<?php /* Vista de solo lectura */ ?>
<?php if(isset($formulario)): ?>
	<?php echo Form::model($formulario, ['class' => 'form-horizontal']); ?>

<?php endif; ?>

<!-- Para cargar el último formulario registrado con la finalidad de que sea una muestra para el nuevo formulario -->
<?php if(isset($ultimoFormulario)): ?>
	<?php echo Form::model($ultimoFormulario, ['class' => 'form-horizontal', 'route' => 'seguimiento.store', 'method' => 'post', 'id' => 'formularioSeguimiento']); ?>

<?php elseif(!isset($formulario)): ?>
	<?php echo Form::open(['class' => 'form-horizontal', 'route' => 'seguimiento.store', 'method' => 'post']); ?>

<?php endif; ?>

<?php echo $__env->make('componentes.hidden-json-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

<?php echo Form::hidden('hiddenEdad',''); ?>

<?php echo Form::hidden('hiddenSexo',''); ?>


<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">

			<?php if(!\Auth::user()->es_responsable && !isset($formulario)): ?>
				<div class="col-xs-5 col-xs-offset-3">
					<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
						<?php echo Form::label('usuario_id', 'Responsable', ['class' => 'col-xs-4 control-label']); ?>

						<div class="col-xs-8">
							<?php echo Form::select('usuario_id', $responsables, null, ['class' => 'form-control']); ?>

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

				<div class="clearfix"></div>
			<?php endif; ?>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha', 'Fecha', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<?php if(!isset($formulario)): ?>
							<?php echo Form::text('fecha', $fechaActual, ['class' => 'form-control', 'id' => 'fecha']); ?>

						<?php else: ?>
							<?php echo Form::text('fecha', explode(' ', $formulario->fecha_hora)[0], ['class' => 'form-control', 'id' => 'fecha']); ?>

						<?php endif; ?>
					</div>
				</div>
			</div>

			<div class="col-xs-5">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('motivo_de_consulta', 'Motivo de consulta', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::text('motivo_de_consulta', null, ['class' => 'form-control']); ?>

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

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hora', 'Hora', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<?php if(!isset($formulario)): ?>
							<?php echo Form::text('hora', \Carbon\Carbon::now()->format('H:i:s'), ['class' => 'form-control', 'id' => 'hora']); ?>

						<?php else: ?>
							<?php echo Form::text('hora', explode(' ', $formulario->fecha_hora)[1], ['class' => 'form-control', 'id' => 'hora']); ?>

						<?php endif; ?>
					</div>
				</div>
			</div>

			<div class="col-xs-5">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('enfermedad_actual', 'Enfermedad actual', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::text('enfermedad_actual', null, ['class' => 'form-control']); ?>

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

			<div class="col-xs-8">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('revision_por_sistemas', 'Revisión por sistemas', ['class' => 'col-xs-3 control-label']); ?>

					<div class="col-xs-9">
						<?php echo Form::text('revision_por_sistemas', null, ['class' => 'form-control']); ?>

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

			<div class="col-xs-8">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('entidad_id', 'Entidad', ['class' => 'col-xs-2 control-label']); ?>

					<div class="col-xs-10">
						<?php echo Form::select('entidad_id', $entidades, null, ['class' => 'form-control']); ?>

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

			<div class="col-xs-4 text-right">
				<?php if(isset($formulario)): ?>
					<?php echo $__env->make('componentes.boton-volver-al-listado-de-historicos-e-imprimir-en-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
				<?php else: ?>
					<?php echo $__env->make('componentes.boton-salir-de-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
					<?php echo $__env->make('componentes.boton-guardar-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
				<?php endif; ?>
			</div>

		</div>
	</a>

	<?php echo $__env->make('componentes/formulario-diagnosticos', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('familiares_tbc')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('familiares_tbc', 'Tbc?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('familiares_tbc', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('familiares_tbc', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('pustulas_o_vesiculas_en_piel')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('pustulas_o_vesiculas_en_piel', 'Pústulas o vesiculas en piel?', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('familiares_diabetes', [
							'' => '',
							'muchas o extensas' => 'muchas o extensas',
							'pocas y localizadas' => 'pocas y localizadas',
							'eritema periumbilical' => 'eritema periumbilical'
						], null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('familiares_hipertension')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('familiares_hipertension', 'Hipertension?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('familiares_hipertension', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('familiares_hipertension', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('familiares_preclampsia_eclampsia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('familiares_preclampsia_eclampsia', 'Preclampsia eclampsia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('familiares_preclampsia_eclampsia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('familiares_preclampsia_eclampsia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('familiares_otros')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('familiares_otros', 'Otros?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('familiares_otros', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('familiares_otros', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('personales_tbc')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('personales_tbc', 'Tbc?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_tbc', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_tbc', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('personales_diabetes')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('personales_diabetes', 'Diabetes', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('personales_diabetes', [
							'' => '',
							'I' => 'I',
							'II' => 'II',
							'G' => 'G'
						], null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm  
					'<?php if(count($errors)): ?> <?php if($errors->has('personales_hipertension')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('personales_hipertension', 'Hipertension?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_hipertension', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_hipertension', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm  
					'<?php if(count($errors)): ?> <?php if($errors->has('personales_preclampsia_eclampsia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('personales_preclampsia_eclampsia', 'Preclampsia eclampsia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_preclampsia_eclampsia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_preclampsia_eclampsia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm  
					'<?php if(count($errors)): ?> <?php if($errors->has('personales_otros')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('personales_otros', 'Otros?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_otros', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_otros', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm  
					'<?php if(count($errors)): ?> <?php if($errors->has('personales_cirugia_pelvica')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('personales_cirugia_pelvica', 'Cirugia pelvica?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_cirugia_pelvica', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_cirugia_pelvica', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm  
					'<?php if(count($errors)): ?> <?php if($errors->has('personales_infertilidad')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('personales_infertilidad', 'Infertilidad?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_infertilidad', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_infertilidad', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm  
					'<?php if(count($errors)): ?> <?php if($errors->has('personales_vih')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('personales_vih', 'Vih?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_vih', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_vih', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm  
					'<?php if(count($errors)): ?> <?php if($errors->has('personales_cardiopatia_nefropatia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('personales_cardiopatia_nefropatia', 'Cardiopatia nefropatia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_cardiopatia_nefropatia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_cardiopatia_nefropatia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('personales_cond_medica_grave')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('personales_cond_medica_grave', 'Cond medica grave?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_cond_medica_grave', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('personales_cond_medica_grave', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('menor_2500_gr')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('menor_2500_gr', 'Menor 2500 gr?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('menor_2500_gr', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('menor_2500_gr', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('mayor_4500_gr')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('mayor_4500_gr', 'Mayor 4500 gr?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('mayor_4500_gr', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('mayor_4500_gr', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('gemelares')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('gemelares', 'Gemelares?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('gemelares', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('gemelares', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('gestas_previas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('gestas_previas', 'gestas previas', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('gestas_previas', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('abortos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('abortos', 'abortos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('abortos', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('partos_vanigales')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('partos_vanigales', 'partos vanigales', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('partos_vanigales', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('partos_cesareas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('partos_cesareas', 'partos cesareas', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('partos_cesareas', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nacidos_vivos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nacidos_vivos', 'nacidos vivos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('nacidos_vivos', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cuantos_de_los_nacidos_vivos_viven')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('cuantos_de_los_nacidos_vivos_viven', 'cuantos de los nacidos vivos viven', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('cuantos_de_los_nacidos_vivos_viven', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nacidos_muertos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nacidos_muertos', 'nacidos muertos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('nacidos_muertos', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nacidos_muertos_en_la_primera_semana')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nacidos_muertos_en_la_primera_semana', 'nacidos muertos en la primera semana', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('nacidos_muertos_en_la_primera_semana', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nac_muertos_despues_primera_semana')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nac_muertos_despues_primera_semana', 'nac muertos despues primera semana', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('nac_muertos_despues_primera_semana', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('3_espont_consecut')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('3_espont_consecut', '3 espont consecut?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('3_espont_consecut', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('3_espont_consecut', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fin_embarazo_anterior')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fin_embarazo_anterior', 'Fin embarazo anterior', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('fin_embarazo_anterior', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('menor_de_1_ano')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('menor_de_1_ano', 'Menor de 1 ano?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('menor_de_1_ano', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('menor_de_1_ano', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('mas_de_5_anos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('mas_de_5_anos', 'Mas de 5 anos?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('mas_de_5_anos', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('mas_de_5_anos', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('embarazo_planeado')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('embarazo_planeado', 'Embarazo planeado?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('embarazo_planeado', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('embarazo_planeado', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fracaso_metodo_anticonceptivo')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fracaso_metodo_anticonceptivo', 'Fracaso metodo anticonceptivo?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('fracaso_metodo_anticonceptivo', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('fracaso_metodo_anticonceptivo', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso_anterior')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso_anterior', 'Peso anterior', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('peso_anterior', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

