芝麻web文件管理V1.00

编辑当前文件:/home/rejoandoctor/public_html/resources/views/Prescribe/payment_extend.blade.php

@extends('layouts.app')

@section('title', 'Doctor | Extend Date')

@section('content')
<div class="main-content">
  <div class="main-content-inner">
	    <div class="breadcrumbs ace-save-state" id="breadcrumbs">
	        @include('layouts.header_menu')
	    </div>
		<div class="page-content">
			<div class="row">
				<div class="col-sm-3"></div>
				<div class="col-sm-6">
			        <div class="widget-box">
			            <div class="widget-header">
			                <h4 class="widget-title">Payment Customer Information</h4>
			            </div>
			            
			            <div class="widget-body">
			            	<div class="widget-main">
			               	<form action="{{route('payment_approve', $extend->id)}}" class="form-horizontal" method="POST" style="margin-top:10px;">
			               		@csrf
			                	@method('PUT')
				            	<div class="" style="margin-top:10px;">
	    							<div class="form-group">
	    								<label class="col-sm-3 control-label no-padding-right" for=""> Expected Date <span class="text-danger">*</span></label>
	    
		    							<div class="col-sm-9">
		    								<input type="text" class="form-control" value="{{Request::segment(4)}}" readonly>
		    							</div>
	    							</div>

<div class="form-group">
	    								<label class="col-sm-3 control-label no-padding-right" for=""> Customer Name <span class="text-danger">*</span></label>
	    
		    							<div class="col-sm-9">
		    								<input type="text" class="form-control" value="{{$extend->customer_name}}" readonly>
		    							</div>
	    							</div>

<div class="form-group">
	    								<label class="col-sm-3 control-label no-padding-right" for=""> Approval Date <span class="text-danger">*</span></label>
	    
		    							<div class="col-sm-9">
		    								<input type="text" class="form-control" id="c_date" name="end_date">
		    							</div>
	    							</div>
	    							<div class="form-action center">
	    								<button class="btn btn-sm btn-round btn-success" type="submit">Approve</button>
	    							</div>
	    						</div>
	    					</form>
	    				</div>
	    			</div>
	    		</div>
				<div class="col-sm-3"></div>
			</div>

@endsection