<?php /* Vista de solo lectura */ ?>
<?php if(isset($formulario)): ?>
	<?php echo Form::model($formulario, ['class' => 'form-horizontal']); ?>

<?php endif; ?>

<!-- Para cargar el último formulario registrado con la finalidad de que sea una muestra para el nuevo formulario -->
<?php if(!\Session::has('success')): ?>
	<?php if(isset($ultimoFormulario)): ?>
		<?php echo Form::model($ultimoFormulario, ['class' => 'form-horizontal', 'route' => 'seguimiento.store', 'method' => 'post', 'id' => 'formularioSeguimiento']); ?>

	<?php elseif(!isset($formulario)  ): ?>
		<?php echo Form::open(['class' => 'form-horizontal', 'route' => 'seguimiento.store', 'method' => 'post']); ?>

	<?php endif; ?>
<?php else: ?>
	<?php echo Form::model(Session::get('ultimoFormularior'), ['class' => 'form-horizontal', 'route' => 'seguimiento.store', 'method' => 'post', 'id' => 'formularioSeguimiento']); ?>

<?php endif; ?>


<?php echo $__env->make('componentes.hidden-json-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

<?php echo Form::hidden('hiddenEdad',''); ?>

<?php echo Form::hidden('hiddenSexo',''); ?>

<?php echo $__env->make('componentes.mensajeError', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

<div class="list-group">

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

		<div class="col-xs-12 text-right">
				<?php if(isset($formulario)): ?>
					<?php echo $__env->make('componentes.boton-volver-al-listado-de-historicos-e-imprimir-en-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
				<?php else: ?>
					<?php echo $__env->make('componentes.boton-salir-de-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
					<?php echo $__env->make('componentes.boton-guardar-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
				<?php endif; ?>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha', 'Fecha', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<?php if(!isset($formulario)): ?>
							<?php echo Form::text('fecha', $fechaActual, ['class' => 'form-control', 'id' => 'fecha']); ?>

						<?php else: ?>
							<?php echo Form::text('fecha', explode(' ', $formulario->fecha_hora)[0], ['class' => 'form-control', 'id' => 'fecha']); ?>

						<?php endif; ?>
					</div>
				</div>
			</div>
			
			<?php if(!\Auth::user()->es_responsable && !isset($formulario)): ?>
				<div class="col-xs-5 col-xs-offset-1">
					<div class="form-group form-group-sm '
					<?php if(count($errors)): ?> <?php if($errors->has('usuario_id')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
						<?php echo Form::label('usuario_id', 'Responsable', ['class' => 'col-xs-2 control-label'],'autofocus'); ?>

						<div class="col-xs-8">
							<?php echo Form::select('usuario_id', $responsables, null, ['class' => 'form-control'],'autofocus'); ?>

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

				<div class="clearfix"></div>
			<?php endif; ?>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hora')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hora', 'Hora', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<?php if(!isset($formulario)): ?>
							<?php echo Form::text('hora', \Carbon\Carbon::now()->format('H:i:s'), ['class' => 'form-control', 'id' => 'hora']); ?>

						<?php else: ?>
							<?php echo Form::text('hora', explode(' ', $formulario->fecha_hora)[1], ['class' => 'form-control', 'id' => 'hora']); ?>

						<?php endif; ?>
					</div>					
				</div>
			</div>
			
			<div class="col-xs-8">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('entidad_id')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('entidad_id', 'Entidad', ['class' => 'col-xs-2 control-label']); ?>

					<div class="col-xs-10">
						<?php echo Form::select('entidad_id', $entidades, null, ['class' => 'form-control']); ?>

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

		
			<div class="col-sm-4">
				<div class="form-group form-group-sm '
					<?php if(count($errors)): ?> <?php if($errors->has('motivo_de_consulta')): ?> 
						<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
						<?php echo Form::label('motivo_de_consulta', 'Motivo de consulta', ['class' => 'col-xs-4 control-label']); ?>

						<div class="col-xs-8">
							<?php echo Form::textarea('motivo_de_consulta', null, ['class' => 'form-control', 'rows' => 4, 'maxlength' => 2000,'required']); ?>

							<?php if( ! isset($formulario) ): ?>
								<span id="contador-motivo_de_consulta">0 de 2000</span>
							<?php endif; ?>
						</div>
				</div>
			</div>

