{{-- 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', $entidades, null, ['class' => 'form-control']) !!}
					</div>
				</div>
			</div>
			<div class="col-xs-5">
				<div class="form-group form-group-sm '@if (count($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-xs-5">
				<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::text('enfermedad_actual', null, ['class' => 'form-control']) !!}-->
						{!! 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>
	</a>
	
	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Ha presentado recientemente</b></p>
		<div class="row formulario-horizontal">

			<div class="col-xs-4">
				<div class="form-group form-group-sm">
					{!! Form::label('polidipsia', 'Polidipsia', ['class' => 'col-xs-5 control-label']) !!}
					<div class="col-xs-7">
						{!! Form::checkbox('polidipsia', 1, false) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm ">
					{!! Form::label('poliuria', 'Poliuria', ['class' => 'col-xs-5 control-label']) !!}
					<div class="col-xs-7">
						{!! Form::checkbox('poliuria', 1, false) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm ">
					{!! Form::label('polifagia', 'Polifagia', ['class' => 'col-xs-5 control-label']) !!}
					<div class="col-xs-7">
						{!! Form::checkbox('polifagia', 1, false) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Antacedentes</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_familiares')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('antecedentes_familiares', 'Antecedentes familiares', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::text('antecedentes_familiares', null, ['class' => 'form-control','required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('dm')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('dm', 'DM', ['class' => 'col-xs-3 control-label']) !!}
					<div class="col-xs-9">
						{!! Form::text('dm', null, ['class' => 'form-control','required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-6">
				<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('enfermedad_cardiovascular')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('enfermedad_cardiovascular', 'Enfermedad cardiovascular', ['class' => 'col-xs-5 control-label']) !!}
					<div class="col-xs-7">
						{!! Form::text('enfermedad_cardiovascular', 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_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-8">
				<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('frecuencia_severidad_y_causas_de_complicaciones_agudas')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('frecuencia_severidad_y_causas_de_complicaciones_agudas', 'Frecuencia Severidad y causas de complicaciones agudas', ['class' => 'col-xs-7 control-label']) !!}
					<div class="col-xs-5">
						{!! Form::text('frecuencia_severidad_y_causas_de_complicaciones_agudas', 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_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-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>

			<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="clearfix"></div>

			<div class="col-xs-3">
				<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-3">
				<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', 'Cantidad / frecuencia', ['class' => 'col-xs-7 control-label']) !!}
					<div class="col-xs-5">
						{!! Form::text('cantidad_frecuencia_consumo_de_tabaco', null, ['class' => 'form-control','required']) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('consumo_de_alcohol')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('consumo_de_alcohol', 'Consumo de alcohol', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('consumo_de_alcohol', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('consumo_de_alcohol', 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('cantidad_frecuencia_consumo_de_alcohol')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('cantidad_frecuencia_consumo_de_alcohol', 'Cantidad / frecuencia', ['class' => 'col-xs-7 control-label']) !!}
					<div class="col-xs-5">
						{!! Form::text('cantidad_frecuencia_consumo_de_alcohol', 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('habitos_nutricionales')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('habitos_nutricionales', 'Habitos nutricionales', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::text('habitos_nutricionales', 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('actividad_fisica')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('actividad_fisica', 'Actividad física', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::text('actividad_fisica', 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('biopsicosocial')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('biopsicosocial', 'Biopsicosocial', ['class' => 'col-xs-6 control-label']) !!}
					<div class="col-xs-6">
						{!! Form::text('biopsicosocial', null, ['class' => 'form-control','required']) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Factores de riesgo cardiovascular</b></p>
		<div class="row formulario-horizontal">

			{{-- 1 --}}
			@if ($pacienteSolicitado->sexo == 'm' || $pacienteSolicitado->sexo == 'i')
				<div class="col-xs-3">
					<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('hombre_mayor_o_igual_55_anos')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('hombre_mayor_o_igual_55_anos', 'Hombre >= 55 años', ['class' => 'col-xs-9 control-label']) !!}
						<div class="col-xs-3">
							{!! Form::checkbox('hombre_mayor_o_igual_55_anos', 1, false) !!}
						</div>
					</div>
				</div>
			@endif

			@if ($pacienteSolicitado->sexo == 'f' || $pacienteSolicitado->sexo == 'i')
				<div class="col-xs-3">
					<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('mujer_mayor_o_igual_65_anos')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('mujer_mayor_o_igual_65_anos', 'Mujer >= 65 años', ['class' => 'col-xs-9 control-label']) !!}
						<div class="col-xs-3">
							{!! Form::checkbox('mujer_mayor_o_igual_65_anos', 1, false) !!}
						</div>
					</div>
				</div>
			@endif

			@if ($pacienteSolicitado->sexo == 'i')
				<div class="clearfix"></div>
			@endif

