<div class="row">
    <div class="container">

        <ol class="breadcrumb">
            <li><a href="#">نظام الجمعيات</a></li>
            <li><a href="beneficiariesController.php?do=show"> المستفيدين</a></li>
            <li class="active">اضافة </li>
        </ol>


        <div class="panel panel-default panel-m">
            <div class="panel-heading">
                <h3 class="panel-title">اضافة </h3>
            </div>
            <div class="panel-body">


                {literal}
                <form class="form-horizontal" action="beneficiariesController.php" id="charityformajax" method="post"
                    enctype="multipart/form-data" data-dosave="?do=savedata">
                    {/literal}
                    <div class="form-group">
                        <label class="col-lg-2 control-label">المنطقة </label>
                        <div class="col-lg-4">
                            <input id="areaId" type="text" name="area_id" class="getselectjoin areaId"
                                data-placeholder=" المنطقة" data-table="area" data-tableid="areaId" data-join=""
                                data-filter="" data-parent="" data-itr="" data-search="name" />
                            <input type="hidden" name="areaId" class="selectedit" data-tableidname="id" data-itr=""
                                data-join="" data-table="area" data-tableid="id" data-search="name" value="" />
                        </div>
                        <button type="button" class="btn btn-primary adddatamodal" data-table="area"
                            data-tableid="areaId" data-toggle="modal" data-target="#ModalareaId" data-whatever="@area"
                            data-formt="formarea" data-selectitr="">اضافة منطقة</button>
                        <button type="button" class="btn btn-primary editdatamodal" data-model="#ModalareaId"
                            data-table="area" data-name="areaId" data-tableid="id" data-join="" data-formt="formarea"
                            data-control="beneficiariesController.php" data-selectitr="">تعديل منطقة</button>
                    </div>

                    <div class="form-group">
                        <label class="col-lg-2 control-label">الجمعية </label>
                        <div class="col-lg-4">
                            <select name="charity_id" data-placeholder="اختر " class="selectnew" required
                                data-table="beneficiaries" data-tablecol="charity_id">
                                <option value=""></option>
                                {foreach $allCharities as $single}
                                <option value="{$single.id}">{$single.charityname}</option>
                                {/foreach}
                            </select>
                        </div>
                    </div>
                    <hr />

                    <div class="caption">
                        <h4 style="text-decoration: underline; font-weight: bold;">البيانات الشخصية</h4>
                    </div>
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">اسم المستفيد</label>
                        <div class="col-lg-4">
                            <input required="required" type="text" name="b_name" class="form-control checkcolumn"
                                placeholder="اسم المستفيد" data-table="beneficiaries" data-tablecol="name"
                                data-tableid="" data-parentid="" data-parentcol="" />
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الشهرة</label>
                        <div class="col-lg-4">
                            <input type="text" name="nickname" class="form-control" placeholder="الشهرة"
                                data-table="beneficiaries" data-tablecol="nickname" data-tableid="" data-parentid=""
                                data-parentcol="" />
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">السن</label>
                        <div class="col-lg-4">
                            <input required="required" type="number" name="age" id="age" class="form-control numbers"
                                placeholder="السن" />
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الرقم القومي</label>
                        <div class="col-lg-4">
                            <input required="required" type="text" name="idnumber" id="idnumber"
                                data-table="beneficiaries" data-tablecol="idnumber"
                                class="form-control checkcolumn numbers" placeholder="الرقم القومي" />
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">رقم تليفون المستفيد </label>
                        <div class="col-lg-4">
                            <input required="required" type="text" name="phone_no" digits="true"
                                class="form-control checkcolumn numbers" placeholder="رقم تليفون المستفيد  "
                                data-table="beneficiaries" data-tablecol="phone_no" data-tableid="" data-parentid=""
                                data-parentcol="" />
                        </div>
                    </div>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label"> عنوان المستفيد</label>
                        <div class="col-lg-4">
                            <input required="required" type="text" name="address" class="form-control"
                                placeholder="عنوان المستفيد" />
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label"> الحالة الاجتماعية</label>
                        <div class="col-lg-4">
                            <select name="marital_status" data-placeholder="اختر " class="selectnew">
                                <option value="1">أعزب/عزباء</option>
                                <option value="2">خاطب/مخطوبة</option>
                                <option value="3">متزوج/ة</option>
                                <option value="4">أرمل/ة</option>
                            </select>
                        </div>
                    </div>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الصوره</label>
                        <div class="col-lg-4">
                            <input type="file" name="image" />
                        </div>
                    </div>

