{{-- Vista de solo lectura --}}
@if(isset($formulario))
	{!! Form::model($formulario, ['class' => 'form-horizontal']) !!}
@endif

<!-- Para cargar el último formulario registrado con la finalidad de que sea una muestra para el nuevo formulario -->
@if(!\Session::has('success'))
	@if(isset($ultimoFormulario))
		{!! Form::model($ultimoFormulario, ['class' => 'form-horizontal', 'route' => 'seguimiento.store', 'method' => 'post', 'id' => 'formularioSeguimiento']) !!}
	@elseif(!isset($formulario)  )
		{!! Form::open(['class' => 'form-horizontal', 'route' => 'seguimiento.store', 'method' => 'post']) !!}
	@endif
@else
	{!! Form::model(Session::get('ultimoFormularior'), ['class' => 'form-horizontal', 'route' => 'seguimiento.store', 'method' => 'post', 'id' => 'formularioSeguimiento']) !!}
@endif

@include('componentes.hidden-json-seguimiento')

{!!Form::hidden('hiddenEdad','')!!}
{!!Form::hidden('hiddenSexo','')!!}
@include('componentes.mensajeError')

<div class="list-group">

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Información básica</b></p>
		<div class="row formulario-horizontal">
			<div class="col-xs-12 text-right">
				@if(isset($formulario))
					@include('componentes.boton-volver-al-listado-de-historicos-e-imprimir-en-seguimiento')
				@else
					@include('componentes.boton-salir-de-seguimiento')
					@include('componentes.boton-guardar-seguimiento')
				@endif
			</div>
			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('fecha')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('fecha', 'Fecha', ['class' => 'col-xs-5 control-label']) !!}
					<div class="col-xs-7">
						@if(!isset($formulario))
							{!! Form::text('fecha', $fechaActual, ['class' => 'form-control', 'id' => 'fecha']) !!}
						@else
							{!! Form::text('fecha', explode(' ', $formulario->fecha_hora)[0], ['class' => 'form-control', 'id' => 'fecha']) !!}
						@endif
					</div>
				</div>
			</div>

			@if(!\Auth::user()->es_responsable && !isset($formulario))
				<div class="col-xs-5 col-xs-offset-1">
					<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('usuario_id')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('usuario_id', 'Responsable', ['class' => 'col-xs-2 control-label']) !!}
						<div class="col-xs-8">
							{!! Form::select('usuario_id', $responsables, null, ['class' => 'form-control']) !!}
						</div>
					</div>
				</div>
				<div class="clearfix"></div>
			@endif

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('hora')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('hora', 'Hora', ['class' => 'col-xs-5 control-label']) !!}
					<div class="col-xs-7">
						@if(!isset($formulario))
							{!! Form::text('hora', \Carbon\Carbon::now()->format('H:i:s'), ['class' => 'form-control', 'id' => 'hora']) !!}
						@else
							{!! Form::text('hora', explode(' ', $formulario->fecha_hora)[1], ['class' => 'form-control', 'id' => 'hora']) !!}
						@endif
					</div>
				</div>
			</div>
			<div class="col-xs-8">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('entidad_id')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('entidad_id', 'Entidad', ['class' => 'col-xs-2 control-label']) !!}
					<div class="col-xs-10">
						{!! Form::select('entidad_id', $entidades, null, ['class' => 'form-control']) !!}
					</div>
				</div>
			</div>

			<div class="col-sm-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('enfermedad_actual')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('motivo_de_consulta', 'Motivo de consulta', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('motivo_de_consulta', null, ['class' => 'form-control', 'rows' => 4, 'maxlength' => 2000,'required']) !!}
						@if( ! isset($formulario) )
							<span id="contador-motivo_de_consulta">0 de 2000</span>
						@endif
					</div>
				</div>
			</div>


			<div class="col-sm-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('enfermedad_actual')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('enfermedad_actual', 'Enfermedad actual', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('enfermedad_actual', null, ['class' => 'form-control', 'rows' => 4, 'maxlength' => 2000,'required']) !!}
						@if( ! isset($formulario) )
							<span id="contador-enfermedad_actual">0 de 2000</span>
						@endif
					</div>
				</div>
			</div>

