

<?php $__env->startSection('content'); ?>


    <style>
        body {
            font-family: Arial, sans-serif;
            font-size: 14px;
            margin: 0;
            padding: 0;
            background-color: #f8f9fa;
        }
        .container {
            width: 90%;
            margin: 0 auto;
            padding: 20px;
            background: white;
            box-shadow: 0 0 10px rgba(0, 0, 0, 0.1);
            border-radius: 5px;
        }
        table {
            width: 100%;
            border-collapse: collapse;
            margin-bottom: 20px;
            background: white;
            border-radius: 5px;
            overflow: hidden;
        }
        th, td {
            padding: 10px;
            number-align: left;
           
        }
        
                td {
    padding: 5px; /* Reduce unnecessary space */
    vertical-align: top; /* Align content to the top */
}
ul {
    margin-top: 0; /* Remove extra margin */
    padding-left: 20px; /* Keep bullet indentation */
}

        th {
            background-color: #525659;
            color: white;
        }
        hr {
            border: 0;
            height: 1px;
            background: #ddd;
            margin: 20px 0;
        }
        .footers {
            background-color: #007BFF;
            color: white;
            padding: 15px;
            number-align: center;
            font-size: 12px;
            border-top: 3px solid #0056b3;
            margin-top: 20px;
        } 
        
        @page {
    size: A4;
    margin: 10px;
    scale: 0.8; /* Reduce size */
}
    </style>
</head>
<body>
    <div class="container">
    <div class="row">
     <div class="col-md-6">
        <table>
            <tr>
                <td colspan="2">
                    <img src="https://bluhealth.bluai.ai/admin/assets/images/logo/BluHealth_Logo.png" alt="BluHealth Logo" width="150">
                </td>
                <td colspan="2" style="number-align: center;">
                    <h3>Clinical Information</h3>
                </td>
            </tr>
        </table>
        <hr>

        <!-- Patient & Doctor Information -->
        <table>
            <tr>
                <th colspan="2">Patient Information</th>
                <th colspan="2">Doctor Information</th>
            </tr>
            <tr>
                <td><strong>Name:</strong></td>
                <td><?php echo e($patient ? $patient->first_name .' ' .$patient->last_name : 'N/A'); ?></td>
                <td><strong>Dr.:</strong></td>
                <td><?php echo e($hcp ? $hcp->first_name .' ' .$hcp->last_name : 'N/A'); ?></td>
            </tr>
            <tr>
                <td><strong>Email:</strong></td>
                <td><?php echo e($patient ? $patient->email : 'N/A'); ?></td>
                <td><strong>Email:</strong></td>
                <td><?php echo e($hcp ? $hcp->email : 'N/A'); ?></td>
            </tr>
            <tr>
                <td colspan="2"></td>
                <td><strong>Address:</strong></td>
                <td><?php echo e($hcp ? $hcp->address : 'N/A'); ?></td>
            </tr>
            <tr>
                <td colspan="2"></td>
                <td><strong>Phone:</strong></td>
                <td><?php echo e($hcp ? $hcp->contact_phone_personal : 'N/A'); ?></td> 
            </tr>
        </table>

        <!-- Reason for Blood Work & Specialty Tests -->
        <table>
            <tr>
                <th>Reason for Blood Work</th>
                <th>Specialty Tests</th>
            </tr>
            <tr>
                <td>
                
                 <ul class="list-unstyled mb-0">
                        <?php $__currentLoopData = $reason_for_blood_work ?? []; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $reason): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                            <li class="d-flex align-items-center mb-1">
                                <i class="fas fa-check-circle number-success me-2" style="font-size: 1rem;"></i>
                                <span class="fw-medium"><?php echo e(ucfirst(str_replace('_', ' ', $reason))); ?></span>
                            </li>
                            <?php if('otherReason' == $reason): ?>
                                <div class=" number-muted small">
                                    <i class="fas fa-angle-right ms-5 me-1"></i><?php echo e(strtoupper($other_reason)); ?>

                                </div>
                            <?php endif; ?>
                        <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                    </ul>
                    
