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

        <ol class="breadcrumb">
            <li><a href="#">العيادات</a></li>
            <li><a href="rb_doc_kashf.php?do=">كشف</a></li>
            <li class="active"> عرض الكشوفات</li>
        </ol>


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



                <form class="nameToBeChecked form-horizontal" id="rb_doc_kashf" enctype="multipart/form-data" role="form" action="rb_doc_kashf.php?do=update" method="post" >






                    <div class="form-group">


                        <div class="form-group">
                            <label class="col-lg-6 control-label">اسم العميل :
                                {foreach $allcust as $getdata}
                                {if $getdata->clientid eq $cust}{$getdata->clientname} {/if}
                                {/foreach}
                            </label>
                        </div>

                        <div class="form-group">
                            <label class="col-lg-6 control-label">اسم الطبيب :
                                {foreach $allDoct as $getdata}
                                {if $getdata->userid eq $docId}{$getdata->username} {/if}
                                {/foreach}
                            </label>
                        </div>

                        <input type="hidden" value="{$allcust->id}" name="custid"/>
                        <!-- =================================================   -->
                        <input type="hidden" value="{$editdata->id}" name="kashfid"/>
                        <!-- =================================================   -->


                        <div class="form-group">

                            <div class="col-lg-6">


                                <table class="table-black">
                                    <tr>

                                        <td style="padding-right: 259px;padding-top: 30px;font-size: 20px;padding-bottom: 13px;" colspan="6"> <label class="sr-only">Left Eye</label> </td>

                                    </tr>
                                    <tr>

                                        <td></td>
                                        <td style="padding-right: 36px;" > <label class="sr-only">L-va</label> </td>

                                        <td style="padding-right: 36px;" > <label class="sr-only">L-prism</label> </td>

                                        <td style="padding-right: 36px;" > <label class="sr-only">L-axis</label> </td>

                                        <td style="padding-right: 22px;" > <label class="sr-only">L-cylinder</label> </td>

                                        <td style="padding-right: 22px;" >   <label class="sr-only">L-sphere</label> </td>


                                    </tr>
                                    <tr>


                                        <td style="border: 1px solid black;"> <label class="sr-only">المسافة</label> </td>





                                        <td style="border: 1px solid black;"> <input required="required"   value="{if $editdata->ldva >0}{/if}{$editdata->ldva}"   type="text" name="D_Lva" id="customer_name"   class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;"> <input required="required"  value="{if $editdata->ldprism >0}{/if}{$editdata->ldprism}"   type="text" name="D_Lprism" id="customer_name"   class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;"> <input required="required"  value="{$editdata->ldaxis}"   type="text" name="D_Laxis" id="customer_name"    class="form-control positiveNo" /></td>

                                        <td style="border: 1px solid black;"> <input required="required"  value="{if $editdata->ldcylinder >0}{/if}{$editdata->ldcylinder}"   type="text" name="D_Lcylinder" id="customer_name"  class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;"> <input required="required" value="{if $editdata->ldsphere >0}{/if}{$editdata->ldsphere}"  type="text"  name="D_Lsphere"  class="form-control  checknumintfolat realNo" /></td>

                                    </tr>
                                    <tr>

                                        <td style="border: 1px solid black;"> <label class="sr-only">القراءة</label> </td>





                                        <td style="border: 1px solid black;"> <input required="required"  value="{if $editdata->lnva >0}{/if}{$editdata->lnva}"    type="text" name="N_Lva" id="customer_name"    class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;"> <input required="required"  value="{if $editdata->lnprism >0}{/if}{$editdata->lnprism}"    type="text" name="N_Lprism" id="customer_name"   class="form-control checknumintfolat realNo" /></td>


                                        <td style="border: 1px solid black;"> <input required="required"  value="{$editdata->lnaxis}"    type="text" name="N_Laxis" id="customer_name"   class="form-control positiveNo" /></td>

