{% block scripts %}
    <script type="text/javascript" src="{{ asset('bundles/shedule/js/receive_Appointment_Scheduled.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>
    <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/shedule/css/bootstrap-datetimepicker.min.css') }}" />
    <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 src="{{ asset('bundles/fosjsrouting/js/router.js') }}"></script>
    <script src="{{ path('fos_js_routing_js', { callback: 'fos.Router.setData' }) }}"></script>
    
    <script type="text/javascript">
        var search = "{{ 'labels.dataTable.search'|trans([], 'LocalizationBundle')}}";
        var lengthMenu = "{{ 'labels.dataTable.lengthMenu'|trans([], 'LocalizationBundle')}}";
        var info = "{{ 'labels.dataTable.info'|trans([], 'LocalizationBundle')}}";
        var infoFiltered = "{{ 'labels.dataTable.infoFiltered'|trans([], 'LocalizationBundle')}}";
        var InfoEmpty = "{{ 'labels.dataTable.InfoEmpty'|trans([], 'LocalizationBundle')}}";
        var loadingRecords = "{{ 'labels.dataTable.loadingRecords'|trans([], 'LocalizationBundle')}}";
        var zeroRecords = "{{ 'labels.dataTable.zeroRecords'|trans([], 'LocalizationBundle')}}";
        var emptyTable = "{{ 'labels.dataTable.emptyTable'|trans([], 'LocalizationBundle')}}";
        var first = "{{ 'labels.dataTable.paginate.first'|trans([], 'LocalizationBundle')}}";
        var previous = "{{ 'labels.dataTable.paginate.previous'|trans([], 'LocalizationBundle')}}";
        var next = "{{ 'labels.dataTable.paginate.next'|trans([], 'LocalizationBundle')}}";
        var last = "{{ 'labels.dataTable.paginate.last'|trans([], 'LocalizationBundle')}}";
        var findAllPatient = '{{ path('FindAllPatient') }}';
        var UrlDataScheduleAppointment = '{{ path("receive_ScheduledAppointment_FindDataScheduledAppointment") }}';        
        var urlValidarResolucion = '{{ path("hiruko_validar_resolucion") }}';
        var urlConsultaResolucion = '{{ path("contratos_resolucion_valores")}}';
        var UrlScheduleLogs = '{{ path("receive_ScheduledAppointment_Logs") }}';
        var years = '{{ 'labels.date.years'|trans([], 'LocalizationBundle') }}';
        var months = '{{ 'labels.date.months'|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.day'|trans([], 'LocalizationBundle') }}';
        var select = '{{ 'button.select'|trans([], 'LocalizationBundle') }}';
        var study = '{{ 'labels.study.singular'|trans([], 'LocalizationBundle') }}';
        var room = '{{ 'labels.room'|trans([], 'LocalizationBundle') }}';
        var modality = '{{ 'modalities.modality'|trans([], 'LocalizationBundle') }}';
        var ok = '{{ 'button.acept'|trans([], 'LocalizationBundle') }}';
        var cancel = '{{ 'button.cancel'|trans([], 'LocalizationBundle') }}';
        var ClinicalOrder = '{{ ClinicalOrder }}';
        var folio_consecutive = '{{ folio_consecutive }}';
        var consecutive = '{{ consecutive }}';
        var convenioL = '{{ 'labels.convenio'|trans([], 'LocalizationBundle') }}';
        var origin = '{{ 'labels.origin'|trans([], 'LocalizationBundle') }}';
        var assignMed = '{{ 'labels.medicoAsignado'|trans([], 'LocalizationBundle') }}';
        var citaSede = '{{ 'labels.citaSede'|trans([], 'LocalizationBundle') }}';
        var horaCita = '{{ 'labels.horaCita'|trans([], 'LocalizationBundle') }}';
        var horaFinal = '{{ 'labels.horaFinal'|trans([], 'LocalizationBundle') }}';
        var duracion = '{{ 'labels.duracion'|trans([], 'LocalizationBundle') }}';
        var comments = '{{ 'labels.comments'|trans([], 'LocalizationBundle') }}';
        var otraSede = '{{ 'messages.otraSede'|trans([], 'LocalizationBundle') }}';
        var pleaseWait = '{{ 'messages.pleaseWait'|trans([], 'LocalizationBundle') }}';
        var SrcGif = '{{ asset('bundles/utilities/images/anim_gif.gif') }}';
        var allData = '{{ 'messages.allData'|trans([], 'LocalizationBundle') }}';
        var sinCita = '{{ 'labels.sinCita'|trans([], 'LocalizationBundle') }}';
        var citaOk = '{{ 'messages.selectAppointmentSuccess'|trans([], 'LocalizationBundle') }}';
        var citaError = '{{ 'messages.selectAppointmentError'|trans([], 'LocalizationBundle') }}';
        var convenios= '<option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>';

