<div class="tab-pane active p-t-20 clearfix" id="details">
    <div class='col-md-6 col-lg-3'>

        @if (!$referral_patient->id)
            {!! Form::select('division_id')->required()->options(Company::divisions(), user('admin.web')->division_id)->value($referral_clinic->division_id)->label(trans('referral_clinic::referral_patient.label.division_id'))->placeholder(trans('referral_clinic::referral_patient.placeholder.division_id'))->addGroupClass('form-group-sm') !!}
        @else
            {!! Form::select('division_id')->required()->options(Company::divisions(), $referral->division_id)->value($referral_clinic->division_id)->label(trans('referral_clinic::referral_patient.label.division_id'))->placeholder(trans('referral_clinic::referral_patient.placeholder.division_id'))->addGroupClass('form-group-sm') !!}
        @endif

        {!! Form::select('referral_clinic_id')->id('referral_clinic_id')->required()->options(ReferralClinic::referral_Clinic())->label(trans('referral_clinic::referral_patient.label.referral_clinic_id'))->placeholder(trans('referral_clinic::referral_patient.placeholder.referral_clinic_id'))->addGroupClass('form-group-sm') !!}

        {!! Form::select('doctor_department_id')->required()->options(ReferralClinic::doctor_departments())->label(trans('referral_clinic::referral_patient.label.doctor_department_id'))->placeholder(trans('referral_clinic::referral_patient.placeholder.doctor_department_id'))->addGroupClass('form-group-sm') !!}

        {!! Form::select('referral_doctor_id')->id('referral_doctor_id')->required()->options(ReferralClinic::doctor())->label(trans('referral_clinic::referral_patient.label.referral_doctor_id'))->placeholder(trans('referral_clinic::referral_patient.placeholder.referral_doctor_id'))->addGroupClass('form-group-sm') !!}

        {!! Form::date('referral_date')->addClass('datepick')->label('Referral Date')->placeholder('Select Date')->addGroupClass('form-group-sm')->required() !!}

    </div>
    <div class='col-md-6 col-lg-3'>

        {!! Form::text('patient_name')->required()->label(trans('referral_clinic::referral_patient.label.patient_name'))->placeholder(trans('referral_clinic::referral_patient.placeholder.patient_name'))->addGroupClass('form-group-sm') !!}

        {!! Form::text('op_no')->required()->label(trans('referral_clinic::referral_patient.label.op_no'))->placeholder(trans('referral_clinic::referral_patient.placeholder.op_no'))->addGroupClass('form-group-sm') !!}

        {!! Form::select('destination_department_id')->required()->options(ReferralClinic::doctor_departments())->label(trans('referral_clinic::referral_patient.label.destination_department_id'))->placeholder(trans('referral_clinic::referral_patient.placeholder.destination_department_id'))->addGroupClass('form-group-sm') !!}

        {!! Form::textarea('remarks')->label(trans('referral_clinic::referral_patient.label.remarks'))->placeholder(trans('referral_clinic::referral_patient.placeholder.remarks'))->addGroupClass('form-group-sm') !!}

    </div>
    <div class='col-md-6 col-lg-3'>