        
        <?php $__env->startSection('content'); ?>
        
        <!-- Content Wrapper. Contains page content -->
        
        <div class="content-wrapper">
        
        <!-- Content Header (Page header) -->
        
        <section class   = "content-header">
            
            <div class     = "container-fluid">
            
            <div class   = "row mb-2">
              
              <div class = "col-sm-6">
              
                <h1>  <a href="">  UD CASE REFERENCE (WB Form No - 5870)  </a> </h1>
              
              </div>
              
              <div class    = "col-sm-6">
              
                <ol class   = "breadcrumb float-sm-right">
              
                  <li class = "breadcrumb-item">    <a href = "#">  Home </a>    </li>
              
                  <li class = "breadcrumb-item active"> WB Form No - 5870 </li>
              
                </ol>
              
              </div>
              
            </div>
        
        </div> 
        
        <!-- /.container-fluid -->
         
        </section>
    
         <?php if(session('status')): ?>
        
         <div class="alert alert-success">
            <?php echo e(session('status')); ?>

         </div>
         <?php endif; ?>
    
         <section class = "content">
    
         <div class = "container-fluid">
    
         <div class = "row">
               
              <!-- left column -->
    
              <div class="col-md-12">
                
                <!-- jquery validation -->
    
                <div class = "card card-primary">
    
                <div class = "card-header">
                  
                    <h3 class = "card-title">Add FORM WB 5870 </h3>
                
                </div>
    
              <meta name="viewport" content="width=device-width, initial-scale=1">
    <style>
    .accordion {
      background-color: #33afff;
      color: #fdfdfd;
      cursor: pointer;
      padding: 18px;
      width: 100%;
      border: none;
      text-align: left;
      outline: none;
      font-size: 15px;
      transition: 0.4s;
    }
    
    .active, .accordion:hover {
      background-color: #ccc; 
    }
    
    .panel {
      padding: 0 18px;
      display: none;
      background-color: white;
      overflow: hidden;
    }
    </style>
    </head>
    <body>
    
    <h2></h2>
    
    <button class="accordion">UD Case Reference</button>
    <div class="panel">
     
     <div class="container">
      <div class="row">
          
        <form action = "<?php echo e(url('save_5870')); ?>"  method = "post" > 
       
        <?php echo csrf_field(); ?>
        <div class="col-md-4">
        
            <label for="exampleFormControlInput1" class="form-label"> PS </label>
         
        <input type="hidden" name = "form5371_id" value = "<?php echo e($id); ?>" > 
        
          <input type="text" name="ps" value="<?php echo e($case_no[0]['psname']); ?>" disabled>
    
        </div>
        
        <div class="col-md-4">
         
         <label for="exampleFormControlInput1" class="form-label">  Case No </label>
         
         <input type="TEXT" class="form-control" name="case_no"  value  = "<?php echo e($case_no[0]['ud_case_no']); ?>" required placeholder="Case no"  readonly >
        
        </div>
        
        <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">  Date  </label>
            <input type="date" class="form-control" name = "ud_case_date" id="exampleFormControlInput1" required placeholder="Case no">
        </div>
        
        <div class="col-md-4">
         <label for="exampleFormControlInput1" class="form-label">   Name of IO / EO  </label>
        
            <select class="form-select" name = "ud_name_of_io" aria-label="Default select example" required>
        
                <option selected>Select IO / EO</option>
                <?php $__currentLoopData = $AllInvestigation_Offc; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $AllInvestigation_Officers): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
               
                <option value="<?php echo e($AllInvestigation_Officers['id']); ?>"><?php echo e($AllInvestigation_Officers['name']); ?></option>
               
               <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
        
            </select>
        </div>
        
      </div>
    </div>
    
     
     </div>
    
    <button class="accordion">Details Of Informant </button>
    <div class="panel">
      <div class="container">
      <div class="row">
          
        <div class="col-md-4">
         
         <label for="exampleFormControlInput1" class="form-label">  Name </label>
         <input type="TEXT" class="form-control" name = "infoman_name" id="exampleFormControlInput1" required placeholder="Name">
        
        </div>
        
        <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">  Gender  </label>
            
             <select class="form-select" name ="infoman_gend" aria-label="Default select example">
        
                <option selected>Select Gender </option>
                <option value="Male"> Male</option>
                <option value="Female"> Female</option>
                <option value="Transgender"> Transgender</option>
               
            </select>
            
        </div>
        
         <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">  Address  </label>
             <textarea class="form-control" name = "infoman_address"  id=""  required rows="3"></textarea>
    
