<?php $page = 'patient-details'; ?>

<?php $__env->startSection('content'); ?>
    <div class="left-panel">
        <div class="onboarding-logo text-center">
            <a href="<?php echo e(url('/')); ?>"><img src="<?php echo e(URL::asset('/assets/img/onboard-img/onb-logo.png')); ?>" class="img-fluid"
                    alt="doccure-logo"></a>
        </div>
        <div class="onboard-img">
            <img src="<?php echo e(URL::asset('/assets/img/onboard-img/onb-slide-img.png')); ?>" class="img-fluid" alt="onboard-slider">
        </div>
        <div class="onboarding-slider">
            <!-- Slider -->
            <div id="onboard-slider" class="owl-carousel owl-theme onboard-slider slider">
                <!-- Slider Item -->
                <div class="onboard-item text-center">
                    <div class="onboard-content">
                        <h3>Welcome to Doccure</h3>
                        <p>
                            Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor
                            incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam.
                        </p>
                    </div>
                </div>
                <!-- /Slider Item -->
                <!-- Slider Item -->
                <div class="onboard-item text-center">
                    <div class="onboard-content">
                        <h3>Welcome to Doccure</h3>
                        <p>
                            Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor
                            incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam.
                        </p>
                    </div>
                </div>
                <!-- /Slider Item -->
                <!-- Slider Item -->
                <div class="onboard-item text-center">
                    <div class="onboard-content">
                        <h3>Welcome to Doccure</h3>
                        <p>
                            Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor
                            incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam.
                        </p>
                    </div>
                </div>
                <!-- /Slider Item -->