                                        <td style="border: 1px solid black;"> <input required="required"  value="{if $editdata->lncylinder >0}{/if}{$editdata->lncylinder}"    type="text" name="N_Lcylinder" id="customer_name"   class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;"> <input required="required"   value="{if $editdata->lnsphere >0}{/if}{$editdata->lnsphere}"    type="text" name="N_Lsphere" id="customer_name"  class="form-control checknumintfolat realNo" /></td>

                                    </tr>
                                </table>
                            </div>


                            <div class="col-lg-6">



                                <table class="table-black">
                                    <tr>

                                        <td  style="padding-right: 194px;padding-top: 30px;font-size: 20px;padding-bottom: 13px;" colspan="6"> <label class="sr-only">Right Eye</label>  </td>

                                    </tr>
                                    <tr>


                                        <td style="padding-right: 36px;" > <label class="sr-only">R-va</label> </td>
                                        <td style="padding-right: 36px;" > <label class="sr-only">R-prism</label> </td>

                                        <td style="padding-right: 36px;" > <label class="sr-only">R-axis</label> </td>

                                        <td style="padding-right: 22px;" > <label class="sr-only">R-cylinder</label> </td>

                                        <td style="padding-right: 22px;" > <label class="sr-only">R-sphere</label> </td>

                                        <td></td>

                                    </tr>
                                    <tr>



                                        <td style="border: 1px solid black;">  <input required="required"  value="{if $editdata->rdva >0}{/if}{$editdata->rdva}"   type="text" name="D_Rva" id="customer_name"   class="form-control checknumintfolat realNo" /></td>


                                        <td style="border: 1px solid black;"> <input required="required"  value="{if $editdata->rdprism >0}{/if}{$editdata->rdprism}"   type="text" name="D_Rprism" id="customer_name"   class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;"> <input  required="required"  value="{$editdata->rdaxis}"  type="text" name="D_Raxis" id="customer_name"   class="form-control positiveNo" /></td>

                                        <td style="border: 1px solid black;">  <input required="required"  value="{if $editdata->rdcylinder >0}{/if}{$editdata->rdcylinder}"   type="text" name="D_Rcylinder" id="customer_name"   class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;"> <input  required="required"  value="{if $editdata->rdsphere >0}{/if}{$editdata->rdsphere}"   type="text" name="D_Rsphere" id="customer_name"  class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;"> <label style="    margin-left: 21px;" class="sr-only checknumintfolat">Distance</label> </td>

                                    </tr>
                                    <tr>


                                        <td style="border: 1px solid black;">   <input   required="required" value="{if $editdata->rnva >0}{/if}{$editdata->rnva}"  type="text" name="N_Rva" id="customer_name"   class="form-control checknumintfolat realNo" /></td>


                                        <td style="border: 1px solid black;"> <input required="required"  value="{if $editdata->rnprism >0}{/if}{$editdata->rnprism}"   type="text" name="N_Rprism" id="customer_name"    class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;"> <input  required="required" value="{$editdata->rnaxis}"   type="text" name="N_Raxis" id="customer_name"    class="form-control positiveNo" /></td>


                                        <td style="border: 1px solid black;">  <input  required="required"  value="{if $editdata->rncylinder >0}{/if}{$editdata->rncylinder}"   type="text" name="N_Rcylinder" id="customer_name"  class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;">  <input   required="required"  value="{if $editdata->rnsphere >0}{/if}{$editdata->rnsphere}"   type="text" name="N_Rsphere" id="customer_name"    class="form-control checknumintfolat realNo" /></td>

                                        <td style="border: 1px solid black;"> <label style="    margin-right: 24px;"  class="sr-only">Near</label> </td>

