{% extends 'MainBundle:Master:template.html.twig' %}

{% block scripts %}

    <link rel="stylesheet" href="{{ asset('bundles/receive/css/receive.css') }}"/>
    {#Bootstrap#}
    <link rel="stylesheet" href="{{ asset('bundles/utilities/bootstrap-3.3.7/css/bootstrap.min.css') }}"/>
    {# Custom #}
    <link rel="stylesheet" href="{{ asset('bundles/shedule/'~ hrk_skin ~'/dataTableCustom.css') }}"/>
    {#Select2 css#}
    <link rel="stylesheet" href="{{ asset('bundles/main/css/select2.css') }}"/>
    {# selectpicker #}
    <link rel="stylesheet" href="{{ asset('bundles/indicator/css/bootstrap-select.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/shedule/css/bootstrap-datetimepicker.min.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/shedule/datatable/css/dataTables.bootstrap.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/shedule/datatable/css/dataTables.responsive.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/shedule/datatable/css/dataTables.tableTools.css') }}"/>
    <link rel="stylesheet" href="{{ asset('bundles/utilities/sweetalert/sweetalert.css') }}" >

    <script src="{{ asset('bundles/fosjsrouting/js/router.js') }}"></script>
    <script src="{{ path('fos_js_routing_js', { callback: 'fos.Router.setData' }) }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/bootstrap/js/bootstrap.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/indicator/js/bootstrap-select.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/adesignscalendar/js/fullcalendar/moment.min.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/js/bootstrap-datetimepicker.min.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/jquery.dataTables.min.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/dataTables.tableTools.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/dataTables.responsive.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/datatable/js/dataTables.bootstrap.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/receive/js/receive.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/shedule/js/blockUI.js') }}"></script>
    <script type="text/javascript" src="{{ asset('bundles/utilities/sweetalert/sweetalert.min.js') }}"></script>
    <script type="text/javascript">
        var cita6meses = "{{ 'messages.cita6meses'|trans([], 'LocalizationBundle') }}";
        var asignacion_citas = false;
        var recepcion = false;
        var findAllPatient = '{{ path('FindAllPatient') }}';
        var UrlUpdaData = '{{ path("updateDataPatient") }}';
        var urlSendFile = '{{ path("SendFile") }}';
        var UrlSaveDataWorklist = '{{ path("SaveDataWorklist") }}';
        var UrlDataHis = '{{ path("hiruko_integration_his_homepage") }}';
        var UrlNewData = '{{ path('receive_homepage') }}';
        var UrlDataMunicipality = '{{ path("municipalityList") }}';
        var UrlDataPatient = '{{ path("patientList") }}';
        var UrlDataStudies = '{{ path("studyList") }}';
        var UrlDataRoom = '{{ path("roomList") }}';
        var years = '{{ 'labels.date.years'|trans([], 'LocalizationBundle') }}';
        var months = '{{ 'labels.date.month'|trans([], 'LocalizationBundle') }}';
        var year = '{{ 'labels.date.years'|trans([], 'LocalizationBundle') }}';
        var month = '{{ 'labels.date.month'|trans([], 'LocalizationBundle') }}';
        var day = '{{ 'labels.date.day'|trans([], 'LocalizationBundle') }}';
        var days = '{{ 'labels.date.days'|trans([], 'LocalizationBundle') }}';
        var select = '{{ 'button.select'|trans([], 'LocalizationBundle') }}';
        var study = '{{ 'labels.study.plural'|trans([], 'LocalizationBundle') }}';
        var room = '{{ 'labels.room'|trans([], 'LocalizationBundle') }}';
        var errorAjax = '{{ 'messages.ajax.errorProcess'|trans([], 'LocalizationBundle') }}';
        var processok = '{{ 'messages.processOk'|trans([], 'LocalizationBundle') }}';
        var pleaseWait = '{{ 'messages.pleaseWait'|trans([], 'LocalizationBundle') }}';
        var receiptOk = '{{ 'labels.appointment.receiptOk'|trans([], 'LocalizationBundle') }}';
        var noOrden = '{{ 'messages.noOrden'|trans([], 'LocalizationBundle') }}';
        var filtroCIE10 = '{{ 'messages.filtroCie10'|trans([], 'LocalizationBundle') }}';
        var selected = '{{ 'messages.yes_select_patient'|trans([], 'LocalizationBundle') }}';
        var option = '';
        {% for mod in modList %}
        option += '<option value="{{ mod.varMod }}">{{ mod.varMod }}</option>';
        {% endfor %}
        var tipoInsumos = '{{ 'modalities.tipoInsumos' |trans([], 'LocalizationBundle') }}';
        var modality = '{{ 'modalities.modality'|trans([], 'LocalizationBundle') }}';
        var mandatory_email = '{{ 'messages.campoObliga'|trans([], 'LocalizationBundle') }}';
        var ok = '{{ 'button.acept'|trans([], 'LocalizationBundle') }}';
        var close = '{{ 'button.close'|trans([], 'LocalizationBundle') }}';
        var cancel = '{{ 'button.cancel'|trans([], 'LocalizationBundle') }}';
        var URLfilterCie10 = '{{ path('filterCie10') }}';
        var SrcAlert = '{{ asset('bundles/utilities/images/alert.png') }}';
        var ClinicalOrder = '{{ ClinicalOrder }}';
        var folio_consecutive = '{{ folio_consecutive }}';
        var consecutive = '{{ consecutive }}';
        var UrlConsultarModalidadesConvenio = '{{ path('hiruko_consultar_modalidades_convenios') }}';
        var UrlDataEstudiosContratos = '{{ path('estudiosContratos') }}';
        var urlCopagosCuotaModeradora = '{{ path('CopagosCuotaModeradora') }}';
        var urlOrdenServicio = '{{ path('hiruko_factura_orden_servicio', {'cit':'cit'}) }}';
        var urlFactura = '{{ path('hiruko_factura', {'cit':'cit'}) }}';
        var urlFacturaReciboCaja = '{{ path('hiruko_factura_recibos_caja', {'cit':'cit'}) }}';
        var urlSticker = '{{ path('PrintSticker76x60', {'appCode':'appCode'}) }}'
        var urlRecibodePago = '{{ path('hiruko_factura_recibo_pago', {'cit':'cit'}) }}';
        var urlContratosFacturacion = '{{ path('DefinicionContratosFacturacion') }}';
        var urlConsultaValores = '{{ path('ValoresEstudios') }}';
        var urlConsultaFechaContratos = '{{ path('contratos_val_valores') }}';
        var urlIncrementarCodigoUnico = '{{ path('IncrementarCodigoUnico') }}';
        var cliente = '{{ id_cliente }}';
        var urlConsultaValoresContratos = '{{ path('ValoresContratos') }}';
        var urlConsultaValoresContratosC = '{{ path('ValoresContratosC') }}';
        var urlValidarResolucion = '{{ path("hiruko_validar_resolucion") }}';
        var urlConsultaResolucion = '{{ path("contratos_resolucion_valores") }}';
        var urlRangosMonto = '{{ path("alert_monto") }}';
        var urlAlertModalidad = '{{ path("alert_modalidad") }}';
        var urlConsultaValoresConvenios = '{{ path('ValoresConvenios') }}';
        var urlConsultaConvenios = '{{ path('ConveniosLista') }}';
        var facturacion = '{{ facturacion }}';
        var factura_cafam = '{{ factura_cafam }}';
        var sticker = '{{ sticker }}';
        var factura_convenio = '{{ factura_convenio }}';
        var closer = "{{ asset('bundles/utilities/images/cerrar.png') }}";
        var his_integration = '{{ his_integration }}';
        var loader = "{{ asset('bundles/utilities/images/anim_gif.gif') }}";
        var codigo_unico_his = '{{ codigoUnico }}';
        var id_cliente = '{{ id_cliente }}';
        var codigo_defecto_departamento = '{{ cod_departamento }}';
        var allData = '{{ 'messages.allData'|trans([], 'LocalizationBundle') }}';
        var codigo_defecto_municipio = '{{ cod_municipio }}';
        var modificarValorEstudio = '{{ 'messages.modificarValorEstudio'|trans([], 'LocalizationBundle') }}';
        var finalidadTrans = '{{ 'receive.finalidad'|trans([], 'LocalizationBundle') }}';
        var diagnostico= '{{ 'receive.diagnostico'|trans([], 'LocalizationBundle') }}';
        var terapeutico= '{{ 'receive.terapeutico'|trans([], 'LocalizationBundle') }}';
        var proteccion= '{{ 'receive.proteccionEsp'|trans([], 'LocalizationBundle') }}';
        var dteg='{{ 'receive.dteg'|trans([], 'LocalizationBundle') }}';
        var dtel='{{ 'receive.dteg'|trans([], 'LocalizationBundle') }}';
        var codigoAut_contrato = '{{ 'labels.appointment.codigoAut_contrato'|trans([], 'LocalizationBundle') }}';
        var agrupar='{{ 'receive.agrupar'|trans([], 'LocalizationBundle') }}';
        var title ='{{ 'receive.titlAgrupar'|trans([], 'LocalizationBundle') }}';
        var div_est='false';
        {% if division_estudios == true %}

