<div class="row">
                    <!-- customar project  start -->
                    <div class="col-xl-12">
                        <div class="card">
                            <div class="card-body">

                                <form id="validation-form" novalidate="novalidate" method="POST"
                                    enctype="multipart/form-data" autocomplete="off" action="">
                                    <input type="hidden" name="action" id="action" value="Save">

                                    @csrf
                                    <div class="form-row">
                                        <div class="form-group col-md-1">
                                            <label class="floating-label" for="Name">ID </label>
                                            <input class="form-control" list="DataList2" name="id" id="id"
                                                oninput="getCounselDetails()">
                                            <datalist id="DataList2">
                                                @foreach($otschid as $result)
                                                <option value="{{$result->id}}">
                                                    @endforeach
                                            </datalist>


                                        </div>


                                        <div class="form-group col-md-1" style="margin-bottom: 0rem;">
                                            <label class="floating-label" for="Name">MRD No <span
                                                    class="text-danger">*</span></label>
                                            <input name="MrdNo" type="text" class="form-control" id="MrdNo" value=""
                                                placeholder="" oninput="get">

                                        </div>
                                        <div class="form-group col-md-2" style="margin-bottom: 0rem;">
                                            <label class="floating-label" for="Name">Patient Name <span
                                                    class="text-danger">*</span></label>
                                            <input name="PatientName" type="text" class="form-control" id="PatientName"
                                                value="" placeholder="">

                                        </div>
                                        <div class="form-group col-md-3" style="margin-bottom: 0rem;">
                                            <label class="floating-label" for="Name">Scheudle Date <span
                                                    class="text-danger">*</span></label>
                                            <div class="input-group">
                                                <input type="date" class="form-control" name="ScheduleDate"
                                                    id="ScheduleDate" value="{{date('Y-m-d')}}">
                                                <span class="input-group-append" style="height: 25px;line-height: 1px;">
                                                    <button class="btn btn-secondary" type="button"
                                                        onclick="otSchList()" style="line-height: 1px;">View OT
                                                        List</button>
                                                </span>
                                            </div>

                                        </div>
                                        <div class="form-group col-md-2" style="margin-bottom: 0rem;">
                                            <label class="floating-label" for="Name">Contact No <span
                                                    class="text-danger">*</span></label>
                                            <input name="Phone" type="text" class="form-control" id="Phone" value=""
                                                placeholder="">
                                            <input type="hidden" name="Age" id="Age" value="">
                                            <input type="hidden" name="Address" id="Address" value="">
                                            <input type="hidden" name="Gender" id="Gender" value="">
                                        </div>

                                        <div class="form-group col-md-3" style="margin-bottom: 0rem;">
                                            <label class="floating-label" for="Name">Lock Date <span
                                                    class="text-danger">*</span></label>
                                            <div class="input-group">
                                                <!-- <span class="input-group-prepend">
                                                    <input name="Phone" type="date" class="form-control" id="Phone"
                                                        value="" placeholder="">
                                                </span> -->

                                                <input name="FixedDate" type="date" class="form-control" id="FixedDate"
                                                    value="" placeholder="">
                                                <span class="input-group-append" style="height: 25px;line-height: 1px;">
                                                    <button class="btn btn-secondary" type="button"
                                                        onclick="fixedDate()" style="line-height: 1px;">Fixed</button>
                                                </span>
                                            </div>
                                        </div>


                                    </div>


                                    <div class="row">
                                        <div class="col-md-4"
                                            style="margin-bottom: 0rem;padding-right: 1px;padding-left: 1px;">

