<div id="editIpdTimelineModal" class="modal fade" role="dialog" tabindex="-1" aria-hidden="true">
    <div class="modal-dialog modal-lg">
        <!-- Modal content-->
        <div class="modal-content">
            <div class="modal-header">
                <h2>{{ __('messages.ipd_patient_timeline.edit_ipd_timeline') }}</h2>
                <button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button>
            </div>
            {{ Form::open(['id'=>'editIpdTimelineForm', 'files'=>true]) }}
            <div class="modal-body">
                <div class="alert alert-danger d-none hide" id="editIpdTimelineErrorsBox"></div>
                {{ Form::hidden('ipd_patient_department_id',$ipdPatientDepartment->id) }}
                {{ Form::hidden('id',null,['id'=>'ipdTimelineId']) }}
                <div class="row">
                    <div class="form-group col-sm-6 mb-5">
                        {{ Form::label('title', __('messages.ipd_patient_timeline.title').':',['class' => 'form-label']) }}
                        <span class="required"></span>
                        {{ Form::text('title', null, ['class' => 'form-control','required' , 'id' => 'editIpdTimelineTitle', 'placeholder' => __('messages.ipd_patient_timeline.title')]) }}
                    </div>
                    <div class="form-group col-md-6 mb-5">
                        <div class="form-group">
                            {{ Form::label('date', __('messages.ipd_patient_timeline.date').':',['class' => 'form-label']) }}
                            <span class="required"></span>
                            {{ Form::text('date', null, ['class' => (getLoggedInUser()->thememode ? 'bg-light form-control' : 'bg-white form-control'),'id' => 'editIpdTimelineDate', 'placeholder' => __('messages.ipd_patient_timeline.date')]) }}
                        </div>
                    </div>
                    <div class="form-group col-md-6 mb-5">
                        <div class="form-group">
                            {{ Form::label('description', __('messages.ipd_patient_timeline.description').':',['class' => 'form-label']) }}
                            {{ Form::textarea('description', null, ['class' => 'form-control', 'rows' => 4, 'id' => 'editIpdTimelineDescription', 'placeholder' => __('messages.ipd_patient_timeline.description')]) }}
                        </div>
                    </div>
                    <div class="form-group col-md-6 mb-5">
                        {{ Form::label('visible_to_person', __('messages.ipd_patient_timeline.visible_to_person').(':'),['class' => 'form-label']) }}
                        <div class="form-check form-switch">
                            <input class="form-check-input w-35px h-20px switch-input" name="visible_to_person"
                                   id="editIpdTimelineVisibleToPerson" type="checkbox" value="1" tabindex="8" checked>
                        </div>
                    </div>
                    <div class="form-group col-sm-6 mb-5">
                        {{ Form::label('document', __('messages.ipd_patient_timeline.document').':',['class' => 'fs-5 fw-bolder text-gray-600 mb-2 d-block']) }}
                        <div class="d-block"></div>
                        <div class="image-picker">
                            <div class="image previewImage" id="editPreviewIpdTimelineImage"
                                 style="background-image: url({{ asset('assets/img/default_image.jpg') }})">
                            </div>
                            <span class="picker-edit rounded-circle text-gray-500 fs-small" title="Change document">
                                <label>
                                <i class="fa-solid fa-pen" id="profileImageIcon"></i>
                                    {{ Form::file('attachment',['id'=>'editIpdTimelineDocumentImage','class' => 'image-upload d-none', 'accept' => '.png, .jpg, .jpeg, .gif, .pdf']) }}
                                    <input type="hidden" name="avatar_remove">
                                </label>
                            </span>
                        </div>
                    </div>
                </div>
                <div class="modal-footer p-0">
                    {{ Form::button(__('messages.common.save'), ['type'=>'submit','class' => 'btn btn-primary me-3','id'=>'btnIpdTimelineEdit','data-loading-text'=>"<span class='spinner-border spinner-border-sm'></span> Processing..."]) }}
                    <button type="button" class="btn btn-secondary"
                            data-bs-dismiss="modal">{{ __('messages.common.cancel') }}</button>
                </div>
            </div>
            {{ Form::close() }}
        </div>
    </div>
</div>