                    <div class="caption">
                        <h4 style="text-decoration: underline; font-weight: bold;">بيانات جهة العمل</h4>
                    </div>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">العمل </label>
                        <div class="col-lg-4">
                            <input type="text" name="work" class="form-control" placeholder="العمل" />
                        </div>
                    </div>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label"> محل العمل </label>
                        <div class="col-lg-4">
                            <input type="text" name="workplace" class="form-control" placeholder=" محل العمل " />
                        </div>
                    </div>
                    <hr />

                    <div class="caption">
                        <h4 style="text-decoration: underline; font-weight: bold;">بيانات صحية</h4>
                    </div>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label"> الأمراض المزمنة </label>
                        <div class="col-lg-4">
                            <input id="diseaseId" type="text" multiple="" name="diseas"
                                class="getselectmultiple diseaseId" data-placeholder=" الأمراض المزمنة"
                                data-table="disease" data-tableid="diseaseId" data-join="" data-filter="" data-parent=""
                                data-itr="" data-search="name" />
                            <input type="hidden" name="diseaseId" class="selectedit" data-tableidname="id" data-itr=""
                                data-join="" data-table="disease" data-tableid="id" data-search="name" value="" />
                        </div>

                        <button type="button" class="btn btn-primary adddatamodal" data-table="disease"
                            data-tableid="diseaseId" data-toggle="modal" data-target="#ModaldiseaseId"
                            data-whatever="@disease" data-formt="formdisease" data-selectitr="">اضافة مرض</button>
                        <button type="button" class="btn btn-primary editdataMulti" data-model="#ModalEditDiseas"
                            data-table="disease" data-name="diseaseId" data-tableid="id">تعديل مرض</button>
                    </div>
                    <hr />

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">وصف الحالة</label>
                        <div class="col-lg-4">
                            <textarea class="form-control" name="status_description" rows="5"
                                placeholder="وصف الحالة"></textarea>
                        </div>
                    </div>
                    <hr />

                    <div class="caption">
                        <h4 style="text-decoration: underline; font-weight: bold;">تكوين الأسرة</h4>
                    </div>
                    <button type="button" name="addNewFamily" id="addNewFamily" data-container="family"
                        class="btn btn-primary pull-left ft-nor addappend">إضافة
                        جديد</button>
                    <div class="table-responsive">
                        <table class="table billtable table-bordered  table-black">
                            <thead>
                                <tr>
                                    <th>م</th>
                                    <th>الاسم</th>
                                    <th>القرابة</th>
                                    <th>السن</th>
                                    <th>الرقم القومي</th>
                                    <th>الحالة الاجتماعية</th>
                                    <th>المهنة</th>
                                    <th>الدخل</th>
                                    <th>الحالة الصحية</th>
                                    <th>الحالة التعليمية</th>
                                    <th>حذف</th>
                                </tr>
                            </thead>
                            <input type="hidden" name="familyItr" id="familyItr" value="1" />
                            <tbody id="familyTbl">
                                <tr>
                                    <td>1</td>
                                    <td>
                                        <input type="text" name="name1" class="form-control" placeholder="الاسم" />
                                    </td>
                                    <td>
                                        <input type="text" name="relation1" class="form-control"
                                            placeholder="القرابة" />
                                    </td>
                                    <td>
                                        <input type="text" name="age1" class="form-control" placeholder="السن" />
                                    </td>
                                    <td>
                                        <input type="text" name="id_number1" class="form-control"
                                            placeholder="الرقم القومي" />
                                    </td>
                                    <td>
                                        <select name="status1" data-placeholder="اختر " class="selectnew">
                                            <option value="1">أعزب/عزباء
                                            </option>
                                            <option value="2">خاطب/مخطوبة
                                            </option>
                                            <option value="3">متزوج/ة
                                            </option>
                                            <option value="4">أرمل/ة
                                            </option>
                                        </select>
                                    </td>
                                    <td>
                                        <input type="text" name="job1" class="form-control" placeholder="المهنة" />
                                    </td>
                                    <td>
                                        <input type="text" name="salary1" class="form-control" placeholder="الدخل" />
                                    </td>
                                    <td>
                                        <input type="text" name="health_status1" class="form-control"
                                            placeholder="الحالة الصحية" />
                                    </td>
                                    <td>
                                        <input type="text" name="education_status1" class="form-control"
                                            placeholder="الحالة التعليمية" />
                                    </td>
                                    <td>
                                        <button type="button" data-itr="1" data-container="family"
                                            class="btn btn-danger ft-nor delRow">حذف</button>
                                    </td>
                                </tr>
                            </tbody>
                        </table>
                    </div>
                    <hr />
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الحالة الاجتماعية للأسرة</label>
                        <div class="col-lg-4">
                            <textarea class="form-control" name="social_status" rows="5"
                                placeholder="الحالة الاجتماعية للأسرة"></textarea>
                        </div>
                    </div>