                                            <fieldset>
                                                <legend>Biometry & Keratometry</legend>
                                                <table class="table table-bordered table-striped mb-0">
                                                    <thead>
                                                        <tr>
                                                            <td width="10" align="left" valign="top">AL </td>
                                                            <td width="100" align="left" valign="top"><input name="AL"
                                                                    type="text" class="form-control" id="AL" value=""
                                                                    placeholder=""></td>
                                                            <td width="10" align="left" valign="top">K1 </td>
                                                            <td width="75" align="left" valign="top"><input name="K1Re"
                                                                    type="text" class="form-control" id="K1Re" value=""
                                                                    placeholder=""></td>
                                                            <td width="75" align="left" valign="top"><input name="K1Le"
                                                                    type="text" class="form-control" id="K1Le" value=""
                                                                    placeholder=""></td>
                                                        </tr>
                                                        <tr>
                                                            <td width="10" align="left" valign="top">ACD </td>
                                                            <td width="50" align="left" valign="top"><input name="Acd"
                                                                    type="text" class="form-control" id="Acd" value=""
                                                                    placeholder=""></td>
                                                            <td width="50" align="left" valign="top">K2 </td>
                                                            <td width="50" align="left" valign="top"><input name="K2Re"
                                                                    type="text" class="form-control" id="K2Re" value=""
                                                                    placeholder=""></td>
                                                            <td width="50" align="left" valign="top"><input name="K2Le"
                                                                    type="text" class="form-control" id="K2Le" value=""
                                                                    placeholder=""></td>
                                                        </tr>
                                                        <tr>
                                                            <td width="10" align="left" valign="top">LT </td>
                                                            <td width="50" align="left" valign="top"><input name="LT"
                                                                    type="text" class="form-control" id="LT" value=""
                                                                    placeholder=""></td>
                                                            <td width="50" align="left" valign="top">Diff </td>
                                                            <td width="50" align="left" valign="top" colspan="2"><input
                                                                    name="Diff" type="text" class="form-control"
                                                                    id="Diff" value="" placeholder=""></td>
                                                        </tr>
                                                        <tr>
                                                            <td width="10" align="left" valign="top">WTW </td>
                                                            <td width="50" align="left" valign="top"><input name="Wtw"
                                                                    type="text" class="form-control" id="Wtw" value=""
                                                                    placeholder=""></td>
                                                            <td width="50" align="left" valign="top">A Constant </td>
                                                            <td width="50" align="left" valign="top" colspan="2"><input
                                                                    name="Aconstant" type="text" class="form-control"
                                                                    id="Aconstant" value="" placeholder=""></td>
                                                        </tr>

                                                    </thead>
                                                </table>
                                            </fieldset>
                                        </div>
                                        <!-- 
                                        <div class="col-md-2"
                                            style="margin-bottom: 0rem;padding-right: 1px;padding-left: 1px;">

                                            <fieldset>
                                                <legend>Keratometry</legend>
                                                <table class="table table-bordered table-striped mb-0">
                                                    <thead>
                                                        
                                                    </thead>
                                                </table>
                                            </fieldset>
                                        </div> -->

                                        <div class="col-md-3"
                                            style="margin-bottom: 0rem;padding-right: 1px;padding-left: 1px;">

                                            <fieldset>
                                                <legend>IOl Details </legend>
                                                <table class="table table-bordered table-striped mb-0">
                                                    <thead>
                                                        <tr>
                                                            <td width="20" align="left" valign="top">Eye</td>
                                                            <td width="150" align="left" valign="top" colspan="2">
                                                                <select class="form-control" name="Eye" id="Eye"
                                                                    style="height: 33px;">
                                                                    <option selected="" value="">...
                                                                    </option>
                                                                    <option value="RE">RE
                                                                    </option>
                                                                    <option value="LE">LE
                                                                    </option>
                                                                    <option value="BE">BE
                                                                    </option>
                                                                </select>
                                                            </td>
                                                        </tr>
                                                        <tr>
                                                            <td width="10" align="left" valign="top">IOL Name </td>
                                                            <td width="50" align="left" valign="top" colspan="2">
                                                            <select class="form-control" name="IolName" id="IolName"
                                                                    style="height: 33px;" onchange="modelLists(this.value,'')">
                                                                    <option selected="" value="">...
                                                                    </option>
                                                                    
                                                                </select>
                                                            
                                                           
                                                            </td>
                                                        </tr>
                                                        <tr>
                                                            <td width="10" align="left" valign="top">IOL Type </td>
                                                            <td width="50" align="left" valign="top" colspan="2">
                                                            <select class="form-control" name="IolType" id="IolType"
                                                                    style="height: 33px;" onchange="powerLists(this.value,'')">
                                                                    <option selected="" value="">...
                                                                    </option>
                                                                   
                                                                </select>
                                                           
                                                            </td>
                                                        </tr>
                                                        <tr>
                                                            <td width="10" align="left" valign="top">IOL Power </td>
                                                            <td width="50" align="left" valign="top">
                                                            <select class="form-control" name="IolPower" id="IolPower"
                                                                    style="height: 33px;">
                                                                    <option selected="" value="">...
                                                                    </option>
                                                                   
