@extends('layouts.app')

@section('content')
<div class="page-header"><h2> {{ $pageTitle }} <small> {{ $pageNote }} </small> </h2></div>

	{!! Form::open(array('url'=>'medicalnetwork?return='.$return, 'class'=>'form-horizontal validated','files' => true )) !!}
	<div class="toolbar-nav">
		<div class="row">
			
			<div class="col-md-6 " >
				<button name="apply" class="tips btn btn-sm btn-default  "  title="{{ __('core.btn_back') }}" ><i class="fa  fa-check"></i> {{ __('core.sb_apply') }} </button>
				<button name="save" class="tips btn btn-sm btn-default"  title="{{ __('core.btn_back') }}" ><i class="fa  fa-paste"></i> {{ __('core.sb_save') }} </button> 
			</div>
			<div class="col-md-6 text-right " >
				<a href="{{ url($pageModule.'?return='.$return) }}" class="tips btn btn-sm "  title="{{ __('core.btn_back') }}" ><i class="fa  fa-times"></i></a> 
			</div>
		</div>
	</div>	


	<div class="p-5">
		<ul class="parsley-error-list">
			@foreach($errors->all() as $error)
				<li>{{ $error }}</li>
			@endforeach
		</ul>		
		<div class="row">
	<div class="col-md-12">
						<fieldset><legend> Réseau médical</legend>
									
									  <div class="form-group row  " >
										<label for="Id" class=" control-label col-md-4 text-left"> Id <span class="asterix"> * </span></label>
										<div class="col-md-6">
										  <input  type='text' name='id' id='id' value='{{ $row['id'] }}' 
						     class='form-control form-control-sm ' /> 
										 </div> 
										 <div class="col-md-2">
										 	
										 </div>
									  </div> 					
									  <div class="form-group row  " >
										<label for="Ville" class=" control-label col-md-4 text-left"> Ville <span class="asterix"> * </span></label>
										<div class="col-md-6">
										  <input  type='text' name='city' id='city' value='{{ $row['city'] }}' 
						     class='form-control form-control-sm ' /> 
										 </div> 
										 <div class="col-md-2">
										 	
										 </div>
									  </div> 					
									  <div class="form-group row  " >
										<label for="Type" class=" control-label col-md-4 text-left"> Type <span class="asterix"> * </span></label>
										<div class="col-md-6">
										  <input  type='text' name='type' id='type' value='{{ $row['type'] }}' 
						     class='form-control form-control-sm ' /> 
										 </div> 
										 <div class="col-md-2">
										 	
										 </div>
									  </div> 					
									  <div class="form-group row  " >
										<label for="Désignation" class=" control-label col-md-4 text-left"> Désignation <span class="asterix"> * </span></label>
										<div class="col-md-6">
										  <input  type='text' name='name' id='name' value='{{ $row['name'] }}' 
						     class='form-control form-control-sm ' /> 
										 </div> 
										 <div class="col-md-2">
										 	
										 </div>
									  </div> 					
									  <div class="form-group row  " >
										<label for="Adresse" class=" control-label col-md-4 text-left"> Adresse <span class="asterix"> * </span></label>
										<div class="col-md-6">
										  <input  type='text' name='address' id='address' value='{{ $row['address'] }}' 
						     class='form-control form-control-sm ' /> 
										 </div> 
										 <div class="col-md-2">
										 	
										 </div>
									  </div> 					
									  <div class="form-group row  " >
										<label for="Téléphone" class=" control-label col-md-4 text-left"> Téléphone <span class="asterix"> * </span></label>
										<div class="col-md-6">
										  <input  type='text' name='phone' id='phone' value='{{ $row['phone'] }}' 
						     class='form-control form-control-sm ' /> 
										 </div> 
										 <div class="col-md-2">
										 	
										 </div>
									  </div> 					
									  <div class="form-group row  " >
										<label for="Fax" class=" control-label col-md-4 text-left"> Fax <span class="asterix"> * </span></label>
										<div class="col-md-6">
										  <input  type='text' name='fax' id='fax' value='{{ $row['fax'] }}' 
						     class='form-control form-control-sm ' /> 
										 </div> 
										 <div class="col-md-2">
										 	
										 </div>
									  </div> </fieldset>
			</div>
			
			
	
		</div>

		<input type="hidden" name="action_task" value="save" />
		
		</div>
	</div>		
	{!! Form::close() !!}
		 
   <script type="text/javascript">
	$(document).ready(function() { 
		
		
		 		 

		$('.removeMultiFiles').on('click',function(){
			var removeUrl = '{{ url("medicalnetwork/removefiles?file=")}}'+$(this).attr('url');
			$(this).parent().remove();
			$.get(removeUrl,function(response){});
			$(this).parent('div').empty();	
			return false;
		});		
		
	});
	</script>		 
@stop