<div class="wrapper wrapper-content">

    {$action = 'create'}
    {$title_action = $_L['Agreement_Add_Module']}
    {if (!empty($agreements))}
        {$action = 'update'}
        {$title_action = $_L['Agreement_Edit_Module']}
    {/if}

    <form class="form-horizontal" method="post" action="{$_url}module_med_scheduling/agreement/{$action}">

        <div class="row">

            <div class="col-md-12">

                <div class="ibox float-e-margins">

                    <div class="ibox-title">
                        <h5>{$title_action}</h5>
                        <a href="{$_url}module_med_scheduling/agreement/listAgreement"
                           class="btn btn-xs btn-primary btn-rounded pull-right">
                            <i class="fa fa-bars"></i> {$_L['Agreement_List']}
                        </a>
                    </div>

                    <div class="ibox-content" id="ibox_form">

                        <div class="row">

                            <div class="col-md-12 col-sm-12 col-xs-12">
                                {$company_name = ''}
                                {if (!empty($agreements->agreement_company_name))}
                                    {$company_name = $agreements->agreement_company_name}
                                {/if}
                                <label class="control-label" for="title">
                                    {$_L['Agreement_Company_Name']} <small class="red">*</small>
                                </label>
                                <input type="text" name="agreement_company_name" id="agreement_company_name"
                                       class="form-control" value="{$company_name}" required>
                            </div>

                        </div>

                        <div class="row">

                            <div class="col-md-12 col-sm-12 col-xs-12">
                                {$register_ans = ''}
                                {if (!empty($agreements->register_ans))}
                                    {$register_ans = $agreements->register_ans}
                                {/if}
                                <label class="control-label" for="title">
                                    {$_L['Agreement_ANS']} <small class="red">*</small>
                                </label>
                                <input type="text" name="register_ans" id="register_ans" class="form-control"
                                       value="{$register_ans}" required>
                            </div>

                        </div>

                        <div class="row">

                            <div class="col-md-12 col-sm-12 col-xs-12">
                                {$agreement_cnpj = ''}
                                {if (!empty($agreements->agreement_cnpj))}
                                    {$agreement_cnpj = $agreements->agreement_cnpj}
                                {/if}
                                <label class="control-label" for="title">
                                    {$_L['Agreement_Cnpj']} <small class="red">*</small>
                                </label>
                                <input type="text" name="agreement_cnpj" id="agreement_cnpj" class="form-control"
                                       value="{$agreement_cnpj}" required>
                            </div>

                        </div>

                        <div class="row">

                            <div class="col-md-12 col-sm-12 col-xs-12">
                                {$fantasy_name = ''}
                                {if (!empty($agreements->agreement_fantasy_name))}
                                    {$fantasy_name = $agreements->agreement_fantasy_name}
                                {/if}
                                <label class="control-label" for="title">
                                    {$_L['Agreement_Fantasy_Name']} <small class="red">*</small>
                                </label>
                                <input type="text" name="agreement_fantasy_name" id="agreement_fantasy_name" class="form-control"
                                       value="{$fantasy_name}" required>
                            </div>

                        </div>

                        <div class="row">

                            <div class="col-md-12 col-sm-12 col-xs-12">
                                {$modality = ''}
                                {if (!empty($agreements->modality))}
                                    {$modality = $agreements->modality}
                                {/if}
                                <label class="control-label" for="title">
                                    {$_L['Agreement_Modality']} <small class="red">*</small>
                                </label>
                                <input type="text" name="modality" id="modality" class="form-control"
                                       value="{$modality}" required>
                            </div>

                        </div>

                        <div class="row" style="margin-top:20px">
                            <div class=" col-md-12 form-group">
                                <div class="col-lg-10">
                                    {if !empty($agreements->id)}
                                        <input type="hidden" id="agreementId" name="id" value="{$agreements->id}">
                                    {/if}
                                    <button class="md-btn md-btn-primary waves-effect waves-light" type="submit" id="submit">
                                        <i class="fa fa-check"></i> {$_L['Submit']}
                                    </button>
                                    | <a href="{$_url}module_med_scheduling/agreement/listAgreement">{$_L['Or Cancel']}</a>
                                </div>
                            </div>
                        </div>

                    </div>

                </div>

            </div>

        </div>

    </form>

</div>