
{% extends "doctor_base.html" %}
{% load static %}


{% block content %}
	<div class="section section-custom billinfo"> 
		<!--section-title -->
		<h2>Add Prescription</h2><!--section-title end -->
		<!-- section content start-->
		<div class="pmd-card pmd-z-depth">
			<div class="pmd-card-body">	
				<form class="form-horizontal" role="form" action="{% url 'saveprescriptionmedicine' %}" method="POST">
				{% csrf_token %}
					<div class="form-group pmd-textfield pb-5">       
						<label for="dropdown" class="col-sm-2 control-label">Medicine</label>
							<div class="col-sm-10">
								<select class="select-simple form-control pmd-select2" id="dropdown" name="medicine">
									<option></option>
									{% for i in data %}
										<option>{{ i.name }}</option>
									{% endfor %}
								</select>
							</div>
					</div>
					
					<div class="form-group pmd-textfield">
						<label for="inputEmail3" class="col-sm-2 control-label">Dosage</label>
						<div class="col-sm-10">
							<input class="form-control input-sm" id="inputEmail3" placeholder="Doasage" name="dose" type="text">
						</div>
					</div>
					<div class="form-group pmd-textfield">
						<label for="inputPassword3" class="col-sm-2 control-label">Days</label>
						<div class="col-sm-10">

							<div class="fg-line">
								<input class="form-control input-sm" id="inputPassword3" placeholder="Days" name="day" type="day">
							</div>
						</div>
					</div>
					<input type="hidden" name="prescriptid" value="{{ prescript }}">
					<div class="form-group">
						<div class="col-sm-offset-2 col-sm-10">
							<button type="submit" class="btn btn-danger pmd-ripple-effect" id="btn">Submit</button>
						</div>
					</div>
				</form>
			</div>
		</div> <!-- section content end -->  
	</div>
{% endblock content %}