            </div>
            <!-- /Slider -->
        </div>
    </div>
    <div class="right-panel">
        <div class="container">
            <div class="onboarding-content passcode-wrap mail-box">
                <div class="row">
                    <div class="col-lg-12 p-0">
                        <div class="right-panel-title text-center">
                            <a href="<?php echo e(url('/')); ?>"> <img
                                    src="<?php echo e(URL::asset('/assets/img/onboard-img/onb-logo.png')); ?>" alt="doccure-logo"></a>
                        </div>
                    </div>
                    <div class="col-lg-4 col-md-12">
                        <div class="on-board-wizard">
                            <ul>
                                <li>
                                    <a href="<?php echo e(url('patient-email')); ?>">
                                        <div class="onboarding-progress active">
                                            <span>1</span>
                                        </div>
                                        <div class="onboarding-list">
                                            <h6>Registration</h6>
                                            <p>Enter Details for Register </p>
                                        </div>
                                    </a>
                                </li>
                                <li>
                                    <a href="<?php echo e(url('patient-Personalize')); ?>">
                                        <div class="onboarding-progress active">
                                            <span>2</span>
                                        </div>
                                        <div class="onboarding-list">
                                            <h6>Profile Picture</h6>
                                            <p>Upload Profile picture</p>
                                        </div>
                                    </a>
                                </li>
                                <li>
                                    <a href="<?php echo e(url('patient-details')); ?>">
                                        <div class="onboarding-progress active">
                                            <span>3</span>
                                        </div>
                                        <div class="onboarding-list">
                                            <h6>Personal Details</h6>
                                            <p>Enter your Personal Details</p>
                                        </div>
                                    </a>
                                </li>
                                <li>
                                    <a href="<?php echo e(url('patient-family-details')); ?>">
                                        <div class="onboarding-progress">
                                            <span>4</span>
                                        </div>
                                        <div class="onboarding-list">
                                            <h6>Select Members</h6>
                                            <p>Enter Details for Register </p>
                                        </div>
                                    </a>
                                </li>
                                <li>
                                    <a href="<?php echo e(url('patient-dependant-details')); ?>">
                                        <div class="onboarding-progress">
                                            <span>5</span>
                                        </div>
                                        <div class="onboarding-list">
                                            <h6>Dependant details</h6>
                                            <p>Dependants Profile</p>
                                        </div>
                                    </a>
                                </li>
                                <li>
                                    <a href="<?php echo e(url('patient-other-details')); ?>">
                                        <div class="onboarding-progress">
                                            <span>6</span>
                                        </div>
                                        <div class="onboarding-list">
                                            <h6>Other Detail</h6>
                                            <p>More information</p>
                                        </div>
                                    </a>
                                </li>
                            </ul>
                        </div>
                    </div>
                    <div class="col-lg-8 col-md-12">
                        <div class="onboarding-content-box content-wrap">
                            <div class="onboarding-title">
                                <h2>What are your personal details? <span>*</span></h2>
                                <h6>Please provide your personal information</h6>
                            </div>
                            <div class="patient-details-form">
                                <div class="login-header">
                                    <form id="personal_details" enctype="multipart/form-data">
                                        <div class="mb-3">
                                            <div class="row select-gender-option">
                                                <div class="col-6">
                                                    <div class="option-set">
                                                        <input type="radio" id="test1" name="gender" value="Male">
                                                        <label for="test1">
                                                            <span><i class="fas fa-mars"></i> Male</span>
                                                        </label>
                                                    </div>
                                                </div>
                                                <div class="col-6 ">
                                                    <input type="radio" id="test2" name="gender" value="Female">
                                                    <label for="test2">
                                                        <span><i class="fas fa-venus"></i> Female</span>
                                                    </label>
                                                </div>
                                            </div>
                                        </div>
                                        <div class="row">
                                            <div class="col-lg-9">
                                                <div class="mb-3">
                                                    <div class="passcode-wrap input-placeholder form-focus">
                                                        <label class="focus-label">Your Weight<span>*</span></label>
                                                        <input type="text" class="form-control floating" required="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="col-lg-3">
                                                <div class="mb-3">
                                                    <select class="select">
                                                        <option selected>KG</option>
                                                        <option>LBS</option>
                                                    </select>
                                                </div>
                                            </div>
                                            <div class="col-lg-9">
                                                <div class="mb-3">
                                                    <div class="passcode-wrap input-placeholder form-focus">
                                                        <label class="focus-label">Your Height<span>*</span></label>
                                                        <input type="text" class="form-control floating" required="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="col-lg-3">
                                                <div class="mb-3">
                                                    <select class="select">
                                                        <option selected>CM</option>
                                                        <option>FEET</option>
                                                        <option>INCH</option>
                                                    </select>
                                                </div>
                                            </div>
                                            <div class="col-lg-12">
                                                <div class="mb-3">
                                                    <div class="passcode-wrap input-placeholder form-focus">
                                                        <label class="focus-label">Age<span>*</span></label>
                                                        <input type="text" class="form-control floating" required="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="col-lg-12">
                                                <div class="mb-3">
                                                    <select class="select">
                                                        <option disabled selected>Blood Type</option>
                                                        <option>O+ve</option>
                                                        <option>O-ve</option>
                                                        <option>B+ve</option>
                                                        <option>B-ve</option>
                                                    </select>
                                                </div>
                                            </div>
                                            <div class="col-lg-12">
                                                <div class="mb-3">
                                                    <div class="passcode-wrap input-placeholder form-focus">
