{% extends 'base.html.twig' %}

{% block title %}Detail Receipt{% endblock %}

{% block content %}
<div class="kt-container kt-grid__item kt-grid__item--fluid">
	<div class="kt-portlet kt-portlet--mobile">
		<div class="kt-portlet__head kt-portlet__head--lg">
			<div class="kt-portlet__head-label">
				<h3 class="kt-portlet__head-title">Detail Receipt</h3>
			</div>

			<div class="kt-portlet__head-toolbar">
				<div class="kt-portlet__head-wrapper">
					<a href="{{ path('pages', {'path': 'dean/ipd/general/name'}) }}" class="btn btn-clean btn-icon-sm"><i class="la la-long-arrow-left"></i>Back</a>
					<a href="#" class="btn btn-clean text-capitalize border-0" data-mdb-ripple-color="dark"><i class="fas fa-print text-primary"></i> Print</a>
					<a href="#" class="btn btn-clean text-capitalize" data-mdb-ripple-color="dark"><i class="far fa-file-pdf text-danger"></i>Export</a>
				</div>
			</div>
		</div>

		<div class="card">
			<div class="card-body">
				<div class="container mb-5 mt-3" style=" border: 1px solid black; padding: 33px;">
					<div class="col-md-12" style="background:#189F9F;">
						<div class="row">
							<div class="col-sm-5" style="color:#fff;"><i class="far fa-hospital fa-4x ms-0"></i></div>
							<div class="col-sm-6" style="color:#fff; margin-top:10px;"><strong style="font-size: 20px;">Agrwal Hospital - 2002 Receipt</strong></div>
						</div>
					</div>

					<div class="container">
						<div class="row py-3">
							<div class="col-sm-3">
								<ul class="list-unstyled">
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>MRD No.:</strong></span>
										<span>125679</span>
									</li>
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Name:</strong></span>
										<span>John Lorem</span>
									</li>
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Address:</strong></span>
										<span>2435 Sweetwater, National City, California.</span>
									</li>
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Date Of Visit:</strong></span>
										<span>Jun 23, 2021</span>
									</li>
								</ul>
							</div>

							<div class="col-sm-3">
								<ul class="list-unstyled">
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>ABHA No.:</strong></span>
										<span>91-1254-1245-9874</span>
									</li>
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Age:</strong></span>
										<span>27</span>
									</li>
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Contact No:</strong></span>
										<span>123-456-789</span>
									</li>
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Discharge:</strong></span>
										<span>Jun 23, 2021</span>
									</li>
								</ul>
							</div>

							<div class="col-sm-3">
								<ul class="list-unstyled">
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>M/F:</strong></span>
										<span>Male</span>
									</li>
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Email:</strong></span>
										<span><i class="fas fa-email"></i>pt1@gmail.com</span>
									</li>
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Net Payment:</strong></span>
										<span><i class="fas fa-email"></i>0</span>
									</li>
								</ul>
							</div>
							<div class="col-sm-3">
								<ul class="list-unstyled">
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Unique ID:</strong></span>
										<span>91-1254-1245</span>
									</li>
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Treating Doctor:</strong></span>
										<span><i class="fas fa-email"></i>Doctor Agrawal</span>
									</li>
									<li>
										<span style="color:#53585b; font-weight: 400;"><strong>Cash/card/Gpay/Net banking:</strong></span>
										<span>Net banking</span>
									</li>
								</ul>
							</div>
						</div>