           div_est='true';
        {% endif %}
        {% if codigoUnico != '' %}
        var nombre_municipio = '{{ resultDataHis['result'].0.munnom }}';
        var codigo_municipio_His = '{{ resultDataHis['result'].0.muncod }}';
        var descripcion_cie10_His = '{{ resultDataHis['result'].0.coddia|trim }}';
        {% endif %}

        {% if his_integration == 'true' %}
            {% if resultDataHis['result'].0.nomact is defined %}
                var studyIntegrationHIS = '{{ resultDataHis['result'].0.nomact | trim }}';
            {% else %}
                var studyIntegrationHIS = '';
            {% endif %}
        {% else %}
            var studyIntegrationHIS = '';
        {% endif %}
        var signo = "$ ";
        var dec = 2;

        if (cliente == "RIS-DPI") {
            signo = "S/ ";
            dec = 2;
        }
        var turno = '';
        {% for usu in usuarios %}
        {% if( usu.firstname) == 'DE TURNO' %}
        turno = '{{ usu.id }}';
        {% endif %}
        {% endfor %}
        var modListIns = '';
        {% for modi in modListIns %}
        modListIns += '<option value="{{ modi.varMod }}">{{ modi.varMod }}</option>';
        {% endfor %}
        $(document).ready(function () {
            $('.campoNum').keydown(function (e) { // 110 - 190
                if ($.inArray(e.keyCode, [46, 8, 9, 27, 13]) !== -1 ||
                    (e.keyCode == 65 && e.ctrlKey === true) ||
                    (e.keyCode >= 35 && e.keyCode <= 39)) {
                    return;
                }

                if ((e.shiftKey || (e.keyCode < 48 || e.keyCode > 57)) && (e.keyCode < 96 || e.keyCode > 105)) {
                    e.preventDefault();
                }
            });

            {% if his_integration == 'true' %}
                $('#doctor_referring').val({{ medicoRemitenteIntegracion }});
                $('#doctor_referring').selectpicker('refresh');
                $('#tags').val('{{ personD }}');
                $('#tags').trigger('keyUp');
            {% endif %}
        });
    </script>
    {# Select2 js#}
    <script src="{{ asset('bundles/main/js/select2.js') }}"></script>

    <style>
        .input-group input {
            height: 34px;
            border-radius: 4px;
        }

        .error {
            border: 2px solid #d9534f;
            background-color: #d9534f;
        }