                </td>
                <td>
                    <ul class="list-unstyled mb-0">
                        <?php $__currentLoopData = $specialty_tests ?? []; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $specialty): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                            <li class="d-flex align-items-center mb-1">
                                <i class="fas fa-check-circle number-success me-2" style="font-size: 1rem;"></i>
                                <span class="fw-medium"><?php echo e(ucfirst(str_replace('_', ' ', $specialty))); ?></span>
                            </li>
                            <?php if('cardiacMarkers' == $specialty): ?>
                                <div class="d-flex flex-column number-muted small">
                                    <?php $__currentLoopData = $cardiac_tests ?? []; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $cardiac): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                        <div class="d-flex align-items-center">
                                            <i class="fas fa-angle-right ms-5 me-2"></i> <span><?php echo e(strtoupper($cardiac)); ?></span>
                                        </div>
                                    <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                </div>
                            <?php endif; ?>
                            <?php if('inflammatoryMarkers' == $specialty): ?>
                                <div class="d-flex flex-column number-muted small">
                                    <?php $__currentLoopData = $inflammatory_tests ?? []; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $inflammatory): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                        <div class="d-flex align-items-center">
                                            <i class="fas fa-angle-right ms-5 me-2"></i> <span><?php echo e(strtoupper($inflammatory)); ?></span>
                                        </div>
                                    <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                </div>
                            <?php endif; ?>
                            <?php if('hormonalStudies' == $specialty): ?>
                                <div class="d-flex flex-column number-muted small">
                                    <?php $__currentLoopData = $hormone_tests ?? []; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $hormone): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                        <div class="d-flex align-items-center">
                                            <i class="fas fa-angle-right ms-5 me-2"></i> <span><?php echo e(strtoupper($hormone)); ?></span>
                                        </div>
                                    <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                </div>
                            <?php endif; ?>
                        <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                    </ul>
                </td>
            </tr>
        </table>

        <!-- Basic Panel -->
        <table>
            <tr>
                <th>Basic Panel</th>
            </tr>
            <tr>
                <td>
    <ul class="list-unstyled mb-0">
        <?php $__currentLoopData = $basic_panel ?? []; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $panel): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
            <li class="d-flex align-items-center mb-1">
                <i class="fas fa-check-circle number-success me-2" style="font-size: 1rem;"></i>
                <span class="fw-medium"><?php echo e(ucfirst(str_replace('_', ' ', $panel))); ?></span>
            </li>

            <?php if($panel == 'cbc'): ?>
                <ul class="number-muted small ms-4">
                    <li class="d-flex align-items-center">
                        <i class="fas fa-angle-right me-2"></i>
                        <span><?php echo e(strtoupper($basic_panel_options[0] ?? 'No options available')); ?></span>
                    </li>
                </ul>
            <?php endif; ?> 

            <?php if($panel == 'thyroidFunctionTests'): ?>
                <ul class="number-muted small ms-4">
                    <?php $__currentLoopData = $thyroid_tests ?? []; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                        <li class="d-flex align-items-center">
                            <i class="fas fa-angle-right me-2"></i>
                            <span><?php echo e(strtoupper($test)); ?></span>
                        </li>
                    <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                </ul>
            <?php endif; ?>
        <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
    </ul>
</td>
            </tr>
        </table>
        <hr>

        <!-- Footer --> 
        <div class="footers">
            &copy; 2025 BluHealth. All rights reserved.
        </div>
        </div>
         <div class="col-md-6">
         <form id="imageForm" class="ajax-form forms-sample" action="<?php echo e(route('labs.reportStore')); ?>" data-redirect="" enctype="multipart/form-data">
         <input type="file" name="report" id="imageUpload"accept="image/*, application/pdf" class="form-control mb-3">
         <input type="hidden" name="lab_id" value="<?php echo e($lab_id); ?>">
         <div id="previewContainer" class="d-none">
    <img id="previewImage" class="img-fluid d-none" alt="Selected Image">
    <iframe id="previewPDF" class="d-none" width="100%" height="500px"></iframe>
</div>

     
        
         </div>
        
    </div>

<br>
    <table>
            <tr>
                <th>Reason for Blood Work</th>
         
            </tr>
            <tr>
                <td>
                 
                 <ul class="list-unstyled mb-0">
               
                        <?php $__currentLoopData = $reason_for_blood_work ?? []; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $reason): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                            <?php if($reason == 'routineCheckup'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Routine Checkup</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Complete Blood Count (CBC)</h5>
                                    
