{!! Form::numeric('id')->label(trans('clinical_incident::clinical_incident.label.id'))->placeholder('< auto generated>')->addGroupClass('form-group-sm')->disabled() !!}
@if (@$clinical_incident->id)
{!! Form::date('created_at')->label(trans('Ref Date'))->addGroupClass('form-group-sm') !!}
@endif
{!! Form::select('division_id')->options([])->label(trans('assets::asset.label.division_id'))->placeholder(trans('assets::asset.placeholder.division_id'))->addGroupClass('form-group-sm') !!}
{!! Form::date('incident_date')->addClass('datepick')->label('Incident Date')->required()->placeholder('Incident Date')->addGroupClass('form-group-sm') !!}
{!! Form::text('incident_time')->label('Time')->required()->placeholder('Time')->addGroupClass('form-group-sm') !!}
{!! Form::hidden('company_id')->id('company_id')->value(user('admin.web')->current_comp) !!}
@if (@$clinical_incident->user_id)
{!! Form::hidden('user_id')->id('user_id')->value(@$clinical_incident->user_id) !!}
@else
{!! Form::hidden('user_id')->id('user_id')->value(user('admin.web')->id) !!}
@endif
{!! Form::select('incident_severity')->options(trans('clinical_incident::clinical_incident.options.incident_severity'))->label('Incident Severity')->placeholder('Incident Severity')->required()->addGroupClass('form-group-sm') !!}
{!! Form::select('event_type')->options(trans('clinical_incident::clinical_incident.options.event_type'))->label('Event Type')->required()->addGroupClass('form-group-sm') !!}
{!! Form::textarea('damagedetails')->row(2)->addGroupClass('form-group-sm')->required()->label(trans('Description of Incidence'))->placeholder(trans('Description of Incidence')) !!}
{{--
{!! Form::select('adverse_event')->options(ClinicalIncident::adverseEvent())->addGroupClass('form-group-sm')->label(trans('Adverse Event'))->placeholder(trans('Adverse Event')) !!}
--}}
{!! Form::select('nearmiss_event')->options(ClinicalIncident::nearMissEvent())->addGroupClass('form-group-sm')->label(trans('Nearmiss Event'))->placeholder(trans('Nearmiss Event')) !!}
{{--
{!! Form::select('sentinel_event')->options(ClinicalIncident::SentinelEvent())->addGroupClass('form-group-sm')->label(trans('Sentinel Event'))->placeholder(trans('Sentinel Event')) !!}
--}}
{!! Form::hidden('regional_head_email')->addGroupClass('form-group-sm')->label(trans('Regional Head Email'))->placeholder(trans('Regional Head Email')) !!}
{!! Form::text('escalate_email_ids')->addGroupClass('form-group-sm')->label(trans('Escalate To'))->placeholder(trans('Escalate To')) !!}
@if (user('admin.web')->canDo('clinical_incident.clinical_incident.first_level_approval') &&
!user('admin.web')->canDo('clinical_incident.clinical_incident.second_level_approval') || user('admin.web')->isSuperUser())
{!! Form::select('incident_status')->id('incident_status_f')->options(trans('clinical_incident::clinical_incident.options.status_level1'))->label('Status')->disabled($clinical_incident->id == '' || $clinical_incident->incident_status == 'Closed' ? true : false)->required()->addGroupClass('form-group-sm') !!}
@endif
@if (user('admin.web')->canDo('clinical_incident.clinical_incident.second_level_approval') || user('admin.web')->isSuperUser())
{!! Form::select('incident_status')->id('incident_status_s')->options(trans('clinical_incident::clinical_incident.options.status_level2'))->label('Status')->disabled($clinical_incident->id == '' || $clinical_incident->incident_status == 'Closed' ? true : false)->required()->addGroupClass('form-group-sm') !!}
@endif
{!! Form::date('statusdate')->label(trans('Status Date'))->disabled()->addGroupClass('form-group-sm') !!}
{!! Form::text('closed_time')->label('Status Time')->disabled()->placeholder('Status Time')->addGroupClass('form-group-sm') !!}
{!! Form::select('reporting_sector_id')->id('reporting_sector_id')->select(@$clinical_incident->clinicalDetails->reporting_sector_id ?: 0)->options(['' => 'Select'] + ClinicalIncident::reportingSector())->addGroupClass('form-group-sm')->label(trans('Reporting Sector'))->placeholder(trans('Reporting Sector')) !!}
{!! Form::text('location')->id('location')->addGroupClass('form-group-sm')->label(trans('Location'))->placeholder(trans('Location')) !!}