        .w-30 {
            width: 30px;
        }

        .w-80 {
            width: 80px;
        }

        .row {
            margin-bottom: 10px;
        }

        .mt-20 {
            margin-top: 20px;
        }
    </style>
{% endblock %}


{% block content %}

    <div class="container-fluid">
    <div class="panel panel-primary">
    <div class="panel-heading">
        <h3 class="panel-title">{{ 'labels.priorityReceive'|trans([], 'LocalizationBundle') }}</h3>
    </div>
    <div class="panel panel-default">
        <div class="panel-body">
            {{ render(controller('PatientBundle:Patient:index')) }}
        </div>
    </div>
    <div class="clearfix"></div>


    <div class="modal fade" id="DoctorModal" role="dialog">
        <div class="modal-dialog" style="z-index:1041">
            <div class="modal-content">
                <div class="modal-header">
                    <button type="button" class="close" data-dismiss="modal">&times;</button>
                    <h4 class="modal-title">{{ 'labels.registerDoctorReferring'|trans([], 'LocalizationBundle') }}</h4>
                </div>
                <div class="modal-body">
                    {{ render(controller('HirukoAdminBundle:Referring:index')) }}
                </div>
            </div>
        </div>
    </div>


    <div class="clearfix"></div>

    {# panel datos cl�nicos #}
    <div class="panel panel-default hide hideWorkFlow">
    <div class="panel-heading">
        <h3 class="panel-title">{{ 'labels.patient.clinicalData'|trans([], 'LocalizationBundle') }}</h3>
    </div>
    <div class="panel-body">
        <div class="panel panel-default">
            <div class="panel-body">
                <div class="row">
                    {% if his_integration == 'true' %}
                        <input type="hidden" id="input_codigoUnico" value="{{ codigoUnico }}" >
                    {% endif %}
                    <div class="col-md-6">
                        <label for="style" class="col-md-2">{{ 'labels.son_of'|trans([], 'LocalizationBundle') }}
                            :</label>
                        <div class="div_left_check">
                            {% if hijo_de_integracion == true and resultDataHis['result'].0.tipide == 'MS' %}
                                <input type="checkbox" name="hijo" id="son_of" checked/>
                            {% else %}
                                <input type="checkbox" name="hijo" id="son_of"/>
                            {% endif %}
                        </div>
                    </div>

                    {#trae info clinica#}
                    <div class="col-md-6">
                        <div class="form-group">
                            <label for="style"
                                   class="col-sm-4 control-label">{{ 'labels.patient.bringsClinicalData'|trans([], 'LocalizationBundle') }}
                                :</label>
                            <div class="col-sm-8">
                                <div class="radio">
                                    <label class="col-md-6">
                                        <input type="radio" name="clinicalData" value="1" checked="checked"
                                               required="required">
                                        {{ 'labels.yes'|trans([], 'LocalizationBundle') }}
                                    </label>
                                </div>
                                <div class="radio">
                                    <label class="col-md-6">
                                        <input type="radio" name="clinicalData" value="2" required="required">
                                        {{ 'labels.no'|trans([], 'LocalizationBundle') }}
                                    </label>
                                </div>
                            </div>
                        </div>
                    </div>
                    {#Fin trae info clinica#}
                </div>

                <div class="row">
                    {#Doctor#}
                    <div class="col-md-6" style="margin-bottom: 10px;">
                        <div class="form-group">
                            <label for="style"
                                   class="col-md-4 control-label">{{ 'labels.role.doctor_referring'|trans([], 'LocalizationBundle') }}
                                :</label>
                            {#<div {% if ris_internacional %}class="col-md-6" {% else %}class="col-md-8"{% endif %}>#}
                            <div class="col-md-6" %}>
                                {#{% if remitente == false %}#}
                                {#<input id="doctor_referring" name="doctor_referring" class="form-control field_receive"#}
                                {#value="{{ resultDataHis['result'].0.nommed|default('') }}" type="text"#}
                                {#onkeyup="javascript:this.value=this.value.toUpperCase();">#}
                                {#{% else %}#}
                                <select id="doctor_referring" name="doctor_referring" class="form-control selectpicker"
                                        data-actions-box="true" data-id="selmedRem" data-style="btn-default"
                                        data-live-search="true"
                                        title="{{ 'button.select'|trans([], 'LocalizationBundle') }}">
                                    {% for medicoRemite in medicoRemitente %}
                                        <option value="{{ medicoRemite.id }}">{{ medicoRemite.firstName }} {{ medicoRemite.lastName }}
                                            - {{ medicoRemite.practiceName }}</option>
                                    {% endfor %}
                                </select>
                                {#{% endif %}#}
                            </div>
                            {#{% if ris_internacional %}#}
                            <div class="col-md-2">
                                <a class="btn btn-primary" id="btnModalMedical">
                                    {{ 'button.new'|trans([], 'LocalizationBundle') }}
                                </a>
                            </div>
                            {#{% endif %}#}
                        </div>
                    </div>
                    {# Fin Doctor #}
                    {#usuarios#}
                    <div class="col-md-6">
                        <div class="form-group">
                            <label for="style"
                                   class="col-sm-4 control-label">{{ 'labels.medicoAsignado'|trans([], 'LocalizationBundle') }}
                                : (*)</label>
                            <div class="col-sm-8">
                                <select id="select_medico" name="select_medico"
                                        class="form-control select_receive required selectpicker"
                                        data-actions-box="true"
                                        data-id="select_medico" data-style="btn-default" data-live-search="true"
                                        title="{{ 'button.select'|trans([], 'LocalizationBundle') }}">
                                    <option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>
                                    {% for usu in usuarios %}
                                        {% if codigoUnico != '' %}
                                            {% if usu.firstname == 'DE TURNO' %}
                                                <option value="{{ usu.id }}"
                                                        selected>{{ usu.firstname }} {{ usu.lastname }}</option>
                                            {% else %}
                                                <option value="{{ usu.id }}">{{ usu.firstname }} {{ usu.lastname }}</option>
                                            {% endif %}
                                        {% else %}
                                            {% if usu.firstname == 'DE TURNO' %}
                                                <option value="{{ usu.id }}"
                                                        selected>{{ usu.firstname }} {{ usu.lastname }}</option>
                                            {% else %}
                                                <option value="{{ usu.id }}">{{ usu.firstname }} {{ usu.lastname }}</option>
                                            {% endif %}
                                        {% endif %}
                                    {% endfor %}
                                </select>
                            </div>
                        </div>
                    </div>
                    {# fin usuarios#}
                </div>


