<style>
    table {
        font-family: arial, sans-serif;
        border-collapse: collapse;
        width: 100%;
        table-layout: fixed
    }

    td, th {
        border: 1px solid #000000;
        text-align: center;
        padding: 2px;
    }

    tr:nth-child(even) {
        background-color: #dddddd;
    }
</style>


<div class="page-content-wrapper">
    <div class="page-content">
        <div class="row">
            <div class="col-md-12 clinick invz" >
                <div class="portlet box blue">
                    <div class="portlet-title">
                        <div class="caption">

                            <i class="fa fa-user"></i>Doctors
                        </div>
                        <div class="actions">
                            <a href="{$hosturl}/controllers/{$controllname}.php?ac=refer_show"
                               class="btn btn-default btn-sm">
                                Show </a>
                        </div>
                    </div>

                    <div class="portlet-body all">
                        <div class="row">
                            <div class="portlet-body form">
                                <form action="{$hosturl}/controllers/{$controllname}.php?ac=refer_add" method="post">
                                    <div class="form-body">
                                        <div class="portlet box grey-cascade">
                                            <div class="portlet-body">
                                                <div class="row">
                                                    <table>
                                                        <tbody>
                                                            <tr>
                                                                <th class="wds20">Id</th>
                                                                <td>
                                                                    <input type="text" class="form-control " name="refer_id"  required />
                                                                </td>
                                                            </tr>

                                                            <tr>
                                                                <th>Name</th>
                                                                <td>
                                                                    <input type="text" class="form-control " name="name" required />
                                                                </td>
                                                            </tr>

                                                            <tr>
                                                                <th>Phone No.</th>
                                                                <td>
                                                                    <input type="text" class="form-control " name="phone" />
                                                                </td>
                                                            </tr>

                                                            <tr>
                                                                <th>Location</th>
                                                                <td>
                                                                    <input type="text" class="form-control " name="location" />
                                                                </td>
                                                            </tr>

                                                            <tr>
                                                                <th>Cash Transfer % </th>
                                                                <td>
                                                                    <input type="text" class="form-control " name="cash_transfer" />
                                                                </td>
                                                            </tr>

                                                            <tr>
                                                                <th>Email</th>
                                                                <td>
                                                                    <input type="text" class="form-control " name="email" />
                                                                </td>

                                                            </tr>

                                                            <tr>
                                                                <th>Dr Specialist Group</th>
                                                                <td>
                                                                    <input type="text" class="form-control " name="specialist_group" />
                                                                </td>
                                                            </tr>

                                                            <tr>
                                                                <th>Price List</th>
                                                                <td>
                                                                    <select  class="form-control select2h"  name="price_list">
                                                                        <option value="">choose</option>
                                                                        {foreach  $price_lists as $one}
                                                                        <option value="{$one.id}" >{$one.name}</option>
                                                                        {/foreach}
                                                                    </select> 
                                                                </td>
                                                            </tr>

                                                            <tr>
                                                                <th>Sales Person</th>
                                                                <td>
                                                                    <select  class="form-control sales_persons"  name="sales_persons"
                                                                             id="sales_persons">
                                                                        <option value="">choose</option>
                                                                        {foreach  $sales_persons as $one}
                                                                        <option value="{$one.id}" >{$one.name}</option>
                                                                        {/foreach}
                                                                        <option value="-1" class="deleteoptincompo">تعديل </option>
                                                                    </select>
                                                                </td>
                                                            </tr>
                                                        </tbody>
                                                    </table>
                                                </div>
                                            </div>
                                        </div>

                                    </div>


                                    <div class="form-actions">
                                        <div class="row">
                                            <div class="col-md-offset-3 col-md-4 fright">
                                                <button type="submit" class="btn green">Save</button>
                                                <a href="{$hosturl}/controllers/{$controllname}.php?ac=refer_show"
                                                   class="btn default">
                                                    Cancel </a>
                                            </div>
                                        </div>
                                    </div>
                                </form>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>



<div  id="editModalDiv"></div>