@extends("layout") @section("content")
{{ Form::open(array('url' => 'facilityrequest', 'id' => 'form-facilityrequest', 'method' => 'POST')) }}

{{ HTML::image(Config::get('kblis.organization-logo'), Config::get('kblis.country') . trans('messages.court-of-arms'), array('width' => '100px')) }}
{{ strtoupper(Config::get('constants.FACILITY_REQUEST_FORM_HEADER')) }}
{{Config::get('kblis.address-info')}}

Form# 601

{{ Form::label('facility', 'Requesting Facility', array('class' => 'required')) }} {{ Form::select('facility', $facility, null,array('class' => 'form-control','id'=>'facility_dropdown_id'))}} @if ($errors->has('facility_id')) {{ $errors->first('facility_id') }} @endif
{{ Form::label('hub', 'Hub') }} {{Form::text('hub', Input::old('hub'),array('class' => 'form-control','id'=>'hub_id','name'=>'unhls_hub', 'readonly'))}}
{{ Form::label('district_id', 'District:', array('class'=>'col-sm-2')) }} {{ Form::text('district_id', Input::old('district_id'), array('class' => 'form-control col-sm-4', 'readonly')) }}
{{ Form::label('ip', 'IP:', array('class'=>'col-sm-2')) }} {{ Form::text('ip_id',Input::old('ip_id'), array('class' => 'form-control col-sm-4', 'readonly')) }}
{{ Form::label('start_date', 'Start:', array('class'=>'col-sm-2')) }} {{ Form::text('start_date', Input::old('start_date'),array('class' => 'form-control standard-datepicker-nofuture', 'placeholder' =>'Start Date...','required'=>'required','id'=>'start_date')) }}
{{ Form::label('end_date', 'End:', array('class'=>'col-sm-2')) }} {{ Form::text('end_date', Input::old('end_date'),array('class' => 'form-control standard-datepicker-nofuture', 'placeholder' =>'End Date...','required'=>'required','id'=>'_date')) }}
{{ Form::label('date_submitted', 'Submitted:', array('class' =>'col-sm-2 ')) }} {{ Form::text('date_submitted', Input::old('date_submitted'),array('class' => 'form-control standard-datepicker-nofuture', 'placeholder' =>'Date Submitted','required'=>'required','id'=>'expiry_date')) }}
{{ Form::label('incharge_mail', 'E-mail:', array('class' =>'col-sm-2 ')) }} {{ Form::text('incharge_mail',Input::old('incharge_mail'), array('class' => 'form-control col-sm-4', 'placeholder' =>'Hub Coordinator Email address')) }} {{ Form::label('requested_by', 'Prepared By:',array('class' =>'col-sm-2', 'hidden')) }} {{ Form::text('requested_by', Auth::user()->username,array('class' => 'hidden', 'form-control col-sm-4')) }}
Item Description Basic Unit No. of Samples
(Collected during the reporting period)
Opening Balance
at start
of opening cycle
Qty Received
during the
reporting period
Total Consumption
during the
reporting period
Losses / Adjustments
(-/+)
Total Closing Balance Maximum Stock Quantity Required Quantity To Order Comments
{{ Form::button(" ".trans('messages.save'), array('class' => 'btn btn-primary', 'onclick' => 'submit()')) }}

@stop