                <div class="row">
                    {#Procedencia de HIS#}
                    {% if codigoUnico != '' %}
                        <div class="col-md-6 pull-right">
                            <div class="form-group">
                                <label for="style" class="col-sm-4 control-label">{{ 'labels.origin'|trans([], 'LocalizationBundle') }}:</label>
                                <div class="col-sm-8">
                                    <label for="style" class="control-label">{{ resultDataHis['result'].0.nomser|default('') }}</label>
                                </div>
                            </div>
                        </div>
                    {% endif %}
                    {#Fin procedencia de HIS#}
                </div>

                <div class="row">
                    {#prioridad#}
                    <div class="col-md-6">
                        <div class="form-group">
                            <label for="style"
                                   class="col-sm-4 control-label">{{ 'labels.priority'|trans([], 'LocalizationBundle') }}
                                :
                                (*)</label>
                            <div class="col-sm-8">
                                <select id="select_priority" name="select_priority"
                                        class="form-control selectpicker required">
                                    <option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>
                                    {% for priority in priList %}
                                        {% if codigoUnico != '' %}
                                            {% if resultDataHis['result'].0.priori|trim ==  priority.priId %}
                                                <option value="{{ priority.priId }}"
                                                        selected>{{ priority.priName }}</option>
                                            {% else %}
                                                <option value="{{ priority.priId }}">{{ priority.priName }}</option>
                                            {% endif %}
                                        {% else %}
                                            <option value="{{ priority.priId }}">{{ priority.priName }}</option>
                                        {% endif %}
                                    {% endfor %}
                                </select>
                            </div>
                        </div>
                    </div>
                    {#Fin prioridad#}
                    {#procedencia#}
                    <div class="col-md-6">
                        <div class="form-group">
                            <label for="style"
                                   class="col-sm-4 control-label">{{ 'labels.origin'|trans([], 'LocalizationBundle') }}:
                                (*)</label>
                            <div class="col-sm-8">
                                <select id="select_procedence" name="select_procedence" data-actions-box="true"
                                        data-id="select_procedence" data-style="btn-default" data-live-search="true"
                                        class="form-control selectpicker required">
                                    <option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>
                                    {% for provenance in proList %}
                                        {% if codigoUnico != '' %}
                                            {% if resultDataHis['result'].0.codser == provenance.id %}
                                                <option value="{{ provenance.id }}"
                                                        selected>{{ provenance.name }}</option>
                                            {% else %}
                                                <option value="{{ provenance.id }}">{{ provenance.name }}</option>
                                            {% endif %}
                                        {% else %}
                                            <option value="{{ provenance.id }}">{{ provenance.name }}</option>
                                        {% endif %}
                                    {% endfor %}
                                </select>
                            </div>
                        </div>
                    </div>
                    {#Fin procedencia#}
                </div>

                <div class="row mt-20">
                    {# cie_10 #}
                    <div class="form-group">
                        <div class="col-sm-6">
                            <label class="col-md-4">{{ 'labels.filtroCIE10'|trans([], 'LocalizationBundle') }}</label>
                            <div class="col-sm-6">
                                {% if codigoUnico != '' %}
                                    <input type="text" name="filtroCIE10" id="filtroCIE10" class="form-control"
                                           value="{{ resultDataHis['result'].0.coddia|trim }}"
                                           placeholder="{{ 'labels.filtroCIE10'|trans([], 'LocalizationBundle') }}"/>
                                {% else %}
                                    <input type="text" name="filtroCIE10" id="filtroCIE10" class="form-control"
                                           placeholder="{{ 'labels.filtroCIE10'|trans([], 'LocalizationBundle') }}"/>
                                {% endif %}
                            </div>
                            <div class="col-sm-2">
                                <a id="filterSearch"
                                   class="btn btn-default">{{ 'labels.filtroCIE10'|trans([], 'LocalizationBundle') }}</a>
                            </div>
                        </div>
                        <div class="col-sm-6" id="divCie10">
                            <label class="col-md-4">{{ 'labels.SeleccionarCIE10'|trans([], 'LocalizationBundle') }}:</label>
                            <div class="col-md-8">
                                <select id="select_cie10" name="select_cie10" class="form-control selectpicker"
                                        data-actions-box="true" data-id="selCIE" data-style="btn-default"
                                        data-live-search="true"
                                        title="{{ 'button.select'|trans([], 'LocalizationBundle') }}">
                                </select>
                            </div>
                        </div>
                    </div>
                    {# fin cie_10 #}
                </div>


                <div class="clearfix"></div>

                <div class="row mt-20">
                    {% if (facturacion =='false') %}
                        {#convenio#}
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="style"
                                       class="col-sm-4 control-label">{{ 'labels.convenio'|trans([], 'LocalizationBundle') }}
                                    :
                                    (*)</label>
                                <div class="col-sm-8">
                                    <select id="select_convenio" name="select_convenio"
                                            class="form-control select_receive required selectpicker"
                                            data-actions-box="true"
                                            data-id="selConvenio" data-style="btn-default" data-live-search="true"
                                            title="{{ 'button.select'|trans([], 'LocalizationBundle') }}">
                                        <option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>
                                        {% for eps in epsList %}
                                            {% if codigoUnico != '' %}
                                                {% if resultDataHis['result'].0.nomemp == eps.name %}
                                                    <option value="{{ eps.idEps }}" selected>{{ eps.name }}</option>
                                                {% else %}
                                                    <option value="{{ eps.idEps }}">{{ eps.name }}</option>
                                                {% endif %}
                                            {% else %}
                                                <option value="{{ eps.idEps }}">{{ eps.name }}</option>
                                            {% endif %}
                                        {% endfor %}
                                    </select>
                                </div>
                            </div>
                        </div>
                        {#Fin convenio#}