        var urlConsultaConvenios = '{{ path('ConveniosLista') }}';
        var urlConsultaConveniosFacturables = '{{ path('ContratosFacturables') }}';
        var urlConsultaValoresContratos = '{{ path('ValoresContratos') }}';
        var urlConsultaContratosEstudios = '{{ path('receiveEstudiosContratos') }}';
        var urlConsultaValoresConvenios = '{{ path('ValoresConvenios') }}';
        var UrlConsultarModalidadesConvenio = '{{ path('hiruko_consultar_modalidades_convenios') }}';
        /**
         * esta es la condición para aplicar la parte de facturación dependiendo de la parametrizaci�n utilizada actualmente.
         * @type {string}
         */

        var facturacion = '{{ facturacion }}';
        var factura_cafam = '{{ factura_cafam }}';
        var factura_convenio = '{{ factura_convenio }}';
        var contratos='';
        var signo="$ ";
        var dec=2;
        var recepcion = true;
        var cliente = '{{ id_cliente }}';
        if(cliente=="RIS-DPI"){
            signo="S/ ";
            dec=2;
        }
        {% if(facturacion=='true') %}
            {% if(factura_cafam=='true') %}
                {#var convenios= '<option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>';
                {% for convenio in convenios %}
                convenios += '<option value="{{ convenio.idEps }}*{{ convenio.municipio }}">{{ convenio.name }}</option>';
                {% endfor %}#}

                {#var conveniosContratos = '<option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>';
                {% for convenioContrato in conveniosContratos %}
                conveniosContratos += '<option value="{{ convenioContrato.idEps }}">{{ convenioContrato.name }}</option>';
                {% endfor %}#}
            {% elseif(factura_convenio=='true') %}

                var contratos = '<option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>';
                {% for contrato in contratos %}
                contratos += '<option value="{{ contrato.idContratos }}">{{ contrato.name }} - {{ contrato.nombreContrato }}</option>';
                {% endfor %}
                var convenios= '<option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>';
				{% for convenio in convenios %}
                convenios += '<option value="{{ convenio.idEps }}">{{ convenio.name }}</option>';
                {% endfor %}

            {% else %}

                var convenios= '<option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>';
				{% for convenio in convenios %}
                convenios += '<option value="{{ convenio.idEps }}">{{ convenio.name }}</option>';
                {% endfor %}

               /*{# var contratos = '<option value="">{{ 'receive.select'|trans([], 'LocalizationBundle') }}</option>';
                {% for contrato in contratos %}
                contratos += '<option value="{{ contrato.idContratos }}">{{  contrato.name }} - {{ contrato.nombreContrato }}</option>';
                {% endfor %}#}
                */
            {% endif %}

        {% else %}

            var convenios= '<option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>';
			{% for convenio in convenios %}
            convenios += '<option value="{{ convenio.idEps }}">{{ convenio.name }}</option>';
            {% endfor %}

