<div class="modal fade" id="modal-report656" tabindex="-1" role="dialog" aria-labelledby="myExtraLargeModalLabel"
    aria-hidden="true">
    <div class="modal-dialog" style="max-width: 70rem; ">
        <div class="modal-content">


            <div class="modal-header" >
                <h5 class="modal-title" style="width: 100%;" id="drugtitle">Update Bill Charges 
               
                </h5>
                <button type="button" class="close" data-dismiss="modal" aria-label="Close">
                    <span aria-hidden="true">&times;</span>
                </button>
            </div>
            <div class="modal-body">
            <form>
                        @csrf
                        <div class="row">
                        <input type="hidden" id="Chargesaction" value="Save">
                            <input type="hidden"id="Chargesid" />
                        

                            <div class="col-sm-12">
                                <div class="form-group">
                                    <label class="floating-label" for="Name">Charges Name <span
                                            class="text-danger">*</span></label>
                                    <input type="text" class="form-control" id="ChargesName" placeholder=""
                                        required="" style="height:31px;">
                                </div>
                            </div>

                            
                            <!-- <div class="col-sm-4">
                                <div class="form-group">
                                    <label class="floating-label" for="Name">Amount <span
                                            class="text-danger">*</span></label>
                                    <input type="text" class="form-control" id="Amount" placeholder=""
                                        required="" style="height:31px;">
                                </div>
                            </div> -->


                            <div class="col-sm-12">
                                <button class="btn btn-primary" type="button" id="medicinebtn" onclick="saveUpdateCharges()">Submit</button>
                                <button class="btn btn-danger" data-dismiss="modal">close</button>
                            </div>
                        </div>
                    </form>
                    
            </div>
            </div>
            </div>
            </div>