                    {% else %}
                        {#contratos#}
                        {% if (factura_cafam =='true') %}
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">
                                        {{ 'receive.agreement'|trans([], 'LocalizationBundle') }}
                                        : (*)</label>

                                    <div class="col-sm-8">
                                        <select id="select_contrato" name="select_contrato"
                                                class="form-control select_receive required selectpicker"
                                                data-actions-box="true" data-id="selContrato" data-live-search="true"
                                                title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">
                                            <option value="">Seleccione</option>

                                            {% for eps in epsList %}
                                                <option value="{{ eps.idEps }}*{{ eps.municipio }}">{{ eps.name }}</option>
                                            {% endfor %}

                                        </select>
                                    </div>
                                </div>
                            </div>
                        {% elseif (factura_convenio =='true') %}

                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">
                                        Contratos {{ factura_convenio }}
                                        : (*)</label>

                                    <div class="col-sm-8">
                                        <select id="select_contrato" name="select_contrato"
                                                class="form-control select_receive required selectpicker"
                                                data-actions-box="true" data-id="selContrato" data-live-search="true"
                                                title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">
                                            {% for eps in epsListContratos %}
                                                <option value="{{ eps.idContratos }}">{{ eps.name }}
                                                    -{{ eps.nombreContrato }}</option>
                                            {% endfor %}
                                        </select>
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6" id="div_convenios">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'receive.agreement'|trans([], 'LocalizationBundle') }}
                                        : (*)</label>

                                    <div class="col-sm-8">
                                        <select id="select_convenio" name="select_convenio"
                                                class="form-control select_receive required selectpicker"
                                                data-actions-box="true" data-id="selConvenio" data-live-search="true"
                                                title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">
                                            <option value="">Seleccione</option>
                                            {% for eps in epsList %}
                                                <option value="{{ eps.idEps }}">{{ eps.name }}</option>

                                            {% endfor %}
                                        </select>
                                    </div>
                                </div>
                            </div>
                        {% else %}
                            <div class="col-md-6" id="div_convenios">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'receive.agreement'|trans([], 'LocalizationBundle') }}
                                        : (*)</label>

                                    <div class="col-sm-8">
                                        <select id="select_convenio" name="select_convenio"
                                                class="form-control select_receive required selectpicker"
                                                data-actions-box="true" data-id="selConvenio" data-live-search="true"
                                                title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">
                                            <option value="">Seleccione</option>
                                            {% for eps in epsList %}
                                                <option value="{{ eps.idEps }}">{{ eps.name }}</option>
                                            {% endfor %}
                                        </select>
                                    </div>
                                </div>
                            </div>
                            <div class="col-md-6" id="div_contratos">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">
                                        Contratos
                                        : (*)</label>

                                    <div class="col-sm-8">
                                        <select id="select_contrato" name="select_contrato"
                                                class="form-control select_receive required selectpicker"
                                                data-actions-box="true" data-id="selContrato" data-live-search="true"
                                                title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">

                                        </select>
                                    </div>
                                </div>
                            </div>
                        {% endif %}
                    {% endif %}
                </div>


            </div>
        </div>
        <div class="clearfix"></div>
        {% if facturacion == 'true' %}
        {# Notificación de resoluciones #}
        <div class="panel panel-default cl_resoluciones">
                <div class="col-md-3 alert alert-success alertCotratos" id="resoluciones" role="alert"></div>
                <div class="col-md-3 alert alert-success alertCotratos" id="resolucionesF" role="alert"></div>
                <div class="col-md-3 alert alert-success alertCotratos" id="contratosVal" role="alert"></div>
                <div class="col-md-3 alert alert-success alertCotratos" id="rangoMonto" role="alert"></div>
        </div>
        <div class="clearfix cl_resoluciones"></div>
        {% endif %}
        {# Fin Notificación resoluciones #}
        {# cie_10 #}
        <div class="panel panel-default" id="divCodigoAutorizacion" style="display: none">
            <div class="panel-body">
                {#codigo autorizaci�n#}
                <div class="col-md-6" >
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label"
                               id="lbl_codigo_autorizacion">{{ 'labels.codAutorizacion'|trans([], 'LocalizationBundle') }}
                            :(*)</label>
                        <div class="col-sm-6">
                            <input type="text" name="" id="input_codigo_autorizacion" class="form-control"/>
                        </div>
                    </div>
                </div>
                {#Fin codigo autorizaci�n#}

                {#poliza soat#}
                <div class="col-md-6" id="divPolizaSoat" style="display: none">
                    <div class="form-group">
                        <label for="style" class="col-sm-6 control-label"
                               id="lbl_poliza_soat">{{ 'labels.polizaSoat'|trans([], 'LocalizationBundle') }}:
                            (*)</label>
                        <div class="col-sm-6">
                            <input type="text" name="" id="input_poliza_soat" class="form-control"/>
                        </div>
                    </div>
                </div>
                {#Fin poliza soat#}

            </div>
        </div>
        {# fin cie_10 #}
        {#FOLIO - CONSECUTIVO#}
        <div class="panel panel-default">
            <div class="panel-body">
                {% if folio_consecutive == 'true' %}
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="col-sm-6 control-label">{{ 'labels.folio'|trans([], 'LocalizationBundle') }}
                                :</label>
                            <div class="col-sm-6">
                                <input id="input_folio_receive_priority" class="form-control "
                                       name="input_folio_receive_priority" type="text" value="" title="">
                            </div>
                        </div>
                    </div>