        {% endif %}
        /**
         * fin de parametrizaci�n
         * @type {string}
         */
        var Radiologos= '<option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>';
        {% for rad in radiol %}
            Radiologos+='<option value="{{ rad.id }}">{{ rad.firstname}} {{ rad.lastname }}</option>';
        {% endfor %}
        var SrcGif = '{{ asset('bundles/utilities/images/anim_gif.gif') }}';  
        var Sede = '{{ app.session.get('headquarter') }}';

    </script>
    <style>
        body{
            background: white;
        }
        .hir_body{
            color:black;
            font-size: 14px; background: #f5f5f5;
        }
        .row {
            margin-bottom: 10px;
        }
        .mt-20{
            margin-top:20px;
        }
        .modal-dialog {
            width: 80%;
            margin: 30px auto;
        }
        .appSelected{
            border: 3px solid #337ab7;
        }
    </style>
{% endblock %}
{% block content %}

    <div class="panel panel-default">
        <div class="panel-body">
            {#Datos Paciente#}
            {{ render(controller('PatientBundle:Patient:index')) }}
            {#Fin Datos Paciente#}
        </div>
    </div>

        
        <div class="clearfix"></div>
        {# Btn Buscar Citas #}

        
        {#Citas Agendadas#}
            {#<h3 id="fechaCitas">{{ 'labels.appointmentSchedule'|trans([], 'LocalizationBundle') }}</h3>#}
            <div id="citasAgendadas">

            </div>
        {#Fin Citas Agendadas#}
    <div class="clearfix"></div>



    {#************************************************************************************#}
    <div class="clearfix"></div>
    <input type="hidden" id="contratosD">
    <input type="hidden" id="convenioD" >
    <input type="hidden" id="valorTotalD" >
    <input type="hidden" id="valorNetoD" >
    <input type="hidden" id="copagoD" >
    {% if(facturacion=='true') %}
        {# Notificación de resoluciones #}
        <div class="panel panel-default cl_resoluciones">
            <div class="panel-body">
                <div class="col-md-6 alert alert-success alertCotratos" id="resoluciones" role="alert" > </div>
                <div class="col-md-6 alert alert-success alertCotratos" id="resolucionesF" role="alert" > </div>
                <div class="col-md-4 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>
        <div class="clearfix cl_resoluciones"></div>
        {# Fin Notificación resoluciones #}
        <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>
                    </div>

                    <div class="form-group" style="margin-bottom:0;">
                        <label for="style" class="control-label">Insumos : </label>
                        <div id="insumos_estudio">
                        </div>
                    </div>
                </div>
                {#Comentarios Factura  #}

                <div class="col-md-6" id="divComentarios">
                    <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-6">
                            <textarea id="input_comentarios" class="form-control" rows="1"  style="width: 400px; height: 50px; 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>

                        {% if (id_cliente== 'RIS-DPI') %}
                            <label for="style" class="control-label">Valor paciente: </label>

                            <label class=" " id="valor_paciente">

                            </label>
                        {% endif %}
                        <div id="cuotasd" class=" ">

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

            </div>

        </div>

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

        <div class="panel panel-default" id="tipo_facturar" style="display: none;">
            <div class="panel-body">
                {#tipo Afiliación#}
                <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 afiliación#}

                {#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"
                                   oninput="this.value = this.value.replace(/[^0-9.]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');">
                            <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>
                    <br>
                    <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" style="margin-left: 4px;  width: 532.98px; ">
                        </div>
                    </div>
                </div>
                <div class="form-group">
                    <div class="col-md-6"  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-6" 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>
                    <input id="valor_paciente" type="hidden">

                </div>

            </div>
        </div>
        {# fin de tipo_pago #}
        {# Btn Seleccionar valores #}
        <div class="col-md-6">
            <div class="form-group">
                <input type="button" id="selectValores" class="btn btn-primary"
                       value="{{ 'receive.seleccionarValores'|trans([],'LocalizationBundle') }}">
            </div>
        </div>
        {# Fin Btn Seleccionar citas #}

