<fieldset>
    <legend>Treatment</legend>
    <div class="table-responsive" style="overflow-x:auto;">
        <table id="report-table" class="table table-bordered table-striped mb-0">
            <thead>
                <tr>
                    <th colspan="7" align="left" valign="top">

                        <input class="form-control" type="text" list="Treatments" name="Treatment" id="Treatment"
                            value="{{$data3[0]->Treatment}}" onchange="getRecords(this.value)">
                        <datalist id="Treatments">
                        <?php
        foreach($json_data2['items'] as $result) {?>
                            <option value="<?php echo $result['Treatment']; ?>">
                                <?php } ?>
                        </datalist>
                    </th>
                </tr>
                <tr>
                    <th width="20" align="center" valign="top">&nbsp;&nbsp;&nbsp;#&nbsp;&nbsp;&nbsp;</th>
                    <th width="50"> Type </th>
                    <th width="150"> Name </th>
                    <th width="50">Dose</th>
                    <th width="50">Freq.</th>
                    <th width="70">Duration</th>
                    <th width="20">Eye </th>
                </tr>
            </thead>
            <tbody id="showTreatments">
                <tr>
                    <td align="center" valign="top"><input class="form-check-input" type="checkbox" value="1"
                            id="TreatChk1" name="TreatChk1" <?php if($data3[0]->TreatChk1 == '1') {?> checked <?php } ?> style="height:31px;">
                    </td>
                    <td>
                        
                         <input class="form-control" type="text" list="Treat_Type1" name="TreatType1" id="TreatType1"
                            value="{{$data3[0]->TreatType1}}">
                        <datalist id="Treat_Type1">
                            <?php
                            foreach($json_data['JsonData']['TreatType'] as $result) {?>
                            <option value="<?php echo $result['Values']; ?>">
                                <?php } ?>
                        </datalist> 
                    </td>
                    <td>
                        <input class="form-control" type="text" name="TreatName1" list="Treat_Name1" id="TreatName1"
                            value="{{$data3[0]->TreatName1}}" style="height:31px;">
                        <datalist id="Treat_Name1">
                                
                        </datalist>
                    </td>
                    <td>
                  
                        <input class="form-control" type="text" list="Treat_Dose1" name="TreatDose1" id="TreatDose1"
                            value="{{$data3[0]->TreatDose1}}">
                        <datalist id="Treat_Dose1">
                            <?php
        foreach($json_data['JsonData']['TreatDose'] as $result) {?>
                            <option value="<?php echo $result['Values']; ?>">
                                <?php } ?>

                        </datalist> 
                    </td>
                    <td>
                  
                        <input class="form-control" type="text" list="Treat_Freq1" name="TreatFreq1" id="TreatFreq1"
                            value="{{$data3[0]->TreatFreq1}}">
                        <datalist id="Treat_Freq1">
                            <?php
        foreach($json_data['JsonData']['TreatFreq'] as $result) {?>
                            <option value="<?php echo $result['Values']; ?>">
                                <?php } ?>
                        </datalist> 
                    </td>
                    <td>
                   
                        <input class="form-control" type="text" list="Treat_Dur1" name="TreatDur1" id="TreatDur1"
                            value="{{$data3[0]->TreatDur1}}">
                        <datalist id="Treat_Dur1">
                            <?php
        foreach($json_data['JsonData']['TreatDur'] as $result) {?>
                            <option value="<?php echo $result['Values']; ?>">
                                <?php } ?>
                        </datalist> 
                    </td>
                    <td>
                    
                         <input class="form-control" type="text" list="Treat_Eye1" name="TreatEye1" id="TreatEye1"
                            value="{{$data3[0]->TreatEye1}}">
                        <datalist id="Treat_Eye1">
                            <?php
        foreach($json_data['JsonData']['TreatEye'] as $result) {?>
                            <option value="<?php echo $result['Values']; ?>">
                                <?php } ?>
                        </datalist>
                    </td>
                </tr>