							<span class="input-group-addon">g</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('gestacion_actual_talla')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('gestacion_actual_talla', 'Gestacion actual talla', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('gestacion_actual_talla', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fum')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fum', 'FUM', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('fum', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fpp')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fpp', 'FPP', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('fpp', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('es_confiable')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('es_confiable', 'Es confiable?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('es_confiable', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('es_confiable', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fum_eco_menor_20a')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fum_eco_menor_20a', 'Fum eco menor 20a?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('fum_eco_menor_20a', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('fum_eco_menor_20a', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fuma')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fuma', 'fuma', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('fuma', [
							'' => '',
							'si' => 'si',
							'no' => 'no',
							'pasiva' => 'pasiva'
						], null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('cigarrillos_por_dia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('cigarrillos_por_dia', 'Cigarrillos por dia', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('cigarrillos_por_dia', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('alcohol')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('alcohol', 'Alcohol?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('alcohol', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('alcohol', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('drogas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('drogas', 'Drogas?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('drogas', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('drogas', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hierro')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hierro', 'Hierro?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hierro', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hierro', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('folatos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('folatos', 'Folatos?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('folatos', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('folatos', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('antitetaica_vigente')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('antitetaica_vigente', 'Antitetaica vigente?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('antitetaica_vigente', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('antitetaica_vigente', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('dosis_mes_gestacion_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('dosis_mes_gestacion_1', 'Dosis mes gestacion 1', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('dosis_mes_gestacion_1', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('dosis_mes_gestacion_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('dosis_mes_gestacion_2', 'Dosis mes gestacion 2', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('dosis_mes_gestacion_2', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('antirubeola')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('antirubeola', 'Antirubeola?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('antirubeola', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('antirubeola', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('antirubeola_embarazo')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('antirubeola_embarazo', 'Antirubeola embarazo?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('antirubeola_embarazo', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('antirubeola_embarazo', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('citologia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('citologia', 'Citologia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('citologia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('citologia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('colposcopia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('colposcopia', 'Colposcopia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('colposcopia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('colposcopia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ex_normal_odont')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ex_normal_odont', 'Ex normal odont?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ex_normal_odont', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ex_normal_odont', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ex_normal_mamas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ex_normal_mamas', 'Ex normal mamas?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ex_normal_mamas', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ex_normal_mamas', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ex_normal_cervix')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ex_normal_cervix', 'Ex normal cervix?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ex_normal_cervix', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ex_normal_cervix', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ingreso_grupo')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ingreso_grupo', 'Ingreso grupo', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('ingreso_grupo', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('rh')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('rh', 'rh', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('rh', [
							'' => '',
							'+' => '+',
							'-' => '-'
						], null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ingreso_sensibil')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ingreso_sensibil', 'Ingreso sensibil?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ingreso_sensibil', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ingreso_sensibil', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('vih_consejeria')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('vih_consejeria', 'Vih consejeria?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('vih_consejeria', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('vih_consejeria', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('vih_solicitado')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('vih_solicitado', 'Vih solicitado?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('vih_solicitado', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('vih_solicitado', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('uroanalisis')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('uroanalisis', 'Uroanalisis', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('uroanalisis', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('menor_11_g')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('menor_11_g', 'Menor 11 g', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('menor_11_g', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('glicemia_en_ayunas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('glicemia_en_ayunas', 'Glicemia en ayunas', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('glicemia_en_ayunas', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ingreso_vdrl')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ingreso_vdrl', 'Ingreso vdrl', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('ingreso_vdrl', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ecografía_menor_14_sem')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ecografía_menor_14_sem', 'Ecografía menor 14 sem', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('ecografía_menor_14_sem', null, ['class' => 'form-control', 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>2° trimestre</b></p>
		<div class="row formulario-horizontal">

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('uroanalisis_trimestre_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('uroanalisis_trimestre_2', 'uroanalisis trimestre 2', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('uroanalisis_trimestre_2', [
							'' => '',
							'Normal' => 'Normal',
							'Anormal' => 'Anormal',
							'No se hizo' => 'No se hizo'
						], null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('test_o_sullivan')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('test_o_sullivan', 'test o sullivan', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('test_o_sullivan', [
							'' => '',
							'< 135' => '< 135',
							'135 - 199' => '135 - 199',
							'> 200' => '> 200',
							'-' => '-'
						], null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ecografia_19_24_sem')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ecografia_19_24_sem', 'ecografia 19 24 sem', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('ecografia_19_24_sem', [
							'' => '',
							'Se hizo' => 'Se hizo',
							'No se hizo' => 'No se hizo'
						], null, ['class' => 'form-control' , 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>3° trimestre</b></p>
		<div class="row formulario-horizontal">