			<div class="col-sm-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('revision_por_sistemas')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('revision_por_sistemas', 'Revisión por sistemas', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('revision_por_sistemas', null, ['class' => 'form-control', 'rows' => 4, 'maxlength' => 2000,'required']) !!}
						@if( ! isset($formulario) )
							<span id="contador-revision_por_sistemas">0 de 2000</span>
						@endif
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Adicionalmente se realizan las siguientes preguntas a la paciente:</b></p>
		<div class="row formulario-horizontal">

			<div class="col-xs-7">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('conoce_los')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('conoce_los', 'Conoce los derechos y deberes en salud sexual y reproductiva ?', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-1">
						<label class="radio-inline">
							{!! Form::radio('conoce_los', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('conoce_los', 0, true) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('paridad_satisfecha')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('paridad_satisfecha', 'Paridad satisfecha ?', ['class' => 'col-xs-5 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('paridad_satisfecha', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('paridad_satisfecha', 0, true) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('satisfaccion_con')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('satisfaccion_con', 'Satisfacción con la vida sexual ?', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('satisfaccion_con', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('satisfaccion_con', 0, true) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('uso_de')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('uso_de', 'Uso de protección para ETS ?', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('uso_de', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('uso_de', 0, true) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('violencia_de')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('violencia_de', 'Violencia de género ?', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('violencia_de', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('violencia_de', 0,true) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('tipo_de')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('tipo_de', 'Tipo de orientación sexual', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::text('tipo_de', null, ['class' => 'form-control','required']) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Antecedentes</b></p>
		<div class="row formulario-horizontal">

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('antecedentes_patologicos')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('antecedentes_patologicos', 'Antecedentes patológicos', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::text('antecedentes_patologicos', null, ['class' => 'form-control', 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('antecedentes_farmacologicos')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('antecedentes_farmacologicos', 'Antecedentes farmacológicos', ['class' => 'col-xs-7 control-label']) !!}
					<div class="col-xs-5">
						{!! Form::text('antecedentes_farmacologicos', null, ['class' => 'form-control', 'required']) !!}
					</div>
				</div>
			</div>

