{$action = 'create'}
{$title_action = $_L['Payment_Add']}
{if (!empty($payment))}
    {$action = 'update'}
    {$title_action = $_L['Payment_Edit']}
{/if}

<div class="modal-header">
	<button type="button" class="close" data-dismiss="modal" aria-hidden="true">&times;</button>
	<h3>{$title_action}</h3>
</div>

<div class="modal-body">

	<form class="form-horizontal" id="form_payment" name="form_payment" method="post"
		  action="{$_url}module_med_scheduling/payment/{$action}" enctype="multipart/form-data">

		<input type="hidden" name="scheduling_id" value="{$id}">

{*        {if !empty($payment[0]['id'])}
                <input type="hidden" id="paymentId" name="id" value="{$payment[0]['id']}">
        {/if}*}

		<div class="tab-content">

			<div id="general_data" class="tab-pane fade in active">

				<div class="row" style="margin-top:20px">

					<div class=" col-md-12 col-sm-12 col-xs-12">
						{$value = ''}
                       {* {if (!empty($payment[0]['value']))}
                            {$value = $payment[0]['value']}
                        {/if}*}
						<label class="control-label" for="value">{$_L['Payment_Value']} <small class="red">*</small> </label>
						<input type="text" id="value" name="value" class="form-control" maxlength="100"
							   value="{$value}" required>
					</div>

				</div>

				<div class="row">

					<div id="div_cpf" class="pf col-md-612col-sm-12 col-xs-12">
                        {$date = date("Y-m-d")}
                      {*  {if (!empty($payment[0]['date']))}
                            {$date = $payment[0]['date']}
                        {/if}*}
						<label class="control-label" for="date">{$_L['Date']} <small class="red">*</small></label>
						<input type="text" name="date" id="date" class="form-control dt datepicker" required
							   data-date-format="{$_c['formatDate']}" data-auto-close="true"
                                                    value="{date( $_c['df'], strtotime(date('Y-m-d')))}"   >
					</div>

				</div>

				<div class='row'>

					<div class="col-md-12 col-sm-12 col-xs-12">
                        {$observation = ''}
                       {* {if (!empty($payment[0]['observation']))}
                            {$observation = $payment[0]['observation']}
                        {/if}*}
						<label class="control-label" for="observation">{$_L['Scheduling_Obs']} </label>
						<textarea id="observation" name="observation" class="form-control" rows="6">
							{$observation}
						</textarea>
					</div>

				</div>

			</div>

		</div>

	</form>

</div>

<div class="modal-footer">
	<button class="btn btn-primary payment_submit" type="submit" id="submit">
		<i class="fa fa-check"></i> {$title_action}
	</button>
	<a href="#" data-dismiss="modal"> | {$_L['Or Cancel']}</a>
</div>