                                    </tr>
                                </table>



                            </div>


                            <div class="col-lg-5" style="padding-left: 0px;">
                                <table style="border: 1px solid black;margin-right:52px;width: 85%;" class="table-blak">
                                    <tr>
                                        <td style="padding-right: 70px;padding-top: 10px;border: 1px solid black;" ><label class="sr-only">Add</label> </td>
                                        <td style="padding-right: 70px;padding-top: 10px;border: 1px solid black;" > <label class="sr-only">Biofocal</label> </td>
                                    </tr>
                                    <tr>
                                        <td style="border: 1px solid black;"> <input required="required"  type="text" name="ladd" value="{if $editdata->ladd >0}{/if}{$editdata->ladd}"   class="form-control checknumintfolat realNo" /></td>
                                        <td style="border: 1px solid black;"> <input required="required"  type="text" name="lbiofocal"  value="{if $editdata->lbiofocal >0}{/if}{$editdata->lbiofocal}"   class="form-control checknumintfolat realNo" /></td>
                                    </tr>
                                </table>
                            </div>

                            <div class="col-lg-3">
                                <table style="border: 1px solid black; margin-top: 5px;width: 100%;" class="table-blak">
                                    <tr>
                                        <td style="border: 1px solid black;">  <input  required="required" type="text" name="pd" value="{$editdata->pd}"   class="form-control positiveNo" /></td>
                                        <td style="border: 1px solid black;text-align: left;"> <label style="margin: 5px;" class="sr-only">PD</label> </td>
                                    </tr>
                                    <tr>
                                        <td style="border: 1px solid black;">  <input  required="required" type="text" name="bvd" value="{$editdata->bvd}"   class="form-control positiveNo" /></td>
                                        <td style="border: 1px solid black; text-align: left;"> <label style="margin: 5px;" class="sr-only">BVD</label> </td>
                                    </tr>
                                </table>
                            </div>

                            <div class="col-lg-4">
                                <table style="border: 1px solid black;margin-left: 76px;margin-right: -5px;" class="table-blak">
                                    <tr>
                                        <td style="padding-right: 45px;padding-top: 10px;border: 1px solid black;" ><label class="sr-only">Add</label> </td>
                                        <td style="padding-right: 45px;padding-top: 10px;border: 1px solid black;" > <label class="sr-only">Biofocal</label> </td>
                                    </tr>
                                    <tr>
                                        <td style="border: 1px solid black;"> <input required="required"  type="text" name="radd" value="{if $editdata->radd >0}{/if}{$editdata->radd}"   class="form-control checknumintfolat realNo" /></td>
                                        <td style="border: 1px solid black;"> <input required="required"  type="text" name="rbiofocal" value="{if $editdata->rbiofocal >0}{/if}{$editdata->rbiofocal}"    class="form-control checknumintfolat realNo" /></td>
                                    </tr>
                                </table>
                            </div>

                            <div class="col-lg-12">
                                <table style="margin-top: 5px;width: 100%;border: 1px solid black;" class="table-blak">
                                    <tr>
                                        <td style="border: 1px solid black;"> <label style="margin: 5px;" class="sr-only">ملاحظات</label> </td>
                                        <td style="border: 1px solid black;">  <input  required="required" type="text" name="notes" value="{$editdata->notes}"    class="form-control" /></td>
                                    </tr>

                                </table>
                            </div>
                        </div>


                        <!-- =================================================   -->



                        <div class="form-group">
                            <div class="col-lg-offset-2 col-lg-4">
                                <button style="    margin-left: -538px;margin-top: 20px;" id="docKashfS" type="button"  class="btn btn-primary pull-left">تعديل </button>
                            </div>
                        </div>


                </form>
            </div>
        </div>




    </div>
</div>



{literal}

<script type="text/javascript">
    var name = new Spry.Widget.ValidationTextField("name");
    var sprytextfield1 = new Spry.Widget.ValidationTextField("sprytextfield1", "real");
    var sprytextfield3 = new Spry.Widget.ValidationTextField("sprytextfield3");
    var spryselect1 = new Spry.Widget.ValidationSelect("spryselect1", {invalidValue: "-1"});



</script>
<script type="text/javascript">
    var sprytextfield2 = new Spry.Widget.ValidationTextField("sprytextfield2");
</script>
{/literal}


