@extends('frontend.layouts.split')

@section('title', 'Stock Order' . ' '.html_entity_decode("—", ENT_QUOTES, 'UTF-8').' ' . app_name())

@section('content')
<style>
    .rx-form-content select,
    .rx-form-content input{
        max-width: 300px;
    }
</style>
<div class="row">
    <div class="col-12">
        <img alt="stock-center-logo" height="100" src="{{ URL::asset('public/img/StockCenter.jpg') }}" style="margin-bottom: 20px">
    </div>
</div>
{{ html()->form('POST', route('frontend.store-stock-order'))->attribute('id','stock-order_form')->open() }}
<div class="row m-t-20">
    <div class="col-md-7 col-order-form-container" style="overflow: hidden scroll;">
        <div class="portlet light bordered">
            <div class="portlet-title">
                <div class="caption">
                    <i class=" icon-layers font-green"></i>
                    <span class="caption-subject font-green sbold uppercase">Stock Order</span><br>
                    <!-- <small style="padding-left: 20px;"><b>All prices on this page are Net/Net. No further discounts applicable.</b></small> -->
                </div>
                <div class="actions">
                    @if(auth()->user()->isCustomerAdmin())
                        <a class="btn blue btn-circle btn-sm" href="{{ route('frontend.files.others',custom_encode_path('uploads/stock_center_price_file.pdf','others')) }}" target="_blank" data-close-others="true" aria-expanded="false"> Download Price List
                            <i class="fa fa-external-link"></i> 
                        </a>
                    @endif
                </div>
            </div>
            <div class="portlet-body form rx-form-content stock-sub-header">
                <input type="hidden" name="submit_type" id="submit_type" value="submitted">
                <input type="hidden" name="l_barcode" id="l_barcode" value="">
                <input type="hidden" name="r_barcode" id="r_barcode" value="">
                <input type="hidden" name="l_vendor" id="l_vendor" value="">
                <input type="hidden" name="l_cards" id="l_cards" value="">
                <input type="hidden" name="r_vendor" id="r_vendor" value="">
                <input type="hidden" name="r_cards" id="r_cards" value="">
                <div class="row">
                    <div class="col-md-6">
                        <label>Patient/Reference</label>
                        <input type="text" name="patient" class="form-control" required>
                    </div>
                    <div class="col-md-6">
                        <div class="form-group text-center m-0" style="padding-top: 20px;">
                            <div class="mt-radio-inline">
                                <label class="mt-radio">
                                    <input type="radio" name="combinition" id="both-eyes" value="