						<div class="row my-2 mx-1 justify-content-center">
							<table class="table table-striped table-borderless">
								<thead style="background: #189F9F; font-size: 16px;" class="text-white">
									<tr>
										<th scope="col">#</th>
										<th scope="col">Procedure</th>
										<th scope="col">No. of Procedures/Services</th>
										<th scope="col">Detail of Procedure/Service</th>
										<th scope="col">Quantity</th>
										<th scope="col">Charges</th>
										<th scope="col">GST</th>
									</tr>
								</thead>
								<tbody>
									<tr>
										<th scope="row">1</th>
										<td>Case</td>
										<td>1</td>
										<td>Details of Case</td>
										<td>1</td>
										<td><i class="fas fa-rupee-sign"></i> 10,000</td>
										<td><i class="fas fa-rupee-sign"></i> 1,000</td>
									</tr>
									<tr>
										<th scope="row">2</th>
										<td>Injection Charges</td>
										<td>1</td>
										<td>Details of Injection Charges</td>
										<td>1</td>
										<td><i class="fas fa-rupee-sign"></i> 3,000</td>
										<td><i class="fas fa-rupee-sign"></i> 300</td>
									</tr>
									<tr>
										<th scope="row">3</th>
										<td>Dressing Charges</td>
										<td>1</td>
										<td>Details of Dressing Charges</td>
										<td>1</td>
										<td><i class="fas fa-rupee-sign"></i> 1,000</td>
										<td><i class="fas fa-rupee-sign"></i> 100</td>
									</tr>
									<tr>
										<th scope="row">4</th>
										<td>Cosumable Charges</td>
										<td>1</td>
										<td>Details of Cosumable Charges</td>
										<td>1</td>
										<td><i class="fas fa-rupee-sign"></i> 800</td>
										<td><i class="fas fa-rupee-sign"></i> 80</td>
									</tr>
									<tr>
										<th scope="row">5</th>
										<td>Bed</td>
										<td>0</td>
										<td>Details of Bed</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">6</th>
										<td>ICU</td>
										<td>0</td>
										<td>Details of ICU</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">7</th>
										<td>OT</td>
										<td>0</td>
										<td>Details of OT</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">8</th>
										<td>Labour Room</td>
										<td>0</td>
										<td>Details of Labour Room</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">9</th>
										<td>Operation Charges</td>
										<td>0</td>
										<td>Details of Operation Charges</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">10</th>
										<td>Anaesthesia Charges</td>
										<td>0</td>
										<td>Details of Anaesthesia Charges</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">11</th>
										<td>Pharmacy</td>
										<td>0</td>
										<td>Details of Pharmacy</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">12</th>
										<td>Laboratory Chages</td>
										<td>0</td>
										<td>Details of Laboratory Chages</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">13</th>
										<td>Blood Bank Charges</td>
										<td>0</td>
										<td>Details of Blood Bank Charges</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">14</th>
										<td>Doctor Opinion Charges</td>
										<td>0</td>
										<td>Details of Doctor Opinion Charges</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">15</th>
										<td>Radiology Charges</td>
										<td>0</td>
										<td>Details of Radiology Charges</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">16</th>
										<td>Radiotherapy Charges</td>
										<td>0</td>
										<td>Details of Radiotherapy Charges</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">17</th>
										<td>Ambulance Charges</td>
										<td>0</td>
										<td>Details of Ambulance Charges</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">18</th>
										<td>Kitchen/Food</td>
										<td>0</td>
										<td>Details of Kitchen/Food</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">19</th>
										<td>Laundry</td>
										<td>0</td>
										<td>Details of Laundry</td>
										<td>0</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
										<td><i class="fas fa-rupee-sign"></i> -</td>
									</tr>
									<tr>
										<th scope="row">20</th>
										<td>Total</td>
										<td>4</td>
										<td>-</td>
										<td>4</td>
										<td><i class="fas fa-rupee-sign"></i> 14,800</td>
										<td><i class="fas fa-rupee-sign"></i> 1,480</td>
									</tr>
								</tbody>
							</table>
						</div>

						<div class="row">
							<div class="col-sm-3">
								<ul class="list-unstyled">
									<li><strong>Advance Paid: </strong><i class="fas fa-rupee-sign"></i> 0</li>
									<li class="mt-2"><strong>Net Expenditure: </strong><i class="fas fa-rupee-sign"></i> 0</li>
									<li class="mt-2"><strong>Payble/Refundable: </strong><i class="fas fa-rupee-sign"></i> 0</li>
									<li class="mt-2"><strong>Balance Amount: </strong><i class="fas fa-rupee-sign"></i> 0</li>
								</ul>
							</div>
							<div class="col-sm-3">
								<ul class="list-unstyled">
									<li><strong>Total Payment: </strong><i class="fas fa-rupee-sign"></i> 0</li>
									<li class="mt-2"><strong>Insurance Claim: </strong><i class="fas fa-rupee-sign"></i> 0</li>
									<li class="mt-2"><strong>Discount: </strong><i class="fas fa-rupee-sign"></i> 0</li>
									<li class="mt-2"><strong>GST: </strong><i class="fas fa-rupee-sign"></i> 0</li>
								</ul>
							</div>
							<div class="col-sm-3">
								<ul class="list-unstyled">
									<li><strong>Mode of payment: </strong>Online</li>
									<li class="mt-2"><strong>Insurance Compney: </strong>Company Name</li>
									<li class="mt-2"><strong>After Discount: </strong><i class="fas fa-rupee-sign"></i> 0</li>
									<li class="mt-2"><strong>Total: </strong><i class="fas fa-rupee-sign"></i> 0</li>
								</ul>
							</div>
							<div class="col-sm-3">
								<ul class="list-unstyled">
									<li><strong>Total Payable by Insurance/Scheme: </strong><i class="fas fa-rupee-sign"></i> 0</li>
									<li><strong>Payment other than Insurance/Scheme: </strong><i class="fas fa-rupee-sign"></i> 0</li>
									<li><strong>Transuction ID: </strong>6824AJH5669</li>
								</ul>
							</div>
						</div>
					</div>
				</div>
			</div>
		</div>
	</div>
</div>
{% endblock %}