                                                                </select>
                                                                
                                                                </td>
                                                                <td width="50" align="left" valign="top">
                                                                <input name="Cyl"
                                                                    type="text" class="form-control" id="Cyl" value=""
                                                                    placeholder="Cyl" style="height: 22px;">
                                                            </td>
                                                        </tr>
                                                        

                                                    </thead>
                                                </table>
                                            </fieldset>
                                        </div>

                                        <div class="col-md-5"
                                            style="margin-bottom: 0rem;padding-right: 1px;padding-left: 1px;">

                                            <fieldset style="height: 180px;">
                                                <legend>Investigation</legend>
                                                <table class="table table-bordered table-striped mb-0">
                                                    <thead>
                                                        <tr>
                                                            <td width="10" align="left" valign="top">IOP </td>
                                                            <td width="75" align="left" valign="top"><input name="IopRe"
                                                                    type="text" class="form-control" id="IopRe" value=""
                                                                    placeholder="" style="height: 20px;"></td>
                                                            <td width="75" align="left" valign="top"><input name="IopLe"
                                                                    type="text" class="form-control" id="IopLe" value=""
                                                                    placeholder="" style="height: 20px;"></td>
                                                            <td width="10" align="left" valign="top">B.S </td>
                                                            <td width="50" align="left" valign="top"><input name="Bs"
                                                                    type="text" class="form-control" id="Bs" value=""
                                                                    placeholder="" style="height: 20px;"></td>
                                                            <td width="50" align="left" valign="top">B.P </td>
                                                            <td width="50" align="left" valign="top"><input name="Bp"
                                                                    type="text" class="form-control" id="Bp" value=""
                                                                    placeholder="" style="height: 20px;"></td>

                                                        </tr>

                                                        <tr>
                                                            <td width="20" align="left" valign="top">Package</td>
                                                            <td width="100" align="left" valign="top" colspan="2">
                                                            <input type="text"  style="height: 33px;"
                                                        name="Package" list="package_list" id="Package"
                                                        class="form-control" placeholder="" value=""
                                                        oninput="getPkgDetails(document.getElementById('Package').value)">
                                                    <datalist id="package_list">
                                                    @foreach($packagelist as $result)
                                                    <option value="{{$result->PackageName}}">{{$result->PackageName}}
                                                    </option>
                                                    @endforeach
                                                    </datalist>
                                                                <!-- <select class="form-control" name="Package" id="Package"
                                                                    style="height: 33px;"
                                                                    onchange=getPkgDetails(this.value)>
                                                                    <option selected="" value="">...
                                                                    </option>
                                                                    @foreach($packagelist as $result)
                                                                    <option value="{{$result->PackageName}}">
                                                                        {{$result->PackageName}}
                                                                    </option>
                                                                    @endforeach

                                                                </select> -->
                                                            </td>
                                                            <td width="10" align="left" valign="top">Package Amount </td>
                                                            <td width="50" align="left" valign="top" colspan="3"><input
                                                                    name="Amount" type="text" class="form-control"
                                                                    id="Amount" value="" placeholder=""></td>
                                                        </tr>
                                                        <tr>
                                                        <td width="10" align="left" valign="top">Category </td>
                                                            <td width="50" align="left" valign="top" colspan="2">
                                                                <select class="form-control" name="Category"
                                                                    id="Category" style="height: 33px;">
                                                                    <option selected="" value="">...
                                                                    </option>
                                                                    <option value="Routine">Routine
                                                                    </option>
                                                                    <option value="Cashless">Cashless
                                                                    </option>

                                                                </select>
                                                            </td>
                                                            <td width="20" align="left" valign="top">Anaethetia</td>
                                                            <td width="50" align="left" valign="top" colspan="3">
                                                                <select class="form-control" name="Ga" id="Ga"
                                                                    style="height: 33px;">
                                                                    <option selected="" value="">...
                                                                    </option>
                                                                    <option value="Yes">Yes
                                                                    </option>
                                                                    <option value="No">No
                                                                    </option>

                                                                </select>
                                                            </td>
                                                            <!-- <td width="10" align="left" valign="top">CYL </td>
                                                            <td width="50" align="left" valign="top" colspan="3"><input name="Cyl"
                                                                    type="text" class="form-control" id="Cyl" value=""
                                                                    placeholder="" style="height: 22px;"></td> -->
                                                        </tr>
                                                        <!-- <tr>
                                                        <td width="10" align="left" valign="top">ADD </td>
                                                            <td width="50" align="left" valign="top" colspan="2"><input name="AddIol"
                                                                    type="text" class="form-control" id="AddIol" value=""
                                                                    placeholder="" style="height: 22px;"></td>
                                                        </tr> -->