        {#<div class="clearfix"></div>#}
        {#<div class="col-md-6">#}
        {#<div class="form-group">#}
        {#<label id="no_Seleccionado_valores" style="display: none" for="style"#}
        {#class="col-sm-6 control-label"#}
        {#<h5>{{ 'messages.selectValueError'|trans([], 'LocalizationBundle') }}</h5>#}
        {#</label>#}
        {#<label id="si_Seleccionado_valores" style="display: none" for="style"#}
        {#class="col-sm-6 control-label">#}
        {#<h5>{{ 'messages.selectValueSuccess'|trans([], 'LocalizationBundle') }}</h5>#}
        {#</label>#}
        {#</div>#}
        {#</div>#}
    {% endif %}
    {#************************************************************************************#}

    <div class="panel panel-default hideWorkFlow hide">
        <div class="panel-body">
            <div class="row">
                {#check Sin Lectura#}
                <div class="col-md-6">
                    <div class="checkbox">
                        <label> <input type="checkbox" id="sinLectura" value=" " name="sinLectura" >{{ 'receive.sin_lectura'|trans([], 'LocalizationBundle') }}</label>
                    </div>
                </div>
                {# Fin check Sin Lectura#}

                {#trae info clinica#}
                <div class="col-md-6" >
                    <div class="form-group">
                        <label for="style" class="col-sm-4">{{ 'labels.patient.clinicalData'|trans([], 'LocalizationBundle') }}:</label>
                        <div class="col-sm-8">
                            <div class="radio">
                                <label class="col-sm-6">
                                    <input type="radio" name="clinicalData_receiveAppointment" id="clinicalData_receiveAppointment" value="1" checked="checked" required="required">
                                    {{ 'labels.yes'|trans([], 'LocalizationBundle') }}
                                </label>
                            </div>
                            <div class="radio">
                                <label class="col-sm-6">
                                    <input type="radio" name="clinicalData_receiveAppointment" value="2" required="required">
                                    {{ 'labels.no'|trans([], 'LocalizationBundle') }}
                                </label>
                            </div>
                        </div>
                    </div>
                </div>
                {#Fin trae info clinica#}
            </div>
            <div class="row">
                {#FOLIO - CONSECUTIVO#}
                {% if folio_consecutive == 'true' %}
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="col-sm-4 control-label">{{ 'labels.folio'|trans([], 'LocalizationBundle') }}:</label>
                            <div class="col-sm-8">
                                <input id="input_folio_receive" class="form-control" name="input_folio_receive" type="text" value="" title="" onkeyup="">
                            </div>
                        </div>
                    </div>
                {% endif %}
                {% if consecutive == 'true' %}
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="col-sm-4 control-label">{{ 'labels.consecutive'|trans([], 'LocalizationBundle') }}&nbsp;*:</label>
                            <div class="col-sm-8">
                                <input id="input_consecutive_receive" class="form-control" name="input_consecutive_receive" type="text" value="" title="" onkeyup="">
                            </div>
                        </div>
                    </div>
                {% endif %}
            </div>
            <div class="row">
                {#prioridad#}
                <div class="col-md-6">
                    <div class="form-group">
                        <label for="style" class="col-sm-4">{{ 'labels.priority'|trans([], 'LocalizationBundle') }}: (*)</label>
                        <div class="col-sm-8">
                            <select id="select_priority_receiveAppointment" name="select_priority_receiveAppointment" class="form-control selectpicker">
                                <option value="">{{ 'button.select'|trans([], 'LocalizationBundle') }}</option>
                                {% for priority in priList %}
                                    <option value="{{ priority.priId }}">{{ priority.priName }}</option>
                                {% endfor %}
                            </select>
                        </div>
                    </div>
                </div>
                {#Fin prioridad#}

                <div class="col-md-6">
                    {# Medico remitente #}
                    <div class="form-group">
                        <label class="col-sm-4">{{ 'assistive.attendingphysician.label'|trans([], 'LocalizationBundle') }}: *</label>