{!! Form::select('reporter_id')->select(@$clinical_incident->clinicalDetails->reporter_id ?: 0)->options(['' => 'Select'] + ClinicalIncident::reporter())->addGroupClass('form-group-sm')->label(trans('Reporter'))->placeholder(trans('Reporter')) !!}
{!! Form::select('responsibility_of_incidence')->id('responsibility')->options(
trans('clinical_incident::clinical_incident.options.responsibility_of_incidence'),
@$clinical_incident->clinicalDetails->responsibility_of_incidence,
)->label('Responsibility of Incidence')->placeholder('Responsibility of Incidence')->addGroupClass('form-group-sm') !!}
{!! Form::select('level_of_incidence_management')->id('level_of_incidence')->options(
trans('clinical_incident::clinical_incident.options.level_of_incidence_management'),
@$clinical_incident->clinicalDetails->level_of_incidence_management,
)->label('Level of Incidence management')->placeholder('Level of Incidence management')->addGroupClass('form-group-sm') !!}
{!! Form::select('level_of_sample_management')->options(
trans('clinical_incident::clinical_incident.options.level_of_sample_management'),
@$clinical_incident->clinicalDetails->level_of_sample_management,
)->label('Level of Sample Management')->placeholder('Level of Sample Management')->addGroupClass('form-group-sm') !!}
{!! Form::select('incidence_triggers')->options(
trans('clinical_incident::clinical_incident.options.incidence_triggers'),
@$clinical_incident->clinicalDetails->incidence_triggers,
)->label('Incidence Triggers')->placeholder('Incidence Triggers')->addGroupClass('form-group-sm') !!}
@if (@$clinical_incident->incident_status == 'Closed')
{!! Form::textarea('root_cause')->required()->id('root_cause')->row(2)->addGroupClass('form-group-sm')->label(trans('Root Cause Analysis for the incidence'))->placeholder(trans('Root Cause Analysis for the incidence')) !!}
@else
{!! Form::textarea('root_cause')->id('root_cause')->row(2)->addGroupClass('form-group-sm')->label(trans('Root Cause Analysis for the incidence'))->placeholder(trans('Root Cause Analysis for the incidence')) !!}
@endif
@if (@$clinical_incident->incident_status == 'Closed')
{!! Form::textarea('corrective_action')->id('action')->disabled(
@$clinical_incident->id == null ||
$clinical_incident->incident_status == 'Pending' ||
$clinical_incident->incident_status == 'Closed'
? true
: false,
)->required()->label(trans('Corrective Action'))->addGroupClass('form-group-sm')->placeholder(trans('Corrective Action')) !!}
@else
{!! Form::textarea('corrective_action')->id('action')->disabled(
@$clinical_incident->id == null ||
$clinical_incident->incident_status == 'Pending' ||
$clinical_incident->incident_status == 'Closed'
? true
: false,
)->label(trans('Corrective Action'))->addGroupClass('form-group-sm')->placeholder(trans('Corrective Action')) !!}
@endif
Please Upload Image
{!! $clinical_incident->fileUpload('image')->view('facility_inspection::admin.facility_inspection.filer.uploader') !!}
{!! $clinical_incident->fileEdit('image')->view('facility_inspection::admin.facility_inspection.filer.editor') !!}
{!! Form::hidden('company_id')->id('company_id')->value(user('admin.web')->current_comp) !!}
MEDICATION ERROR
{!! Form::inline_checkboxes('medication_error[]')->checkboxes(trans('clinical_incident::clinical_incident.options.medication_error'))->label(false)->addGroupClass('form-group-sm')->addGroupClass('type_of_incident')->addGroupClass('medication_error')->inline() !!}
{!! Form::text('drug_name')->addGroupClass('form-group-sm')->label(trans('Drug Name'))->placeholder(trans('Drug Name'))->value(@$clinical_incident->clinicalDetails->drug_name) !!}
{!! Form::date('drug_date')->id('drug_date')->label(trans('Drug EXP.Date'))->addGroupClass('form-group-sm')->value(@$clinical_incident->clinicalDetails->drug_date) !!}
{!! Form::textarea('medication_error_remark')->value(@$clinical_incident->clinicalDetails->medication_error_remark)->addGroupClass('form-group-sm')->label(trans('Others (Specify)'))->placeholder(trans('Others (Specify)')) !!}
TYPE OF INCIDENT: FALL
{!! Form::inline_checkboxes('type_of_incident_fall[]')->checkboxes(trans('clinical_incident::clinical_incident.options.type_of_incident_fall'))->label(false)->addGroupClass('form-group-sm')->addGroupClass('type_of_incident')->inline() !!}
