            </div>

            <div class="col-lg-8">
                <div class="form-group">
                    <label class="floating-label" for="gender">Counselling Remark</label>
                    <textarea class="form-control" id="CouncRemark" name="CouncRemark" style="height: 35px"><?php echo e($consult_data['items']['CouncRemark']); ?></textarea>
                </div>
            </div>

            <div class="col-sm-12 sub_btn" style="padding-top:10px" id="consbtns">
                <button class="btn btn-primary" type="submit" name="submit" id="savecoun"
                    onclick="getsaveprintval(1,'savecoun')"
                    style="background-color: rgb(79, 175, 184);">Save</button>
                <!-- <a
            onclick="opdDetailPrint(<?php echo e($MrdNo); ?>,'<?php echo e($VisitNo); ?>')" href='javascript:void(0);'
            class="btn btn-success"> Save & Print</a> -->
                <button class="btn btn-success" type="submit" name="submit" id="saveprintcoun"
                    onclick="getsaveprintval(2,'saveprintcoun')" style="background-color: rgb(65, 110, 110);">Detail
                    Print</button>

                <button class="btn btn-success" type="submit" name="submit" id="saveshortprintcoun"
                    onclick="getsaveprintval(3,'saveshortprintcoun')"
                    style="background-color: rgb(65, 110, 110);">Brief
                    Print</button>

                <!-- <button class="btn btn-success" type="button" id="saveprintcoun"
            onclick="printDetailPrint(<?php echo e($MrdNo); ?>)" style="background-color: rgb(65, 110, 110);">Detail
            Print</button>

        <button class="btn btn-success" type="button" id="saveshortprintcoun"
            onclick="printBriefPrint(<?php echo e($MrdNo); ?>)" style="background-color: rgb(65, 110, 110);">Brief
            Print</button> -->

                &nbsp;&nbsp;
                <!-- <input type="checkbox" value="1" name="PageBreak" <?php if($consult_data['items']['PageBreak'] == 1){?> checked
            <?php } ?>>&nbsp;Page Break &nbsp;&nbsp; -->
                <?php if($opto_data['items']['Checked'] == 1){} else{?>
                <button class="btn btn-info" type="button"
                    onclick="patientCheck(<?php echo e($MrdNo); ?>,'<?php echo e($VisitNo); ?>')"
                    style="background-color: rgb(79, 175, 184);">OUT</button>
                <?php } ?>
                <button type="button" class="btn btn-danger" onclick="exitcoun()"
                    style="background-color: rgb(65, 110, 110);">Exit</button>
            </div>


        </div>





        <div class="col-sm-12 sub_btn" style="padding-top:10px;display:none;" id="consbtns2">


            <button class="btn btn-success" type="button" id="saveprintcoun2"
                onclick="checkPreviousDetails(<?php echo e($MrdNo); ?>)"
                style="background-color: rgb(65, 110, 110);">Detail
                Print</button>

            <button class="btn btn-success" type="button" id="saveshortprintcoun2"
                onclick="checkPreviousBrief(<?php echo e($MrdNo); ?>)"
                style="background-color: rgb(65, 110, 110);">Brief
                Print</button>
            &nbsp;&nbsp;


            <button type="button" class="btn btn-danger" onclick="exitcoun()"
                style="background-color: rgb(65, 110, 110);">Exit</button>

        </div>


    </div>






</div>
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