        </div>
    
      </div>
    </div>
     </div>
    
    <button class="accordion">Details Of Deceased </button>
    <div class="panel">
     <div class="container">
      <div class="row">
        
        <div class="col-md-4">
        
            <label for="exampleFormControlInput1" class="form-label"> Select Body Type  </label>
        
            <select class="form-select" name="decease_body_type" required aria-label="Default select example">
        
                <option selected>Select Body Type </option>
                <option value="Identified">Identified</option>
                <option value="Un-identified">Un-identified</option>
               
            </select>
    
        </div>
        
        <div class="col-md-4">
         
         <label for="exampleFormControlInput1" class="form-label">  Name </label>
         
         <input type="TEXT" class="form-control" name = "decease_name" id="exampleFormControlInput1" placeholder="Name" value="<?php echo e($case_no[0]['name_deceased']); ?>">
        
        </div>
        
        <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">  Address  </label>
            <input type="text" class="form-control" name = "decease_add" id="exampleFormControlInput1" value="<?php echo e($case_no[0]['residence']); ?>" placeholder="Address">
        </div>
        
        <div class="col-md-4">
         
        <label for="exampleFormControlInput1" class="form-label">  Age </label>
        
            <select class="form-select" name ="decease_age" aria-label="">
        
                <option selected>Select AGE </option>
               
                <?php for($i=1;$i<=100;$i++){?>
                
                    <option value = "<?php echo $i;?>" > <?php echo $i;?> </option>
               
                <?php }?>
               
            </select>
            
        </div>
        
         <div class="col-md-4">
        
         <label for="exampleFormControlInput1" class="form-label">  Gender</label>
        
        <input type="text" value="<?php echo e($case_no[0]['sex_gender']); ?>" name="decease_gend" > 
            
        </div>
        
        <div class="col-md-4">
             
         <label for="exampleFormControlInput1" class="form-label"> Marks Of Identification </label>
        
            <input type="text" class="form-control" name = "marks_ident" required id="exampleFormControlInput1" placeholder="Marks Of Identification">
        
        </div>
        
        <div class="col-md-4">
           
            <label for="exampleFormControlInput1" class="form-label"> Complexion </label>
        
            <input type="text" class="form-control" name = "marks_complexion" required id="exampleFormControlInput1" placeholder="Complexion ">
        
        </div>
        
        <div class="col-md-4">
        
            <label for  = "exampleFormControlInput1" class="form-label">  Wearing Apparels </label>
        
            <input type = "text" class="form-control" name = "marks_wearing" required  id="exampleFormControlInput1" placeholder="Wearing Apparels  ">
        
        </div>
    
      </div>
    </div>

     </div>
    
    <button class="accordion">Details Of Dead Body Challan</button>
    <div class="panel">
     
     <div class="container">
      <div class="row">
          
        <div class="col-md-4">
         
         <label for="exampleFormControlInput1" class="form-label">  Challan No  </label>
         <input type="TEXT" class="form-control" name = "dead_body_challan" required id="exampleFormControlInput1" placeholder="Challan No">
        
        </div>
        
        <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">  Date  </label>
            <input type="date" name = "dead_body_found_date" class="form-control" required id="exampleFormControlInput1" placeholder="Date">
        </div>
        
        <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">  Time  </label>
            <input type="text" name = "dead_body_found_time"  class="form-control" required id="exampleFormControlInput1" value = "<?php echo e($case_no[0]['where_body_found_time']); ?>" placeholder="Time">
        </div>
        
         <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">  Where Body Was Found  </label>
             <textarea class="form-control" name = "dead_body_found_place"  required id="exampleFormControlTextarea1" rows="3" placeholder="Where Body Was Found "><?php echo e($case_no[0]['where_body_found']); ?></textarea>
        </div>
        
      </div>
    </div>
    </div>
    
    <button class = "accordion">Details Of PM Examination </button>
    
    <div class = "panel">
    <div class="container">
      <div class="row">
        <div class="col-md-4">
         <label for="exampleFormControlInput1" class="form-label">  Hospital Name  </label>
        
              <select class = "form-select" name = "pm_exm_hospital" required aria-label = "Default select example">
        
                <option selected>Select Hospital </option>
               
                 <?php $__currentLoopData = $AllHospital; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $AllHospitals): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
               
                    <option value="<?php echo e($AllHospitals['id']); ?>"><?php echo e($AllHospitals['hospital_name']); ?></option>
                