{!! Form::textarea('previous_history')->value(@$clinical_incident->clinicalDetails->previous_history)->addGroupClass('form-group-sm')->label(trans('Previous History of fall, if any'))->placeholder(trans('Previous History of fall, if any')) !!}
*If yes, then please specify the below:
Type of Error
Ordered
Administered
Effects
{!! Form::text('type_of_error_level_1')->id('type_of_error_level_1')->value(@$clinical_incident->errorTypeDetails->type_of_error_level_1)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Type of Error')) !!}
{!! Form::text('ordered_level_1')->id('ordered_level_1')->value(@$clinical_incident->errorTypeDetails->ordered_level_1)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Ordered')) !!}
{!! Form::text('administered_level_1')->id('administered_level_1')->value(@$clinical_incident->errorTypeDetails->administered_level_1)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Administered')) !!}
{!! Form::text('effects_level_1')->id('effects_level_1')->value(@$clinical_incident->errorTypeDetails->effects_level_1)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Effects')) !!}
{!! Form::text('type_of_error_level_2')->id('type_of_error_level_2')->value(@$clinical_incident->errorTypeDetails->type_of_error_level_2)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Type of Error')) !!}
{!! Form::text('ordered_level_2')->id('ordered_level_2')->value(@$clinical_incident->errorTypeDetails->ordered_level_2)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Ordered')) !!}
{!! Form::text('administered_level_2')->id('administered_level_2')->value(@$clinical_incident->errorTypeDetails->administered_level_2)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Administered')) !!}
{!! Form::text('effects_level_2')->id('effects_level_2')->value(@$clinical_incident->errorTypeDetails->effects_level_2)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Effects')) !!}
{!! Form::text('type_of_error_level_3')->id('type_of_error_level_3')->value(@$clinical_incident->errorTypeDetails->type_of_error_level_3)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Type of Error')) !!}
{!! Form::text('ordered_level_3')->id('ordered_level_3')->value(@$clinical_incident->errorTypeDetails->ordered_level_3)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Ordered')) !!}
{!! Form::text('administered_level_3')->id('administered_level_3')->value(@$clinical_incident->errorTypeDetails->administered_level_3)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Administered')) !!}
{!! Form::text('effects_level_3')->id('effects_level_3')->value(@$clinical_incident->errorTypeDetails->effects_level_3)->addGroupClass('form-group-sm')->label(false)->placeholder(trans('Effects')) !!}
TYPE OF INCIDENT: SECURITY RELATED
{!! Form::inline_checkboxes('type_security_related[]')->checkboxes(trans('clinical_incident::clinical_incident.options.type_security_related'))->label(false)->addGroupClass('form-group-sm')->addGroupClass('type_of_incident')->inline() !!}
{!! Form::textarea('security_related_remark')->value(@$clinical_incident->clinicalDetails->security_related_remark)->addGroupClass('form-group-sm')->label(trans('Others (Specify)'))->placeholder(trans('Others (Specify)')) !!}
TYPE OF INCIDENT: EQUIPMENT RELATED
{!! Form::inline_checkboxes('equipment_related[]')->checkboxes(trans('clinical_incident::clinical_incident.options.equipment_related'))->label(false)->addGroupClass('form-group-sm')->addGroupClass('type_of_incident')->inline() !!}
{!! Form::textarea('equipment_related_remark')->value(@$clinical_incident->clinicalDetails->equipment_related_remark)->addGroupClass('form-group-sm')->label(trans('Others (Specify)'))->placeholder(trans('Others (Specify)')) !!}
TYPE OF INCIDENT: OTHERS
{!! Form::inline_checkboxes('type_of_incident_others[]')->checkboxes(trans('clinical_incident::clinical_incident.options.type_of_incident_others'))->label(false)->addGroupClass('form-group-sm')->addGroupClass('type_of_incident')->inline() !!}
{!! Form::textarea('others_remark')->value(@$clinical_incident->clinicalDetails->others_remark)->addGroupClass('form-group-sm')->label(trans('Others (Specify)'))->placeholder(trans('Others (Specify)')) !!}