@extends("layout")
@section("content")
<div>
	<ol class="breadcrumb">
	  <li><a href="{{{URL::route('user.home')}}}">{{trans('messages.home')}}</a></li>
	  <li><a href="{{{URL::route('order.index')}}}">Orders</a></li>
	  <li class="active">New Order</li>
	</ol>
</div>

<div class="col-md-8 col-md-offset-2">
	<span><b>BOX A (Inputs)</b></span>

	<div  class="panel panel-default row" style="width:50%">
		<br>

		<div class="form-group">
	 		 {{ Form::label('tests', 'Number of Tests Requested') }}
	 		 {{ Form::text('tests', Input::old('tests'),array('class' => 'form-control', 'rows' => '2', 'id'=>'folio_number')) }}
	  </div>

		<div class="form-group">
	 		 {{ Form::label('weeks', 'Number of weeks ordering for') }}
	 		 {{ Form::text('weeksr', Input::old('weeks'),array('class' => 'form-control', 'rows' => '2', 'id'=>'folio_number')) }}
	  </div>

		<div class="form-group">
	 		 {{ Form::label('batch_size', 'Batch size (No. of tests per run)') }}
	 		 {{ Form::text('batch_size', Input::old('batch_size'),array('class' => 'form-control', 'rows' => '2', 'id'=>'folio_number')) }}
	  </div>
	</div>
	</div>

@if (Session::has('message'))
	<div class="alert alert-info">{{ trans(Session::get('message')) }}</div>
@endif
@if($errors->all())
                <div class="alert alert-danger">
                    {{ HTML::ul($errors->all()) }}
                </div>
            @endif
						<div class="col-md-8 col-md-offset-2">
	<div  class="panel panel-default row" style="width:85%">
	<div class="panel-heading ">
		<span class="glyphicon glyphicon-list"></span>
New in-house requisition
</div>
<div  class="panel-body">

	<table class="table table-bordered">
		<thead>
			<tr>
				<th class="text-center">#</th>
				<th class="text-center">#</th>
				<th class="text-center">Product Description</th>
				<th class="text-center">Cat No.</th>
				<th class="text-center">Pack Size</th>
				<th class="text-center">No. Of Tests Per Pack</th>
				<th class="text-center">Packs Required</th>

			</tr>
		</thead>
		<td>
			<td>1</td>
			<td>Abbott RealTime HIV-1 Amplification Reagent Kit</td>
			<td>2G31-90</td>
			<td>1 pack with 4 boxes x 24 tests</td>
			<td>93</td>
			<td></td>
		</td>
	</table>
		<!--
	<div class="panel-body">
           {{ Form::open(array('url' => 'inhouserequest', 'id' => 'form-inhouserequest', 'method' => 'POST')) }}

					 <div class="form-group">
							 {{ Form::label('folio_number', 'Folio Number') }}
							 {{ Form::text('folio_number', Input::old('folio_number'),array('class' => 'form-control', 'rows' => '2', 'id'=>'folio_number')) }}
					 </div>

						 <div class="form-group">
                {{ Form::label('commodity_id', 'Item') }}
                {{ Form::select('commodity_id', $commodities, Input::old('commodity_id'), array('class' => 'form-control')) }}
            </div>

						<div class="form-group">
							 {{ Form::label('issue_unit', 'Issue Unit') }}
							 {{ Form::select('issue_unit', array(null => 'Select Unit of measure')+$metrics,'', array('class' => 'form-control', 'id' => 'issue_unit')) }}
					 </div>

            </div>

            <div class="form-group">
                {{ Form::label('quantity', 'Quantity Required') }}
                {{ Form::text('quantity', Input::old('quantity'),array('class' => 'form-control', 'rows' => '2', 'id'=>'quantity')) }}
            </div>

						<div class="form-group">
						{{  Form::label('department', 'Requesting Department', array('class'=>'control-label')) }}
										{{ Form::select('department', array_merge(array(null => 'Select department...	'), $department_list), Input::old('department'), array('class' => 'form-control', 'id' => 'location_id')) }}
										@if ($errors->has('department'))
												<span class="text-danger">
														<strong>{{ $errors->first('department') }}</strong>
												</span>
										@endif
							</div>


							<div class="form-group">
									{{ Form::label('incharge', 'In-charge Name') }}
									{{ Form::text('incharge', Input::old('incharge'),array('class' => 'form-control', 'rows' => '2', 'id'=>'incharge')) }}
							</div>

						</div>-->

            <div class="form-group actions-row">

                    {{ Form::button("<span class='glyphicon glyphicon-save'></span> ".trans('messages.save'),
                        array('class' => 'btn btn-primary', 'onclick' => 'submit()')) }}

            </div>
        {{ Form::close() }}