                        <div class="col-sm-6" id="divrefDoc">
                            <select name="doctor_referring" id="doctor_referring" class="form-control selectpicker">
                                {% for remitentes in medicoRemitente %}
                                    <option value="{{ remitentes.id }}" >{{ remitentes.firstName }} {{ remitentes.lastName }}</option>
                                {% endfor %}
                            </select>
                        </div>
                        <div class="col-sm-2" >
                            <a class="btn btn-primary" data-toggle="modal" data-target="#myModal">
                                {{ 'button.new'|trans([], 'LocalizationBundle') }}
                            </a>
                        </div>
                    </div>
                </div>
            </div>
            <div class="row">
                <div class="form-group">
                    <div class="col-sm-6">
                        <label class="col-md-4">{{ 'labels.filtroCIE10'|trans([], 'LocalizationBundle') }}</label>
                        <div class="col-sm-6">
                            <input type="text" name="filtroCIE10" id="filtroCIE10" class="form-control" placeholder="{{ 'labels.filtroCIE10'|trans([], 'LocalizationBundle') }}"/>
                        </div>
                        <div class="col-sm-2">
                            <a id="filterSearch" class="btn btn-default form-control">{{ 'labels.filtroCIE10'|trans([], 'LocalizationBundle') }}</a>
                        </div>
                        <div class="col-sm-8 col-md-offset-4" id="divCie10" >
                            <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>
            </div>

            <div class="row mt-20" >
                {#orden medica#}
                <form id="registerReceiveAppointment" name="registerReceiveAppointment" enctype="multipart/form-data" method="post">
                    <div class="col-md-6">
                        <div class="form-group">
                            <label class="col-sm-4">{{ 'labels.patient.orden'|trans([], 'LocalizationBundle') }}:</label>
                            <div class="col-sm-8">
                                <input id="file_Clinical_Order_receiveAppointment" class="form-control" name="file_Clinical_Order_receiveAppointment" type="file">
                            </div>
                        </div>
                    </div>
                </form>
                {#Fin orden medica#}
            </div>
            {#Modal medico Remitente#}
            <div class="modal fade" id="myModal" role="dialog">
                <div class="modal-dialog">
                    <div class="modal-content">
                        <div class="modal-header">
                            <button type="button" class="close" data-dismiss="modal">&times;</button>
                            <h4 class="modal-title">Register Doctor Referring</h4>
                        </div>
                        <div class="modal-body">
                            {{ render(controller('HirukoAdminBundle:Referring:index')) }}
                        </div>
                    </div>
                </div>
            </div>
            {#Fin Modal medico Remitente#}
        </div>
    </div>

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

        <div class="panel panel-default">
            <div class="panel-body" >
                {#codigo autorización#}
                <div class="col-md-6"  id="divCodigoAutorizacion" >
                    <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 autorización#}

                {#poliza soat#}
                <div class="col-md-6" id="divPolizaSoat" >
                    <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>


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

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

        {# Btn Seleccionar Citas #}
        {#<div class="col-md-6">#}
            {#<div class="form-group">#}
                {#<input type="button" id="selectAppointment" class="btn btn-primary" value="{{ 'labels.selectAppointment'|trans([], 'LocalizationBundle') }}">#}
            {#</div>#}
        {#</div>#}
        {# Fin Btn Seleccionar citas #}
        {#<div class="col-md-6">#}
            {#<div class="form-group">#}
                {#<label id="no_Seleccionado_citas" style="display: none" for="style" class="col-sm-6 control-label"><h5>{{ 'messages.selectAppointmentError'|trans([], 'LocalizationBundle') }}</h5></label>#}
                {#<label id="si_Seleccionado_citas" style="display: none" for="style" class="col-sm-6 control-label"><h5>{{ 'messages.selectAppointmentSuccess'|trans([], 'LocalizationBundle') }}</h5></label>#}
            {#</div>#}
        {#</div>#}



{% endblock %}