			@if ($pacienteSolicitado->sexo == 'm' || $pacienteSolicitado->sexo == 'i')
				<div class="col-xs-4">
					<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('circunferencia_abdominal_mayor_o_igual_102_en_hombres')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('circunferencia_abdominal_mayor_o_igual_102_en_hombres', 'Circunferencia abdominal >= 102 en hombres', ['class' => 'col-xs-10 control-label']) !!}
						<div class="col-xs-2">
							{!! Form::checkbox('circunferencia_abdominal_mayor_o_igual_102_en_hombres', 1, false) !!}
						</div>
					</div>
				</div>
			@endif

			@if ($pacienteSolicitado->sexo == 'f' || $pacienteSolicitado->sexo == 'i')
				<div class="col-xs-4">
					<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('circunferencia_abdominal_mayor_o_igual_88_en_mujeres')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('circunferencia_abdominal_mayor_o_igual_88_en_mujeres', 'Circunferencia abdominal >= 88 en mujeres', ['class' => 'col-xs-10 control-label']) !!}
						<div class="col-xs-2">
							{!! Form::checkbox('circunferencia_abdominal_mayor_o_igual_88_en_mujeres', 1, false) !!}
						</div>
					</div>
				</div>
			@endif

			@if ($pacienteSolicitado->sexo == 'i')
				<div class="clearfix"></div>
			@endif

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('tabaquismo')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('tabaquismo', 'Tabaquisco', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('tabaquismo', 1, false) !!}
					</div>
				</div>
			</div>

			@if ($pacienteSolicitado->sexo == 'i')
				<div class="clearfix"></div>
			@endif

			@if ($pacienteSolicitado->sexo == 'm' || $pacienteSolicitado->sexo == 'i')
				<div class="col-xs-3">
					<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('hdl_menor_40_mg_dl_en_hombres')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('hdl_menor_40_mg_dl_en_hombres', 'HDL < 40 mg/dl en hombres', ['class' => 'col-xs-9 control-label']) !!}
						<div class="col-xs-3">
							{!! Form::checkbox('hdl_menor_40_mg_dl_en_hombres', 1, false) !!}
						</div>
					</div>
				</div>
			@endif

			@if ($pacienteSolicitado->sexo == 'f' || $pacienteSolicitado->sexo == 'i')
				<div class="col-xs-3">
					<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('hdl_menor_48_mg_dl_en_mujeres')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('hdl_menor_48_mg_dl_en_mujeres', 'HDL < 48 mg/dl en mujeres', ['class' => 'col-xs-9 control-label']) !!}
						<div class="col-xs-3">
							{!! Form::checkbox('hdl_menor_48_mg_dl_en_mujeres', 1, false) !!}
						</div>
					</div>
				</div>
			@endif

			@if ($pacienteSolicitado->sexo == 'i')
				<div class="clearfix"></div>
			@endif

			{{-- 2 --}}
			<div class="col-xs-3">
				<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('colesterol_total_mayor_255_mg_dl')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('colesterol_total_mayor_255_mg_dl', 'Colesterol total > 255 mg/dl', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('colesterol_total_mayor_255_mg_dl', 1, false) !!}
					</div>
				</div>
			</div>

			@if ($pacienteSolicitado->sexo == 'i')
				<div class="clearfix"></div>
			@endif

			@if ($pacienteSolicitado->sexo == 'm' || $pacienteSolicitado->sexo == 'i')
				<div class="col-xs-4">
					<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('historia_familiar_ecv_menor_55_anos_en_hombres')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('historia_familiar_ecv_menor_55_anos_en_hombres', 'Historia familiar ECV < 55 anos en hombres', ['class' => 'col-xs-10 control-label']) !!}
						<div class="col-xs-2">
							{!! Form::checkbox('historia_familiar_ecv_menor_55_anos_en_hombres', 1, false) !!}
						</div>
					</div>
				</div>
			@endif

			@if ($pacienteSolicitado->sexo == 'f' || $pacienteSolicitado->sexo == 'i')
				<div class="col-xs-4">
					<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('historia_familiar_ecv_menor_65_anos_en_mujeres')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('historia_familiar_ecv_menor_65_anos_en_mujeres', 'Historia familiar ECV < 65 anos en mujeres', ['class' => 'col-xs-10 control-label']) !!}
						<div class="col-xs-2">
							{!! Form::checkbox('historia_familiar_ecv_menor_65_anos_en_mujeres', 1, false) !!}
						</div>
					</div>
				</div>
			@endif

			@if ($pacienteSolicitado->sexo == 'i')
				<div class="clearfix"></div>
			@endif

