<form class="row g-3 auto-width create_death_register" id="create_death_register_form" enctype='multipart/form-data' action="{{route('death-registers-account-store', $ipd_admission_id) }}">
    @csrf
    @method('POST')
    <!--  @if(!$ipd_admission_id)
    <div class="col-md-6">
        <div>
            <label for="ipd_case_id" class="form-label"> Case ID  <span class="text-danger"><b>*</b></span></label>
                <input type="text" class="form-control" id="ipd_case_id" name="ipd_case_id" placeholder=" Case ID" value="">
                
        </div>
    </div>
    @endif -->
 
    <div class="col-md-6">
        <div>
            <label for="death_date" class="form-label"> Death Date </label>
            <input type="date" class="form-control" id="death_date" name="death_date" placeholder="Death Date">
        </div>
    </div>
    <div class="col-md-6">
        <div>
            <label for="death_time" class="form-label"> Death Time </label>
            <input type="time" class="form-control" id="death_time" name="death_time" placeholder="Death Time">
        </div>
    </div>
    <div class="col-md-6">
        <div>
            <label for="guardian_name" class="form-label"> Guardian Name </label>
            <input type="text" class="form-control" id="guardian_name" name="guardian_name" placeholder="Guardian Name">
        </div>
    </div>

    @if(!$ipd_admission_id)
    <div class="col-md-6">
        <label for="gender_id" class="form-label"> Gender </label>
        <select class="form-control" name="gender_id" id="gender_id" required>
            <option value="">Select Gender</option>
            @foreach($genders as $gender)
                <option value="{{ $gender->id }}">{{ $gender->name }}</option>
            @endforeach
        </select>
    </div>
    @endif


    <div class="col-md-6">
        <div>
            <label for="attachment_name" class="form-label">Attachment</label>
            <input type="file" class="form-control" id="attachment_name" name="attachment_name">
        </div>
    </div>
    <div class="col-md-6">
        <div>
            <label for="death_report" class="form-label"> Report </label>
            <input type="text" class="form-control" id="death_report" name="death_report" placeholder="Report">
        </div>
    </div>

    <div class="col-md-6">
        <div>
            <label for="file_url" class="form-label"> File Url </label>
            <input type="text" class="form-control" id="file_url" name="file_url" placeholder="Report">
        </div>
    </div>
</form>

<script src="https://cdnjs.cloudflare.com/ajax/libs/intl-tel-input/12.1.10/js/intlTelInput.js"></script>
<script type="text/javascript" src="{{ asset('admin/plugins/datepicker/js/bootstrap-datepicker.js') }}"></script>
<script src="{!! asset('admin/js/accounts.js') !!}"></script>
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script>
<script src="https://cdn.jsdelivr.net/npm/flatpickr"></script>