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('uroanalisis_trimestre_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('uroanalisis_trimestre_3', 'uroanalisis trimestre 3', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('uroanalisis_trimestre_3', [
							'' => '',
							'Normal' => 'Normal',
							'Anormal' => 'Anormal',
							'No se hizo' => 'No se hizo'
						], null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('trimestre_3_vdrl')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('trimestre_3_vdrl', 'trimestre 3 vdrl', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('trimestre_3_vdrl', [
							'' => '',
							'-' => '-',
							'+' => '+',
							'No se hizo' => 'No se hizo'
						], null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('sifilis_confirmada_por_fta')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('sifilis_confirmada_por_fta', 'sifilis confirmada por fta', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('sifilis_confirmada_por_fta', [
							'' => '',
							'si' => 'si',
							'no' => 'no',
							'No se hizo' => 'No se hizo'
						], null, ['class' => 'form-control' , 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>1</b></p>
		<div class="row formulario-horizontal">

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha_1', 'Fecha', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fecha_1', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('edad_gestacional_1', 'Edad gestacional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('edad_gestacional_1', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso_1', 'Peso', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('peso_1', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">g</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presion_arteral_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presion_arteral_1', 'Presion arteral', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('presion_arteral_1', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('altura_uterina_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('altura_uterina_1', 'Altura uterina', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('altura_uterina_1', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presentacion_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presentacion_1', 'Presentacion', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('presentacion_1', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fcf_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fcf_1', 'FCF', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fcf_1', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('movim_fetales_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('movim_fetales_1', 'Movim fetales', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('movim_fetales_1', null, ['class' => 'form-control','required']); ?>

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

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('estado_nutricional_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('estado_nutricional_1', 'Estado nutricional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('estado_nutricional_1', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hierro_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hierro_1', 'Hierro', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('hierro_1', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('folatos_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('folatos_1', 'Folatos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('folatos_1', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('calcio_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('calcio_1', 'Calcio', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('calcio_1', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('riesgo_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('riesgo_1', 'Riesgo', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('riesgo_1', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('sig_alarma_exa_tratamiento_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('sig_alarma_exa_tratamiento_1', 'Sig alarma exa tratamiento', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('sig_alarma_exa_tratamiento_1', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nombre_del_profesional_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nombre_del_profesional_1', 'Nombre del profesional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('nombre_del_profesional_1', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('proxima_cita_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('proxima_cita_1', 'Proxima cita', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('proxima_cita_1', null, ['class' => 'form-control' , 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>2</b></p>
		<div class="row formulario-horizontal">
			
			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha_2', 'Fecha', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fecha_2', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('edad_gestacional_2', 'Edad gestacional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('edad_gestacional_2', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso_2', 'Peso', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('peso_2', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">g</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presion_arteral_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presion_arteral_2', 'Presion arteral', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('presion_arteral_2', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('altura_uterina_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('altura_uterina_2', 'Altura uterina', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('altura_uterina_2', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presentacion_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presentacion_2', 'Presentacion', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('presentacion_2', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fcf_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fcf_2', 'FCF', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fcf_2', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('movim_fetales_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('movim_fetales_2', 'Movim fetales', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('movim_fetales_2', null, ['class' => 'form-control' , 'required']); ?>

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

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('estado_nutricional_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('estado_nutricional_2', 'Estado nutricional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('estado_nutricional_2', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hierro_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hierro_2', 'Hierro', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('hierro_2', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('folatos_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('folatos_2', 'Folatos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('folatos_2', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('calcio_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('calcio_2', 'Calcio', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('calcio_2', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('riesgo_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('riesgo_2', 'Riesgo', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('riesgo_2', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('sig_alarma_exa_tratamiento_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('sig_alarma_exa_tratamiento_2', 'Sig alarma exa tratamiento', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('sig_alarma_exa_tratamiento_2', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nombre_del_profesional_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nombre_del_profesional_2', 'Nombre del profesional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('nombre_del_profesional_2', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('proxima_cita_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('proxima_cita_2', 'Proxima cita', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('proxima_cita_2', null, ['class' => 'form-control' , 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>3</b></p>
		<div class="row formulario-horizontal">
			
			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha_3', 'Fecha', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fecha_3', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('edad_gestacional_3', 'Edad gestacional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('edad_gestacional_3', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso_3', 'Peso', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('peso_3', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">g</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presion_arteral_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presion_arteral_3', 'Presion arteral', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('presion_arteral_3', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('altura_uterina_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('altura_uterina_3', 'Altura uterina', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('altura_uterina_3', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presentacion_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presentacion_3', 'Presentacion', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('presentacion_3', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fcf_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fcf_3', 'FCF', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fcf_3', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('movim_fetales_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('movim_fetales_3', 'Movim fetales', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('movim_fetales_3', null, ['class' => 'form-control' , 'required']); ?>

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

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('estado_nutricional_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('estado_nutricional_3', 'Estado nutricional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('estado_nutricional_3', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hierro_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hierro_3', 'Hierro', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('hierro_3', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('folatos_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('folatos_3', 'Folatos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('folatos_3', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('calcio_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('calcio_3', 'Calcio', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('calcio_3', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('riesgo_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('riesgo_3', 'Riesgo', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('riesgo_3', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('sig_alarma_exa_tratamiento_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('sig_alarma_exa_tratamiento_3', 'Sig alarma exa tratamiento', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('sig_alarma_exa_tratamiento_3', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nombre_del_profesional_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nombre_del_profesional_3', 'Nombre del profesional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('nombre_del_profesional_3', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('proxima_cita_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('proxima_cita_3', 'Proxima cita', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('proxima_cita_3', null, ['class' => 'form-control' , 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>4</b></p>
		<div class="row formulario-horizontal">
			
			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha_4', 'Fecha', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fecha_4', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('edad_gestacional_4', 'Edad gestacional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('edad_gestacional_4', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso_4', 'Peso', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('peso_4', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">g</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presion_arteral_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presion_arteral_4', 'Presion arteral', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('presion_arteral_4', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('altura_uterina_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('altura_uterina_4', 'Altura uterina', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('altura_uterina_4', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presentacion_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presentacion_4', 'Presentacion', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('presentacion_4', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fcf_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fcf_4', 'FCF', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fcf_4', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('movim_fetales_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('movim_fetales_4', 'Movim fetales', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('movim_fetales_4', null, ['class' => 'form-control' , 'required']); ?>

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

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('estado_nutricional_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('estado_nutricional_4', 'Estado nutricional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('estado_nutricional_4', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hierro_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hierro_4', 'Hierro', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('hierro_4', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('folatos_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('folatos_4', 'Folatos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('folatos_4', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('calcio_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('calcio_4', 'Calcio', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('calcio_4', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('riesgo_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('riesgo_4', 'Riesgo', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('riesgo_4', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('sig_alarma_exa_tratamiento_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('sig_alarma_exa_tratamiento_4', 'Sig alarma exa tratamiento', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('sig_alarma_exa_tratamiento_4', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nombre_del_profesional_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nombre_del_profesional_4', 'Nombre del profesional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('nombre_del_profesional_4', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('proxima_cita_4')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('proxima_cita_4', 'Proxima cita', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('proxima_cita_4', null, ['class' => 'form-control' , 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>5</b></p>
		<div class="row formulario-horizontal">
			