                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الحالة الصحية للأسرة</label>
                        <div class="col-lg-4">
                            <textarea class="form-control" name="health_status" rows="5"
                                placeholder="الحالة الصحية للأسرة"></textarea>
                        </div>
                    </div>

                    <div class="caption">
                        <h4 style="text-decoration: underline; font-weight: bold;">الحالة الاقتصادية للأسرة</h4>
                    </div>

                    <button type="button" name="addNewEco" id="addNewEco" data-container="eco"
                        class="btn btn-primary pull-left ft-nor addappend">إضافة
                        جديد</button>
                    <div class="table-responsive">
                        <table class="table billtable table-bordered  table-black">
                            <thead>
                                <tr>
                                    <th>م</th>
                                    <th>أوجه الدخل</th>
                                    <th>أوجه الإنفاق</th>
                                    <th>حذف</th>
                                </tr>
                            </thead>
                            <input type="hidden" name="ecoItr" id="ecoItr" value="1" />
                            <tbody id="ecoTbl">
                                <tr>
                                    <td>1</td>
                                    <td>
                                        <input type="text" name="income1" class="form-control"
                                            placeholder="أوجه الدخل" />
                                    </td>
                                    <td>
                                        <input type="text" name="paying1" class="form-control"
                                            placeholder="أوجه الإنفاق" />
                                    </td>
                                    <td>
                                        <button type="button" data-itr="1" data-container="eco"
                                            class="btn btn-danger ft-nor delRow">حذف</button>
                                    </td>
                                </tr>
                            </tbody>
                        </table>
                    </div>
                    <hr />

                    <div class="caption">
                        <h4 style="text-decoration: underline; font-weight: bold;">وصف السكن</h4>
                    </div>
                    <h4 style="text-decoration: underline; font-weight: bold;">1) البنية التحتية</h4>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">عدد الأدوار </label>
                        <div class="col-lg-4">
                            <input type="text" name="floors_no" class="form-control numbers"
                                placeholder="عدد الأدوار" />
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">عدد الغرف </label>
                        <div class="col-lg-4">
                            <input type="text" name="rooms_no" class="form-control numbers" placeholder="عدد الغرف" />
                        </div>
                    </div>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الإيجار </label>
                        <div class="col-lg-4">
                            <input type="text" name="rent" class="form-control numbers" placeholder="الإيجار" />
                        </div>
                    </div>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الحمام </label>
                        <div class="col-lg-4">
                            <input type="radio" name="bathroom" value="1" checked>خاص
                            <input type="radio" name="bathroom" value="2">مشترك
                        </div>
                    </div>


                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الأرضيات </label>
                        <div class="col-lg-4">
                            <input type="text" name="flooring" class="form-control" placeholder="الأرضيات" />
                        </div>
                    </div>