			<div class="col-sm-4">
				<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('enfermedad_actual')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('enfermedad_actual', 'Enfermedad actual', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<!--<?php echo Form::text('enfermedad_actual', null, ['class' => 'form-control']); ?>-->
						<?php echo Form::textarea('enfermedad_actual', null, ['class' => 'form-control', 'rows' => 4, 'maxlength' => 2000,'required']); ?>

						<?php if( ! isset($formulario) ): ?>
							<span id="contador-enfermedad_actual">0 de 2000</span>
						<?php endif; ?>
					</div>
				</div>
			</div>
			
			<div class="col-sm-4">
				<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('revision_por_sistemas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('revision_por_sistemas', 'Revisión por sistemas', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<!--<?php echo Form::text('revision_por_sistemas', null, ['class' => 'form-control']); ?>-->
						<?php echo Form::textarea('revision_por_sistemas', null, ['class' => 'form-control', 'rows' => 4, 'maxlength' => 2000,'required']); ?>

						<?php if( ! isset($formulario) ): ?>
							<span id="contador-revision_por_sistemas">0 de 2000</span>
						<?php endif; ?>
					</div>
				</div>
			</div>

			<div class="col-xs-5">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('numero_consulta')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<p class="list-group-item-heading"><b>Consulta Prenatal N° </b>
					<?php echo Form::text('numero_consulta',$pacienteSolicitado->numeroSeguimiento); ?></p>
				</div>
			</div>	


		</div>
	</a>
	
	<a class="list-group-item">
		<div class="row formulario-horizontal">

			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('conoce_derechos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('conoce_derechos', 'Conoce los derechos y deberes en salud sexual y reproductiva?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('conoce_derechos', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('conoce_derechos', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('paridad')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('paridad', 'Paridad satisfecha?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('paridad', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('paridad', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('satisfaccion')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('satisfaccion', 'Satisfaccion con la vida sexual?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('satisfaccion', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('satisfaccion', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('proteccion_ets')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('proteccion_ets', 'Uso de protección para ETS?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('proteccion_ets', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('proteccion_ets', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('violencia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('violencia', 'Violencia de género, violencia sexual?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('violencia', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('violencia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-9">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('orientacion')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('orientacion', 'Tipo de orientación sexual', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('orientacion', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
		</div>
	</a>
	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Antecedentes</b></p>
		<div class="row formulario-horizontal">
			<div class="col-xs-9">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('patologicos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('patologicos', 'Patológicos:', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('patologicos', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hipertension')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hipertension', 'Hipertensión arterial crónica?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('hipertension', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('hipertension', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('preeclampsia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('preeclampsia', 'Preeclampsia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('preeclampsia', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('preeclampsia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('eclampsia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('eclampsia', 'Eclampsia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('eclampsia', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('eclampsia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cardiopatia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('cardiopatia', 'Cardiopatía?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('cardiopatia', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('cardiopatia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('diabetes_mellitus')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('diabetes_mellitus', 'diabetes-mellitus?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('diabetes_mellitus', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('diabetes_mellitus', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('tbc')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('tbc', 'TBC?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('tbc', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('tbc', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('otra')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('otra', 'Otra condición médica?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('otra', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('otra', 0, true); ?>

							no
						</label>
					</div>
					<div class="col-xs-8 col-xs-offset-4">
						<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('otra_condicion')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
							<?php echo Form::label('otra_condicion', 'cuál?', ['class' => 'col-xs-5 control-label']); ?>

							<div class="col-xs-7">
								<?php echo Form::text('otra_condicion', null, ['class' => 'form-control']); ?>

							</div>
						</div>
					</div>
				</div>
			</div>
		</div>
	</a>
	<a class="list-group-item">
		<div class="row formulario-horizontal">
			<div class="col-xs-9">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('quirurgicos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('quirurgicos', 'Quirúrgicos:', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('quirurgicos', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cirugias_abdominopelvicas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('cirugias_abdominopelvicas', 'Realización de cirugías abdominopelvicas?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('cirugias_abdominopelvicas', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('cirugias_abdominopelvicas', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-8 col-xs-offset-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cual_cirugia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('cual_cirugia', 'cuál?', ['class' => 'col-xs-2 control-label']); ?>

					<div class="col-xs-7">
						<?php echo Form::text('cual_cirugia', null, ['class' => 'form-control']); ?>