                <tr>
                    <td align="center" valign="top"><input class="form-check-input" type="checkbox" value="1"
                            id="TreatChk2" name="TreatChk2" <?php if($data3[0]->TreatChk2 == '1') {?> checked <?php } ?>>
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Type1" name="TreatType2" id="TreatType2"
                            value="{{$data3[0]->TreatType2}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Name1" name="TreatName2" id="TreatName2"
                            value="{{$data3[0]->TreatName2}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dose1" name="TreatDose2" id="TreatDose2"
                            value="{{$data3[0]->TreatDose2}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Freq1" name="TreatFreq2" id="TreatFreq2"
                            value="{{$data3[0]->TreatFreq2}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dur1" name="TreatDur2" id="TreatDur2"
                            value="{{$data3[0]->TreatDur2}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Eye1" name="TreatEye2" id="TreatEye2"
                            value="{{$data3[0]->TreatEye2}}">
                    </td>
                </tr>

                <tr>
                    <td align="center" valign="top"><input class="form-check-input" type="checkbox" value="1"
                            id="TreatChk3" name="TreatChk3" <?php if($data3[0]->TreatChk3 == '1') {?> checked <?php } ?>>
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Type1" name="TreatType3" id="TreatType3"
                            value="{{$data3[0]->TreatType3}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Name1" name="TreatName3" id="TreatName3"
                            value="{{$data3[0]->TreatName3}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dose1" name="TreatDose3" id="TreatDose3"
                            value="{{$data3[0]->TreatDose3}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Freq1" name="TreatFreq3" id="TreatFreq3"
                            value="{{$data3[0]->TreatFreq3}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dur1" name="TreatDur3" id="TreatDur3"
                            value="{{$data3[0]->TreatDur3}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Eye1" name="TreatEye3" id="TreatEye3"
                            value="{{$data3[0]->TreatEye3}}">
                    </td>
                </tr>

                <tr>
                    <td align="center" valign="top"><input class="form-check-input" type="checkbox" value="1"
                            id="TreatChk4" name="TreatChk4" <?php if($data3[0]->TreatChk4 == '1') {?> checked <?php } ?>>
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Type1" name="TreatType4" id="TreatType4"
                            value="{{$data3[0]->TreatType4}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Name1" name="TreatName4" id="TreatName4"
                            value="{{$data3[0]->TreatName4}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dose1" name="TreatDose4" id="TreatDose4"
                            value="{{$data3[0]->TreatDose4}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Freq1" name="TreatFreq4" id="TreatFreq4"
                            value="{{$data3[0]->TreatFreq4}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dur1" name="TreatDur4" id="TreatDur4"
                            value="{{$data3[0]->TreatDur4}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Eye1" name="TreatEye4" id="TreatEye4"
                            value="{{$data3[0]->TreatEye4}}">
                    </td>
                </tr>

                <tr>
                    <td align="center" valign="top"><input class="form-check-input" type="checkbox" value="1"
                            id="TreatChk5" name="TreatChk5" <?php if($data3[0]->TreatChk5 == '1') {?> checked <?php } ?>>
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Type1" name="TreatType5" id="TreatType5"
                            value="{{$data3[0]->TreatType5}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Name1" name="TreatName5" id="TreatName5"
                            value="{{$data3[0]->TreatName5}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dose1" name="TreatDose5" id="TreatDose5"
                            value="{{$data3[0]->TreatDose5}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Freq1" name="TreatFreq5" id="TreatFreq5"
                            value="{{$data3[0]->TreatFreq5}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dur1" name="TreatDur5" id="TreatDur5"
                            value="{{$data3[0]->TreatDur5}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Eye1" name="TreatEye5" id="TreatEye5"
                            value="{{$data3[0]->TreatEye5}}">
                    </td>
                </tr>

                <tr>
                    <td align="center" valign="top"><input class="form-check-input" type="checkbox" value="1"
                            id="TreatChk6" name="TreatChk6" <?php if($data3[0]->TreatChk6 == '1') {?> checked <?php } ?>>
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Type1" name="TreatType6" id="TreatType6"
                            value="{{$data3[0]->TreatType6}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Name1" name="TreatName6" id="TreatName6"
                            value="{{$data3[0]->TreatName6}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dose1" name="TreatDose6" id="TreatDose6"
                            value="{{$data3[0]->TreatDose6}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Freq1" name="TreatFreq6" id="TreatFreq6"
                            value="{{$data3[0]->TreatFreq6}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dur1" name="TreatDur6" id="TreatDur6"
                            value="{{$data3[0]->TreatDur6}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Eye1" name="TreatEye6" id="TreatEye6"
                            value="{{$data3[0]->TreatEye6}}">
                    </td>
                </tr>