                                                        <label class="focus-label">Heart Rate<span>*</span></label>
                                                        <input type="text" class="form-control floating"
                                                            required="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="col-lg-12">
                                                <div class="mb-3">
                                                    <div class="passcode-wrap input-placeholder form-focus">
                                                        <label class="focus-label">Blood Pressure <span>*</span></label>
                                                        <input type="text" class="form-control floating"
                                                            required="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="col-lg-12">
                                                <div class="mb-3">
                                                    <div class="passcode-wrap input-placeholder form-focus">
                                                        <label class="focus-label">Glucose Level <span>*</span></label>
                                                        <input type="text" class="form-control floating"
                                                            required="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="col-lg-12">
                                                <div class="mb-3">
                                                    <div class="passcode-wrap input-placeholder form-focus">
                                                        <label class="focus-label">Allergies <span>*</span></label>
                                                        <input type="text" class="form-control floating"
                                                            required="">
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="col-lg-12">
                                                <div class="mb-3">
                                                    <div class="pregnant-col pt-4">
                                                        <div>
                                                            <div
                                                                class="remember-me-col d-flex justify-content-between align-items-center">
                                                                <span class="mt-1">Are you Pregnant</span>
                                                                <label class="custom_check">
                                                                    <input type="checkbox" class=""
                                                                        id="is_registered" name="pregnant"
                                                                        value="1">
                                                                    <span class="checkmark"></span>
                                                                </label>
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="step-process-col mt-4">
                                                        <div class="mb-3" id="preg_div" style="display: none;">
                                                            <select class=" select form-control" id="preg_term"
                                                                name="preg_term" tabindex="-1" aria-hidden="true">
                                                                <option selected="" value="">Select Your
                                                                    Pregnancy Month</option>
                                                                <option value="1">1</option>
                                                                <option value="2">2</option>
                                                                <option value="3">3</option>
                                                                <option value="4">4</option>
                                                                <option value="5">5</option>
                                                                <option value="6">6</option>
                                                                <option value="">7</option>
                                                                <option value="8">8</option>
                                                                <option value="9">9</option>
                                                                <option value="10">10</option>
                                                            </select>
                                                        </div>
                                                    </div>
                                                </div>
                                                <div class="col-lg-12">
                                                    <div class="mb-3">
                                                        <div class="checklist-col">
                                                            <div
                                                                class="remember-me-col d-flex justify-content-between align-items-center">
                                                                <span class="mt-1">Do you have any pre-exisiting
                                                                    conditions?</span>
                                                                <label class="custom_check">
                                                                    <input type="checkbox" class="" name="cancer"
                                                                        id="cancer" onclick="show_cancer()"
                                                                        value="1">
                                                                    <span class="checkmark"></span>
                                                                </label>
                                                            </div>
                                                            <div class="remember-me-col" id="cancer_div"
                                                                style="display:none">
                                                                <div class="condition_input">
                                                                    <input type="text" id="conditions"
                                                                        name="conditions[]" class="form-control"
                                                                        placeholder="">
                                                                </div>
                                                                <a href="javascript:void(0);" class="add_condition"><i
                                                                        class="fa fa-plus"></i></a>
                                                            </div>
                                                            <div
                                                                class="remember-me-col d-flex justify-content-between align-items-center">
                                                                <span class="mt-1">Are you currently taking any
                                                                    medication</span>
                                                                <label class="custom_check">
                                                                    <input type="checkbox" class="" name="medicine"
                                                                        id="medicine" onclick="show_medicine()"
                                                                        value="1">
                                                                    <span class="checkmark"></span>
                                                                </label>
                                                            </div>
                                                            <div class="remember-me-col" id="medicine_div"
                                                                style="display:none">
                                                                <div class="medicine_input">
                                                                    <input type="text" id="medicine_name"
                                                                        name="medicine_name[]" value=""
                                                                        class="form-control"
                                                                        placeholder="Enter medicine_name">
                                                                    <input type="text" value="" id="dosage"
                                                                        name="dosage[]" class="form-control"
                                                                        placeholder="Enter dosage">
                                                                </div>
                                                                <a href="javascript:void(0);" class="add_medicine"><i
                                                                        class="fa fa-plus"></i></a>
                                                            </div>
                                                        </div>
                                                    </div>
                                                </div>

                                            </div>

                                    </form>
                                </div>
                            </div>
                            <div class="onboarding-btn">
                                <a href="<?php echo e(url('patient-family-details')); ?>">Continue</a>
                            </div>
                        </div>
                    </div>
                </div>
            </div>

        </div>
    </div>
<?php $__env->stopSection(); ?>

<?php echo $__env->make('layout.mainlayout', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH C:\xampp\htdocs\doccure\laravel\template\resources\views/patient-details.blade.php ENDPATH**/ ?>