                                        <div class="row">
                                            <?php $__currentLoopData = ['Hemoglobin (Hb)', 'WBC Count', 'Platelets']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">
                                                <div class="border p-3 rounded">
                                                <label class="form-check-label fw-bold me-3">
                                                        <input type="checkbox" name="complete_blood_count[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="complete_blood_count[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="complete_blood_count[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="complete_blood_count[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="complete_blood_count[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                    <!-- Lipid Profile -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Lipid Profile</h5>
                                     
                                        <div class="row">
                                            <?php $__currentLoopData = ['Total Cholesterol', 'LDL', 'HDL']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="lipid_profile[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="lipid_profile[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="lipid_profile[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="lipid_profile[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="lipid_profile[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                    <!-- Blood Glucose -->
                                

                                </div>
                            <?php endif; ?>

                            <?php if($reason == 'preOperative'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Pre-Operative</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Coagulation Profile</h5>
                               
                                        <div class="row">
                                            <?php $__currentLoopData = ['PT/INR', 'APTT']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="preoperative[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="preoperative[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="preoperative[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="preoperative[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="preoperative[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>


                            <?php if($reason == 'acuteIllness'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Acute Illness</h4>
                                   
                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Inflammatory Markers</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['CRP', 'ESR']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="acute_illness[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="acute_illness[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="acute_illness[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="acute_illness[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="acute_illness[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>


                            <?php if($reason == 'screening'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Screening</h4>
                                 
                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Cancer Screening</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['PSA', 'CA-125']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="screening[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="screening[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="screening[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="screening[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="screening[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>


                            <?php if($reason == 'medicationMonitoring'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">MedicationMonitoring</h4>
                            
                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Liver Function Tests (LFT)</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['ALT', 'AST', 'Albumin']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="medicationmonitoring[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="medicationmonitoring[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="medicationmonitoring[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="medicationmonitoring[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="medicationmonitoring[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>

                            

                            
                            <?php if('otherReason' == $reason): ?>
                                <div class=" number-muted small">
                                    <i class="fas fa-angle-right ms-5 me-1"></i><?php echo e(strtoupper($other_reason)); ?>

                                </div>
                            <?php endif; ?>
                        <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                    </ul>
                    
                </td>
               
            </tr> 
        </table>

        <table>
        <tr>
        <th>Specialty Tests</th>
      </tr>
        <td>
                    <ul class="list-unstyled mb-0">
                        <?php $__currentLoopData = $specialty_tests ?? []; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $specialty): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                        


                            <?php if($specialty == 'cardiacMarkers'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Cardiac Markers</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Cardiac Markers</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['Troponin I/T', 'BNP (Brain Natriuretic Peptide)']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="cardiacmarkers[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="cardiacmarkers[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="cardiacmarkers[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="cardiacmarkers[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="cardiacmarkers[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>


                            <?php if($specialty == 'inflammatoryMarkers'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Inflammatory Markers</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Inflammatory Markers</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['CRP (C-Reactive Protein)', 'ESR (Erythrocyte Sedimentation Rate)']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="inflammatorymarkers[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="inflammatorymarkers[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="inflammatorymarkers[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="inflammatorymarkers[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="inflammatorymarkers[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>



                            <?php if($specialty == 'hormonalStudies'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Hormonal Studies</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Hormonal Studies</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['Cortisol (AM)', 'Testosterone (Total)	']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="hormonalstudies[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="hormonalstudies[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="hormonalstudies[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="hormonalstudies[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="hormonalstudies[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>




                            <?php if($specialty == 'InfectiousDiseaseScreening'): ?> 
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Infectious Disease Screening</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Infectious Disease Screening</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['HIV Antibody', 'Hepatitis B/C Panel']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="infectiousdiseasescreening[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="infectiousdiseasescreening[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="infectiousdiseasescreening[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="infectiousdiseasescreening[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="infectiousdiseasescreening[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>



                            <?php if($specialty == 'geneticTesting'): ?> 
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Genetic Testing</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Genetic Testing</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['BRCA1/2 Mutation', 'APOE Genotyping']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="genetictesting[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="genetictesting[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="genetictesting[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="genetictesting[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="genetictesting[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>



                            <?php if($specialty == 'DrugScreening'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Drug Screening</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Drug Screening</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = [' Toxicology Panel (Urine)']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="drugscreening[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="drugscreening[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="drugscreening[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="drugscreening[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="drugscreening[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>
        
