@extends('layouts.admin-bloqueo-vista') @section('titulo', 'Formulario de Inscripción') @section('botonera') @include('componentes.boton-salir-con-aviso') @endsection @section('css') {!! Html::style('css/inscripcion-seguimiento.css') !!} {!! Html::style('css/jquery.datetimepicker.min.css') !!} @endsection @section('scripts') {!! Html::script('js/ajax-cargar-paciente-con-documento.js') !!} {!! Html::script('js/ajax-cargar-inscripcion-programas.js') !!} {!! Html::script('js/ajax-validar-edad.js') !!} {!! Html::script('js/jquery.datetimepicker.full.js') !!} {{-- Script para calcular la edad por js --}} {!! Html::script('js/obtener-edad.js') !!} @endsection @section('content-extra')
{!! Form::open(['class' => 'form-horizontal']) !!}
{!! Form::label('documento', 'Documento:', ['class' => 'col-sm-1 control-label input-sm','autofocus']) !!}
{!! Form::text('documento', null, ['class' => 'form-control input-sm','autofocus']) !!}
{!! Form::label('paciente_id', 'Paciente:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::select('paciente_id', $pacientes, null, ['class' => 'form-control input-sm']) !!}
{!! Form::label('programa_id', 'Programa:', ['class' => 'col-sm-1 control-label input-sm col-sm-1-original']) !!}
{!! Form::select('programa_id', $programas, null, ['class' => 'form-control input-sm', 'id' => 'select-programa', 'disabled' ]) !!}

{!! Form::label('fechaDeNacimiento', 'Fecha de Nacimiento:', ['class' => 'col-sm-1 control-label input-sm']) !!}
{!! Form::text('fechaDeNacimiento', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('tipoUsuario', 'Tipo Usuario:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::text('tipoUsuario', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('estadoCivil', 'Estado Civil:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::text('estadoCivil', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('sexo', 'Sexo:', ['class' => 'col-sm-1 control-label input-sm col-sm-1-reducido']) !!}
{!! Form::text('sexo', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('ocupacion', 'Ocupación:', ['class' => 'col-sm-1 control-label input-sm']) !!}
{!! Form::text('ocupacion', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('direccion', 'Dirección:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::text('direccion', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('telefono1', 'Tel 1:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::text('telefono1', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('telefono2', 'Tel 2:', ['class' => 'col-sm-1 col-sm-1-original col-sm-1-reducido control-label input-sm']) !!}
{!! Form::text('telefono2', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('sisben', 'Sisben:', ['class' => 'col-sm-1 control-label input-sm']) !!}
{!! Form::text('sisben', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('edad_actual', 'Edad actual:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::text('edad_actual', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::close() !!}
@endsection @section('content') {{-- modals --}} @include('componentes.modal-salir') @include('alerts.request') {!! Form::open(['route' => 'inscripcion.store', 'class' => 'form-horizontal', 'id' => 'formulario']) !!}
{!! Form::close() !!} @endsection @section('scripts') {{-- {!! Html::script('js/ajax-cargar-paciente-con-documento.js') !!} {!! Html::script('js/ajax-cargar-inscripcion-programas.js') !!} {!! Html::script('js/ajax-validar-edad.js') !!} {!! Html::script('js/jquery.datetimepicker.full.js') !!} {{-- Script para calcular la edad por js --}} {{-- {!! Html::script('js/obtener-edad.js') !!} --}} --}} @endsection