			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha_5', 'Fecha', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fecha_5', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('edad_gestacional_5', 'Edad gestacional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('edad_gestacional_5', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso_5', 'Peso', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('peso_5', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">g</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presion_arteral_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presion_arteral_5', 'Presion arteral', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('presion_arteral_5', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('altura_uterina_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('altura_uterina_5', 'Altura uterina', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('altura_uterina_5', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presentacion_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presentacion_5', 'Presentacion', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('presentacion_5', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fcf_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fcf_5', 'FCF', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fcf_5', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('movim_fetales_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('movim_fetales_5', 'Movim fetales', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('movim_fetales_5', null, ['class' => 'form-control' , 'required']); ?>

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

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('estado_nutricional_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('estado_nutricional_5', 'Estado nutricional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('estado_nutricional_5', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hierro_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hierro_5', 'Hierro', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('hierro_5', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('folatos_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'" >
					<?php echo Form::label('folatos_5', 'Folatos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('folatos_5', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('calcio_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('calcio_5', 'Calcio', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('calcio_5', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('riesgo_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('riesgo_5', 'Riesgo', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('riesgo_5', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('sig_alarma_exa_tratamiento_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('sig_alarma_exa_tratamiento_5', 'Sig alarma exa tratamiento', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('sig_alarma_exa_tratamiento_5', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nombre_del_profesional_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nombre_del_profesional_5', 'Nombre del profesional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('nombre_del_profesional_5', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('proxima_cita_5')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('proxima_cita_5', 'Proxima cita', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('proxima_cita_5', null, ['class' => 'form-control' , 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>6</b></p>
		<div class="row formulario-horizontal">
			
			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha_6', 'Fecha', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fecha_6', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('edad_gestacional_6', 'Edad gestacional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('edad_gestacional_6', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso_6', 'Peso', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('peso_6', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">g</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presion_arteral_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presion_arteral_6', 'Presion arteral', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('presion_arteral_6', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('altura_uterina_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('altura_uterina_6', 'Altura uterina', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('altura_uterina_6', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presentacion_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presentacion_6', 'Presentacion', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('presentacion_6', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fcf_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fcf_6', 'FCF', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fcf_6', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('movim_fetales_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('movim_fetales_6', 'Movim fetales', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('movim_fetales_6', null, ['class' => 'form-control' , 'required']); ?>

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

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('estado_nutricional_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('estado_nutricional_6', 'Estado nutricional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('estado_nutricional_6', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hierro_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hierro_6', 'Hierro', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('hierro_6', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('folatos_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('folatos_6', 'Folatos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('folatos_6', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('calcio_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('calcio_6', 'Calcio', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('calcio_6', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('riesgo_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('riesgo_6', 'Riesgo', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('riesgo_6', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('sig_alarma_exa_tratamiento_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('sig_alarma_exa_tratamiento_6', 'Sig alarma exa tratamiento', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('sig_alarma_exa_tratamiento_6', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nombre_del_profesional_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nombre_del_profesional_6', 'Nombre del profesional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('nombre_del_profesional_6', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('proxima_cita_6')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('proxima_cita_6', 'Proxima cita', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('proxima_cita_6', null, ['class' => 'form-control' , 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>7</b></p>
		<div class="row formulario-horizontal">
			
			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha_7', 'Fecha', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fecha_7', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gestacional_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('edad_gestacional_7', 'Edad gestacional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('edad_gestacional_7', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso_7', 'Peso', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('peso_7', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">g</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presion_arteral_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presion_arteral_7', 'Presion arteral', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('presion_arteral_7', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">mmHg</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('altura_uterina_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('altura_uterina_7', 'Altura uterina', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('altura_uterina_7', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('presentacion_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('presentacion_7', 'Presentacion', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('presentacion_7', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fcf_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fcf_7', 'FCF', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('fcf_7', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('movim_fetales_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('movim_fetales_7', 'Movim fetales', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('movim_fetales_7', null, ['class' => 'form-control' , 'required']); ?>

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

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('estado_nutricional_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('estado_nutricional_7', 'Estado nutricional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('estado_nutricional_7', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hierro_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hierro_7', 'Hierro', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('hierro_7', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('folatos_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('folatos_7', 'Folatos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('folatos_7', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('calcio_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('calcio_7', 'Calcio', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('calcio_7', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('riesgo_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('riesgo_7', 'Riesgo', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('riesgo_7', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('sig_alarma_exa_tratamiento_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('sig_alarma_exa_tratamiento_7', 'Sig alarma exa tratamiento', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('sig_alarma_exa_tratamiento_7', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nombre_del_profesional_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nombre_del_profesional_7', 'Nombre del profesional', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('nombre_del_profesional_7', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('proxima_cita_7')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('proxima_cita_7', 'Proxima cita', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::text('proxima_cita_7', null, ['class' => 'form-control' , 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Notas</b></p>
		<div class="row formulario-horizontal">
			<div class="col-xs-12">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('notas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<div class="col-xs-12">
						<?php echo Form::textarea('notas', null, ['class' => 'form-control', 'rows' => 2 , 'required']); ?>