<!-- asi estaba...lo deje de muestra !!!
			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('antecedentes_ginecoobtetricios')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('antecedentes_ginecoobtetricios', 'Antecedentes gineco-obtetricios', ['class' => 'col-xs-7 control-label']) !!}
					<div class="col-xs-5">
						{!! Form::text('antecedentes_ginecoobtetricios', null, ['class' => 'form-control', 'required']) !!}
					</div>
				</div>
			</div>
-->
			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('antecedentes_ginecoobtetricios'))
					{{'form-group has-error has-feedback'}} @endif @endif'">
					<div class="col-xs-5">
						{!! Form::hidden('antecedentes_ginecoobtetricios', 0, ['class' => 'form-control', 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('antecedentes_quirurgicos'))
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('antecedentes_quirurgicos', 'Antecedentes quirúrgicos', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::text('antecedentes_quirurgicos', null, ['class' => 'form-control', 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-5">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('realizacion_de_cirugias_abdominopelvicas'))
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('realizacion_de_cirugias_abdominopelvicas', 'Realización de cirugias abdominopélvicas ?', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('realizacion_de_cirugias_abdominopelvicas', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('realizacion_de_cirugias_abdominopelvicas', 0, true) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('cual_cirugia_abdominopelvica')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('cual_cirugia_abdominopelvica', 'Cual ?', ['class' => 'col-xs-3 control-label']) !!}
					<div class="col-xs-9">
						{!! Form::text('cual_cirugia_abdominopelvica', null, ['class' => 'form-control']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('antecedentes_toxico_alergicos')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('antecedentes_toxico_alergicos', 'Antecedentes tóxico alérgicos', ['class' => 'col-xs-7 control-label']) !!}
					<div class="col-xs-5">
						{!! Form::text('antecedentes_toxico_alergicos', null, ['class' => 'form-control', 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('consumo_de_tabaco')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('consumo_de_tabaco', 'Consumo de tabaco ?', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('consumo_de_tabaco', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('consumo_de_tabaco', 0,true) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('cantidad_frecuencia_consumo_de_tabaco'))
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('cantidad_frecuencia_consumo_de_tabaco', 'Canidad / frecuencia', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::text('cantidad_frecuencia_consumo_de_tabaco', null, ['class' => 'form-control', 'required']) !!}
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('isiniciovicio'))
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('isiniciovicio', 'Inicio Vida Sexual ?', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('isiniciovicio', 1, false, ['onClick' => 'validaInicioSexual()']) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('isiniciovicio', 0,true,['onClick' => 'validaInicioSexual()']) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('edad_inicio_vida_sexual'))
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('edad_inicio_vida_sexual', 'Edad inicio vida sexual', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-4">
						@if(isset($ultimoFormulario->isiniciovicio))
								@if($ultimoFormulario->isiniciovicio)
										{!! Form::number('edad_inicio_vida_sexual', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'required']) !!}
								@else
											{!! Form::number('edad_inicio_vida_sexual', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'disabled', 'required']) !!}
								@endif
						@else
								{!! Form::number('edad_inicio_vida_sexual', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'disabled', 'required']) !!}
						@endif
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('numero_de_companeros_sexuales')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('numero_de_companeros_sexuales', 'Número de companeros sexuales', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-4">
						{!! Form::number('numero_de_companeros_sexuales', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'required']) !!}
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-xs-5">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('antecedente_de_ets_epi_leucorreas_dispareunia')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('antecedente_de_ets_epi_leucorreas_dispareunia', 'Antecedente de ETS EPI leucorreas dispareunia', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('antecedente_de_ets_epi_leucorreas_dispareunia', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('antecedente_de_ets_epi_leucorreas_dispareunia', 0,true) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('cual_antecedente_de_ets_epi_leucorreas_dispareunia')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('cual_antecedente_de_ets_epi_leucorreas_dispareunia', 'Cual ?', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::text('cual_antecedente_de_ets_epi_leucorreas_dispareunia', null, ['class' => 'form-control']) !!}
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('menarquia')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('menarquia', 'Menarquía', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::text('menarquia', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('fum')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('fum', 'FUM', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::text('fum', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('ciclos_mestruales')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('ciclos_mestruales', 'Ciclos mestruales', ['class' => 'col-xs-5 control-label']) !!}
					<div class="col-xs-7">
						{!! Form::text('ciclos_mestruales', null, ['class' => 'form-control', 'min' => 0, 'max' => 200,'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('gestaciones')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('gestaciones', 'Gestaciones', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::number('gestaciones', null, ['class' => 'form-control', 'min' => 0, 'max' => 200,' required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('partos')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('partos', 'Partos', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::number('partos', null, ['class' => 'form-control', 'min' => 0, 'max' => 200,' required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('cesarias')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('cesarias', 'Cesáreas', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::number('cesarias', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('abortos')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('abortos', 'Abortos', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::number('abortos', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('ectopicos')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('ectopicos', 'Ectópicos', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::number('ectopicos', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('molas')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('molas', 'Molas', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::number('molas', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('nacidos_vivos')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('nacidos_vivos', 'Nacidos vivos', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::number('nacidos_vivos', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('nacidos_muertos')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('nacidos_muertos', 'Nacidos muertos', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::number('nacidos_muertos', null, ['class' => 'form-control', 'min' => 0, 'max' => 200, 'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('isultimoparto'))
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('isultimoparto', 'Último Parto ?', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('isultimoparto', 1,false, ['onClick' => 'validaParto()']) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('isultimoparto', 0,true,['onClick' => 'validaParto()']) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('fecha_ultimo_parto'))
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('fecha_ultimo_parto', 'Fecha del último parto', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						@if(isset($ultimoFormulario->isultimoparto))
							@if($ultimoFormulario->isultimoparto)
								{!! Form::text('fecha_ultimo_parto', null, ['class' => 'form-control', 'id' => 'fecha_ultimo_parto']) !!}
							@else
								{!! Form::text('fecha_ultimo_parto', null, ['class' => 'form-control', 'id' => 'fecha_ultimo_parto', 'disabled']) !!}
							@endif
						@else
							{!! Form::text('fecha_ultimo_parto', null, ['class' => 'form-control', 'id' => 'fecha_ultimo_parto', 'disabled']) !!}
						@endif
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('isultimacitologia'))
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('isultimacitologia', 'Última Citología ?', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('isultimacitologia', 1,false, ['onClick' => 'validaCitologia()']) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('isultimacitologia', 0,true,['onClick' => 'validaCitologia()']) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('fecha_ultima_citologia'))
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('fecha_ultima_citologia', 'Fecha de la última citología', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						@if(isset($ultimoFormulario->isultimacitologia))
							@if($ultimoFormulario->isultimacitologia)
									{!! Form::text('fecha_ultima_citologia', null, ['class' => 'form-control', 'id ' => 'fecha_ultima_citologia','required']) !!}
							@else
									{!! Form::text('fecha_ultima_citologia', null, ['class' => 'form-control', 'id ' => 'fecha_ultima_citologia','required', 'disabled']) !!}
							@endif
						@else
								{!! Form::text('fecha_ultima_citologia', null, ['class' => 'form-control', 'id ' => 'fecha_ultima_citologia','required', 'disabled']) !!}
						@endif
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('resultado_citologia')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('resultado_citologia', 'Resultado', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::text('resultado_citologia', null, ['class' => 'form-control','required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-8">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('metodos_de_planificacion_utilizados_hasta_la_fecha')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('metodos_de_planificacion_utilizados_hasta_la_fecha', 'Métodos de planificacion utilizados hasta la fecha', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::text('metodos_de_planificacion_utilizados_hasta_la_fecha', null, ['class' => 'form-control', 'required']) !!}
					</div>
				</div>
			</div>