					</div>
				</div>
			</div>
		</div>
	</a>
	<a class="list-group-item">
		<div class="row formulario-horizontal">
			<div class="col-xs-9">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('toxico_alergicos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('toxico_alergicos', 'Tóxico/Alérgicos:', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('toxico_alergicos', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-9">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('medicamentos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('medicamentos', 'Medicamentos recibidos:', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('medicamentos', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('tabaco')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('tabaco', 'Consumo de tabaco?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('tabaco', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('tabaco', 0, true); ?>

							no
						</label>
					</div>
					<div class="col-xs-8 col-xs-offset-6">
						<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cantidad_tabaco')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
							<?php echo Form::label('cantidad_tabaco', 'Cantidad/Frecuencia', ['class' => 'col-xs-5 control-label']); ?>

							<div class="col-xs-7">
								<?php echo Form::text('cantidad_tabaco', null, ['class' => 'form-control','required']); ?>

							</div>
						</div>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('licor')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('licor', 'Consumo de licor?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('licor', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('licor', 0, true); ?>

							no
						</label>
					</div>
					<div class="col-xs-8 col-xs-offset-6">
						<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cantidad_licor')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
							<?php echo Form::label('cantidad_licor', 'Cantidad/Frecuencia', ['class' => 'col-xs-5 control-label']); ?>

							<div class="col-xs-7">
								<?php echo Form::text('cantidad_licor', null, ['class' => 'form-control','required']); ?>

							</div>
						</div>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('spa')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('spa', 'Consumo otras SPA?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('spa', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('spa', 0, true); ?>

							no
						</label>
					</div>
					<div class="col-xs-8 col-xs-offset-6">
						<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cual_spa')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
							<?php echo Form::label('cual_spa', 'Cuál?', ['class' => 'col-xs-5 control-label']); ?>

							<div class="col-xs-7">
								<?php echo Form::text('cual_spa', null, ['class' => 'form-control']); ?>

							</div>
						</div>
					</div>
					<div class="col-xs-8 col-xs-offset-6">
						<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cantidad_spa')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
							<?php echo Form::label('cantidad_spa', 'Cantidad/Frecuencia', ['class' => 'col-xs-5 control-label']); ?>

							<div class="col-xs-7">
								<?php echo Form::text('cantidad_spa', null, ['class' => 'form-control','required']); ?>

							</div>
						</div>
					</div>
				</div>
			</div>
			<div class="col-xs-7">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('exposicion_toxicos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('exposicion_toxicos', 'Exposición a Tóxicos e irradiación?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('exposicion_toxicos', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('exposicion_toxicos', 0, true); ?>

							no
						</label>
					</div>
					<div class="col-xs-8 col-xs-offset-6">
						<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cuales_toxicos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
							<?php echo Form::label('cuales_toxicos', 'Cuál?', ['class' => 'col-xs-5 control-label']); ?>

							<div class="col-xs-7">
								<?php echo Form::text('cuales_toxicos', null, ['class' => 'form-control']); ?>

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

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Gineco/Obstétricos</b></p>
		<div class="row formulario-horizontal">
			

			<div class="col-xs-9" style="display: none;">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('gineco_obstetricos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('gineco_obstetricos', 'Gineco/Obstétricos:', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('gineco_obstetricos', 0, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4 col-xs-offset-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('inicio_vidaSexual')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('inicio_vidaSexual', 'Edad inicio vida sexual:', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::number('inicio_vidaSexual', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-6">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('compañeros')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('compañeros', 'Número de compañeros sexuales:', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-3">
						<?php echo Form::number('compañeros', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-6 col-xs-offset-2">			
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('antecedentes')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('antecedentes', 'Antecedente de ETS/EPI/LEUCORREAS/DISPAREUNIA?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('antecedentes', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('antecedentes', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cual_antecedente')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('cual_antecedente', 'Cúal?', ['class' => 'col-xs-3 control-label']); ?>