					</div>
				</div>
			</div>
		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('enfermedades_ninguna')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('enfermedades_ninguna', 'Enfermedades ninguna?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('enfermedades_ninguna', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('enfermedades_ninguna', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hta_cronica')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hta_cronica', 'Hta cronica?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hta_cronica', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hta_cronica', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hta_gestacional')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hta_gestacional', 'Hta gestacional?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hta_gestacional', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hta_gestacional', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('preclampsia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('preclampsia', 'Preclampsia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('preclampsia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('preclampsia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('eclampsia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('eclampsia', 'Eclampsia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('eclampsia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('eclampsia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('diabetes')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('diabetes', 'Diabetes', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('diabetes', [
							'' => '',
							'I' => 'I',
							'II' => 'II',
							'G' => 'G'
						], null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('anemia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('anemia', 'Anemia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('anemia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('anemia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('infec_urinaria')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('infec_urinaria', 'Infec urinaria?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('infec_urinaria', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('infec_urinaria', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('amenaza_parto_preter')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('amenaza_parto_preter', 'Amenaza parto preter?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('amenaza_parto_preter', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('amenaza_parto_preter', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('rciu')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('rciu', 'Rciu?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('rciu', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('rciu', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ruptura_prem_de_membrana')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ruptura_prem_de_membrana', 'Ruptura prem de membrana?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ruptura_prem_de_membrana', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ruptura_prem_de_membrana', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('otras')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('otras', 'Otras', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('otras', [
							'' => '',
							'si' => 'si',
							'no' => 'no',
							'grave' => 'grave'
						], null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('corjoamnionitis')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('corjoamnionitis', 'Corjoamnionitis?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('corjoamnionitis', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('corjoamnionitis', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hemorragia_1er_trim')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hemorragia_1er_trim', 'Hemorragia 1er trim?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hemorragia_1er_trim', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hemorragia_1er_trim', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hemorragia_2do_trim')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hemorragia_2do_trim', 'Hemorragia 2do trim?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hemorragia_2do_trim', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hemorragia_2do_trim', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hemorragia_2er_trim')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hemorragia_2er_trim', 'Hemorragia 2er trim?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hemorragia_2er_trim', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hemorragia_2er_trim', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('parto_o_aborto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('parto_o_aborto', 'Parto o aborto', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('parto_o_aborto', [
							'' => '',
							'parto' => 'parto',
							'aborto' => 'aborto'
						], null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fecha_de_ingreso')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fecha_de_ingreso', 'Fecha de ingreso', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('fecha_de_ingreso', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('carne')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('carne', 'Carné?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('carne', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('carne', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('consultas_prenatales_total')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('consultas_prenatales_total', 'Consultas prenatales total', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('consultas_prenatales_total', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hopitaliz_en_embarazo_dias')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hopitaliz_en_embarazo_dias', 'Hopitaliz en embarazo dias', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('hopitaliz_en_embarazo_dias', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ciclo_unico')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ciclo_unico', 'Ciclo único', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('ciclo_unico', [
							'' => '',
							'completo' => 'completo',
							'incompleto' => 'incompleto'
						], null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('semana_inicio')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('semana_inicio', 'Semana inicio', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('semana_inicio', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('multiples'); ?> Multiples
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('corticoides_antenatales_ninguna'); ?> Corticoides antenatales ninguna
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('nc'); ?> Nc
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('inicio_tdp_espontaneo'); ?> Inicio tdp espontaneo
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('inicio_tdp_incluido'); ?> Inicio tdp incluido
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('inicio_tdp_cesar_alect'); ?> Inicio tdp cesar alect
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('rup_membranas_anteparto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('rup_membranas_anteparto', 'Rup membranas anteparto?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('rup_membranas_anteparto', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('rup_membranas_anteparto', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('rup_membranas_anteparto_fecha')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('rup_membranas_anteparto_fecha', 'Fecha', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('rup_membranas_anteparto_fecha', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('rup_membranas_anteparto_hora_minuto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('rup_membranas_anteparto_hora_minuto', 'Hora minuto', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('rup_membranas_anteparto_hora_minuto', null, ['class' => 'form-control' , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('menor_37_sem'); ?> Menor 37 sem
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('mayor_igual_18_hs'); ?> Mayor igual 18 hs
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('temp_mayor_igual_38'); ?> Temp mayor igual 38
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('horas_entre_ruptura_y_parto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('horas_entre_ruptura_y_parto', 'Horas entre ruptura y parto', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('horas_entre_ruptura_y_parto', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gest_al_parto_semanas')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('edad_gest_al_parto_semanas', 'Edad gest al parto semanas', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('edad_gest_al_parto_semanas', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_gest_al_parto_dias')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('edad_gest_al_parto_dias', 'Edad gest al parto dias', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('edad_gest_al_parto_dias', null, ['class' => 'form-control', 'min' => 0 , 'required']); ?>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('por_fum'); ?> Por fum
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('por_eco'); ?> Por eco
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('presentacion_cefalica'); ?> Presentacion cefalica
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('presentacion_pelviana'); ?> Presentacion pelviana
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('presentacion_transversa'); ?> Presentacion transversa
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('acompanante_en_t_de_p')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('acompanante_en_t_de_p', 'Acompanante en t de p?', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('acompanante_en_t_de_p', [
							'' => '',
							'pareja' => 'pareja',
							'familiar' => 'familiar',
							'otro' => 'otro',
							'ninguno' => 'ninguno'
						], null, ['class' => 'form-control' , 'required']); ?>

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

		</div>
	</a>

	<a class="list-group-item">
		<p class="list-group-item-heading"><b>Ruptura de membranas anteparto</b></p>
		<div class="row formulario-horizontal">

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nacimiento_vivo_muerto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nacimiento_vivo_muerto', 'Nacimiento vivo muerto', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('nacimiento_vivo_muerto', [
							'' => '',
							'Vivo' => 'Vivo',
							'Muerto' => 'Muerto'
						], null, ['class' => 'form-control']); ?>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('nacimiento_anteparto'); ?> Nacimiento anteparto temp >= 38°C
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('nacimiento_parto'); ?> Nacimiento parto
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('nacimiento_ignora_momento'); ?> Nacimiento ignora momento
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nacimiento_fecha')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nacimiento_fecha', 'Fecha', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('nacimiento_fecha', null, ['class' => 'form-control', 'require']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nacimiento_hora_minuto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nacimiento_hora_minuto', 'Hora minuto', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('nacimiento_hora_minuto', null, ['class' => 'form-control', 'require']); ?>

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

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('multiple')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('multiple', 'Multiple (orden 0 = único)', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('multiple', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fetos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fetos', 'Fetos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('fetos', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('indicacion_principal')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('indicacion_principal', 'Indicacion principal', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('indicacion_principal', null, ['class' => 'form-control', 'require']); ?>

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

			<div class="col-xs-12">
				<div class="form-group form-group-sm">
					<?php echo Form::label('codigo_induccion', 'Codigo induccion', ['class' => 'col-md-2 control-label']); ?>

					<?php if(!isset($formulario)): ?>
						<div class="col-sm-2">
						<?php echo Form::select('codigo_induccion', $diagnosticosPorId, null, ['id' => 'codigo_induccion_id', 'class' => 'form-control select-diagnostico']); ?>

					</div>
					<?php endif; ?>
					<div class="col-sm-8">
					<?php echo Form::text('codigo_induccion', null, ['autocomplete' => 'off', 'class' => 'form-control', 'id' => 'codigo_induccion']); ?>

				</div>
				</div>
			</div>
          
		  <div class="form-group form-group-sm">
				<?php echo Form::label('codigo_induccion2', 'Diagnóstico relacionado 1', ['class' => 'col-md-2 control-label']); ?>

				<?php if(!isset($formulario)): ?>
					<div class="col-sm-2">
						<?php echo Form::select('diagnostico_r1', $diagnosticosPorId, null, ['id' => 'diagnostico_r1_id', 'class' => 'form-control select-diagnostico']); ?>

					</div>
				<?php endif; ?>
				<div class="col-sm-8">
					<?php echo Form::text('diagnostico_r1', null, ['autocomplete' => 'off', 'class' => 'form-control', 'id' => 'diagnostico_r1']); ?>

				</div>
			</div>


			<div class="col-xs-12">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('codigo_operatorio')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('codigo_operatorio', 'Codigo operatorio', ['class' => 'col-md-2 control-label']); ?>

					<?php if(!isset($formulario)): ?>
						<div class="col-sm-2">
							<?php echo Form::select('codigo_operatorio', $diagnosticosPorId, null, ['id' => 'codigo_operatorio_id', 'class' => 'form-control select-diagnostico', 'required']); ?>

