extend($_SESSION['userrole'].'/layout/form.php') ?> section('content') ?> get('usercityid'); if ($usercityid == 1) { $placeholdervisitnumber = "placeholder='BV........'"; $locationdropdown = " "; } else if ($usercityid == 2){ $placeholdervisitnumber = "placeholder='SV........'"; $locationdropdown = " "; } ?>

Order Creation

Patient Information

MR#
Patient Name
BirthDate
Sex
Address
Phone#

Order Information

Visit#	id="visitnumber" class="form-control form-control-sm" oninput="this.value = this.value.toUpperCase();">	Visit Date
Location
Payer Name

Tests

MR#	:
Patient Name	:
BirthDate	:
Sex	:
Address	:
Phone	:

endSection() ?> section('script') ?> endSection() ?>