					<div class="col-xs-5">
						<?php echo Form::text('cual_antecedente', null, ['class' => 'form-control']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('menarquia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('menarquia', 'Menarquía', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('menarquia', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fum')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fum', 'FUM', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fum', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ciclos_mens')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ciclos_mens', 'Ciclos Menstruales', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('ciclos_mens', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('gestaciones')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('gestaciones', 'Gestaciones', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::number('gestaciones', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('partos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('partos', 'Partos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::number('partos', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cesareas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('cesareas', 'Cesáreas', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::number('cesareas', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('abortos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('abortos', 'Abortos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::number('abortos', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ectopicos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ectopicos', 'Ectópicos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::number('ectopicos', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('molas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('molas', 'Molas', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::number('molas', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('n_vivos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('n_vivos', 'Nacidos Vivos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::number('n_vivos', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('n_muertos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('n_muertos', 'Nacidos Muertos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::number('n_muertos', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha_u_parto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha_u_parto', 'Fecha del último parto', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fecha_u_parto', null, ['class' => 'form-control', 'id' => 'fecha_u_parto']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-6">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('unico_multiple')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('unico_multiple', 'Único o múltiple', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('unico_multiple', null, ['class' => 'form-control']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha_u_citologia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha_u_citologia', 'Fecha de la última citología', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fecha_u_citologia', null, ['class' => 'form-control', 'id' => 'fecha_u_citologia','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-6">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('resul_citologia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('resul_citologia', 'Resultado', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('resul_citologia', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-8">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('metodos_hasta_la_fecha')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('metodos_hasta_la_fecha', 'Métodos de planificación utilizados hasta la fecha', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('metodos_hasta_la_fecha', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-8">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('satisfaccion_metodo')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('"satisfaccion_metodo"', 'Satisfacción con los métodos utilizados', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('satisfaccion_metodo', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('satisfaccion_metodo', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>
			<div class="col-xs-8">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('adherencia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('adherencia', 'Adherencia a métodos utilizados', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-3">
						<label class="radio-inline">
							<?php echo Form::radio('adherencia', 1); ?>

							si
						</label>
						<label class="radio-inline">
							<?php echo Form::radio('adherencia', 0, true); ?>

							no
						</label>
					</div>
				</div>			
			</div>
		</div>
	</a>
	<a class="list-group-item">
		<div class="row formulario-horizontal">
			<div class="col-xs-9">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('traumaticos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('traumaticos', 'Traumáticos:', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('traumaticos', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
		</div>
	</a>
	<a class="list-group-item">
		<div class="row formulario-horizontal">
			<div class="col-xs-9">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('habitos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('habitos', 'Hábitos de vida saludables:', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('habitos', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
		</div>
	</a>
	<a class="list-group-item">
		<div class="row formulario-horizontal">
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('general')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('general', 'General:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('general', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cabeza_orl')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('cabeza_orl', 'Cabeza y ORL:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('cabeza_orl', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cuello')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('cuello', 'Cuello:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('cuello', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('torax')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('torax', 'Tórax:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('torax', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('mamas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('mamas', 'Mamas:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('mamas', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cp')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('cp', 'CP:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('cp', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('abdomen')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('abdomen', 'Abdomen:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('abdomen', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('genitales')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('genitales', 'Genitales:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('genitales', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('especuloscopia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('especuloscopia', 'Especuloscopia:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('especuloscopia', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('extremidades')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('extremidades', 'Extremidades:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('extremidades', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('piel')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('piel', 'Piel:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('piel', null, ['class' => 'form-control','required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('neurologico')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('neurologico', 'Neurológico:', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::textarea('neurologico', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ta_sentado')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ta_sentado', 'TA sentado', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<div class="input-group">
							<?php echo Form::text('ta_sentado', null, ['class' => 'form-control','required']); ?>

							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('temperatura')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('temperatura', 'Temperatura', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<div class="input-group">
							<?php echo Form::text('temperatura', null, ['class' => 'form-control','required']); ?>

							<span class="input-group-addon">°C</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('altura_uterina')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('altura_uterina', 'Altura Uterina', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<div class="input-group">
							<?php echo Form::text('altura_uterina', null, ['class' => 'form-control','required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fc')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fc', 'FC', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<div class="input-group">
							<?php echo Form::text('fc', null, ['class' => 'form-control','required']); ?>

							<span class="input-group-addon">Lat / min</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fr')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fr', 'FR', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<div class="input-group">
							<?php echo Form::text('fr', null, ['class' => 'form-control','required']); ?>

							<span class="input-group-addon">Resp / min</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso', 'Peso', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<div class="input-group">
							<?php echo Form::text('peso', null, ['class' => 'form-control','required']); ?>