						</div>
					<?php endif; ?>
					<div class="col-sm-8">
						<?php echo Form::text('codigo_operatorio', null, ['autocomplete' => 'off', 'class' => 'form-control', 'id' => 'codigo_operatorio', 'require']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('posicion_parto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('posicion_parto', 'Posicion parto', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('posicion_parto', [
							'' => '',
							'sentada' => 'sentada',
							'acostada' => 'acostada',
							'cuclillas' => 'cuclillas'
						], null, ['class' => 'form-control', 'require']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('enema')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('enema', 'Enema?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('enema', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('enema', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('rasurado')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('rasurado', 'Rasurado?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('rasurado', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('rasurado', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('episiotomia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('episiotomia', 'Episiotomia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('episiotomia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('episiotomia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('desgarros')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('desgarros', 'Desgarros', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('desgarros', [
							'' => '',
							'< 30s' => '< 30s',
							'30s a 1m' => '30s a 1m',
							'> 1m' => '> 1m'
						], null, ['class' => 'form-control', 'require']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ocitocicos_en_alumbramiento')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ocitocicos_en_alumbramiento', 'Ocitocicos en alumbramiento?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ocitocicos_en_alumbramiento', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ocitocicos_en_alumbramiento', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('placenta_completa')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('placenta_completa', 'Placenta completa?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('placenta_completa', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('placenta_completa', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('placenta_retenida')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('placenta_retenida', 'Placenta retenida?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('placenta_retenida', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('placenta_retenida', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ligadura_cordon')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ligadura_cordon', 'Ligadura cordon', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('ligadura_cordon', [
							'' => '',
							'grado 1 a 4' => 'grado 1 a 4',
							'no' => 'no'
						], null, ['class' => 'form-control', 'require']); ?>

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

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('oxitocicos_en_t_de_p')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('oxitocicos_en_t_de_p', 'Oxitocicos en t de p?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('oxitocicos_en_t_de_p', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('oxitocicos_en_t_de_p', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('antibiot')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('antibiot', 'Antibiot?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('antibiot', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('antibiot', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('analgesia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('analgesia', 'Analgesia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('analgesia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('analgesia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('anest_region')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('anest_region', 'Anest region?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('anest_region', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('anest_region', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('anest_gral')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('anest_gral', 'Anest gral?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('anest_gral', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('anest_gral', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('sulfato_de_mg')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('sulfato_de_mg', 'Sulfato de mg?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('sulfato_de_mg', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('sulfato_de_mg', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('trasfusion')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('trasfusion', 'Trasfusion?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('trasfusion', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('trasfusion', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('otros_especifica')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('otros_especifica', 'Otros especifica', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('otros_especifica', null, ['class' => 'form-control']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('se_hizo_partograma')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('se_hizo_partograma', 'Se hizo partograma?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('se_hizo_partograma', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('se_hizo_partograma', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('sexo')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('sexo', 'sexo', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('sexo', [
							'' => '',
							'f' => 'f',
							'm' => 'm',
							'no definido' => 'no definido'
						], null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso_al_nacer')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso_al_nacer', 'Peso al nacer', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('peso_al_nacer', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

							<span class="input-group-addon">gr</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('perimetro_cefalico')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('perimetro_cefalico', 'Perimetro cefalico', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('perimetro_cefalico', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('recien_nacido_talla')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('recien_nacido_talla', 'Recién nacido talla', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('recien_nacido_talla', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

							<span class="input-group-addon">cm</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('eg_confiable_sem')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('eg_confiable_sem', 'Eg confiable sem', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('eg_confiable_sem', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('eg_confiable_dias')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('eg_confiable_dias', 'Eg confiable dias', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('eg_confiable_dias', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('eg_confiable')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('eg_confiable', 'Eg confiable', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('eg_confiable', [
							'' => '',
							'eg_confiable' => 'eg_confiable',
							'ECO' => 'ECO',
							'ESTIMADA' => 'ESTIMADA'
						], null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('peso_e_g_adec'); ?> adec
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('peso_e_g_peq'); ?> peq
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('peso_e_g_gde'); ?> gde
					</label>
				</div>
			</div>

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('flujo_libre_o2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('flujo_libre_o2', 'Flujo libre o2?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('flujo_libre_o2', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('flujo_libre_o2', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('ventilacion_presion')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('ventilacion_presion', 'Ventilacion presion?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ventilacion_presion', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('ventilacion_presion', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('intubacion_ot')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('intubacion_ot', 'Intubacion ot?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('intubacion_ot', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('intubacion_ot', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('masaje_cardiaco')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('masaje_cardiaco', 'Masaje cardiaco?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('masaje_cardiaco', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('masaje_cardiaco', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('adrenalina')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('adrenalina', 'Adrenalina?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('adrenalina', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('adrenalina', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('fallece_en_sala_de_parto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('fallece_en_sala_de_parto', 'Fallece en sala de parto?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('fallece_en_sala_de_parto', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('fallece_en_sala_de_parto', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('referido_aloj_conj'); ?> Referido aloj conj
					</label>
				</div>
			</div>


			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('referido_hosp'); ?> Referido hosp
					</label>
				</div>
			</div>


			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('referido_otro_hosp'); ?> Referido otro hosp
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('apgar_1ermin')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('apgar_1ermin', 'APGAR 1ermin', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('apgar_1ermin', null, ['class' => 'form-control', 'min' => 0,'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('apgar_5_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('apgar_5_1', 'APGAR 5 1', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('apgar_5_1', null, ['class' => 'form-control', 'min' => 0,'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('apgar_5_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('apgar_5_2', 'APGAR 5 2', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('apgar_5_2', null, ['class' => 'form-control', 'min' => 0,'required']); ?>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('parto_médico'); ?> Parto médico
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('parto_enf'); ?> Parto enf
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('parto_auxil'); ?> Parto auxil
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('parto_estud'); ?> Parto estud
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('parto_empir'); ?> Parto empir
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('parto_otro'); ?> Parto otro
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('parto_nombre')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('parto_nombre', 'Parto nombre', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('parto_nombre', null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('neonato_médico'); ?> Neonato médico
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('neonato_enf'); ?> Neonato enf
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('neonato_auxil'); ?> Neonato auxil
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('neonato_estud'); ?> Neonato estud
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('neonato_empir'); ?> Neonato empir
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('neonato_otro'); ?> Neonato otro
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('neonato_nombre')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('neonato_nombre', 'Neonato nombre', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('neonato_nombre', null, ['class' => 'form-control','required']); ?>

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

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('defectos_congenitos_no'); ?> Defectos congenitos no
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('defectos_congenitos_menor'); ?> Defectos congenitos menor
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('defectos_congenitos_mayor'); ?> Defectos congenitos mayor
					</label>
				</div>
			</div>

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('enf_recien_nacido_ninguna'); ?> Enf recién nacido ninguna
					</label>
				</div>
			</div>

			<div class="col-xs-12">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('enfermedad_recien_nacido_1')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('enfermedad_recien_nacido_1', 'Enfermedad recién nacido 1', ['class' => 'col-md-2 control-label']); ?>

					<?php if(!isset($formulario)): ?>
						<div class="col-sm-2">
							<?php echo Form::select('enfermedad_recien_nacido_1', $diagnosticosPorId, null, ['id' => 'enfermedad_recien_nacido_1_id', 'class' => 'form-control select-diagnostico','required']); ?>

