@if(isset($inscripcion))
	{!! Form::model($inscripcion, ['class' => 'form-horizontal']) !!}
@else
	{!! Form::open(['route' => 'inscripcion.store', 'class' => 'form-horizontal']) !!}
@endif

<div class="list-group">

	<a class="list-group-item">

		<p class="list-group-item-heading">Información básica</p>
		<div class="row formulario-horizontal">

			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('fecha', 'Fecha de la inscripción: ', ['class' => 'col-md-5 control-label']) !!}
					<div class="col-md-7">
						@if(isset($fechaActual))
							{!! Form::text('fecha', $fechaActual, ['class' => 'form-control']) !!}
						@else
							{!! Form::text('fecha', null, ['class' => 'form-control']) !!}
						@endif
					</div>
				</div>
				<div class="form-group form-group-sm">
					{!! Form::label('hora', 'Hora de la inscripción: ', ['class' => 'col-md-5 control-label']) !!}
					<div class="col-md-7">
						@if(isset($inscripcion))
							{!! Form::text('hora', null, ['placeholder' => 'hh:mm:ss', 'class' => 'form-control']) !!}
						@else
							{!! Form::text('hora', \Carbon\Carbon::now()->toTimeString(), ['placeholder' => 'hh:mm:ss', 'class' => 'form-control']) !!}
						@endif
					</div>
				</div>
				<div class="form-group form-group-sm">
					{!! Form::label('edad', 'Edad al momento de inscribirse: ', ['class' => 'col-md-5 control-label']) !!}
					<div class="col-md-7">
						{!! Form::text('edad', null, ['class' => 'form-control ', 'disabled' => 'true']) !!}
					</div>
				</div>
			</div>
			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('motivo', 'Motivo: ', ['class' => 'col-md-3 control-label']) !!}
					<div class="col-md-9">
						{!! Form::text('motivo', null, ['class' => 'form-control', 'rows' => '3']) !!}
					</div>
				</div>
				<div class="form-group form-group-sm">
					{!! Form::label('acudiente', 'Acudiente: ', ['class' => 'col-md-3 control-label']) !!}
					<div class="col-md-9">
						{!! Form::text('acudiente', null, ['class' => 'form-control']) !!}
					</div>
				</div>

				<div class="form-group form-group-sm">
					{!! Form::label('parentesco', 'Parentesco del Acudiente: ', ['class' => 'col-md-3 control-label']) !!}
					<div class="col-md-9">
						{!! Form::text('parentesco', null, ['class' => 'form-control']) !!}
					</div>
				</div>

				@if (!\Auth::user()->es_responsable || isset($inscripcion))
					<div class="form-group form-group-sm">
						{!! Form::label('responsable', 'Responsable: ', ['class' => 'col-md-3 control-label']) !!}
						<div class="col-md-9">
							@if (isset($responsables))
								{!! Form::select('responsable_id', $responsables, null, ['class' => 'form-control']) !!}
							@else
								{!! Form::text('responsable_id', null, ['class' => 'form-control']) !!}
							@endif
						</div>
					</div>
				@endif

			</div>
		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading">Factores de riesgo no modificables</p>
		<div class="row formulario-horizontal">

			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('herencia', 'Herencia  (Presencia de HTA, hasta 2° grado de consanguinidad)', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('herencia', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-2">
				<div class="form-group form-group-sm">
					{!! Form::label('edad_mayor_a_65_anos', 'Mayor a 65 años', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('edad_mayor_a_65_anos', 1) !!}
					</div>
				</div>
			</div>

			@if ($paciente->sexo != 'm')
				<div class="col-md-2">
					<div class="form-group form-group-sm">
						{!! Form::label('menopausia', 'Menopausia', ['class' => 'col-xs-9 control-label']) !!}
						<div class="col-xs-3">
							{!! Form::checkbox('menopausia', 1) !!}
						</div>
					</div>
				</div>
			@endif

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('raza_negra', 'Origen étnico (raza negra)', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('raza_negra', 1) !!}
					</div>
				</div>
			</div>

			@if ($paciente->sexo != 'f')
				<div class="col-md-6">
					<div class="form-group form-group-sm">
						{!! Form::label('enfermedad_coronaria_accidente_cerebrovascular', 'Enfermedad coronaria / accidente cerebrovascular', ['class' => 'col-xs-10 control-label']) !!}
						<div class="col-xs-2">
							{!! Form::checkbox('enfermedad_coronaria_accidente_cerebrovascular', 1) !!}
						</div>
					</div>
				</div>
			@endif

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading">Factores de riesgo comportamentales</p>
		<div class="row formulario-horizontal">