							<span class="input-group-addon">Kg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('talla')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('talla', 'Talla', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<div class="input-group">
							<?php echo Form::text('talla', null, ['class' => 'form-control','required']); ?>

							<span class="input-group-addon">m</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('imc')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('imc', 'IMC', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<div class="input-group">
							<?php echo Form::text('imc', null, ['class' => 'form-control', 'readonly']); ?>

							<span class="input-group-addon">Kg / m<sup>2</sup></span>
						</div>
					</div>
				</div>
			</div>
		</div>
	</a>
	<?php echo $__env->make('componentes/formulario-diagnosticos', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Anotaciones finales</b></p>
		<div class="row formulario-horizontal">
			<div class="col-xs-12">

				<div class="col-sm-4">
					<div class="form-group-sm
					'<?php if(count($errors)): ?> <?php if($errors->has('analisis')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
						<?php echo Form::label('analisis', 'Análisis', ['class' => 'control-label']); ?>

						<?php echo Form::textarea('analisis', null, ['class' => 'form-control', 'rows' => 8, 'maxlength' => 2000,'required']); ?>

						<?php if( ! isset($formulario) ): ?>
							<span id="contador-analisis">0 de 2000</span>
						<?php endif; ?>
					</div>
				</div>

				<div class="col-sm-4">
					<div class="form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('conducta')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
						<?php echo Form::label('conducta', 'Conducta', ['class' => 'control-label']); ?>

						<?php echo Form::textarea('conducta', null, ['class' => 'form-control', 'rows' => 8, 'maxlength' => 2000,'required']); ?>

						<?php if( ! isset($formulario) ): ?>
							<span id="contador-conducta">0 de 2000</span>
						<?php endif; ?>
					</div>
				</div>

				<div class="col-sm-4">
					<div class="form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('recomendaciones')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
						<?php echo Form::label('recomendaciones', 'Recomendaciones', ['class' => 'control-label']); ?>

						<?php echo Form::textarea('recomendaciones', null, ['class' => 'form-control', 'rows' => 8, 'maxlength' => 2000,'required']); ?>

						<?php if( ! isset($formulario) ): ?>
							<span id="contador-recomendaciones">0 de 2000</span>
						<?php endif; ?>
					</div>
				</div>

			</div>
		</div>
	</a>
	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Añadido</b></p>
		<div class="row formulario-horizontal">
			<div class="col-xs-12">
				<div class="col-sm-4">
					<div class="form-group-sm">
						<?php echo Form::label('auto_carga', 'Auto Cargado',['class' => 'control-label']); ?>

						<?php echo Form::textarea('auto_carga', $consulta->detalle, ['class' => 'form-control', 'rows' => 8, 'maxlength' => 2000,'disabled']); ?>

						<?php /* <?php echo Form::hidden('auto_carga', $consulta->detalle); ?> */ ?>

					</div>
				</div>
			</div>
		</div>
	</a>
	
	<?php if(isset($formulario)): ?> <?php /* Para poder ver y utilizar el form model */ ?>

		<?php echo $__env->make('componentes.lista-de-medicamentos', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
		<?php echo $__env->make('componentes.lista-de-procedimientos', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
		<?php echo $__env->make('componentes.lista-de-remisiones', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

		<?php echo Form::close(); ?>

	<?php elseif(isset($ultimoFormulario) || !isset($formulario)): ?>
		<?php echo $__env->make('componentes.modal-confirmar-registro-de-seguimineto', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

		<?php echo Form::hidden('paciente_id', $paciente); ?>

		<?php echo Form::hidden('programa', $programa); ?>


		<?php echo Form::close(); ?>


		<a class="list-group-item">
			<div class="row formulario-horizontal">
				<div class="col-xs-12 text-right">
					<?php echo $__env->make('componentes.boton-guardar-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
				</div>
			</div>
		</a>
	<?php endif; ?>

</div> <?php /* list group */ ?>

<?php /* Cargar los inputs tipo custom de fecha y hora cuando se solicita el formulario actual desde seguimiento o inscripción */ ?>
<?php echo $__env->make('componentes.script-cargar-inputs-fecha-hora-desde-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
<?php echo $__env->make('componentes.script-verificar-sexo-diagnosticos', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
