@extends('layouts.admin-bloqueo-vista') @section('titulo') Seguimiento - "{{ $formularioNombre }}" @endsection @section('css') {!! Html::style('css/inscripcion-seguimiento.css') !!} {!! Html::style('css/jquery.datetimepicker.min.css') !!} {{-- autocomplete --}} {!! Html::style('css/jquery-ui.theme.min.css') !!} {!! Html::style('css/jquery-ui.structure.min.css') !!} @endsection @section('botonera') {{-- Si se encuentra revisando un seguimiento deshabilitado --}} @if($inscripcion != null) @include('componentes.boton-volver-a-la-busqueda-de-paciente') @include('componentes.boton-salir-con-aviso') @endif @endsection @section('content-extra')
{!! Form::model($pacienteSolicitado, ['class' => 'form-horizontal']) !!}
{!! Form::label('documento', 'Documento:', ['class' => 'col-sm-1 control-label input-sm']) !!}
{!! Form::text('documento', null, ['class' => 'form-control input-sm']) !!}
{!! Form::label('nombre', 'Paciente:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::text('nombre', null, ['class' => 'form-control input-sm']) !!}

{!! Form::label('nacimiento', 'Fecha de Nacimiento:', ['class' => 'col-sm-1 control-label input-sm']) !!}
{!! Form::text('nacimiento', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('tipo_usuario', 'Tipo Usuario:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::select('tipo_usuario', array( 'co' => 'Contributivo', 'su' => 'Subsidiado', 'vi' => 'Vinculado', 'pa' => 'Particular', 'ot' => 'Otro', 'dc' => 'Desplazado Contributivo', 'ds' => 'Desplazado Subsidiado', 'dv' => 'Desplazado Vinculado' ), null, ['class' => 'form-control input-sm', 'disabled']) !!}
{!! Form::label('estado_civil', 'Estado Civil:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::select('estado_civil', array( 'so' => 'Soltero', 'ca' => 'Casado', 'vi' => 'Viudo', 'se' => 'Separado', 'un' => 'Union Libre', 'ot' => 'Otro' ), null, ['class' => 'form-control input-sm', 'disabled']) !!}
{!! Form::label('sexo', 'Sexo:', ['class' => 'col-sm-1 control-label input-sm col-sm-1-reducido']) !!}
{!! Form::select('sexo', [ 'm' => 'Masculino', 'f' => 'Femenino', 'i' => 'Indeterminado' ], null, ['class' => 'form-control input-sm', 'disabled']) !!}
{!! Form::label('ocupacion', 'Ocupación:', ['class' => 'col-sm-1 control-label input-sm']) !!}
{!! Form::text('ocupacion', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('direccion', 'Dirección:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::text('direccion', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('telefono_1', 'Tel 1:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::text('telefono_1', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('telefono_2', 'Tel 2:', ['class' => 'col-sm-1 col-sm-1-original col-sm-1-reducido control-label input-sm']) !!}
{!! Form::text('telefono_2', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('sisben', 'Sisben:', ['class' => 'col-sm-1 control-label input-sm']) !!}
{!! Form::text('sisben', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::label('edad', 'Edad actual:', ['class' => 'col-sm-1 col-sm-1-original control-label input-sm']) !!}
{!! Form::text('edad', null, ['class' => 'form-control input-sm', 'readonly']) !!}
{!! Form::close() !!}
@endsection @section('content') {{-- modals --}} @if($inscripcion != null) @include('componentes.modal-salir') @endif @include('componentes.modal-volver-a-la-busqueda-de-paciente') {{-- Modal agregar medicamento --}} {{-- Modal agregar procedimientos --}} {{-- Modal agregar Remisiones --}}
@if (count($errors)) @include('alerts.request') @endif