			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('psicologicos_y_sociales', 'Psicológicos y sociales (Stress, patrón de comportamiento tipo A, competitividad, hostilidad, impaciencia, verbalización y movimientos rápidos)', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('psicologicos_y_sociales', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('habitos_alimentarios_inadecuados', 'Hábitos alimentarios inadecuados (consumo de azucar, grasa animal, poca fibra', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('habitos_alimentarios_inadecuados', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('tabaquismo', 'Tabaquismo', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('tabaquismo', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('alcohol', 'Alcohól', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('alcohol', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('nutricionales', 'Nutricionales', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('nutricionales', 1) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading">Factores de riesgo biológicos</p>
		<div class="row formulario-horizontal">

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('obesidad', 'Obesidad', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('obesidad', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('f_r_b_dislipidemias', 'Dislipidemias', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('f_r_b_dislipidemias', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('diabetes_mellitus', 'Diabetes mellitus', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('diabetes_mellitus', 1) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading">Examen físico de ingreso</p>
		<div class="row formulario-horizontal">

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('peso', 'Peso', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('peso', null, ['class' => 'form-control']) !!}
							<span class="input-group-addon">Kg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('talla', 'Talla', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('talla',null, ['class' => 'form-control']) !!}
							<span class="input-group-addon">m</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('imc', 'IMC', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('imc', null, ['class' => 'form-control', 'readonly']) !!}
							<span class="input-group-addon">Kg / m<sup>2</sup></span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('perimetro_abdominal', 'Perímetro abdominal', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						<div class="input-group">
							{!! Form::text('perimetro_abdominal', null, ['class' => 'form-control']) !!}
							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('presion_arterial', 'Presión arterial', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						<div class="input-group">
							{!! Form::text('presion_arterial', null, ['class' => 'form-control']) !!}
							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="clearfix"></div>
			<hr style="margin: 8px 0 4px 0" />

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('entrecruzamientos', '(Fondo de ojo) Entrecruzamientos', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('entrecruzamientos', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('hemorragia', '(Fondo de ojo) Hemorragia', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hemorragia', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('edema_papilar', '(Fondo de ojo) Edema papilar', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('edema_papilar', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('rinon_proteinas', '(Riñón) Proteinas', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('rinon_proteinas', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('rinon_creatinina', '(Riñón) Creatinina', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('rinon_creatinina', 1) !!}
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('insuficiencia_cardiaca_congestiva', '(Corazón) Insuficiencia cardiaca congestiva', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('insuficiencia_cardiaca_congestiva', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('enfermedad_coronaria', '(Corazón) Enfermedad coronaria', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('enfermedad_coronaria', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('hipertrofia_ventricular_izquierda', '(Corazón) Hipertrofia ventricular izquierda', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hipertrofia_ventricular_izquierda', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-4">
				<div class="form-group form-group-sm">
					{!! Form::label('accidente_cerebrovascular', '(Cerebro) Accidente cerebrovascular', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('accidente_cerebrovascular', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-8">
				<div class="form-group form-group-sm">
					{!! Form::label('alteracion_del_sistema_vascular_periferico_svp', '(Cerebro) Alteración del sistema vascular periferico SVP', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('alteracion_del_sistema_vascular_periferico_svp', 1) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading">Signos y síntomas de ingreso</p>
		<div class="row formulario-horizontal">

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('hipertension_cefalea', '(Hipertensión) cefalea', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hipertension_cefalea', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('hipertension_tinitus', '(Hipertensión) tinitus', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hipertension_tinitus', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('hipertension_mareos', '(Hipertensión) mareos', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hipertension_mareos', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('hipertension_alteracion_visual', '(Hipertensión) alteracion_visual', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hipertension_alteracion_visual', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('diabetes_poliuria', '(Diabetes) poliuria', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('diabetes_poliuria', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('diabetes_polifagia', '(Diabetes) polifagia', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('diabetes_polifagia', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('diabetes_polidipsia', '(Diabetes) polidipsia', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('diabetes_polidipsia', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('diabetes_alteracion_visual', '(Diabetes) alteracion_visual', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('diabetes_alteracion_visual', 1) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading">Otros diagnósticos asociados</p>
		<div class="row formulario-horizontal">

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('enfermedad_cerebro_vascular_ecv', 'Enfermedad cerebrovascular', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('enfermedad_cerebro_vascular_ecv', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('coronarias', 'Coronarias', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('coronarias', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('nefropatia', 'Nefropatía', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('nefropatia', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('retinopatia', 'Retinopatía', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('retinopatia', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('o_d_a_dislipidemias', 'Dislipidemias', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('o_d_a_dislipidemias', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('gota', 'Gota', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('gota', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('otro_diagnostico_asociado', 'Otro (Cuál)', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::text('otro_diagnostico_asociado', null, ['class' => 'form-control']) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading">Exámenes paraclínicos de ingreso</p>
		<div class="row formulario-horizontal">