                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">أسقف </label>
                        <div class="col-lg-4">
                            <input type="text" name="ceiling" class="form-control" placeholder="أسقف" />
                        </div>
                    </div>


                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">حوائط </label>
                        <div class="col-lg-4">
                            <input type="text" name="walls" class="form-control" placeholder="حوائط" />
                        </div>
                    </div>


                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الإضاءة </label>
                        <div class="col-lg-4">
                            <input type="text" name="lighting" class="form-control" placeholder="الإضاءة" />
                        </div>
                    </div>


                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">وصف الصالة </label>
                        <div class="col-lg-4">
                            <input type="text" name="hall" class="form-control" placeholder="وصف الصالة" />
                        </div>
                    </div>


                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">وصف غرفة النوم </label>
                        <div class="col-lg-4">
                            <input type="text" name="bedroom" class="form-control" placeholder="وصف غرفة النوم" />
                        </div>
                    </div>


                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">وصف الحمام </label>
                        <div class="col-lg-4">
                            <input type="text" name="bathroom_desc" class="form-control" placeholder="وصف الحمام" />
                        </div>
                    </div>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">وصف المطبخ </label>
                        <div class="col-lg-4">
                            <input type="text" name="kitchen" class="form-control" placeholder="وصف المطبخ" />
                        </div>
                    </div>

                    <h4 style="text-decoration: underline; font-weight: bold;">2) الأثاث والأجهزة</h4>
                    <div class="table-responsive">
                        <table class="table billtable table-bordered  table-black">
                            <thead>
                                <tr>
                                    <th>الاسم</th>
                                    <th>هل يوجد</th>
                                    <th>عدد</th>
                                    <th>الحالة</th>
                                    <th>ملاحظات</th>
                                </tr>
                                <tr>
                                    <th colspan="5">الأجهزة</th>
                                </tr>
                            </thead>
                            <tbody>
                                <tr>
                                    <td>بوتوجاز</td>
                                    <td>
                                        <input type="radio" name="cooker" value="1" checked>نعم
                                        <input type="radio" name="cooker" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="cooker_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="cooker_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="cooker_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>غسالة</td>
                                    <td>
                                        <input type="radio" name="washer" value="1" checked>نعم
                                        <input type="radio" name="washer" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="washer_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="washer_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="washer_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>ثلاجة</td>
                                    <td>
                                        <input type="radio" name="fridge" value="1" checked>نعم
                                        <input type="radio" name="fridge" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="fridge_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="fridge_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="fridge_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>مروحة</td>
                                    <td>
                                        <input type="radio" name="fan" value="1" checked>نعم
                                        <input type="radio" name="fan" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="fan_no" class="form-control numbers" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="fan_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="fan_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>تليفون</td>
                                    <td>
                                        <input type="radio" name="phone" value="1" checked>نعم
                                        <input type="radio" name="phone" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="phone_nu" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="phone_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="phone_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>كاسيت</td>
                                    <td>
                                        <input type="radio" name="casset" value="1" checked>نعم
                                        <input type="radio" name="casset" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="casset_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="casset_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="casset_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>خلاط</td>
                                    <td>
                                        <input type="radio" name="blender" value="1" checked>نعم
                                        <input type="radio" name="blender" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="blender_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="blender_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="blender_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>تلفزيون</td>
                                    <td>
                                        <input type="radio" name="tv" value="1" checked>نعم
                                        <input type="radio" name="tv" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="tv_no" class="form-control numbers" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="tv_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="tv_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>أخرى</td>
                                    <td>
                                        <input type="text" name="machine_name" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="machine_no" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="machine_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="machine_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                            </tbody>
                            <thead>
                                <tr>
                                    <th colspan="5">الأثاث</th>
                                </tr>
                            </thead>
                            <tbody>
                                <tr>
                                    <td>سرير</td>
                                    <td>
                                        <input type="radio" name="bed" value="1" checked>نعم
                                        <input type="radio" name="bed" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="bed_no" class="form-control numbers" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="bed_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="bed_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>دولاب</td>
                                    <td>
                                        <input type="radio" name="wardrobe" value="1" checked>نعم
                                        <input type="radio" name="wardrobe" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="wardrobe_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="wardrobe_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="wardrobe_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>كنب</td>
                                    <td>
                                        <input type="radio" name="couch" value="1" checked>نعم
                                        <input type="radio" name="couch" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="couch_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="couch_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="couch_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>صالون</td>
                                    <td>
                                        <input type="radio" name="salon" value="1" checked>نعم
                                        <input type="radio" name="salon" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="salon_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="salon_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="salon_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>كرسي</td>
                                    <td>
                                        <input type="radio" name="chair" value="1" checked>نعم
                                        <input type="radio" name="chair" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="chair_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="chair_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="chair_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>مكتبة</td>
                                    <td>
                                        <input type="radio" name="library" value="1" checked>نعم
                                        <input type="radio" name="library" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="library_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="library_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="library_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>سجاد</td>
                                    <td>
                                        <input type="radio" name="carpet" value="1" checked>نعم
                                        <input type="radio" name="carpet" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="carpet_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="carpet_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="carpet_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>حصير</td>
                                    <td>
                                        <input type="radio" name="mat" value="1" checked>نعم
                                        <input type="radio" name="mat" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="mat_no" class="form-control numbers" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="mat_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="mat_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <td>بطاطين</td>
                                    <td>
                                        <input type="radio" name="blanket" value="1" checked>نعم
                                        <input type="radio" name="blanket" value="2">لا
                                    </td>
                                    <td>
                                        <input type="text" name="blanket_no" class="form-control numbers"
                                            placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="blanket_status" class="form-control" placeholder="" />
                                    </td>
                                    <td>
                                        <input type="text" name="blanket_notes" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                            </tbody>
                        </table>
                    </div>