                 <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
              
              </select>
            
        </div>
        
        <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label"> PME No </label>
            <input type="text" class="form-control" name = "pm_exm_pme_no" required  id="exampleFormControlInput1" placeholder="PME No ">
        </div>
        
        <div class="col-md-4">
            
            <label for="exampleFormControlInput1" class="form-label">  Name Of Autopsy Surgeon   </label>
            
             <select class="form-select" name = "pm_exm_autopsy_surgeon" required aria-label="Default select example">
        
                <option >Select Autopsy Surgeon </option>
               
                <?php $__currentLoopData = $allSurgeon; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $autopsySurgeon): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
               
                <option value="<?php echo e($autopsySurgeon['id']); ?>"><?php echo e($autopsySurgeon['doctor_name']); ?></option>
               
               <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
               
            </select>
            
        </div>
        
        <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label"> Date of Examination </label>
            <input type="date" class="form-control" name = "pm_exm_date_examine" required id="" placeholder="Date of Examination  ">
        </div>
        
        
         <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">  Time of Examination </label>
            <input type="text" class="form-control" name = "pm_exm_time_examine" required id="" placeholder=" Time of Examination  ">
        </div>
        
         <div class="col-md-4">
             
            <label for="exampleFormControlInput1" class="form-label"> Place Of Death </label>
             <textarea class="form-control" name="pm_exe_autopsy_place_death" required id="" rows="3" placeholder="Place Of Death"></textarea>
    
        </div>
        
           <div class = "col-md-4">
            
           <label for = "exampleFormControlInput1" class="form-label"> Cause Of Death </label>
            
           <select class = "form-select" name="pm_exe_cause_death" required aria-label="Default select example">
        
                <option selected>Select Cause</option>
                <option value="Homicide">Homicide</option>
                <option value="Suicide">Suicide</option>
                <option value="Accident">Accident</option>
                <option value="Not Known">Not Known</option>
        
            </select>
            
        </div>
        
         <div class = "col-md-4">
            
           <label for = "exampleFormControlInput1" class="form-label"> Videography Done </label>
            
           <select class = "form-select"  name = "pm_exe_videography" required aria-label="Default select example">
        
                <option selected>Select Videography Done</option>
                <option value="Yes">Yes</option>
                <option value="No">No</option>
               
            </select>
            
        </div>
        
         <div class = "col-md-4">
            
           <label for = "exampleFormControlInput1" class="form-label"> PM Done In Presence Of Family  </label>
            
           <select class = "form-select" name = "pm_exe_done_pres_fam" required aria-label="Default select example">
        
                <option selected>Select PM Done In Presence Of Family </option>
                <option value="Yes">Yes</option>
                <option value="No">No</option>
               
            </select>
            
        </div>
        
         <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label"> Name Of The Family Member </label>
            <input type="text" class="form-control"  required name = "pm_exe_name_family" id="exampleFormControlInput1" placeholder="Name Of The Family Member ">
        </div>
        
        <div class="col-md-4">
            
            <label for="exampleFormControlInput1" class="form-label"> Gender </label>
            
             <select class="form-select" name = "pm_exe_gender" required aria-label="Default select example">
        
                <option selected>Select Gender</option>
                <option value="Male">Male</option>
                <option value="Female">Female</option>
                <option value="Transgender">Transgender</option>
               
            </select>
        
        </div>
        
        <div class="col-md-4">
            
            <label for="exampleFormControlInput1" class="form-label"> Relation With The Dead Body     </label>
            
            <input type="text" class="form-control" required name = "pm_exe_relation_with_body" id="exampleFormControlInput1" placeholder="Relation With The Dead Body ">
         
        </div>
        
          <div class="col-md-4">
            
            <label for="exampleFormControlInput1" class="form-label"> Ph. No   </label>
            
            <input type="text" class="form-control" required name = "pm_exe_ph_no" id="exampleFormControlInput1" placeholder="Ph. No  ">
         
        </div>
        
        
        
      </div>
      
    </div>

    </div>
    
    <button class="accordion">Details Of Investigation / Enquiry Report  </button>
    
    <div class="panel">
    
     <div class="container">
      <div class="row">
          
        <div class="col-md-4">
         
         <label for="exampleFormControlInput1" class="form-label">  Date Of PO Visit By IO / IE</label>
         <input type="date" class="form-control" required name="invest_date_po_visit_date" id="exampleFormControlInput1" 
        placeholder="Date Of PO Visit By IO / IE">
        