                {% endif %}
                {% if consecutive == 'true' %}
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="col-sm-6 control-label">{{ 'labels.consecutive'|trans([], 'LocalizationBundle') }}
                                &nbsp;*:</label>
                            <div class="col-sm-6">
                                <input id="input_consecutive_receive_priority" class="form-control"
                                       name="input_consecutive_receive_priority" type="text" value="" title="">
                            </div>
                        </div>
                    </div>
                {% endif %}
                {#Fin FOLIO - CONSECUTIVO#}
                {% if codigoUnico != '' %}
                <div class="clearfix"></div>
                <div class="panel panel-default">
                    <div class="panel-body">
                        {# Si el estudio es de HIS se visualiza el estudio que se debe seleccionar para recepcionar el estudio #}

                        <div>
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'labels.estudiosHIS'|trans([], 'LocalizationBundle') }}
                                        :</label>
                                    <div class="col-sm-8">
                                        <label for="style"
                                               class="control-label">{{ resultDataHis['result'].0.nomact }}</label>
                                        {% if resultDataHis['result'].0.contraste == 'true' %}
                                            <label for="style" class="control-label"> + CONTRASTE </label>
                                        {% endif %}
                                    </div>
                                </div>
                            </div>
                        </div>
                        {% endif %}
                        {# Fin de label de nombre de estudio por parte del HIS #}

                        <div class="clearfix"></div>

                        {#Adicionar campos con select2#}




                        {#Adicionar campos con select2#}
                        <div id="modality_st">
                            {#Modalidad#}
                        <div>
                        {% if division_estudios == true %}

                         <div class="col-md-12">
                            <div class="form-group">
                                <input type ="checkbox" name="studyGroup" class="studyGroup" id="chk_group"   title="{{'receive.titlAgrupar'|trans([], 'LocalizationBundle') }}">
                                <label for="style" >{{'receive.agrupar'|trans([], 'LocalizationBundle') }} <label>
                            </div>
                        </div>
                        {% endif %}
                                <div class="form-group">
                                <div class="col-md-6">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'modalities.modality'|trans([], 'LocalizationBundle') }}
                                        : (*)</label>
                                    <div class="col-sm-8">
                                        <select id="select_modality" title="select_studies" alt="select_room"
                                                name="select_modality" data-final="select_finalidad"
                                                data-valSt="val_std" data-group="chk_group"
                                                class="form-control select_receive modality_worklist"
                                                onchange="checkBoxSinLectura()">
                                            <option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>
                                            {% if facturacion =='false' %}

                                                {% if modList[0] is defined %}
                                                    {% if modList[0]['idFluxType'] == '1' %}
                                                        <option value="US">US</option>
                                                    {% else %}
                                                        {% for mod in modList %}
                                                            {% if codigoUnico != '' %}
                                                                {% if resultDataHis['result'].0.modalidad == mod.varMod %}
                                                                    <option value="{{ mod.varMod }}"
                                                                            selected>{{ mod.varMod }}</option>
                                                                {% else %}
                                                                    <option value="{{ mod.varMod }}">{{ mod.varMod }}</option>
                                                                {% endif %}
                                                            {% else %}
                                                                <option value="{{ mod.varMod }}">{{ mod.varMod }}</option>
                                                            {% endif %}
                                                        {% endfor %}
                                                    {% endif %}
                                                {% else %}
                                                    <option value="US">US</option>

                                                {% endif %}
                                            {% endif %}
                                        </select>
                                        <div class="alert alert-success" id="rangoModalidad" role="alert"></div>
                                    </div>
                                </div>
                            </div>
                            {#Fin Modalidad#}
                            {#Sala#}
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'receive.room'|trans([], 'LocalizationBundle') }}
                                        : (*)</label>

                                    <div class="col-sm-8">
                                        <select id="select_room" name="select_room"
                                                class="form-control select_receive "
                                                onchange="checkBoxSinLectura()">
                                            <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                                        </select>
                                        <div id="pasoLecturaMessage_select_room"></div>
                                    </div>
                                </div>
                            </div>
                            {#Fin Sala#}
                            <div class="clearfix"></div>
                            {#Estudios#}
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style"
                                           class="col-sm-4 control-label">{{ 'receive.study'|trans([], 'LocalizationBundle') }}
                                        : (*)</label>

                                    <div class="col-sm-8">
                                        <select id="select_studies" name="select_studies"
                                                class="select_studies basic select_receive required"
                                                style="width:100%;">
                                            <option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>
                                        </select>
                                        <input type="hidden" id="select_studies" class="currencyD"/>
                                        <input type="hidden" id="selectVal" class="required"/>
                                    </div>
                                </div>
                            </div>
                            
                            {#Fin Estudios#}


                            {#Boton +#}
                            <button class="btn btn col-md-1 btn-xs" id="plus_modality">+</button>
                            
                            <div class="clearfix"></div>
                            {#Fin Boton +#}

                            <br>
                            <div class="clearfix"></div>
                            <div class="col-md-6 div_val_st" style="display: none">
                                <div class="form-group">
                                    <label for="style" class="col-sm-4 control-label" id="lbl_val_st">{{ 'receive.valStd'|trans([], 'LocalizationBundle')}}</label>
                                    <div class="col-sm-8">
                                        <input id="val_std" maxlength="10" value="0"
                                               oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');"
                                               class="form-control val_estd sumando" name="val_std" type="text"
                                               title='{{ 'messages.modificarValorEstudio'|trans([], 'LocalizationBundle') }}'>
                                    </div>
                                </div>
                            </div>
                            {#Finalidad de procedimieto#}

                            <div class="clearfix"></div>
                            <div class="col-md-6">

                                <div class="form-group">
                                    <label for="style" class="col-sm-4 control-label">{{ 'receive.finalidad'|trans([], 'LocalizationBundle') }}
                                        (*)</label>

                                    <div class="col-sm-8">
                                        <select id="select_finalidad" name="select_finalidad" required="required"
                                                class="form-control select_receive">