                                                    </thead>
                                                </table>
                                            </fieldset>
                                        </div>



                                        <div class="form-group col-md-3"
                                            style="margin-bottom: 0rem;padding-right: 1px;padding-left: 1px;">
                                            <fieldset>
                                                <legend>Diagnosis</legend>
                                                <table id="report-table"
                                                    class="table table-bordered table-striped mb-0">
                                                    <thead>
                                                        <td width="50" align="left" valign="top" colspan="5"><textarea
                                                                name="Diagnosis" class="form-control" id="Diagnosis"
                                                                placeholder="" style="height: 90px;"></textarea></td>
                                                    </thead>
                                                </table>
                                            </fieldset>

                                            <fieldset>
                                                <legend>Advice</legend>
                                                <table id="report-table"
                                                    class="table table-bordered table-striped mb-0">
                                                    <thead>
                                                        <td width="50" align="left" valign="top" colspan="5"><textarea
                                                                name="Advice" class="form-control" id="Advice" value=""
                                                                placeholder="" style="height: 89px;"></textarea></td>
                                                    </thead>
                                                </table>
                                            </fieldset>

                                            <fieldset>
                                                <legend>SMS Advice</legend>
                                                <table id="report-table"
                                                    class="table table-bordered table-striped mb-0">
                                                    <thead>
                                                        <td width="50" align="left" valign="top" colspan="5"><textarea
                                                                name="SmsAdvice" class="form-control" id="SmsAdvice" 
                                                                placeholder="" style="height: 89px;">Catract Surgery</textarea></td>
                                                    </thead>
                                                </table>
                                            </fieldset>
                                        </div>

                                        <div class="form-group col-md-9"
                                            style="margin-bottom: 0rem;padding-right: 1px;padding-left: 1px;">


                                            <fieldset>
                                                <legend>Cashless Package</legend>
                                                <div class="table-responsive" style="overflow-x:auto;">
                                                    <table id="report-table"
                                                        class="table table-bordered table-striped mb-0">
                                                        <thead>
                                                            <tr>


                                                                <td width="10" align="left" valign="top">Package Amount
                                                                </td>
                                                                <td width="100" align="left" valign="top"><input
                                                                        name="PkgAmt" type="text" class="form-control"
                                                                        id="PkgAmt" value="" placeholder="">
                                                                </td>

                                                                <td width="10" align="left" valign="top">Insurane
                                                                    Company
                                                                </td>
                                                                <td width="200" align="left" valign="top"><input
                                                                        name="InsComp" type="text" class="form-control"
                                                                        id="InsComp" value="" placeholder="">
                                                                </td>

                                                                <td width="10" align="left" valign="top">Request Amount
                                                                </td>
                                                                <td width="100" align="left" valign="top"><input
                                                                        name="ReqAmt" type="text" class="form-control"
                                                                        id="ReqAmt" value="" placeholder="">
                                                                </td>
                                                            </tr>
                                                            <tr>

                                                                <td width="10" align="left" valign="top">Sanctioned
                                                                    Amount
                                                                </td>
                                                                <td width="100" align="left" valign="top"><input
                                                                        name="SanctAmt" type="text" class="form-control"
                                                                        id="SanctAmt" value="" placeholder="">
                                                                </td>

                                                                <td width="10" align="left" valign="top">Additional Amt
                                                                    Paid
                                                                    from Patient
                                                                </td>
                                                                <td width="100" align="left" valign="top"><input
                                                                        name="AddAmt" type="text" class="form-control"
                                                                        id="AddAmt" value="" placeholder="">
                                                                </td>

                                                                <td width="10" align="left" valign="top">Settle Amount
                                                                </td>
                                                                <td width="200" align="left" valign="top"><input
                                                                        name="SettleAmt" type="text"
                                                                        class="form-control" id="SettleAmt" value=""
                                                                        placeholder="">
                                                                </td>