                        <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                    </ul>
                </td>

        <!-- Basic Panel -->
        <table>
            <tr>
                <th>Basic Panel</th>
            </tr>
            <tr>
                <td>
    <ul class="list-unstyled mb-0">
        <?php $__currentLoopData = $basic_panel ?? []; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $panel): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
           

        <?php if($panel == 'cbc'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Complete Blood Count (CBC) with Differential</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Complete Blood Count (CBC) with Differential</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['WBC Count', 'RBC Count', 'Hemoglobin (Hb)', 'Platelets']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="cbc[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="cbc[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="cbc[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="cbc[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="cbc[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>



                            
        <?php if($panel == 'bmp'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Basic Metabolic Panel (BMP)</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Basic Metabolic Panel (BMP)</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['Sodium', 'Potassium', 'Chloride', 'CO2 (Bicarbonate)', 'Glucose', 'BUN', 'Creatinine']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">  
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="bmp[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="bmp[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="bmp[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="bmp[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="bmp[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>

  

                               
        <?php if($panel == 'cmp'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Comprehensive Metabolic Panel (CMP)	</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Comprehensive Metabolic Panel (CMP)</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['Albumin', 'Total Protein', 'ALT', 'AST', 'ALP', 'Bilirubin (Total)']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">  
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="cmp[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="cmp[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="cmp[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="cmp[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="cmp[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>


                            <?php if($panel == 'lipidPanel'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Lipid Panel	</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Lipid Panel</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['Total Cholesterol', 'LDL', 'HDL', 'Triglycerides']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">  
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="lipidpanel[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="lipidpanel[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="lipidpanel[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="lipidpanel[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="lipidpanel[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>


                            <?php if($panel == 'thyroidFunctionTests'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Thyroid Function Tests	</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Thyroid Function Tests</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['TSH', 'Free T4', 'Free T3', 'Triglycerides']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">  
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="thyroidfunctiontests[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="thyroidfunctiontests[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="thyroidfunctiontests[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="thyroidfunctiontests[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="thyroidfunctiontests[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>



                            <?php if($panel == 'glucose'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Glucose & HbA1c</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Glucose & HbA1c</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['Fasting Blood Glucose', 'Hemoglobin A1c (HbA1c)']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">  
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="glucose[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3"> 
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="glucose[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="glucose[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="glucose[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="glucose[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>


                            <?php if($panel == 'urinalysis'): ?>
                                <div class="container mt-4">
                                    <h4 class="fw-bold">Urinalysis</h4>

                                    <!-- Complete Blood Count (CBC) -->
                                    <div class="mb-4">
                                        <h5 class="fw-medium">Urinalysis</h5>
                                        <div class="row">
                                            <?php $__currentLoopData = ['pH', 'Protein', 'Glucose (Urine)', 'Ketones']; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $test): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <div class="col-md-12">   
                                                <div class="border p-3 rounded">  
                                                    <label class="form-check-label fw-bold">
                                                        <input type="checkbox" name="urinalysis[<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]" class="form-check-input">
                                                        <?php echo e($test); ?>

                                                    </label>
                                                    <div class="d-flex flex-wrap align-items-center gap-3">  
                                                        <label class="small">Result</label>
                                                        <input type="number" class="form-control" name="urinalysis[result_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Normal Range</label>
                                                        <input type="number" class="form-control" name="urinalysis[normal_range_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Units</label>
                                                        <input type="number" class="form-control" name="urinalysis[units_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">

                                                        <label class="small mt-2">Remarks</label>
                                                        <input type="number" class="form-control" name="urinalysis[remarks_<?php echo e(str_replace(' ', '_', strtolower($test))); ?>]">
                                                    </div>
                                                </div>
                                            </div>
                                            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                        </div>
                                    </div>

                                </div>
                            <?php endif; ?>


                            

        <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
    </ul>
</td>
            </tr>
        </table>
           <div class="d-flex justify-content-center mt-3">
       <button id="submitButton" class="btn btn-primary">Submit</button>
       </div>

        </form>
</body>
</html>



<?php $__env->stopSection(); ?>;
<?php echo $__env->make('labs.layout.app', array_diff_key(get_defined_vars(), ['__data' => 1, '__path' => 1]))->render(); ?><?php /**PATH /var/www/html/resources/views/labs/addreport.blade.php ENDPATH**/ ?>