@extends('collector.layouts.master') @section('content')
Patient Details

@csrf
Name*
{{-- --}} @if ($errors->has('fname'))
{{ $errors->first('fname') }}
@endif
{{-- --}} @if ($errors->has('lname'))
{{ $errors->first('lname') }}
@endif
Gender*
user->gender ? ($patient->user->gender == 'male' ? 'checked' : '') : '' }} required>
user->gender ? ($patient->user->gender == 'female' ? 'checked' : '') : '' }}>
user->gender ? ($patient->user->gender == 'Prefer not to respond' ? 'checked' : '') : '' }}> @if ($errors->has('gender'))
{{ $errors->first('gender') }}
@endif
Ethnicity*
@if ($errors->has('ethnicity'))
{{ $errors->first('ethnicity') }}
@endif
Date Of Birth *
@if ($errors->has('dob'))
{{ $errors->first('dob') }}
@endif
Email*
@if ($errors->has('email'))
{{ $errors->first('email') }}
@endif
Phone*
@if ($errors->has('phone'))
{{ $errors->first('phone') }}
@endif
Contact Name*
Home Address*
@if ($errors->has('address_one'))
{{ $errors->first('address_one') }}
@endif
@if ($errors->has('address_two'))
{{ $errors->first('address_two') }}
@endif
City*
@if ($errors->has('city'))
{{ $errors->first('city') }}
@endif
State*
{{-- --}}
Zip Code*
@if ($errors->has('zipcode'))
{{ $errors->first('zipcode') }}
@endif
{{--
Are you 18 or older?*
--}} {{--
Do you have Health Insurance*
--}}
Insurance Type
{{-- --}} @if ($errors->has('insurance_type'))
{{ $errors->first('insurance_type') }}
@endif
Policy Number
@if ($errors->has('policy_id'))
{{ $errors->first('policy_id') }}
@endif
Group Number
@if ($errors->has('group_id'))
{{ $errors->first('group_id') }}
@endif
@if (!$patient->documents->isEmpty())

Documents

@foreach ($patient->documents as $document) @endforeach
@endif
@endsection @push('scripts') @endpush