
<div class="page-content-wrapper">
    <div class="page-content">
        <div class="row">
            <div class="col-md-12">
                <!-- BEGIN EXAMPLE TABLE PORTLET-->
                <div class="portlet box blue">
                    <div class="portlet-title">
                        <div class="caption">
                            <i class="fa fa-user"></i>instruction
                        </div>
                    </div>
                    <div class="portlet-body">

                        <!--Begin Semen-->

                        <div class="row">


                            <div class="portlet-title tbox">
                                <div class="caption font-blue-haze col-md-6">
                                    <span class="caption-subject bold uppercase">Add instruction</span>
                                </div>

                            </div>

                            <div class="clearfix"></div>

                            {if $patientId}
                            <form action="{$hosturl}/controllers/{$controllname}.php?ac=addit&patientid={$patientId}" method="post" class="clinick">
                                {else}
                                <form action="{$hosturl}/controllers/{$controllname}.php?ac=addit" method="post" class="clinick">
                                    {/if}
                                    <div class="form-body">


                                        <div class="form-group ">
                                            <label class="col-md-2 txtl" for="form_control_1">File Name</label>
                                            <div class="col-md-10">
                                                <input type="text" class="form-control" id="form_control_1" placeholder="Enter Name" name="name" required>
                                                <div class="form-control-focus">
                                                </div>

                                            </div>
                                        </div>

                                        <div class="form-group ">
                                            <label class="col-md-2 txtl" for="form_control_1">Content</label>
                                            <div class="col-md-10">
                                                <textarea class="form-control has-info ckeditor" rows="3" placeholder="Enter more text" name="content" required></textarea>
                                                <div class="form-control-focus">
                                                </div>
                                            </div>
                                        </div>

                                    </div>




                                    <div class="form-actions">
                                        <div class="row">
                                            <div class="col-md-offset-2 col-md-10">
                                                {if $patientId}
                                                <a class="btn default" href="{$hosturl}/controllers/{$controllname}.php?ac=show&patientid={$patientId}">Cancel</a>
                                                {else}
                                                <a class="btn default" href="{$hosturl}/controllers/{$controllname}.php?ac=show">Cancel</a>
                                                {/if}

                                                <button type="submit" class="btn blue">Submit</button>

                                            </div>
                                        </div>
                                    </div>
                                </form>

                        </div>
                    </div>
                </div>
            </div>

            <div class="bootbox modal fade bootbox-alert in" tabindex="-1" role="dialog" aria-hidden="false"  id="edit_model">
                <div class="modal-dialog">
                    <div class="modal-content">
                        <div class="modal-header">
                            <button type="button" class="close" data-dismiss="modal" aria-hidden="true"></button>
                            <h4 class="modal-title"> Edit </h4>
                        </div>
                        <div class="modal-body">
                            <div class="portlet-body form">
                                <form action="" id="" method="post" class="form-horizontal  emptyform" >
                                    <div class="form-body all" >
                                        <!------===========================================------->
                                        <div class="form-group">
                                            <label class="col-md-1 control-label"> </label>
                                            <div class="col-md-10">
                                                <div id="alldatadiv" class="" > </div>
                                            </div>
                                            <label class="col-md-1 control-label"> </label>
                                        </div>

                                        <!------===========================================------->

                                        <!------===========================================------->
                                        <div class="modal-footer">

                                            <button type="button" id="amountcloseinput"   class="btn default" data-dismiss="modal">Close</button>
                                        </div>
                                    </div>
                                </form>
                            </div>
                        </div>
                        <!-- /.modal-content -->
                    </div>
                </div>
            </div>



        </div>
    </div>
</div>