			<div class="clearfix"></div>

			<div class="col-xs-5">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('satisfaccion_con_los_metodos_utilizados')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('satisfaccion_con_los_metodos_utilizados', 'Satisfacción con los métodos utilizados', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('satisfaccion_con_los_metodos_utilizados', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('satisfaccion_con_los_metodos_utilizados', 0,true) !!}
							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-5">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('adherencia_a_metodos_utilizados')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('adherencia_a_metodos_utilizados', 'Adherencia a métodos utilizados', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('adherencia_a_metodos_utilizados', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('adherencia_a_metodos_utilizados', 0,true) !!}
							no
						</label>
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Examen físico</b></p>
		<div class="row formulario-horizontal">

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('ta_sentado')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('ta_sentado', 'TA sentado', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('ta_sentado', null, ['class' => 'form-control', 'required']) !!}
							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('ta_de_pie')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('ta_de_pie', 'TA de pié', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('ta_de_pie', null, ['class' => 'form-control', 'required']) !!}
							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('ta_acostado')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('ta_acostado', 'TA acostado', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('ta_acostado', null, ['class' => 'form-control', 'required']) !!}
							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('fc')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('fc', 'FC', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('fc', null, ['class' => 'form-control', 'required']) !!}
							<span class="input-group-addon">Lat / min</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('fr')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('fr', 'FR', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('fr', null, ['class' => 'form-control', 'required']) !!}
							<span class="input-group-addon">Resp / min</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('peso')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('peso', 'Peso', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('peso', null, ['class' => 'form-control', 'required']) !!}
							<span class="input-group-addon">Kg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('talla')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('talla', 'Talla', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('talla', null, ['class' => 'form-control','required']) !!}
							<span class="input-group-addon">m</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('imc')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('imc', 'IMC', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('imc', null, ['class' => 'form-control', 'readonly']) !!}
							<span class="input-group-addon">Kg / m<sup>2</sup></span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm" style="display: none;">
					{!! Form::label('perimetro_abdominal', 'Perímetro abdominal', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						<div class="input-group">
							{!! Form::text('perimetro_abdominal', 1, ['class' => 'form-control','required']) !!}
							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm" style="display: none;">
					{!! Form::label('creatinina', 'Creatinina', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('creatinina', 1, ['class' => 'form-control','required']) !!}
							<span class="input-group-addon">mg / dL</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4" style="display: none;">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('tfg')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('tfg', 'TFG', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('tfg', 1, ['class' => 'form-control', 'readonly']) !!}
							<span class="input-group-addon">mL / min / 1.73</span>
						</div>
					</div>
				</div>
			</div>
			
		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Descripción</b></p>
		<div class="row formulario-horizontal">

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('paciente')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('paciente', 'Paciente', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('paciente', null, ['class' => 'form-control', 'rows' => 3]) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('cabeza_y_orl')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('cabeza_y_orl', 'Cabeza y orl', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('cabeza_y_orl', null, ['class' => 'form-control', 'rows' => 3]) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('cuello')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('cuello', 'Cuello', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('cuello', null, ['class' => 'form-control', 'rows' => 3]) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('torax')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('torax', 'Torax', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('torax', null, ['class' => 'form-control', 'rows' => 3]) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('cp')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('cp', 'CP', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('cp', null, ['class' => 'form-control', 'rows' => 3]) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('abdomen')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('abdomen', 'Abdomen', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('abdomen', null, ['class' => 'form-control', 'rows' => 3]) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('genitales')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('genitales', 'Genitales', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('genitales', null, ['class' => 'form-control', 'rows' => 3]) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('extremidades')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('extremidades', 'Extremidades', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('extremidades', null, ['class' => 'form-control', 'rows' => 3]) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('piel')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('piel', 'Piel', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('piel', null, ['class' => 'form-control', 'rows' => 3,'required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm '@if (count($errors)) @if($errors->has('neurologico')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('neurologico', 'Neurológico', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						{!! Form::textarea('neurologico', null, ['class' => 'form-control', 'rows' => 3,'required']) !!}
					</div>
				</div>
			</div>