						</div>
					<?php endif; ?>
					<div class="col-sm-8">
						<?php echo Form::text('enfermedad_recien_nacido_1', null, ['autocomplete' => 'off', 'class' => 'form-control', 'id' => 'enfermedad_recien_nacido_1']); ?>

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

			<div class="col-xs-12">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('enfermedad_recien_nacido_2')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('enfermedad_recien_nacido_2', 'Enfermedad recién nacido 2', ['class' => 'col-md-2 control-label']); ?>

					<?php if(!isset($formulario)): ?>
						<div class="col-sm-2">
							<?php echo Form::select('enfermedad_recien_nacido_2', $diagnosticosPorId, null, ['id' => 'enfermedad_recien_nacido_2_id', 'class' => 'form-control select-diagnostico']); ?>

						</div>
					<?php endif; ?>
					<div class="col-sm-8">
						<?php echo Form::text('enfermedad_recien_nacido_2', null, ['autocomplete' => 'off', 'class' => 'form-control', 'id' => 'enfermedad_recien_nacido_2']); ?>

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

			<div class="col-xs-12">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('enfermedad_recien_nacido_3')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('enfermedad_recien_nacido_3', 'Enfermedad recién nacido 3', ['class' => 'col-md-2 control-label']); ?>

					<?php if(!isset($formulario)): ?>
						<div class="col-sm-2">
							<?php echo Form::select('enfermedad_recien_nacido_3', $diagnosticosPorId, null, ['id' => 'enfermedad_recien_nacido_3_id', 'class' => 'form-control select-diagnostico']); ?>

						</div>
					<?php endif; ?>
					<div class="col-sm-8">
						<?php echo Form::text('enfermedad_recien_nacido_3', null, ['autocomplete' => 'off', 'class' => 'form-control', 'id' => 'enfermedad_recien_nacido_3']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('vitamina_k')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('vitamina_k', 'Vitamina k?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('vitamina_k', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('vitamina_k', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('enf_recien_nacido_rh')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('enf_recien_nacido_rh', 'rh', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('enf_recien_nacido_rh', [
							'' => '',
							'+' => '+',
							'-' => '-'
						], null, ['class' => 'form-control','required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('enf_recien_nacido_sensibil')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('enf_recien_nacido_sensibil', 'Enf recién nacido sensibil?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('enf_recien_nacido_sensibil', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('enf_recien_nacido_sensibil', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('enf_recien_nacido_grupo')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('enf_recien_nacido_grupo', 'Enf recién nacido grupo', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('enf_recien_nacido_grupo', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('notas_del_recien_nacido')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('notas_del_recien_nacido', 'Notas del recién nacido', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('notas_del_recien_nacido', null, ['class' => 'form-control', 'required']); ?>

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

		</div>
	</a>

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

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('negativo_vdrl'); ?> Negativo vdrl
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('positivo_vdrl'); ?> Positivo vdrl
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('no_se_hizo_vdrl'); ?> No se hizo vdrl
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('pend_result_vdrl'); ?> Pend result vdrl
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('negativo_tsh'); ?> Negativo tsh
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('positivo_tsh'); ?> Positivo tsh
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('no_se_hizo_tsh'); ?> No se hizo tsh
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('pend_result_tsh'); ?> Pend result tsh
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('negativo_hbpatia'); ?> Negativo hbpatia
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('positivo_hbpatia'); ?> Positivo hbpatia
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('no_se_hizo_hbpatia'); ?> No se hizo hbpatia
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('pend_result_hbpatia'); ?> Pend result hbpatia
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('negativo_audicion'); ?> Negativo audicion
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('positivo_audicion'); ?> Positivo audicion
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('no_se_hizo_audicion'); ?> No se hizo audicion
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('pend_result_audicion'); ?> Pend result audicion
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('negativo_billir'); ?> Negativo billir
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('positivo_billir'); ?> Positivo billir
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('no_se_hizo_billir'); ?> No se hizo billir
					</label>
				</div>
			</div>

			<div class="col-xs-3">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('pend_result_billir'); ?> Pend result billir
					</label>
				</div>
			</div>

			<div class="col-xs-6">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('meconico_1er_dia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('meconico_1er_dia', 'Meconico 1er dia?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('meconico_1er_dia', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('meconico_1er_dia', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-6">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('boca_arriba')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('boca_arriba', 'Boca arriba?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('boca_arriba', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('boca_arriba', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

		</div>
	</a>

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

		<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_1_hora_min')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_1_hora_min', 'h|m', ['class' => 'col-xs-3 control-label']); ?>

					<div class="col-xs-7">
						<?php echo Form::text('puerperio_1_hora_min', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_1_tc')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_1_tc', '1 T°C', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_1_tc', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_1_pulso')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_1_pulso', '1 pulso', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_1_pulso', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_1_pa')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_1_pa', '1 PA', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_1_pa', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_1_invol_uter')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_1_invol_uter', '1 invol uter', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_1_invol_uter', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_1_loquios')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_1_loquios', '1 loquios', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_1_loquios', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_2_hora_min')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_2_hora_min', 'h|m', ['class' => 'col-xs-3 control-label']); ?>

					<div class="col-xs-7">
						<?php echo Form::text('puerperio_2_hora_min', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_2_tc')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_2_tc', '2 T°C', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_2_tc', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_2_pulso')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_2_pulso', '2 pulso', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_2_pulso', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_2_pa')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_2_pa', '2 PA', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_2_pa', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_2_invol_uter')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_2_invol_uter', '2 invol uter', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_2_invol_uter', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_2_loquios')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_2_loquios', '2 loquios', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_2_loquios', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_3_hora_min')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_3_hora_min', 'h|m', ['class' => 'col-xs-3 control-label']); ?>

					<div class="col-xs-7">
						<?php echo Form::text('puerperio_3_hora_min', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_3_tc')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_3_tc', '3 T°C', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_3_tc', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_3_pulso')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_3_pulso', '3 pulso', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_3_pulso', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_3_pa')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_3_pa', '3 PA', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_3_pa', null, ['class' => 'form-control', 'min' => 0,'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_3_invol_uter')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_3_invol_uter', '3 invol uter', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_3_invol_uter', null, ['class' => 'form-control', 'min' => 0,'required']); ?>

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

			<div class="col-xs-2">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('puerperio_3_loquios')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('puerperio_3_loquios', '3 loquios', ['class' => 'col-xs-5 control-label']); ?>

					<div class="col-xs-7">
						<div class="input-group">
							<?php echo Form::number('puerperio_3_loquios', null, ['class' => 'form-control', 'min' => 0,'required']); ?>

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

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

			<div class="col-xs-6">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('notas_del_perpuerio')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('notas_del_perpuerio', 'Notas del perpuerio', ['class' => 'col-xs-4 control-label']); ?>

					<div class="col-xs-8">
						<?php echo Form::text('notas_del_perpuerio', null, ['class' => 'form-control','required']); ?>

