Professional Documents
Culture Documents
-- IMCU -->
@if($menu == 'Add ESR')
<div class="row">
<div class="col-lg-6">
<table style="width:100%">
<tr>
<td style="padding:10px">Census:</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[1]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
<tr>
<td style="padding:10px">Adult:</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[2]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
<tr>
<td style="padding:10px">Pedia:</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[3]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
<tr>
<td style="padding:10px">Intermediate:</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[4]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
<tr>
<td style="padding:10px">Admission:</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[5]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
<tr>
<td style="padding:10px">Trans-In:</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[6]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
</table>
</div>
<div class="col-lg-6">
<table style="width:100%">
<tr>
<td style="padding:10px">Trans-Out:</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[7]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
<tr>
<td style="padding:10px">Discharge:</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[8]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
<tr>
<td style="padding:10px">Patient Category (1):</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[9]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
<tr>
<td style="padding:10px">Patient Category (2):</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[10]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
<tr>
<td style="padding:10px">Patient Category (3):</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[11]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
<tr>
<td style="padding:10px">Patient Category (4):</td>
<td><input type="number" class="cen form-control" value="0"
min="0" name="imcu[12]" id="items[1]" data-amount="1" data-id="1"></td>
</tr>
</table>
</div>
</div>