                                                            </tr>
                                                            <tr>
                                                                <td width="10" align="left" valign="top">Settle Date
                                                                </td>
                                                                <td width="100" align="left" valign="top"><input
                                                                        type="date" class="form-control"
                                                                        name="SettleDate" id="SettleDate" value=""></td>
                                                                <td width="10" align="left" valign="top">UTR No </td>
                                                                <td width="100" align="left" valign="top"><input
                                                                        name="UtrNo" type="text" class="form-control"
                                                                        id="UtrNo" value="" placeholder="">
                                                                </td>

                                                              
                                                                <td width="100" align="left" valign="top" colspan="1">
                                                                    <input type="checkbox" class="" name="PostPone" id="PostPone"
                                                                        value="1" 
                                                                        style="transform: scale(1);margin-left: 10px;margin-right: 10px;">
                                                                        <label for="PostPone">PostPone</label>
                                                                  
                                                                </td>
                                                                <td width="150" align="left" valign="top">
                                                                <select class="form-control" name="Language" id="Language"
                                                                    style="height: 40px;">
                                                                    
                                                                    <option value="1">Marathi
                                                                    </option>
                                                                    <option value="2">Hindi
                                                                    </option>
                                                                    <option value="3">English
                                                                    </option>
                                                                </select>
                                                            </td>
                                                            </tr>

                                                            <tr>
                                                            <td width="100" align="left" valign="top" colspan="1">
                                                                    <input type="checkbox" class="" name="Tab1" id="Tab1"
                                                                        value="1" 
                                                                        style="transform: scale(1);margin-left: 10px;margin-right: 10px;">
                                                                        <label for="Tab1">Tab 1</label>
                                                                  
                                                                </td>

                                                                <td width="100" align="left" valign="top" colspan="1">
                                                                    <input type="checkbox" class="" name="Tab2" id="Tab2"
                                                                        value="1" 
                                                                        style="transform: scale(1);margin-left: 10px;margin-right: 10px;">
                                                                        <label for="Tab2">Tab 2</label>
                                                                  
                                                                </td>

                                                                <td width="100" align="left" valign="top" colspan="1">
                                                                    <input type="checkbox" class="" name="Cataract" id="Cataract"
                                                                        value="1" 
                                                                        style="transform: scale(1);margin-left: 10px;margin-right: 10px;">
                                                                        <label for="Cataract">Cataract</label>
                                                                  
                                                                </td>

</tr>
                                                        </thead>

                                                    </table>

                                                </div>

                                            </fieldset>
                                            <fieldset style="padding-top: 1px;">
                                                <table id="report-table"
                                                    class="table table-bordered table-striped mb-0">
                                                    <thead>
                                                        <tr>


                                                            <td width="10" align="left" valign="top">Consultant
                                                            </td>
                                                            <td width="150" align="left" valign="top"><input
                                                                    name="Consultant" type="text" class="form-control"
                                                                    id="Consultant" value="" placeholder="">
                                                            </td>
                                                            <td align="center" style="padding-top: 10px;"><button
                                                                    type="button" id="preopt_notes"
                                                                    class="btn btn-primary btn-finish btnpadding"
                                                                    onclick="preOptNotes()" disabled>Pre-Operative
                                                                    Prescription</button></td>
                                                            <td align="center"><button type="button"
                                                                    class="btn btn-primary btn-finish btnpadding"
                                                                    onclick="surgicalPresc()" id="surgical_presc"
                                                                    disabled>Surgical
                                                                    Prescription</button>
                                                                <button class="btn btn-secondary" type="button"
                                                                    data-toggle="modal" data-target="#modal-report656"
                                                                    id="add-drugs" onclick="addNewDrug()">+</button>
                                                            </td>
                                                            <td align="center" valign="top">
                                                                <button name="submit" type="submit" id="submit"
                                                                    class="btn btn-primary btn-finish btnpadding2">Save</button>
                                                                <button type="button"
                                                                    class="btn btn-primary btn-finish btnpadding2"
                                                                    onclick="refresh()">Refresh</button>
                                                                <button type="button" id="delete"
                                                                    onclick="deleteRecord()"
                                                                    class="btn btn-primary btn-finish btnpadding2"
                                                                    disabled>Delete</button>


                                                            </td>

                                                        </tr>
                                                    </thead>
                                                </table>
                                            </fieldset>

                                        </div>

                                    </div>




                                </form>

                                <input type="hidden" id="CurrDate" value="{{date('Y-m-d')}}">
                            </div>
                        </div>
                    </div>
                    <!-- customar project  end -->
                </div>