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

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('egreso_rn_dia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('egreso_rn_dia', 'dia', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('egreso_rn_dia', null, ['class' => 'form-control', 'min' => 0,'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('egreso_rn_mes')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('egreso_rn_mes', 'mes', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('egreso_rn_mes', null, ['class' => 'form-control', 'min' => 0,'required']); ?>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('vivo'); ?> Vivo
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('vivo_despues_del_traslado'); ?> Vivo despues del traslado
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('fallece'); ?> Fallece
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('fallece_despues_del_traslado'); ?> Fallece despues del traslado
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('edad_dias_completos')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('edad_dias_completos', 'Edad dias completos', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('edad_dias_completos', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('edad_dias_completos_men_1_dia'); ?> Edad dias completos men 1 dia
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('lactancia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('lactancia', 'Lactancia', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('lactancia', [
							'' => '',
							'exclusiva' => 'exclusiva',
							'parcial' => 'parcial',
							'fórmula' => 'fórmula'
						], null, ['class' => 'form-control', 'required']); ?>

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

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('polio')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('polio', 'polio', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('polio', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('polio', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('bcg')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('bcg', 'BCG', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('bcg', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('bcg', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hepat_b')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hepat_b', 'Hepat.B', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hepat_b', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hepat_b', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('peso_al_egreso')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('peso_al_egreso', 'Peso al egreso', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('peso_al_egreso', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

							<span class="input-group-addon">g</span>
						</div>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('numero_unico_identificacion_personal')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('numero_unico_identificacion_personal', 'Número unico identificacion personal', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('numero_unico_identificacion_personal', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('nombre_del_recien_nacido')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('nombre_del_recien_nacido', 'Nombre del recién nacido', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('nombre_del_recien_nacido', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('responsable')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('responsable', 'responsable', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('responsable', null, ['class' => 'form-control', 'required']); ?>

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

		</div>
	</a>

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

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('egreso_rn_2_viva'); ?> Egreso rn 2 viva
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('egreso_rn_2_viva_despues_del_trasl'); ?> Egreso rn 2 viva despues del trasl
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('egreso_rn_2_fallece'); ?> Egreso rn 2 fallece
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="checkbox">
					<label>
						<?php echo Form::checkbox('egreso_rn_2_fallece_despues_del_trasl'); ?> Egreso rn 2 fallece despues del trasl
					</label>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('egreso_rn_2_dia')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('egreso_rn_2_dia', 'Egreso rn 2 dia', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('egreso_rn_2_dia', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('egreso_rn_2_mes')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('egreso_rn_2_mes', 'Egreso rn 2 mes', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<div class="input-group">
							<?php echo Form::number('egreso_rn_2_mes', null, ['class' => 'form-control', 'min' => 0, 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('egreso_rn_2_hora_postparto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('egreso_rn_2_hora_postparto', 'Egreso rn 2 hora postparto', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('egreso_rn_2_hora_postparto', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('antirubiola_postparto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('antirubiola_postparto', 'Antirubiola postparto', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('antirubiola_postparto', null, ['class' => 'form-control', 'required']); ?>

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

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('referida_posparto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('referida_posparto', 'Referida posparto?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('referida_posparto', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('referida_posparto', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('hemorragia_posparto')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('hemorragia_posparto', 'Hemorragia posparto?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hemorragia_posparto', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('hemorragia_posparto', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('infeccion_puerperal')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('infeccion_puerperal', 'Infección puerperal?', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('infeccion_puerperal', 1); ?>

							si
						</label>
					</div>
					<div class="col-xs-2">
						<label class="radio-inline">
							<?php echo Form::radio('infeccion_puerperal', 0, true); ?>

							no
						</label>
					</div>
				</div>
			</div>

			<div class="col-xs-4">
				<div class="form-group form-group-sm 
					'<?php if(count($errors)): ?> <?php if($errors->has('anticoncepcion')): ?> 
					<?php echo e('form-group has-error has-feedback'); ?> <?php endif; ?> <?php endif; ?>'">
					<?php echo Form::label('anticoncepcion', 'anticoncepción', ['class' => 'col-xs-6 control-label']); ?>

					<div class="col-xs-6">
						<?php echo Form::select('anticoncepcion', [
							'' => '',
							'no se informa' => 'no se informa',
							'referida' => 'referida',
							'barrera' => 'barrera',
							'DIU' => 'DIU',
							'hormonal' => 'hormonal',
							'ligadura tubarica' => 'ligadura tubarica',
							'lnatural' => 'lnatural',
							'otro' => 'otro'
						], null, ['class' => 'form-control','required']); ?>

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

			<div  style="display: none;">
				<div class="col-xs-4">
				<div class="form-group form-group-sm">
					<?php echo Form::label('peso_menor_2500_gr', 'Antirubiola postparto', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('peso_menor_2500_gr', 0, ['class' => 'form-control', 'required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm">
					<?php echo Form::label('termnacion', 'Antirubiola postparto', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('termnacion', 0, ['class' => 'form-control', 'required']); ?>

					</div>
				</div>
			</div>
			<div class="col-xs-4">
				<div class="form-group form-group-sm">
					<?php echo Form::label('hb_menor_14_sem', 'Antirubiola postparto', ['class' => 'col-xs-8 control-label']); ?>

					<div class="col-xs-4">
						<?php echo Form::text('hb_menor_14_sem', 0, ['class' => 'form-control', 'required']); ?>

					</div>
				</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">
						<?php echo Form::label('auto_carga', 'Auto Cargado', $consulta->detalle, ['class' => 'control-label']); ?>

						<?php echo Form::textarea('auto_carga', $consulta->detalle, ['class' => 'form-control', 'rows' => 8, 'maxlength' => 500,'disabled']); ?>

						<?php echo Form::hidden('auto_carga', $consulta->detalle); ?>

						
					</div>
				</div>
			</div>
		</div>
	</a>

	<?php if(isset($formulario)): ?> <?php /* Para poder ver y utilizar el form model */ ?>

		<?php echo $__env->make('componentes.lista-de-medicamentos', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
		<?php echo $__env->make('componentes.lista-de-procedimientos', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

		<?php echo Form::close(); ?>

	<?php elseif(isset($ultimoFormulario) || !isset($formulario)): ?>
		<?php echo $__env->make('componentes.modal-confirmar-registro-de-seguimineto', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

		<?php echo Form::hidden('paciente_id', $paciente); ?>

		<?php echo Form::hidden('programa', $programa); ?>


		<?php echo Form::close(); ?>


		<a class="list-group-item">
			<div class="row formulario-horizontal">
				<div class="col-xs-12 text-right">
					<?php echo $__env->make('componentes.boton-guardar-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
				</div>
			</div>
		</a>
	<?php endif; ?>

</div> <?php /* list group */ ?>

<?php /* Cargar los inputs tipo custom de fecha y hora cuando se solicita el formulario actual desde seguimiento o inscripción */ ?>
<?php echo $__env->make('componentes.script-cargar-inputs-fecha-hora-desde-seguimiento', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