        </div>
        
         <div class="col-md-4">
         
         <label for="exampleFormControlInput1" class="form-label"> Time Of PO Visit By IO / IE</label>
         <input type="text" class="form-control" required name="invest_time_po_visit" id="exampleFormControlInput1" 
        placeholder="Time Of PO Visit By IO / IE">
        
        </div>
        
        
        <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">  IO / IE Name  </label>
            
            <select class="form-select" name="invest_io_ie" required aria-label="Default select example">
        
                <option selected>Select IO / IE</option>
                
                 <?php $__currentLoopData = $AllInvestigation_Offc; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $AllInvestigation_Officers): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
               
                <option value="<?php echo e($AllInvestigation_Officers['id']); ?>"><?php echo e($AllInvestigation_Officers['name']); ?></option>
               
               <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
        
            </select>
        </div>
        
        <div class="col-md-4">
            
            <label for="exampleFormControlInput1" class="form-label"> Date Of Final Report </label>
            <input type="date" class="form-control" required name = "invest_final_report_date" id="invest_final_report_date" placeholder="Date Of Final Report">
            
        </div> 
        
        <div class="col-md-4">
            
            <label for="exampleFormControlInput1" class="form-label"> Time Of Final Report </label>
            <input type="text" class="form-control" required name = "invest_final_report_time" id="invest_final_report_time" placeholder=" Time Of Final Report">
            
        </div>
        
         <div class="col-md-4">
            
            <label for="exampleFormControlInput1" class="form-label">   Result Of UD Case  </label>
            
             <select class="form-select" name = "invest_result_ud_case" required aria-label="Default select example">
        
                <option value ="" >Select Result Of UD Case </option>
                <option value="Filled">Filled</option>
                <option value="Specific Cases Started">Specific Cases Started</option>
                <option value="Pending">Pending</option>
        
            </select>
        
        </div>
        
        <div class="col-md-4">
        
            <label for="exampleFormControlInput1" class="form-label">  Remarks  </label>
        
             <textarea class="form-control" name = "invest_remarks" id="exampleFormControlTextarea1" rows="3" placeholder="Remarks "></textarea>
    
        </div>
    
      </div>
    </div>
    
    </div>
    
    <button class="accordion"> Disposal Of Dead Body   </button>
    
    <div class="panel">
    
       <div class="container">
      <div class="row">
          <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">   Current Status   </label>
             <select class="form-select" name = "disposal_current_status" required aria-label="Default select example">
        
                <option selected>Select Current Status</option>
                <option value="Handed Over To Family">Handed Over To Family</option>
                <option value="Sent To Morque ">Sent To Morque </option>
               
            </select>
        </div>
        
         <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label"> Morque Status    </label>
            
             <select class="form-select"  name="disposal_morque_status" aria-label="Default select example" required>
        
                <option selected>Select Morque Status </option>
                <option value="Disposed By Morque ">Disposed By Morque </option>
                <option value="Not Yet Disposed By Morque">Not Yet Disposed By Morque </option>
               
            </select>
            
        </div>
        
        <div class="col-md-4">
            <label for="exampleFormControlInput1" class="form-label">  Remarks  </label>
             <textarea class="form-control" name="disposal_dead_remarks" rows="3" required placeholder="Remarks "><?php echo e($case_no[0]['remarks']); ?></textarea>
    
        </div>
    
        <div class="col-md-4">
            
             <input type="submit" class="btn btn-primary" name = "submit"  value="Submit" >
             
        </div>

        </form>
    
      </div>
      
    </div>
    
    </div>
    
    <script>
    
    var acc = document.getElementsByClassName("accordion");
    var i;
    
    for (i = 0; i < acc.length; i++) {
      acc[i].addEventListener("click", function() {
        this.classList.toggle("active");
        var panel = this.nextElementSibling;
        if (panel.style.display === "block") {
          panel.style.display = "none";
        } else {
          panel.style.display = "block";
        }
      });
    }
    
    </script>
    
    </div>
                
    <!-- /.card -->
    
    </div>
    
    <!--/.col (left) -->
    <!-- right column -->
    
    <div class = "col-md-6">
    
    </div>
    
    <!--/.col (right) -->
    
    </div>
    
    <!-- /.row -->
    
    </div>

          <!-- /.container-fluid -->
        
        </section>
        
        <!-- /.content -->
      
      
      </div>
      
      <!-- /.content-wrapper -->
      
      <?php $__env->stopSection(); ?>

<?php echo $__env->make('layouts.main', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH /home/hpinfome/public_html/mirs/resources/views/layouts/wb_5870.blade.php ENDPATH**/ ?>