                    <div class="caption">
                        <h4 style="text-decoration: underline; font-weight: bold;">الاحتياجات</h4>
                    </div>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">وفقاً للطلب المقدم من الحالة</label>
                        <div class="col-lg-6">
                            <textarea class="form-control" name="beneficiaries_needs" rows="5"
                                placeholder="وفقاً للطلب المقدم من الحالة"></textarea>
                        </div>
                    </div>

                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">وفقاً لوجهة نظر المستكشف</label>
                        <div class="col-lg-6">
                            <textarea class="form-control" name="observer_needs" rows="5"
                                placeholder="وفقاً لوجهة نظر المستكشف"></textarea>
                        </div>
                    </div>

                    <div class="caption">
                        <h4 style="text-decoration: underline; font-weight: bold;">آراء داعمة للاستكشاف</h4>
                    </div>
                    <h4 style="text-decoration: underline; font-weight: bold;">رأي الجيران</h4>
                    <div class="table-responsive">
                        <table class="table billtable table-bordered  table-black">
                            <thead>
                                <tr>
                                    <th>أقرب محل</th>
                                    <td>
                                        <input type="text" name="nearest_shop" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <th>أقرب جار</th>
                                    <td>
                                        <input type="text" name="nearest_neighbour" class="form-control"
                                            placeholder="" />
                                    </td>
                                </tr>
                                <tr>
                                    <th>أخرى</th>
                                    <td>
                                        <input type="text" name="other_opinion" class="form-control" placeholder="" />
                                    </td>
                                </tr>
                            </thead>
                        </table>
                    </div>
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">رأي المستكشف</label>
                        <div class="col-lg-6">
                            <textarea class="form-control" name="observer_opinion" rows="5"
                                placeholder="رأي المستكشف"></textarea>
                        </div>
                    </div>
                    <hr />
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الرأي النهائي لللجنة</label>

                        <div class="col-lg-4">
                            <input type="radio" name="final_opinion" value="1" checked>تستحق
                            <input type="radio" name="final_opinion" value="2">لا تستحق
                        </div>
                    </div>
                    <div class="form-group">
                        <label for="txtName" class="col-lg-2 control-label">الأسباب</label>
                        <div class="col-lg-6">
                            <textarea class="form-control" name="reasons" rows="5" placeholder="الأسباب"></textarea>
                        </div>
                    </div>