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('ta')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('ta', 'TA', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('ta', 1, false) !!}
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('ldl_mayor_155_mg_dl')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('ldl_mayor_155_mg_dl', 'LDL > 155 mg dl', ['class' => 'col-xs-9 control-label']) !!}
					<div class="col-xs-3">
						{!! Form::checkbox('ldl_mayor_155_mg_dl', 1, false) !!}
					</div>
				</div>
			</div>

		</div>
	</a>

	<a class="list-group-item">
		<div class="row">

			<div class="col-xs-12">
				<table class="table table-bordered table-condensed informe">
					<thead>
						<th>FACTORES DE RIESGO \ TENSIÓN ARTERIAL</th>
						<th>PAS 140 - 159 | PAD 90 - 99</th>
						<th>PAS 140 - 159 | PAD 90 - 99</th>
						<th>PAS 140 - 159 | PAD 90 - 99</th>
					</thead>
					<tbody>
						<tr>
							<th>SIN FACTORES DE RIESGO</th>
							<td>RIESGO BAJO</td>
							<td>RIESGO MODERADO</td>
							<td>RIESGO ALTO</td>
						</tr>
						<tr>
							<th>1 - 2 FACTORES DE RIESGO</th>
							<td>RIESGO MODERADO</td>
							<td>RIESGO MODERADO</td>
							<td>RIESGO MUY ALTO</td>
						</tr>
						<tr>
							<th>3 Ó MÁS FACTORES DE RIESGO, LESIÓN DE ÓRGANO BLANCO O DIABETES</th>
							<td>RIESGO ALTO</td>
							<td>RIESGO ALTO</td>
							<td>RIESGO MUY ALTO</td>
						</tr>
						<tr>
							<th>CONDICIONES CLÍNICAS ASOCIADAS</th>
							<td>RIESGO MUY ALTO</td>
							<td>RIESGO MUY ALTO</td>
							<td>RIESGO MUY ALTO</td>
						</tr>
					</tbody>
				</table>
			</div>

		</div>

		<div class="row formulario-horizontal">
			<div class="col-xs-12">
				<div class="form-group form-group-sm">
					<div class="col-xs-3">
						<label class="radio-inline">
							{!! Form::radio('factores_de_riesgo_cardiovascular', 1) !!}
							Bajo < 15 %
						</label>
					</div>
					<div class="col-xs-3">
						<label class="radio-inline">
							{!! Form::radio('factores_de_riesgo_cardiovascular', 2) !!}
							Moderado 15 - 20%
						</label>
					</div>
					<div class="col-xs-3">
						<label class="radio-inline">
							{!! Form::radio('factores_de_riesgo_cardiovascular', 3) !!}
							Alto 20 - 30%
						</label>
					</div>
					<div class="col-xs-3">
						<label class="radio-inline">
							{!! Form::radio('factores_de_riesgo_cardiovascular', 4) !!}
							Muy alto > 30%
						</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 
				'@if (count($errors)) @if($errors->has('perimetro_abdominal')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! 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', null, ['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 
				'@if (count($errors)) @if($errors->has('creatinina')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('creatinina', 'Creatinina', ['class' => 'col-xs-4 control-label']) !!}
					<div class="col-xs-8">
						<div class="input-group">
							{!! Form::text('creatinina', null, ['class' => 'form-control','required']) !!}
							<span class="input-group-addon">mg / dL</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<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', null, ['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,'required']) !!}
					</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,'required']) !!}
					</div>
				</div>
			</div>

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

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

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Complicaciones crónicas</b></p>
		<div class="row formulario-horizontal" style="padding-right: 20px">

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

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

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

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

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

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

			<div class="col-sm-4">
				<div class="form-group form-group-sm 
				'@if (count($errors)) @if($errors->has('pie_diabetico')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
					{!! Form::label('pie_diabetico', 'Pié diabético', ['class' => 'col-xs-8 control-label']) !!}
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('pie_diabetico', 1) !!}
							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							{!! Form::radio('pie_diabetico', 0, true) !!}
							no
						</label>
					</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-4">
					<div class="form-group-sm 
				'@if (count($errors)) @if($errors->has('analisis')) 
				{{'form-group has-error has-feedback'}} @endif @endif'">
						{!! Form::label('analisis', 'Análisis', ['class' => 'control-label']) !!}
						{!! Form::textarea('analisis', null, ['class' => 'form-control', 'rows' => 8, 'maxlength' => 2000]) !!}
						@if( ! isset($formulario) )
							<span id="contador-analisis">0 de 2000</span>
						@endif
					</div>
				</div>

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

				<div class="col-sm-4">
					<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' => 8, 'maxlength' => 2000,'required']) !!}
						@if( ! isset($formulario) )
							<span id="contador-recomendaciones">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']) !!}
					</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')
{{-- @include('componentes.script-validar-programa') --}}