                                            <option value="1"> {{ 'receive.diagnostico'|trans([], 'LocalizationBundle') }}</option>
                                            <option value="2"> {{ 'receive.terapeutico'|trans([], 'LocalizationBundle') }}</option>
                                            <option value="3"> {{ 'receive.proteccionEsp'|trans([], 'LocalizationBundle') }}</option>
                                            <option value="4"> {{ 'receive.dteg'|trans([], 'LocalizationBundle') }}</option>
                                            <option value="5"> {{ 'receive.dtel'|trans([], 'LocalizationBundle') }}</option>

                                        </select>
                                    </div>
                                </div>
                            </div>
                            <div class="clearfix"></div>
                            {#Fin finalidad procedimientos#}
                            <div class="clearfix" style="margin-bottom:10px;"></div>
                            {#Insumos#}
                            {% if facturacion == 'true' %}
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label for="style" class="col-sm-4 control-label">Agregar insumos:
                                            <input type="checkbox" class="insumos2" id="insumos" value="0" name="insumos">
                                        </label>
                                    </div>
                                </div>
                                <div class="clearfix" style="margin-bottom:10px;"></div>
                                <div id="insumos_st_">

                                </div>
                            {% endif %}
                            <hr>
                            {#Fin Insumos#}

                            <div class="clearfix" style="margin-bottom:10px;"></div>
                            </div>
                        </div>{#Fin modality_st#}
                    </div>
                </div>


                {% if (facturacion =='true') %}
                    <div class="clearfix"></div>

                    <div class="panel panel-default" id="tarifas_estudios">
                        <div class="panel-body">
                            <div class="clearfix" style="margin-bottom:10px;"></div>
                            <div class="col-md-6">
                                <div class="form-group" style="margin-bottom:0;">
                                    <label for="style" class="control-label">Tarifas : </label>

                                    <label class=" " id="tarifa_estudio">

                                    </label>
                                    <input type="hidden" id="valores_estudio" value="">
                                    <span id="tarifas_estudios"></span>
                                    {% if(id_cliente== 'RIS-DPI') %}
                                        <a id="dpi" class="btn btn-default">Datos DPI</a>

                                    {% endif %}
                                </div>
                            </div>

                            {#Comentarios Factura  #}

                            <div class="col-md-6" id="divComentarios" style="display: none">
                                <div class="form-group">
                                    <label for="style" class=" col-sm-4 control-label"
                                           id="lbl_comentarios">{{ 'labels.comentarios_fact'|trans([], 'LocalizationBundle') }}
                                        : (*)</label>
                                    <div class="col-xs-4">
                                        <textarea id="input_comentarios" class="form-control" rows="1"
                                                  style="width: 299px; height: 31px; resize:none;  "></textarea>
                                    </div>
                                </div>
                            </div>

                            {#Fin Comentarios Factura#}

                            <div class="col-md-12">
                                <div class="form-group">
                                    <label for="style" class="control-label">Valores : </label>

                                    <label class=" " id="valor_total">

                                    </label>

                                    <div id="cuotasd" class=" ">

                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>

                    <div class="clearfix"></div>

                    <div class="panel panel-default" id="tipo_facturar">
                        <div class="panel-body">
                            {#tipo Afiliaci?n#}
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style" class="col-sm-6 control-label">Tipo de
                                        afiliaci&oacute;n: (*)</label>

                                    <div class="col-sm-6">
                                        <select id="select_tipo_afiliacion"
                                                name="select_tipo_afiliacion"
                                                class="form-control select_receive required"
                                                data-actions-box="true" data-id="selTipoAfiliacion"
                                                data-style="btn-primary" data-live-search="true"
                                                title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">
                                            <option value="">Seleccione</option>
                                            <option value="Ex">Excluido</option>
                                            <option value="Ct">Cotizante</option>
                                            <option value="Bf">Beneficiario</option>
                                        </select>
                                    </div>
                                </div>
                            </div>
                            {#Fin tipo afiliaci?n#}

                            {#nivel Afiliacion#}
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style" class="col-sm-6 control-label">Nivel de
                                        afiliaci&oacute;n: (*)</label>

                                    <div class="col-sm-6">
                                        <select id="select_nivel_afiliacion"
                                                name="select_nivel_afiliacion"
                                                class="form-control select_receive required"
                                                data-actions-box="true" data-id="selNivelAfiliacion"
                                                data-style="btn-primary" data-live-search="true"
                                                title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">
                                            <option value="">Seleccione</option>
                                            <option value="1">Nivel 1</option>
                                            <option value="2">Nivel 2</option>
                                            <option value="3">Nivel 3</option>
                                        </select>
                                    </div>
                                </div>
                            </div>
                            {#Fin nivel afiliacion#}

                            {#valor Copago-Cuota Moderadora#}
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style" class="col-sm-6 control-label">Valor Copago-Cuota
                                        Moderadora: (*)</label>

                                    <div class="col-sm-6">
                                        <input id="valor_Copago_CuotaModeradora"
                                               name="valor_Copago_CuotaModeradora"
                                               class="form-control field_receive" type="text"
                                               required="required">
                                        <input id="v_cp_cm" type="hidden">
                                        <input id="v_real" type="hidden">
                                    </div>
                                </div>
                            </div>
                            {#Fin Copago-Cuota Moderadora#}

                            {#redondedo#}
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label for="style" class="col-sm-6 control-label">Redondeo:</label>