                    <div class="form-group">
                        <div class="col-lg-offset-2 col-lg-4">
                            <button type="button" class="btn btn-primary pull-left charityformajax">حفظ
                                الامر</button>
                        </div>
                    </div>
                </form>
            </div>
        </div>
    </div>
</div>

<div class="modal fade" id="ModalareaId" tabindex="-1" role="dialog" aria-labelledby="ModalareaIdLabel"
    aria-hidden="true">
    <div class="modal-dialog" role="document">
        <div class="modal-content">
            <div class="modal-header">
                <h3 class="modal-title" id="ModalareaIdLabel"> اضافة </h3>
                <button type="button" class="close" data-dismiss="modal" aria-label="Close">
                    <span aria-hidden="true">&times;</span>
                </button>
            </div>
            <div class="modal-body">
                <form class="form-horizontal" action="beneficiariesController.php" id="formarea" method="post"
                    enctype="multipart/form-data" data-dosave="?do=savearea" data-direction="">
                    <div class="form-group">
                        <label for="name" class="col-form-label"> اسم المنطقة </label>
                        <input required="required" type="text" name="name" class="form-control checkcolumn"
                            placeholder=" اسم المنطقة " data-table="area" data-tablecol="name" data-filter=" name = ? "
                            data-tableid="" data-parentid="" data-parentcol="" />
                    </div>

                    <input id="poparea" type="hidden" name="areaId" value="" />
                    <input id="itrarea" type="hidden" name="selectitr" value="" />

                </form>
            </div>
            <div class="modal-footer">
                <button type="button" class="btn btn-secondary" data-dismiss="modal">الغاء</button>
                <button type="button" class="btn btn-primary saveformajax" data-action="0" data-form="formarea">
                    حفظ</button>
            </div>
        </div>
    </div>
</div>

<div class="modal fade" id="ModaldiseaseId" tabindex="-1" role="dialog" aria-labelledby="ModaldiseaseIdLabel"
    aria-hidden="true">
    <div class="modal-dialog" role="document">
        <div class="modal-content">
            <div class="modal-header">
                <h3 class="modal-title" id="ModaldiseaseIdLabel"> اضافة </h3>
                <button type="button" class="close" data-dismiss="modal" aria-label="Close">
                    <span aria-hidden="true">&times;</span>
                </button>
            </div>
            <div class="modal-body">
                <form class="form-horizontal" action="beneficiariesController.php" id="formdisease" method="post"
                    enctype="multipart/form-data" data-dosave="?do=savedisease" data-direction="">
                    <div class="form-group">
                        <label for="name" class="col-form-label"> اسم المرض </label>
                        <input required="required" type="text" name="name" class="form-control checkcolumn"
                            placeholder=" اسم المرض " data-table="disease" data-tablecol="name" data-filter=" name = ? "
                            data-tableid="" data-parentid="" data-parentcol="" />
                    </div>

                    <input id="popdisease" type="hidden" name="diseaseId" value="" />
                    <input id="itrdisease" type="hidden" name="selectitr" value="" />

                </form>
            </div>
            <div class="modal-footer">
                <button type="button" class="btn btn-secondary" data-dismiss="modal">الغاء</button>
                <button type="button" class="btn btn-primary saveformajax" data-action="0" data-form="formdisease">
                    حفظ</button>
            </div>
        </div>
    </div>
</div>
<div class="modal fade" id="ModalEditDiseas" tabindex="-1" role="dialog" aria-labelledby="ModaldiseaseIdLabel"
    aria-hidden="true">
    <div class="modal-dialog" role="document">
        <div class="modal-content">
            <div class="modal-header">
                <h3 class="modal-title" id="ModaldiseaseIdLabel"> تعديل </h3>
                <button type="button" class="close" data-dismiss="modal" aria-label="Close">
                    <span aria-hidden="true">&times;</span>
                </button>
            </div>
            <div class="modal-body" id="editDis">
            </div>
        </div>
    </div>
</div>

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    $(document).ready(function () {
        selectedit();
    });
</script>