<div class="row">
	<div class="col-sm-3">
		<div id="campo-documento" class="form-group form-group-sm has-feedback">	
			<?php echo Form::label('documento', 'Documento de Id.'); ?>

			<?php echo Form::text('documento', null, [
				'class'=>'form-control input',
				'placeholder'=>'ingresa el documento de identidad del responsable'
			]); ?>

			<span class="display-none glyphicon glyphicon-ok form-control-feedback" aria-hidden="true"></span>
			<span class="display-none glyphicon glyphicon-remove form-control-feedback" aria-hidden="true"></span>
		</div>
	</div>
	<div class="col-sm-3">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('email')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
			<?php echo Form::label('email', 'Correo electróncio'); ?>

			<?php echo Form::email('email', null, [
				'class'=>'form-control',
				'placeholder'=>'ingresa el email'
			]); ?>

		</div>
	</div>
	<div class="col-sm-3">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('password')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('password', 'Contraseña'); ?>

			<?php echo Form::text('password', null, [
				'class'=>'form-control',
				'placeholder'=>'minimo 6 digitos'
			]); ?>

		</div>
	</div>
	<div class="col-sm-3">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('password_confirmation')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('password_confirmation', 'Confirmar contraseña'); ?>

			<?php echo Form::text('password_confirmation', null, [
				'class'=>'form-control',
				'placeholder'=>'minimo 6 digitos'
			]); ?>

		</div>
	</div>

</div>
<div class="row">
	<div class="col-sm-3">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('nombre_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('nombre_1', 'Primer Nombre'); ?>

			<?php echo Form::text('nombre_1', null, [
				'class'=>'form-control',
				'placeholder'=>'ingresa el primer nombre'
			]); ?>

		</div>
	</div>
	<div class="col-sm-3">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('nombre_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('nombre_2', 'Segundo Nombre'); ?>

			<?php echo Form::text('nombre_2', null, [
				'class'=>'form-control',
				'placeholder'=>'ingresa el segundo nombre'
			]); ?>

		</div>
	</div>
	<div class="col-sm-3">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('apellido_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('apellido_1', 'Primer Apellido'); ?>

			<?php echo Form::text('apellido_1', null, [
				'class'=>'form-control',
				'placeholder'=>'ingresa el primer apellido'
			]); ?>

		</div>
	</div>
	<div class="col-sm-3">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('apellido_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('apellido_2', 'Segundo Apellido'); ?>

			<?php echo Form::text('apellido_2', null, [
				'class'=>'form-control',
				'placeholder'=>'ingresa el segundo apellido'
			]); ?>

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

<div class="row">
	<div class="col-sm-2">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('direccion')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('direccion', 'Dirección'); ?>

			<?php echo Form::text('direccion', null, [
				'class'=>'form-control',
				'placeholder'=>'ingresa la dirección de residencia'
			]); ?>

		</div>
	</div>
	<div class="col-sm-3">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('departamento_id')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('Departamento'); ?>

			<?php echo Form::select('departamento_id', $departamentos, null,  ['class' => 'form-control', 'id' => 'departamento']); ?>

		</div>
	</div>
	<div class="col-sm-3">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('municipio_id')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('Municipio'); ?>

			<?php if(isset($editando)): ?>
				<?php echo Form::select('municipio_id', $municipios, null,  ['class' => 'form-control', 'id' => 'municipio']); ?>

			<?php elseif(Session::has('municipios')): ?>
				<?php echo Form::select('municipio_id', Session::get('municipios'), null,  ['class' => 'form-control', 'id' => 'municipio']); ?>

			<?php else: ?>
				<?php echo Form::select('municipio_id', ['0' => 'Ninguno seleccionado'], null,  ['class' => 'form-control', 'disabled', 'id' => 'municipio']); ?>

			<?php endif; ?>
		</div>
	</div>
	<div class="col-sm-2">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('telefono_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('telefono_1', 'Teléfono 1'); ?>

			<?php echo Form::text('telefono_1', null, [
				'class'=>'form-control',
				'placeholder'=>'ingresa el celular o el teléfono'
			]); ?>

		</div>
	</div>
	<div class="col-sm-2">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('telefono_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('telefono_2', 'Teléfono 2'); ?>

			<?php echo Form::text('telefono_2', null, [
				'class'=>'form-control',
				'placeholder'=>'ingresa un número telefónico opcional'
			]); ?>

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

<div class="row">
	<div class="col-sm-2">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('estado_civil')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('estado_civil', 'Estado Civil'); ?>

			<?php echo Form::select('estado_civil', array(
				'so' => 'Soltero',
				'ca' => 'Casado',
				'vi' => 'Viudo',
				'se' => 'Separado',
				'un' => 'Union Libre',
				'ot' => 'Otro'
			), null,  ['class' => 'form-control']); ?>

		</div>
	</div>
	<div class="col-sm-2">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('sexo')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('sexo', 'Sexo'); ?>

			<?php echo Form::select('sexo', array(
				'm' => 'Masculino',
				'f' => 'Femenino',
				'i' => 'Indeterminado'
			), null,  ['class' => 'form-control']); ?>

		</div>
	</div>
	<div class="col-sm-2">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('ocupacion')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">	
			<?php echo Form::label('ocupacion', 'Ocupación'); ?>

			<?php echo Form::text('ocupacion', null, [
				'class'=>'form-control',
				'placeholder'=>'ingresa la ocupación'
			]); ?>

		</div>
	</div>
	<div class="col-sm-2">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('cargo')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">	
			<?php echo Form::label('cargo', 'Cargo'); ?>

			<?php echo Form::text('cargo', null, [
				'class'=>'form-control input',
				'placeholder'=>'ingresa el cargo'
			]); ?>

		</div>
	</div>
	<div class="col-sm-2">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('registro_profesional')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">	
			<?php echo Form::label('registro_profesional', 'Registro Profesional'); ?>

			<?php echo Form::text('registro_profesional', null, [
				'class'=>'form-control input',
				'placeholder'=>'ingresa el registro_profesional'
			]); ?>

		</div>
	</div>
	<div class="col-sm-2">
		<div class="form-group form-group-sm '<?php if(count($errors)): ?> <?php if($errors->has('especialidad_id')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'"">
			<?php echo Form::label('especialidad_id', 'Especialidad'); ?>

			<?php if(isset($editando)): ?>
				<?php echo Form::select('especialidad_id', $especialidades, $responsable->especialidad_id,  ['class' => 'form-control']); ?>

			<?php else: ?>
				<?php echo Form::select('especialidad_id', $especialidades, null,  ['class' => 'form-control']); ?>

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

			<?php echo Form::file('archivo_firma', ['class' => 'form-control']); ?>

		</div>
	</div>
	<div class="col-sm-4">
		<div id="div-firma" class="form-group form-group-sm">
			<?php if(isset($editando)): ?>
				<img height="100px" id="imagen-output" src='<?php echo e(URL::to("/img/firmas/$responsable->firma")); ?>'>
			<?php else: ?>
				<img height="100px" id="imagen-output">
			<?php endif; ?>

		</div>
	</div>
	<div class="col-sm-6"></div>
</div>