		</div>
	</a>
	@include('componentes/formulario-diagnosticos')
	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Anotaciones finales</b></p>
		<div class="row formulario-horizontal">
			<div class="col-xs-12">

				<div class="col-sm-6">
					<div class="form-group-sm '@if (count($errors)) @if($errors->has('recomendaciones')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('recomendaciones', 'Recomendaciones', ['class' => 'control-label']) !!}
						{!! Form::textarea('recomendaciones', null, ['class' => 'form-control', 'rows' => 7, 'maxlength' => 2000,'required']) !!}
						@if( ! isset($formulario) )
							<span id="contador-recomendaciones">0 de 2000</span>
						@endif
					</div>
				</div>

				<div class="col-sm-6">
					<div class="form-group-sm '@if (count($errors)) @if($errors->has('analisis_y_conducta')) 
					{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('analisis_y_conducta', 'Análisis y conducta', ['class' => 'control-label']) !!}
						{!! Form::textarea('analisis_y_conducta', null, ['class' => 'form-control', 'rows' => 7, 'maxlength' => 2000,'required']) !!}
						@if( ! isset($formulario) )
							<span id="contador-analisis_y_conducta">0 de 2000</span>
						@endif
					</div>
				</div>

			</div>
		</div>
	</a>
	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Añadido</b></p>
		<div class="row formulario-horizontal">
			<div class="col-xs-12">
				<div class="col-sm-4">
					<div class="form-group-sm">
						{!! Form::label('auto_carga', 'Auto Cargado', $consulta->detalle, ['class' => 'control-label']) !!}
						{!! Form::textarea('auto_carga', $consulta->detalle, ['class' => 'form-control', 'rows' => 8, 'maxlength' => 2000,'disabled']) !!}
						{!! Form::hidden('auto_carga', $consulta->detalle) !!}
						
					</div>
				</div>
			</div>
		</div>
	</a>	

	@if(isset($formulario)) {{-- Para poder ver y utilizar el form model --}}

		@include('componentes.lista-de-medicamentos')
		@include('componentes.lista-de-procedimientos')
		@include('componentes.lista-de-remisiones')
		
		{!! Form::close() !!}
	@elseif(isset($ultimoFormulario) || !isset($formulario))
		@include('componentes.modal-confirmar-registro-de-seguimineto')

		{!! Form::hidden('paciente_id', $paciente) !!}
		{!! Form::hidden('programa', $programa) !!}

		{!! Form::close() !!}

		<a class="list-group-item">
			<div class="row formulario-horizontal">
				<div class="col-xs-12 text-right">
					@include('componentes.boton-guardar-seguimiento')
				</div>
			</div>
		</a>
	@endif

</div> {{-- list group --}}

{{-- Cargar los inputs tipo custom de fecha y hora cuando se solicita el formulario actual desde seguimiento o inscripción --}}
@include('componentes.script-cargar-inputs-fecha-hora-desde-seguimiento')

<script>

	function validaInicioSexual(){
		if($('input:radio[name=isiniciovicio]:checked').val()==1){
				document.getElementById("edad_inicio_vida_sexual").disabled = false;
		}else{
			  document.getElementById("edad_inicio_vida_sexual").disabled = true;
				document.getElementById("edad_inicio_vida_sexual").value = "";
		}
	}

	function validaParto(){
		if($('input:radio[name=isultimoparto]:checked').val()==1){
				document.getElementById("fecha_ultimo_parto").disabled = false;
		}else{
			  document.getElementById("fecha_ultimo_parto").disabled = true;
				document.getElementById("fecha_ultimo_parto").value = "";
		}
	}

	function validaCitologia(){
			if($('input:radio[name=isultimacitologia]:checked').val()==1){
					document.getElementById("fecha_ultima_citologia").disabled = false;
			}else{
				  document.getElementById("fecha_ultima_citologia").disabled = true;
					document.getElementById("fecha_ultima_citologia").value = "";
			}
		}
</script>