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<div class="modal-header">
<button type="button" class="close" data-dismiss="modal" aria-hidden="true">×</button>
<h3>{$title_action}</h3>
</div>
<div class="modal-body">
<div class="alert alert-danger msg_add_payment hide" >
<span class="add_payent_emsgbody"></span>
</div>
<form class="form-horizontal" id="form_payment" name="form_payment" method="post"
action="{$_url}module_med_scheduling/payment/post_registry" enctype="multipart/form-data">
<input type="hidden" name="scheduling_id" value="{$scheduling->id}">
<input type="hidden" class="form-control" id="sales_date" name="sales_date" datepicker
data-date-format="{$_c['formatDate']}" data-auto-close="true"
value="{date( $_c['df'], strtotime($scheduling->date))}">
<div class="row">
<div class="col-xs-4">
<label>{$_L['Total']}</label>
<input disabled="disabled" value='{$scheduling->totalPatient}' type="text" id="total" name="total" class="form-control amount am" autocomplete="off" data-a-sign="{$_c['currency_code']} " data-a-dec="{$_c['dec_point']}" data-a-sep="{$_c['thousands_sep']}" data-d-group="2">
</div>
</div>
<div class="row">
<div class=" col-md-4 col-sm-4 col-xs-12">
<label>{$_L['Payment Method Invoice']}</label>
<div class="input-group">
<select id="mtdopgto" name="mtdopgto" class="form-control" >
<option value="0">{$_L['None']}</option>
{foreach $payment_methods as $pmethod}
<option value="{$pmethod['id']}">{$pmethod['name']}</option>
{/foreach}
<option value="-1">{$_L['Multiply']}</option>
</select>
<span class="input-group-addon after " style="border:none">
<a href="#" class="hide" id="icon_cheque"><i class="fa fa-list-alt edit_check_data"></i></a>
</span>
</div>
<input type="hidden" name="check_name" id="check_name">
<input type="hidden" name="check_kind_of_person" id="check_kind_of_person">
<input type="hidden" name="check_cpf_cnpj" id="check_cpf_cnpj">
<input type="hidden" name="check_code1" id="check_code1">
<input type="hidden" name="check_code2" id="check_code2">
<input type="hidden" name="check_code3" id="check_code3">
<input type="hidden" name="check_edited" id="check_edited" value="0">
</div>
<div class=" col-md-4 col-sm-4 col-xs-12">
<label for="cdtpgto">{$_L['Payment Condition Invoice']}</label>
<select id="cdtpgto" name="cdtpgto" class="form-control">
<option value="0">{$_L['None']}</option>
<option value="1" selected="">{$_L['Payment Condition Invoice0']}</option>
<option value="2">{$_L['Payment Condition Invoice1']}</option>
<option value="3">{$_L['Payment Condition Invoice2']}</option>
</select>
</div>
<div class="div_divided col-md-3 col-sm-3 col-xs-9 hide">
<label > </label>
<div class="input-group">
<input type="text" id="divided_condition" name="divided_condition" class="form-control" maxlength="45"/>
<span class="input-group-addon after dropdown-toggle" data-toggle="dropdown">
<i class="caret"></i>
</span>
<ul class="dropdown-menu pull-right" >
<!-- <li><a href="#" data-value="1x" class="divided">{$_L['Divided in']} 1x</a></li> -->
<li><a href="#" data-value="2x" class="divided" style=""> {$_L['Divided in']} 2x</a></li>
<li><a href="#" data-value="3x" class="divided" style="">{$_L['Divided in']} 3x</a></li>
<li><a href="#" data-value="4x" class="divided" style="">{$_L['Divided in']} 4x</a></li>
<li><a href="#" data-value="5x" class="divided" style="">{$_L['Divided in']} 5x</a></li>
<li><a href="#" data-value="6x" class="divided" style="">{$_L['Divided in']} 6x</a></li>
<li><a href="#" data-value="7x" class="divided" style="">{$_L['Divided in']} 7x</a></li>
<li><a href="#" data-value="8x" class="divided" style="">{$_L['Divided in']} 8x</a></li>
<li><a href="#" data-value="9x" class="divided" style="">{$_L['Divided in']} 9x</a></li>
<li><a href="#" data-value="10x" class="divided" style="">{$_L['Divided in']} 10x</a></li>
<li><a href="#" data-value="11x" class="divided" style="">{$_L['Divided in']} 11x</a></li>
<li><a href="#" data-value="12x" class="divided" style="">{$_L['Divided in']} 12x</a></li>
</ul>
</div>
<span class="help-block">{$_L['Ex: 30 60, 3x ou 15 +2x']} </span>
</div>
<div class=" col-md-4 col-sm-4 col-xs-12 destiny_payment_account hide">
<label>{$_L['Destiny Account']}</label>
<select id="destiny_payment_account" name="destiny_payment_account" class="form-control">
</select>
</div>
<input type="hidden" id="_dec_point" name="_dec_point" value="{$_c['dec_point']}">
<input type="hidden" value="{$_c['thousands_sep']}" name="_mil_point" id="_mil_point">
<input type="hidden" value="{$_c['currency_code']}" name="_curr_code" id="_curr_code">
</div>
<div class="row hide" id="div_especification_payment">
<div class="table-responsive m-t">
<table class="table invoice-table" id="especification_payment">
<thead>
<tr data-row='fixed'>
<th class='middle' width="50px">{$_L['N']}</th>
<th class="col-xs-1">{$_L['Days']}</th>
<th class='col-xs-2' >{$_L['Date']}</th>
<th class='col-xs-2' >{$_L['Price']}</th>
<th class='col-xs-2 multiplas hide' >{$_L['Payment Method Invoice']}</th>
<th class='col-xs-2 multiplas hide' >{$_L['Details']}</th>
<th class='middle'>{$_L['Obs']}</th>
</tr>
</thead>
<tbody>
<tr id='condition' data-row='fixed'>
<td>1</td>
<td>
<input type="number" data-row='0' class="form-control days" id='days_0' name="days[]" value="0"></td>
<td>
<input type="text" data-row='0' class="form-control due_date_especification_payment" id="duedate_0" name="duedate[]" datepicker data-date-format="{$_c['formatDate']}" data-auto-close="true" value="{date( $_c['df'], strtotime($scheduling->date))}">
</td>
<td>
<input type="text" class="form-control divided_price amount" id="price_0" name="price[]" value="{$scheduling->totalPatient}"></td>
<td class="multiplas hide">
<select id="mtdopgto_0" name="mtdopgto_0" class="form-control mtdopgto_condition" data-row='0'>
<option value="0">{$_L['None']}</option>
{foreach $payment_methods as $pmethod}
<option value="{$pmethod['id']}">{$pmethod['name']}</option>
{/foreach}
</select>
</td>
<td class="multiplas hide">
<div class="col-xs-12">
<select id="destiny_payment_account_0" name="destiny_payment_account_0" data-row="0" class="form-control destiny_payment_account_condition">
</select>
<small>{$_L['Destiny Account']}</small>
</div>
</td>
<td><input type="text" title="" value="" class="form-control" id="obs_0" name="obs[]">
<input type="hidden" id="row_especification_payment" value="1">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</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>