                                    <div class="col-sm-6">
                                        <select id="select_redondeo" name="select_redondeo"
                                                class="form-control select_receive required"
                                                data-actions-box="true" data-id="selNivelAfiliacion"
                                                data-style="btn-primary" data-live-search="true"
                                                title="{{ 'receive.select'|trans([], 'LocalizationBundle') }}">
                                            <option value="">Seleccione</option>
                                        </select>
                                    </div>
                                </div>
                            </div>
                            {#Fin redondeo#}
                        </div>
                    </div>
                    {# inicio tipo_pago#}
                    <div class="panel panel-default" id="tipo_pago">
                        <div class="panel-body">
                            <div class="clearfix" style="margin-bottom:10px;"></div>
                            <div class="col-md-12">
                                <div class="form-group" style="margin-bottom:0;">
                                    <label class="col-sm-2">Tipo de pago:
                                    </label>
                                    <div class="col-sm-4" align="left">
                                        <input type="radio" name="tipo_pago_d" value="Tarjeta">
                                        <label>Tarjeta</label>
                                        <input type="radio" name="tipo_pago_d" value="Efectivo" checked="checked">
                                        <label>Efectivo</label>
                                        <input type="radio" name="tipo_pago_d" value="Mixto">
                                        <label>Mixto</label>
                                    </div>
                                    <div class="col-md-6" id="div_descuento">
                                        <label class="col-sm-4">Descuento:</label>
                                        <div class="col-sm-8">
                                            <input id="descuento" maxlength="10" value="0"
                                                   oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');"
                                                   class="form-control" name="descuento" type="text">
                                        </div>
                                    </div>
                                </div>
                            </div>
                            <div class="form-group">
                                <div class="col-md-6" >
                                    <div class="col-md-12" id="div_valor_tarjeta">
                                        <label class="col-sm-4">Valor tarjeta:
                                        </label>
                                        <div class="col-sm-8">
                                            <input id="valor_credito" maxlength="10"
                                                oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');"
                                                class="form-control" name="valor_tarjeta" type="text">
                                        </div>
                                    </div>
                                    <div class="col-md-12" id="div_valor_efectivo">
                                        <label class="col-sm-4">Valor efectivo:
                                        </label>
                                        <div class="col-sm-8">
                                            <input id="valor_efectivo" maxlength="10"
                                                oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');"
                                                class="form-control" name="valor_efectivo" type="text">
                                        </div>

                                    </div>
                                </div>
                                 <div class="col-md-6" id="div_valor_bono">
                                    <label class="col-sm-4">Valor bono:
                                    </label>
                                    <div class="col-sm-8">
                                        <input id="valor_bono" maxlength="10"
                                               oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');"
                                               class="form-control" name="valor_bono" type="text">
                                    </div>

                                </div>

                                <input id="valor_paciente" type="hidden">
                            </div>
                        </div>
                    </div>
                    {# fin de tipo_pago #}
                {% endif %}
                {#orden medica#}
                <div class="panel panel-default">
                    <div class="panel-body">
                        <form id="registerReceipt" name="registerReceipt" enctype="multipart/form-data" method="post">
                            <div class="col-md-6">
                                <label class="col-sm-4">{{ 'labels.patient.orden'|trans([], 'LocalizationBundle') }}{{ 'labels.and'|trans([], 'LocalizationBundle') }}{{ 'labels.patient.clinicalData'|trans([], 'LocalizationBundle') }}
                                    :</label>
                                <div class="col-sm-8">
                                    <input id="file_Clinical_Order" class="form-control" name="file_Clinical_Order"
                                           type="file">
                                    <input type="hidden" id="contratosD" name="contratosD">
                                </div>
                            </div>
                            {#Fin orden medica#}

                            {# Check lectura#}
                            <div class="col-md-1">
                                <div class="form-group">
                                    <label for="style" class=" control-label">{{ 'receive.sin_lectura'|trans([], 'LocalizationBundle') }}
                                        <input type="checkbox" class="sinLectura" id="sinLectura" value=" " name="sinLectura">
                                    </label>
                                </div>
                            </div>
                            <div class="col-md-1">
                                <div class="form-group">
                                    <label for="style" class=" control-label">Investigación
                                        <input type="checkbox" class="investigacion" id="investigacion" value=" " name="investigacion" onchange="checkboxInvestigacion()">
                                    </label>
                                </div>
                            </div>
                            <div class="clearfix" style="margin-bottom:10px;"></div>
                            {# fin check lectura #}
                        </form>
                    </div>
                </div>


                <div class="clearfix"></div>


                <div>
                    <div id="spinner" style="display: none;">
                        <img style="width: 40px;" src="{{ asset('bundles/utilities/images/spinner.gif') }}"
                             style="border: none;"/>
                    </div>
                    <p id="container_btn_save">
                        <button type="button" id="NewData" class="btn btn-default"><span class="glyphicon glyphicon-remove" aria-hidden="true"></span> {{ 'button.cancel'|trans([], 'LocalizationBundle') }}</button>
                        <button class="btn btn-primary" id="save">{{ 'labels.action.enviarEstudio'|trans([], 'LocalizationBundle') }}</button>
                    </p>
                </div>

                <!-- </div> table data-->
                <!--Muestra un mensaje cuando se debe mostrar al usuario alg�n mensaje que no sea de error-->
                <div>
                    <div id="confirm" class="ui-widget">
                        <div class="ui-state-highlight ui-corner-all" style="margin-top: 20px; padding: 0 .7em;">
                            <p>
                                <span class="ui-icon ui-icon-info" style="float: left; margin-right: .3em;"></span>
                            <div id="mensajeConfirm"></div>
                            </p>
                        </div>
                    </div>
                    <!--Muestra un mensaje cuando se presenta alg�n error-->
                    <div id="error" class="ui-widget" style="margin-top: 10px;">
                        <div class="ui-state-error ui-corner-all" style="padding: 0 .7em;">
                            <p>
                                <span class="ui-icon ui-icon-alert" style="float: left; margin-right: .3em;"></span>

                            <div id="mensajeError"></div>
                            </p>
                        </div>
                    </div>
                </div>
            </div>
        </div>{# fin panel datos clinicos #}
    </div>
    </div>{# Fin panel body #}
    </div>{# Fin panel #}
    </div>{# Fin Container Fluid #}

{% endblock %}