                <tr>
                    <td align="center" valign="top"><input class="form-check-input" type="checkbox" value="1"
                            id="TreatChk7" name="TreatChk7" <?php if($data3[0]->TreatChk7 == '1') {?> checked <?php } ?>>
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Type1" name="TreatType7" id="TreatType7"
                            value="{{$data3[0]->TreatType7}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Name1" name="TreatName7" id="TreatName7"
                            value="{{$data3[0]->TreatName7}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dose1" name="TreatDose7" id="TreatDose7"
                            value="{{$data3[0]->TreatDose7}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Freq1" name="TreatFreq7" id="TreatFreq7"
                            value="{{$data3[0]->TreatFreq7}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dur1" name="TreatDur7" id="TreatDur7"
                            value="{{$data3[0]->TreatDur7}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Eye1" name="TreatEye7" id="TreatEye7"
                            value="{{$data3[0]->TreatEye7}}">
                    </td>
                </tr>

                <tr>
                    <td align="center" valign="top"><input class="form-check-input" type="checkbox" value="1"
                            id="TreatChk8" name="TreatChk8" <?php if($data3[0]->TreatChk8 == '1') {?> checked <?php } ?>>
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Type1" name="TreatType8" id="TreatType8"
                            value="{{$data3[0]->TreatType8}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Name1" name="TreatName8" id="TreatName8"
                            value="{{$data3[0]->TreatName8}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dose1" name="TreatDose8" id="TreatDose8"
                            value="{{$data3[0]->TreatDose8}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Freq1" name="TreatFreq8" id="TreatFreq8"
                            value="{{$data3[0]->TreatFreq8}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dur1" name="TreatDur8" id="TreatDur8"
                            value="{{$data3[0]->TreatDur8}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Eye1" name="TreatEye8" id="TreatEye8"
                            value="{{$data3[0]->TreatEye8}}">
                    </td>
                </tr>

                <tr>
                    <td align="center" valign="top"><input class="form-check-input" type="checkbox" value="1"
                            id="TreatChk9" name="TreatChk9" <?php if($data3[0]->TreatChk9 == '1') {?> checked <?php } ?>>
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Type1" name="TreatType9" id="TreatType9"
                            value="{{$data3[0]->TreatType9}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Name1" name="TreatName9" id="TreatName9"
                            value="{{$data3[0]->TreatName9}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dose1" name="TreatDose9" id="TreatDose9"
                            value="{{$data3[0]->TreatDose9}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Freq1" name="TreatFreq9" id="TreatFreq9"
                            value="{{$data3[0]->TreatFreq9}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dur1" name="TreatDur9" id="TreatDur9"
                            value="{{$data3[0]->TreatDur9}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Eye1" name="TreatEye9" id="TreatEye9"
                            value="{{$data3[0]->TreatEye9}}">
                    </td>
                </tr>

                <tr>
                    <td align="center" valign="top"><input class="form-check-input" type="checkbox" value="1"
                            id="TreatChk10" name="TreatChk10" <?php if($data3[0]->TreatChk10 == '1') {?> checked <?php } ?>>
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Type1" name="TreatType10" id="TreatType10"
                            value="{{$data3[0]->TreatType10}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Name1" name="TreatName10" id="TreatName10"
                            value="{{$data3[0]->TreatName10}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dose1" name="TreatDose10" id="TreatDose10"
                            value="{{$data3[0]->TreatDose10}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Freq1" name="TreatFreq10" id="TreatFreq10"
                            value="{{$data3[0]->TreatFreq10}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Dur1" name="TreatDur10" id="TreatDur10"
                            value="{{$data3[0]->TreatDur10}}">
                    </td>
                    <td>
                        <input class="form-control" type="text" list="Treat_Eye1" name="TreatEye10" id="TreatEye10"
                            value="{{$data3[0]->TreatEye10}}">
                    </td>
                </tr>

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