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('hemograma_hemoglobina', '(Hemograma) Hemoglobina', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hemograma_hemoglobina', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('hematocrito', '(Hemograma) hematocrito', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hematocrito', 1) !!}
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('parcial_de_orina_proteinas', '(Parcial de orina) proteinas', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('parcial_de_orina_proteinas', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('glucosa', '(Parcial de orina) glucosa', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('glucosa', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('parcial_de_orina_hemoglobina', '(Parcial de orina) hemoglobina', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('parcial_de_orina_hemoglobina', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('bacterias', '(Parcial de orina) bacterias', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('bacterias', 1) !!}
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('colesterol', '(Pierfil lipídico) colesterol', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('colesterol', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('hdl', '(Pierfil lipídico) HDL', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hdl', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('ldl', '(Pierfil lipídico) LDL', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('ldl', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('trigliceridos', '(Pierfil lipídico) trigliceridos', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('trigliceridos', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('perfil_lipidico_creatinina', '(Pierfil lipídico) creatinina', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('perfil_lipidico_creatinina', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('glicemia', '(Pierfil lipídico) glicemia', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('glicemia', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('rx_torax', '(Pierfil lipídico) RX tórax', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('rx_torax', 1) !!}
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('frecuencia', '(Electrocardiograma) frecuencia', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('frecuencia', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('isquemia', '(Electrocardiograma) isquemia', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('isquemia', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('ritmos', '(Electrocardiograma) ritmos', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('ritmos', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('bloqueos', '(Electrocardiograma) bloqueos', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('bloqueos', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-3">
				<div class="form-group form-group-sm">
					{!! Form::label('eje', '(Electrocardiograma) eje', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('eje', 1) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading">
			Clasificación de los niveles de presión arterial en adultos
			<small>(Según JNC. Tabla 3 pag. 168. Guía de atención de la HTA. MPS .2007)</small>
		</p>
		<div class="row formulario-horizontal">

			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('normal', 'Normal: < 120 / < 80 mm Hg', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('normal', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('prehipertension', 'Prehipertension: 120 - 139 / 80 - 89 mm Hg', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('prehipertension', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('hipertension_estadio_i', 'Hipertensión estadio I: 140 - 159 / 90 - 99 mm Hg', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hipertension_estadio_i', 1) !!}
					</div>
				</div>
			</div>

			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('hipertension_estadio_ii', 'Hipertensión estadio II: >= 160 / ó / >= 100 mm Hg', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('hipertension_estadio_ii', 1) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading">
			Clasificación diabetes
			<small>(MPS. Guía de diagnóstico y manejo de diabetes tipo) - (Guía 17. Guía de atención de la diabetes mellitus tipo 2. MPS, 2007)</small>
		</p>
		<div class="row formulario-horizontal">

			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('clasificacion_diabetes', 'Clasificación de diabetes', ['class' => 'col-md-4 control-label']) !!}
					<div class="col-md-2">
						<label class="radio-inline">
							{!! Form::radio('clasificacion_diabetes', 0) !!}
							no
						</label>
					</div>
					<div class="col-md-3">
						<label class="radio-inline">
							{!! Form::radio('clasificacion_diabetes', 1) !!}
							Tipo 1
						</label>
					</div>
					<div class="col-md-3">
						<label class="radio-inline">
							{!! Form::radio('clasificacion_diabetes', 2) !!}
							Tipo 2
						</label>
					</div>
				</div>
			</div>

			<div class="col-md-6">
				<div class="form-group form-group-sm">
					{!! Form::label('sindrome_metabolico', '(Otros) Síndrome metabólico', ['class' => 'col-xs-10 control-label']) !!}
					<div class="col-xs-2">
						{!! Form::checkbox('sindrome_metabolico', 1) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<br>

	@if(isset($inscripcion))
		@include('componentes.btn-mostrar-pdf-inscripcion')
	@endif

</div>


{!! Form::close() !!}

{{-- Cargar los inputs tipo custom de fecha y hora cuando se solicita el formulario actual desde seguimiento o inscripción --}}
{{-- si no se encuentra en la sección inscripción de seguimiento --}}
@if(!isset($inscripcion))
	<script type="text/javascript">
		// Date picker
		$('#fecha').datetimepicker({
			timepicker:false,
				format:'d M Y'
		});

		// Time picker
		$('#hora').datetimepicker({
			datepicker:false,
			format:'H:i:00',
			formatTime:'H:i:',
			allowTimes:horasPermitidas
		});

		$(document).ready(function(){
			@include('componentes.script-calcular-imc')
		});
	</script>
@endif