{{ __('messages.ipd_payments.edit_ipd_payment') }}

{{ Form::open(['id'=>'editIpdPaymentForm']) }}
@if($ipdPatientDepartment->bill)
Note: After adding Payment you must need to re-generate Bill.
@endif
{{ Form::hidden('id',null,['id'=>'ipdPaymentId']) }} {{ Form::hidden('ipd_patient_department_id',$ipdPatientDepartment->id) }}
{{ Form::label('amount', __('messages.ambulance_call.amount').':',['class' => 'form-label required fs-6 fw-bolder text-gray-700 mb-3']) }}
{{ Form::text('amount', null, ['class' => 'form-control form-control-solid price-input','id' => 'editIpdPaymentAmount', 'required']) }}
{{ Form::label('date', __('messages.ipd_patient_charges.date').':',['class' => 'form-label required fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::text('date', null, ['class' => 'form-control form-control-solid','id' => 'editIpdPaymentDate','autocomplete' => 'off', 'required']) }}
{{ Form::label('charge_type_id', __('messages.ipd_payments.payment_mode').':',['class' => 'form-label required fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::select('payment_mode', $paymentModes, null, ['class' => 'form-select form-select-solid select2Selector', 'id' => 'editPaymentModeId', 'required','placeholder'=>'Select Payment Mode']) }}
{{ Form::label('document', __('messages.ipd_patient_diagnosis.document').':',['class' => 'fs-5 fw-bolder text-gray-600 mb-2 d-block']) }}
{{ Form::label('notes', __('messages.ipd_patient.notes').':',['class' => 'form-label fs-6 fw-bolder text-gray-700 mb-3']) }} {{ Form::textarea('notes', null, ['class' => 'form-control form-control-solid', 'rows' => 4,'id'=>'editIpdPaymentNote']) }}
{{ Form::button(__('messages.common.save'), ['type'=>'submit','class' => 'btn btn-primary me-3','id'=>'btnEditIpdPaymentSave','data-loading-text'=>" Processing..."]) }}
{{ Form::close() }}