|
|
@ -1,6 +1,6 @@ |
|
|
|
<template> |
|
|
|
<div v-if="showModal" class="z-10 modal h-screen w-full fixed left-0 top-0 flex justify-center items-center bg-black bg-opacity-50"> |
|
|
|
<div class="py-3 sm:max-w-xl sm:mx-auto w-11/12 md:w-1/4"> |
|
|
|
<div class="py-3 sm:max-w-xl sm:mx-auto w-11/12 xl:w-2/4"> |
|
|
|
<div class="relative px-4 py-10 bg-white mx-8 md:mx-0 shadow rounded-3xl sm:p-10"> |
|
|
|
<div class="max-w-md mx-auto"> |
|
|
|
<div class="flex items-center space-x-5"> |
|
|
@ -13,28 +13,28 @@ |
|
|
|
<div class="divide-y divide-gray-200"> |
|
|
|
<div class="py-8 text-base leading-6 space-y-4 text-gray-700 sm:text-lg sm:leading-7"> |
|
|
|
<div class="flex flex-col items-center space-x-4"> |
|
|
|
<div class="ml-auto w-full flex flex-col"> |
|
|
|
<label class="leading-loose">Name:</label> |
|
|
|
<div class="ml-4 w-full flex flex-col md:flex-row md:mb-3"> |
|
|
|
<label class="leading-loose mr-1">Name:</label> |
|
|
|
<input v-model="patient.name" type="text" class="px-4 py-2 border focus:ring-gray-500 focus:border-gray-900 w-full sm:text-sm border-gray-300 rounded-md focus:outline-none text-gray-600" placeholder="Patient Name"> |
|
|
|
</div> |
|
|
|
<div class="w-full flex flex-col"> |
|
|
|
<label class="leading-loose">Phone:</label> |
|
|
|
<div class="w-full flex flex-col md:flex-row md:mb-3"> |
|
|
|
<label class="leading-loose mr-1">Phone:</label> |
|
|
|
<input v-model="patient.phone" type="text" class="px-4 py-2 border focus:ring-gray-500 focus:border-gray-900 w-full sm:text-sm border-gray-300 rounded-md focus:outline-none text-gray-600" placeholder="Patient Name"> |
|
|
|
</div> |
|
|
|
<div class="w-full flex flex-col"> |
|
|
|
<label class="leading-loose">E-Mail:</label> |
|
|
|
<div class="w-full flex flex-col md:flex-row md:mb-3"> |
|
|
|
<label class="leading-loose mr-1">E-Mail:</label> |
|
|
|
<input v-model="patient.email" type="text" class="px-4 py-2 border focus:ring-gray-500 focus:border-gray-900 w-full sm:text-sm border-gray-300 rounded-md focus:outline-none text-gray-600" placeholder="Patient Name"> |
|
|
|
</div> |
|
|
|
<div class="w-full flex flex-col"> |
|
|
|
<label class="leading-loose">TC No:</label> |
|
|
|
<div class="w-full flex flex-col md:flex-row md:mb-3"> |
|
|
|
<label class="leading-loose mr-1">TC:</label> |
|
|
|
<input v-model="patient.tcno" type="text" class="px-4 py-2 border focus:ring-gray-500 focus:border-gray-900 w-full sm:text-sm border-gray-300 rounded-md focus:outline-none text-gray-600" placeholder="Patient Name"> |
|
|
|
</div> |
|
|
|
<div class="w-full flex flex-col"> |
|
|
|
<label class="leading-loose">Hes Code:</label> |
|
|
|
<div class="w-full flex flex-col md:flex-row md:mb-3"> |
|
|
|
<label class="leading-loose mr-1">Hes:</label> |
|
|
|
<input v-model="patient.hescode" type="text" class="px-4 py-2 border focus:ring-gray-500 focus:border-gray-900 w-full sm:text-sm border-gray-300 rounded-md focus:outline-none text-gray-600" placeholder="Patient Name"> |
|
|
|
</div> |
|
|
|
<div class="w-full flex flex-col"> |
|
|
|
<label class="leading-loose">Protocol Numbers:</label> |
|
|
|
<div class="w-full flex flex-col md:flex-row md:mb-3"> |
|
|
|
<label class="leading-loose mr-1">Protocol:</label> |
|
|
|
<vue-tags-input |
|
|
|
class="focus:ring-gray-500 focus:border-gray-900 w-full sm:text-sm border-gray-300 rounded-md focus:outline-none text-gray-600" |
|
|
|
v-model="tag" |
|
|
|